Monday, July 30, 2012

Invest more in mental health research

Sunday Nation 29 July 2012

Over the past two weeks, I participated in two mental health conferences that are of particular relevance to our situation in Kenya. The first was the Kenya Psychiatric Association’s Annual Scientific Conference in Kisumu.

Mental health workers from all over the country interrogated the place of mental health in national development, specifically its impact on Vision 2030. The meagre budgetary allocation to health (amounting to 5.8 per cent of national expenditure) and the practically non-existent mental health vote were some of the key concerns raised at that meeting.

Participants urged the government to increase health expenditure towards the Abuja target of 15 per cent of national expenditure, and also to raise the mental health expenditure from the current 0.01 per cent of health expenditure. Recommendations were made on improvement of infrastructure, particularly upgrading Mathari Hospital to national referral status.

The state of this hospital is currently deplorable, and those working there pointed out that due to perennial underfunding, patient clothing and linen is scarce, sanitation is difficult to maintain, and food and medications are inadequate. Indeed, the medical superintendent of the facility reportedly resigned in frustration a few days before the conference.

The second meeting I attended last week was a World Health Organisation conference bringing together collaborators in the World Mental Health Survey Initiative, and was held in Brussels, Belgium. Leading mental health researchers met to share current knowledge on the state of mental health in the world. The burden of mental disorders was noted to be rising worldwide, including in developing countries, and it was agreed that global mental health funding needs to increase exponentially to meet this need.

A key finding concerned the role of mental conditions in increasing the risk for physical illnesses. For instance, a clear link was demonstrated between depression and a heart condition that is the commonest cause of death in many Western countries. Causative links between mental disorders and other illnesses such as diabetes mellitus, peptic ulcers and even hypertension suggest that mental illnesses must now be managed as part of a prevention strategy for chronic medical diseases.

A key observation for me at this meeting was that African countries are grossly under-represented in mental health research. This is due to the meagre allocations to research in most African countries, coupled with the already inadequate health care funding by African governments. It must be appreciated that without health research all that is left is the experience of the clinician, which can be very capricious even with the most experienced doctor.

Health research helps us to discover what the priority problems are in our country, and what proven solutions may work in dealing with these problems. With political will, it is possible to invest in health research and translate research findings into clinical practice, gradually improving the health of our people.

What little research is available in this country indeed suggests that we are facing a huge burden of chronic diseases, many of them related to mental health. According to the emerging evidence, unless mental disorders are addressed, they will continue to complicate efforts to deal with other medical conditions, as well as the concomitant social and economic challenges in developing countries.

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

Wednesday, July 25, 2012

Presidential transport hurts the economy


Sunday Nation 22 July 2012

Last week I needed to travel out of the country to attend a meeting of mental health researchers who, under the World Health Organisation, are driving the global research agenda in the field. To get to my destination, I had to get a flight from Eldoret Airport and connect with another flight at the Jomo Kenyatta International Airport scheduled to leave three hours later.

Unfortunately, those of us using airports that day chose the wrong day to travel, for the Head of State was also arriving back home from a meeting in Ethiopia. To further compound matters, there was heavy rain in Nairobi with significantly reduced visibility.

As a result, our departure from Eldoret Airport was delayed due to what the airline described as “operational reasons”, but which an insider confirmed was due to the President’s arrival. Many flights out of JKIA were also subsequently delayed, and it is possible that some people may have missed onward connections in other international airports. Those using Mombasa Road and other roads in any way connected to the airport reported serious traffic congestion, partly for the same reason.

Economists have estimated the cost of traffic congestion to the national economy to run into billions of shillings. Were they to factor in the cost of unnecessary flight delays and the opportunities lost due to presidential interruptions and related issues, the cost would conceivably be much higher than it is at the moment

Creative ways

It therefore follows that this is an important enough issue that the government must have some strategy aimed at addressing it.

In my opinion, the first step must include calculating and finding creative ways of reducing the amounts of money lost due to delays and traffic jams caused by the presidential motorcade and those of other politicians.
It might turn out that the costs to the economy associated with presidential travel could be offset by ensuring that he lands at some separate airport and uses a helicopter to get around the city. A military airport would be ideal for this, and one could think of using the Eastleigh Airbase as the custodian of presidential transport.

Second, the old suggestion that a separate lane be constructed on major roads for the President and other ‘VIP’ travellers may need to be revisited. This may ensure smoother flow of traffic and a more predictable travelling time than is the case presently.

Finally, as has been pointed out numerous times before, Kenyans must learn to obey rules that they have made themselves, including traffic rules. The peculiar “me-first” mentality that permeates all our social interactions is unsustainable, and will eventually bring down our country. In my opinion, this mentality is a bigger threat to our national security than any terrorist threat we have ever faced.

With this in mind, perhaps it is time we apologised to former Safaricom CEO who raised a storm of indignation by suggesting that Kenyans have peculiar calling habits. The peculiarity of Kenyans is obviously not only confined to calling habits, but runs the entire gamut of human behaviour.

And it runs through the entire fabric of our nation, starting at the very top where leaders consider it a privilege to interrupt the national economy in order for them to get from one point to another.

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

Devaluing education is a disservice to Kenya

By Lukoye Atwoli
Sunday Nation 15 July 2012

In the wake of the High Court ruling that was featured in this column last week on educational requirements for our leaders, many voices are emerging to offer a rationale for the practically illiterate leader. In arguments that are slowly becoming shouting contests between the educational haves and have-nots, examples are being trotted out to demonstrate that having higher education would not add value to most leaders, and may indeed be a drag on one’s leadership abilities.

We have been harangued about the academic ineptitude of leaders such as Sir Winston Churchill of the United Kingdom, among many other leaders who allegedly thrived without higher education. Numerous examples are given of highly educated leaders with multiple degrees who have been spectacular failures in their government dockets.

The implication here is that higher education, and especially an academic degree, is often a handicap that should not be extolled when it comes to leadership abilities. In sum, going to school is pointless to one who is destined to become a great leader. This argument is not only restricted to the political sphere.

Many leaders and innovators in industry are notably school dropouts, with prime examples being information technology mavericks like Bill Gates and the late Steve Jobs. Entrepreneurs like Sir Richard Branson are further trotted out to buttress the argument that academic achievement is nothing but a hindrance to success in life.
It is time to interrogate the accuracy of these assertions lest they be accepted as gospel truth. Importantly, there is a reason why only the successful “illiterate” politicians are cited.

When an illiterate leader makes a fool of himself, he is quickly forgotten and no one is surprised at his ineptitude, given his lack of education. Similarly, when an educated leader performs his job to perfection, nobody makes a fuss about it. However, people notice when one bucks this trend and does something unexpected.

For instance, a village buffoon who fortuitously solves a complex problem is instantly elevated to the position of village hero, all his past indiscretions forgotten. A monument is erected in his honour and he is held up as evidence that one does not need an education to solve complex problems.

Similarly, when the neighbourhood “professor” finally meets a problem that stumps him, everybody takes the opportunity to remind all that will listen that intelligence or “book smarts” cannot solve all problems. Indeed some even go as far as suggesting that school learning makes it difficult to solve these problems.

Considering the so-called successful entrepreneurial dropouts, a lot of detail is often glossed over. Many of them dropped out of school because they are clever entrepreneurs, and not because dropping out of school would itself make them successful. Most dropped out to pursue passions they already had, and did not need schooling to develop.
In any population there are persons who do not conform to the norm, and such mavericks cannot be said to be representative of their communities. Encouraging young people to drop out of school or disregard education because some illiterate leaders and entrepreneurs were successful is therefore disingenuous.
Even the societies that spawned the successful “illiterati” currently place a massive premium on education.

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

Brief Break

For the past two weeks I have been away attending meetings that brought together mental health teachers, clinicians and researchers in different settings. I will be writing about those in the coming days, and the lessons we can learn from these events.
In the meantime, I will shortly upload my articles from 15th July and 22nd July in the Sunday Nation. Apologies for the delayed posting. I will strive to be more prompt next time!

Monday, July 9, 2012

Court went too far on MPs' education ruling

By Lukoye Atwoli
Sunday Nation 08 July 2012

A few days ago, the High court made a ruling on a controversial issue that had been exercising the minds of Kenyans for quite some time. Judge Mumbi Ngugi ruled that a requirement in the Elections Act requiring parliamentary candidates to have post-secondary education was unconstitutional. In the same ruling, she argued that an even higher educational standard for presidential and gubernatorial candidates was constitutional.

The judge anchored her reasoning on the prevailing socio-economic and political situation in the country and the nature of work required by the positions referred to in this case. On eligibility for office, she pointed out that the right of every adult Kenyan to participate in the political process would be infringed upon by the requirement for a high educational qualification for parliamentary candidates. She therefore ruled that this requirement would be unconstitutional.

Her opinion on presidential and gubernatorial candidates was that due to the limited number of these positions, and the complex nature of the work involved, these candidates could be required to have not only post-secondary education, but university degrees.

To put this whole argument into context, it should be clear that the constitution does not provide for a different set of educational, ethical and moral qualifications for candidates for any office, whether parliamentary, gubernatorial or presidential. In my opinion, therefore, Justice Ngugi’s differentiation of the two categories of aspirants is itself unconstitutional, and may be challenged in a higher court.

The court’s argument that since there are sections of the population that have not been exposed to higher education it would be discriminatory and therefore unconstitutional to require parliamentary aspirants to have such qualifications is similarly flawed. The constitution allows parliament to set the minimum educational, ethical and moral standards for all aspirants. It does not provide any limits to such standards. 

It follows therefore that parliament, as the people’s representative, is empowered to consider what educational, ethical and moral standards are appropriate for the candidates. Enacting such legislation cannot, therefore, be unconstitutional!

It is difficult not to sympathise with the court’s position that in a country where almost half the population live in absolute poverty it would be unfair to require that anyone who wants to be an MP must have post-secondary education. The further assertion that, in a roundabout way, this requirement would discriminate against women and girls is one that merits active measures to address.

In actual fact, then, the court should have argued that the educational requirements for all posts are inherently unfair and potentially discriminatory, and that the government must take urgent measures to ensure that all those interested in higher education have access to it without discrimination. In this regard, Justice Ngugi’s ruling was a damning statement about pervasive poverty and inequalities in the Kenyan education system, rather than on the constitutionality of requiring higher education for aspirants.

In my view, this court overstepped its mandate by delving into socio-economic arguments that are the province of government policy and belong in the sphere of political party manifestoes. This ruling perpetuates the common Kenyan mantra that whatever is wrong or unfair must also be inherently unconstitutional. The assumption is that all constitutional provisions are fair and right, and that one only needs to use their gut feeling such that if something feels wrong or unfair, it is, of course unconstitutional!

Dr Lukoye Atwoli is the Secretary, Kenya Psychiatry Association and a Lecturer at Moi University's School of Medicine; twitter @LukoyeAtwoli

Monday, July 2, 2012

Let the government bring Zack back home

Sunday Nation, 01 July 2012

There is an ongoing campaign aimed at raising funds for the construction of a spinal injury rehabilitation facility in Kenya. With the involvement of several organisations and common wananchi, it is headed towards achieving and surpassing its stated target of a quarter of a billion shillings. Campaigns both in mainstream and social media are encouraging all Kenyans to “Bring Zack Back Home” by donating to this initiative.

Despite the great intentions of this appeal, it raises a couple of issues that must not be ignored about the functioning of our government.

Firstly, a perfectly normal man going about nation-building was shot by thugs in a carjacking attempt in Nairobi. Someone in this country is responsible for preventing such acts, and apprehending the culprits and punishing them to the fullest extent of the law. That a citizen’s life can be so drastically altered in this manner suggests that the citizens’ security is not top on the agenda of this person. Remember just this past week, a minister’s security detail was beefed up after he claimed that his life was in danger. Mwananchi’s life is in danger everyday!

Secondly, after he was shot in this manner, this man received treatment and was eventually discharged from the hospital. Unfortunately, spinal injury changes one’s life in a manner that is difficult to describe unless one has experienced it firsthand. Things that one took for granted become impossible to do without assistance and, for a while, one becomes dependent on others for well-being.

This can be particularly difficult for high-achievers and, in many cases, the psychological stress related to such drastic changes in living circumstance causes problems ranging from anxiety disorders to depression. To obviate this and help the survivor to return back to normal life, rehabilitation is often necessary. It helps the patient to develop skills that will enable them to be integrated back into society with the least possible disruption.

Obviously, then, this should be among the national health priorities in a country that aims at achieving middle-income status by 2030. It is utterly conceivable that in government, there is a department in charge of curative and rehabilitative services, including rehabilitation for spinal injury patients. It is also possible that in this department, there exist dusty blueprints for different level facilities to offer these services.

Further, we would not be stretching the truth much if we imagined that this department annually puts in requests for funds to build just such a rehabilitation unit as Zack is raising funds for, and every year some mandarin deep in the bowels of government says there are no funds for this.

This is the tragedy of our times. A paraplegic is rolling his wheelchair down South in order to raise money to build a facility that is probably already in the government’s plans. If it is not in the government’s plans, then someone is obviously sleeping on the job!

It is not too late yet. The government can still do something to stop this man from doing more harm to himself. Let the government pledge to provide, from the Health budget, the required Sh250 million to build this facility. Let them also provide for the equipment and staffing of this facility, in order to ensure that this crucial function is addressed.

Let the government bring Zack back home.

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