Sunday, October 28, 2012

Lessons from the American electoral process

By Lukoye Atwoli
Sunday Nation 28 October 2012

The American political system is far from perfect, and suffers from many of the same problems our own system consistently throws at us. It is entirely conceivable that in their upcoming election, many Americans have already made up their minds to vote for a person whose ethnic background is similar to their own. There is little any one can do about that.

But that is as far as any similarity between the American and Kenyan political systems goes. The contrast becomes very stark after this.

First, the vast majority of Americans are agreed that if their candidate does not win the election, the world will not necessarily come to an end, and there will be an opportunity to get their favourite candidate elected at the next election. In Kenya, we have invested so much emotionally in political aspirants that in ego terms, there does not seem to be a boundary between the individual supporter and his favourite candidate.

The result, of course, is that whenever anyone denigrates the politician’s position on any issue, it comes out as though it is a personal attack on the supporters. The outcome, as obviously expected, is a catastrophic hysterical reaction that often ends in open conflict between opposing camps.

Second, despite the apparent gulf in their positions on various issues, the American candidates have maintained a healthy respect for each other, with no insults or intemperate language flowing between them. 

Debate vigorously

They are able to sit in the same room, debate vigorously and sometimes very roughly, but in the end they shake hands and say nice things about each other.

Third, the candidates have stuck to attempting to demonstrate real differences in their policy proposals, instead of engaging in personal attacks. Even in areas where an objective observer would notice similarities, such as in foreign policy, the candidates continued to show how they would do things differently from each other.

If our politicians want a peaceful country to govern after next year’s General Election, there are several things they will do as a matter of urgency.

One, they will make it clear to their supporters that there is a very real chance that they may not win the election, and that in any case the margin between the winner and the others may be razor-thin. They will then tell their supporters in no uncertain terms that they will not be associated with violence, and will in fact denounce anyone engaging in violence in the candidate’s name.

Two, they will run an issue-based campaign, clearly indicating their planned policy initiatives in health, education, security and infrastructure. They will canvass their positions on trade, agriculture and social issues such as family, religious freedoms and immigration. They will demonstrate to Kenyans how progressive their positions are, and how they will benefit the country should they win the election.

Finally, the candidates will maintain respect for each other, and use wholesome language when referring to their opponents. Using derogatory language in reference to their opponents will be avoided and punished by public condemnation. Calling their opponents snakes, horses or donkeys will be avoided, keeping in mind the amount of emotional investment and lack of ego boundaries among the supporters.

This way, we shall have a government that is committed to the welfare of all Kenyans after March 2013. 

Dr Atwoli is the secretary, Kenya Psychiatric Associaton and a senior lecturer at Moi University’s school of medicine; twitter @LukoyeAtwoli

Continuing neglect of mental health dangerous

By Lukoye Atwoli
Sunday Nation 21 October 2012

Just under two weeks ago, the world marked the World Mental Health Day. In Kenya, it was in a low-key manner unlike in the past when there would be processions and speeches at a public health facility, and usually around the Mathari Hospital in Nairobi.

Perhaps the low-key commemoration was an appropriate metaphor for the amount of attention being paid to this very important aspect of our national life. Despite going through the annual ritual of lamenting under funding for mental health and neglect of the national referral mental hospital, very little seems to change each year.

Indeed, it could be argued that things are getting worse. Predictably, rates of mental illness are increasing as a function of industrialisation and “development”. Further, as people become more and more aware of mental health issues, demand for mental health services continues to rise.

Finally, as the national population continues growing rapidly, the absolute numbers of people with mental illness will follow suit, even if the prevalence rates remain constant. The upshot of this increased demand is that we need more mental health facilities and workers to address this need.

Unfortunately, the health sector as a whole is suffering from systemic neglect born of government policy that considers health to be a side-issue that can be addressed after “more important” sectors have been taken care of. Despite government commitment to spend 15 per cent of the budget on health, current expenditure is still less than half that figure.

Health facilities are still largely understaffed, have old and battered equipment, and suffer from shortages of essential supplies. To make matters worse, less than one per cent of the health budget is spent on mental health, with the bulk of it going to pay salaries. The Kenya Board of Mental Health, established by statute over two decades ago, has yet to be facilitated and its effect has not been felt across the land. Regional mental health boards as provided for in the same Act are unheard of.

Mental health programmes are rare and completely dependent on donor funding. Sponsorship for training in mental health is dwindling, and most postgraduate students in psychiatry have lately been from other countries in the region.

The truth of the matter is that this continued neglect of mental health poses a grave danger to the well-being of our country. The danger is not as abstract as saying that a nation whose mental health is unattended to cannot prosper socially or economically.

It is the real danger that mentally unwell people are running this country and making decisions that affect all of us. Mentally unwell people are teaching our children, preaching in our places of worship, driving our public transport vehicles, and treating our sick relatives in hospitals.

Mentally unwell people are shaping national discourse in the media, and others are leaving their homes in droves to join Al Shabaab and related militias. Mentally unwell people are roaming our streets unattended, posing unspoken dangers to themselves and others. Mental ill-health, running the entire gamut from mild afflictions to the more severe disorders, is very common in this country.

And unless we start funding mental health programmes and paying attention to staffing and infrastructure needs, we might as well give up on all the other national endeavours we are pretending to pursue. 

The writer is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine; twitter @LukoyeAtwoli

Monday, October 15, 2012

There’s a need to do more to tame MPs’ greed

By Lukoye Atwoli
Sunday Nation 14 October 2012

President Kibaki has declined to sign into law a Bill that, among other things, sought to award members of parliament a “winding up allowance” of close to Sh10 million each. This would have cost the exchequer upwards of two billion shillings at a time the government was adamant that there isn’t enough money to pay teachers, lecturers and other public sector workers demanding a pay rise.

This show of insensitivity only goes to demonstrate the inaccuracy of the belief that one should go to parliament with the intention to serve the country, rather than to enrich oneself. In Kenya, parliament has become one of the ways an individual can say goodbye to poverty without too much trouble.

To cure this malady, it may be worthwhile considering paying MPs a salary based on the average income of the citizen. This way, they may become more likely to support legislation that improves the average income of Kenyans through sound economic policy and prudent management of available resources.

Alternatively, their pay should be pegged on their income immediately prior to their election or that of someone with their qualifications and experience in the public service. This will ensure that they get remuneration commensurate with whatever they would be getting were they in other areas of the public service, eliminating parliament’s current reputation as a cash cow.

The President’s argument that he rejected the Bill due to its unconstitutionality also raises interesting possibilities. Article 2 of the constitution proclaims the supremacy of the constitution, and provides that any law that is inconsistent with constitutional provisions is a nullity to the extent of the inconsistency.

It, therefore, beats reason why the executive arm of government found it necessary to send back the Bill to an avaricious bunch in parliament who will, in all probability, find ways to get it enacted anyway. In my opinion, President Kibaki should just have assented to the Bill and then refused to implement the unconstitutional sections.

The constitution makes it the duty of every citizen to protect its integrity, and the President could have argued that implementing an unconstitutional law would expose him to the danger of impeachment and possible prosecution now or in the future.

Interestingly, it has been argued that the golden handshake provision was just a red herring, and the MPs never intended to get it passed in the first place. Some commentators claim that perhaps their key intention was to blind the public to the change in the elections law making it easier for them to defect from their political parties as close as two months to the General Election.

From where I sit, it is difficult to believe this argument given the sneaky manner they passed the amendment. It was not on the order paper, and it was passed without debate at night when very few Kenyans were paying attention. They wanted it badly, and they hoped that Kenyans would not notice.

It is necessary for Kenyans to institute a process by which the legality of the many self-serving laws our MPs have recently been making can be examined.

In any system of government, any combination of judicial, legislative and executive powers in the same person or institution is a recipe for a dangerous plutocracy over which the citizen would have absolutely no control. 

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

Wednesday, October 10, 2012

Health care must become interest of every Kenyan

By Lukoye Atwoli
Sunday Nation 07 October 2012

If there is anything events in the health sector in the recent past have demonstrated, the most startling is that health is very far from most of our leaders’ list of priorities. Despite a doctors’ strike continuing for over three weeks, Kenya’s leading political contenders continued with their lives as if nothing was amiss. A few, of course, made token statements about supporting health and health workers, but it is clear to any observer that none of the candidates has a comprehensive campaign strategy on health.

In other countries, health is a make-or-break issue during any campaign. In the United States, for instance, there are major differences between the two presidential candidates on how to handle health care, and many consider these differences to be so fundamental as to influence their voting choices. In Kenya, obviously no one gives too much thought to this issue.

The tragedy is that the public health sector, broken as it is, is the main provider for a majority of citizens. Over 80 per cent of voters visit public health facilities when they fall ill. Almost all our politicians fall outside this group, and are able to afford care in expensive private facilities. It is thus clear that a chasm exists between the experiences of the leaders and the led, and the possibility of this chasm being bridged is remote.

As someone pointed out to me recently, a developed country is one in which, by choice, everyone uses public social services, including health services. 

Cherished property 

In Kenya, people sell their cherished property in order to afford care in private hospitals. The private health sector is thus the greatest beneficiary of the rot in the public health sector. Indeed, it has been observed that private health providers wrote to the Salaries and Remuneration Commission (SRC) prevailing upon it not to increase the pay of public health workers by a big margin since this would have an impact on their profitability.

One hopes that reason will prevail in the SRC, and that their recommendations will go a long way in making public health care services more attractive than private ones.

The time has come for our presidential aspirants and their political parties to have clear proposals on the improvement of our health sector. Kenyans must start demanding substance from their favourite leaders, instead of fawning all over them on account of their ethnic background. In any case, your tribesmate will not save your life at a time of need if he cannot guarantee a hospital with adequate equipment and staffing in your vicinity.

We need to hear political party positions on the formation of a Health Service Commission to manage human resources for health in this country. We need to know where they stand on the implementation of the Abuja Declaration that called for spending 15 per cent of the budget on health. We need to be told how they intend to improve health infrastructure from the community level all the way to the national level.

Indeed, we need to know who they intend to nominate as their Health Cabinet and Principal secretaries, so that we can scrutinise their integrity and abilities, and make our voting decisions accordingly. Health care must be everyone’s priority, not just for health workers.

This is the thrust of the “Peremende Movement” that exploded out of social media this week. 

Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a senior lecturer at Moi University’s school of medicine; twitter @LukoyeAtwoli

Monday, October 1, 2012

We must not normalise hate speech by inaction

By Lukoye Atwoli
Sunday Nation 30 September 2012

Some time in the last century, a behavioural scientist known as B.F. Skinner observed that random behaviours can be shaped into a desired behaviour by way of reinforcement. In this model, known as operant conditioning, random behaviour is “shaped” as desired through a system that rewards the desired behaviour.

For instance, a child who randomly gives up his seat for an elder and is rewarded with praise or a gift is more likely to engage in similar behaviour than one who does the same thing and is either ignored or punished for it. This is a fundamental principle in learning and is used in homes, schools, prisons and institutions in which certain behaviours are expected and others frowned upon.

This brings us to the matter of hate speech and how we have been handling it in this country. In January 2008, at the height of the post-election violence, I observed in the Daily Nation that: “... use of ethnic stereotypes must be deemed taboo whether in public or in private. Use of insulting language targeting whole communities must be discouraged whether on the campaign platform or in the privacy of our homes.”

These observations were made in the context of preventing future eruptions of a similar nature, in the hope that Kenyans would learn their lesson and adopt behaviour that would minimise the risk of violence and encourage behaviour that promotes peaceful coexistence of all peoples. Unfortunately, it appears that our social behaviour has not changed, probably due to the wrong schedule of operant reinforcement. 

Largely ignore

We have set rules to prevent hate speech and incitement, but we largely ignore those that engage in this behaviour that we have determined to be obnoxious and inimical to our national goals. Many leaders in the past who engaged in this sort of behaviour were not even made to feel as if they had done something wrong. Indeed they were often congratulated on their forthrightness and encouraged to keep it up.

After we changed our laws and outlawed certain kinds of speech, we had an episode where senior government officials allegedly engaged in hate speech and were eventually arrested and charged. The tragedy is that nobody was then convicted of these crimes, giving the impression that it was sort of okay to engage in this kind of behaviour.

Recently, another Cabinet minister was charged with a similar offence, but managed to somehow wriggle out of criminal responsibility by delivering a public apology, courtesy of the National Cohesion and Integration Commission.

This may have emboldened another politician to go into a cosmopolitan city constituency and allegedly order the eviction of a section of the population that he accused of being foreigners and killers. This politician then tried to follow in the footsteps of his predecessor, and gave some sort of apology, after which he tried to escape justice by hiding from the police and rushing to court to pre-empt his arrest and prosecution.

It is clear in my mind that how we handle these very public instances of hate speech and incitement will determine the tone of the forthcoming campaigns, and probably the aftermath of the next General Election. All arms of government, therefore, need to be vigilant and initiate a culture of operant conditioning of all citizens if we hope to gradually eliminate this atavistic behaviour. 

Dr Lukoye Atwoli is Secretary, Kenya Psychiatric Association and Senior Lecturer, Moi University School of Medicine; twitter @LukoyeAtwoli