Tuesday, April 26, 2011

Increased scrutiny good for the public service

Sunday Nation 24 April 2011

This past week has left most Kenyans with little to cheer about.

From protests about rising food and fuel prices to finger-pointing over the slow pace of the implementation of the Constitution, many would be forgiven for feeling boxed into a corner with very few options open to them.

However, amid all the gloom and lamentations, there was a glimmer of hope that things are looking up in the governance structures of this country from the most unlikely of sources.

Appearing before the Parliamentary Accounts Committee, Roads permanent secretary admitted that senior civil servants are living in fear of prosecution for real or perceived corruption in their dockets.

This statement was obviously meant to elicit some sympathy from the parliamentarians, and it probably did, given that some members of the committee purported to warn the Kenya Anti-Corruption Commission to “respect other bodies (read Parliament) since it does not work in isolation . . .”

Progressive Kenyans, on the other hand, had cause to be jubilant over such a confession. At the risk of being branded a sadist, I was one of those who were happy to hear that senior government officials can no longer just do whatever they like with public resources.

They have to keep looking over their shoulders every time they are spending our money, knowing that there are multiple eyes trained on them to prevent them from misusing it.

If Kenyans needed any evidence that the impunity of yesteryears is slowly but surely vanishing, this is it.

Few months

In the few months since the 2010 promulgation of the Constitution of Kenya, the president and his ministers have had to constantly consult and study their obligations under the law before performing any official act.

Whenever they have failed the public interest test, they have had to face the wrath of other constitutional and civil society bodies that have made it their business to prevent monkey business in government.

This is a good start for our nascent democracy, and there is reason to hope for a better future.

Contrary to the permanent secretary’s assertion that such scrutiny will discourage young people from taking up government appointments, many young, untainted experts and leaders will relish the opportunity to serve their country without any hesitation.

The assumption that every Kenyan is afraid of scrutiny is false, and taken to its logical conclusion (that we are all innately corrupt), it is even insulting.

This scrutiny of public officials should serve as a wake-up call to all the old fogies who are not used to fulfilling their responsibilities without succumbing to the temptation to steal.

Those that are unable to stand the heat should, to use a cliché perfected on the Kenyan political landscape, do the honourable thing and “step aside”.

County governments

The coming of county governments will demand even greater scrutiny at lower levels of government. It is conceivable that many in the corrupt classes will seek to “decentralise” corruption to a level where they think the risk is lower. We must not let them get away with it.

We must keep in mind the old saying that the price of liberty is eternal vigilance.

Fear of scrutiny and prosecution for wrong-doing betrays a pilfering mentality that has no place in the public service. Like the man said, the guilty are always afraid.

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

Monday, April 18, 2011

Kibunjia Commission move a double-edged sword

Sunday Nation 17 April 2011

Recently, the National Cohesion and Integration Commission interpreted its mandate rightly or wrongly as including publication of reports on the ethnic composition of offices in the public service.

In their first such report, the commission indicted the office of the President and that of the Prime Minister as major culprits in loading their offices with their tribesmates, at the expense of other deserving citizens.

All in all, the report indicated that a few Kenyan tribes took up over two-thirds of the jobs in the civil service, leaving the majority of tribes under-represented in government.

Soon after the publication of the report, both the Office of the President and the Prime Minister’s office issued statements indicating that they either do not directly hire their own staff, or that the figures were exaggerated and calculated to cause embarrassment to one or the other Principal.

Indeed, the Public Service Commission accused the NCIC of ignoring the progress achieved over the past decade in improving ethnic balance in the civil service!

Such protestations of innocence do not do much to address the inequities identified in the NCIC report, and only serve to whitewash a reality that all Kenyans are familiar with.

Whenever one is appointed to a senior position in the public service, they often take it upon themselves to load their zone of influence with their tribesmates in a show of largesse to their “people”.

Those who do not do this are lampooned by their relatives as being selfish and misguided, and are often at risk of losing their jobs for some minor infringement.

Given the scenario outlined above, the NCIC report has its merits as long as it exposes this dangerous practice that feeds the “winner takes all” mentality in our politics, resulting in losers refusing to accept defeat, and winners gloating greedily about their good fortune.

However, reports such as these have a very serious downside, and may end up doing more harm than good.

Ethnic statistics may open up the potential for everyone to claim that they are being marginalised, and to demand government jobs without regard to merit or qualification.

In any case, many tribes are really just colonial constructions that the imperial powers used to understand, subjugate and exploit “natives”.

Many of the so-called tribes are actually a conglomeration of neighbouring ethnic communities with similar culture and similar-sounding languages.

Examples of such ethnic constructions will necessarily include the Luhya and the Kalenjin, but many other “tribes” share this attribute.

Is it possible for the NCIC to release statistics for, say, the number of Kisas, Marakwets, Maragolis, Sengwers or Terik in government?

Also, during the last census, many Kenyans indicated that their tribe was “Kenyan”.

Can the NCIC release information on what proportion of “Kenyans” hold positions in the “Government of Kenya?”

If this information is missing, wouldn’t this only feed the perception that they are victims of blatant discrimination?

Finally, it would be interesting to know the method used to collect information on tribe in the civil service.

The Public Service Commission’s own application form (PSC 2 Revised 2007) does not have any item on the applicant’s tribe (except for “languages spoken”), so it is a fair assumption that the information was largely based on conjecture and not fact.

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

Sunday, April 10, 2011

Mental illness not same thing as mental disability

Sunday Nation 10 April 2011

In the past few days, the ministry of Special Programmes and the agency responsible for administering programmes for disabled persons have engaged in a publicity blitz to demonstrate just how much they are doing for disabled people in Kenya.

This was in response to a string of demonstrations and media campaigns alleging that the government was sitting on funds meant for people with mental disabilities.

Mental health in Kenya was recently thrust into the limelight when the international news channel CNN aired a documentary on mental health in Kenya titled “Locked up and forgotten”.

This documentary exposed the level of neglect that the mentally ill and people with mental disabilities face in this country.

The net result of this media blitz has been a certain amount of confusion on the real meanings of terms such as mental illness, mental disability and mental handicap.

An impression has been created that mentally ill people are also disabled or handicapped, and should benefit from the disability funds.

While I have no problem with mentally ill persons being supported by the government one way or the other, it is important to ensure that the designations they get will not result in further confusion and stigma.

Mental illness, often used interchangeably with mental disorder, refers to a change in an individual’s feelings, thoughts or behaviour that causes significant distress or interferes with important areas of functioning.

Sometimes people with mental illness constitute a threat to themselves or to others, and need inpatient treatment in hospital.

The important thing to note here is that mental illness, just like other illnesses, can be managed in a way that allows the individual to go back to as near normal functioning as possible.

Common mental illnesses include depression and anxiety disorders, while the more dramatic ones include schizophrenia and bipolar disorders.

Mental disability, or mental handicap as it is sometimes referred to, deals with conditions that often begin in early childhood and interfere with an individual’s ability to express themselves or adapt to their environment adequately for their own survival.

These include conditions such as mental retardation, pervasive developmental disorders (including autism), and learning disabilities including problems with reading, writing and calculation.

From these simple definitions, it should be clear that mental illness (or disorder) is not the same thing as mental disability or mental handicap.

Mental illness may affect a person with previously normal functioning and, with treatment, many are able to regain their previous level of functioning.

Mental disability or handicap, on the other hand, begins early in childhood, and the best management modalities focus on helping them to be as independent as possible in their own lives.

Importantly, mental illness does not necessarily constitute disability. Many people with mental illness are living very fulfilling lives, and playing important roles in the lives of their families, communities and the society at large.

It is, therefore, necessary for those engaged in the discourse on the rights of persons with disabilities to clarify that the term “mental disability” does not in any way include people with such mental illnesses as depression, anxiety disorders, schizophrenia, bipolar disorder and even alcohol dependence.

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

Sunday, April 3, 2011

The Loliondo sad affair continues apace

Sunday Nation 03 April 2011

In northern Tanzania, at a place called Loliondo, a retired priest has allegedly been churning out a ‘‘miracle cure’’ for all chronic illnesses known to man.

The sick, gawkers and tourists have been flocking to the site to see and drink the greenish concoction touted as a panacea.

In my opinion, the concoction he is dispensing would more accurately be described as a “miracle killer”, given that the only miracle in this case is that fewer people are dying after ingesting the poisonous soup.

In Kenyan, and African medical practice, the Loliondo phenomenon is not unique. Claims of ‘‘miracle cure’’ are found all over the continent, with ardent followers swearing by some concoction or other as a cure for diabetes, HIV, cancer, hypertension and mental illness.

Religious leaders have not been left behind, either. They promise exorcism of the “demons” responsible for these illnesses, and all they ask for in return is a small “contribution” to support the “ministry”.

Some get prime airtime on national TV, parading people they claim have terminal illnesses and then performing some religious rituals for them in order to effect “cure”.

Most of these people, believing they are cured, stop taking regular medications and end up dead or suffering from complications soon thereafter.

A walkabout in any urban area in Kenya will leave one in no doubt whatsoever of the clout these “waganga kutoka Tanzania” (Tanzanian healers) wield over the Kenyan psyche.

Even in areas with clear “No Posters” signs, these “waganga” have plastered posters on lampposts and walls, proclaiming their powers to heal all problems of mankind, including problems with relationships, school or work.

Any thinking person knows that no such cure exists, but the practice has no shortage of clients.

Everyone shares a level of responsibility for this. Despite numerous warnings from the medical fraternity about the dangers of ingesting untested substances in the hope of cure, many people continue to queue outside the hovels housing these “waganga”.

Health professionals, on the other hand, have perpetuated this business by developing a false dichotomy between “conventional” and “traditional” medicine.

Human illnesses do not recognise cures as being “traditional” or “conventional”. They only respond to cures that work.

Insisting that we must respect “traditional” practitioners just because we do not understand what they do is in fact harmful in a majority of the cases.

Since nobody has tested whatever they dispense with any scientific rigour, no self-respecting health worker would refer a client to them, or even work side-by-side with them in a formal setting.

Regulatory bodies must also accept that they have neglected their responsibility as far as protecting the health of citizens is concerned. Ideally, any substance that is marketed as a cure for any ailment must undergo rigorous testing to ensure that it is safe, and that it actually cures.

Asking people to take it on “faith” that the substance works results in far more harm than any postulated good. In Loliondo, dozens of people had to die before the Tanzanian government intervened.

And the intervention was really just an endorsement of the priest’s cure, asking him to help deal with the humanitarian crisis his popularity was causing.

Meanwhile, the sad affair continues apace, and dozens more are sure to die before any meaningful action is taken.

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