Sunday, April 25, 2010

It would serve the church well to be more tolerant

Sunday Nation 25 April 2010

Last week, the Kenyan Catholic Church hierarchy released a letter to their faithful titled “Stand up for Life!”, targeting the proposed constitution’s provisions on abortion and kadhis’ courts. The church expressed its reservations on abortion mainly on three stated grounds.

Firstly, that referring to the health of the mother is tantamount to “opening the doors to abortion on demand”. Secondly, that “trained health professional” is unclear, and may include a medical doctor, a clinical officer, a nurse, a mid-wife, a patient attendant or a traditional birth attendant. Thirdly, that the phrase “any other written law” is ambiguous and that “they” are not prepared to “allow Parliament and a majority of the counties to pass other laws on issues of life and death”.

The church, like any other body corporate in this country, has a right to meet and express its opinion on any matter they feel falls within their province. This inalienable right belongs equally to the churches, individual members of their congregations and other organisations. However, having expressed their opinion, they should, like other Kenyans, pause and listen to the voices of others who may hold contrary opinions.

In expressing their opinion, the church leaders have a duty to refrain from making statements that are inaccurate and would end up misleading their followers. For instance, the church’s opposition to inclusion of the phrase “health of the mother” is difficult to understand. By proposing to determine how doctors should intervene in cases involving the health of their patients, the church is arrogating to itself a role best left to professionals. These decisions are often made on a case-by-case basis, and the only interest in each case is the health of the patient.
Everything else is secondary, for that is what it means to take the Hippocratic Oath.

Conditions that pose a threat to the health of an individual often imply a risk of possible loss of life unless some intervention is instituted. No doctor in his right mind waits for pregnant women to terminate their pregnancies without sufficient reason. By insisting on this clause, the church seems to be indicating that the health of the mother is immaterial, and they would rather have a mother crippled or even killed by a pregnancy than consider terminating the pregnancy before it causes irreparable harm.

A condition such as eclampsia poses a significant threat to the health of a woman, and if left unattended, it would result in the death of the mother. Is the church insisting that such a woman be left to suffer until the doctors are sure she will almost certainly die before intervening? How would that point be determined?

Concerning the term “health professional”, the church should suggest alternative phraseology if indeed their objection is genuine. The word “health” has been well defined by the World Health Organisation, and there is no point repeating this. The Oxford Advanced Learner’s Dictionary further defines a profession as “a job requiring special training or skill, especially one that needs a high level of education”. Arguing that hospital cleaners and clerks are health professionals is clearly disingenuous.

Further, it is demeaning to depict nurses, clinical officers and other health professionals as individuals who are so depraved that they are only waiting for the draft constitution to be enacted before they can open “abortion clinics”. On the involvement of Parliament and counties on “issues of life and death” this may come as news to the church hierarchy, but Parliament daily meddles in matters of life and death, including such issues as providing for the death sentence, war, food policy, health expenditure etc. The less that is said about this the better.

On the matter of kadhis’ courts, the church continues the argument that including them in the constitution is tantamount to elevating Islam above other religions in the country. They argue that these courts are privileges and the “beginning of discrimination”. The courts are established as part of the judiciary, not as a religious observance as is being depicted by the Christian right.

Apart from the fact the courts already exist in the current Constitution, the draft seems to even further clarify their role, providing that their mandate is limited to matters of personal law. The current Constitution uses the broader term “extend to”, which is obviously more liberal than what the draft proposes.

The role of a constitution is not to safeguard the majority but to protect the interests of the minorities. The majority can take care of their interests through regular elections and representation in Parliament. It would therefore serve the church well to be more tolerant and allow the views of professionals (on abortion) and fellow citizens (on kadhis’ courts) to be heard without threats and preconditions.

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

Sunday, April 18, 2010

Chang’aa deaths: Time for proactive approach

Sunday Nation 18 April 2010

The use of alcohol is indeed as old as human society itself, and has been chronicled innumerably in both religious and secular literature worldwide. In some regions such as the Middle East, alcohol was used with meals in place of water which was a scarce commodity in those areas.

Like many foods and beverages, alcohol has an effect on the nervous system that is experienced by the individual as a pleasurable sensation, and this increases the probability of continued use. Alcohol is also useful in facilitating social interaction, and all over the world it was a key ingredient in all sorts of social events.

One may therefore wonder why alcohol use causes so many problems for some people, to the extent that every year we have episodes such as that which occurred last week in Nairobi’s Shauri Moyo area. In this incident, many young men took a lethal brew they thought was chang’aa, but which in reality was a concoction containing ethanol and the poisonous chemical methanol, which was responsible for the deaths of many and blindness in others.

The answer to this conundrum lies in the fact that as far as alcohol is concerned, there seem to be two groups of people – those who are able to take alcohol safely and those who are not. It is currently impossible to identify with any degree of certainty into which category one falls before they taste an alcoholic beverage.

It is only after one starts using alcohol that we can clearly see a difference in the pattern of use that identifies those that are unable to safely drink alcohol. These individuals may develop various patterns of harmful use, including alcohol abuse, alcohol dependence and other alcohol related conditions.

People with alcohol abuse may not drink large quantities of alcohol daily but whenever they drink, they often engage in activities that pose a danger to themselves or to others. Such activities include driving while drunk, fighting, breaking the law, destruction of property and other antisocial acts. They may also experience problems in important areas of functioning such as work, home or in relationships, but continue drinking nonetheless.

Alcohol dependence, on the other hand, involves drinking more than four or five standard alcoholic drinks daily, and neglecting important responsibilities due to being hung-over or drunk. People with this condition often develop withdrawal symptoms whenever they reduce their alcohol intake, and need larger amounts of alcohol to achieve the original effect. Once they start drinking, they have difficulties stopping, and will continue drinking until they run out of money or alcohol, or lose consciousness.

Both groups described above are at high risk of developing other alcohol-related disorders such as memory problems, psychotic disorders, depression and other mood disorders, anxiety disorders, sleep disorders and even sexual problems. Other problems include liver disease, cancers, stomach ulcers and nutritional deficiencies.

The importance of treating alcohol related disorders seriously cannot be overstated. The approach must be multi-dimensional, and must avoid knee-jerk reactions such as the brief “crackdowns” that inevitably follow alcohol-related disasters every so often.

The government is very quick to react whenever such tragedies occur, but is otherwise lethargic in enforcing laws that are already in the statute books. A more sustainable approach to the alcohol use problems would lie in the establishment of more treatment centres and training of more personnel in management of substance related disorders.

The lack of proper policy framework and an oversight mechanism has resulted in the mushrooming of so-called rehabilitation centres, some of which are just glorified places of worship with nothing in the way of professional evaluation and treatment services.

Further, the government needs to re-evaluate its policy on alcohol use with a view to establishing a standards oversight mechanism to regulate all brewers, instead of criminalising some alcoholic brews. The current view that alcohol is a source of revenue to the exchequer only serves to raise prices of safe alcohol, driving the poor to consume unsafe home-made brews that so often end in tragedy.

Measures to control the age at which young people first taste alcohol would also reduce the likelihood of alcohol related disorders, and these should target homes, schools and institutions of higher learning. It is a fact that the later in life one is exposed to alcohol, the less likely they are to develop alcohol dependence and related disorders.

We must recognise that it is highly unlikely that we can completely eradicate the use of alcohol in our society. The best we can do is to regulate it so that it does not result in unnecessary death and injury. We must address the issue proactively if we hope to prevent what is becoming an annual “Kwona Mbee” phenomenon.

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

Monday, April 12, 2010

Those loudly opposed to draft law stand on quick sand

Sunday Nation 11 April 2010

After Parliament’s passage of the proposed new constitution of Kenya, a chorus of responses started emerging from all corners of the country.

Politicians continued giving divergent views mostly propelled by nothing more than egotistical posturing and power play, while some religious leaders continued their strident calls for rejection of the document on the basis of provisions on abortion and Kadhis’ courts.

Other busybodies are now working hard to introduce more non-issues such as the possibility of the military and police officers picketing, demonstrating and otherwise expressing their displeasure with their employer through industrial action.

This despite a clear ring-fencing clause in the draft that provides for Parliament to make legislation restricting the rights of the “Kenya Defence Forces” and police officers to engage in just such activity.

Another issue that is emerging as potentially problematic is the assertion by some politicians that the draft “restricts the amount of land a person is allowed to own in this country”.

Among the promoters of this argument are people currently facing multiple court cases relating to illegal acquisition of government land, and it is therefore difficult to separate their arguments from their personal tribulations.

The truth of the matter is that the draft provides, once again, for Parliament to legislate on an acceptable minimum and maximum size of private land an individual may own.

The document does not attempt to set these limits, and instead leaves this task to a Parliament elected by Kenyans, including the politicians now pontificating over the issue.

The question they need to answer is why they have such little faith in the legislative organs of this country when they have been prominent members of the same!

Among those raising a storm over the document is former President Daniel arap Moi. According to press reports, his opposition to this document has to do with the fact that it is “academic” and does not “capture the mood and aspirations of the majority of Kenyan people”.

His definition of “academic” is that there are emotive land and ethnic factors that need to be “handled with utmost care”.

The former president was further quoted in the press as saying that “it appears as if the country is being treated like a testing ground for foreign ideas, some of which are weird”.

Notwithstanding the rather unedifying definition of “academic” attributed to Mr Moi, and his cryptic reference to “foreign ideas”, it is safe to conclude that the former president is fighting hard to ensure that his once-upon-a-time prophecy that Kenyans would never see a new constitution is fulfilled.

In the end, most of those raising these petty issues as grounds for rejecting the draft are only exposing the fact that they had already decided in advance to reject the document, and are currently only fishing for “plausible” excuses to publicly proclaim their opinions.

Serious issues

In the absence of any serious issues apart from the weak ones identified above, it must be assumed therefore that the Committee of Experts and the Parliamentary Select Committee managed to achieve the singularly elephantine feat of producing an acceptably good constitution.

In an environment as poisoned as Kenya’s political landscape, it was always going to be an uphill task coming up with a document that pleases the majority, or at least does not offend them in any way.

The greatest fear of reformists all over the country was that the document would be mercilessly torn apart by accomplished academics raising undeniably valid points.

If the above-quoted reservations are the best the naysayers can come up with, then the message to the Kenyan voter is loud and clear – that there is nothing wrong with this draft, and all of us must seriously consider passing it at a referendum and be done with it.

As was the case in Parliament, the burden of proving the unsoundness of the document should lie squarely on the shoulders of those that claim that it is flawed. They must be compelled to come up with better reasons than those they are currently advancing in their quest to have the draft rejected.

In the highly likely event that nobody comes up with a reason better than the hackneyed repetition of ignorant and prejudice-laden rhetoric, it is incumbent upon the good citizens of this country to vote for this new effort at re-engineering the architecture of our state.

At the very least, Kenyans must be allowed to vote with their own minds without being polluted by the bilge emanating from unrepentant bigots.

Indeed, the former president should be among the very last Kenyans to speak out against any reforms, having been at the helm for over two decades with little to show for it but repression and retrogression.

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

Monday, April 5, 2010

Address biases, prejudices exposed by the review process

Sunday Nation 04 April 2010

In African folklore, it is often said that we only discover who our true friends are in times of our greatest want.

For a number of unfortunate Kenyans who happen to occupy the position of minorities, this aphorism has never been truer than during this final phase of our constitution-making process.

As we seek to write a basic law that will govern this country for generations to come, our opinions on what should be included in it have laid bare our thinking about the place of minorities in our society.

Even those that have traditionally purported to speak for ‘‘minorities’’ have been left tongue-tied at crucial moments when these vulnerable groups have come under withering attacks from those that hold the ‘‘majority’’ view.

Views expressed about homosexuals and others that practise their sexuality differently have exposed a rabid intolerance and imperviousness to alternative opinion in almost all sectors of Kenyan society.

Suggestions were made in public forums that ‘‘these people’’ need to be beaten up, jailed, ‘treated’ or even killed for daring to practise sexuality in a way the rest of us consider ‘‘unusual’’.

Even as the proposed constitution was being introduced for debate in Parliament, the issue of abortion remained a sticking point.

The chairman of the Parliamentary Select Committee, while initiating debate on the draft, proudly declared that the interests of all protagonists had been taken into consideration by maintaining the clause that ‘‘abortion is not permitted’’.

Notwithstanding any subsequent clarifications on the matter, such legislation raises many fundamental issues.

Firstly, it exposes a certain attitude towards the women of our country, implying, as it does, that they are unable to practise their sexuality responsibly and need constitutional control over their reproductive processes.

Given the patriarchal nature of our society, it is not surprising that all organs of constitutional review that have so far touched this matter have attempted to control what happens to a woman once she conceives.

Secondly, the wording of this clause is problematic because it is, quite simply put, nonsensical.

The lawyers will tell us that an important principle of law-making is that a law must not be made in vain.

All laws should be enforceable if they are to enjoy legitimacy within their jurisdiction. It is, therefore, nonsensical for a legislative body to enact a law that, for instance, provides that ‘‘there shall be no rain on Thursdays’’.

No legislature worth its salt would make such a law. It, therefore, beats logic why all the responsible organs, including the Committee of Experts and the PSC, allowed this ‘‘non-sense clause’’ to sneak through in the proposed draft. Saying that ‘‘abortion is not permitted’’ is akin to banning rain on Thursdays!

Just like nobody has any control on when such natural phenomena as rain will occur, it is exceedingly difficult to control abortion in nature.

Indeed, a significant proportion of women undergo what is known as ‘‘spontaneous abortion’’ where they lose pregnancies through no actions of their own.

In the first three months of pregnancy, a lot of abortions occur even before the women become aware that they are pregnant!

With a clause that categorically states that ‘‘abortion is not permitted’’, who will be responsible for these abortions?

Who will be penalised should it be discovered that a woman has had a spontaneous abortion?

More fundamentally, who is the custodian of this ‘‘permission’’ that is now being withdrawn from pregnant women?

It is in this light that one would comfortably refer to this clause as a ‘‘non-sense clause’’, and NARC-Kenya leader, Martha Karua, seemed to allude to this in her contribution on the floor of the House.

The only conceivable reason such a clause may have been sneaked into the proposed constitution is as a product of such deep-seated intolerance that its drafters were blinded to the fact that it was not within their realm to ‘‘permit’’ or refuse to permit abortion.

That the PSC went further and made even more nonsense of the clause by subsequently adding ‘‘saving clauses’’ only goes to show that reason was an afterthought in this process that was very clearly led by raw emotion.

It is, therefore, imperative that having examined the true nature of our beliefs and attitudes during this constitutional review process, we must now begin taking serious steps to address the biases and prejudices the process has exposed.

The proposed draft constitution must be scoured for similar instances of prejudice and intolerance and raked clean if this constitution is to last beyond one generation.

Alternatively, if the National Assembly passes it as it is and Kenyans accept it at a referendum, a process must be put in place to initiate amendment procedures in order to rationalise the document with the aspirations of a modern state.

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