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