Tuesday, June 24, 2014

When you treat security casually, crime festers

By Lukoye Atwoli
Sunday Nation 22 June 2014
Observing the behaviour of Kenyans and their so-called leaders, there is no doubt we have failed to learn from history. For several months now, we have unnecessarily lost many lives in events that demonstrate a lack of creativity in the running of public affairs. These events have particularly escalated in recent weeks.
One could come to several conclusions based on this observation. Firstly, one could argue that it is all a mere coincidence, and that the road crashes, chang’aa deaths, terrorist attacks, increased crime and political instability have just happened to cluster together purely by chance. That is, of
course, possible but it is highly improbable.
Secondly, one could argue that some malevolent force hell-bent on destroying our country for some obscure reason has planned at least some of these events. This is indeed the line adopted by some in and out of government, especially after the attacks at the coast when the government claimed there was a political angle to it all. 
The President laid the blame for the current troubles squarely at the feet of reckless” politicians who were inciting the people. Unfortunately, all indications are that this is also highly improbable, and that any politicians even remotely associated with these attacks are either opportunists or bystanders in the wrong place at the wrong time.
A more plausible explanation is that these events are an indication of ineptitude in the arms of government responsible for maintaining security, law and order. No matter the source of these atrocious happenings, it falls on the government to neutralise the threats before they materialise instead of waiting for people to be killed and then looking for targets to blame.
Social psychologists have long ago demonstrated a link between disorder and crime. In what is now known as the Broken Window Theory, it has been shown that neighbourhoods and property that is left in a state of disrepair soon attracts vandals and criminals of all shades. Wilson and Kelling, in a seminal paper on this topic, argued that untended behaviour leads to the breakdown of community controls and order. They demonstrated how an abandoned piece of property in a nice neighbourhood can cause changes in the behaviour of residents, and eventually lead to increased crime and general
This theory easily explains what is currently happening in the country, and could even predict what is in store for us. The security docket has not properly exerted itself in a professional manner in dealing with crime in this country. That is not in dispute, no matter where one stands politically. As a result, many “small” crimes have been going unpunished while our police officers get collectively tarred with claims of corruption and bribe taking.
Tolerance for “smallcrimes such as assault, robberies and murders has increased so much that police spokespeople routinely refer to them as “normal” crimes. Consequently the country has slid into a general state of lawlessness, and the government’s brazen assertion that we are now responsible for our own security only worsens this perception.
Because of our tolerance for “Broken Windows” in our country, terrorists and other criminals are having a field day. The sooner the government acknowledges this situation and takes firm action to deal with it the better for all of us. 
Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi Universitys School of Medicine.

Tuesday, June 17, 2014

Want to see how nations burn? Visit social media

By Lukoye Atwoli
Sunday Nation 15 June 2014

Kenyans on social media are a loud and boisterous bunch. Over the past few years they have distinguished themselves as a most combative collection of citizens, and nowadays it is not uncommon to learn of social media wars against other countries or individuals who are perceived to have slighted the motherland. National issues discussed on social media often take on the crimson hues of a violent confrontation, and ethnic organisation is never far from the picture.

Many have argued that the anonymity afforded by social media provides people with the perfect cover to slip into fantasy personae and role-play behaviours they would otherwise not engage in outside of the social media environment. Examples are cited of many otherwise timid people morphing into violent bullies online, driving young people to attempt such harmful acts as suicides and violence.

My view is a little different, though. I would argue that the anonymity of the Internet unmasks one’s real motivations, and allows them to act out their real impulses with little fear of immediate embarrassment or punishment. The result, therefore, is that one feels free to act without the constraints of social conventions and mores, and studying one’s online behaviour can often reveal more about their personality than the traditional assessment methods.

Of course this is a highly generalised view, and it would take a highly experienced analyst to uncover these issues, especially in cases where some people use the Internet to attempt to cover up what they consider to be their real selves. They open multiple proxy accounts and often have social media “conversations” with themselves in order to convince their audience that they are in fact separate individuals.

The long and short of it is that studying the behaviour of Kenyans online may actually be key in unravelling the mystery behind the interesting phenomenon in which most Kenyans openly profess love for their motherland while engaging in the most egregious war-mongering activity online.

Almost every open Kenyan discussion one comes across on many social media platforms degenerates into ethnic sparring and name-calling whenever the subject veers towards politics or social conduct. People known to be socially progressive and public-spirited often expose their tribal warrior blood when push comes to shove on the blogosphere.

And there is a pattern to these eruptions. In the run-up to the 2007 elections, social media chatter rose to a crescendo with tribal slurs and threats of annihilation, with plenty of mention of ethnic practices that were deemed to disqualify or qualify some candidates for national leadership. As the post-election violence escalated, the buzz on social media reached deafening heights, and it became impossible for any sane Kenyan to get in a word edgewise at any given time.

My engagement on social media today convinces me that we are approaching that point again. False and exaggerated accusations are being made against politicians on each side of the divide, aimed at casting them almost in the same light as wild animals. These accusations are then being transferred wholesale to their ethnic communities, and explanations are made based on tribal stereotypes. Eventually nothing can be heard but war cries and insults.

That is how nations burn. That is how genocides incubate. Social media is the spark that will eventually ignite the restive tinder-box that goes by the name Kenya.

We cannot say we were not warned this time. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Sunday, June 8, 2014

It’s time leaders did what they were chosen to do

By Lukoye Atwoli
Sunday Nation 08 June 2014

In the past few weeks I have been travelling in the US on business related to research and collaborations between my institution and some American medical schools. As always, I have been keenly observing events on my trip and juxtaposing them against conditions back home. A useful observation I have made concerns our behaviour when we disagree on ideas.

Just like Kenyans, Americans bicker and quibble about everything from who should get state-supported health care to what should happen to the baby in a woman’s womb. And the arguments can get pretty acrimonious and public, sometimes raising tempers to the level of threats of violence in sections of the population.

But that is as far as the similarity extends.

The greatest difference lies in the reason why they engage in these arguments and conflict. To a large extent, the average American is proud of his country and its heritage. In every city one visits there will be a museum dedicated to the history of the city and the state, and the greater US. There are monuments everywhere you go commemorating the most seemingly innocuous achievements of the city’s inhabitants, and American heroes.

Every national holiday is an opportunity to remember and re-enact important historical moments in America’s journey since its founding. School-children recite that history with pride, and point out national monuments as though they were erected in their lifetimes. On the whole, Americans argue about their respective convictions on what is best for the US.

Contrast this with Kenyans. For the past 12 years or so, we have been poised on an ethno-political knife-edge requiring very delicate balancing to avoid outright civil war. Kenyans are almost equally divided into two factions on any national issue — those that support the government and those that don’t. Some members of these two factions have shifted back and forth, both among politicians and among the voting public, but the proportions have remained mostly undisturbed.

At any point in time, these two factions express the most vehement loathing for each other, and at least once in the past 10 years this has erupted into open armed civil conflict. Political arguments are turned into existential matters for the politicians’ tribesmates, and nobody remembers the greater good of the republic.

We have heard leaders and their followers say that they are ready to let the country burn if they cannot achieve their goals peacefully. We have heard politicians taunting each other about nusu mkate (half-loaf) governments, as if Kenya is bounty to be fought over, and the winner takes it all. Political power has become an end in itself, rather than an opportunity to serve.

The result is that we have elected people into positions of power who often act as if they have absolutely no clue what that office entails. People are coming into power without the slightest idea what they will do for the people who elected them. This is especially surprising given the amount of resources that are spent campaigning for public office.

I remain hopeful that in my lifetime I will see my country transform into a land where we argue about ideas we think are good for Kenya, and not for individual leaders’ fortunes. But it is difficult to sustain this hope given our current political landscape. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Wednesday, June 4, 2014

Medical schools should teach, not make money

By Lukoye Atwoli
Sunday Nation 01 June 2014
Recent demonstrations by medical students at one of our local universities exposed just the tip of the iceberg as far as problems in the training of medical personnel are concerned. The students were complaining about lack of facilities and staff to teach critical courses in their curriculum. This shouldn’t surprise anybody knowledgeable about medical education in this country.
Many universities treat medical education as a cash cow rather than as an avenue for increasing the number of critical personnel in the health sector. Several times in the past, medical students have been admitted to “medical schools” only to find themselves idling on campus without teachers or material to learn.
The Medical Practitioners and Dentists’ Board, being responsible for regulating medical training in the country, has tough questions to answer in this regard unless they can demonstrate the problematic institutions are duplicitous in their dealings with the Board.
The Board is certainly aware of the shortage of doctors in this country, and any move to rectify this situation is definitely laudable. Unfortunately this shortage also affects availability of experts to train medical students in the various areas of medicine. Especially in the basic sciences that form the bedrock of medical training, there is an acute shortage of lecturers even in the more established medical schools.
This being the case, it is surprising that there is no sustained policy to focus on training of experts in these fields in order to ensure all medical schools are sufficiently served. The result is that in some cases the same individual is involved in teaching medical students at several universities, obviously to the detriment of quality teaching and all but obliterating any opportunities for research. With the proliferation of medical schools in all corners of this country this situation is sure to worsen.
Further complicating the issue is the involvement of universities in the training of certain paramedical cadres without clear career progression. For a long time in this country, the Kenya Medical Training College has been training a highly qualified cadre of paramedical personnel known as clinical officers.
These officers have helped ensure Kenyans in the most remote parts of the country have access to a clinician who can diagnose and manage common medical conditions. Beginning training at diploma level, they were able to further their training at higher diploma level specialising in one field of medical practice. Those that were so inclined could later join medical school and train to become doctors.
Some of our universities jumped into the fray and initiated the training of this cadre as they prepared medical curricula for future training of doctors. After a while, some bright chaps at these universities came up with the idea that they ought to train the same cadre at degree level, without a thought as to how they would fit in the highly regimented medical fraternity.
Many of the students enrolled in the courses believing they were being trained to become doctors. Unfortunately many of their dreams are ending in frustration when they find that many institutions do not know how to deploy them when they apply for jobs.
It is time we held candid discussions about the direction of medical training in this country because, after all, the arguments and tantrums, the lives and livelihoods of Kenyans are at stake.
Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Doctors’ killing signifies a worrying trend

By Lukoye Atwoli
Sunday Nation 25 May 2014
In the past few weeks, this country has lost several doctors due to various causes. The recent killings of doctors in Nakuru and Meru are particularly noteworthy because they poignantly illustrate the state of our nation.
Firstly, outside of medical circles, these killings have gone virtually unremarked and police have, as usual, chalked them down to “normal thuggery”. This reflects the general situation in this country, where we have accepted that we can lose such important members of our society and not be shocked. We are so preoccupied with ethnic sharing of the national cake that we are unable to appreciate the fact that the scarce health worker resource continues to be depleted in preventable ways.
Secondly, these killings demonstrate the difficult working conditions that many health workers are having to contend with as they serve the thankless populace. Many doctors are working extremely hard to save lives, often without anyone to relieve them when they are tired. They work long hours and have little time for their families or friends. 
Unfortunately, when they burn out and decide to take a break, they are often accused of having abandoned their patients to go and “enjoy” themselves. And when they continue working despite their inevitable problems, they become error-prone and are crucified for every small mistake they make. When their luck finally runs out, they find armed thugs waiting for them when they come home after a long night at work. This once-glorified profession has lost its lustre, and now carries the risk of premature mortality and a lifetime of suffering.
Thirdly, the fact that these unfortunate deaths have not triggered talk of a crisis in the health sector clearly demonstrates that both the national and county governments are only paying lip-service to the health of their people. Measures have not been taken to protect health workers and ensure that they operate in a more conducive environment. The national government has all but abandoned health workers, leaving them at the mercy of county administrations that often don’t have the foggiest idea on how to manage a health workforce.
As a result, health workers are continually being threatened with the sack for a variety of ills, real and imagined. Every so often, a governor lashes out at these “thankless officers who are trying to avoid supervision” and promises citizens that he will make them work or fire them if they are lax in their duties. Many have resigned as a direct consequence of this intimidation, while others have, in the past, been “released to the national government” in an undisguised move to eliminate “foreign” professionals from some counties.
A Kiswahili saying aptly captures the current state of affairs: Usiwatukane wakunga na uzazi ungalipo (Do not insult midwives while women still give birth). As things stand, health professionals feel badly treated, insulted and abandoned by the political class while, on the other hand, citizens are demanding more and more from them.
Perhaps if we knew that everyone will at some point need to see a health professional, we would plan differently. Maybe we would allocate more funding to the health ministry, use the funds to train and hire more health workers, and procure equipment and supplies that would make their work more effective, and rewarding?
But maybe nobody cares!
Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Let’s not interfere with MCAs’ oversight role

Once again sorry for this delayed posting; I've been traveling quite a bit lately, but hopefully I should now be able to post more promptly. Here come a series of the latest articles...
By Lukoye Atwoli
Sunday Nation, 18 May 2014
The recent spate of impeachments and impasses at county assemblies pitting governors against members of county assemblies (MCAs) seem to be raising hackles in certain quarters. There are increasing murmurs suggesting that MCAs are being overzealous in their task of keeping the county executive on its toes. There is even talk of passing legislation to limit the county assemblies’ roles in the impeachment of governors.
The idea that MCAs wield the power to fire the county government terrifies many observers, and there are suggestions that this power will cause governors to try and please them with corrupt deals and money-wasting perks.
I disagree with the doomsayers.
One key reason Kenyans rejected the old constitution was that it had systematically concentrated all power in the hands of the president, who could delegate and use the powers at will. At some point, a little over 20 years ago, a former Attorney-General boldly declared to the National Assembly that “nobody, save the president, is above the law”.
The implication was that the president could do pretty much as he pleased, and all presidents under that constitution did exactly that. In that constitution, there was even a clause that indicated clearly that all public servants served at the pleasure of the president. He had power over life and death, and the many detentions without trial that dot our history are just a few of the demonstrations of that power.
It is in realisation of these dangers that Kenyans resolved to write a new constitution and, in a process spanning two decades, we eventually came up with our current charter. In the new constitution, we reduced and dispersed executive authority, to a large extent. We created multiple executive offices protected by the constitution, and introduced rights that could not be abrogated at will.
In the realisation that even the dispersed executive could go overboard and harm the very people it was supposed to serve, we built in a system of checks and balances that, if implemented, would be the envy of all civilised nations across the globe.
At the national level, we established a Senate with the power to send the President and his Cabinet packing should they contravene the constitution or any other written law. The National Assembly was vested with day-to-day oversight authority to ensure that the interests of the citizen are upheld in all government dealings. Above all, we established a Judiciary to arbitrate in cases of conflict between the different arms of government, and between law-abiding citizens as well.
At the county level, we established the office of governor to parallel that of the national president, and county assemblies to provide oversight and, if necessary, to impeach the governor and his executive should they behave in a manner contrary to the best interests of the citizens. To guard against frivolous motions of impeachment, we gave the Senate the final authority to decide the fate of impeached governors.
As far as oversight of executive authority is concerned, especially in the case of governors, the constitutional procedures have been scrupulously observed. We should let the law take its course because that is how we designed our system of governance. Interfering with the oversight functions can only send this country back to the dark old days of leadership by executive fiat, and this would be a sure recipe for chaos.
Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Tuesday, May 13, 2014

Depression is never the patient’s fault

By Lukoye Atwoli
Sunday Nation 11 May 2014

It is heartening that Kenyans are beginning to see the importance of mental health, and many are beginning to ask questions about how they can improve it. The media has been extremely helpful in this regard, with pieces in the print and electronic media tackling this difficult subject. In this regard, one could safely conclude that the citizens are ahead of their government.

As the government dithers and prevaricates, Kenyans continue to suffer from the debilitating effects of mental ill health. Suicides, homicides, road traffic ‘accidents’ and incidents arising from illicit alcohol use are just some of the outcomes that have become very prominent lately. In response, the government prefers to tackle only the symptoms.

Brewers and consumers of all kinds of alcohol are arrested and processed through the criminal justice system, while nothing is done to deal with the underlying causes. Suicide attempt is still a criminal offence under Kenyan law, although prosecutions and convictions are rare largely due to humane interventions by prosecutors and judicial officers. Interestingly, in the midst of this mental health crisis, the government saw it fit to disband the Division of Mental Health in the Ministry of Health despite clear legal provisions for it.

Increased media coverage obviously cuts both ways. The media can serve to inform and educate the public about mental health, but occasionally some misleading information may be sneaked in, often by good-intentioned individuals. This can only be prevented by inclusion of experts who would then moderate the message and ensure that only accurate information is fed to the public.

A case in point is a recent programme discussing depression and suicide on one of our local TV stations, in which the moderator kept asking participants why they got depressed. In summing up the discussion, one of the panellists suggested that depression can be prevented and even managed by a simple change of attitude. It was in fact stated that ‘depression is a choice’, and that a depressed person can choose not to be depressed.

This is an unfortunate assertion that does more harm than good. Depression is a mood disorder characterised by a profoundly low or irritable mood most of the time over a significant period of time. Other features of depression include changes in sleep and appetite, impaired attention, concentration and memory, a sense of worthlessness and hopelessness, excessive and inappropriate feelings of guilt, slowing of thought and even developing ideas of suicide.

A normal person would never wish to feel depressed, because the pain and anguish associated with depression is so severe that it is often considered more debilitating than physical pain. A depressed individual will initially try all interventions available to them to deal with their depression. They will pray, try to be ‘strong’, use herbs and even try to adopt a positive attitude.

The fact that their depression persists and gets more and more severe is evidence that all these interventions have been unsuccessful, and they need professional help. Throwing the ball back into their court and suggesting that they are responsible for their illness only serves to make things worse, and can drive some to contemplate suicide. It exacerbates their feelings of guilt and may just push them over the edge.

People with depression need supportive family and friends, but above all, they need professional help. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Monday, May 5, 2014

Science and religion not on equal footing

By Lukoye Atwoli
Sunday Nation 04 May 2014

In the past few days, the media have uncharacteristically given lots of attention to the atheist idea and its proponents. A prominent atheist has been interviewed several times on various television stations, and newspapers have written about him and his lack of religious beliefs. As a result, many religious folk have reacted with consternation, arguing that it is wrong to give prominence to the idea that gods do not exist, and that humans are responsible for all decisions they make.

A key feature of all debates between atheists and theists is the idea that everyone must believe in something supernatural, and that if someone does not believe in a god or system of gods, they must then have another belief to replace that. Many think that all atheists have replaced gods with science, or the theory of evolution, to be specific.

As a result of this argument, we live with the misconception that religious ideas are competing at the same level as scientific ideas. In my opinion, it is important to make the distinction that these two systems cannot, by definition, operate at the same level of reasoning.

Whenever two people engage with differing points of view, no amount of passion will win the debate unless logical arguments are presented to support the views. It does not matter whether you are discussing who is the best person to elect as president, or if the sun will rise tomorrow, or indeed if it is right to kill another human being because he dresses differently. Logical arguments are persuasive and convince people to change whenever they encounter them.

Scientific arguments follow this rule to the letter. One can never make a persuasive scientific argument while presenting no logical support for it. In other words, whenever one makes a proposition they are required to provide the evidence. In science, one must lay bare their methods and results, and allow other interested scientists to try and prove the proposition wrong. In other words, science thrives on scepticism and constant questioning.

That is how we have been able to discover more ways of making life easier and more comfortable. 


On the other hand, religious arguments, while they start with the appearance of logic, end with the completely illogical assertion that there are some things that cannot be interrogated or known, except by some mysterious supreme being.

Faith – the idea that it is okay to believe that something is true on the basis that someone authoritative said it is so – is glorified in most religions, and questioning the deity is frowned upon. Doubting the deity is accompanied by threats of eternal damnation, and even earthly punishment.

It is difficult for one to elevate both these ideas to the same level, and argue that they can stand on the same pedestal and attempt to persuade humanity to accept them as equals. How can that be when the religious apologists attempt to use scientific arguments to prove their claims, and when that eventually comes to a cul de sac, they invoke the infallibility of their revelation or authorities?

As we discuss the issue of religion and its effects in our society, these are some of the issues we must take into consideration. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Saturday, May 3, 2014

It’s not too late to redeem health services

By Lukoye Atwoli
Sunday Nation 27 April 2014

The Kenya Medical Association held its 42nd Annual Scientific Conference this past week where it came to light that health services are in dire straits. The Medical Board gave alarming statistics that showed a huge discrepancy between the number of doctors trained in Kenya, and those currently working in the country. Obviously there is an exodus of doctors and other health workers in search of the proverbial “greener pastures”. 

Why is this happening?

Until a few years ago, the terms and conditions of service for doctors were unbelievably pathetic. Following the registration of the doctors’ union and a series of strikes, the government improved the pay packages for health workers and developed a retention policy. For the first time in many years, health workers started seeking change of employer from the private sector to the public sector. Many people in far-flung areas were for the first time in their lives able to see a doctor when unwell.

Then came the new Constitution that devolved a portion of health services to the counties. In a monumental misreading of the Constitution, the national government purported to have devolved the health sector “100 per cent”. As a result, many health workers found themselves in the employ of county governments that had other priorities.

In their first budgets, many county governments did not provide funding for health workers’ pay. As a result, there are still problems with remuneration of health workers. Many health policy decisions are being taken as afterthoughts, without regard to the fact that their impact often means that people could die.

A perception has been created that health workers are against devolution of health to the counties. This is an erroneous assertion aimed at painting health workers as spoilt brats who do not want to be supervised in their work. Many governors are pushing this argument, going as far as to claim that many of those asking for pay are “ghost workers”. Some have embarked on an ethnic audit of their health staff, and others have been encouraging doctors to emigrate to their “home counties”.

Finally, many doctors expect that when employed, their employer would eventually pay for them to undergo further studies in pursuit of specialisation. The national government has, to a large extent, facilitated this through a scholarship programme in the Ministry of Health. Unfortunately, this assurance is lacking in most county governments.

These are some of the issues that are driving doctors and other health workers away from public sector employment to the private sector and, more worryingly, to other countries. Right from the beginning, health workers have proposed solutions to deal with these and other emerging issues. These suggestions have been largely ignored by the powers that be.

Happily, political leaders at the national level are coming to the realisation that unless urgent steps are taken, people will continue to die and suffer from preventable causes. A parliamentary committee has been reported arguing for the formation of a national agency to deal with human resources for health in order to eliminate inequities and address the welfare of health workers and the public.

One hopes that those responsible for the health of Kenyans will take this initiative seriously, unless they are happy with the continued deterioration in the sector. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Be humane in search for illegal aliens

Apologies for delayed posting. But here goes:

Be Humane in search for illegal weapons

By Lukoye Atwoli
Sunday Nation 20 April 2014

There is no doubt at all in my mind that there are terrorists in our midst, hell-bent on causing chaos and inflicting suffering on our fellow citizens. Multiple explosions and shootings bear out this view, and only a person who does not live in Kenya would argue that there is no terror activity going on here.

What is not clear, however, is who the terrorists are. Traditionally, and in other countries, a shadowy terrorist group is always at hand to claim credit for terror attacks. For instance, Al-Qaeda took responsibility for the 1998 US Embassy bombings in Nairobi and Dar-es-Salaam. Similarly, Al-Shabaab claimed responsibility for the attack on the Westgate mall in Nairobi.

In the more recent attacks, it is curious that no group has claimed responsibility, even as we all blame Al-Shabaab. Be that as it may, we cannot take this terrorist activity lightly. Kenyans are paying a cadre of civil servants good money to sniff out the terrorists and ensure that the rest of us get a good night’s sleep without worrying about being attacked.

It is in this light that the government launched an operation to identify and deal with actual and potential terrorists living in our midst. The operation appeared to initially target Somalis in Eastleigh area of Nairobi and some suburbs in Mombasa. The police have since announced that the operation would spread to other regions of the country, and was aimed at catching criminals and foreigners residing in Kenya illegally.

Unfortunately, the perception that Somalis are being unfairly treated persists. At the beginning of the operation, social media was abuzz with activity. Most Somalis pointed out the absurdity of targeting a single community or religious group and meting out dehumanising treatment in the name of searching for terrorists. They gave heart-rending personal accounts of the treatment they or members of their families underwent in the hands of police. 


Many non-Somali Kenyans appeared to fully support the raids, and opined that it was a small sacrifice to pay for enhanced security. That was only until they also bore the full brunt of the operation. Writing from a middle-class neighbourhood in Nairobi, a friend detailed how she woke up in the wee hours of the night to loud noises and bangs at her gate and doors, thinking that the house was being robbed.

In a panic, she called her friends and acquaintances asking them to get help. She later realised that the attackers were not robbers, but policemen conducting an operation to flush out suspected terrorists. Like most of her neighbours, she did not let them into her house. The only neighbour who did had his house ransacked and all rooms turned upside down. By the time the policemen left, most people in this neighbourhood had a very dim view of the police operation.

Is it impossible for our police officers to be more civil in carrying out these operations? Is there no other way of identifying potential terrorists and criminals without causing so much suffering to innocent citizens? Is ethnic profiling the only way of ensuring our national security and enhancing cohesion? How long will these operations last, and how shall we measure their effectiveness?

These are just some of the questions we must deal with, even as we pursue these miscreants. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Thursday, April 17, 2014

‘Healing’ crusade poses serious health risk

By Lukoye Atwoli
Sunday Nation 13 April 2014

Kenyans are a highly religious people. This is borne out not only by their open declarations of religious affiliation, but also by their often overzealous demonstration of religious fervour whenever they are called upon to do so. This, in itself, is not a bad thing. It might even be a good thing, especially in circumstances when this religious zeal is directed at activities aimed at improving the lot of needy individuals or humanity at large.

Unfortunately, due to the nature of religious belief, occasional tragedies occur. There are multiple examples of this, and it is pointless to rehash them here. The reason they occur is that the average religious person takes the message from their holy book or their cleric literally. Many proclaim that their clerics are messengers of their deity, and the holy book is the unquestionable transcription of the deity’s words. Sometimes the outcome of this blind obedience is serious harm and even death, but even these are explained away as the doings of an inscrutable deity.

Over the long Easter weekend, one such cleric will descend upon Eldoret with the professed mission of spreading the message of repentance and holiness. As has been the practice in previous crusades of a similar nature, it is expected that many will ferry their sick relatives from far and wide, and present them to this preacher who is also fabled to be a faith healer. 


Those of us taking care of thousands of Kenyans with chronic conditions will be waiting for the inevitable outcomes with dread. We know many patients who have already abandoned their medications and clinic follow-ups in anticipation of healing at the crusade, and dozens more who will attend the crusade and abandon their treatment.

We dread the reports we shall get when we follow-up patients with chronic conditions like HIV, cancer, diabetes and mental illnesses to their homes. We fear we will be told some of them died after being convinced they were healed at the crusade thus stopping their life-preserving treatments. We fear we will find them at home, wasting away while believing fully that they have either been healed, or that healing is on the way.

We dread the events we shall continue to encounter in the clinics of the Moi Teaching and Referral Hospital, weeks and months after the four-day crusade. Many patients will show up in deplorable health and, when asked what happened, they will say that they thought they had received healing at the Easter crusade. Many more will suffer irreversible damage due to chronic illness, and will return to the hospital only at the urging of worried family members.

Why do we raise the red flag at this point, before the crusade happens? Because we believe it is still within the powers of the organisers of the crusade to do something about it and ensure that no lives are lost, and no one goes home in worse health.

The organisers and preachers should announce to their faithful that nobody should stop taking their medication or stop attending their regular clinics, in anticipation of healing. That simple message will save dozens of lives, and ensure continuing good health for countless others, which one would expect is a good thing for the organisers of the crusade. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Friday, April 11, 2014

Jubilee one year on: Analysis of health pledges in Jubilee Manifesto

Free maternity keeps Uhuru and Ruto health pledge (I didn't do the headline!)
By Lukoye Atwoli
Daily Nation, Wednesday 09 April 2014

Soon after his inauguration, President Kenyatta declared that all maternity care would be offered free of charge in public facilities. Many commentators equated this pronouncement to President Kibaki’s free primary education pledge that was made so early in his term that many thought it would fail. One may suppose that President Kenyatta made his “free maternity care” pledge in this same spirit, and hoped that things would come together somehow and make it work.

To some extent, this has happened in many parts of the country, and the government says that hospital deliveries have registered a significant rise from 40 per cent to 66 per cent. However, there have been hiccups in some parts of the country where, due to limited financing, some counties have decided to start charging for some of the services.

To some extent, the fortunes of the health sector under the Jubilee government may be encapsulated in the success or failure of the free maternity care initiative. In the Jubilee manifesto, party leader Charity Ngilu, now a Cabinet Secretary, indicated that she joined the Jubilee coalition on the basis that it would “ensure that all Kenyans get quality and affordable healthcare.” This then became a key plank in the new government’s agenda, perhaps explaining the President’s haste in providing solutions for the sector.

The coalition identified bureaucracy and corruption as major impediments to improving health services, and further argued that the National Hospital Insurance Fund (NHIF) is “bloated and corrupt”. Brain-drain involving health practitioners, especially doctors, was mentioned as well. The coalition indicated that their first focus would be on preventive health, and universal healthcare was to be rolled out through local primary healthcare centres. Finally, the coalition’s stated intention was to make Kenya an international medical hub with an increase in medical tourism by adopting the “successful Indian model”.

Several specific pledges were made in the manifesto as the method by which the coalition would reach their healthcare goals. The coalition pledged to increase health financing from 6 per cent to 15 per cent of the budgeted expenditure, perhaps to bring the country into compliance with the Abuja Declaration target.

The number of physical facilities were to be increased, bringing a health facility to within five miles of every home, and many previous provincial hospitals were to be upgraded and equipped to the status of referral hospitals. Diagnostic centres for all conceivable illnesses were to be set up, and free mosquito nets would be distributed to all families in need.

Better nutrition was to be encouraged, and medical research, including on indigenous medicine was to be promoted under the Jubilee coalition government. E-health and private sector participation was also to be encouraged and promoted, and pay packages for doctors and other health workers were to be improved.

One year down the line, an evaluation of the Jubilee pledges comes up with perhaps one major success story.

Free maternity care is now government policy, and many facilities across the country are not charging mothers to deliver or get other services related to childbirth. This is a huge plus especially in rural and poor settings where mothers preferred to deliver at home, assisted by local midwives or other women, than go to hospital and have to pay what they considered to be exorbitant rates.

On the whole, however, it is difficult to find much to write home about what this government has done with regards to healthcare. Healthcare financing continues to be meagre, and in the last budget, the national government allocated 2.1 per cent of expenditure to health. It is not known what the counties collectively allocated to health, but the few that were analysed had allocated less than 3 per cent of their budgets to health as well.

The government started out on a bad footing when they appointed both a Cabinet Secretary and a Principal Secretary who were not healthcare professionals, going against the pledge made by Deputy President William Ruto in the Manifesto. This had the effect of delaying any serious initiatives in the sector, given that the two senior officials required a crash course in the sector and how it works.

One of the key handicaps faced by this government is that the manifesto did not take into consideration the changed healthcare environment, with the constitutional shift of primary healthcare and some curative services to the counties. Without a mechanism of ensuring cooperation of the county governments, it is therefore difficult to operationalise many of the pledges concerning healthcare at the county level.

Today, strikes in the sector are an everyday occurrence, and recent reports indicate that many doctors are leaving the civil service to go abroad or into private practice as a result of problems with their terms and conditions of service in the counties. The legislative and policy framework has not done any better. Four years since the coming of a new Constitution, health is the only sector that has not been re-formatted legislatively to conform to the law. The Health Bill has remained in draft form for a long time, and stakeholder involvement in its drafting and progress has been reluctant and limited.

As far as the health sector is concerned, the Jubilee coalition rates a very modest score. 

Dr Atwoli is a senior lecturer, Moi University School of Medicine and national secretary-elect, Kenya Medical Association.

Wednesday, April 9, 2014

Is it time to regulate religious teachings?

By Lukoye Atwoli
Sunday Nation 06 April 2014

Kenya seems to be in the throes of a major social convulsion and time has come for us to confront certain demons that represent a major threat to our continued survival. Lately, a new monster that had remained largely under the surface has emerged, in the manner of “religious extremism”. This has been blamed for incidents of “radicalisation” of youth, and even some of the terrorist attacks that are becoming common.

However, this term is, in my view, misleading. As part of some research I have done in the past, I have asked dozens of religious practitioners what constitutes an extremist or fundamentalist. Even within the same religion, different responses are given. For instance, some argue that an extremist is one who takes a literal interpretation of their religious book or teachings, and behaves accordingly.

Others contend that extremists “misinterpret” religious teachings and use them to harm others. The problem with this argument is that it assumes that everyone, including non-adherents, understand what teachings are actually being misinterpreted. When pressed, those with this opinion argue that no religion teaches intolerance or hate, and none condones murder of “innocent” people.

Unfortunately, a plain reading of the holy texts of the religions that are dominant in Kenya reveals a different picture. Many passages condone the killing of those that are regarded as non-believers, and condemn to death and eternal suffering those that deny the existence of the deity to whom the book refers. Although there are many other passages describing “upright” behaviour and being available to help other human beings in need, it is difficult for an ordinary adherent to determine what is to be done and what is to be avoided on the authority of the holy book.

From a secular perspective, one is left in the difficult position of determining what conforms to religious teaching and what does not. When someone argues that the holy book teaches one thing or the other, it is difficult to contradict them, even if other sections of the same holy book teach quite the opposite.

What is known is that no religion teaches their adherents to be “lukewarm” or to pick and choose what to believe and what to leave out. Both Christianity and Islam hold their holy books to be comprehensive and infallible. They are considered to be either direct utterances of the deity, or material written under the direct guidance of the deity.

If we are to accept that religious extremists or fundamentalists either misinterpret or distort religious texts, then it follows that one cannot gain complete religious insight from a plain reading of the religious texts. It follows also that for one to fully understand the teachings of a particular religion, there is more learning to be had outside of a plain reading of the religious text. 


This begs the question why then religious preachers are so poorly regulated. Almost anyone in this country can start a sect and be allowed the freedom to propagate their teachings without let or hindrance. Perhaps religious institutions should be regulated in much the same way the various professions are regulated, in order to ensure that their teachings do not run afoul of the aspirations of our nation as enshrined on the Constitution.

The alternative is to contend with continued religious “radicalisation”. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com