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