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.