Monday, December 30, 2013

Looking forward to a happier new year

By Lukoye Atwoli
Sunday Nation 29 December 2013

In a couple of days, Kenyans will welcome the year 2014, largely hopeful that it will be a better year than 2013 in more ways than one.

Firstly, we all hope the security situation will be better next year than it has been this year. Since the beginning of this year, it seems our savage instincts were unleashed, and criminal violence has been reported all over the country. From so-called “cattle-rustling” through terror attacks to “normal robberies” with fatal consequences, no location in Kenya has been spared.

Despite the resolve displayed by the government in dealing more firmly with the security crisis after the Westgate terrorist attack, things have gone back to “normal”, with no visible changes in the security apparatus to increase the citizens’ confidence. One hopes that this will change in the coming year, and that the security of Kenyans will take precedence over other considerations in this government.

Secondly, it has lately become evident that the health sector is in disarray. Rushed devolution without first putting in place adequate structures resulted in a protracted strike by health care workers across the country. Despite clear constitutional provisions dividing health functions between the national and county governments, both levels of government spouted fallacious arguments that health is a “100 per cent devolved function”. Going by the chaotic processes of human resource management already being displayed, it is clear that it will become increasingly expensive for Kenyans to get sick in the coming days. 

Ironically, the relevant arms of government have belatedly discovered this danger and are now cautioning county governments against rushing to take over human resource functions that are currently still under the Public Service Commission. One can only hope that the government will listen to the grievances by public servants about ill-regulated devolution, and address them adequately in order to forestall further industrial unrest with the attendant suffering of hapless citizens.

Thirdly, the cost of living has been inching up inexorably over the past year. Government actions do not seem to inspire any hope of a respite in 2014. Increasing taxes and levies are constantly chipping away at the meagre earnings of Kenyans at the bottom of the barrel, and the year has ended with claims that State House is further pinching pennies from ministries for purposes of publicity.

Additionally, the President just signed into law legislation aimed at deducting a percentage of workers’ pay for purposes of social security, notwithstanding the fact that some may already be contributing to registered pension schemes. Unless government puts in place measures aimed at mitigating these escalating costs of living, there’s no telling where the situation will lead to!

Finally, we have spent most of this year under a cloud of uncertainty as to the legal status of our top leaders, who stand accused of crimes against humanity at the International Criminal Court at The Hague. Despite indications that at least one of the cases is severely weakened due to lack of witnesses, the prosecutor insists that she will go ahead with the case after further evidence collection. One hopes that this cloud will be lifted once and for all without jeopardising the prospects of justice for the victims and survivors of our post-election pogroms of 2008.

Notwithstanding all that though, may providence grant us a largely happy and trouble-free 2014! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Distracted government allowing sabotage

By Lukoye Atwoli
Sunday Nation 22 December 2013

Last Thursday, I read a piece penned by the president’s speech-writer, decrying an unconstitutional parallel executive within the civil service. At about the same time, the health workers’ strike was entering the second week and the government was largely ignoring it. The Health cabinet secretary had dismissed the issues raised by health workers as frivolous and unconstitutional, and soon after that the president issued a similar statement asking the workers to end their strike.

Disturbing though it was, Eric Ng’eno’s piece captured very neatly the problem with our State at the moment. He argued that the constitutional executive is not in control of government, and a shadowy cabal is probably pulling the strings in the background. Indeed, the president and his deputy alluded to this during their recent Eldoret tour, accusing some Members of Parliament of having been bought by disgruntled businessmen who were losing out on government contracts.

The government is behaving like a creature under siege from all sides, lashing out at anything that moves in its vicinity. Some have commented that the Jubilee government is beginning to more and more mirror the Kanu State of the 1980s in which any dissenting voice was labelled an enemy of the people and an agent of foreign forces. Recent moves to stifle constitutional freedoms seem to confirm this retrogression.

It is difficult to understand why this is happening under this relatively youthful administration that seemed to be so connected to the needs of the populace that future election wins were guaranteed.

One needs not bother analysing Ng’eno’s claim that a powerful segment of the civil service stands in the way of reform and progress. Every administration inherits workers from the previous regime, and going out of one’s way to antagonise those workers has obvious consequences. In fact, despite expected resistance from those sections of the civil service, previous administrations achieved a significant measure of success in implementing their manifestos. This administration is in fact luckier than the government that took over from Kanu in 2002 which faced more inertia than any succeeding regime.

In my view, the main problem with this government so far is that the distinction between government business and personal affairs has been blurring progressively. The result is that whenever the leadership feels threatened, they act in ways that suggest that the entire nation is in peril. We have become the true embodiment of the old French imperial attitude that the King and the State are one and the same thing.

As it is, the president and his deputy have been for the most part distracted, dealing with one crisis after another, and it is obvious that the civil service remains unsettled by this. In the process, the business of government is suffering, and the voter is taking note.

People expected their lives to improve after the elections, not least because of the promises that were made during campaigns. When these improvements seem too late in coming, and what is said by government officials indicates that in fact some of the promises will be reversed, the citizen is bound to get restless.

The government will do well to step back from the strident rhetoric emanating from top officials, and develop a more coherent, forward-looking governance strategy. The alternative is to buckle up and prepare for planned or unplanned sabotage going forward. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Blow as mental health division is scrapped

I am once again sorry for delayed posting of some of the December articles, beginning with this one that appeared in the Sunday Nation of 8th December 2013. I was unable to update this blog as regularly as I'd like due to several reasons that would make the subject of independent posts in their own right! Here goes!

Blow as Mental Health Division is scrapped

By Lukoye Atwoli
Sunday Nation 08 December 2013

Last week, a friend working at the Ministry of Health headquarters, Afya House, sent me an email informing me that with the stroke of a pen, the head honchos in the ministry had scrapped the Division of Mental Health and instead replaced it with a nondescript unit with an unclear mandate. It is unclear what is to happen to positions in the division such as that of the director of mental health who was the top-ranking civil servant mandated to develop and implement mental health policies, strategies, plans and programmes across the country.

If it is, indeed, true that the division has been scrapped, the implications of this seemingly innocuous move are enormous.

Firstly, it is of course inconceivable that a unit in the ministry of health would have any direct budgetary allocations to carry out its own programmes. Obviously this means that the recent promises and proclamations by government that they will enhance mental health funding and improve mental health services across the country cannot be taken with any degree of seriousness.

Secondly, and perhaps more importantly, the move amounts to a demonstration of high-level self-defeating impunity. The Mental Health Act of 1989 provided for the setting up of the Kenya Board of Mental Health, with the Division of Mental Health serving as the secretariat of this board. The director of mental health was meant to be secretary to this board, and chief mental health specialist in the country. The holder of this position would be the government’s go-to person whenever mental health advice was needed, as well as being the person responsible for ensuring that the government’s mental health policies are properly implemented.

Today, the Act is yet to be fully implemented, and there is no mental health vote in the budget.
The Mental Health Board has not been fully facilitated to fulfill its mandate, and mental health services remain rudimentary in most parts of this country. And now, to add insult to injury, the government appears to be moving with speed to dismantle even the few gains made over the decades in this delicate field.

The Cabinet Secretary for Health, Mr James Macharia, needs to move with haste to correct this situation if he knows what is good for the ministry. He must establish a vote for the Mental Health Division within the Health budget and, as per earlier recommendations, this needs to be significantly higher than the current 0.01 per cent of the health budget.

He needs to advertise and competitively fill the position of director of mental health as required under the Constitution. He must complete the process of developing Kenya’s Mental Health Policy which has stalled in the corridors of Afya House for decades. He must institute programmes to deal with mental health crises in this country, including substance use, illness-related suicides, homicides, accidents and violent crimes.

The Cabinet secretary needs to establish a fully staffed and provisioned Kenya Board of Mental Health, with a functioning secretariat as envisaged by existing legislation. Funds must also be set aside for supportive supervision and mental health research in order to ensure the evidence base for decision-making is broader and well-supported.

In short, Mr Macharia should not only reverse this illegal and immoral decision if, indeed, it has already been made, but also implement measures to fully operationalise the existing mental health legislation. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, December 16, 2013

Stop playing games with Kenyans’ lives

By Lukoye Atwoli
Sunday Nation 15 December 2013

Last week, health workers declared a nationwide strike. This was the culmination of several weeks of activity and engagement that was largely ignored by the responsible authorities. Even without being in Kenya, one could easily have predicted the course this industrial action would take.

First, the health workers would begin complaining about things they felt strongly about. They would write to the responsible authorities and try and engage them in attempts to find a solution to the problem. The authorities would studiously ignore them, or alternatively call “consultation” forums in which they would read the riot act to the workers, informing them that their demands were unreasonable, or illegal, or even unconstitutional.

The workers would insist that their grievances are genuine, and the government would hold fast to the position that the strike was unnecessary. Eventually, things would come to a head and the workers would go on strike. The government would let the strike fester for a day or two, perhaps hoping that the strikers would tire or “come to their senses” somehow.

After waiting in vain for a change of heart, the government would go to court seeking to declare the strike illegal. As a matter of course, the courts would oblige and declare the strike illegal, or issue some form of injunction or other. This would be done late on a Friday evening, or on the eve of a public holiday, so that there is no time for the striking workers to appeal the decision. 

Spirit of give and take

For a while, the workers would ignore the orders, until the government agrees to come to the negotiating table. After several hours of frenetically paced talks, an agreement would be reached and a return to work formula announced to the public. In the spirit of give and take, the workers would gain some benefits, and the government would save face.

Unfortunately this pattern is repeated every time there is a problem in any labour sector. More tragically, it is allowed to happen in the crucial health sector, where every minute of industrial action puts lives at risk. The government, under the labour laws, identifies health as an essential service in which strike action is prohibited, but provides little recourse for aggrieved workers in the sector.

This provision unfortunately gives the minister (in consultation with the National Labour Board) virtually unfettered powers to declare any service an “essential service”, in effect denying workers in that sector their constitutional right to strike. This often emboldens employers who neglect workers in the sector, safe in the knowledge that they cannot withdraw their services.

The best illustration of this scenario is the health sector. Apart from being hobbled by the Hippocratic Oath that puts the life of patients above all other considerations, the health sector is also declared an essential service in which strikes are prohibited. As a result, health workers have been virtually reduced to superintendents over death and suffering they can do little to assuage. This situation has only marginally improved in the recent past with the emergence of health workers’ unions that have agitated both for their own welfare and that of their patients.

The government needs to realise that we cannot continue playing Russian roulette with the lives of Kenyans. A healthy health workforce guarantees a healthy population, and that should mean something to those in power. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Sunday, December 1, 2013

Prayer will not help prevent calamities

By Lukoye Atwoli
Sunday Nation 01 December 2013

As we come to the end of the year and the beginning of the holiday season, we are once again confronted by the spectre of deaths on our roads, in our homes and on our streets. Road crashes have increased exponentially, and daily we are bombarded by news of yet another “grisly” collision that leaves many dead and dozens injured.

Violent crime is also on the rise, and hospitals across the country are finding that they have to develop expertise in dealing with gunshot injuries. Carjackings resulting in fatalities are now commonplace even in relatively rural hamlets. Kidnappings and muggings, often with fatal results, are also increasing in frequency.

Daily, people are killing each other for such flimsy reasons as “she touched my genitals, so I had to kill her,” as was reported recently in the press. The alleged culprit had allegedly dismembered his victim and slit open her abdomen, and stored the head in a basket.

Reports of young people engaging in gun battles over a garbage dump or some other seemingly “trivial” property have become the new “normal” news, as are incidents in which these same young people kidnap women and sexually assault them for sport.

In all our endeavours, we have degenerated into monstrous robots that seem obsessed only with “making it” in life, without regard to the welfare of those we leave behind. Our leaders in all spheres have not offered a good example, either. From political leaders facing all sorts of charges in court, to business magnates who break all possible laws with abandon, we are caught between a rock and a hard place.

Religious leaders, many of whom engage in questionable practices, are now weighing in with their usual rhetoric. “We must pray more,” they intone. They argue that we are facing the present calamities because we have displeased one deity or the other, and we must take steps to appease these beings or else face inevitable destruction.

As a result, we opt to address the madness with a healthy dose of prayer and dedication to our favourite deity, while leaving the conditions that led to the death and destruction intact. We have had religious leaders congregate at the scene of multiple road crashes to pray that a supreme being intervenes and stops the carnage. Many times these prayers are attended by senior government officials, some of them in charge of road safety. The irony of taking part in prayers meant to shift their responsibilities into the spiritual realm is often lost on them.

Similarly, after the Westgate terror attack we held national prayers attended by all top government leaders, and asked for supernatural protection against future attacks. We have since moved on and forgotten to deal with the weaknesses exposed in subsequent investigations.

Prayer does it for us. It helps us absolve ourselves and the governments we elect from all responsibility in dealing with problems. Prayer is our national disaster management and prevention plan. Prayer is our refuge, our shield against evil global and local forces that would stand in the way of our prosperity as individuals and as a nation.

Unfortunately, as long as we do not take concrete steps to deal with the threats to our safety and security, no amount of prayer will keep us safe. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, November 25, 2013

Why true reconciliation remains a mirage

By Lukoye Atwoli
Sunday Nation 24 November 2013

Last week at a meeting in Pretoria evaluating peace and reconciliation processes across the continent, I had the opportunity to reflect upon the role of trauma in conflict and reconciliation.

Kenya is a prime example of a country that has recently had major civil upheaval, exposing many citizens to extremely traumatic events. Today, many, especially politicians, are parroting the mantra that people have reconciled and are living together in peace and harmony. The Jubilee political coalition is touted as evidence of this.

In the parlance of conflict studies, one would term the method employed in managing our post-election violence as having succeeded at arriving at a negotiated political settlement. While this was a good outcome, it by no means constituted reconciliation. What happened was a suspension of hostilities while, hopefully, more lasting solutions were sought and implemented.

Research has indicated that trauma management and reconciliation are so intertwined that one cannot realistically hope to succeed in implementing one without the other. Unfortunately, many past efforts at reconciliation in this and other African countries have been similarly focused on settling conflicts by dealing with the competing interests, and convincing the combatants that they cannot do without each other.

Little effort has been focused on true reconciliation, whose aim is to effect a change in how people identify themselves, removing the need to negate the hated “other” as a core part of self-identity. True reconciliation facilitates the development of a positive communal identity independent of the need to demonise others, and the acknowledgment of the others’ humanity and right to exist and have competing narratives about common events.

In my presentation at the Pretoria meeting, I argued that traumatised individuals are at increased risk of getting traumatised again, and of perpetrating traumatic events on others. Unaddressed trauma tends to create a spiral of repeated conflict, making it near-impossible to intervene without addressing the trauma effects. Further, although they are most in need of reconciliation, traumatised individuals are unlikely to openly welcome interventions due to their suspicious nature.

Interestingly, societies or communities that have suffered long-term conflict often behave in the same manner as traumatised individuals. They are more likely to be insular and isolated, suspicious of strangers and ready to react with violence at the slightest provocation. They are also likely to experience internal conflict and upheaval as the members recalibrate their own views on the nature of human interactions.

These communal reactions are often enhanced and magnified by leaders who often have been at the heart of the conflict and have been perhaps more intimately affected by it than those they lead. The result is that the population is afraid to second-guess their “liberation heroes” who, in turn, are afraid to acknowledge their possible psychological frailties.

The obvious outcome is that possibly traumatised leaders make erratic decisions that increase, rather than ameliorate, the risk of conflict. The populace applaud and unquestioningly follow the leader. Reconciliation initiatives cannot thrive in such an environment.

Future conflict interventions must build in principles of reconciliation along these lines, and also deal with the needs of traumatised individuals and populations. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Friday, November 22, 2013

How to resolve crisis in the health sector

A late post on this blog, but...

By Lukoye Atwoli
Sunday Nation, 17 November 2013

A standoff looms due to a disagreement between government agencies on the one hand, and public health officials on the other, over the speed and extent to which health services are to be devolved to the counties.
Since this matter is now in court, I will not discuss the merits of arguments by either side in this standoff in any detail. Instead, I will rehash suggested solutions that we have advised government to implement over and over again to no avail.

First, it is impossible to stop the train of devolution much less in health services which was conceded as the prize catch for counties during constitutional negotiations. However, it is important to ensure that in meeting the constitutional requirements, human life and dignity is safe-guarded, and service is guaranteed no matter who is paying for it.

In this regard, my view is that the writers of the constitution did not intend that health services be hastily handed over to the counties regardless of their state of readiness. This is why they built in transitional arrangements to allow a phased transfer to prevent just such a crisis.

Second, the extent of devolution of health services is open to interpretation. How far does policy guidance by the national government go? Does it include policy on human resource management? Does it include regulation of the health professionals? The answer to these questions is an obvious yes, given that no county can carry out these functions.

This being the case, one may argue that due to the scarcity of the human resources for health, the national government must be involved in its distribution in order to ensure that all Kenyans have equitable access to healthcare all over the country. This function cannot at this time be ceded to the county governments.

For instance, it is currently estimated that there are about 0.14 doctors for every 1,000 Kenyans against a recommendation of one doctor per 1,000. If Nairobi County, with a population of about three million people, were to be free to hire all the doctors it needs, it would hire the entire public complement of about 3,000 doctors, leaving none to be shared by the other counties! The same problem obtains for other cadres of highly skilled health workers.

It is, therefore, very dangerous for the national government to leave each county to its own devices, given the resource constraints that preclude making each county attractive to health workers. Further, even if all counties had enough money to hire all the doctors and health workers they need, we would need to import almost 40,000 more doctors and hundreds of thousands of other health workers in order to attain the recommended ratio. The numbers currently in the country would simply be insufficient to supply all needs.

The solution lies in devolving most of the healthcare services to the county, but having a national body to organise registration, recruitment, deployment and remuneration of these scarce human resources for health. Such a body, in the form of a Health Service Commission, has been postulated countless times, and perhaps the time has come for central government to implement this recommendation and end the unnecessary health care crises. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, November 11, 2013

Why Kenyans have reason to be afraid

By Lukoye Atwoli
Sunday Nation 10 November 2013

For the past few weeks, I have been experiencing a nagging feeling that something is just not right in this country. In the beginning, I had no idea what was behind this feeling apart from the fact that our top leadership was saddled with enormous “personal challenges” in a foreign court as they struggled with questions of governance. Then a series of events began unfolding that clarified matters somewhat.

An angry Parliament passed a motion calling on the government to introduce a Bill to repeal the International Crimes Act and pull us out of the Rome Statute that established the International Criminal Court. A time frame was given for this, but this has since lapsed without much indication of progress on this process. But a warning shot had been fired — the ruling coalition would steamroll anyone who stands in the way of their quest to totally control the State.

Then a series of legislative gems followed, with the most evocative one being the VAT Act whose net effect was to raise the prices of basic commodities. After a public uproar and demonstrations, government appeared just at the right moment to save Kenyans from the effects of this legislative misadventure. In the best Machiavellian tradition, some minor functionaries took the flak while the rest of us moved on to the next big thing, as we are wont to do.

Soon after the Westgate mall attack, a chorus of enforced patriotism emerged from among the staunch supporters of the ruling coalition. Anyone who criticises the government is today labelled unpatriotic, negative and even a saboteur of government efforts to develop the country.

As the praise-singers reached a crescendo, Parliament pulled yet another surprise — an amendment to the ICT Bill that set limits to media freedom and threatened huge penalties for infringements. The tribunal created to implement the punitive measures was proposed to be top-heavy with political appointees whose main task would be to ensure that all media toe the government line.

In the resulting commotion with media freedom themes, Parliament once again sneaked in a piece of legislation aimed at reining in non-governmental organisations. A particularly nefarious section of the Bill required that NGOs ensure that no more than 15 per cent of their income comes from foreign sources. The aim, of course, is to completely paralyse this notoriously defiant segment of our population.

Meanwhile, the Inspector-General of Police seems to be acquiring absolute power over the domestic security apparatus, with little or no civilian oversight. Independent commissions have been crippled by the Executive’s failure to replace commissioners whose terms have expired. The Executive has been making extra-legal appointments with the active connivance of Parliament, and recent moves concerning the Lands cabinet secretary amount to little more than window-dressing.

The net effect of all these moves is to concentrate power in the hands of the Executive, emasculate dissenting voices and return the country to the era of Moi’s monolithic monster. This may look like a good thing to those in power but, as sure as rain, it always leads to disaster in the long run.

The Jubilee government must learn from history and remember that entering a sword fight with hands firmly around the sword-blade is a sure ticket to amputation.

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Friday, November 8, 2013

We must take responsibility for our actions

By Lukoye Atwoli
Sunday Nation 03 November 2013

Last week I came across something on social media that really illustrated the Kenyan thought process with such clarity that it blew my mind. After a road crash involving a public service bus and a train, someone, presumably associated with the ownership of the bus company, posted what passed as an attempt at exonerating the driver and company from any blame.

This individual wrote that the “bus was not driven carelessly” but only “got stuck” on the railway line. In his view, it was wrong to place blame on the bus driver or management of the bus company, and he ended up insinuating that the police and others in authority had slept on the job for not stopping the bus before it got to the railway line.

I got very angry when I read the response but, after some contemplation, I gained an insight into where the writer of the “explanation” was coming from. In Kenya, as in many parts of Africa I have had the privilege of visiting, we seem to have developed a culture in which taking personal responsibility is alien. A psychologist would describe us as individuals with external loci of control whenever it comes to most events.

In our world, events always have an external causation or just happen on their own. For instance, when a small child plays with some chinaware and happens to drop the item and break it, she will explain that the “plate fell down and broke”, rather than looking at her own role in the whole affair. This is replicated throughout our public interactions.

Today, we are almost unanimous that the 2007/2008 post-election violence just happened, and we should just bury our heads in the sand and forget about that nasty period in our history. The frequent road crashes (not accidents!) that happen on our roads have no causative agency. They just happen and, unfortunately, result in massive loss of lives annually. 


Poor leadership in this country also seems to be imposed upon us by forces beyond our control, which is why we keep lamenting about it but doing nothing active about it. Periodic famines that predictably follow food gluts are obviously also beyond our capacity to deal with, and a few prayers should do the trick.

It is not unheard of to hear a senior government official in this country blaming “the government” for one thing or other, even for shortcomings in his own docket. This attitude explains our regular “naomba serikali itusaidie” (begging the government to help) attitude, even when the solution is staring us straight in the face.

A combination of this helpless attitude, and the supplication to our respective deities in the face of adversity, has resulted in a society that can never get anything right. Nobody has the motivation to set things right if they don’t feel responsible for them.

However, the moment everyone recognises that they are responsible for events in their environment, and that nothing truly happens by accident or by supernatural agency, they become more proactive in dealing with potential threats.

Unless we change how we explain events for which we are responsible, we are doomed to continue suffering under what we think are forces of nature when, in fact, we have the power and ability to deal with them. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Leaders must speak the truth at all times

Apologies for late posting. I was traveling and I've only just returned to Eldoret!

By Lukoye Atwoli
Sunday Nation 27 October 2013

From the utterances of Kenyans in positions of leadership, it is very clear that we have come to a time when the “uta do?” phenomenon rules. Obviously, our leaders have lost all respect for us, perhaps because we have in the past demonstrated our propensity to shout ourselves hoarse and then go back to our daily routines.

After the Westgate attack, our military chiefs insisted that the soldiers involved in the response did not engage in any acts of looting, despite video evidence to the contrary.  Later, the Chief of the Defence Forces, Julius Karangi, had the temerity to suggest that soldiers caught on camera with paperbags full of loot were actually carrying water to quench their thirst! The insinuation here is that it is okay to loot a supermarket if you happen to be thirsty, no matter what else is going on.

The saga in the Judiciary involving the Judicial Service Commission and its Chief Registrar further illustrates the amount of disrespect Kenyans are being subjected to by those in positions of authority. 


Each of the parties involved in the saga have their own story, which contradicts that of the other. Obviously someone (or both) in this case is not telling the truth, for whatever reason.

Throughout our history, the organs of state have gradually perfected the art of peddling falsehoods, often citing the amorphous justification of “state security” to obfuscate on issues that should be in the public domain. Perceived adversaries of the State have been killed and extrajudicial executions taken place.

Although State operatives may have “good” reasons for the decisions they make, they must consider the fact that among the citizens there are those that will see through the tissue of falsehoods they put out. And once government is caught out telling falsehoods, it becomes difficult for the discerning citizen to believe anything else coming from officialdom.

Sadly, this has now come to pass concerning the Westgate affair, with multiple conspiracy theories being spun all over the country. It would be a sad day when we cannot all come together to deal with national crises of this nature because we do not trust the official version of events. 


The situation is now so bad that we are speculating about a link between recent episodes of insecurity in the country and a wider geopolitical scheme aimed at influencing the outside world one way or the other. Obviously, one must remain sceptical about such theories because, if true, then the Kenyan experiment at statehood would have come a cropper.

Additionally, if it were true that State officials are involved in schemes aimed at causing insecurity and killing unwitting people going about their daily lives, treason trials would be on the cards. And if any of them hold positions in government, they would, at least in a civilised society, not be allowed to continue holding such positions.

It is, therefore, imperative for the survival of our State that we take matters of state more seriously, and maintain honest communication at all times. If State officials are unable to adhere to this standard, it is up to Kenyans to refashion the State in a more desirable image.

Allowing the State to be captured by peddlers of falsehoods would be the greatest mistake we can ever make in our short republican life. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Tuesday, October 22, 2013

Disbanding cohesion team not a solution

By Lukoye Atwoli
Sunday Nation 20 October 2013

Kenya is a relatively young member of the community of nations, having become an independent republic about half a century ago. Fifty years, in the normal lifespan of a nation, is not enough time to accomplish earthshaking things by any stretch of the imagination. Survival is often the only preoccupation of such an infant republic.

Although socio-political commentators, including this column, routinely criticise the leadership and citizenry of this country harshly, we must acknowledge that Kenya has done a pretty good job at surviving turmoil over the past 50 years.

We survived the intrigues and political murders of the Kenyatta years, the coup attempt against President Moi in 1982, and the subsequent crackdown on dissenters and intellectuals. We survived the transition from a single party dictatorship to a multi-party system, and the handover of power from President Moi to President Kibaki.

We survived the laissez-faire years of the Kibaki administration, culminating in the defining moment of our nationhood, the 2007 elections and the ensuing civil strife. We survived the dysfunctional coalition government of Kibaki and Raila Odinga, and this year’s General Election and subsequent installation of Uhuru Kenyatta’s government.

It is important to note that we did not survive all these events and periods because of any conscious effort on the part of the State to ensure that we did. We survived only because of our multiplicity of talent, our resilience in the face of adversity, our ability to ignore our differences when our needs coincide. Perhaps we even survived because of our ability to, at least superficially, accept whatever happens to us and move on.


After the 2008 violence, those involved in resolving the crisis agreed to take measures to ensure that such violence never visits our country again. They identified poor ethnic relations to be one of the driving factors behind periodic ethno-political violence in our country, and in order to deal with this once and for all, they established the National Cohesion and Integration Commission.

Its mandate was broad, and included ensuring that national resources are distributed in a manner that minimises discrimination and promotes integration. The commission was also required to promote ethnic and racial harmony in the country, spearheading legislation outlawing hate speech and encouraging more cohesive communication in the public sphere.

An audit of the commission’s performance would obviously return mixed results.

The fact that it lasted as long as it did is itself a success in this brutally individualistic society whose members are known to bend the law past its elastic limit just to see how much they can get away with. Of course Kenya remains hugely segmented on ethnic lines, but one could not have expected the commission to reverse this phenomenon single-handedly in a few short years.

My view is that if Kenya remains fractured on ethnic grounds, it is their own fault, their leaders included. We cannot use the commission as a scapegoat and hope that our terrible ethnic relations will right themselves somehow. (READ: MPs plan to disband ‘failed’ cohesion team)

The best option is to do a better job at selecting the commissioners and staff and to clarify their mandate to ensure that we build on past gains and learn from our mistakes. Disbanding the commission is the equivalent of throwing out the baby with the bathwater! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, October 14, 2013

Why ‘miraa’ debate is purely political

By Lukoye Atwoli
Sunday Nation 13 October 2013

Kenya is a very interesting country. Most citizens will argue about almost anything, which is a healthy and good thing, especially if the arguments are backed by evidence that follows the precepts of logic. Unfortunately, we tend to hold opinions and defend them strongly without much independent evidence. We mistake strong feelings for strong evidence, and dismiss any piece of information that contradicts our already formed positions.

Sadly, this is the case with the ongoing arguments about khat, or miraa. Misleadingly, the argument has been framed as an attempt to answer the very straight-forward question: Is miraa (or does miraa contain) a drug? Subsequent arguments have laid bare the real question being answered, which is: Should miraa be considered a dangerous drug, and be restricted or banned? (READ: Kenyan leaders and farmers challenge miraa ban in UK)

These are obviously two different questions, and attempting to answer them as though they were one and the same thing is bound to lead to confusion. Usually, the first step towards finding a solution to a problem is finding out its source. In this case, the source of the problem is the decision by some countries to ban or restrict the consumption of miraa on the basis that the disadvantages of use far outweigh any benefits.

Let us try and answer these two questions, and perhaps frame the question for argument correctly.

Firstly, is miraa a drug? The simple answer to this question is an unqualified yes! The World Health Organisation defines a drug as “a chemical agent that alters the biochemical or physiological processes of tissues or organisms”. In other words, a drug changes the structure and function of the body.

Since early in the last century, scientists have described the main active ingredients in khat to be cathine and cathinone, which are known psychostimulants that affect the structure and function of the nervous system. Khat ingestion has been shown clinically to result in symptoms similar to those induced by other stimulants, such as restlessness, garrulousness, sleep and mood changes and even psychotic symptoms. 


Indeed, doctors who have worked in areas where miraa use is widespread have numerous anecdotes of “khat psychosis”. To “treat” this condition, relatives often lock up the “sick” individual for a few days and, after the stimulant has worked its way out of the system, they are considered “healed” and resume normal functions.

More studies have described dental and gastrointestinal effects of chronic miraa use, while others have clearly described effects on the reproductive system. In short, there is no doubt in the minds of experts that miraa is a drug!

The only question that needs answering therefore is whether miraa should be considered a dangerous drug and perhaps be restricted or even banned. This is, however, not a medical or scientific question, but a political one.

The scientists must honestly tell the politicians the scientific effects of miraa on the body of the user, which are well established and require no further study. The politicians should then determine whether, in their own opinion, those effects are sufficiently harmful to the physical, psychological, and social well-being of the population to warrant legislative action.

Lawmakers in a number of other countries have made this determination and taken action restricting or banning miraa use. The miraa debate is thus purely political, and has no bearing on whether miraa is a drug or not! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Sunday, October 6, 2013

From leaders to the lowly, all love to loot

By Lukoye Atwoli
Sunday Nation 06 October 2013

In the wake of the Westgate terror attack, revelations are being made by shop owners of a massive looting spree that took place during the siege. In one video posted online, a restaurant is shown with empty beer and spirits bottles strewn on all available surfaces. Heavy losses of jewelry, electronics and cash have been reported by proprietors at the mall.

As usual, these revelations have been greeted with indignation and a collective cry of “shame! shame!” Kenyans have even called for the indictment and sacking of those involved in the looting, including officers affiliated to the Kenya Police Service as well as the Kenya Defence Forces. All this is as it should be in a civilised society where stealing is strongly discouraged and all citizens are on the lookout for anti-social louts.

So the more relevant question to ask is this: Is Kenya a place where such behaviour is discouraged? In order to answer this question, one has to examine the behaviour of regular citizens by observing how their heroes behave. It is perhaps pertinent to first interrogate who our national heroes are.

Most of our acknowledged national heroes are politicians, and with very few being private individuals who overcame some sort of adversity to do something for Kenya. Almost none are paragons of virtue, and many have stolen public property, engineered killings of opponents, mismanaged public office, and generally just behaved obnoxiously.

Further, our national story is anchored on the narrative of the pre-independence freedom struggle. Two things stand out in this narrative.

First, it largely ignores the real protagonists in the freedom struggle, and replaces them with politicians whose role was largely to generate more heat than light, to pontificate in the public spaces while the real fighters endured cold nights in the jungle and faced real bullets and machetes. The politicians were the chief beneficiaries of political independence, and a cursory look at who-is-who in our economy clearly demonstrates this.

Secondly, the use of this violent insurgency to anchor the Kenyan story is itself problematic. It has resulted in a society that believes that there are few legitimate means to gain political power and that ultimately, force and subterfuge must be and are often employed in this quest. This has led to a scenario where it is difficult to accept that anyone can win an election legitimately, and of course every election outcome is vehemently disputed, often leading to violent confrontations.

The result is that we end up electing people of questionable behaviour into public office, with the occasional murderers and violent robbers sneaking in as well. These then become our national heroes, the centrepiece of our national narrative. Their first action upon assumption of office is to survey the landscape for anything that can be “liberated”, and the second is to agitate for improved terms and conditions of service for themselves.

Where then do we get the self-righteous indignation to condemn the looters who burst onto the scene of a terrorist attack and happened upon unguarded jewelry, electronics, and money, and decided to “liberate” these goodies? How can we condemn those that chose to partake of free drinks during a lull in the fighting, when our airwaves are full of offers of one free thing or another?

Aren’t we all just a bunch of pathetic hypocrites?

Dr Atwoli is a Consultant Psychiatrist and Senior Lecturer at Moi University's School of Medicine.; Twitter @LukoyeAtwoli 

Monday, September 30, 2013

For once, let us learn from this tragedy

By Lukoye Atwoli
Sunday Nation 29 September 2013

The siege at Westgate Mall in Nairobi’s Westlands suburb is over.

As I write this piece there is still no clear picture of how many people died in this terrorist attack. It is also not clear how many attackers were involved, and what happened to them. Towards the end of the siege a section of the mall collapsed, complicating recovery efforts and making it extremely difficult to know the eventual fate of those that were in the building at the time.

During the attack, Kenyans demonstrated their strength in ways that nobody could have expected. Ordinary citizens found ways of contributing to the rescue and recovery, in all sorts of ways. Some prepared food for the responders; others donated blood, while even others volunteered to take care of the immediate needs of the survivors.

Many Kenyans converted their vehicles into ambulances and took the injured to hospitals, while others braved the hail of bullets and grenades and went into the mall to save trapped civilians. This attack has brought us together, and helped us to momentarily forget our political and ethnic differences in the face of attack by a foreign terrorist organisation.

No one paused to ask the tribe or status of the person they were helping. People were not taken only to hospitals run by people who share their political or religious views. For a moment, we were simply Kenyans again. 


Despite the show of unity, however, questions about how the attack was handled abound. One expects that investigations will be diligently carried out to get to the bottom of this atrocity. Initial indications were disconcerting.

For instance, there seemed to be no overall co-ordination of the government response to the attack.
Information was being provided by different government agencies and officials and sometimes they contradicted each other.

During a disaster, the first and most important need is information. There ought to be an authority to inform the public regularly of the progress being made to deal with the crisis. Involved citizens often only want an assurance that everything is under control and that they are safe from further attacks. They want regular updates on the progress of rescue and recovery, from a source they trust has the correct information.

In our case, the government was initially too quiet for too long, and when they started talking to Kenyans, they gave information that often contradicted the actual situation on the ground. In a disaster, it is often better to say that it is not clear what is going on, than to make up stories that will later be revealed to have been untrue.

Despite the fact that we have had many such disasters in the past, it seems that we are incapable of learning simple lessons from such events. Due to the high profile of the Westgate attack, one hopes that we will, for once, learn a few lessons that will make it more difficult for similar attacks to happen, and improve our response should they happen.

We must also begin to implement the many disaster management strategies and plans that are gathering dust on the shelves of various government offices after lots of resources were expended in producing them. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, September 23, 2013

PEV psychological wounds far from healed; And now #WestgateAttack

Friends, I wrote this article for the Sunday Nation before the Saturday attacks at Westgate Mall in the Westlands surburb of Nairobi. It was subsequently published on Sunday, in the paper that contained the relatively insensitive cover picture that elicited an apology from the Nation Media Group after a social media uproar.
I upload it here for two reasons.
Firstly, I use this space to share my 'Barometer' column with my readers who may not have access to the paper for one reason or another, or prefer using social media links to get it.
Secondly, and perhaps more importantly, I think it is particularly instructive, insofar as it stipulates some of the prerequisites for healing of psychological wounds such as those inflicted on our countrymen and women before and in 2008, and again, now in September 2013.
I wish to express my deepest condolences to all families that have lost loved ones in this tragedy, and hope that what we take away from here is the resolve to take measures to ensure that it becomes exceedingly difficult for anyone to plot and carry out attacks on Kenyan soil ever again.
May you find support and healing in these difficult times. As we say in these parts, 'Tuko pamoja', or #WeAreOne
By Lukoye Atwoli
Sunday Nation 22 September 2013

The opening of the trials of Kenyans accused of crimes against humanity at the International Criminal Court (ICC) at The Hague has rekindled painful memories among many survivors of the 2008 post-election violence. While many Kenyans are watching the trials with different motives depending on their political leanings, for the survivors this was the last recourse in their search for justice.

The media has highlighted reactions of segments of our society and in my view, provided a window into the soul of our nation. There are those that hold that some of the atrocities being mentioned at the ICC never occurred, and that the trials are a political attempt at humiliating Kenyan leaders.

Obviously, everyone is entitled to their own opinion. But, as an American leader once said, nobody is entitled to their own facts. The reality is that in 2008 Kenyans went on an orgy of violence that left over a thousand dead, and thousands displaced from their homes. We all saw the burning buildings, the machete-wielding militia, the bow-and-arrow brigades, policemen shooting at protestors and politicians shouting epithets at each other.

As medical doctors, we personally attended to dozens of survivors with physical and psychological wounds, and organised a mental health and psychosocial response that reached tens of thousands. We escorted bereaved relatives to mortuaries and helped them identify their kin, providing psychological support to those that needed it.

It was a tough time. At some point we thought that the country had finally jumped off the cliff, and that recovery would take more effort than we were capable of marshalling as a country. Luckily for us, international mediators took it upon themselves to break the impasse, resulting in the grand coalition mongrel that ruled us for five years before the elections early this year.

It is therefore disturbing to hear some Kenyans argue that we have since reconciled, and that we should simply move on because all is well in the political sphere. In my opinion, it is only those that are far removed from the actual victims that are capable of making such callous statements.

Healing psychological wounds cannot be legislated or ordered by the powers that be. It is a process that takes time, and depends heavily on a secure enabling environment. Just like with physical wounds, an enabling environment for psychological healing has certain indispensable elements.

Firstly, it is pervaded by a sense that something wrong was done, accompanied by true, deep remorse on the part of the perpetrators. Secondly, there is a sense that justice has been done, and that some attempt at restitution has been carried out. Thirdly, there is a collective agreement that the atrocities must never be allowed to happen again, and tangible early intervention measures have been put in place to deal with them should they recur. Finally, provision of long-term care to those survivors who need it is a sine qua non of a healing society.

From where I sit, I cannot honestly say Kenya provides such a secure enabling healing environment for survivors of past atrocities. We are still at a place where a slight misunderstanding could spark an all-out conflagration that will make 2008 look like New Year’s Day fireworks.

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

Monday, September 16, 2013

We should pay attention to mental health

By Lukoye Atwoli
Sunday Nation 15 September 2013

Whenever government makes plans on health, whether at national or county level, technocrats focus on the conditions that result in the largest numbers of deaths at that level, the so-called top causes of mortality.
Obviously, this is an important approach aimed at reducing unnecessary deaths in the population before embarking on improving quality of life.

Over time, therefore, we are supposed to witness less preventable deaths, ensuring that a sizeable healthy population is available for national development. Government health reports are therefore likely to contain information on such killers as HIV-related conditions, diarrhoea and vomiting in children, malaria, respiratory infections and trauma. As long as the data collected is accurate, it is a useful planning tool.

The data on mortality however is grossly inaccurate, leading to problems in identifying and planning priorities. Mental illnesses are rarely cited as causes of death, leading planners and citizens to believe that mental conditions cannot cause death. This is a fallacious assumption that needs to be laid to rest.

How do mental illnesses kill?

Firstly, the final common pathway for most severe mental disorders is suicide. This week, the world marked the global suicide prevention day on Tuesday. According to the World Health Organisation, most people who attempt and commit suicide suffer from severe mental illnesses that thus increase their risk of suicide. Conditions such as major depressive or bipolar disorders and schizophrenia are leading causes of suicide, though major life stresses too can cause one to contemplate suicide.

Unfortunately, even when it is obvious that a person died from suicide, this information is hardly ever indicated on death certificates and other health documents. One is therefore unlikely to find any serious statistics on the rates of suicide in this country, causing policy-makers to ignore this important cause of death especially among the youth and the elderly members of our society.

Secondly, another major cause of death in this country is through road traffic crashes. Although we do not have much research evidence, it is plausible that many drivers involved in these crashes suffer from mental disorders that alter their thinking and concentration to such an extent that they become dangerous to other road users. Conditions such as drug abuse and dependence, attention deficit hyperactivity disorder, impulse control disorders, and even depression and bipolar disorders could impair an individual’s ability to drive safely when untreated.

Once again, programme planners rarely associate these problems with mental disorders, leading to fragmented planning that does not take into consideration the root causes. The misconception that mental illnesses are benign conditions leads to neglect of the mental health sector, with nationwide implications.

Many people have the misconception that mentally ill individuals are very easy to identify. It is as if mental illness gets inscribed on the patient’s forehead! The truth of the matter is that only a small fraction of mental illnesses present with dramatic behavioural symptoms that are obvious to all observers. Most of them suffer in silence without anyone knowing about it.

Mental illnesses kill, and their prevention and treatment actually saves lives! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.; Twitter @LukoyeAtwoli

Monday, September 9, 2013

Consequences of withdrawing from the ICC

By Lukoye Atwoli
Sunday Nation 08 September 2013

The past few days have seen frantic activity for the top echelons of our government. At the top of the executive arm of government, the nation’s leaders are due to appear at the International Criminal Court at The Hague to answer charges related to crimes against humanity. Legal and political decisions have to be made to safeguard their best interests in these difficult times, and one could imagine the frenzy of activity on multiple fronts that is needed just to maintain the status quo.

Happily for Kenya, since their election the president and his deputy have never suggested that the trials at The Hague are state affairs. During the campaign, the president indicated that the case is just a personal matter that he will continue handling at that level even after occupying State House. The deputy president, on his part, assured the ICC, “without fear of contradiction,” that he would continue to cooperate with the court even if he is elected into office.

Amazingly, though, our parliament has just realised that the ICC is an imperial structure and that Kenya must withdraw from its jurisdiction as soon as it is practicable. Despite their vehement denials, the move is obviously informed by the predicament facing the president and his deputy. Members of Parliament are fulminating about our sovereignty and the unconstitutional gap in the executive should the two leaders happen to be away at the same time.

It is general knowledge that no matter what decision is made by our parliament or any other body, the cases facing our national leaders will only be won or lost at The Hague. No amount of pontificating and threatening will terminate the cases outside of the legal processes provided for in the relevant statutes.

There is only one cause to worry, and this touches on the implications of a decision by Kenya’s parliament to repeal the International Crimes Act and withdraw from the Rome Statute.

Any decision made by parliament at this time will only apply to future possible cases of crimes against humanity and related cases. What this means is that if in future Kenyans decide to go berserk and butcher each other again on the same scale as we saw in 2008, there will be nowhere to turn.

Withdrawal from the Rome Statute will mean that when the current politicians are voted out of office, and we, in our wisdom, elect a bloodthirsty kleptomaniac to be our leader, there will be no safe haven for them if this leader decides to hound them because he doesn’t like how they roll their R’s. With our weak judicial systems and lack of legislative oversight over the executive, this is not a far-fetched scenario.

It will therefore behove our political leaders to think more seriously about the decisions they are making today, keeping in mind that some of them are already suffering the consequences of the decisions they took before dissolution of the last parliament. Many current senators, who were in the last parliament, short-sightedly voted to emasculate the Senate, and are now crying bitterly about the depleted roles the organ now has.

Removing ourselves from the jurisdiction of the ICC at this time is a risky venture, even to the governing elite themselves. As the song goes, life has a funny way of sneaking up on you when you think everything is alright!

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.; Twitter @LukoyeAtwoli

Sunday, September 1, 2013

We need a Kenyan narrative to ensure unity

By Lukoye Atwoli
Sunday Nation 01 September 2013

This past week, during a training workshop organised by the National Cohesion and Integration Commission, we explored the theme that conflict is often a product of dysfunctional communal narratives that magnify the role of “others” in causing trauma or “marginalisation” of the community.

A common narrative is a key prerequisite for the maintenance of a cohesive community. Each community creates such a narrative based on real events, exaggerations of actual events or even mythical events that never really happened.

In our case, each of the ethnic communities that make up the country has a narrative that magnifies all the good things about them and has something negative to say about all neighbouring and some distant communities. This is not unique to our country, and is a common feature of communities everywhere.

These narratives are the source of the ethnic stereotypes we carry around, and most members of a community never question their community narrative. They accept it and use it to make important decisions about their own lives, and to decide who to interact with in important areas of their lives. Unfortunately, this is often also the driving force behind the many conflicts we have in this country.

To understand this concept of community narratives and their impact on conflict, one needs only look at how different communities explain the 2008 post-election violence. Having interacted with many members of different communities affected by this violence in the North Rift, I came across several different, often opposing explanations.

Some members of one community argue that they are a chosen people who will prosper no matter what. They liken themselves to the biblical Israelites who underwent much suffering on their way to the Promised Land. The 2008 violence is conceptualised as part of this narrative, and envy among other “lazy” communities is thought to be the main motivation for the supposed ethnic targeting.

Others have argued that since before independence, their land and property has been systematically alienated and given to “foreigners” while the rightful owners suffer with the little land they have been left. According to them, successive governments have conspired with these “outsider” communities to continue with this unfair system, and any legitimate attempt at reclaiming the land has failed. They argue that eviction of these “outsiders” is therefore justified in order for the community to reclaim their land.

An alternative narrative argues that post-election violence was a spontaneous reaction to a “stolen” election. According to them, there is nothing more to be read from the event, and any claims that the violence was pre-planned are derisively dismissed.

Of course it is not possible that all these and other opposing narratives about the same event are equally true. What is however surprising is the confidence and tenacity with which these beliefs are held and expressed. Every narrator expects that the listener is aware of the “obvious” facts he states!

The missing link in all these, therefore, is the Kenyan narrative. What is the “Kenyan” perspective in all this? Was it a temporary stop on our journey towards a more cohesive nationhood, or is it evidence of failure of the project? Creation and maintenance of a national narrative is the task that nation-building institutions must tackle urgently if we are to have any hope of peaceful co-existence in our time. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine; Twitter @LukoyeAtwoli

Sunday, August 25, 2013

Nothing new in religious healing claims

By Lukoye Atwoli
Sunday Nation 25 August 2013

The revelation in the past few days that some evangelists are actually conmen seems to have stung many people who believe that their pastors are “legitimate”. Many Kenyans are feigning surprise that at least some of the pastors peddle fake miracles and promise prosperity in exchange for “seeds” planted in the form of cash transfers to the clerics.

A group of “genuine” evangelists has now emerged to challenge these so-called “fake” pastors, claiming to have a checklist that can separate the wheat from the chaff, as far as miracle healing is concerned. They claim that “genuine” miracle healing can occur, but it is based purely on “faith”, and the healer does not ask for money in exchange for the healing.

Sadly, however, the “genuine” pastors do not provide any evidence of this type of faith healing, and end up only sounding like more conservative versions of the con pastors. By not denouncing the notion of “faith healing”, they keep the unrealistic expectations alive among their flock that chronic medical conditions such as HIV, cancer, diabetes and hypertension can be healed without the active agency of experts trained in the management of such conditions.

In my opinion, the emergence of “faith healers” is just the latest manifestation of a con game that has been going on for ages all over the world. Human desire for the easy life and quick options to deal with complex problems has resulted in a gullible populace that will buy snake oil cures despite clear evidence that they will not work.

A few weeks ago, a famous “faith healer” organised a crusade in Nakuru, during which he hosted multitudes of followers, including government officials. Many sick people were removed from hospitals and taken to the venue, with the expectation of miraculous healing. Despite the multiple claims of healing at the crusade, those that really needed it went home without a cure in spite of their enormous faith.

In fact, newspaper reports indicated that some people actually died during the crusade while waiting for their faith to perform miracles. The evangelist continues to parade discredited medics at his rallies to bolster his unproven claims that prayers have healed many people suffering from HIV and other chronic conditions.

Our national hypocrisy is exposed when we condemn the greedy miracle-promising televangelists while at the same time entertaining “genuine” pastors who claim that they are agents of a higher power that cures all maladies miraculously. We are afraid of interrogating miracle cure claims because their purveyors threaten “doubting Thomases” with fire and brimstone on judgement day.

However, when lives are at risk, all right-thinking Kenyans must question these claims. We have written several times in these columns about conmen hiding behind religion and tradition to peddle dangerous ideas that result in death and disability among our people.

These warnings continue to be ignored, and every weekend all the main television channels air people of cloth making all sorts of medical claims without fear of being challenged. They are able to pay millions of shillings to be given lots of airtime on national TV, suggesting that they are making a lot more money from gullible Kenyans.

Desperate Kenyans must be protected from these people, perhaps through a government agency like the Medical Practitioners and Dentists’ Board, whose mandate is to regulate all those that purport to practise medicine. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine; Twitter @LukoyeAtwoli

Tuesday, August 20, 2013

Our habits led to flooding of Thika highway

By Lukoye Atwoli
Sunday Nation 18 August 2013

Kenyans who live in Nairobi and think the capital city is the beginning and end of Kenya were shocked last Wednesday when the flagship project of our “development”, Thika Road, was rendered impassable due to heavy flooding.

Pictures posted online showed roads that seemed to have turned into rivers, complete with submerged vehicles and people wading in knee-deep water. What many did not realise was that this phenomenon was not only restricted to Nairobi and Thika Road. Outside Nairobi, many roads regularly turn into rivers whenever it rains. The difference is that they are already hazardous due to the many craters one has to reckon with even on dry days.

It was, therefore, amusing to see some people pouring vitriol on the Chinese, who they deemed responsible for the allegedly “poorly designed roads” that provided proof of inferior techniques. Unfortunately, the evidence against Chinese builders is very weak to begin with.

First, one only needs to look at the roads built by the Chinese in their own country to understand why their engineering and construction cannot be to blame. Every direction one looks in China, there are roads more complex than any we have in this country. Thika Road would approximate the equivalent of a rural access road in comparison!

Second, the criticism of Chinese architecture loses its sting when one looks at Kenyan roads designed and built by Kenyans. They are pockmarked with potholes within weeks of completion, and the usually thin layer of tarmac is washed away within days of a drizzle. If Chinese road-builders are pathetic, then obviously ours are non-existent!

One is, therefore, justified to ask what went wrong last week leading to the conversion of this architectural masterpiece (in Kenyan terms, of course!) into a raging river.

The obvious answer is that there was a problem with drainage. On Kenyan-built roads, drainage is not an integral consideration during construction. Our builders only think about drainage whenever water pools in the craters that inevitably form a few weeks after “completion”. However, Thika Road was built with adequate drainage channels, at least in the eyes of a road construction layman like me. 


Unfortunately, soon after it was opened for use, those of us enjoying the smoothness of the road continued with our peculiar habits. We buy foodstuffs on our journeys, and when we are done with them, we throw the wrappers and any left-overs out of the windows.

Plastic bags, maize cobs, milk cartons, and banana peels -- nothing is spared in our quest to “clean up” our personal space. We subscribe to the philosophy that once something is out of sight (out of the car window in our case), it no longer exists. And if it does, it is somebody else’s problem.

A second problem is the lack of a maintenance culture in Kenya. Despite our uncouth behaviour of throwing all waste out of car windows, had the responsible authorities been regularly unclogging the drains, the problem of flooded roads would not arise. In Kenya, unfortunately, we build things and then sit back to watch them degenerate. Once this happens, we turn around and look for someone else to blame.

In this case, we must acknowledge our own responsibility for our flooded roads and leave the Chinese out of it. We cannot live first-class lives without developing first-class habits! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine

Tuesday, August 13, 2013

We have made life very cheap in Kenya

By Lukoye Atwoli
Sunday Nation 11 August 2013

Kenya is an interesting place to call home. On paper, we are a nation built on a combination of conservative religious values and African traditional beliefs — a most improbable concoction under any other circumstances. In theory, we value life and would do everything in our power to save and preserve it under the most adverse of situations. Indeed, our constitution even has an injunction that states exactly when life begins!

It is, therefore, difficult to understand our attitude towards the avoidable deaths that have become so commonplace that no editor would use them as headline news.

Sample the following stories.

A senior policeman was killed in the line of duty in Kitui a few days ago. According to newspaper reports, his was only the latest of a series of “mysterious” killings of high-flying policemen in the country. Conspiracy theories abound, linking these deaths to all sorts of nefarious activities by powerful Kenyans, but the only thing we can be sure of is that the truth will never be known.

This policeman, by the way, is said to have been the main executioner of youth alleged to belong to the outlawed Mungiki gang a few years ago. The deaths of those Mungiki adherents have also never been fully explained by the government, and remain the subject of conspiratorial whispers implicating people at high levels of government.

Last week, a man was reported to have stabbed his children and attempted to kill himself after a disagreement with his wife somewhere in Uasin Gishu County in western Kenya. An intriguing item in the newspaper report of the incident was the observation by the neighbours that the man had tried to kill himself several times in the past, and had constant quarrels with his wife over her alleged infidelity.

To my mind, that situation suggests someone in need of assistance from a mental health professional, and early intervention would probably have averted these tragic deaths and injuries. To the villagers, however, this was the work of the devil and, as one of them put it: “It seems the devil had driven him for long. At times he would be heard saying he would some day kill his wife and himself. He also had taken poison about five years ago.”

Elsewhere, some villagers gathered together to think about possible interventions to curb the rising incidents of road crashes that had claimed several lives in the recent past. Having concluded that supernatural forces were at work, they resolved to deal with the situation using prayers and “cleansing” rituals. No mention of what happens to those responsible for those deaths.

Finally, five years ago, more than 1,000 Kenyans perished in what has been christened “post-election violence”. We made noises about how horrible that period was, and how we must do everything possible to ensure it does not recur. We regretted the deaths and vowed to leave no stone unturned until those responsible had been brought to book. We chanted, “Don’t be vague, go to the Hague”, only partly in jest.

Five years on, nobody has been successfully prosecuted for those heinous crimes and, to many Kenyans, those deaths could as well be classified as self-inflicted.

Having reviewed these and many other preventable deaths in this country, one can come to no other conclusion than that life is very cheap in Kenya. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine Twitter @LukoyeAtwoli

Monday, August 5, 2013

Retain national control over health workers

By Lukoye Atwoli
Sunday Nation 04 August 2013

The health sector has been in the news once again, for all the wrong reasons. After a delay in payment of salaries for doctors, nurses and other workers in the ministry of Health, doctors threatened to “march to Afya House to look for their salaries”, while nurses have issued a strike notice due to certain shortcomings in their terms of service.

Apart from subpar remuneration, health workers have raised a raft of issues which, if addressed, would not only improve their own working conditions, but would benefit every Kenyan’s health. A key bone of contention is the move by government to operationalise the constitutional injunction to devolve certain functions to the counties.

According to Part 2 of the Fourth Schedule of the Constitution, the functions to be devolved include “County health services, including, in particular, county health facilities and pharmacies, ambulance services, promotion of primary health care …” among others.

Of course it is impossible to devolve a function without ensuring that the resources for implementing the function are available within the county that is supposed to carry it out. In this regard, the national government has indicated that soon, all health workers’ salaries will be paid by county governments, which will also run all the county hospitals and health services.

Therein lies the rub.

Human resources for health are, for the time being at least, scarce. There are not enough doctors in the public or private sector to serve the needs of all Kenyans. Although they are available in larger numbers, other cadres of health workers including nurses, clinical officers, physiotherapists, social workers and clinical psychologists are still too few to effectively address our nation’s health concerns.

It is therefore difficult to envisage a situation where a county with a health worker shortage advertises positions for doctors and gets enough applications to fill its health facilities. This was spectacularly illustrated during a doctors’ strike last year at the Kenyatta National Hospital where an advertisement for dozens of positions elicited almost no response despite the relatively lucrative nature of a Kenyatta National Hospital posting.

It is with this in mind that one would urge caution as far as devolution of health functions is concerned. It is prudent to devolve the management of health facilities, procurement of medications, primary health care functions and promotive health activities to the counties, while retaining some sort of national control over the health workforce.

Registration of health workers, setting and enforcement of standards and ethics, recruitment and deployment on secondment, discipline and even termination of service ought to be a national function, given the nature of the health professions. Due to scarcity of human resources for health, centralised recruitment and deployment would ensure that even the most remote counties benefit from access to qualified health workers and services.

To address the fear of an overbearing national government inequitably distributing this scarce resource, we have recommended a Health Service Commission to manage Kenya’s human resources for health, much in the same way as the Teachers’ Service Commission does for teachers.

A proposed Bill for the Health Service Commission has already been developed and delivered to the Attorney-General’s office.

One hopes this initiative will become a reality for the sake of our national well-being. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s school of medicine Twitter @LukoyeAtwoli

Monday, July 29, 2013

Leaders should tread softly to enhance peace

By Lukoye Atwoli
Sunday Nation 28 July 2013

Recently, President Uhuru Kenyatta indicated that one of the greatest challenges of his government will be the unification of this country after decades of ethnic mistrust with regular eruptions of inter-ethnic violence. This is obviously an admission that Kenya is a deeply divided nation, and competing socio-economic and political interests have packaged themselves with ethnic tags.

To my mind, it has been clear that this is the case since the early nineties when political competition brought to the fore longstanding ethnic animosity, erupting in the famously labelled “tribal clashes”. This culminated in the grand slaughter of 2007/2008 that introduced yet another euphemism into our national lexicon -- post-election violence.

Bringing lasting peace to this country is therefore quite an onerous task and can, indeed, consume a president’s entire term, and perhaps the full lifespan of an individual. In the event that the president has discovered a clear path out of this unenviable morass, then one can only wish him the very best in navigating through it. One would further expect a refreshingly new approach to the conduct of public affairs that inspires optimism and a sense of new beginnings.

Unfortunately the public pronouncements and activities of this government in the few weeks since its installation betray the very antithesis of a unifying force. To a disinterested observer, it would appear that all the institutions of state have conspired to drive a certain agenda that in the Moi days used to be termed “singing the same tune”.

The apparent consonance, even if purely coincidental, between the executive, the judiciary and some independent commissions such as the Independent Electoral and Boundaries Commission (IEBC) is simply staggering, as is the “tyranny of numbers” rhetoric emanating from Parliament.

The arrogant, semi-coherent pejoratives emanating from government spokesmen do little to inspire the image of a unifying government.

If President Kenyatta’s government is truly interested in leaving behind a prosperous country at peace with itself, there are certain signals they must begin sending to the citizenry. Firstly, the chest-thumping rhetoric and denigration of their opponents must stop. When leaders fight in public, even when they are only sparring in jest, their followers are left confused.

Those in power must avoid the temptation to engage every opponent in a war of attrition. Leaders must learn to pick their fights carefully, and only engage in contests that serve to further the greater national interest.  The president must, therefore, rein in his more jubilant acolytes, and prevail upon them not to present their opponents as animals unworthy of even basic courtesies and unfit to present alternative views on governance.

Secondly, government leaders must reach out more substantively to those living in areas that did not substantially support their election. The continuing perceived hostility towards regions that are in the “opposition” does not augur well for our unified vision, and will only further reduce us into pathetic ethnic enclaves.

Magnanimity, contrary to prevailing macho perceptions, is actually a sign of strength. 

Dr Lukoye Atwoli is a Consultant Psychiatrist and Senior Lecturer, Moi University School of Medicine; Twitter @LukoyeAtwoli

Friday, July 26, 2013

This fixation with sexuality is unhealthy

This was published in the Sunday Nation's Barometer column on 07 July 2013, but I did not upload it on time as I was traveling. Apologies for delayed posting, but I hope it can still be a useful discussion point!

By Lukoye Atwoli
Sunday Nation 07 July 2013

American President Barack Obama ended his Africa tour this past week, leaving in his wake varying opinions about the success or otherwise of his trip. In his own country, eyes are focusing on the business opportunities he opened up in this formerly “dark continent” that is now said to be on the rise. The discovery of numerous mineral resources across the continent is perhaps one draw for world superpowers into this continent, and Americans are arriving here hot on the heels of the more aggressive Chinese.

Kenyans, however, have for the most part been preoccupied with reasons why Obama did not visit his motherland and, indeed, whether it is even important for him to do so in the first place. As is usual in Kenyan social discourse, we shall soon move on to the next big thing, and live happily ever after. Except that we shall not be happy for long.

Already, pundits have latched onto the American President’s exhortation to African governments to decriminalise sexual behaviours between consenting adults. In this regard, many Kenyans are miffed about the talk of “legalizing” homosexuality. It is being argued that he is urging Africans to start engaging in “unnatural”, “unAfrican” and even “unChristian” sexual acts.

But what is it that the Americans are actually telling us?

In summary, we are being told that blanket criminalisation of consensual homosexual, or any other consensual sexual behaviour, results in more harm than any purported good such moves are meant to achieve. We expend lots of resources fighting individuals whose behaviour directly affects no one other than themselves. We are being asked to leave these individuals with sexual orientations different from ours alone.

Pseudo-intellectual arguments have been advanced to counter this advice from our American benefactors. “Homosexuality is unnatural,” they say.

If this is true, and homosexuality is all bad and counter-evolutionary, one would expect that this behaviour would gradually be wiped off the face of the planet in time, given that same-sex relationships do not result in any successful transfer of genetic material from one mate to the other. How does this harm those that are opposed to it and do not practise it?

Secondly, it is argued that this behaviour is “unAfrican”. I do not know what this term “unAfrican” means. At some level it is insulting as it assumes that all Africans have the same behaviour and proclivities across the continent. All the available evidence tells a different story.

Even within our borders, behaviours vary as one traverses the country from Lake Victoria to the Indian Ocean, from Loitokitok to Mandera. The assumption that there is such a thing as “African culture” must be classified in the same category as the ignorant assumption by some non-Africans that Africa is a country.

Finally the argument that homosexuality runs counter to established religious norms is the weakest, in my view. If your religion outlaws homosexual behaviour, you are best advised not to practise it yourself.

Given the threats of celestial punishment prevalent in most of the major world religions, it does not make sense for a religious person to persecute another on behalf of their shared deity. Religious leaders need only declare that among other prohibited supplicants (such as corrupt politicians, killers and liars), they also prohibit those that are attracted to same sex partners!

This fixation with sexuality is patently unhealthy! 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University School of Medicine; twitter @LukoyeAtwoli

We must not slide back to a police state

By Lukoye Atwoli
Sunday Nation 21 July 2013

Last week I came across a very disturbing article in a local daily. It was reported that a politician had been summoned by the police to be grilled over an alleged plot to “destabilise” the government. According to the article, the politician was alleged to be working with churches and non-governmental organisations in a plot to start an “anti-government” campaign, ostensibly in order to cause public disaffection with the government.

There was no allegation that the politician was engaged in extra-legal or unconstitutional activities aimed at overthrowing the democratically elected Government of Kenya. There was no claim that he was organising an armed militia group to attack government installations. There was no indication that he had contacted foreign governments to organise an attack on the sovereign territory of our republic.

All that was alleged was that he was working with churches and NGOs to “destabilise” the government.

There was a time in this country when the “thought police” would work hard at trying to uncover the motives of all Kenyans who dared to speak out publicly about any government initiative. There was a time when being called a “dissident” was equivalent to a death sentence.

There was a time when being accused of plotting to “destabilise” the government was the beginning of a long journey to detention, torture and even assassination. We would like to believe that those times are long gone, but we fear that without citizens’ vigilance we could still slide back into those dark days.

At some level, one would have been comfortable if the police had indicated that they had information that this politician was plotting a crime recognised in law, such as plotting to “establish a government otherwise than in compliance with the Constitution”, which is prohibited in Article 3(2) of our Constitution.

In any case, if the police have any such information, it is incumbent upon them to expeditiously investigate and neutralise the threat in a manner consistent with the law. Summoning a politician to investigate claims of plotting to “destabilise” the government is so eerily reminiscent of the Kanu dictatorship that nobody with any sense of history would countenance such a move.

In a constitutional democracy such as ours aspires to be, it is the responsibility of all citizens, no matter their political affiliation, to keep the government in check and ensure that no arm of government exceeds its powers and oppresses the people.

In other words, it is the duty of every citizen to “destabilise” the government, to keep it on toes, constantly looking over its collective shoulder every time it contemplates some nefarious scheme.

And if we cannot do it ourselves, we must appreciate the efforts of those that do. We must applaud them for ensuring that we remain free to question government. Thomas Paine put it more clearly: “He that would make his own liberty secure must guard even his enemy from oppression; for if he violates this duty he establishes a precedent that will reach to himself.”

For the sake of our freedom we must demand that the government recognises our right to “destabilise” it. The only means open to the government in dealing with the “destabilising” activities of its citizens is to create an environment in which the people’s concerns are addressed expeditiously and satisfactorily. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s school of medicine; Twitter @LukoyeAtwoli

Tuesday, July 16, 2013

A close look reveals a deeply divided Kenya

By Lukoye Atwoli
Sunday Nation 14 July 2013

On the surface, Kenya has moved on from the bungled 2007 election and the resultant violence, and is now a largely peaceful country on the brink of unprecedented socio-economic growth. The government exudes optimism that the challenges facing our country are few and easily surmountable.

Most of the bickering is attributed to a robust opposition which, though vexatious, is being tolerated by the progressive Jubilee Government. A beautiful image, the very fulfilment of the dream of democrats everywhere. On the surface.

A deeper look, though, reveals a deeply divided nation. To illustrate this, let us examine a couple of the newest crises that have faced this government and how we have handled them.

Teachers went on strike three weeks ago, demanding implementation of a deal signed over a decade ago giving them higher allowances. The government initially claimed that the deal had been overtaken by events, then said it had been countered by another Gazette notice, and finally asked the teachers to go and negotiate a fresh deal. The actions of the government are not surprising. What was interesting, however, was the reaction of Kenyans.

A majority of those that made comments exhorting teachers to go back to work were assumed to be supporters of the Jubilee Government while those supporting the strike were deemed to be opposition supporters. Indeed, it has been explicitly stated that the teachers’ union is under instruction from opposition politicians, with senior government officials arguing that there must be a reason the teachers’ union is refusing to negotiate with government.

The question on the lips of government supporters is this: If the teachers’ union negotiated with both the Moi and Kibaki governments over the issue of pay, why are they refusing to negotiate with the current government? Instead of looking at the issues that teachers are raising, many are looking at Raila Odinga’s Cord coalition as the culprit.

The other issue that has been in the public domain is the nomination of aspirants for the Makueni senatorial seat. During the hearings of the tribunal to determine whether one of the candidates was properly nominated or not, most of the publicly expressed sentiments had no legal content. Comments made by individuals only served to expose their political leaning, without offering any clarity as to whether the process was proceeding as it should or not.

Of course the electoral commission continues to provide fodder for both political formations by demonstrating its incompetence in carrying out relatively simple tasks. For instance, many of the ongoing election petitions are confirming the commission’s inability to do simple arithmetic, causing problems for many incumbents through no fault of their own.

However, it has become impossible for many of us to interrogate these issues without an ethnopolitical prism.
It is difficult to see such a society as the paragon of civility and stability, and I am afraid we are bottling up our frustrations, which could explode unpredictably at the time we need them least.

One would hope that the government is working on ways of dealing with these divisions to forestall the sort of nonsensical chaos we faced just five years ago. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s school of medicine; Twitter @LukoyeAtwoli