Friday, December 23, 2011

Doctors' Strike Exposed Rot in the Health Sector

Lukoye Atwoli
18 December 2011

The Kenya Medical Practitioners, Pharmacists and Dentists Union called off the doctors' strike on Wednesday last week after some confusion on Tuesday about whether the strike was on or off. This was done after the union membership was convinced that the interests of the common citizen had been addressed, among other things. Today, it is important to reflect upon the effects of this strike.

For the first time in the history of this country, a trade union organised a strike largely with public interest at the core of it. Among the demands the doctors' union had, the most prominent included construction of more health facilities, equipping existing facilities, training and hiring of more health workers and increasing government spending on health.

The union called off the strike after the government admitted that things were not right in the health sector and made commitments to address the concerns raised by the union. Apart from committing to improve the pay of doctors and other health workers, the government agreed to form a joint task force with the union to deliberate on the way forward in addressing the medium and long-term issues raised by the union.

Quite apart from the fact that the government agreed to work with the doctors' union to improve the health sector in our country, the strike also achieved important milestones.

Importantly, the doctors' strike exposed the rot that exists in the health sector. Many Kenyans did not know that government expenditure on health as a proportion of total spending had been declining over the years. This has been happening despite our commitment to the Abuja Declaration that bound governments to ensure that health sector expenditure be raised to 15 per cent of that total government expenditure.

The result of declining health funding has been enormous. Health facilities have remained few and far between, and those that are available have had neither adequate staffing nor appropriate equipment to carry out basic functions of a health facility. There have also been difficulties recruiting and retaining qualified manpower, with the result that some critical health programmes in the country are solely dependent on donor funding.

The doctors' strike also exposed the dearth of leadership in the ministries of health. Throughout the crisis, both ministers were conspicuously absent. Conveniently, it was reported that they had gone abroad for treatment. How ironic that on the eve of the doctors' strike, those that were supposed to deal with it needed to seek the services of doctors outside the country!

Their absence, as well as the bungling display by the assistant minister and permanent secretary in the ministry of Medical Services, raised serious questions. By failing to provide leadership during these critical moments, the ministers might have been communicating to government that they agree with the doctors' union that there is a problem in the health sector but had no power to deal with the issues raised.

Indeed, a few days before the strike, the minister for medical services had indicated in a newspaper column that there were forces beyond his control that were determined that he does not achieve much in his docket. That it took the Treasury's intervention to end the strike may bear out this claim.

It is irresponsible to play politics with the lives of Kenyans, and the principals must act with speed to end this charade.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University School of Medicine

Sunday, December 11, 2011

Doctors chose the lesser evil by downing tools

Sunday Nation 11 December 2011

Last Monday doctors in the public service went on strike. Among the issues raised by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) were inadequate staffing, absence of a scheme of service, stoppage of training sponsorships, poor working conditions and inadequate remuneration.

At the onset of the strike, fears were expressed that it would result in needless loss of lives, and it was suggested that it would be unethical for medical personnel to go on strike and leave patients to die. The Hippocratic Oath, which exhorts doctors to put their patients’ needs above all considerations, was cited as a good reason for doctors to call off their strike.

An objective observer would actually be horrified that doctors downed their tools and left their patients to their own devices. However, in order to understand why this happened, it is necessary to examine the events leading up to this strike.

Firstly, it must be appreciated that this is not the first time doctors are going on strike in Kenya or elsewhere.
This is the fourth doctors’ strike in Kenya, and the last one happened in the 1990s, resulting in a massive exodus of doctors to Europe, the United States and southern Africa. The reason for the exodus was that the government totally ignored the doctors’ demands, and instead opted to intimidate those that participated in the strike.

Everything possible

Secondly, one needs to understand the working conditions that the doctors are asking to be improved. When a doctor tells a patient or their relative that everything possible is being done to help them, it is often an intricate public relations exercise meant to hide the deficiencies in the system.

The health system in our country is rotten. Over the years, government expenditure on health as a proportion of total expenditure has progressively fallen, despite a commitment to the Abuja Declaration decreeing that 15 per cent of the budget must be spent on healthcare. The result of this neglect is self evident.

Health facilities are still few and far between, and many people have difficulty gaining access to quality healthcare within a few kilometres of their residence. Those that are available are grossly undermanned, and there are health facilities where one person performs the work of all cadres of healthcare workers. This person is often the only one available to diagnose illnesses, to dispense the treatment, to perform nursing duties and to keep the facility clean and habitable.

Supplies to health facilities have remained erratic and often do not meet the needs of the served population.
Health workers in these facilities are poorly remunerated, and it is often viewed as a punishment to be posted to remote areas of the republic because, among other difficulties, one’s housing allowance is reduced significantly outside the capital city.

In many hospitals, including the national referral facilities, needless loss of lives has been going on for a long time, and doctors are often bystanders who know what needs to be done but have no tools with which to deal with the problem.

The ethical dilemma that faced many doctors at the beginning of the strike was really a no-brainer. What is more ethical: to acquiesce to the continued loss of lives in an underfunded system or to walk away from it all and let everyone know that all is not well?

The striking doctors chose the latter.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association, and lecturer, Moi University School of Medicine.

Monday, December 5, 2011

Ombija’s ruling exposes hypocrisy of our leaders

Sunday Nation 04 December 2011

In a week that saw the former President of Cote d’Ivoire shipped off to the International Criminal Court (ICC) to answer charges of crimes against humanity, including murder and rape, the High Court in Nairobi made a ruling that sent shockwaves across the region. Judge Nicholas Ombija ruled that Sudan’s President Omar Hassan Al-Bashir should be arrested and handed over to the ICC should he ever set foot in Kenya again.

The ruling has clearly ruffled many feathers, if the robust response by our government and regional bodies is anything to go by. Many have accused the judge of ignoring regional concerns, and some have even accused him of serving “foreign” masters.

Regional repercussions

The executive arm of the government has vowed to appeal against the ruling, and has suggested that the judiciary needs to be mindful of the regional repercussions of its activities. From my point of view, it is very clear that the Sudan is a very important component in the regional peace and development efforts under the auspices of Igad.

It is also clear that any disagreement with Sudan would be very inconvenient for Kenya especially as we pursue terrorists into the heart of Somalia.The crisis does not augur well for a country that aspires to brand itself as a neutral arbiter for peace in the region.

Apoplectic response

All this is true and may, to a large extent, justify the government’s apoplectic response to the warrant of arrest for President Al-Bashir.

There is only one small problem, I am afraid. The law, as they say, is an ass, and justice is meant to be blind!

Just over a year ago we passed a Constitution to replace the older document that had over several decades been reduced to an autocrat’s charter. Among other provisions, our Constitution today provides that “the general rules of international law shall form part of the law of Kenya”, and that “any treaty or convention ratified by Kenya shall form part of the law of Kenya under this Constitution”.

Article 3 (1) further places upon all persons the “obligation to respect, uphold and defend this Constitution”.
After the passage of the Constitution, our Parliament went a step further and enacted the International Crimes Act that, in practice, domesticates the provisions of the Rome Statute. Attempts by a section of parliamentarians to get the government to pull out of the treaty that established the ICC were ignored by the executive.

Finally, the government is on record indicating that we are cooperating with the ICC and shall continue to do so in the matter of post-election violence where several prominent Kenyan politicians are among the suspects.

A disinterested observer, such as a judge might be, would be left in no doubt that the government is very serious in its commitments to the Rome Statute, and would expect therefore that any legitimate requests emanating from the Hague would be implemented by all arms of the government as required by our Constitution and local and international statutes.

Rome Statute

The High Court ruling exposes the hypocrisy of our leaders who make laws they do not intend to implement.
As long as we remain signatories to the Rome Statute and retain the International Crimes Act, any other judge worth his salt would rule exactly as Mr Justice Ombija did.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and lecturer, Moi University’s school of medicine

Monday, November 28, 2011

The key steps in a review of health legislation

SN 27 November  2011

As the ministries of Health grapple with the enormous task of reviewing all health legislation in line with constitutional requirements, certain steps are necessary to ensure the product of this exercise meets the stated objectives.

The first step in this process should involve a review of all existing legislation on health, as well as all the enabling executive orders that have had a bearing on health in Kenya. This audit will reveal the true scope of the problem, including the existence of some archaic health legislation dating back to the colonial days, side-by-side with modern laws and regulations.

In my view, input from legal experts will be required for this process to be done successfully. Doctors and other Afya House technocrats may not be able to conduct the legislative audit efficiently simply because they are not trained for it.

The second step in this process will be to identify the constitutional provisions relating to health.These include provisions for the right to health, emergency care, clean environment, dignity and so on and so forth. This will provide Afya House with the scope of the problem as far as harmonising existing legislation with the Constitution is concerned.

Such a review may reveal that some of the health laws need to be repealed, and new Acts of Parliament will have to be drafted in order to address issues that had not been addressed under the previous constitutional regime.

In my opinion, once these reviews have been done, it will then be necessary for the government to develop a national health policy that is in line with the constitution, in order to provide a framework for the enactment of the necessary legislation. Given that a policy framework already exists in the health sector, tweaking it to redirect it towards constitutional requirements should not be difficult.

Once the policy has been reviewed and redirected, a few laws will have to be written to implement the policy directives and ensure full compliance with the constitution. In my view, such laws must include provision for a health services commission to coordinate the deployment and remuneration of all health workers in the public service.

Although it had earlier been suggested that this commission be provided for in the constitution, this commission was ignored probably due to the docility of the health workforce in this country. The situation may, however, be remedied by an Act of Parliament.

The second provision that the proposed health law must include is a health professionals’ council which will help craft the definitions of the various health professionals. It will provide benchmarks to be fulfilled for one to be considered a medical doctor, nurse, clinical officer, nutritionist or physiotherapist, among other health professionals. Apart from regulating ethical practice in the health professions, the council will also help clarify constitutional terms such as health, abortion and emergency care.

Finally, we must ensure that the process of making the proposed health law is fully participatory, and the health ministries must initiate a consultative process both within and without the health sector. They should also ensure that the concerns of health workers through their professional associations and unions are addressed in the new law.

These are the minimum requirements that will ensure that the health of Kenyans is in safe hands under the new dispensation.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and lecturer at Moi University’s School of Medicine

Sunday, November 20, 2011

Government should not use war as a stock excuse


Sunday Nation 20 November 2011

Lecturers went on strike on November 9 after a two-year wait for negotiations with government bore no fruit. It is claimed that a circular from the head of the civil service advised all public service employers that there should be no negotiations until the Salaries and Remuneration Commission was in place.

Even after that purported circular was released, teachers threatened industrial unrest, and their demands were met with alacrity. Money was also allocated for police and military salaries and allowances after some low-level grumbling and veiled threats to national security. More recently, money has been found to address problems at the two national referral hospitals, after work stoppages at both institutions threatened to get out of hand.

The message that is coming out of these events is that it is pointless to engage the government in civilised conversation when it comes to improvement in terms and conditions of work in the public service. Apparently the only language top government officials understand is of unrest and strikes.

Indeed, preparations are under way for a nationwide strike by doctors and other health workers in the public service over poor pay, unhealthy working conditions and uncertain career progression. The government is aware of the preparations, but has kept mum, waiting for the crisis to explode so it takes action.

Lately, senior government officials have taken to asking workers to be patriotic, suggesting that all government resources have been diverted to the war in Somalia against the Al-Shabaab. The PM practically accused striking lecturers of being unpatriotic by creating a second “war front” at a time when the country is at war.

This accusation has been repeated by the minister for Higher Education and her assistant, both former lecturers, who would be expected to be more sensitive to their colleagues’ demands. It seems, therefore, that the government has decided the stock response to any salary demands will feature the war in Somalia and appeals for patriotism. This implies the war was impulsive and unplanned, and that necessary resources were not set aside for the war in order to allow the rest of the economy to function normally.

If this is true, then it is clear that we are being led by government devoid of any sense of direction, and we are in real trouble. A more plausible explanation is that the war is being used to hoodwink Kenyans about the true cause of financial haemorrhage in this country.

Kenya experiences economic difficulties towards an election year, as politicians engage in schemes to raise campaign funds. It is not inconceivable that massive looting is going on on both sides of the grand coalition, and that we shall only be able to appreciate the scale of the looting after the General Election next year.

The PM repeatedly reminds us that it is possible to chew gum and climb stairs at the same time. Is he now suggesting that this is no longer the case?

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer at Moi University’s School of Medicine 

Sunday, November 13, 2011

Finally, tribe is king in the Kenyan public service

By Lukoye Atwoli
Sunday Nation 13 November 2011

Last Wednesday, a parliamentary committee made a decision that should have wide-ranging repercussions across the governance structures in this country. The parliamentary Labour and Social Welfare Committee reportedly rejected the nomination of Ms Winfred Lichuma to be the chair of the National Gender and Equality Commission, and questioned the grounds on which the selection panel overlooked three others in making their choice.

Apparently, the panel rejected the top three contenders on the grounds that their nomination would skew the ethnic composition of the commission and other government organs, and run afoul of the constitutional requirement for ethnic balance in state institutions.

A point of concern was that their ethnicity was determined by others, and none of them was asked about their tribe during the interviews. For instance, it was assumed that Prof Maria Nzomo was Kikuyu despite having a mother she considers to be Kikuyu and a father she considers to be Kamba. To further muddy the waters, she is married to a person considered to be Luhya.

Another candidate, Dr Jane Dwasi, was rejected allegedly because despite having Luhya parentage, her father had moved to “Luoland” and she now “prefers to be identified as a Luo”. The selection panel allegedly decided not to nominate her on the grounds that another of her “tribesmates” had already been appointed to a senior post in another constitutional commission.

Serious concerns

Two serious concerns emerge in this case. The first regards the injustice of allowing others to define an individual’s ethnicity using some vague criteria.

The examples of Prof Nzomo and Dr Dwasi demonstrate the difficulty inherent in using a vague social attribute to make decisions that have a bearing on people’s lives and the opportunities available to them. For no fault of their own, and in spite of their obvious qualifications, they were stood over because it was thought that their brilliance was subordinate to the tribe they were boxed into by some government functionary which, in any case, turned out to be inaccurate.

Ethnicity is a very complicated social construct, and must be approached with great care. For instance, a European student of mine was scandalised to learn that children whose parents hailed from different ethnic communities were considered to belong to their father’s tribe. She felt that the only thing the children shared with their father’s tribe was the language. Their personalities and values were so heavily influenced by their mother that they should, for all intents and purposes, be considered to share her ethnicity.

The second concern is the relevance of tribe in national decision-making. In a functioning meritocracy, people take credit for their own success, and accept responsibility for their failures without excuses. In Kenya, it seems we are moving towards a system where the fortunes of our tribesmates will determine how far we go in securing public office.

If one intends to apply for a senior post in government, they must make sure that none of their tribesmates apply for the same job. They must further ensure that they find a way of flaunting their ethnicity in a way that is obvious to the interviewers, so that qualifications become secondary to that ethnic expression.

Tribe has finally become the key qualification for positions in the public service.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University’s school of medicine

Sunday, November 6, 2011

Elections can be held any time during 2012

Sunday Nation 06 November 2011

Last week, the chair of the Interim Independent Electoral Commission, while being interviewed for the same post in the successor electoral body, asserted that “it will be impossible to hold elections in August 2012”. He went ahead and recycled the same arguments that have been presented in the past by the government, including the budgetary cycle, time for preparations, voter education and others in a similar vein.

As a layperson, I must admit that my reading of the law is usually very plain, and devoid of the refined nuances that I suspect are imparted in law schools all over the world. However, my understanding of the law is that everyone must strive to know it, and try to understand the implications. Indeed, the lawyers will be the first ones to tell us that ignorance of the law is not a legitimate defence.

It is in this spirit that I would politely beg to differ with the IIEC chairman. Making an assertion such as the one he made during the interview is dangerous, and indicates that Kenya is already facing a constitutional crisis.

Under the constitution and the laws of the land, it is a basic assumption that elections can be held at any time whenever necessitated by happenings in the political arena. Indeed, the IIEC has successfully carried out several by-elections and a referendum, without telling us that it is impossible to fulfil its mandate.

Ten months

Coming out 10 months before the scheduled date of elections to tell us that it is “impossible” to plan and organise elections on time is an admission of serious lack of foresight, and brings into question the competence of the chairman and his team.

Since it is clear that the IIEC and the government have identified possible bottlenecks that will make it difficult to hold a General Election in August next year, why have they not set in motion strategies to eliminate the constraints?

Why did the IIEC not include budget estimates for the next elections in the last budget? Why have they not begun voter education both locally and in the diaspora? Why have they not begun recruiting the manpower needed for elections in August, and identifying suppliers who may be approached for various services related to the elections?

If the IIEC and government have not started addressing these issues with the seriousness they deserve, one can only read a conspiracy to make it “impossible” to hold elections when they are due in order to facilitate some obscure agenda.

If, on the other hand, steps are already being taken to ensure that these problems are addressed, why is the IIEC chair supporting claims that elections cannot be held on schedule next year?

Further insight may be gained by reading Part 3 of the Sixth Schedule of the Constitution. Section 9(2) of this schedule clearly anticipates the possibility that the coalition established under the National Accord may be dissolved even before 2012, resulting in a General Election as provided for under the Constitution.

Reading this section, and of course keeping in mind that nature has its own designs on our lives, what would the IIEC (or its successor) do in case vacancies arise in all elective posts in the republic before August next year? Will they just wring their hands and proclaim their impotence?

I don’t think so.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and Lecturer, Moi University School of Medicine

Thursday, November 3, 2011

Government responsible for deaths at Moi hospital

Sorry for the delayed posting of last Sunday's article. Here goes!


Sunday Nation 30 October 2011

Last week the Moi Teaching and Referral Hospital in Eldoret was virtually closed down due to a shortage of essential supplies that would allow it to function as a referral hospital. Specialists at the hospital concluded that the hospital could hardly operate at the level of a sub-district hospital, and stopped offering all specialist clinical services as a result.

The hospital’s Intensive Care Unit had long ceased to function after all the machines broke down, and the theatre was closed due to lack of essential supplies to ensure that patients could get safe surgery at the facility. The few emergency cases that were attended to before the theatre was closed had poor outcomes as a result of lack of sterilising supplies and antibiotics to prevent infections.

In the rest of the hospital, lack of bare essentials such as medicines, gloves, syringes and needles, and stationery, together with a demotivated workforce combined to make a patient’s stay at the hospital a living nightmare. Doctors at the hospital agreed that the ethical thing to do was to refer patients to safer facilities, and advise colleagues not to refer their clients to the second largest referral hospital in Kenya.

The government response was typical. A new acting director was appointed, and promises were made about funds being made available to address the hole in the hospital’s budget. Supportive noises were made by politicians, and a turf war even erupted when the vice-president visited the facility on Sunday.

On the same day the VP visited the hospital, a patient died at the private wing of the hospital due to anaemia. Although her relatives and well-wishers were willing and ready to donate blood to save her life, the hospital and the regional blood transfusion centre did not have blood screening kits to ensure the safety of the product. Many patients died, and continue to die, of easily treatable conditions due to lack of cheap antibiotics in the wards.

Health workers in the hospital have been exposed to grave risks due to a shortage of protective gear while handling highly infectious material.

It is time someone took direct responsibility for this state of affairs. Several individuals must sleep with these preventable deaths on their conscience.

The hospital management should not have allowed the situation to deteriorate to this level. If necessary, they should have left their posts and gone back to the wards if they felt that the government was prepared to let patients die for whatever reason.

The hospital management board cannot escape responsibility by pretending that the situation deteriorated suddenly without their knowledge. If the board was unaware about the true financial position of the hospital, then the whole lot of them should bear responsibility for the preventable deaths.

The minister for Medical Services, under whose docket the hospital falls, was aware of the financial problems at the hospital long before the crisis exploded into the national limelight. He must not be allowed to have one more peaceful night’s sleep until he exorcises the ghosts of the innocent patients who died, and continue to die unnecessarily under his watch.

Above all, President Kibaki and Prime Minister Raila Odinga must be held to account. The blood of these innocent Kenyans is on the collective head of these two men and their “nusu mkate (half a loaf)” Cabinet.

Dr Atwoli is secretary, Kenya Psychiatric Association, and lecturer at Moi University’s School of Medicine 

Sunday, October 23, 2011

War in Somalia: Clear objectives needed


Sunday Nation 23 October 2011

Last week, we declared war on the al Shabaab militia that was accused by our government of masterminding kidnappings and attacks on targets within our territory. A declaration of war is not a light thing, and certain procedures needed to be followed.

Since we were committing our military and economic resources to the objective of eliminating the terror threat to our country, one would have expected the commander-in-chief of the Kenya Defence Forces address the nation, laying out the reasons for the declaration of war, the objectives of the war, and how we will know when we have achieved those objectives.

Instead, we got a press statement from the ministers for Defence and Internal Security. To their credit, the ministers outlined a cogent case for a war, enumerating the long chain of events that eventually led to the decision to attack al Shabaab deep within Somali territory. From their presentation, it is clear that the war is fully justified. What is not clear, however, is the objective of the war.

“Pursuing the terrorists wherever they may be” makes a good soundbite, but it provides very little information on the specific objectives of the conflict. A second bit of information that was missing from the statement concerned the end-point and exit strategy. Citizens do not expect to get fine details of the campaign, understanding that secrecy is part of military strategy.

Broad goals

However, broad goals of a conflict must be enumerated in order to help Kenyans to track the progress of our forces, and know when the time comes to pull out and let others continue with the war. This information needs to be provided by the commander-in-chief, who was technically given that responsibility by the Kenyan voter.

HG Wells, writing in “Outline of History”, says that “war is a horrible thing, and constantly more horrible and dreadful, so that unless it is ended it will certainly end human society”. It is for this reason that a nation must not contemplate the decision to go to war lightly, and when it does, the strategy, objectives and end-points must be very clear both to the soldiers and to the general population.

In our case, those of us that support this action can imagine one main short-term objective for this war, with a related secondary objective riding on it.

The main short-term objective, in my view, should be to create a buffer zone between Kenya and Somalia.
This zone should be heavily policed to ensure that no militiamen enter our country to terrorise Kenyans with impunity.

The secondary aim of this incursion into Somalia should be to use the buffer zone to enable the transfer of the refugee camps in the North-Eastern region of our country to Somalia. Creating a secure buffer zone will provide an environment that will allow the international humanitarian community to operate within Somalia, and free Kenya of the risks and responsibilities inherent in hosting a refugee population containing potential terrorist militia.

In the long run, it will then fall on the international community to provide support for the refugees nearer to their homes within Somalia, making it easier to re-integrate them into normal life when the situation improves in the rest of their country.

However, whatever the reasons for this war, we must continue to support our soldiers as they engage this amorphous enemy, and wish them quick success.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer at Moi University’s School of Medicine.

Sunday, October 16, 2011

Mental Health: Well done, but we can do better

Sunday Nation 16 October 2011

Last week on Monday I attended the World Mental Health Day commemoration at Mathari Hospital together with colleagues from all over the country. Workers of all cadres at the hospital put up quite a show, and included both the patients and the neighbouring community in the organisation of the event. The minister for Medical Services graced the occasion, despite having just arrived in the country from an official trip to India.

During the event, guests were conducted on a guided tour of the hospital, and one could not help but notice the great enthusiasm with which the management and board of the hospital are going about improving facilities and services at the hospital. Many of the wards were under renovation, the grounds were neatly kept, and the staff appeared to have some intrinsic motivation as they went about their duties.

All these are commendable achievements in the wake of international media revelations of patient abuse and inadequate services to clients at the only national referral hospital for mental health in the country. It is difficult to blame the staff who are doing the best they can under the most difficult of circumstances to serve the most neglected segment of our society.

It is, however, important to note that whatever little has been achieved by this facility has been done under the most formidable odds possible. The national hospital operates with the budget of a district (or sub-county) hospital, and is graded as Level 4 as far as allocation of resources is concerned. The buildings being spruced up at the facility were built in the early 20th century, and most cannot be certified for human habitation if they are properly inspected.

Indeed, the hospital board seems to have realised just this, and during our visit to the hospital they presented to the minister and Afya House officials a blueprint for a new hospital to serve as the national referral facility for mental health.

This, in my view is the crux of the matter. The minister promised to do all in his power to ensure that the master-plan was implemented, and undertook to present a Cabinet briefing to his colleagues to initiate the sourcing of funds to make it a reality. He also promised to advocate for increased allocation to the hospital, and to mental health services in general, to better address the mental health of our nation.

In my opinion, we must hold the minister, and by extension the entire government, to account over this promise. We must interrogate the government’s spending priorities to ensure that mental health is included at all levels of health expenditure, and that mental health programmes are designed and implemented all over the country.

We must do these things not because any particular individual stands to benefit from the resultant improvements, but because it is the right thing to do.

Better funding

We must insist on better funding for mental health and health programmes because no nation in the whole world has ever prospered without ensuring that the whole population has access to the highest quality of health care services available within its borders.

We must recognise that failure to improve our mental health services guarantees several generations of mediocre leadership and under-achieving technocrats, leading to continued retrogression and needless suffering.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and lecturer at Moi University’s School of Medicine

Monday, October 10, 2011

Why budgeting for mental health care is crucial

Sunday Nation 9 October 2011

Every year, October 10th is marked as the World Mental Health Day all over the world. This year’s theme is “Investing in Mental Health”, an issue that has been on top of the agenda for the mental health community for a long time.

Concerns about under-investment in mental health are backed by global budget figures, with the World Health Organisation (WHO) estimating that most low and middle income countries invest less than 2 per cent of their total budgets in mental health activities, the bulk of which goes to fund mental hospitals and pay workers.

In Kenya, our government continues to pay lip service to the Abuja Declaration that suggested that at least 15 per cent of the budget should be dedicated to health, and our health expenditure as a proportion of total expenditure has been declining steadily over the years. Additionally, health expenditure on mental health remains abysmal at less than 0.5 per cent, most of which goes to pay salaries and allowances of staff at ministry headquarters.

Mental ill health contributes a significant burden of disease globally, more so in low income countries such as Kenya. According to the WHO, depression is currently the leading cause of disability worldwide, and it is further estimated that one in four people will be affected by a mental
disorder at some point in their lives.

These statistics are even worse in Kenya, where no community-level intervention exists to reduce the burden of mental ill health.

No care

Due to under-investment in mental health, it is estimated that over 80 per cent of people with mental disorders in our country do not receive any sort of care, and many go through life believing that it is normal to suffer as they do.

The reason the government continues to ignore mental health in the budget might be attributed to the false perception that mental illnesses do not kill. Quite to the contrary, mental illnesses can and do kill millions of people annually.

For instance, a person commits suicide every 40 seconds somewhere in the world. Most of those that commit or attempt to commit suicide have severe psychological and social distress that can only be addressed by properly organised and funded mental health services.

Additionally, 2.5 million deaths annually are due to harmful use of alcohol, an area of immense concern in mental health. Kenya is among the countries identified as having a large proportion of people with harmful alcohol use, and it is conceivable that many of our “road accidents” are due to alcohol and other substance use.

Mental ill health also increases the risk of acquiring and dying from other serious medical conditions, including HIV/Aids, Diabetes, Cancer, and infectious diseases. Investment in mental health will, therefore, be useful in bridging the service gap in these areas, enabling the provision of care at different levels for people with mental

Budgeting for increased training of mental health personnel, improved infrastructure, hiring more staff, and providing medications and other resources must be prioritised if we are to make a dent on the burden of mental ill health.

Finally, as part of full implementation of the Constitution, the government must take steps to actualise the citizens’ constitutional right to, among other things, the “highest attainable standard of health”, a right that includes access to good quality mental health care.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer at Moi University’s school of medicine

Monday, October 3, 2011

A December election date is a recipe for a disaster

Sunday Nation 02 October 2011

The Constitution of Kenya, Article 118(1)(b) provides that Parliament shall “facilitate public participation and involvement in the legislative and other business of Parliament and its committees”. This is the spirit in which the following piece has been written.

Recently, the minister for Justice published a Bill seeking to amend the Constitution to provide for, among other things, a change of the election date from “the second Tuesday in August to the third Monday in December of every fifth year”.

In the memorandum of objects and reasons for the amendment, a couple of brief sentences purported to explain the reason behind the change of dates.

In the first paragraph, the Memorandum reads: “The Bill further seeks to bring clarity and certainty to the term of the tenth Parliament while also removing any doubts as to the date of the next general elections under the Constitution of Kenya 2010.”

The other sentence concerning the election date reads: “The Bill also proposes to amend Articles 101(1), 136(2)(a), 177(1)(a) and 180(1) of the Constitution by introducing a date that settles all controversy surrounding the date for the next general elections.” There is no mention of the budget cycle, a popular explanation from government, nor is the nature of the controversy discussed.

Legal scholar

Opinions expressed on this matter have been largely meant to justify firmly held positions. Indeed, just last week, eminent legal scholar, Prof Yash Pal Ghai and colleagues argued that the Sixth Schedule of the Constitution provides for an election in early 2013.

In reality, the only date provided for in this schedule is in part 3, Article 9(2), which provides that in case the government “is dissolved and general elections held before 2012, elections for the first county assemblies and governors shall be held during 2012”.

Obviously, the framers of this section anticipated that, all factors remaining constant, the General Election would be held “during 2012”, with the only date provided for being the second Tuesday of August.
Quite apart from the legal and constitutional reasons against a change of date from August to December, it is important for Kenyans to contemplate for a moment the implications of a December election date on the national psyche.

Let us for a moment flash back to the 2007 post-election violence. Majority of the perpetrators and victims were thought to have been young males aged between 15 and 25 years. Many of them were school-going youth, and some had just undergone initiation ceremonies that are often held during the long December school holidays. All of them were idle, and provided the perfect substrate for politicians in need of cheap hands for hire.

Research has shown that this demographic segment is the most violence-prone, especially when they are poor, unemployed and have weak social support networks. One of the ways other societies have reduced violence is by keeping these youth in school, providing employment, and offering opportunities for fulfilling social interactions when they are idle.

Is it not conceivable, therefore, that an August election date would potentially be less violent than a December one? Due to the short holiday, students busy preparing for national examinations will probably not be available for “political violence”.

If only for the sake of peaceful elections next year, we must avoid a December election date by all means.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Sunday, September 25, 2011

Why the buck must stop with victims of disasters


Sunday Nation 25 September 2011

Kenya has experienced a number of mishaps in the past few days. The fire at the Sinai slums seems to have marked a turning point in our nation’s fortunes, with a series of bloody crashes on our roads resulting in a mounting body count that one member of Parliament likened to casualties of war.

Scores more died when a house they were putting “finishing touches” to collapsed in western Kenya, while in central Kenya others continued to succumb to the effects of poisonous liquor.

In the midst of all this, stringent voices have been heard exhorting Kenyans to repent and “go back to God” in order to stop any further calamities. Almost all these events are being referred to as “accidents” and a lot of the responsibility is being laid at God’s door. Of course others are going hoarse pointing fingers at government functionaries and officialdom without much effect.

When columnist Macharia Gaitho suggested that average citizens carry a significant proportion of the blame for some of the misfortunes that befall them, enraged commentators came out accusing him of being insensitive to the plight of slum-dwellers. Some argued that one cannot understand the life of the poor unless one experienced it first-hand, a classical case of insisting that one must be a chicken to criticise an egg.

No matter the level of indignation, the blame must be laid squarely where it belongs.

Proximity to the pipeline

The reason the Sinai fire tragedy happened is that poor people are living in close proximity to the pipeline, and when there was a leak, many rushed to collect the flammable liquid right from the source as it were. Buildings are collapsing because they are poorly constructed; people are being killed by liquor because they are drinking poisonous stuff; drivers are causing road crashes because they are not obeying traffic rules, are too tired, or are intoxicated and should not be allowed to drive in the first place.

The buck does finally stop with the individuals who put themselves at risk. Last week we watched on TV as a man who lives in a slum on the approach path of aircraft at Wilson Airport said he will not move despite being warned of the dangers he was exposing himself and his family to. It would have been easier to commiserate with him if he had argued that because of poverty he is unable to find alternative accommodation. His argument that “if the government wants us to build stone structures they should just say so and we will do it” was proof of the cynical impunity that pervades all strata of our beloved country.

Poverty has been made into the stock excuse for all the criminal activity we carry out, and we are bringing up children with a sense of entitlement that enables them to forcefully ask for handouts while warning us that the alternative is a life of crime.

Call to prayer
The call to prayer from all religious denominations will probably change nothing if past similar appeals are anything to go by. Kenyans will congregate and pray, and then go back to their daily routine. Instead of asking Kenyans to pray harder, is it not time our clergy embarked on a project to inculcate in their own congregants values such as fidelity to law and order and respect for human life?

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Monday, September 19, 2011

Why periodic famine is responsible for inequality

By LUKOYE ATWOLI Sunday Nation 18 September 2011 A healthy mind dwells in a healthy body, or so the aphorism goes. Science has long established the link between mental health and physical health. Malnourished children perform poorly at physical and cognitive tasks compared to their well-nourished counterparts. This is because food provides the energy needed by both the body and the brain for peak performance. In the absence of this energy, the body’s systems slow down and only distribute resources to those functions that are essential for the maintenance of life. Higher brain functions are secondary to more vegetative functions when it comes to maintaining life and they are, therefore, likely to be sacrificed when an individual is starving. The result is sluggish thinking processes, lethargy and apathy to the surroundings. In school, this will manifest as poor performance in class, giving the impression that the individual is “dull” or less intelligent than others. A recent survey carried out by the National Cohesion and Integration Commission indicated that top government posts in this country are occupied mainly by people from the most populous tribes, especially the ones whose members ruled the country at some point. “Smaller” communities are poorly represented in government, and the main assumption has been that their “sons” have not been president, and so their “time to eat” had not come. However, the truth is more nuanced than that. It is clear that the so-called “marginalised” peoples are also the most prone to famines and food deprivation. Most of their time is spent looking for food and water, and they have little time to pursue “higher” needs in the hierarchy described by American professor of psychology, Abraham Maslow. They are, therefore, less likely to be found in colleges and universities, further diminishing their prospects of serving in government. More fundamentally, however, even when they get the opportunity to attend school alongside other Kenyans, their performance is often poorer due to malnutrition and their struggles in pursuit of food and water. The few who excel are often idolised, masking the broader impact of malnutrition on most of their siblings. The truth is that for every brilliant child from these famine-stricken peoples, there are hundreds who will never achieve much in school, the primary reason being that starvation has significantly reduced their intellectual capabilities. In my view it follows, therefore, that anyone interested in redressing the ethnic imbalance in employment and intellectual achievement will invest in improving the food availability in the arid and semi-arid regions. Focus on reducing child malnutrition alone will ensure that those that go to school will compete on an equal footing with their colleagues from other parts of the country. Obviously, then, affirmative action is not sustainable. The horizon for solving the problem must be long-term, focusing 20 or 30 years from now, where the ideal should be that no region in this country should suffer the rates of malnutrition that are being seen in Turkana and contiguous areas. I would encourage public-spirited Kenyans to take the government to task on this issue. Allowing some regions to continue enduring starvation in this day and age is not only inhuman, but also amounts to a culpable dereliction of duty that ranks up there with genocide and other crimes against humanity. Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Tuesday, September 13, 2011

Perhaps Kenya needs a new story besides politics

Sunday Nation 11 September 2011

This past week, the confirmation of charges hearings of the Kenyan cases at The Hague were the only subject of conversation everywhere one turned. Total strangers would stop each other in the street to discuss how the hearings will turn out. Everyone has an opinion on the quality of the lawyers or witnesses, and which side is obviously winning. Every evening, dozens of Kenyans are glued to television screens listening to legal jargon and trying to make sense out of it all, and only end up confirming their own prejudices.

The Hague trials have only confirmed for me one trait that could be said to be authentically Kenyan — the love for political drama. Every election season This scenario actually repeats itself every election season in a major way, when politics is all we can talk about. After the elections we spend the next four or five years discussing political realignments, and soon another election catches up with us. In public places on any given day, all TV sets will be tuned in to the region’s favourite channel at “news time”, and all activities stop to allow us to “catch up with the news”.

Every morning we voraciously devour the same news as presented in our favourite dailies, with those who cannot afford a newspaper borrowing from another buyer or the news vendor. In short, our national life is now defined by the drama inflicted upon us by politicians and wannabe politicians. Amazingly, this unending dalliance with politicians has caused us much grief, but we are loath to let go.

Perhaps it is time we started defining a new reality for those of us who refuse to be pigeonholed into a “type” or typecast into predefined roles. It is in this connection that I would like to flag two special events that will take place this coming week whose significance may only come to be appreciated decades from now.

The first is really a very humdrum scientific conference discussing reproductive health, with emphasis on prevention of maternal deaths. This meeting, due to be held at the KICC on Thursday and Friday this week, will examine the progress made since 2005 when a similar conference was held and several resolutions made. Has the situation improved since then? Yes and no.

Yes, because we now have a new Constitution that attempts to provide health, including reproductive health, as a constitutional right. It also now prescribes clearly the
circumstances under which abortion is allowed. The negative assessment concerns the rate of maternal deaths, which has remained relatively constant since 2005, and currently stands at just under 500 maternal deaths for every 100,000 live births. Perhaps this conference will come up with something radical enough to prevent my wife and sisters from facing the very real risk of dying as a result of pregnancy.

The second event is concerned with the very literal task of rewriting our country’s story. This is the Storymoja Hay Festival, which will be held at the Railways Sports Club
grounds in Nairobi from Friday to Sunday this coming week. Poetry, prose of all types and books will be discussed, bought and sold. Writing workshops will be held for budding writers, and hopefully everyone will have fun and learn something at the same time.

It is my hope that these events, and not The Hague hearings, will define this coming week.

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

Sunday, September 4, 2011

The tasks ahead for the new doctors’ union

Sunday Nation 04 September 2011

Last week, the Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU) was registered.

Coming on the first anniversary of the promulgation of a Constitution that guarantees labour rights to all workers, this happy event demonstrated the extent of openness that now permeates most of our sectors.

As the new union gets down to business, the members must now think of electing leaders who have the interests of the health worker at heart, and who have experienced first-hand the suffering that these professionals go through in the execution of their daily tasks.

It is my conviction that the success of this union will improve not only the lot of all health workers, but also the standards of health care delivery.

The union will provide the forum through which the government may be compelled to explain the recent policy changes that stopped funding for postgraduate students in the various medical specialties.

Escalating human resource transfer to the private sector is evidence of rampant maltreatment of these highly trained professionals, whose only demand has traditionally been reasonable working conditions as per the law.

Today’s health workers demand a proper working environment and reasonable working hours, adequate facilities for work, and commensurate remuneration for their efforts.

The fact that the entire nation trusts its health in the hands of these few individuals clearly demonstrates the importance of the work they do.

As we have argued before in this column, the time has come for the health ministries to produce legislation that will create a regulatory body bringing together all health workers’ professional licensing boards.

This body, similar to South Africa’s Health Professionals Council, would be responsible for licensing and professional regulation of all health workers, as well as setting standards for ethical and quality health care.

In the absence of such a body, the constitutional provisions on health risk being handled haphazardly, resulting in the negation of their spirit and intent. For instance, the controversial provision on abortion and the beginning of life cannot be resolved by politicians or even the courts. Only a body comprising health workers will translate this provision into a tangible and enforceable regulation.

Other areas that will need professional interpretation by a statutory body include definitions of ‘emergency medical treatment’, ‘reproductive health’ and even ‘highest attainable standard of health’ as provided for all Kenyans under the Constitution. This council will be in a position to prescribe what the minimum package of health care would meet this constitutional threshold for health rights.

In my view, the doctors’ union must position itself together with the other health professional associations such as the Kenya Medical Association in agitating for the formation of this council to safeguard the standing of the professions. In the face of official reluctance to create this body, the union must be prepared to play this role in consultation with other professional bodies.

Finally, in order to be successful as the representative of the social welfare of diverse health professionals, KMPDU must embark on a massive membership drive, and it would probably be useful to encourage all doctors employed by diverse organisations to join in order to more effectively negotiate for better working conditions, and better health for all Kenyans.

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

Monday, August 29, 2011

Celebrating the triumph of hope over cynicism

Sunday Nation 28 August 2011

Twenty years ago, some time in early July 1991, hundreds of excited high school boys were let out of school early due to riots that were then going on in Nairobi.

The country was afire with opposition leaders playing hide and seek with the police while their followers shouted slogans in favour of constitutional change. I was among those excited boys, happy to take part in a national event we had hitherto only been hearing about on radio and television.

As we drove home along Limuru Road, my father and I had to keep flashing the two-finger salute then synonymous with the multi-party movement.

Protesters had blocked all roads and were only allowing through those who supported their cause. At the turn-off to Banana, we came across a police road block with a huge crowd milling around shouting slogans.

We later learnt that a primary school pupil was shot dead at that same spot when police officers attacked demonstrators with live bullets.

The next day I stood by the roadside and watched matatus plying the Limuru-Nairobi route ferrying demonstrators to the city, occasionally flashing the two-finger salute at them.

Those heady times served to feed my then testosterone-driven enthusiasm for anarchy and disorder, but they also etched a sense of history irreversibly into my impressionable mind. Full of optimism, I shared Martin Luther King’s conviction that the arc of history is long, but it inexorably bends towards justice.

The bigger picture

As we marked the first anniversary of the promulgation of our new Constitution yesterday, the emotive scenes from 20 years ago served as a backdrop for my memories. When one looks at the bigger picture, it is obvious that things have changed in a big way.

For a long time, we had been very pessimistic about the prospects for change in our country. This pessimism was informed by the heavy-handed approach the then regime dealt with any dissent, real or perceived.

Twenty years ago, when the tide was seen to be too heavy to be held back, the then President Moi drained its force by cunningly accepting minimal constitutional changes, specifically by repealing section 2A that had established a de jure single-party State.

One may be forgiven for thinking that the years since 1991 would provide ample justification for enhanced pessimism, given the number of powerful individuals and institutions that are ready to sabotage any move towards fundamental change.

However, although the 20 years since the repeal of section 2A have been turbulent, the promulgation of a new Constitution last year must be viewed as the logical culmination of all the efforts at creating a freer, more equal society. In my opinion, we must celebrate it as the triumph of hope over cynicism and cynical use of State power for personal aggrandisement.

Despite the spirited fight being put up by reactionary anti-reform forces, we must continue to demand the full and unconditional implementation of the Constitution.

We must not give in to those who tell us to go slow; instead, we must remind them of the thousands of lives lost due to this habit of pussyfooting around the most essential and practical solutions to the fundamental problems of our society.

Paraphrasing Georges-Jacques Danton, we must say: “The kings of impunity would dare challenge us? We throw them the head of tyranny!”

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Time to finally address stigma in mental health

Sunday Nation 21 August 2011

This coming week, mental health specialists will descend on Nairobi to attend a conference organised by the Kenya Psychiatric Association in conjunction with the African Association of Psychiatrists and Allied Professionals and the World Psychiatric Association.

The conference opens on Thursday, and will be preceded by a three-day training course on leadership and professional skills for early career psychiatrists.

This is, therefore, an ideal time to review the progress made in improving mental health services in our country, specifically focusing on stigma reduction.

For a long time, we have lamented about poor mental health services, worsened by meagre investment in this important area. The official response has been one of tokenism and whitewashing, the most prominent of which was the attempt to rename Mathari Hospital as Upper Muthaiga Hospital.

The former minister for Health had suggested that this change of name would contribute in reducing stigma towards mental illness.

However, as I commented at the time, the effect was more likely to be a transfer of stigma from “Mathari” to “Upper Muthaiga”, without having any impact on the stigma itself. Today, stigma towards the mentally ill is rampant, as recently exposed on the CNN documentary,“Locked up and forgotten”.

This stigma extends even to mental health workers, and emanates not only from the uninformed public, but also from other health workers.

Field of oncology

When the current minister for Medical Services returned home after receiving cancer treatment in the US, he became much more visible in the field of oncology. Suddenly we discovered that there is an epidemic of cancer, and foundations were launched to combat the menace.

Should a mental health catastrophe strike someone in Kenya’s health leadership for us to see an improvement in investment in mental health?

The young psychiatrists who are due to complete their training later this week will be released into an unkind world where their services will be sought in darkness and nobody will want to say to their friends in public, “there goes my doctor”.

Everybody will expect them to work very hard to eliminate mental illness in their area of operation, equipped only with their brains, a pen, and, if they are lucky, a dark abandoned room in a neglected section of a public hospital.

For instance, at the Moi Teaching and Referral Hospital where I work, the mental unit is actually a converted maternity wing of the former district hospital, with very little having changed since its conversion close to 30 years ago.

Mathari Hospital is a former small-pox isolation centre, with most of the structures dating back to the early 20th century.

This situation persists despite global evidence that mental illness is a leading cause of disability, and many countries incur huge costs in managing these illnesses and dealing with the resultant lost productivity.

One wonders who among our health leaders, from the directors in the health ministries all the way to the ministers themselves, would be happy being admitted in a psychiatric unit of a public hospital.

Hopeful, during the opening ceremony for our conference on Thursday evening, the minister will match words with action, and announce what measures the government has taken this financial year to improve mental health services.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Monday, August 15, 2011

Parallels between UK riots and our post-poll chaos

Sunday Nation 14 August 2011

In December 2007, a full two weeks before our last General Election, I wrote the following paragraph in the Daily Nation: “Clearly, we are not living under normal circumstances today. All around the country, crazed mobs are running around armed with all sorts of simple and sophisticated weapons maiming and killing fellow citizens with abandon.”

In that article, I argued that there was nothing like “political violence” and all perpetrators of violence must be subjected to “strict, impartial and severe application of the law” and that “killers must be held personally responsible for their crimes”.

Of course that advice was not heeded, although many commentators today still insist that the post-election violence was unprecedented and unforeseen.

Memories of this time came flooding back to me last week as I watched and read about the riots that broke out in London after the killing of a young man suspected of criminal activity.

A London blogger wrote: “I’m huddled in the front room with some shell-shocked friends, watching my city burn. The BBC is interchanging footage of blazing cars and running street battles in Hackney, of police horses lining up in Lewisham, of roiling infernos that were once shops and houses in Croydon and in Peckham”.

I felt exactly like this in early January 2008, as angry youths barricaded roads and stopped all vehicles, selecting people of the “wrong” ethnicity for summary execution.

In Nairobi, Kisumu, Mombasa, Eldoret, Naivasha, Mumias and other urban areas around the country, shops were looted and burnt, and “non-indigenous” residents were given their marching orders.

Examining the underlying issues in both events, one comes away with the feeling that they share parallels at several levels.

Firstly, the trigger. A relatively “trivial” event resulted in an uprising that surprised even the perpetrators by its ferocity and rapid spread. In Kenya, it was a “stolen election”. In London, it was the killing of Marc Duggan.

Second, the sense of disenfranchisement and grievance among the perpetrators of the resultant violence and looting is an obvious parallel. In Kenya, the “Mount Kenya Mafia” was blamed for perpetuating the “marginalisation” of the rest of the country, and people from related communities paid for the “sins of their fathers”.

In London, the economic and racial minorities continue to live on the fringes of this relatively prosperous economy, and it is conceivable that seemingly minor slights would trigger the sort of riots that started in London early last week.

A final parallel is the reaction of the genteel middle class in both countries. In both cases, the looters and rioters were dismissed as “scumbags” engaging in “mindless violence” and the authorities issued threats of force.

These particular “scumbags” often have no sense of history or the global picture, and are only concerned about their welfare in the here and now.

They are not concerned with the growing economy, nor are they interested in the obvious fact that they may be better off than poor fellows in other areas.

Often, the “scumbags” have nothing to lose and are apt to continue with their “mindless” campaign until something gives. In the case of Kenya, we got the mongrel Grand Coalition Government. In the case of the UK, we shall wait and see.

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

Sunday, August 7, 2011

The Obama era has finally caught up with us

Sunday Nation 07 August 2011

The past few days have been very illuminating for me. I watched in astonishment as an ambitious project to raise funds for hunger victims in the North raised Sh500 million in a few days.

I sent in my contribution in the early days, expecting the ever-procrastinating Kenyan to wait for the final days before sending in theirs. Alas, how wrong I was! Hundreds of thousands of Kenyans contributed generously, raising close to a Sh100 million within a week.

In Eldoret, where I live and work, residents also got together to raise funds under the banner “Eldoret Food for Turkana”. Within a few days of announcing our effort, residents had donated millions of shillings in cash and food.

Many others had volunteered their time and expertise to help alleviate the famine in parts of this country.

All this set me thinking. Instead of continually complaining about the state of our economy, infrastructure and, especially, our political system, the Kenyan citizen has the power to effect change without asking anyone for permission.

For instance, the “Kenyans for Kenya” drive demonstrated to our politicians the power of the citizenry, and within no time all those with political ambitions were talking about helping the hungry and ‘sustainable’ measures to prevent future catastrophes.

Others started making forays into the affected areas, and trying to show just how concerned they were about the fate of their fellow citizens.

Soon after denying knowledge of any Kenyans dying of hunger, the government mobilised the military to transport food to areas where people are starving. For once in our country, the citizen compelled the politicians to act positively.

These wildly successful fundraisers demonstrated the power of the ordinary Kenyan, and have direct bearing on the next General Election. It is conceivable that in raising funds for the 2012 election, at least some of the candidates will utilise a platform similar to the Kenyans for Kenya and Eldoret Food for Turkana initiatives.

Many are already engaging Kenyans on social media platforms such as Facebook and Twitter, and it is obvious that they are learning more on these platforms than they are teaching.

We are obviously very late converts to this mode of citizen engagement, and it will be interesting to see all the relatively elderly candidates seeking out the expertise of geeky youths in fundraising and political organisation.

The tables will finally have turned in favour of our youth, giving them an opportunity to influence the direction our New Republic takes after the next General Election.

US President Barack Obama used this strategy to raise funds, and more importantly, to attract a traditionally apathetic youth constituency that practically guaranteed his victory.

With our largely youthful voting population, it is possible that the candidate who most identifies with this demographic will carry the day.

It behoves the youth to grab this opportunity and elect the leaders they believe will change the face of our country. It is not too early to start identifying, among the plethora of pretenders to the throne, the one who most represents the face of Kenya, and more specifically the face of Kenya’s de-ethnicised youth.

The Obama era of Facebook, Twitter and alternative media seems to have caught up with us at last; and in the most unlikely of times!

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

Tuesday, August 2, 2011

Ongoing GMO debate has little to do with health

Lukoye Atwoli
Sunday Nation 31 July 2011

Kenya, and the wider Horn of Africa region, is in the throes of a devastating famine, and millions of our people are at risk of starvation.

The truth is that we have proved unable to produce enough food to prevent cyclic famines and starvation deaths.

It is with this in mind that the government passed legislation allowing the importation of genetically modified maize for local consumption. Unfortunately, the resulting debate on genetically modified organisms (GMOs) has been less than illuminating.

There is a lot to be said about the environmental and economic impact of growing GMOs in a country like ours whose priorities do not include policing biotechnology to ensure the products are not harmful in a wider socio-economic sense.

However, if we keep in mind that the current debate centres on the importation of maize by millers for use as food and not seed, the whole problem necessarily collapses into a single issue — health.

The question we should be trying to answer is this: Are GMOs safe for human consumption?

Even more specifically, is the GM maize that has been given the green light for importation safe for our consumption?

To answer this question, we must turn, not to politicians or other social activists, but to scientists.

The global health authority is the World Health Organisation (WHO). The WHO is a largely conservative outfit, and is slow to accept new technologies as mainstream before a huge amount of evidence accumulates to confirm the health benefits.

When addressing the health effects of GMOs, the WHO isolated three main issues — tendencies to provoke allergic reaction (allergenicity), gene transfer (to human consumers or bacteria in the human gut) and outcrossing (mixing with non-GM crops).

The conclusions of an exhaustive review of the then available evidence were revealing.

On allergenicity: “No allergic effects have been found relative to GM foods currently on the market”.

On gene transfer: “Although the probability of transfer is low, the use of technology without antibiotic resistance genes has been encouraged by a recent FAO/WHO expert panel”.

On outcrossing: “Several countries have adopted strategies to reduce mixing, including a clear separation of the fields within which GM crops and conventional crops are grown”.

Of these three issues, only the first two have a direct bearing on the health of the consumer.

The evidence of harm due to both allergenicity and gene transfer is minuscule, compared to the many lives saved due to timely availability of food that has been engineered to maximise benefits to the consumer.

A scientist writing in the journal Nature Biotechnology in July 2003 observed that both conventional methods of breeding (read natural foods) and recombinant technology (read GMOs) can affect the expression of genes and raise questions about food safety.

He, however, concluded that “to date, no food-derived health problems have been identified with the use of GM plants”.

It is, therefore, absurd to get hysterical about the risks of GM foods when our own food stores are full of products of research and breeding — including the seeds we buy from Kenya Seed Company!

As long as the food and seeds are products of rigorous scientific testing, and have proven benefits to consumers, we should not let our people starve in furtherance of some ideological ideal of food purity.

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

Sunday, July 24, 2011

A modest proposal on women’s representation

Sunday Nation 24 July 2011

Last week, a lobby representing women’s interests presented the Interim Independent Electoral Commission with a proposal to guarantee that the constitutional caveat against any elective or appointive body having more than two thirds representation from one gender is respected.

The commission seemed to have given the proposal a sympathetic ear, and it is possible the proposal will be implemented in some form or other ahead of the next General Election.

The formula is intended to force some constituencies, on a “rotational basis”, to vote for women to ensure the constitutional requirement is met for the National Assembly and Senate.
While the idea of women’s empowerment is welcome and long overdue, the way we are going about it is all wrong.

The assumptions being made about the Kenyan voter are insulting at best, and disenfranchising at worst. The worst of these is that we cannot wilfully elect a female candidate when presented with an opportunity to do so.

The proportion of elected women in Parliament has been rising since independence when there were none up to the present time when 7.6 per cent of elected MPs are women.

Between 1997 and 2007, the proportion of elected women MPs quadrupled from 1.9 per cent to the current 7.6 per cent. More women are expected to vie and be elected next year due to the overall increased gender awareness and other equality requirements enshrined in the Constitution.

Article 93 of the Constitution establishes the Parliament of Kenya, consisting of the National Assembly and the Senate. For all intents and purposes, this is one body with the primary functions, as enumerated in Article 94, of making laws, representing the people and protecting the Constitution, among others.

For the purposes of calculating proportions of representation, this arm of government may be considered as a whole, instead of unnecessarily concentrating on the constituent parts. Parliament, therefore, would consist of 337 elected members (290 in the National Assembly and 47 in the Senate).

Another 79 members would be nominated as set out in Articles 97 and 98, and the speakers of the two houses would bring the total number to 418.

Without using the disenfranchising model proposed by the women’s lobby, how is it possible to fulfil the constitutional requirement that the National Assembly should not be dominated by over two thirds of one gender?

The first step would be to reserve all discretionary nominations for the “minority” gender in Parliament.

Assuming that this would be women, they would get a total of 77 seats reserved for them (59 in the National Assembly and 18 in the Senate). If we were to also reserve the positions of speaker of both houses for women, the number of female MPs would be 79 even before considering the elected ones.

The number needed to prevent a greater than two thirds majority for one gender would be 140 (just over a third of 418), meaning that Kenyans would only need to elect at least 61 women MPs out of the total 337 to meet the constitutional minimum.

Here, then, is the challenge: Is our political scene so barren that we cannot elect 61 women to Parliament in 2012?

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Monday, July 18, 2011

Why I should also be exempted from paying tax

Sunday Nation 17 July 2011

In my relatively short working life, I have lately come to the conclusion, just like our legislators, that paying tax is an irritant I can best do without. I would, therefore, like to request the government to exempt me from paying tax; and below are five of my best reasons.

One, I come from a poor family. Due to the suffering I went through as a child when my family scrimped and saved (and paid taxes) in order to ensure I went to school and finally entered a profession, I hold that it is the government’s responsibility to exempt me and my family from taxation. This will enable us to compete on an equal footing with the offspring of wealthy Kenyans who had a head-start in life.

Few hours of sleep

Two, I work very hard! In my line of work, I hardly manage a few hours of sleep before I have to rush to work and save a few more lives. I think it is tempting fate to insist on paying me peanuts, and then bringing all your sick and suffering to me for succour. I should be adequately compensated for the work I do, and unless my income is increased by a factor of 10, I think it is dangerous for the government to continue taxing my meagre pay so heavily. Something will have to give.

Poorer relatives

Three, I contribute to the upkeep of my poorer relatives. I think it is the responsibility of government to ensure that its population is well-fed, secure, sheltered, clothed and generally satisfied with their lives. Since the government has neglected this important responsibility in respect of my clansmen and women, I have taken it upon myself to take care of their needs. It is, therefore, grossly unfair for government to continue taxing my income while expecting me to continue carrying its burden. This amounts to double taxation.

Four, I contribute to the funeral and wedding expenses of my friends and relatives. I attend numerous harambees, and contribute as much as I can afford of my after-tax income. The government should ensure that I am adequately compensated for this function, which once again falls squarely under the mandate of the Treasury.

Five, I simply cannot afford to pay tax. I have several mortgages running concurrently, and a few projects back in the village that I need to complete within the next few months.

Lifetime goals

Paying tax has proved to be a major impediment to the achievement of my lifetime goals, and I demand that the government exempts me and my family from its taxation regime, at least until I retire from my current job.

Since Article 41 of the Constitution guarantees me the right to fair labour practices, fair remuneration and reasonable working conditions, I would contend that I qualify to enjoy tax-free pay and perks.

Of course every right comes with responsibilities. In the event that the government accedes to my demands, I make the following promises.

I will not avail myself of anything paid for by the tax-paying majority. I will not demand sitting allowances to do the work I am paid to do. I will always pay for my transportation, and will take my children to private schools and universities.

Finally, I will not seek to occupy any public office.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Sunday, July 10, 2011

Somebody must pay for state involvement in ICC

Sunday Nation 10 July 2011

Last week the government filed yet another application at the International Criminal Court (ICC), arguing that they are actively investigating the post-election violence suspects, with special reference to the so-called Ocampo Six.

This is only the latest in a series of farcical filings by our government since the beginning of the ICC investigation.

Right from the outset, ICC chief prosecutor Luis Moreno-Ocampo made it clear that his cases targeted individuals in and outside government who were judged to bear the greatest responsibility in the chaos that followed the 2007 General Election.

At no point was the government, at least as currently constituted, held liable collectively for the atrocities.

It was, therefore, baffling for our government, which had sworn to co-operate in ensuring justice for the PEV survivors, to initiate a process of shuttle diplomacy aimed at scuttling the only effort at justice that had the greatest probability of success under the circumstances.

It was very clear from the beginning that the mood of the people was against any government interference with the ICC process, and legal opinion was unanimous that the efforts were doomed to fail.

The fact that the missions went ahead, and spectacularly failed even after coming before the United Nations Security Council, is an early sign that the impunity of the old regime is yet to wear off.

In curing this nascent disease, it is imperative that those involved in that decision face the full force of the law, and additionally be made to refund the monies spent in the ill-fated attempts at scuttling justice for our nation.

Failure to do this will entrench a culture of disregard for public opinion and welfare, which should be the goal of every responsible government.

It would have been bad enough had the government stopped at the failed shuttle diplomacy and allowed the rest of the process to go on to its logical conclusion.

Unfortunately, the government embarked on another strategy in its assault on justice. The outgoing Attorney-General went ahead and hired foreign lawyers to represent the Government of Kenya at the ICC, even though the government is clearly not a party to the cases before the ICC.

International community

Despite the numerous failures of the AG’s hired counsel at The Hague, our government continues to file badly drafted and poorly constructed non-defences at the ICC, all only serving to put all Kenyans to shame in the eyes of the international community.

It is once again my considered opinion that those who continue to waste public resources in this manner must be brought to book, and made to repay the “lost” amounts from their own sources.

Not once has anyone heard the gentlemen facing ICC trials ask for government assistance or defence in their individual cases. All six have hired top-notch lawyers to defend them and, so far, they seem to be satisfied with their services.

At whose instance is the Government of Kenya acting? Whose interests are the Queen’s Counsel hired by the AG serving?

Have the monies being spent on the government’s Hague efforts (and the shuttle diplomacy) been scrutinised and passed by the people’s representatives in Parliament?

Kenyans must ask these hard questions of this Grand Coalition, or risk wasting resources chasing after the wind.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

Sunday, July 3, 2011

Let the family of dead student mourn in peace

Sunday Nation 03 July 2011

This past week there has been a furore over the death of a university student along Waiyaki Way after attending a party in a posh Nairobi suburb.

The circumstances surrounding her death were murky, and there were even suggestions that she may have been killed and dumped on the road by some malevolent individuals.

While death is never an easy matter, and suspicious death is doubly tragic, it is possible that this particular death was poorly handled by many of those concerned.

While it is expected that we shall all join in a chorus and condemn the Police Force for bungling the investigation, it is my considered view that, in this case, the police may have very little to answer for.

The larger share of blame lies in the public handling of the matter; and the media cannot escape blame for fanning the flames that may have interfered with fruitful police investigations.

Elisabeth Kubler-Ross described the stages of death, which may also be modified to describe the reactions to the death of a loved one, as shock and denial followed by anger, bargaining, depression and finally, acceptance.

Whenever a person dies suddenly, it is usual for close friends and family to enter into a stage of denial, where they initially doubt even the fact of the death itself. It is of course difficult to accept the death of a person who only a short while before was full of life.

Period of anger

This stage is followed by a period of anger, during which the bereaved may lash out indiscriminately at all those around them.

There will be accusations against the friends who were with the deceased, and why they did nothing to prevent the death; there will be anger at the authorities for the slow pace of investigations; there will be anger at the deceased for making the choices they made that may have led to their death; and finally, there may even be anger at God and the powers that be, for allowing such a young life to be snuffed out so tragically.

All these reactions are normal. What is not normal, however, is for the media and the public at large to get involved so intimately in this process of mourning. In this particular case, everyone was rushing to weigh in with their opinion, and engaging in expert analysis of events that they were not even remotely involved in.

The speculation created an atmosphere of so much uncertainty that no one was ready to let go and allow themselves to accept the situation and move on with life.

It is conceivable that some family members and friends have been able to overcome their anger, and moved through the stage of bargaining to one of despondence and depression. In these stages they need support to deal with their emotions, instead of getting more scenarios and theories about their loved one’s death.

Give them space

In order to help the family and friends to enter the stage of acceptance, it may be useful for the rest of us to give them space to grieve and mourn in private.

The media, especially, must refrain from encouraging continuing conspiracy theories to run wild, when they know for sure that if the police will not unravel the mystery surrounding this student’s death, then no one else in this country ever will.

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

Sunday, June 26, 2011

Collapsing old order will result in a better Kenya

Sunday Nation 26 June 2011

Two buildings collapsed in Nairobi in the past two weeks, killing several people and injuring many more.

Although this was not the first time such a tragedy was happening in our ill-planned capital city, government officials dutifully trudged to the sites of the misadventures and promised to do all in their power to help prevent similar problems in future.

Nairobi’s Town Clerk had particularly choice words for judges, accusing them of issuing quick injunctions without examining the merits of the cases or the threats posed to human life.

Subsequently, the Local Government ministry indicated that it would move to demolish all city buildings over five stories that did not have an elevator, as required by the law. Of course one wonders how this will remedy the subsisting poor planning and workmanship that result in buildings collapsing even before they are completely built!

The police promised to offer security to council officials inspecting building sites for compliance with established codes.

Other senior government officials offered their condolences and prayers to those affected by the tragedies, and hoped that they would find peace in these trying times.

After this show of government concern and commiseration, we were all supposed to crawl back into our miserable holes and forget about this whole unfortunate incident.

We were expected to go back to cheering our favourite ODM or PNU politicians, and planning the annihilation of our political enemies in 2012.

The odds are that this ruse succeeded. Our political class comprises some of the shrewdest people in this part of the world.

They know how to play with our love for drama and entertainment. It is, therefore, quite conceivable that most Kenyans have already forgotten about the victims and survivors of the collapsed buildings, and have moved on to more entertaining things.

In many ways, events such as these are signs of what is wrong with our country as a whole – the culture of carelessness and a shauri ya Mungu (leaving it to God) attitude on the part of citizens, and the well-developed leadership culture best exemplified by the Sheng phrase, uta-do (what will you do)?

Our carelessness is manifested in the habit of ignoring details in all aspects of our lives.

Unless one is carefully supervised by the eventual service user, the quality of much of our work is way below expectations.

Our use of language is another spectacular example, as are our manners on the road and in public places. And, of course, whenever anything goes wrong, God is always available as an explanation of last resort!

It is also pointless to give the numerous examples of the behaviour of our ‘‘leaders’’, including the exaggerated sense of entitlement in all spheres of life, leading some of them to even threaten the country with dire consequences should they be required to pay tax like ‘‘ordinary’’ citizens. Even in the face of overwhelming evidence of wrongdoing, they take to public platforms and declare “I would rather die than resign!” In other words, mta-do?

Unless there are significant changes in these Kenyan attitudes, the clamour for change and the resultant promulgation of a new Constitution will have been in vain.

Hopefully, the collapse of the old order, symbolised by the unfortunate events in Nairobi, will result in a better Kenya for posterity.

Lukoye Atwoli is a Consultant Psychiatrist and Lecturer at Moi University School of Medicine.

Sunday, June 19, 2011

Get this clear; paedophiles are not necessarily gay

By Lukoye Atwoli
Sunday Nation 19 June 2011

“Clerics seek harsher laws for gays”, screamed a headline on the online edition of the Daily Nation last Tuesday evening. The story went on to document the troubles that certain Muslim clerics had caused children attending madrassa at the coast- defiling them while pretending to be offering religious education. One muslim leader even claimed that “the rising cost of living and drought are due to the behaviour of these Kenyans (read homosexuals) who are not ready to change”.

Throughout the story, one could not find a single indication that the clerics accused of defiling madrassa pupils were homosexuals. It seemed that the article actually contained two stories- the on child sexual abuse and on homosexuality.

The conclusions made by the religious leaders were even more bewildering, considering the issue they were purportedly addressing. Sample this: Sharia or harsher laws should be enacted to punish homosexuals; Christians and Muslims should shun religious leaders and businesspeople who abetted homosexuality; there should be a “crackdown on institutions that spearhead the rights of gays and lesbians in the country” and so on and so forth.

Not once in the article was it indicated that the clerics wanted harsher penalties for child sexual offenders of whatever sexual orientation, leading to the inevitable conclusion that they may be comfortable with a heterosexual cleric sexually assaulting young children of the opposite sex!

Mainstream Kenya will probably identify with the clerics’ call, that all homosexuals should be hunted down like dogs, and probably put to death!

Homosexuality, as we have pointed out before in this column, has several meanings. One, it may refer to a sexual orientation whereby one is sexually attracted to members of the same sex. Secondly, it may indicate a personal or social identity, whereby one chooses to be identified as a homosexual. Thirdly, it may describe sexual behaviour or contact between two individuals of the same sex.

The importance of this distinction is that one may have homosexual orientation and be ‘happily’ married to another person of the opposite sex. Such a person may never (at least publicly) demonstrate homosexual behaviour, and one wonders where the clerics would find them to mete out their punishment.

Secondly, a person who is heterosexual may engage in homosexual behaviour at some point in their life, and still remain firmly heterosexual with no subsequent attraction to members of the same sex.

One concept in psychology holds that among the most vehement critics of a certain behavioural impulse or trait, many often have the exact same impulse or trait. It is explained that the extreme revulsion for those possessing the hated trait or impulse constitutes the ego defence mechanism known as reaction formation. In order to defeat the trait in themselves, they (unconsciously) choose to fight it in others!

Our homophobic fellow-citizens, who often irrationally equate homosexuality to criminal behaviour such as child sexual abuse, rape, murder or theft, must therefore examine the root cause of their own prejudices.

They may just discover a more appropriate outlet for their energies- fighting sexual abuse, whether perpetrated by heterosexuals or homosexuals!

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