Monday, December 28, 2009

Never allow politicians to incite us to violence

Sunday Nation 27 December 2009

Two years ago this week, Kenyans lined up to elect their leaders in a ritual that had become routine since the onset of multi-party politics in the country. The elections came on the cusp of an orgy of violence that had started during campaigns that were so heavily ethnicised that most were voting on the basis of ethnic affiliation rather than on any ideological inclination.

The violence escalated after the elections, and after many Kenyans died as our politicians dithered and prevaricated, the much-maligned “foreigner” intervened and literally wrote a new law for us -- the National Accord and Reconciliation Act. Apart from reducing the violence and returning the country to some semblance of normality, the pact also set in motion a process to investigate the causes of the violence, set up mechanisms to prevent a repeat, and create structures to promote national healing and reconciliation.

Anyone visiting Kenya today would find it difficult to believe that this is the same country that was at war at the beginning of last year. Politicians are back to their usual games of musical chairs and chest-thumping while the citizen continues to suffer from want and disease.

Listening to our politicians, one is convinced that most do not have the best interests of their constituents at heart. They have been heard declaring war and threatening secession on the basis of such disparate issues as Mau forest reclamation and “sharing of the national cake”. Many of them were engaged in misleading their followers on the provisions of the Harmonised Draft Constitution even though they had not taken time to read the document.

Murderous frenzy

At the height of the violence that rocked this country last year, many people tried to formulate an explanation for the eruption of a murderous frenzy all around the country. The reason consistently advanced by Orange Democratic Movement (ODM) supporters was that the incumbent had stolen an election won by his challenger, Mr Raila Odinga.

This, it was stated, had angered citizens who had spontaneously resorted to use of violence to correct this affront on their “democratic” rights. The Party of National Unity (PNU), on the other hand, seemed to hold the view that President Kibaki had won the election fairly and the violence was an ODM ploy to engineer a civilian coup against a democratically elected government.

In some quarters, it was claimed that the violence in the Rift Valley was planned long before the election, and words such as “ethnic cleansing” and even “genocide” were suggested as appropriate descriptions of the state of affairs in the province. Others advanced theories suggesting that “historical injustices” involving land, infrastructure and political power had more to do with the violence than an allegedly stolen election, which only served as the spark that started the inferno.

Two years after our dalliance with anarchy, different versions of the story are being told based on shifting political alliances. As alliances continue to shift, ethnic coalitions with names reminiscent of the infamous Ku Klux Klan are being floated, and the Kenyan commoner is being herded back into the ethno-political morass that contributed significantly to last year’s violence.

Politicians eying the next General Election are gathering their troops and sounding war drums to scare off prospective opponents. All these activities are going on despite the fact that justice is yet to be done for the victims of the post-election violence, and The Hague’s Sword of Damocles continues to hang over our collective heads with indictments promised early next year.

Even efforts to develop a new constitutional dispensation are being held up by the personal interests of political bigwigs who are reading the document with themselves in mind. Clearly, this country was not shaken enough by the events of early last year. Today, we are still lamentably close to another conflagration that many say will be several orders of magnitude worse than the last one.

Because of our short collective memories, we are slowly being led by our politicians toward another war, and this time it is not clear if we will emerge from it as a coherent whole. It seems as if our only hope lies in ignoring our politicians this once and setting up a new constitutional dispensation that will guarantee a brighter future for the coming generations. The alternative will be the equivalent of rending the fabric of the nation once and for all, and throwing the remnants into the dustbin of history.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine:

Monday, December 21, 2009

Does the ICC unfairly ‘target’ African countries?

Sunday Nation 20 December 2009

The involvement of the International Criminal Court in the investigation on the violence that rocked Kenya following the last General Election has raised quite a storm both within the country and on the African continent as a whole.

At least one Kenyan politician has gone on record to indicate that she believes she is one of those in the ICC’s sights notwithstanding her protestations of innocence.

Since its inception, the court has indicted mostly African leaders for various international crimes, and after the high-profile indictment of the Sudanese President Omar el-Bashir, accusations were made that the court is a neo-colonial creature aimed at putting Africans in their place.

Similar allegations have been made by Kenyan politicians who have lately taken to urging Kenyans to seek a “homegrown” solution to our problems.

After initially depicting the ICC as too slow to take any meaningful action against perpetrators of last year’s violence, the politicians are now dismissing the court and its Chief Prosecutor, Mr Moreno-Ocampo, as an intolerable intrusion into our sovereign affairs.

The African Union, whose leadership is made up of many potential ICC indictees, has made it clear that it does not support the ICC’s attempts to chastise wayward leaders who commit unspeakable crimes against their own people.

Clearly, a case is being built up to the effect that Africa is being maligned once again as part of a larger conspiracy to recolonise the continent.

It is therefore important for us to examine in some detail this assertion that the ICC unfairly targets African countries. It is true that the most prominent people being pursued for involvement in international crimes hail from the continent.

Indeed, it is true that the ICC has maintained a rather sharp focus on African countries, and is often quick to open investigations whenever an event occurs on African soil.

Many have argued that more developed countries have committed and continue to commit crimes worse than any they may pin on an African tyrant.

The invasion of Iraq by Western powers and the conflict between Israel and Palestinians are commonly cited as good hunting grounds for war criminals that have been neglected by the ICC in favour of the relatively easy pickings in Africa.

The question that proponents of this argument need to answer is whether the ICC’s attention on Africa is actually unfair.

When one commits a crime and is arraigned in a court of law, he cannot use the argument that his prosecution is unfair because many others commit the same crime and are not similarly prosecuted.

The commission of the crime alone is sufficient reason for one to be prosecuted and, if found guilty, to bear the punishment prescribed in law.

Politicians who are arguing that the ICC is targeting Africans unfairly are therefore unwittingly admitting that Africans are indeed committing crimes against humanity and other international crimes that warrant the attention the ICC is giving them.

The ICC’s presence would not matter in a country that is running its affairs peacefully according to its own laws as well as international law.

A country with a functioning legal justice system that fairly and consistently punishes all wrong-doers would have nothing to worry about even if the ICC prosecutor set up camp in its back yard.

The reason African despots are expressing such sentiments about the ICC is that many of them are guilty. Many have presided over de jure and de facto dictatorships whose modus operandi has involved actions that would land them in trouble in any civilised society.

Others have acquired power through dubious means, and to remain in charge, they have had to use inordinate amounts of force that pass the threshold of crimes against humanity.

It is not uncommon to hear African politicians referring to African peculiarities as justification for the authoritarian rule they subject their people to.

Indeed, many ordinary citizens agree with the view that Africans need a firm hand at the till in order to stabilise the nation, with reference being made to “benevolent dictators” and “gentle tyrants”.

This kind of thinking only serves to perpetuate the image of an African as some sort of savage who needs a certain amount of violence to control. There is no reason this same thinking would not be applied to Africans living in the Diaspora.

It is my contention therefore that it is African countries that continue to attract the attention of the ICC through actions of leaders that put us to shame on the international stage.

Instead of accusing the international community of unfair intrusion into our sovereign business, it is imperative that we clean up our politics and conduct ourselves in ways that do not invite such intrusion.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Tuesday, December 15, 2009

Insurance companies must stop discrimination

Sunday Nation 13 December 2009

John K (not his real name) suffers from a condition known as Major Depressive Disorder. This is characterised by periods of intensely low mood and loss of interest in usual activities, as well as poor sleep, poor appetite, impaired concentration and memory, feelings of hopelessness and worthlessness and even suicidal thoughts and plans.

In extreme circumstances, patients with depression attempt suicide. John is also a responsible family man. He has taken out medical insurance for his entire family in order to ensure that sudden illnesses do not interfere with the family’s financial goals as often advised by the legion of financial advisers.

His cover is provided by a prominent insurance company on whose board sits many prominent Kenyans both in the health sector and in the legal fraternity.

Two weeks ago, John went into an episode of severe depression. He could not go to work and felt so despondent it was difficult to leave the bed in the morning. He stopped eating and would only take a sip of fruit juice before retiring to bed.

One night, he went into the bathroom as if to relieve himself. When his wife followed him there after he had been there for a while, she found him with a rope around his neck, attempting to kill himself. She managed to cut the rope in the nick of time, and called the neighbours to help her take him to hospital.

He was admitted with the diagnosis of “attempted suicide” and, after being reviewed by a psychiatrist, he was found to have “Major Depressive Disorder” and put on appropriate treatment. A few days later he had improved sufficiently to start making arrangements for the payment of his hospital bills.

That is when he was hit by the shocker to the effect that the insurance company had written to the hospital informing them that both “attempted suicide” and “any mental illness, including depression” were “exclusions” under his medical cover. He would have to foot the bill himself.

Suffice it to say that his condition worsened after he received this information, and he stayed longer in hospital than he would otherwise have. Further, upon discharge, he stopped paying his insurance premiums, and thus lost the cover completely.

It is an established fact that a significant proportion of Kenyans will suffer one mental illness or another in their lifetime. A recent study carried out by Professor Ndetei and colleagues in Nairobi and surrounding areas revealed that approximately half of the people who visit hospitals for non-psychiatric complaints have mild to severe depressive illness.

The multifarious “exclusions” by insurers mean that despite having medical cover, most of these people will be compelled to pay for mental health services out of pocket.

This alone is sufficient ground for human rights and other activists to begin beating war drums and asking the government to intervene and improve this state of affairs.

However, the bigger tragedy is that the supposed “exclusions” are in fact against both the letter and spirit of the law. Section 46 of the Mental Health Act (1989) expressly prohibits insurance companies from making exclusions based on mental illness.

It reads: “46. (1) Every person in Kenya shall be entitled, if he wishes, to insurance providing for his treatment as a person suffering from mental disorder and no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder;

“(2) An insurance company which makes any insurance policy which expressly excludes or puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence.”

One need not be a lawyer to see that this section clearly prohibits creation of the infamous “exclusions” with regard to mental illness! The fact that many mentally ill persons and their families are unaware that there is such a provision in the law should not be a reason for insurance companies to continue fleecing them mercilessly.

As insurance companies continue flouting this clear provision, they make an already bad situation worse for the mentally ill and their families. A clear relationship has been demonstrated between mental illness and poverty.

The mentally ill have lower incomes as a result of declining productivity, and the little available resources are channelled towards paying for their treatment.

It has been said that societies are (or should be) judged by the way they treat their most vulnerable members. This wilful discrimination by insurance companies must stop, and the mentally ill must be assured of the same level of care as those with other illnesses.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Sunday, December 6, 2009

Cholera deaths reflect the state of our nation

Sunday Nation 06 December 2009

Cholera is a disease caused by a bacterium spread mainly through faecal contamination of water. It is characterised by profuse diarrhea and rapid loss of body water, and is summarily fatal if untreated.

Interestingly, treatment for cholera consists of intake of copious amounts of clean water mixed with salt and sugar, a mixture that should be available at the most basic level in this country.

Hundreds of Kenyans have recently lost their lives to this disease, and many more continue to be at risk. The ministries of Health have reported deployment of medical personnel to all affected areas in an attempt to control the scourge, but new cases keep popping up in all corners of the country.

It is a hallmark of our times that even as we raucously debate a new constitution that guarantees a right to health, we continue to lose Kenyans to this primitive disease whose control is so painfully simple that it would be correct to term it a disease of absolute poverty.

For instance, the last outbreak of Cholera in the United Kingdom was sometime in the 19th Century, and the study of epidemiology owes its existence to the control of this particular outbreak.

Outbreaks of Cholera and other diarrheal diseases are practically unheard of in countries that have improved their waste disposal systems and ensured a steady supply of clean drinking water for their citizens.

After days in denial, the Public Health and Sanitation minister was heard lamenting that all it would take to control the disease is for Kenyans to “decide to live hygienically”.

She went on to deride the behaviour of poor Kenyans who decide to “go anyhow to the bush” and proceed to drink water contaminated by their own infected faeces.

The minister’s words are eerily evocative at this time in our development, and a brief lesson in history would be useful for the minister and this government.

At the height of the French revolution in the 18th Century, Marie Antoinette, then Queen of France, reportedly uttered the now immortalised words “Let them have cake”, when she heard hungry peasants demonstrating outside her palace over lack of “bread”. She paid the ultimate price for this alleged misstatement soon after this.

The conditions attending the period around the French Revolution are no different from what Kenya is going through today, and indeed a close reading of the French history of the time sounds like a rehash of Kenya’s present, complete with indecisive, lethargic leaders and atrocious conditions for the common citizen.

Even the clamour for a new constitution is reminiscent of the French “Declaration of the Rights of Man and of the Citizen” that was promulgated during the revolution and stands today as one of the key planks of human rights theory.

Kenyan politicians stand the risk of being exposed to the literal and figurative guillotine of citizen action if they continue making such careless statements and ignoring the acute needs of the citizenry.

Inability to supply clean drinking water to a majority of the population is an indictment on the state of our government’s priorities. Every single death that is attributed to Cholera means that our water and sanitation infrastructure is not up to scratch, and we cannot stake a claim to international greatness while still losing people to an illness whose cure is clean water mixed with salt and sugar!

Instead of continuing to insult the citizen with exhortations to choose hygiene over poor sanitation, the government must fulfill its responsibility to its citizens and endeavour to improve the water and sanitation situation in this country.

You cannot ask a poor person without access to adequate supplies of clean drinking water to “decide” to be hygienic when it is just not possible! It is also insulting to insist that a poor Kenyan boils the little dirty water available to him when he has no access to fuel to cook his food, let alone boil water.

If the government wants the citizen to “decide” to live “hygienically” as so graphically put by the Health minister, it must provide a real choice.

It must ensure supply of adequate amounts of clean drinking water to all its citizens. It must work to ensure that fuel is available and affordable to all people. Health facilities must be in close proximity to all Kenyans so that those with more severe infections have access to a facility where they may get intravenous fluids and even antibiotics as necessary.

As long as Kenyans continue dying of a disease caused by poor hygiene and whose treatment is mostly clean water, we must ask ourselves if we are upto the challenges of the new millennium and on track to achieve the Millennium Development Goals and our own vision 2030.

Dr Lukoye Atwoli is a Consultant Psychiatrist and Lecturer at Moi University’s School of Medicine

Sunday, November 29, 2009

Why are politicians dead set against an executive PM?

Sunday Nation 29 November 2009

As the clock ticks towards the end of the stipulated period for comments on the harmonised draft constitution, it is becoming clear that any erudite discussion by ordinary Kenyans faces insurmountable obstacles.

Politicians are already tainting the debate with non-issues in order to obfuscate matters and leave them with the real power to decide what goes into the constitution and what does not.

One argument some have been repeating consistently is that the harmonised draft forces a presidential candidate to run around the country trying to garner 50 per cent plus one vote and 25 per cent of votes in over half the regions only to be rewarded with a practically useless post.

It is difficult to deal with this issue without asking a series of questions in return. For instance, why are people becoming so worked up about a hypothetical candidate who understands the constitution and chooses to follow its provisions to become a “popularly elected president”? If indeed everyone has an equal opportunity to become a leader in this country, why are these politicians so dead set against an “executive” Prime Minister?

Why are these politicians avoiding the issues that are making them fear these positions as proposed in the harmonised draft, and choosing instead to concentrate on the positions themselves? Is it not clear that their fears are driven by the individuals currently holding the positions and those aspiring to hold them, rather than the powers inherent in the positions themselves?

Would they still work themselves into a lather if all the top politicians in Kenya were to rule themselves out of contention at the next elections? Discussion on the executive chapter of the harmonised draft is fast turning into a farcical repeat (in reverse!) of the 2005 referendum, and already some politicians have threatened to campaign against it because it “emasculates” the president and gives the “unelected” prime minister too much power.

Politicians are making singularly uninformed statements such as “nowhere else in the world does a ‘popularly’ elected president not enjoy ‘executive’ power”. Whose interests are they fronting? People are even “popularly elected” to village cattle dip committees, and the only “power” they enjoy is to preside over cattle dip committee meetings.

This debate is clearly not about this draft constitution at all, but about contemporary fears and entrenched prejudices. The terms “president” and “prime minister” in this country have acquired the character of the individuals who have occupied those positions in recent years, and these are the perceptions currently driving the debate.

The prime minister and several other politicians have wisely decided not to trumpet their own opinions concerning the draft in the hope that their supporters will come to their own conclusions. It was, however, reported in the press that the president expressed support for the document. Supporters of President Kibaki and Prime Minister Raila Odinga have chosen to ignore similar counsel and continue to engage in combat.

It is my considered opinion that discussion of any of the specific clauses in the draft constitution is useless in any case. As I have repeatedly argued before, what we need agreement on are the basic principles guiding this nation, and the rest will fall into place.

For instance, we may agree, as implied in the draft, that our tribes are bigger than the nation known as Kenya, and that our first loyalty shall be to our tribes and regions and only finally to Kenya. Conversely, we may agree that we aspire to a greater level of involvement in global affairs and do not desire to be tied down by petty tribal loyalties in our quest for a better life for our citizens.

These should form the basis of any constitution we write. If, on the other hand, we do not agree on any of those basic principles, no amount of debating the clauses in the harmonised draft will result in agreement, for the debate will continue to be duplicitous and full of multi-layered innuendo. The end result will be a rejection of whatever document is presented to Kenyans in a referendum.

Indeed the fact that politicians are already mobilising their supporters to reject the draft on trivial grounds illustrates an attitude that the constitution is about the personal needs of the politicians.

All those Kenyans who are allowing themselves to be led this way by a bunch of irredeemably selfish tribal chiefs should never again waste our time complaining about a “bad” constitution and poor governance after April 2009 comes and goes without any fundamental changes in the country’s constitutional structures.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine:

Friday, November 27, 2009

Weaknesses could pose threat to enactment of new law

Sunday Nation 22 November 2009

With suitable pomp and pageantry, the harmonised draft constitution of Kenya was finally unveiled in Nairobi on Tuesday. Kenyans have been given 30 days to peruse and debate the draft, and suggest to the Committee of Experts any areas they feel need to be changed or addressed to their satisfaction.

No matter what the pundits, bigots, naysayers and other busybodies say, this country is unlikely to come up with any better draft constitution than the harmonised draft this committee has come up with.

This must not be misconstrued to mean that this is the best possible draft that could be produced in this country. On the contrary, it is not far-fetched to suggest that this draft is singularly unimaginative when it comes to re-engineering the architecture of the state.

For instance, regarding devolution, the draft chose to stick to the current “regions”, succumbing to the ethno-political demagoguery that decreed that some provinces would only be split at the expense of spilt blood despite being large and unwieldy.

The proposed counties also bear an uncanny resemblance to the “Moi” districts, some still carrying the stigmata of failed nomenclature, for instance “Butere/Mumias”!

In the interests of honest debate and consideration of issues, it is wise for us to acknowledge some weaknesses in the Kenyan psyche that will pose a serious threat to the enactment of a new constitution.

One, no matter what is contained in the draft constitution, the majority of Kenyans will not read it, and will rely on their ethno-political warlords to read and interpret it for them.

Despite having the draft in all possible forms short of recruiting personal tutors for each and every citizen and their dog, nobody is going to give it any level of sustained attention.

This was true with the last referendum and it will continue to be true with the current constitutional review process, unless something very fundamental shifts in the Kenyan psyche.

Two, those that attempt to read the document will latch onto one or two issues and be blinded to the rest of the constitution. The religious right will definitely continue beating war drums on such marginal issues as the place of religious courts in the constitution as well as sexual orientation.

Politicians will try to interpret the document in light of the current transitional arrangement, and the positions in the document will be replaced with individual names to see how they fit.

Three, current affairs will continue to taint the view of the draft constitution. Contemporary red herrings such as the Mau forest stand-off, 2012 General Election realignments and post-election violence resentments will heavily taint the interpretation of various provisions in the harmonised draft.

Finally, it would be wise to indicate that no constitution, new or old, is going to save Kenyans from themselves. The success or failure of a new constitutional dispensation will depend on the entrenchment of a new culture of constitutionalism. A system that guarantees a healthy respect of the rule of law is more important than the letter of the law itself.

The biggest failure of the Kenyan state since independence has been the blatant disregard for the law by those that are meant to enforce it, and the phenomenon of “impunity” is firmly anchored in this historical foundation.

At the end of the day, it should be reasonable to agree that as long as the constitution is written by well-meaning citizens with the good of the nation at heart, it does not matter what system of government it proposes or how many levels of devolution it provides for. As long as Kenyans are willing to respect the document and the resultant laws, the constitution will be good enough for the majority.

There is therefore no point wasting a lot of resources subjecting the harmonised draft to scrutiny by the average Joe, who will not bother to read it anyway. It further defeats logic to subject the final draft to a referendum, given that a majority of the voters will be voting for or against a document they will not have read.

Unless the above-listed difficulties are surmounted one way or another, there would remain only one practical solution to this conundrum. The president (or the government) should simply declare a state of emergency, abrogate the current constitution and replace it with the harmonised draft which contains adequate transitional mechanisms as it is. Undesirable sections and provisions will be easily amended later as provided for in the draft.

Any other route to a new constitution stands the risk of being hijacked by entrenched interests.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University School of Medicine.

Sunday, November 15, 2009

Is it the President or AG who’s above the law?

Sunday Nation 15 November 2009

In 1991, newly appointed Attorney-General Amos Wako stood on the floor of Parliament and proclaimed that “a characteristic of the rule of law is that no man, save for the President, is above the law”.

All analysts and academics who have studied Mr Wako’s career as Attorney-General have focused on this statement as an indication of his subservience to the whims of a corrupt Executive and evidence of his complicity in subverting the will of the people.

What is lost in this analysis is the more fundamental implication of the statement as regards the position of Mr Wako in this scheme of things. In his usual cheeky manner, the man was laying down new law by fiat, destroying in one fell swoop the principle of equality of all under the law.

If, indeed, it were true that the President was above the law, why did Daniel arap Moi not make the proclamation himself? How could a person subject to the law purport to unilaterally amend it without recourse to the originators of the same law, and confer immunity to another individual? What was the source of Mr Wako’s authority in proclaiming the President to be “above the law”?

After a close examination of this statement and reviewing the subsequent events, it is difficult not to conclude that the AG’s words had nothing to do with the person or office of the President. In his brief opening remarks at the height of the struggle for political pluralism, he was informing Parliament that he, the Attorney-General, was technically above (or beyond) the law.

In one fell swoop he had arrogated to himself the roles of Parliament, the Executive and even the Judiciary, and would henceforth be beyond the reach of any of these organs of the State.

In Kenya, the AG is a member of the Executive at the same level as a minister of government. He is also an ex-officio Member of Parliament, and sits in the Judicial Service Commission that determines who becomes a judge in Kenya. He also sits on many independent commissions set up with varying mandates, the latest being the Committee of Experts tasked with coming up with a draft constitution.

The AG enjoys security of tenure and cannot be removed except through the recommendations of a tribunal and the concurrence of the President. It is almost impossible to successfully prosecute him for any act he commits, whether as a private individual or as the AG, since he wields the all-powerful weapon known in legalese as nolle prosequi.

He has indeed used this weapon in the past for his own protection and the protection of others. In principle, therefore, the AG is the most powerful individual in Kenya, the only one who is truly “above the law”. It is therefore my considered opinion that the entire struggle for democratisation of the Kenyan state has been misguided and focused on the wrong objectives and individuals.

Allure of power

After singing “Moi must go” for over a decade and a half, he eventually “went”, and soon after this the reform train hit another snag as the erstwhile reformists discovered the true allure of absolute power. It is my conviction that if we seek true reforms in the political architecture of the state, we must train our sights on the State Law Office, and specifically trim the outlandish powers wielded by the Attorney-General.

It is jarring against any conception of “democracy” for one individual to wield so much power without any checks and balances on the functions of the office. It is an indictment on our lawyer activists that they have been unable to see or articulate the enormous problems posed to the integrity of the State by the person and office of the AG until the US government declared him an obstacle in the push for reforms.

Prof Philip Alston, the UN special rapporteur on extra-judicial killings, had earlier described the AG as “the embodiment in Kenya of the phenomenon of impunity”. All these years political and human rights activists have been barking up the wrong tree accusing the President of wielding too much power and exercising it to the detriment of the nation when the real problem lay hidden in plain sight.

The recent revocation of the AG’s visa to the US has resulted in closer scrutiny of his office, revealing the unexamined and unrestricted powers wielded by the holder. Whether or not Mr Wako eventually steps down from office, the reform movement must change tack and create more credible institutions to replace this one-man government in the name of the Kenyan AG.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine.

Sunday, November 8, 2009

Focus attention on the real examination cheats

Sunday Nation 08 November 2009

As the Kenya Certificate of Secondary Education (KCSE) examinations enter the home stretch, allegations of cheating and exam leakages have risen stridently to fever pitch.

Never mind that the ‘‘evidence’’ proffered this year has consisted of handwritten approximate questions rather than the full papers that have been offered for sale in the past. Indeed, one of the teachers arrested in connection with examination cheating was accused of collecting money from candidates and failing to produce the leaked papers as promised!


Quite apart from the fact that the leakage allegations may be overrated, these allegations point to the very core of the Kenyan problem. We have never seen a scapegoat we didn’t want to blame for one thing or another. Instead of wasting time blaming the Kenya National Examinations Council (KNEC), we should direct our attention to the real culprits in this alleged malfeasance.

The media cannot escape blame for completely missing the point and continuing to blame the examinations council without producing a shred of evidence of culpability on their part. In amplifying this non-issue unnecessarily, they have succeeded only in raising anxiety among the poor candidates whose emotions are already frayed as they face a make-or-break moment in their lives.

The press seems to have been ready to break some sort of news on an exam leakage if only to spite the KNEC after it declared that this year’s exams would be the most secure ever. In the pursuit of an exclusive story, it behoves the media to be responsible and sensitive to the needs of these young people who constitute the promise of a better future for our country.

They are the investment we make in order to enter old age with satisfaction that we have not lived in vain. Destroying their young lives in the search for an exclusive ‘‘break’’ is not only heartless, it is also extremely irresponsible. The second culprit in this saga is the cabal of greedy teachers and other examination staff who spend sleepless nights dreaming up new ways of making money from gullible parents and students by purporting to sell exam papers.

Looking at the so-called ‘‘leaks’’, it appears some people involved in the examination setting chain made educated guesses as to what questions were likely to appear in the exam, and proceeded to sell these guesses in the name of exam leakages. These individuals must be pursued relentlessly and made to face the full force of the law in order to discourage the notion that examination success can be bought.

Another group that needs chastising is that of parents who raise their children to believe that anything goes in the rat-race of life, and that buying leaked examination papers is par for the course. Prominent thieves are glorified in our living rooms and given positions of responsibility, while those that eke out an honest existence are derided as fools for not ‘‘eating where they work!’’

At the end of it all, we expect our children to import values from another planet and grow up as honest citizens building a ‘‘middle-income industrialising country by 2030’’! Given the sick society they are growing up in, it is difficult to blame the teenage students for rushing to purchase anything that would give them an advantage over their colleagues in the examinations.

But for the sake of equity in this discussion, it would be remiss not to mention them as part of the rot that bedevils our failing education system. No matter what society you grow up in, the ultimate decision to steal rests with the individual thief. Any student caught cheating must, therefore, be severely punished in order to deter like-minded colleagues, and to raise the cost of cheating beyond most potential exam cheats.

In my opinion, it is missing the point to accuse the KNEC of ‘‘not doing enough to stem cheating in our national exams’’ when the parents, teachers and students themselves continue developing newer methods of cheating! Indeed, the ‘‘leakage’’ allegations have yet to be solidly proved, given that so far (at the time of writing this) no one has produced a leaked exam paper that has been offered for sale to a candidate unlike in past years.

All there is to show are a few handwritten fragments of questions whose format and language even differs from the final product itself. For the sake of development of this country, we must start being more proactive and demanding more of ourselves before pointing fingers at others for whatever we perceive to be wrong with our society.

Indeed, in a perfect society, the KNEC would not need to make any elaborate security plans for the exams, since nobody would have an interest in gaining an unfair advantage over another by stealing the exams!

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Saturday, October 31, 2009

Applauding the few brave women of Malindi

Sunday Nation 01 November 2009

Almost unheralded, a revolutionary act was committed by a few brave women at the Kenyan coast last week. During a Sunday sermon in Malindi, female members of the congregation protested loudly when the priest suggested that men were becoming homosexual because women ‘‘had failed to do the job that God gave them’’.

This statement was made in the context of the reported ‘‘marriage’’ between two men of Kenyan descent in the United Kingdom. The local media was awash with the story, interviewing distraught parents and villagers in a bid to contextualise the matter and, of course, outdo their competitors in the process. Some radio presenters on the more raunchy shows were heard suggesting that these (gay) guys should be ‘‘slapped’’ out of their misguided behaviour!

While everyone has given their two cents’ worth on this matter, some more passionately than others, very few have gone beyond simply expressing their disgust to examining the serious underlying issues. The Malindi priest tried to explain his ‘‘disappointment’’ especially with Kenyan women for ‘‘allowing’’ their men to ‘‘go gay’’, but only succeeded in earning their wrath instead.

Suggestions have been made that homosexuality is dangerous because it puts small boys at risk of being sodomised. Others have argued that if allowed, the practice risks spreading rapidly and interfering with the cosmic scheme of things where man (and woman!) was meant to procreate and fill the earth. The bigger issue that needs to be examined is this: are the reasons given above sufficient in and of themselves to justify the extreme outpouring of emotion over private sexual preferences of individuals? Let us examine them in a little more detail.

The contention that homosexuality puts young boys at risk of being sodomised is severely flawed, for it assumes that all homosexual men have no control over their sexuality and will prey on unsuspecting members of the public and practically rape them to satisfy their sexual urges.

Followed to its logical conclusion, however, this argument implies that heterosexuals will similarly put young boys and girls at risk by the mere fact of being sexually active! At the core of this argument is the assumption that people do not have control over their sexual impulses, an assumption that does not find support in empirical evidence.

A similar argument was exposed in Franz Fanon’s writings about the attitudes of colonial Europeans towards the sexuality of Africans, and was thought to be at the core of ideologies such as apartheid that sought to keep white women away from black men for their own protection. African men were thought to be savages with no control over their sexuality, and it seems this argument is now being applied on African homosexual men!

The assertion that homosexuality must be checked to reduce the risk of its rampant spread in this country suggests that all men are susceptible to homosexual impulses and therefore need protection from rampaging gay men who may just convince them to play ball.

The natural conclusion from an argument such as this is that those complaining loudest fear that they may be ‘‘converted’’ themselves and their protests are some sort of self-inoculation against the practice! In psychological terms, this is an ego defence mechanism known as reaction formation, implying that those feeling so strongly about the subject must first examine their own attitudes towards it before going out and causing such a ruckus.

Finally, the Malindi priest attempted to examine the causes of homosexuality among Kenyan men, and came to the conclusion that Kenyan women were to blame for not taking better care of their men. He also suggested that parents had abdicated their responsibility and were therefore also to blame for their children’s transgressions.

Homosexuality is often a very personal experience, and its prevalence in Kenyan society may never really be known as a result. Homosexuals do not clamber onto rooftops to proclaim their sexual preferences, and most practise their sexual behaviour in the privacy of their homes. The decision to practise homosexuality is therefore made privately, and has very little to do with what other people think or feel about it.

Blaming women collectively for the choices of individual men reeks of a form of parochial sexism that has no place in the sort of society we are trying to build in this century. We must therefore applaud the women of Malindi for rekindling the hope that a better future is possible if we are willing to stand up to hypocrisy and destructive leadership. Let us learn from this epochal act and start saying ‘‘No’’ to ethnic chauvinists masquerading as leaders when they attempt to herd us towards inevitable conflict. We must speak up for what we think is right, and maybe then we shall save this country from self-destruction.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Sunday, October 25, 2009

Insecurity talk cannot be swept under the carpet

Sunday Nation 25 October 2009

This past Kenyatta Day, President Kibaki issued a stern warning to criminals in typically harsh fashion, promising to ‘‘crush them’’ and asking wananchi to help in the effort by revealing criminals in their midst and refraining from criminal activity.

As far as the Rift Valley was concerned, the President seemed to allude to recent reports indicating that communities in the province were rearming in readiness for the next elections when he asked residents to ‘‘discourage arms buying in families and our villages …’’

Different script

Even as the President made his very emphatic comments, some administrators and politicians in the Rift Valley appeared to be reading from a totally different script by strenuously denying the reports and going as far as calling for the arrest of the human rights activists who had allegedly originated the reports.

Indeed, a number of activists in Eldoret had earlier been picked up by police for questioning in connection with the reports, and some of them had gone into hiding fearing for their lives even on the day the Head of State was issuing the warning to criminals.

So serious is the situation in the Rift Valley and elsewhere in this country that many are afraid to openly discuss the issue without fear of reprisals.

It appears that in Kenya, the freedoms that were gained gradually since the onset of multiparty politics in the early 1990s are being eroded in the wake of post-election violence.

Last year’s conflagration is now being used as an excuse by both the state and varied groups to silence independent voices under the guise of maintaining a fragile peace.

Already the media is awash with reports that some of the witnesses who gave evidence at the Waki inquiry have had to flee the country after receiving death threats. The remaining witnesses have had to contend with extreme uncertainty, fearing that the same fate may befall them any time now.

At this rate Kenya is going to remain a homogenous nation of greedy self-seekers who see no evil, hear no evil and, above all, speak no evil!

As long as there are patriots who still harbour dreams of a future beyond the ‘‘newly industrialising, middle income country providing a high quality life to its citizens’ rhetoric as encapsulated in Vision 2030, such gagging of independent voices must not be allowed to happen.

We must not allow fear of reprisals by government or militias to silence the voice of truth for, if we do not speak now, we shall lose the moral authority to prognosticate after the fact.

Popular blogs

Trawling cyberspace recently I came across even more disturbing debates on some of the more popular blogs. Some of the sites had people (using practically anonymous avatars) issuing threats against the journalists who first reported the story about purchase of guns in the Rift Valley.

Some bloggers have dedicated themselves to unearthing the identity of the individual reporters, without disclosing the aim of such an enterprise. The degree of hate and intolerance that is being demonstrated by many Kenyans is reaching alarming proportions.

Government protestations that peace and reconciliation efforts are having effect in the clash-torn areas are easily exposed for the hot air they are when one spends even a few minutes in private conversation with an ordinary citizen.

In most ethno-politically homogenous gatherings, people are passing off ignorant bigotry as gospel truth. The larger tragedy is that in the forums they choose to spew such filth, nobody dares to confront them with a contrary opinion, for fear of being branded a traitor or some similar epithet.

Politicians have not helped the situation much by increasingly ratcheting up political talk focusing on the next General Election, in complete disregard of the plight of multitudes of Kenyans who are living in the most deplorable of circumstances.

For all intents and purposes, the country has entered another election cycle, and any hopes we may have had of institutional re-engineering are fading right before our very eyes.

As the politicians focus on the big prize of being President of Kenya, they are attempting to shift our gaze from the urgent reforms as well as the fate of the organisers of last year’s post-election violence.

Despite the ICC’s valiant attempts at bringing the culprits to justice, many Kenyans are becoming sceptical due to the disdain with which our national leadership is dealing with the issue.

Civilised society

Even if nothing further is achieved in the way of reforms in this country, all right-thinking individuals must condemn the intimidation that is being directed at the last bastions of a civilised society we have left — the media and whistle blowers.

As it is, many have already lost faith in all the other pillars of society, including our political leadership and the institutions of government!

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Sunday, October 18, 2009

Tribal alliance talk sets the stage for the next conflict

Sunday Nation 18 October 2009

A new furore has been unleashed on unsuspecting Kenyans following Vice-President Kalonzo Musyoka’s call for an alliance between himself, Deputy Prime Minister Uhuru Kenyatta and Minister for Agriculture William Ruto.

The VP’s remarks came only a few weeks after some Rift Valley politicians and their Central Province counterparts had floated the idea of an alliance between Ruto and Kenyatta, touted as the ‘‘KK’’ alliance, ostensibly bringing together the Kikuyu and the Kalenjin communities.

Kalonzo’s new alliance has already been christened ‘‘KKK’’ to bring on board the VP’s Kamba community from Eastern Province.

What this alliance talk illustrates is the peculiarly Kenyan fatuous leap of logic that misrepresents the political dreams and aspirations of individuals as the consensual positions of entire communities.

It also demonstrates the state of danger any Kenyan living in a cosmopolitan area faces every time some misguided politician opens his mouth and purports to speak for his tribe.

If they last until the next General Election, these KK and KKK alliances will become the nexus around which the next ethno-political war will be fought in this country, and the main victims will definitely be ordinary citizens from these and other communities around the country.

Going by reports of rearming of ethnic militias, it is clear that the next conflict has the potential to completely destroy Kenya as we know it today. To paraphrase Albert Einstein, the war after the next will be fought with sticks and stones!

All our politicians are keenly aware of the effects of their political posturing especially in the poisoned political climate that has existed since late 2007.

In the light of this, Kalonzo’s ethnic posturing exposes him and his ilk as nothing more than wolves in sheepskin balking at nothing in their quest to rend the fragile fabric of our nation for their own nefarious ends.

Further, talk of selective tribal alliances based on personal friendships only illustrates clearly how far off course we have slid as a nation in our search for identity in the community of nations.

There is a manifest absence of a sense of history among our leaders as well as among their most vociferous supporters.

It is, therefore, right and proper for every clear-minded patriot to keep reminding our wayward ‘‘leaders’’ that some of the things they say and do are inimical to the existence of a united prosperous country.

However, the hullaballoo raised by the politicians opposed either to the idea of a KKK alliance or to the VP’s campaign talk this far from a General Election is duplicitous, to say the least. Many of the politicians accusing the VP of balkanising the country are not really sincere in their sentiment.

Recent history will remind us of the major role many of them played in the intense ethnicisation of any issue during the campaigns for the last General Election.

Many historians will eventually agree that the fighting following the 2007 General Election was not caused to a large extent by ‘‘stolen elections’’ but by politicians who have since independence framed every major national issue as a matter of one tribe (or collection of tribes) against the rest.

Indeed at the height of the post-election violence last year there was even talk of isolating Central Kenya into some sort of landlocked country akin to Lesotho, or even of secession of other parts of the country to protest at dictatorship by ‘‘one tribe’’.

The rapprochement between these three individuals should serve as a lesson to ordinary Kenyans who are still suffering the after-effects of a prolonged drought as well as the consequences of the ethno-political flare-ups of December 2007 to February 2008.

If we needed any further evidence of the depravity resident in the souls of our so-called leaders, we need not look any further than what is happening on the political scene.

The National Accord signed last year between the two principals was not an end in itself.

It was, as has been repeatedly pointed out by various commentators, a ceasefire to allow for far-reaching reforms in the architecture of the state.

After Kofi Annan’s recent visit to the country to assess progress on achieving the agenda items comprising the Accord, there is near unanimity that progress is either too slow or non-existent as far as important institutional reforms are concerned.

Instead of focusing on ways of speeding up these reforms and paving the way for a new Kenya, where the events of the recent past will become just a painful memory, these ‘‘leaders’’ are busy laying the groundwork for the next conflagration.

In the interests of the future generations that would like to enjoy a more peaceful existence, these and other tribal demagogues must be stopped before they destroy the little pride left in being Kenyan!

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Sunday, October 11, 2009

Bringing home the reality of our moral vacuity

Sunday Nation 11 October 2009

Last week I had a glimpse into some of the things that make it hard for Kenyans to get ahead in anything they try to do collectively at the national level.

Quite apart from our pathetic politics, everyday occurrences point to the true soul of the ordinary Kenyan. By studying the motivations behind the everyday behaviour of Kenyans, it will be possible to predict what to expect in the various situations facing our nation now and in the future.

During a prime time documentary on national television, people living next to a cemetery were shown desecrating graves and building their dwellings right on top of these so-called ‘‘final resting places’’.

In another location, residents were exhuming dead bodies ostensibly to create space to bury their own, and skulls and bones littered the cemetery in a caricature of some Hollywood horror movie.

Everybody in these communities continues to go about their business as if nothing out of the ordinary is happening around them, and they would be mystified by any fuss made over their activities.

This is a clear demonstration that we are slowly normalising events that were anathema to us only a few years ago.

In the face of many such acts of extreme moral decadence, we shrug our shoulders and blame everything on our national excuse: poverty.

We blame poverty for thefts and robberies, for violence, rapes and even poor governance! It is left to the imagination of the outsider what sort of poverty is being referred to and, after close examination of the matter, one may correctly conclude that it is moral poverty and not material poverty that is being discussed.

Civilised states

History teaches us that individuals and nations evolve from primitive to civilised states over time. Often, the evolution involves learning to understand the needs of others and taking care of the most vulnerable members of a society.

Civilisation further entails development of certain values that define the nation, a moral compass that must be followed by all that would like to be known as members of the group.

In this regard, the foundation of the Kenyan nation seems to have failed, for we gained political independence and founded a state without a solid moral background that could outlast the ‘‘founding fathers’’.

The respect of institutions and laws was left to the individual whims of the rulers, leading to a situation where a law could be interpreted in all possible ways depending on which side of the argument one chooses to endorse.

Since independence, we have been experimenting with various models of national ideology as our moral guides. We have struggled under ‘‘African Socialism’’, capitalism and even flirted with a ‘‘go East’’ philosophy. Each time we only manage to borrow the clothes of our new ideological master without his manners.

If we had managed to embrace the philosophy and morality of the socialist in the same way Tanzania did at independence, we would not have the current back and forth arguments about what system of governance best suits this country.

Borrowing the capitalist mentality together with its moral underpinnings would have ensured that we base competition on a flat platform that offers opportunity to everyone at the beginning and eliminates unfair advantage.

Even if we had seriously decided to ‘‘look East’’ and take on the values and systems of the ‘‘Asian Tigers’’ and their successful neighbours, we would also have inherited the severe moral sanctions that characterise these nations.

It would, therefore, not have been uncommon to hear of ministers who jumped off cliffs over their involvement in political violence!

Kenya perfected the art of inheriting the outward appearances of a system of governance without internalising the associated values and morals.

It is this moral emptiness that allows murderers and thieves to dine with erstwhile moral beacons like religious clergy and other national opinion leaders. Today, masterminds of ethno-political violence in Kenya sit in judgment over the survivors of their atrocious acts while mouthing off about truth, justice and reconciliation and historial injustices.

The television documentary last week brought home the reality of our declining moral standards and the elasticity of our behaviour such that nothing is impossible any more.

We can now understand the national pastime of ‘‘grabbing’’ any unsecured property, knowing that if in future one is called to account, they may fall back on their tribesmates for support, or just blame poverty for their misdeeds.

In the interest of securing a prized inheritance for posterity, all Kenyans who still nurture that vestigial moral fibre must stand up to be counted. We must reassert the superiority of the moral compass over the demands of the moment, and demonstrate that we are a nation that cares for the future generations just as much as we care about ourselves.

The alternative is unimaginable.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Saturday, October 10, 2009


Presentation at Forum for African Affairs/MDGs youth meeting in Eldoret
Friday 09 October 2009


The traditional view has been that the MDGs that refer to health are goals 4, 5, and 6. Goal number 4 deals with reduction of child mortality, goal 5 with maternal mortality and goal 6 with combating HIV/AIDS, Malaria and other diseases. It is clear from a close reading of these goals that the framers of the MDGs intended them to be the main preoccupation of health service delivery systems worldwide, but more so in developing countries including our own.
Unfortunately, due to the discrete nature of the goals, and the difficulty that reading complex documents brings especially in this parts where reading is at best endured during school years and at worst dismissed as the pastime of the ‘bookworm’ or ‘nerd’, there has been a significant disconnect from what I would consider the point of the MDGs.
Careful reading of the UN MDGs indicates that all the goals are closely interlinked, and attainment of any one of them increases the chances of attaining any and all of the others. Let us look at these goals in more detail:
Goal 1: Eradicate extreme poverty:
Poverty and health are closely interlinked. Poor people are more likely to put themselves at risk, and when they do contract diseases, are less likely to have access to high quality health care. Due to the stresses and strains of life in the lower socio-economic echelons, new ‘lifestyle’ diseases like substance abuse and dependence, HIV/AIDS and even mental illness are becoming an everyday feature among the poor. Eradicating extreme poverty will therefore go a long way in improving health outcomes and the quality of life of our populations. Similarly, neglecting health in the search of better economic growth rates is likely to be counter-productive. Populations that are unhealthy are definitely not going to be able to achieve their full potential! I therefore posit today that MDG number one IS a health goal!

Goal 2: Achieve universal primary education:
To the casual observer, this goal does not look like it has anything to do with health. A closer examination, however, demonstrates the clear link between ill health and poor school outcomes. Unhealthy children spend more time away from school than healthy ones, and due to the metabolic demands of ill health, they also have less energy to dedicate to the cognitive demands of our competitive educational system. Further, children from homes in which the primary breadwinner is unwell with such chronic illnesses as HIV, cancer, or mental illness are less likely to go to school, and would instead be utilized to help in boosting the family income. This goal is therefore unlikely to be achieved unless the health of the population is put on top of the agenda!

Goal 3: Promote gender equality and empower women:
Once again this is s goal that is directly linked to the health of the population. Promotion of gender equity is definitely an issue in the health sector. Discrimination in access to health care is heavily skewed against women in our society. In our resource-poor setting, we often make decisions from a male standpoint that has difficulty considering the needs of our women-folk, resulting in unnecessary deaths and suffering among our women. As a matter of fact, the prevalence of HIV among women is almost twice that among men! This would indicate that a specific focus in health care delivery must target women, yet there is little evidence that this is the case.
Unequal gender distribution of the health workforce has resulted in stereotypes and low sensitivity in dealing with patients in our hospitals. For instance, every female health worker is has probably had to deal with the tag ‘sister’, while every male health worker must answer to the honorific ‘daktari’.
Goals 4, 5 and 6 are self-explanatory and deal with discrete health issues, and I will not dwell too much on them. Suffice it to say that from my perspective, a neglected health issue that will come back to haunt us as we focus on these MDGs is MENTAL HEALTH. Without having programs dealing with the mental health of our population, I would go as far as saying that the MDGs are set up in a way that all but guarantees failure. As a matter of fact, I would summarise ALL the MDGs into one sentence (if I was among the architects of the goals, that is): Ensure access to quality mental health services for the entire population (by 2015, or whatever year is convenient!). However, I must only work with the substrate I have been given.

Goal 7: Ensure environmental sustainability:
There is no denying the relationship between the environment and health. Many infectious diseases, which are the bane of our existence, are picked up in our environment. Indeed, a key component of disease prevention programs involves environmental manipulation to reduce risk factors for disease. It should be noted that environmental issues cut across the entire human experience, and the Mau forest saga has clearly demonstrated this. Health workers often take stands to protect the environment against degradation by those whose horizons are short and whose vision of a future does not go beyond a few months to years.

Goal 8: develop a global partnership for development:
This is a goal that cuts across all the other MDGs, and the need for partnerships in health is no less than in the other areas. Indeed, in few other spheres of human existence is partnership demonstrated more than in the health sector. Health workers share knowledge no matter where it is generated, and innovations in health care delivery are publicized for all to use. Expanding these partnerships will have a greater impact on the health of our people. Using the expanding IT platforms including satellite and fibre optic technology, we will be able to deliver high quality health services comparable to any other country in the world.

It is clear therefore that these goals are not discrete planks that can stand on their own in any way. Isolating three of the MDGs and ascribing them to health workers is therefore the height of folly. Indeed, even if health workers had nothing to do with the other five goals, the goals would definitely have an impact on them as citizens of the world, and on their work as health care service providers!


Having said that, I would like therefore to dwell on what health workers can do in order to hasten the achievement of the MDGs. With the background I have laid, I will not restrict myself to the three so-called ‘Health-relate MDGs’, but I will take a holistic approach that ensures that none of the goals is left behind.
Health workers occupy a unique position in the hierarchy of any state. They have authority over all citizens in matters dealing with health, and the citizenry gives them a pedestal from which to carry out their duties. They are respected, and they perhaps compete with priests as among the few individuals no one would dare lie to!
With this position and respect, health workers therefore have a great opportunity to impact positively on the lives of their clients. Often, the doctor’s word must be obeyed if one is to remain healthy. Many people are willing to let go of their usual demands and scruples once they are admitted to a hospital.
On the other hand, this powerful position also confers onerous responsibilities on the health worker. The greatest among these are summarized in the ethical codes that guide medical practice, including:
- Primum non nocere (first do no harm)
- Beneficence (do what is good for your client)
- Autonomy (allow the client room to make decisions about their own health)
- Justice (allocate available resources without regard to extraneous issues)
- Confidentiality (do not broadcast what is divulged in confidence)
These are among the principles upon which the health profession is built, and we swear to ensure that the health of our patients shall be our first consideration.
This oath therefore places us in a position to want to intervene whenever the health of our patient (our country, community, neighbourhood, etc) is threatened. I hold that it is not only good to do so, but that it is a moral imperative, and where you can, you must act!

The next segment of my discussion will focus on some concrete actions that health workers can take have an impact on their communities and thus enhance achievement of the MDGs.

1. Know ALL the MDGs and their implications on health:

It has been correctly said that knowledge is power, and you cannot develop without knowledge. Health workers cannot restrict themselves to a few identified priorities and neglect other issues that impact on the health of their communities and even their own families! It is therefore the responsibility of health workers interested in furthering the noble ideals behind the MDGs to familiarize themselves with all the MDGs, in order to be able to play a part in achieving them. As we have seen earlier in my presentation, all goals have an impact on health, and health can impact on the other goals as well.
I would go as far as suggesting that these and other national and international goals be integrated in the training curricula for health workers, so that they do not enter their professions thinking they have no role to play on a wider stage.

2. Get out of the white coat!

The problem with many health workers has been the tendency to hide behind the white coat and behave as if they are not part of their communities. Often, they dismiss public actions as ‘political’ and therefore not proper to get involved in. The problem with this attitude is that some of the best brains in any country are absorbed into health-related professions, robbing other sectors of society of these important resources. If these brains end up being hidden away in our wards and theatres, not contributing to national debate and employing their exceptional intelligence towards bettering their communities, wouldn’t this be rightly considered to be a waste?
In order to reduce this waste, I therefore propose that health workers periodically get out of their white coats and get involved in their communities, whether their actions will be construed as ‘political’ or not. Involvement of health workers in advocacy will add an important voice to issues, increasing the likelihood of action being taken.
In this regard, therefore, I am glad to identify with the clarion call of this movement: Stand up, Speak out and Take action. I urge you all to do this, and not only on health related MDGs, but on all the MDGs and other issues that threaten the well-being of our people.

3. Do your job well!

It is imperative that as we focus on actions we can take outside of our professions to further the MDGs, we also ensure that we deliver on our core responsibilities. In this country, cases are being highlighted of hospitals and health workers who treat their clients poorly for one reason or another. Medical malpractice issues are rising, and if we are not careful, the few gains we are making in improving the numbers and distribution of the health workforce will be eroded. A great deal of mistrust is creeping into the hallowed relationship between a health provider and the client, and this is not healthy for our country. As health care providers, it is our responsibility to ensure that we maintain the professional mores and ethics that guide our practice, and that we use the resources at our disposal responsibly in order to achieve our health goals. You cannot have a moral platform to stand on if you are not doing your job well; therefore, in order to be effective advocates, you must ensure that like Caesar’s wife, you are beyond reproach.

4.Take care of yourself!

Many of us are often so deeply immersed in our work that we end up neglecting our responsibilities to ourselves and our families. Substance use and dependence, HIV/AIDS, workplace injuries to name just a few are becoming common problems among health workers. I must emphasize that a health worker who is unwell is not useful to the client, and may even be dangerous! The injunction to take care of yourself is therefore an important one, and neglecting your health as a health care provider is tantamount to professional negligence! In the same vein, we must ensure we take care of our families, if not only to serve as an example to the rest of the community. We cannot afford to preach water and drink wine, given that actions often speak louder than words.

The four actions above would help to advance the role of young health workers in creating a world that is favorable for them and for posterity.


It is fitting that as I conclude this talk this afternoon, we ask ourselves if we are on track to achieving the MDGs, including the health goals.
My humble assessment, based on various parameters, is that although these goals form the major plank of the manifestoes of all our political parties, there is simply no sustained action to achieve them. On the whole, pursuit of these goals has been subordinated to other pursuits that we are better known for in this country, namely grabbing, looting, bickering, and lately, murdering, pillaging and raping our own people.
I conclude by saying that unless we get our act together at the highest echelons of governance in this country, we will be lucky to make a dent on any of the MDGs, let alone achieving them!
Finally, I would like to thank the organizers of this forum for inviting me to say the things I have said this afternoon, and I hope I have added something to the menu of activities the young people have organized for themselves as they campaign to end poverty and achieve the MDGs.

Thank you.

Dr Lukoye Atwoli
Consultant Psychiatrist and Lecturer
Moi University School of Medicine

Sunday, October 4, 2009

Moi’s re-emergence only filling a leadership vacuum

Sunday Nation 04 October 2009

Retired President Daniel arap Moi has lately taken to confidently making political pronouncements touching on a variety of national issues at all sorts of public gatherings. He even recently intimated that politics is his lifeblood, and he would literally continue pursuing political issues to the end of his days.

Indeed, in an ironic twist of fate, Energy minister Kiraitu Murungi officially welcomed the former president into the current political fold, over six years after chastising him to “retire to his farm, herd goats and learn how a country should be governed”.

In the years immediately after the Narc administration took over from the Kanu kleptocracy, Mr Moi kept most of his opinions to himself, restricting himself to the odd public appearance at a church, funeral or school function.

However, with the passage of time, he has become bolder and bolder, and is today able to harangue the nation on all matters ranging from the Mau forest to good governance.

Despite murmurs from some victims of the repression of the eighties and nineties, the former president has received tacit approval from the powers that be to continue in his attempts to mould the political landscape of this country in his own image.

It is clear that even erstwhile political enemies have discovered that an alliance with him can be politically handy. What the former president’s renewed prominence suggests is that there is a leadership vacuum in this country, and he is only rising up to fill this gap.

The top leadership in our country is currently too occupied fighting political fires from both within their own and their opponents’ camps to offer any real leadership to Kenyans.

Despite the noise from various interest groups and activists, it remains clear that no one has as yet offered real alternative leadership that appeals to a majority of Kenyans across the ethno-political divide.

Notwithstanding their glowing reformist credentials, most aspiring fresh political voices have been taken hostage by these divisive forces that exist only to perpetuate the status quo. Recently, while having a political discussion with a small group of young men in Eldoret town, I was confronted by one who demanded to know whether I espouse ODM or PNU ideals.

He was emphatic that in order to hold a political opinion in Kenya, one must subscribe to either of the two contending ethno-political blocs in the country.

Quite apart from my ignorance of what “ideals” these two ethno-political alliances represent, I was stunned by this sort of logic that obviously turned a blind eye to recent political history in Kenya.

Sample this: The party that dethroned the Kanu oligarchy, Narc, won the 2002 elections with a massive landslide, and everyone was convinced that it was a force to reckon with in a new political dispensation that would not be “business as usual”.

Three short years after the 2002 General Election, the party was a pale shadow of its former self, and the final nail in its coffin was driven by the cantankerous constitutional referendum of 2005.

The party did not even feature as a force in the subsequent tainted 2007 elections, and “everyone” was once again classified as either ODM or PNU, with no space for anyone with an opinion different from either of these.

The lesson here is that at this stage of our political development, the lifespan of political parties can be as brief as that of a fly, and “ideology” is often no different from the party owner’s personal credo! In sum, there is no ideological difference or longevity on the Kenyan political scene.

It is this kind of short-sightedness among well-meaning youth and other important demographics in this country that encourages the endless recycling of political leaders who have been active since the pre-independence Lancaster conference.

It is therefore fruitless to bang our heads against walls in frustration and lament that the old man has just refused to go away when we are providing a fertile ground for his continued ascendancy.

Testimony of Moi’s eye on his legacy is evidenced by the level of comfort he has displayed since being humiliated by rowdy crowds at Uhuru Park back in December 2002.

Through some inspired foresight, he managed to populate all areas of governance with his acolytes and sycophants, and was so successful at this that there is little difference between the complexion of all the post-Moi Cabinets and the Moi Cabinets of the late nineties and early 2000s.

In the absence of an authoritative voice on the national arena that offers a real departure from the old way of doing things, we are doomed to continue playing this futile game of musical chairs, waltzing from crisis to crisis until we find one that will finally spell doom for this country.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine:

Sunday, September 27, 2009

Uncalled for sideshows

Sunday Nation 27 September 2009

Parliament’s decision to annul the President’s reappointment of Justice Aaron Ringera and his two deputies at the Kacc has elicited a lot of optimism among Kenyans, with many rapturously declaring that the House has at last seen the light and is now making decisions in the public interest.

MPs were seen to be reforming from their usual self-seeking ways that had been signalled right from the beginning of their term by their insistence on tax-free pay, likening this patriotic injunction to a pathway to poverty.

On every national issue that has confronted them, our legislators have voted with their stomachs, and before every major vote in Parliament, members have been hosted by the protagonists and allegedly given inducements to influence them to vote one way or the other.

It was extremely suspicious when they displayed a rare bipartisan camaraderie as they hit out at the President’s decision to unilaterally reappoint the Kacc team. Reports about a deal linking Justice Ringera’s fate and that of the Mau water catchment should have set the alarm bells ringing.

A further pointer to the mischief afoot was the content of the debate in the august House. Apart from a few contributors who restricted themselves to the President’s conduct, most of the MPs tore into the Kacc director’s apparent ineptitude, challenging him to demonstrate even one successful prosecution of a “big fish” for corruption related offences.

This they did knowing full well that the Kacc is not empowered to prosecute or sit in judgment over any of the suspects, big or small! The agency’s role is limited to investigating and recommending for prosecution anyone suspected of corrupt dealings.

Indeed, in their own defence, the Kacc hierarchy produced a report detailing their activities toward fulfilling their mandate. It turned out that many politicians have been investigated and recommended for prosecution, and some still have cases pending in court over corruption.

Our MPs are not blind to all these facts, having created the legislation governing Kacc’s work. It, therefore, defeats logic to keep hearing from MPs and a cross-section of Kenyans that the Kacc has failed to prosecute or convict any big fish over corruption. These functions fall outside its mandate.

Further, Kacc’s failures or successes and those of its director were not the subject of discussion in Parliament when it was debating President Kibaki’s purportedly extra-legal actions. In an ideal situation, Parliament should have examined the President’s action and concluded on its legality or otherwise, and spared the individuals concerned the baseless sideshows over their perceived failings.

The Kacc, to paraphrase Judge Ringera’s words, has been crushed between the hammer of political demagogues and the anvil of the disillusioned public.

Dr Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine;

Sunday, September 20, 2009

Death Threats?

I have been writing opinion articles for over two years now. I have learnt to deal with the barrage of criticism that follows many of the articles I write, and I even take time to respond to each and every mail I receive in connection with these pieces.
I have been vaguely threatened before, but I did not take the threats seriously because they were made in the context of angry outbursts and could not therefore be taken further than the utterances.
Two days ago, a dark coloured Toyota RAV4 followed me upto a few meters from my gate, and then turned back, and I would have thought nothing of it had I not noticed yesterday that someone had cut through my perimeter fence while I was away. Apart from cutting a man-sized space through barbed wire, the perpetrator had also cleared through the live fence, and it seemed as though preparations had been made for an attack on my home at an appropriate time.
I am taking this seriously now. I will go this afternoon to the Central Police Station in Eldoret town to report this.
I hope these incidents are not related, and that they are not related to my writing or other work, for I do not intend to change any of that!
So, there!
Lest I be accused of not having spoken when I should have!

The bane of tribal loyalty will be our undoing

Sunday Nation 20 September 2009

Kenya Bureau of Standards CEO Kioko Mang’eli was recently relieved of his job in unclear circumstances after what was reported as a disagreement with the office of the Prime Minister. The Industrialisation minister implicated the head of the public service in the sacking, who now claims Mang’eli falsified information to justify a huge pay rise. This allegation was denied by the bureau.

Soon after the issue was reported in the press, a fresh angle was introduced, with certain politicians from Eastern Province fulminating that Dr Mang’eli was sacked as part of a wider scheme against Kambas. The CEO then came out fighting and declared he would not quit.

Ever since the destruction of the Mau forest complex entered the national consciousness, a clear tribal perspective became evident. Some Rift Valley politicians went to town with allegations that “our people are being finished”, and that their community was being blamed for all sorts of ills, ostensibly in a conspiracy to demonise them and prevent someone from the community from ascending to power.

Other groups of politicians from other communities are also playing the same game, ratcheting up the rhetoric on protecting the Mau complex, and issuing statement after statement to counter those issued by their perceived protagonists on the other side of the tribal divide.

There have even been noises about there being a conspiracy by the rest of the country to “gang up . . . to block any political appointees from the Mount Kenya region” to quote a letter in the Daily Nation on Tuesday last week.


Indeed, it is instructive that, barring a few ideologically driven Kenyans with no tribal motive whatsoever, most of the actors on the national stage have been taking a blatantly tribal line.

This tendency is bringing to the fore the role of the tribe in our national discourse but, as usual, we are keen to camouflage it as pursuing the “national interest” or some other politically correct euphemisms.

If there is such a thing as a Kenyan, why is it that most of our political disputes follow such a predictably tribal pattern? Why is it that those who speak out loudly in defence of Mr Aaron Ringera today are led by a vanguard of politicians mostly from his tribe and kindred communities?

Why is it that these are the same fellows expected to spring to the President’s defence whenever he is attacked for some executive misstep or other?

Why is it that whenever the Prime Minister is attacked for whatever perceived political failing he may have, the first “Kenyans” to rush to his defence are from his own ethnic community? Conversely, why is he more likely to receive flak from members of communities other than his own?

The situation has degenerated to such an extent that no public servant can be legitimately censured without a subsequent chorus from his or her community alleging some vendetta against them. The sum of this is that mediocrity is being perpetuated at the tax-payer’s expense in the name of tribal loyalty due to the ethno-political decisions being made by all branches of government.

Before the last General Election, there was heated debate on all sorts of topics that were thought to have the potential to influence the outcome of the election. In a commentary published in the Daily Nation on November 29, 2007, I argued that it was not edifying to listen to the arguments being advanced by analysts of all shades of opinion, and that all they needed to do was to utter their surnames and their opinions would become clear to all and sundry.

To be honest, despite the experience we had after the last General Election as a result of this sort of politics, we have learnt absolutely nothing. On any topic of discussion, all one needs to do is to find out what the main tribal chieftains on the political field think, and the opinion of most of their tribesmates would not be much different.

This position prevails on almost every national issue, from conservation of the Mau forest to the reappointment of Justice Ringera and even the rulings by the Speaker of the National Assembly, Mr Kenneth Marende. That Kenyans sit idly by and sometimes applaud and repeat the same opinions held by their “leaders” indicates that we are least bothered by them.

This mentality robs us of the right to seek change in our national governance platform, given that any systematic change would significantly overturn the applecart in favour of meritocratic considerations that would give tribal loudmouths a wide berth.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Sunday, September 13, 2009

Dependence on luck ruining our sports

Sunday Nation 13 September 2009

Perusing through the sports pages of our dailies, one may be forgiven for thinking that Kenya is a nation of the most unlucky people in the world.

Before any major tournament, there is plenty of hype despite the fact that very little advance preparation is done or even contemplated. After the inevitable heavy thrashing, there are recriminations and protests, as though the very best team we had lost by some unlucky happenstance.

Last week’s defeat of Harambee Stars by a solitary goal away to Mozambique, as well as the disastrous performance by the “Hit Squad” at the world boxing championships in Milan are examples of this sort of attitude that seems so pervasive in all spheres of Kenyan life that it can be considered integral in our national psyche.

Most of the problems in our sports have been exacerbated by the realisation by politicians that the fastest route to political Nirvana is through sports administration in this country.

Many clubs and sports federations today count, among their leaders, failed and aspiring politicians marking their time until the next General Election when they will don their party colours and hit the campaign trail with the clubs counted as feathers in their caps.

As a result, the same wrangles that characterise our national political landscape have found another battleground in sports, and a look at the football landscape in this country demonstrates just how deleterious this can be.

No idea

Today, the average football fan has no idea who runs the sport in this country, with a plethora of private companies and individuals each contending for a piece of the pie.

The national team is often unsure who hires even the team coach, and at some point the situation was such that there were two coaches before the Prime Minister waded into the murk and introduced German Antoine Hey as the new coach.

Even as the team jetted into Maputo for the match described as “make-or-break” for them, the media was awash with reports that the government could not afford to pay the coach!

Our subsequent collective surprise at the dismal performance by our national team is symptomatic of the national attitude to success, that it is due mostly to luck and Godly favour.

Hard work, planning and foresight are alien in the lexicon of the average Kenyan, and it is no surprise that the commonest peeve for most Kenyans is that the coach is earning over a million shillings monthly and has not ‘delivered’.

The malady afflicting football administration in this country is replicated across most sports federations nationally. Most of them are steeped in juvenile wrangles that result in stagnation of the game due to the oversized egos of the protagonists.

Even games like chess, thought to be played by individuals of above average intelligence, are equally embroiled in similar circumstances with many of the players constantly at variance with whatever team happens to be managing the sport.

Everybody expects miracles with little investment, and is surprised that this does not happen more often. Similarly, we condemn our entire political class for their obvious failings and corruption and then froth at the mouth in their defence whenever their Karma catches up with them.

Crisis management

Our leadership in all areas consists mostly of crisis management, and the little planning we carry out is short-term and often poorly organised.

It seems that the only reason our athletes continue to perform well despite the prevailing problems in leadership may be due to the fact that athletics is often an individual sport, and Kenya has a depth of talent that is difficult to hold down, even on a bad day.

Sports that require even a small degree of organised preparation and investment in the future are doomed to fail in this country because our enduring vision of the future consists solely of a vague picture of ourselves with fatter bellies than we have currently and a coterie of admirers singing our praises.

This is the same fate that faces the country on the political front, where we seem to have placed all our hope on a rapidly ageing cohort of politicians whose names were already in the headlines even before the vast majority in the current population was born!

The situation prevails despite our protestations that it is time for generational change in leadership if this nation’s future is to be guaranteed.

What we need to realise is that success has very little to do with luck or supernatural intervention, but is often the result of meticulous hard work and planning.

As long as we continue sitting back and waiting for our lucky break or divine intervention, we are doomed to continue lamenting about our poor lot even as other less endowed countries continue on their journey towards prosperity.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Sunday, September 6, 2009

Don’t bribe anybody, for whatever reason

Sunday Nation 06 September 2009

There has been heated debate about President Kibaki’s decision to reappoint Mr Justice Aaron Ringera to head the Kenya Anti-Corruption Commission.

Some of the arguments have focused on the fact that he ignored the provisions of the law that stipulates that the director and his assistants should be appointed on the advice of the advisory board.

Attempting to unravel the legal implications of the President’s decision would be an exercise in futility for, in Kenya, it has become clear in recent history that anything goes.

It may be more useful to interrogate the nature of the cacophony being generated on behalf of a body many Kenyans treat with indifference at best.

Since the formation of the anti-corruption authority, questions have continually been raised about commission’s efficacy in combating corruption, with many insinuations being made about the big fish going free while the occasional small fry get caught and punished.

It is common talk that in many corruption scandals, the real masterminds go scot-free. But where do the so-called “big fish” go? It does not take a genius to see where they are. The who is who in Kenya’s corrupt past currently populate the highest echelons of governance in this country, as well as being celebrated “captains of industry”.

Indeed they are cheered whenever they show their faces, and many of them only need to whisper a few incoherent sentences before they are offered tribal chieftainships and political leadership.

Some even occupy prime positions in our religious organisations, and get healthy chunks of airtime in the mass media with their crusades for righteousness and repentance.

The same Kenyans that fete those they allege stole their birthright are the loudest noisemakers when it comes to condemning the anti-corruption bodies in this country and enumerating their perceived failures.

Another interesting observation to be made in our peculiar country is that once a prominent individual is accused of corrupt practices, he often retreats to the safety of his tribal homeland and proceeds to issue threats to the rest of the country and the government in particular about the dangers of targeting his “community”.

The spectre of bloodshed is often invoked at this point, and often the threats prove to be quite effective because the accusers quickly fall silent and the status quo remains unchanged.

It is, therefore, highly duplicitous for people who do not want justice to be done to their corrupt sons to turn around and accuse the government and its anti-corruption organs of doing nothing to rid the country of this malignant vice.

Many Kenyans do not stop to ask themselves what their role is in the perpetuation of corruption in this country.

It must be remembered that when the National Rainbow Coalition government snatched power from the vilified Moi administration, wananchi briefly styled themselves “Wenye Nchi” (owners of the country) and loudly demanded an end to business as usual. The result was a plethora of citizens arrest of corrupt government officials and exposure of corrupt deals at all levels of government.

The Kenya Anti-Corruption Commission was not even being mentioned at this time, yet corrupt officials found it much more difficult to demand bribes and kick-backs.

As the Narc government settled into place, however, it came face to face with the allure of grand corruption and found it irresistible. Citizens lapsed back to their bribing ways and the only thing left was the endless lamentations about the anti-graft commission doing nothing to fight corruption.

All over the country, Kenyans are perpetuating corrupt practices. For instance, many owners of defective vehicles are bribing traffic police officers to turn a blind eye to their faults and allow them to carry passengers, often to gory ends.

Parents are still struggling to bribe recruitment officers for the police and the armed forces during their recruitment drives. Voters are registering twice to vote in elections in order to influence the outcome in favour of their candidates.

Parents are even buying examination papers from unscrupulous education officials to help their children get ahead academically. Patients are colluding with corrupt hospital staff to inflate their bills so that they can pocket the difference from insurance companies.

In fact, crooks are even buying their freedom in our legal justice system! The examples of so-called “petty corruption” are legion, and yet all anybody talks about is the failure of the “Ringera team” to control and eradicate corruption from our midst.

It is time we all played our part in this fight; we must recognise that if all Kenyan citizens refused to bribe or steal other people’s property, there would be no need for Mr Ringera’s team in the first place.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine