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