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