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