tag:blogger.com,1999:blog-64867188818656239942024-03-13T01:03:50.068+03:00Kenyan PsychiatristOne Kenyan Psychiatrist's Opinions on issues and happenings...A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.comBlogger324125tag:blogger.com,1999:blog-6486718881865623994.post-67175890768335841702014-06-24T21:56:00.002+03:002014-06-24T21:56:27.373+03:00When you treat security casually, crime festers<div class="l t3 L3 h3 Bd">
<span class="f1 s1 c0 C_ l0 w0 r0">By Lukoye Atwoli</span></div>
<div class="l t3 L3 h3 Bd">
<span class="f1 s1 c0 C_ l0 w0 r0">Sunday Nation 22 June 2014</span></div>
<div class="l t3 L3 h3 Bd">
<span class="f1 s1 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L3 h3 Bd">
<span class="f1 s1 c0 C_ l0 w0 r0">O</span><span class="f1 s2 c0 C_ l0 w0 r0">bse<span class="_ _0"></span>rvi<span class="_ _1"></span>ng <span class="_ _1"></span>the<span class="_ _0"></span> <span class="_ _1"></span>beh<span class="_ _0"></span>a<span class="_ _1"></span>vio<span class="_ _0"></span>ur of <span class="_ _2"> </span>Kenyans <span class="_ _2"> </span>and <span class="_ _2"> </span>thei<span class="_ _3"></span>r so-<span class="_ _0"></span>ca<span class="_ _1"></span>lle<span class="_ _0"></span>d <span class="_ _1"></span>lea<span class="_ _0"></span>der<span class="_ _1"></span>s, <span class="_ _1"></span>the<span class="_ _1"></span>r<span class="_ _0"></span>e is <span class="_ _3"></span>no <span class="_ _4"></span>dou<span class="_ _0"></span>bt <span class="_ _3"></span>w<span class="_ _0"></span>e <span class="_ _3"></span>ha<span class="_ _1"></span>v<span class="_ _0"></span>e <span class="_ _4"></span>fa<span class="_ _0"></span>ile<span class="_ _1"></span>d <span class="_ _3"></span>t<span class="_ _0"></span>o lea<span class="_ _0"></span>rn <span class="_ _1"></span>fr<span class="_ _0"></span>om <span class="_ _1"></span>his<span class="_ _0"></span>t<span class="_ _1"></span>ory<span class="_ _1"></span>. <span class="_ _1"></span>F<span class="_ _1"></span>or <span class="_ _0"></span>se<span class="_ _1"></span>v<span class="_ _0"></span>er<span class="_ _1"></span>al m<span class="_ _3"></span>o<span class="_ _3"></span>n<span class="_ _3"></span>t<span class="_ _3"></span>h<span class="_ _4"></span>s<span class="_ _3"></span> <span class="_ _2"> </span>n<span class="_ _3"></span>o<span class="_ _3"></span>w,<span class="_ _3"></span> <span class="_ _2"> </span>w<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _5"> </span>h<span class="_ _3"></span>a<span class="_ _3"></span>v<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _2"> </span>u<span class="_ _3"></span>n<span class="_ _4"></span>nec<span class="_ _0"></span>ess<span class="_ _1"></span>ari<span class="_ _0"></span>ly <span class="_ _0"></span>los<span class="_ _0"></span>t <span class="_ _3"></span>man<span class="_ _1"></span>y <span class="_ _4"></span>liv<span class="_ _1"></span>es <span class="_ _3"></span>in ev<span class="_ _1"></span>en<span class="_ _0"></span>ts<span class="_ _0"></span> <span class="_ _1"></span>th<span class="_ _1"></span>at<span class="_ _0"></span> de<span class="_ _0"></span>mo<span class="_ _1"></span>ns<span class="_ _0"></span>tr<span class="_ _1"></span>at<span class="_ _0"></span>e <span class="_ _1"></span>a <span class="_ _1"></span>la<span class="_ _1"></span>ck<span class="_ _0"></span> of cre<span class="_ _0"></span>ati<span class="_ _1"></span>vit<span class="_ _0"></span>y <span class="_ _0"></span>in the runn<span class="_ _0"></span>ing<span class="_ _1"></span> <span class="_ _3"></span>of pu<span class="_ _3"></span>bl<span class="_ _0"></span>ic<span class="_ _3"></span> <span class="_ _2"> </span>af<span class="_ _3"></span>fai<span class="_ _3"></span>rs.<span class="_ _0"></span> <span class="_ _2"> </span>Th<span class="_ _3"></span>es<span class="_ _3"></span>e <span class="_ _2"> </span>even<span class="_ _3"></span>ts ha<span class="_ _0"></span>v<span class="_ _1"></span>e <span class="_ _4"> </span>par<span class="_ _0"></span>tic<span class="_ _1"></span>ula<span class="_ _0"></span>rly<span class="_ _0"></span> esc<span class="_ _1"></span>ala<span class="_ _0"></span>t<span class="_ _1"></span>ed <span class="_ _4"> </span>in r<span class="_ _0"></span>ec<span class="_ _1"></span>ent<span class="_ _0"></span> w<span class="_ _1"></span>eek<span class="_ _0"></span>s.</span></div>
<div class="l t3 L3 h3 Bd">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L1 h3 B17">
<span class="f1 s2 c0 C_ l0 w0 r0">One <span class="_ _4"> </span>could<span class="_ _0"></span> <span class="_ _4"> </span>come <span class="_ _2"> </span>to <span class="_ _3"></span>sev<span class="_ _0"></span>era<span class="_ _0"></span>l co<span class="_ _0"></span>ncl<span class="_ _1"></span>usi<span class="_ _0"></span>ons<span class="_ _1"></span> <span class="_ _4"></span>bas<span class="_ _1"></span>ed <span class="_ _3"></span>on <span class="_ _3"></span>thi<span class="_ _0"></span>s <span class="_ _3"></span>obser<span class="_ _0"></span>va<span class="_ _1"></span>tio<span class="_ _0"></span>n. Fir<span class="_ _1"></span>stl<span class="_ _0"></span>y<span class="_ _1"></span>, on<span class="_ _1"></span>e c<span class="_ _0"></span>oul<span class="_ _1"></span>d ar<span class="_ _0"></span>gue<span class="_ _1"></span> tha<span class="_ _0"></span>t it<span class="_ _3"></span> <span class="_ _2"> </span>is<span class="_ _0"></span> <span class="_ _2"> </span>al<span class="_ _0"></span>l <span class="_ _2"></span>a <span class="_ _2"> </span>me<span class="_ _3"></span>re <span class="_ _2"> </span>coi<span class="_ _0"></span>nc<span class="_ _3"></span>id<span class="_ _3"></span>en<span class="_ _0"></span>ce, a<span class="_ _3"></span>n<span class="_ _3"></span>d<span class="_ _0"></span> <span class="_ _5"> </span>t<span class="_ _3"></span>h<span class="_ _0"></span>a<span class="_ _3"></span>t<span class="_ _3"></span> <span class="_ _2"> </span>t<span class="_ _3"></span>h<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _2"> </span>ro<span class="_ _3"></span>a<span class="_ _3"></span>d<span class="_ _3"></span> <span class="_ _2"> </span>c<span class="_ _3"></span>ra<span class="_ _4"></span>s<span class="_ _0"></span>h<span class="_ _3"></span>e<span class="_ _3"></span>s<span class="_ _3"></span>, chang’<span class="_ _0"></span>aa <span class="_ _4"></span>deaths, <span class="_ _4"></span>terr<span class="_ _0"></span>orist <span class="_ _3"></span>atta<span class="_ _3"></span>c<span class="_ _3"></span>k<span class="_ _3"></span>s<span class="_ _0"></span>,<span class="_ _3"></span> <span class="_ _2"> </span>i<span class="_ _3"></span>n<span class="_ _3"></span>c<span class="_ _0"></span>re<span class="_ _3"></span>a<span class="_ _3"></span>s<span class="_ _3"></span>e<span class="_ _3"></span>d<span class="_ _0"></span> <span class="_ _5"> </span>c<span class="_ _0"></span>r<span class="_ _3"></span>i<span class="_ _3"></span>m<span class="_ _0"></span>e<span class="_ _3"></span> <span class="_ _2"> </span>a<span class="_ _3"></span>n<span class="_ _3"></span>d poli<span class="_ _3"></span>tical<span class="_ _0"></span> <span class="_ _2"> </span>insta<span class="_ _0"></span>bili<span class="_ _3"></span>ty <span class="_ _2"> </span>have <span class="_ _2"> </span>just happened <span class="_ _4"> </span>to <span class="_ _2"> </span>clust<span class="_ _1"></span>er <span class="_ _2"> </span>tog<span class="_ _1"></span>ether pur<span class="_ _0"></span>ely <span class="_ _4"></span>by <span class="_ _4"> </span>chance<span class="_ _0"></span>. <span class="_ _4"></span>That <span class="_ _2"> </span>is, <span class="_ _4"></span>of </span></div>
<div class="l t3 L3 h3 B1a">
<span class="f1 s2 c0 C_ l0 w0 r0">co<span class="_ _0"></span>ur<span class="_ _1"></span>se<span class="_ _0"></span>, <span class="_ _1"></span>pos<span class="_ _1"></span>sib<span class="_ _0"></span>le <span class="_ _1"></span>but<span class="_ _1"></span> <span class="_ _0"></span>it <span class="_ _1"></span>is <span class="_ _1"></span>hig<span class="_ _1"></span>hly<span class="_ _1"></span> imp<span class="_ _0"></span>r<span class="_ _1"></span>oba<span class="_ _0"></span>ble<span class="_ _1"></span>.</span></div>
<div class="l t3 L3 h3 B1a">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L5 h3 B1">
<span class="f1 s2 c0 C_ l0 w0 r0">Second<span class="_ _3"></span>ly<span class="_ _1"></span>, <span class="_ _2"> </span>one <span class="_ _2"> </span>could <span class="_ _2"> </span>argue th<span class="_ _3"></span>at<span class="_ _3"></span> <span class="_ _2"> </span>so<span class="_ _3"></span>me<span class="_ _3"></span> <span class="_ _2"> </span>ma<span class="_ _3"></span>le<span class="_ _3"></span>vo<span class="_ _3"></span>le<span class="_ _3"></span>nt<span class="_ _3"></span> <span class="_ _2"> </span>fo<span class="_ _3"></span>rce he<span class="_ _3"></span>ll<span class="_ _3"></span>-b<span class="_ _3"></span>en<span class="_ _3"></span>t <span class="_ _2"> </span>on<span class="_ _3"></span> <span class="_ _2"> </span>de<span class="_ _3"></span>st<span class="_ _3"></span>roy<span class="_ _3"></span>in<span class="_ _3"></span>g <span class="_ _2"> </span>ou<span class="_ _3"></span>r co<span class="_ _0"></span>unt<span class="_ _1"></span>ry f<span class="_ _0"></span>or so<span class="_ _1"></span>me ob<span class="_ _0"></span>scu<span class="_ _1"></span>r<span class="_ _0"></span>e re<span class="_ _0"></span>ason<span class="_ _0"></span> has pl<span class="_ _1"></span>ann<span class="_ _0"></span>ed at<span class="_ _1"></span> leas<span class="_ _0"></span>t som<span class="_ _1"></span>e of <span class="_ _0"></span>the<span class="_ _1"></span>se <span class="_ _0"></span>ev<span class="_ _1"></span>ent<span class="_ _1"></span>s. T<span class="_ _3"></span>h<span class="_ _3"></span>i<span class="_ _3"></span>s<span class="_ _3"></span> <span class="_ _6"> </span>i<span class="_ _3"></span>s<span class="_ _3"></span> <span class="_ _6"> </span>i<span class="_ _3"></span>n<span class="_ _3"></span>d<span class="_ _3"></span>e<span class="_ _3"></span>e<span class="_ _3"></span>d<span class="_ _3"></span> <span class="_ _6"> </span>t<span class="_ _3"></span>h<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _6"> </span>l<span class="_ _3"></span>i<span class="_ _3"></span>n<span class="_ _3"></span>e ado<span class="_ _0"></span>pt<span class="_ _1"></span>ed <span class="_ _0"></span>by<span class="_ _1"></span> s<span class="_ _0"></span>ome<span class="_ _1"></span> i<span class="_ _0"></span>n and<span class="_ _0"></span> o<span class="_ _1"></span>ut <span class="_ _0"></span>of g<span class="_ _0"></span>o<span class="_ _1"></span>v<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _0"></span>n<span class="_ _1"></span>m<span class="_ _0"></span>e<span class="_ _1"></span>n<span class="_ _0"></span>t,<span class="_ _1"></span> <span class="_ _1"></span>e<span class="_ _0"></span>s<span class="_ _0"></span>p<span class="_ _1"></span>e<span class="_ _0"></span>c<span class="_ _1"></span>i<span class="_ _0"></span>a<span class="_ _0"></span>l<span class="_ _1"></span>l<span class="_ _0"></span>y<span class="_ _1"></span> <span class="_ _1"></span>a<span class="_ _0"></span>f<span class="_ _1"></span>t<span class="_ _0"></span>e<span class="_ _1"></span>r<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _0"></span>h<span class="_ _1"></span>e att<span class="_ _0"></span>ack<span class="_ _1"></span>s <span class="_ _3"></span>at <span class="_ _4"></span>the<span class="_ _1"></span> <span class="_ _4"> </span>co<span class="_ _0"></span>ast<span class="_ _1"></span> <span class="_ _4"> </span>whe<span class="_ _0"></span>n <span class="_ _3"></span>the<span class="_ _0"></span> go<span class="_ _1"></span>v<span class="_ _0"></span>ern<span class="_ _0"></span>men<span class="_ _1"></span>t <span class="_ _1"></span>cla<span class="_ _0"></span>ime<span class="_ _1"></span>d <span class="_ _1"></span>the<span class="_ _0"></span>r<span class="_ _1"></span>e wa<span class="_ _0"></span>s a p<span class="_ _0"></span>oli<span class="_ _1"></span>tic<span class="_ _0"></span>al <span class="_ _1"></span>ang<span class="_ _0"></span>le <span class="_ _1"></span>t<span class="_ _0"></span>o i<span class="_ _1"></span>t a<span class="_ _0"></span>ll.<span class="_ _1"></span> </span></div>
<div class="l t3 L5 h3 B1">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L5 h3 B10">
<span class="f1 s2 c0 C_ l0 w0 r0">T<span class="_ _3"></span>h<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _7"> </span>P<span class="_ _3"></span>r<span class="_ _3"></span>e<span class="_ _3"></span>s<span class="_ _3"></span>i<span class="_ _3"></span>d<span class="_ _3"></span>e<span class="_ _3"></span>n<span class="_ _4"></span>t<span class="_ _3"></span> <span class="_ _7"> </span>l<span class="_ _0"></span>a<span class="_ _4"></span>i<span class="_ _3"></span>d<span class="_ _3"></span> <span class="_ _7"> </span>t<span class="_ _3"></span>h<span class="_ _3"></span>e bla<span class="_ _0"></span>me fo<span class="_ _1"></span>r the cur<span class="_ _0"></span>r<span class="_ _1"></span>ent<span class="_ _0"></span> tro<span class="_ _1"></span>ubl<span class="_ _0"></span>es s<span class="_ _0"></span>q<span class="_ _1"></span>u<span class="_ _0"></span>a<span class="_ _0"></span>r<span class="_ _1"></span>e<span class="_ _0"></span>l<span class="_ _1"></span>y<span class="_ _0"></span> <span class="_ _1"></span>a<span class="_ _1"></span>t<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _1"></span>h<span class="_ _0"></span>e<span class="_ _0"></span> <span class="_ _1"></span>f<span class="_ _1"></span>e<span class="_ _0"></span>e<span class="_ _1"></span>t<span class="_ _0"></span> <span class="_ _1"></span>o<span class="_ _0"></span>f<span class="_ _1"></span> <span class="_ _1"></span>“<span class="_ _0"></span>r<span class="_ _1"></span>e<span class="_ _0"></span>c<span class="_ _1"></span>k<span class="_ _0"></span>l<span class="_ _1"></span>e<span class="_ _0"></span>s<span class="_ _0"></span>s<span class="_ _1"></span>” p<span class="_ _0"></span>o<span class="_ _1"></span>l<span class="_ _0"></span>i<span class="_ _1"></span>t<span class="_ _0"></span>i<span class="_ _1"></span>c<span class="_ _0"></span>i<span class="_ _0"></span>a<span class="_ _1"></span>n<span class="_ _0"></span>s<span class="_ _1"></span> <span class="_ _1"></span>w<span class="_ _0"></span>h<span class="_ _1"></span>o<span class="_ _0"></span> w<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _1"></span>e<span class="_ _1"></span> <span class="_ _1"></span>i<span class="_ _0"></span>n<span class="_ _1"></span>c<span class="_ _0"></span>i<span class="_ _0"></span>t<span class="_ _1"></span>i<span class="_ _0"></span>n<span class="_ _1"></span>g<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _1"></span>h<span class="_ _0"></span>e peo<span class="_ _0"></span>ple<span class="_ _1"></span>. U<span class="_ _3"></span>n<span class="_ _0"></span>fo<span class="_ _4"></span>r<span class="_ _0"></span>t<span class="_ _3"></span>u<span class="_ _3"></span>n<span class="_ _3"></span>a<span class="_ _0"></span>te<span class="_ _3"></span>l<span class="_ _3"></span>y<span class="_ _0"></span>,<span class="_ _0"></span> <span class="_ _2"> </span>a<span class="_ _3"></span>l<span class="_ _3"></span>l<span class="_ _0"></span> <span class="_ _2"> </span>i<span class="_ _3"></span>n<span class="_ _3"></span>d<span class="_ _3"></span>i<span class="_ _0"></span>ca<span class="_ _4"></span>t<span class="_ _3"></span>i<span class="_ _3"></span>o<span class="_ _3"></span>n<span class="_ _3"></span>s<span class="_ _4"></span> <span class="_ _2"> </span>a<span class="_ _4"></span>r<span class="_ _0"></span>e<span class="_ _3"></span> <span class="_ _5"> </span>t<span class="_ _3"></span>h<span class="_ _4"></span>a<span class="_ _3"></span>t<span class="_ _3"></span> <span class="_ _5"> </span>t<span class="_ _3"></span>h<span class="_ _3"></span>i<span class="_ _3"></span>s<span class="_ _3"></span> <span class="_ _5"> </span>i<span class="_ _3"></span>s<span class="_ _3"></span> <span class="_ _5"> </span>a<span class="_ _3"></span>l<span class="_ _4"></span>s<span class="_ _3"></span>o hi<span class="_ _3"></span>gh<span class="_ _0"></span>ly<span class="_ _3"></span> <span class="_ _2"> </span>im<span class="_ _0"></span>pro<span class="_ _3"></span>ba<span class="_ _3"></span>bl<span class="_ _3"></span>e, <span class="_ _2"> </span>an<span class="_ _3"></span>d <span class="_ _2"> </span>th<span class="_ _0"></span>at an<span class="_ _0"></span>y <span class="_ _4"></span>pol<span class="_ _0"></span>iti<span class="_ _1"></span>cia<span class="_ _0"></span>ns <span class="_ _4"></span>ev<span class="_ _1"></span>en <span class="_ _2"> </span>re<span class="_ _1"></span>mot<span class="_ _0"></span>ely<span class="_ _1"></span> asso<span class="_ _0"></span>ciat<span class="_ _1"></span>ed <span class="_ _4"></span>with<span class="_ _0"></span> <span class="_ _4"></span>thes<span class="_ _0"></span>e <span class="_ _4"></span>att<span class="_ _0"></span>ack<span class="_ _1"></span>s ar<span class="_ _0"></span>e <span class="_ _3"></span>eit<span class="_ _0"></span>her<span class="_ _1"></span> <span class="_ _4"></span>opp<span class="_ _1"></span>ort<span class="_ _0"></span>uni<span class="_ _1"></span>st<span class="_ _0"></span>s <span class="_ _3"></span>or <span class="_ _4"></span>by<span class="_ _0"></span>st<span class="_ _0"></span>and<span class="_ _1"></span>er<span class="_ _0"></span>s in<span class="_ _1"></span> the<span class="_ _0"></span> wr<span class="_ _1"></span>ong<span class="_ _0"></span> pla<span class="_ _0"></span>ce<span class="_ _1"></span> at the<span class="_ _0"></span> wr<span class="_ _1"></span>ong<span class="_ _1"></span> ti<span class="_ _0"></span>me<span class="_ _1"></span>.</span></div>
<div class="l t3 L5 h3 B10">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L7 h3 B6">
<span class="f1 s2 c0 C_ l0 w0 r0">A <span class="_ _1"></span>mo<span class="_ _1"></span>r<span class="_ _0"></span>e <span class="_ _1"></span>pl<span class="_ _1"></span>au<span class="_ _1"></span>si<span class="_ _0"></span>bl<span class="_ _1"></span>e <span class="_ _1"></span>e<span class="_ _0"></span>xp<span class="_ _1"></span>la<span class="_ _1"></span>na<span class="_ _0"></span>ti<span class="_ _1"></span>on<span class="_ _0"></span> is<span class="_ _0"></span> <span class="_ _1"></span>th<span class="_ _0"></span>at<span class="_ _1"></span> <span class="_ _1"></span>th<span class="_ _0"></span>es<span class="_ _0"></span>e <span class="_ _1"></span>ev<span class="_ _1"></span>en<span class="_ _0"></span>ts<span class="_ _1"></span> <span class="_ _1"></span>ar<span class="_ _0"></span>e <span class="_ _1"></span>an<span class="_ _1"></span> <span class="_ _1"></span>in<span class="_ _0"></span>dic<span class="_ _0"></span>at<span class="_ _1"></span>io<span class="_ _0"></span>n <span class="_ _1"></span>of<span class="_ _1"></span> <span class="_ _1"></span>in<span class="_ _1"></span>ep<span class="_ _0"></span>ti<span class="_ _1"></span>tu<span class="_ _0"></span>de<span class="_ _1"></span> <span class="_ _1"></span>in<span class="_ _0"></span> <span class="_ _1"></span>th<span class="_ _1"></span>e <span class="_ _1"></span>ar<span class="_ _0"></span>ms<span class="_ _1"></span> of g<span class="_ _0"></span>o<span class="_ _1"></span>v<span class="_ _0"></span>ern<span class="_ _1"></span>men<span class="_ _0"></span>t re<span class="_ _1"></span>spo<span class="_ _0"></span>nsi<span class="_ _1"></span>ble<span class="_ _0"></span> for<span class="_ _0"></span> mai<span class="_ _0"></span>nt<span class="_ _1"></span>ain<span class="_ _0"></span>ing<span class="_ _1"></span> <span class="_ _2"> </span>sec<span class="_ _0"></span>uri<span class="_ _1"></span>ty<span class="_ _1"></span>, <span class="_ _4"></span>la<span class="_ _0"></span>w <span class="_ _3"></span>and<span class="_ _0"></span> or<span class="_ _0"></span>der<span class="_ _8"></span>. N<span class="_ _0"></span>o<span class="_ _1"></span> <span class="_ _1"></span>m<span class="_ _0"></span>a<span class="_ _1"></span>t<span class="_ _0"></span>t<span class="_ _0"></span>e<span class="_ _1"></span>r<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _1"></span>h<span class="_ _0"></span>e<span class="_ _0"></span> <span class="_ _8"></span>s<span class="_ _0"></span>o<span class="_ _0"></span>u<span class="_ _1"></span>r<span class="_ _0"></span>c<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _1"></span>o<span class="_ _0"></span>f<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>h<span class="_ _0"></span>e<span class="_ _1"></span>s<span class="_ _0"></span>e at<span class="_ _1"></span>r<span class="_ _0"></span>oc<span class="_ _1"></span>io<span class="_ _0"></span>us<span class="_ _1"></span> <span class="_ _1"></span>ha<span class="_ _1"></span>pp<span class="_ _0"></span>en<span class="_ _1"></span>in<span class="_ _1"></span>g<span class="_ _0"></span>s,<span class="_ _1"></span> <span class="_ _1"></span>it<span class="_ _1"></span> <span class="_ _1"></span>f<span class="_ _0"></span>al<span class="_ _1"></span>ls<span class="_ _0"></span> <span class="_ _8"></span>on<span class="_ _0"></span> t<span class="_ _0"></span>h<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _8"></span>g<span class="_ _0"></span>o<span class="_ _1"></span>v<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _1"></span>n<span class="_ _0"></span>m<span class="_ _1"></span>e<span class="_ _0"></span>n<span class="_ _1"></span>t<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _1"></span>o<span class="_ _0"></span> <span class="_ _8"></span>n<span class="_ _0"></span>e<span class="_ _1"></span>u<span class="_ _0"></span>t<span class="_ _1"></span>r<span class="_ _0"></span>a<span class="_ _1"></span>l<span class="_ _0"></span>i<span class="_ _1"></span>s<span class="_ _0"></span>e<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>h<span class="_ _1"></span>e thr<span class="_ _1"></span>eat<span class="_ _0"></span>s <span class="_ _1"></span>bef<span class="_ _0"></span>or<span class="_ _1"></span>e <span class="_ _0"></span>the<span class="_ _1"></span>y <span class="_ _0"></span>mat<span class="_ _1"></span>eri<span class="_ _0"></span>ali<span class="_ _1"></span>se in<span class="_ _0"></span>st<span class="_ _1"></span>ea<span class="_ _0"></span>d <span class="_ _1"></span>of<span class="_ _1"></span> <span class="_ _1"></span>w<span class="_ _0"></span>ai<span class="_ _0"></span>ti<span class="_ _1"></span>ng<span class="_ _0"></span> <span class="_ _1"></span>fo<span class="_ _0"></span>r <span class="_ _8"></span>pe<span class="_ _0"></span>op<span class="_ _0"></span>le<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>o be <span class="_ _3"></span>kil<span class="_ _0"></span>led<span class="_ _1"></span> <span class="_ _3"></span>and<span class="_ _0"></span> <span class="_ _3"></span>the<span class="_ _0"></span>n <span class="_ _0"></span>loo<span class="_ _0"></span>kin<span class="_ _1"></span>g <span class="_ _3"></span>fo<span class="_ _0"></span>r ta<span class="_ _0"></span>r<span class="_ _1"></span>ge<span class="_ _0"></span>ts<span class="_ _1"></span> t<span class="_ _0"></span>o b<span class="_ _1"></span>lam<span class="_ _0"></span>e.</span></div>
<div class="l t3 L7 h3 B6">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L6 h3 B19">
<span class="f1 s2 c0 C_ l0 w0 r0">So<span class="_ _3"></span>ci<span class="_ _3"></span>al<span class="_ _3"></span> <span class="_ _2"> </span>ps<span class="_ _0"></span>yc<span class="_ _3"></span>ho<span class="_ _3"></span>lo<span class="_ _3"></span>gi<span class="_ _3"></span>st<span class="_ _3"></span>s <span class="_ _2"> </span>ha<span class="_ _3"></span>ve lon<span class="_ _0"></span>g <span class="_ _3"></span>ag<span class="_ _0"></span>o <span class="_ _4"></span>dem<span class="_ _1"></span>ons<span class="_ _0"></span>tr<span class="_ _1"></span>at<span class="_ _0"></span>ed <span class="_ _3"></span>a <span class="_ _4"> </span>lin<span class="_ _0"></span>k be<span class="_ _0"></span>tw<span class="_ _1"></span>ee<span class="_ _1"></span>n <span class="_ _1"></span>di<span class="_ _0"></span>so<span class="_ _1"></span>r<span class="_ _0"></span>de<span class="_ _1"></span>r <span class="_ _1"></span>an<span class="_ _0"></span>d <span class="_ _8"></span>cr<span class="_ _0"></span>im<span class="_ _1"></span>e<span class="_ _0"></span>. <span class="_ _1"></span>In<span class="_ _1"></span> wha<span class="_ _0"></span>t <span class="_ _1"></span>is <span class="_ _1"></span>no<span class="_ _1"></span>w kno<span class="_ _1"></span>wn <span class="_ _1"></span>as <span class="_ _1"></span>the<span class="_ _1"></span> <span class="_ _0"></span>Br<span class="_ _1"></span>ok<span class="_ _0"></span>e<span class="_ _1"></span>n<span class="_ _0"></span> <span class="_ _1"></span>W<span class="_ _1"></span>i<span class="_ _0"></span>n<span class="_ _0"></span>d<span class="_ _1"></span>o<span class="_ _0"></span>w<span class="_ _1"></span> <span class="_ _1"></span>T<span class="_ _0"></span>h<span class="_ _0"></span>e<span class="_ _1"></span>o<span class="_ _0"></span>r<span class="_ _1"></span>y<span class="_ _1"></span>,<span class="_ _0"></span> <span class="_ _8"></span>i<span class="_ _0"></span>t<span class="_ _0"></span> <span class="_ _8"></span>h<span class="_ _0"></span>a<span class="_ _0"></span>s<span class="_ _1"></span> <span class="_ _1"></span>b<span class="_ _0"></span>e<span class="_ _0"></span>e<span class="_ _1"></span>n s<span class="_ _0"></span>h<span class="_ _1"></span>o<span class="_ _1"></span>w<span class="_ _0"></span>n<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>h<span class="_ _1"></span>a<span class="_ _0"></span>t<span class="_ _1"></span> <span class="_ _1"></span>n<span class="_ _0"></span>e<span class="_ _1"></span>i<span class="_ _0"></span>g<span class="_ _1"></span>h<span class="_ _0"></span>b<span class="_ _1"></span>o<span class="_ _0"></span>u<span class="_ _1"></span>r<span class="_ _0"></span>h<span class="_ _1"></span>o<span class="_ _0"></span>o<span class="_ _1"></span>d<span class="_ _0"></span>s<span class="_ _1"></span> <span class="_ _1"></span>a<span class="_ _0"></span>n<span class="_ _1"></span>d pr<span class="_ _1"></span>op<span class="_ _0"></span>er<span class="_ _0"></span>ty<span class="_ _1"></span> <span class="_ _1"></span>th<span class="_ _0"></span>at<span class="_ _1"></span> <span class="_ _1"></span>is<span class="_ _0"></span> le<span class="_ _0"></span>ft<span class="_ _1"></span> <span class="_ _1"></span>in<span class="_ _0"></span> <span class="_ _1"></span>a <span class="_ _1"></span>st<span class="_ _1"></span>at<span class="_ _0"></span>e <span class="_ _8"></span>of<span class="_ _0"></span> dis<span class="_ _0"></span>r<span class="_ _1"></span>epa<span class="_ _0"></span>ir <span class="_ _8"></span>soo<span class="_ _0"></span>n <span class="_ _1"></span>att<span class="_ _1"></span>r<span class="_ _0"></span>act<span class="_ _1"></span>s <span class="_ _1"></span>va<span class="_ _0"></span>nda<span class="_ _1"></span>ls and<span class="_ _0"></span> cr<span class="_ _1"></span>imi<span class="_ _0"></span>nal<span class="_ _1"></span>s o<span class="_ _0"></span>f a<span class="_ _1"></span>ll <span class="_ _0"></span>sha<span class="_ _1"></span>des<span class="_ _0"></span>. W<span class="_ _0"></span>i<span class="_ _1"></span>l<span class="_ _0"></span>s<span class="_ _0"></span>o<span class="_ _1"></span>n<span class="_ _0"></span> <span class="_ _1"></span>a<span class="_ _0"></span>n<span class="_ _1"></span>d<span class="_ _0"></span> <span class="_ _1"></span>K<span class="_ _1"></span>e<span class="_ _0"></span>l<span class="_ _1"></span>l<span class="_ _0"></span>i<span class="_ _0"></span>n<span class="_ _1"></span>g<span class="_ _0"></span>,<span class="_ _0"></span> <span class="_ _8"></span>i<span class="_ _0"></span>n<span class="_ _0"></span> <span class="_ _8"></span>a<span class="_ _0"></span> <span class="_ _1"></span>s<span class="_ _0"></span>e<span class="_ _1"></span>m<span class="_ _0"></span>i<span class="_ _1"></span>nal<span class="_ _0"></span> p<span class="_ _1"></span>ape<span class="_ _0"></span>r <span class="_ _1"></span>on <span class="_ _0"></span>thi<span class="_ _1"></span>s <span class="_ _0"></span>t<span class="_ _1"></span>opi<span class="_ _0"></span>c,<span class="_ _0"></span> a<span class="_ _1"></span>r<span class="_ _0"></span>gue<span class="_ _1"></span>d t<span class="_ _0"></span>h<span class="_ _1"></span>a<span class="_ _0"></span>t<span class="_ _1"></span> <span class="_ _1"></span>“<span class="_ _0"></span>u<span class="_ _1"></span>n<span class="_ _0"></span>t<span class="_ _1"></span>e<span class="_ _0"></span>n<span class="_ _1"></span>d<span class="_ _0"></span>e<span class="_ _1"></span>d<span class="_ _0"></span>”<span class="_ _1"></span> <span class="_ _1"></span>b<span class="_ _0"></span>e<span class="_ _1"></span>h<span class="_ _0"></span>a<span class="_ _1"></span>v<span class="_ _0"></span>i<span class="_ _1"></span>o<span class="_ _0"></span>u<span class="_ _1"></span>r<span class="_ _0"></span> <span class="_ _8"></span>l<span class="_ _0"></span>e<span class="_ _1"></span>a<span class="_ _0"></span>d<span class="_ _1"></span>s t<span class="_ _0"></span>o<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>h<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _1"></span>b<span class="_ _1"></span>r<span class="_ _0"></span>e<span class="_ _1"></span>a<span class="_ _0"></span>k<span class="_ _1"></span>d<span class="_ _0"></span>o<span class="_ _1"></span>w<span class="_ _0"></span>n<span class="_ _1"></span> <span class="_ _1"></span>o<span class="_ _0"></span>f<span class="_ _0"></span> <span class="_ _8"></span>c<span class="_ _0"></span>o<span class="_ _1"></span>m<span class="_ _0"></span>m<span class="_ _0"></span>u<span class="_ _1"></span>n<span class="_ _0"></span>i<span class="_ _1"></span>t<span class="_ _0"></span>y co<span class="_ _0"></span>ntr<span class="_ _1"></span>ols<span class="_ _1"></span> an<span class="_ _0"></span>d o<span class="_ _1"></span>r<span class="_ _0"></span>der<span class="_ _1"></span>. The<span class="_ _0"></span>y <span class="_ _0"></span>dem<span class="_ _0"></span>ons<span class="_ _1"></span>tr<span class="_ _0"></span>at<span class="_ _1"></span>ed <span class="_ _4"></span>ho<span class="_ _1"></span>w <span class="_ _4"></span>an abandoned <span class="_ _2"> </span>piece <span class="_ _4"></span>of <span class="_ _4"> </span>property<span class="_ _0"></span> in <span class="_ _2"> </span>a <span class="_ _4"></span>nice <span class="_ _2"> </span>neighbourhood <span class="_ _4"></span>can ca<span class="_ _0"></span>us<span class="_ _1"></span>e <span class="_ _1"></span>ch<span class="_ _0"></span>an<span class="_ _1"></span>g<span class="_ _0"></span>es<span class="_ _1"></span> <span class="_ _1"></span>in<span class="_ _0"></span> <span class="_ _1"></span>th<span class="_ _0"></span>e <span class="_ _8"></span>be<span class="_ _0"></span>ha<span class="_ _1"></span>vi<span class="_ _0"></span>ou<span class="_ _1"></span>r o<span class="_ _0"></span>f<span class="_ _1"></span> <span class="_ _1"></span>r<span class="_ _0"></span>e<span class="_ _1"></span>s<span class="_ _0"></span>i<span class="_ _0"></span>d<span class="_ _1"></span>e<span class="_ _0"></span>n<span class="_ _1"></span>t<span class="_ _0"></span>s<span class="_ _1"></span>,<span class="_ _0"></span> <span class="_ _1"></span>a<span class="_ _0"></span>n<span class="_ _1"></span>d<span class="_ _0"></span> <span class="_ _1"></span>e<span class="_ _1"></span>v<span class="_ _0"></span>e<span class="_ _1"></span>n<span class="_ _0"></span>t<span class="_ _1"></span>u<span class="_ _0"></span>a<span class="_ _0"></span>l<span class="_ _1"></span>l<span class="_ _0"></span>y<span class="_ _0"></span> <span class="_ _8"></span>l<span class="_ _0"></span>e<span class="_ _0"></span>a<span class="_ _1"></span>d t<span class="_ _0"></span>o <span class="_ _1"></span>inc<span class="_ _1"></span>r<span class="_ _0"></span>eas<span class="_ _0"></span>ed <span class="_ _8"></span>cri<span class="_ _0"></span>me <span class="_ _1"></span>and<span class="_ _1"></span> <span class="_ _0"></span>ge<span class="_ _1"></span>ner<span class="_ _0"></span>al </span></div>
<div class="l t3 L7 h3 B1b">
<span class="f1 s2 c0 C_ l0 w0 r0">dis<span class="_ _0"></span>or<span class="_ _1"></span>der<span class="_ _1"></span>.</span></div>
<div class="l t3 L7 h3 B1b">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L9 h3 B9">
<span class="f1 s2 c0 C_ l0 w0 r0">This <span class="_ _4"></span>theory<span class="_ _0"></span> <span class="_ _4"> </span>easily<span class="_ _0"></span> <span class="_ _4"> </span>expl<span class="_ _0"></span>ains<span class="_ _0"></span> wha<span class="_ _0"></span>t <span class="_ _1"></span>is <span class="_ _1"></span>cur<span class="_ _0"></span>r<span class="_ _0"></span>ent<span class="_ _1"></span>ly <span class="_ _1"></span>hap<span class="_ _0"></span>pen<span class="_ _1"></span>ing<span class="_ _0"></span> <span class="_ _1"></span>in t<span class="_ _0"></span>h<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _1"></span>c<span class="_ _1"></span>o<span class="_ _0"></span>u<span class="_ _0"></span>n<span class="_ _1"></span>t<span class="_ _0"></span>r<span class="_ _0"></span>y<span class="_ _8"></span>,<span class="_ _0"></span> <span class="_ _8"></span>a<span class="_ _0"></span>n<span class="_ _0"></span>d<span class="_ _1"></span> <span class="_ _1"></span>c<span class="_ _0"></span>o<span class="_ _1"></span>u<span class="_ _0"></span>l<span class="_ _0"></span>d<span class="_ _1"></span> <span class="_ _1"></span>e<span class="_ _0"></span>v<span class="_ _1"></span>e<span class="_ _0"></span>n<span class="_ _1"></span> <span class="_ _1"></span>p<span class="_ _0"></span>r<span class="_ _1"></span>edic<span class="_ _0"></span>t <span class="_ _1"></span>wha<span class="_ _1"></span>t <span class="_ _1"></span>is in <span class="_ _1"></span>st<span class="_ _1"></span>or<span class="_ _0"></span>e <span class="_ _1"></span>fo<span class="_ _0"></span>r <span class="_ _8"></span>us.<span class="_ _0"></span> <span class="_ _1"></span>The<span class="_ _0"></span> s<span class="_ _0"></span>e<span class="_ _1"></span>c<span class="_ _0"></span>u<span class="_ _1"></span>r<span class="_ _0"></span>i<span class="_ _0"></span>t<span class="_ _1"></span>y<span class="_ _0"></span> <span class="_ _8"></span>d<span class="_ _0"></span>o<span class="_ _0"></span>c<span class="_ _1"></span>k<span class="_ _1"></span>e<span class="_ _0"></span>t<span class="_ _0"></span> <span class="_ _8"></span>h<span class="_ _0"></span>a<span class="_ _1"></span>s<span class="_ _0"></span> <span class="_ _1"></span>n<span class="_ _1"></span>o<span class="_ _0"></span>t<span class="_ _0"></span> <span class="_ _8"></span>p<span class="_ _0"></span>r<span class="_ _1"></span>o<span class="_ _0"></span>p<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _1"></span>l<span class="_ _0"></span>y ex<span class="_ _0"></span>ert<span class="_ _1"></span>ed it<span class="_ _1"></span>sel<span class="_ _0"></span>f in a <span class="_ _3"></span>pr<span class="_ _1"></span>of<span class="_ _0"></span>ess<span class="_ _1"></span>ion<span class="_ _0"></span>al man<span class="_ _0"></span>ner<span class="_ _1"></span> <span class="_ _4"></span>in <span class="_ _3"></span>dea<span class="_ _0"></span>lin<span class="_ _1"></span>g <span class="_ _3"></span>wit<span class="_ _0"></span>h <span class="_ _3"></span>cri<span class="_ _0"></span>me in <span class="_ _0"></span>thi<span class="_ _1"></span>s c<span class="_ _0"></span>oun<span class="_ _1"></span>try<span class="_ _8"></span>. Tha<span class="_ _3"></span>t <span class="_ _2"> </span>is <span class="_ _2"> </span>not<span class="_ _0"></span> <span class="_ _2"> </span>in <span class="_ _2"> </span>dis<span class="_ _3"></span>pute,<span class="_ _3"></span> <span class="_ _2"> </span>no matt<span class="_ _0"></span>er <span class="_ _4"></span>wher<span class="_ _1"></span>e <span class="_ _2"> </span>one <span class="_ _4"></span>stan<span class="_ _0"></span>ds <span class="_ _4"></span>polit<span class="_ _0"></span>ic<span class="_ _1"></span>all<span class="_ _0"></span>y<span class="_ _8"></span>. As<span class="_ _3"></span> <span class="_ _2"> </span>a <span class="_ _2"> </span>resu<span class="_ _0"></span>lt<span class="_ _3"></span>, <span class="_ _2"> </span>ma<span class="_ _3"></span>ny <span class="_ _2"> </span>“s<span class="_ _3"></span>ma<span class="_ _0"></span>ll<span class="_ _3"></span>” cr<span class="_ _3"></span>im<span class="_ _0"></span>es<span class="_ _3"></span> <span class="_ _2"> </span>have<span class="_ _0"></span> <span class="_ _2"> </span>be<span class="_ _3"></span>en<span class="_ _0"></span> <span class="_ _2"> </span>goi<span class="_ _3"></span>ng<span class="_ _0"></span> <span class="_ _2"> </span>un<span class="_ _3"></span>p<span class="_ _3"></span>u<span class="_ _3"></span>n<span class="_ _3"></span>i<span class="_ _3"></span>s<span class="_ _4"></span>h<span class="_ _3"></span>e<span class="_ _3"></span>d<span class="_ _3"></span> <span class="_ _5"> </span>w<span class="_ _3"></span>h<span class="_ _3"></span>i<span class="_ _3"></span>l<span class="_ _3"></span>e<span class="_ _3"></span> <span class="_ _5"> </span>o<span class="_ _3"></span>u<span class="_ _3"></span>r<span class="_ _3"></span> <span class="_ _5"> </span>p<span class="_ _3"></span>o<span class="_ _3"></span>l<span class="_ _3"></span>i<span class="_ _3"></span>c<span class="_ _3"></span>e offic<span class="_ _0"></span>er<span class="_ _1"></span>s <span class="_ _4"></span>ge<span class="_ _1"></span>t <span class="_ _4"> </span>co<span class="_ _0"></span>lle<span class="_ _1"></span>cti<span class="_ _0"></span>v<span class="_ _0"></span>ely<span class="_ _1"></span> <span class="_ _4"></span>ta<span class="_ _0"></span>rr<span class="_ _1"></span>ed wit<span class="_ _0"></span>h <span class="_ _0"></span>cla<span class="_ _0"></span>ims<span class="_ _1"></span> <span class="_ _4"></span>of <span class="_ _0"></span>co<span class="_ _0"></span>rru<span class="_ _0"></span>pti<span class="_ _1"></span>on <span class="_ _3"></span>and<span class="_ _1"></span> bri<span class="_ _0"></span>be <span class="_ _1"></span>ta<span class="_ _0"></span>kin<span class="_ _1"></span>g.</span></div>
<div class="l t3 L9 h3 B9">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L8 h3 B15">
<span class="f1 s2 c0 C_ l0 w0 r0">T<span class="_ _0"></span>ol<span class="_ _1"></span>er<span class="_ _0"></span>an<span class="_ _1"></span>ce<span class="_ _0"></span> <span class="_ _1"></span>fo<span class="_ _1"></span>r <span class="_ _1"></span>“s<span class="_ _0"></span>ma<span class="_ _1"></span>ll<span class="_ _0"></span>” <span class="_ _1"></span>cr<span class="_ _1"></span>im<span class="_ _0"></span>es<span class="_ _0"></span> suc<span class="_ _0"></span>h as <span class="_ _0"></span>ass<span class="_ _0"></span>aul<span class="_ _1"></span>t, <span class="_ _3"></span>r<span class="_ _0"></span>obb<span class="_ _1"></span>eri<span class="_ _0"></span>es and<span class="_ _1"></span> mu<span class="_ _1"></span>r<span class="_ _0"></span>de<span class="_ _1"></span>r<span class="_ _0"></span>s <span class="_ _8"></span>ha<span class="_ _0"></span>s <span class="_ _8"></span>in<span class="_ _1"></span>cr<span class="_ _1"></span>ea<span class="_ _0"></span>se<span class="_ _1"></span>d <span class="_ _1"></span>so<span class="_ _1"></span> <span class="_ _1"></span>mu<span class="_ _1"></span>ch<span class="_ _0"></span> tha<span class="_ _0"></span>t <span class="_ _3"></span>pol<span class="_ _0"></span>ic<span class="_ _0"></span>e spo<span class="_ _0"></span>k<span class="_ _1"></span>esp<span class="_ _0"></span>eop<span class="_ _0"></span>le <span class="_ _3"></span>r<span class="_ _0"></span>outi<span class="_ _0"></span>ne<span class="_ _1"></span>ly<span class="_ _1"></span> <span class="_ _1"></span>r<span class="_ _0"></span>ef<span class="_ _1"></span>er<span class="_ _1"></span> <span class="_ _1"></span>t<span class="_ _0"></span>o <span class="_ _8"></span>th<span class="_ _0"></span>em<span class="_ _1"></span> <span class="_ _1"></span>as<span class="_ _1"></span> <span class="_ _1"></span>“n<span class="_ _0"></span>or<span class="_ _1"></span>ma<span class="_ _1"></span>l”<span class="_ _0"></span> cri<span class="_ _0"></span>mes<span class="_ _1"></span>. Con<span class="_ _3"></span>se<span class="_ _0"></span>qu<span class="_ _3"></span>en<span class="_ _3"></span>tl<span class="_ _0"></span>y <span class="_ _2"> </span>th<span class="_ _3"></span>e <span class="_ _2"> </span>cou<span class="_ _3"></span>nt<span class="_ _3"></span>ry has<span class="_ _0"></span> <span class="_ _0"></span>sli<span class="_ _0"></span>d int<span class="_ _1"></span>o a ge<span class="_ _0"></span>ner<span class="_ _1"></span>al st<span class="_ _0"></span>at<span class="_ _1"></span>e of lawlessness, <span class="_ _2"> </span>and <span class="_ _4"></span>the <span class="_ _2"> </span>go<span class="_ _0"></span>vernment’<span class="_ _0"></span>s <span class="_ _4"></span>brazen <span class="_ _2"> </span>asserti<span class="_ _0"></span>on <span class="_ _2"> </span>that w<span class="_ _0"></span>e <span class="_ _1"></span>ar<span class="_ _1"></span>e <span class="_ _0"></span>no<span class="_ _1"></span>w <span class="_ _1"></span>r<span class="_ _0"></span>esp<span class="_ _0"></span>ons<span class="_ _1"></span>ibl<span class="_ _0"></span>e <span class="_ _1"></span>fo<span class="_ _1"></span>r <span class="_ _0"></span>our<span class="_ _1"></span> o<span class="_ _0"></span>wn <span class="_ _8"></span>sec<span class="_ _0"></span>uri<span class="_ _1"></span>ty <span class="_ _1"></span>onl<span class="_ _0"></span>y <span class="_ _1"></span>w<span class="_ _1"></span>or<span class="_ _0"></span>sen<span class="_ _1"></span>s <span class="_ _1"></span>thi<span class="_ _0"></span>s per<span class="_ _1"></span>ce<span class="_ _0"></span>pti<span class="_ _1"></span>on.<span class="_ _0"></span> </span></div>
<div class="l t4 L9 h3 B16">
<span class="f1 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L8 h4 B24">
<span class="f1 s2 c0 C_ l0 w0 r0">Be<span class="_ _3"></span>ca<span class="_ _0"></span>us<span class="_ _3"></span>e <span class="_ _2"> </span>of<span class="_ _3"></span> <span class="_ _2"> </span>ou<span class="_ _3"></span>r <span class="_ _2"> </span>tol<span class="_ _3"></span>era<span class="_ _3"></span>nc<span class="_ _0"></span>e fo<span class="_ _0"></span>r “Br<span class="_ _1"></span>ok<span class="_ _0"></span>en Win<span class="_ _1"></span>do<span class="_ _1"></span>w<span class="_ _0"></span>s” in ou<span class="_ _0"></span>r co<span class="_ _0"></span>unt<span class="_ _1"></span>ry<span class="_ _1"></span>, <span class="_ _4"> </span>te<span class="_ _0"></span>rr<span class="_ _1"></span>ori<span class="_ _0"></span>st<span class="_ _0"></span>s <span class="_ _4"></span>and<span class="_ _0"></span> <span class="_ _4"></span>oth<span class="_ _0"></span>er crim<span class="_ _3"></span>inal<span class="_ _0"></span>s <span class="_ _2"> </span>are <span class="_ _2"></span>having <span class="_ _2"> </span>a <span class="_ _2"> </span>field d<span class="_ _0"></span>a<span class="_ _1"></span>y<span class="_ _8"></span>.<span class="_ _0"></span> T<span class="_ _0"></span>h<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _8"></span>s<span class="_ _0"></span>o<span class="_ _1"></span>o<span class="_ _0"></span>n<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _0"></span> <span class="_ _8"></span>t<span class="_ _0"></span>h<span class="_ _1"></span>e<span class="_ _0"></span> <span class="_ _8"></span>g<span class="_ _0"></span>o<span class="_ _1"></span>v<span class="_ _1"></span>e<span class="_ _0"></span>r<span class="_ _1"></span>n<span class="_ _0"></span>m<span class="_ _1"></span>e<span class="_ _0"></span>n<span class="_ _0"></span>t a<span class="_ _0"></span>c<span class="_ _1"></span>k<span class="_ _0"></span>n<span class="_ _0"></span>o<span class="_ _1"></span>w<span class="_ _1"></span>l<span class="_ _0"></span>e<span class="_ _0"></span>d<span class="_ _1"></span>g<span class="_ _0"></span>e<span class="_ _1"></span>s<span class="_ _0"></span> <span class="_ _1"></span>t<span class="_ _1"></span>h<span class="_ _0"></span>i<span class="_ _1"></span>s<span class="_ _0"></span> <span class="_ _1"></span>s<span class="_ _0"></span>i<span class="_ _1"></span>t<span class="_ _0"></span>u<span class="_ _1"></span>a<span class="_ _0"></span>t<span class="_ _0"></span>i<span class="_ _1"></span>o<span class="_ _0"></span>n<span class="_ _1"></span> <span class="_ _1"></span>a<span class="_ _0"></span>n<span class="_ _1"></span>d ta<span class="_ _0"></span>k<span class="_ _1"></span>es<span class="_ _0"></span> <span class="_ _1"></span>fir<span class="_ _0"></span>m <span class="_ _8"></span>ac<span class="_ _0"></span>ti<span class="_ _0"></span>on<span class="_ _1"></span> <span class="_ _0"></span>t<span class="_ _1"></span>o de<span class="_ _0"></span>al<span class="_ _1"></span> <span class="_ _1"></span>wi<span class="_ _0"></span>th<span class="_ _0"></span> <span class="_ _1"></span>it the<span class="_ _0"></span> be<span class="_ _1"></span>tt<span class="_ _0"></span>er <span class="_ _1"></span>fo<span class="_ _0"></span>r a<span class="_ _1"></span>ll <span class="_ _0"></span>of <span class="_ _1"></span>us.</span><span class="f2 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L8 h4 B24">
<span class="f2 s2 c0 C_ l0 w0 r0"> </span></div>
<div class="l t3 L8 h4 B27">
<i><span class="f2 s2 c0 C_ l0 w0 r0">Dr <span class="_ _0"></span>A<span class="_ _1"></span>tw<span class="_ _0"></span>oli<span class="_ _1"></span> is<span class="_ _0"></span> a <span class="_ _1"></span>co<span class="_ _0"></span>nsu<span class="_ _1"></span>lta<span class="_ _0"></span>nt <span class="_ _1"></span>ps<span class="_ _0"></span>ychi<span class="_ _0"></span>at<span class="_ _1"></span>ris<span class="_ _0"></span>t a<span class="_ _1"></span>nd <span class="_ _0"></span>sen<span class="_ _1"></span>ior<span class="_ _0"></span> le<span class="_ _1"></span>ctu<span class="_ _0"></span>r<span class="_ _1"></span>er at<span class="_ _0"></span> Mo<span class="_ _1"></span>i U<span class="_ _0"></span>niv<span class="_ _1"></span>ers<span class="_ _1"></span>ity<span class="_ _0"></span>’<span class="_ _0"></span>s S<span class="_ _1"></span>cho<span class="_ _0"></span>ol <span class="_ _1"></span>of Med<span class="_ _0"></span>ici<span class="_ _1"></span>ne<span class="_ _0"></span>.</span></i></div>
<div class="l t3 L8 h4 B27">
<i><span class="f2 s2 c0 C_ l0 w0 r0">l<span class="_ _1"></span>uk<span class="_ _0"></span>o<span class="_ _1"></span>y<span class="_ _0"></span>e@g<span class="_ _1"></span>mai<span class="_ _0"></span>l.<span class="_ _1"></span>co<span class="_ _0"></span>m</span></i></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com8tag:blogger.com,1999:blog-6486718881865623994.post-88985104988760358402014-06-17T21:47:00.002+03:002014-06-17T21:47:28.847+03:00Want to see how nations burn? Visit social mediaBy Lukoye Atwoli<br />
Sunday Nation 15 June 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
We cannot say we were not warned this time.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com3tag:blogger.com,1999:blog-6486718881865623994.post-20160619886572716822014-06-08T18:54:00.004+03:002014-06-08T18:54:56.628+03:00It’s time leaders did what they were chosen to do<div>
By Lukoye Atwoli<br />
Sunday Nation 08 June 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
But that is as far as the similarity extends.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com3tag:blogger.com,1999:blog-6486718881865623994.post-71159580177086429902014-06-04T05:07:00.002+03:002014-06-04T05:07:38.708+03:00Medical schools should teach, not make money<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
By Lukoye Atwoli</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
Sunday Nation 01 June 2014</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
<strong>CAREER PROGRESSION</strong></div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
<em style="color: #a6a6a6;">Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com6tag:blogger.com,1999:blog-6486718881865623994.post-23075240420338696262014-06-04T04:41:00.000+03:002014-06-04T04:41:30.042+03:00Doctors’ killing signifies a worrying trend<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
By Lukoye Atwoli</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
Sunday Nation 25 May 2014</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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. </div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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?</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
But maybe nobody cares!</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
<em style="color: #a6a6a6;">Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com3tag:blogger.com,1999:blog-6486718881865623994.post-46637945059215508102014-06-04T04:31:00.000+03:002014-06-04T04:31:02.442+03:00Let’s not interfere with MCAs’ oversight role<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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...</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
By Lukoye Atwoli</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
Sunday Nation, 18 May 2014</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
I disagree with the doomsayers.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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”.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
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.</div>
<div style="color: grey; font-family: Georgia, 'ITC Century W01 Light'; font-size: 15px; line-height: 25px; margin-bottom: 15.600000000000001px;">
<em style="color: #a6a6a6;">Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-6273622018098123742014-05-13T12:16:00.004+03:002014-05-13T12:16:59.534+03:00Depression is never the patient’s fault<div>
By Lukoye Atwoli<br />
Sunday Nation 11 May 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
People with depression need supportive family and friends, but above all, they need professional help.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com4tag:blogger.com,1999:blog-6486718881865623994.post-39333877356286655482014-05-05T14:27:00.000+03:002014-05-05T14:27:48.364+03:00Science and religion not on equal footing<div>
By Lukoye Atwoli<br />
Sunday Nation 04 May 2014 <br />
<br />
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That is how we have been able to discover more ways of making life easier and more comfortable.<strong> </strong></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<strong>APPEARANCE OF LOGIC</strong> </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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 <em>cul de sac,</em> they invoke the infallibility of their revelation or authorities?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As
we discuss the issue of religion and its effects in our society, these
are some of the issues we must take into consideration.<em> </em></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
</div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-37146048430838750412014-05-03T11:34:00.001+03:002014-05-03T11:34:33.428+03:00It’s not too late to redeem health services<div>
By Lukoye Atwoli<br />
Sunday Nation 27 April 2014 <br />
<br />
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”.<strong> </strong><br />
<br />
<strong>Why is this happening?</strong><br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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”.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-64625922409565913482014-05-03T11:31:00.002+03:002014-05-03T11:31:14.750+03:00Be humane in search for illegal aliensApologies for delayed posting. But here goes:<br />
<br />
<b>Be Humane in search for illegal weapons</b><br />
<br />
By Lukoye Atwoli<br />
Sunday Nation 20 April 2014<br />
<br />
<br />
<div>
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
<br />
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.<strong> </strong><br />
<br />
<strong>SMALL SACRIFICE</strong><br />
<br />
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.<br />
<br />
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.<br />
<br />
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?<br />
<br />
These are just some of the questions we must deal with, even as we pursue these miscreants.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
<br />A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-55711234448334052452014-04-17T12:15:00.001+03:002014-04-17T12:15:32.503+03:00‘Healing’ crusade poses serious health risk<div>
By Lukoye Atwoli<br />
Sunday Nation 13 April 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<strong> </strong><br />
<br />
<strong>ABANDONED MEDICATION</strong><br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-47052527685127697812014-04-11T16:06:00.001+03:002014-04-11T16:06:33.525+03:00Jubilee one year on: Analysis of health pledges in Jubilee Manifesto<div>
Free maternity keeps Uhuru and Ruto health pledge (I didn't do the headline!)<br />
By Lukoye Atwoli<br />
Daily Nation, Wednesday 09 April 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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”.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
One year down the line, an evaluation of the Jubilee pledges comes up with perhaps one major success story.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
As far as the health sector is concerned, the Jubilee coalition rates a very modest score.<strong><em> </em></strong><br />
<br />
<strong><em>Dr Atwoli is a senior lecturer, Moi University School of Medicine and national secretary-elect, Kenya Medical Association.</em></strong></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-85595619759075946722014-04-09T12:02:00.004+03:002014-04-09T12:02:58.293+03:00Is it time to regulate religious teachings?<div>
By Lukoye Atwoli<br />
Sunday Nation 06 April 2014<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<strong> </strong><br />
<br />
<strong>NO HINDRANCE</strong><br />
<br />
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.<br />
<br />
The alternative is to contend with continued religious “radicalisation”.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-25265479258398630732014-04-01T09:21:00.001+03:002014-04-01T09:21:19.368+03:00Wage bill debate sets stage for law review<div>
By Dr Lukoye Atwoli<br />
Sunday Nation 23 March 2014<br />
<br />
Finally, and as predicted, the motive behind the recent wage
bill ‘conversation’ is becoming clear. Already there are moves in
Parliament to reduce the number of elected representatives ostensibly
because someone has determined that they are a major contributor to the
allegedly ‘ballooning wage bill’.<br />
<br />
Apparently we must get rid of
women members of the National Assembly, nominated Members of Parliament,
members of the county assembly and even reduce the number of counties
in order to reduce recurrent expenditure.<br />
<br />
An interesting
observation about this whole charade is that it is obviously being led
by people who have always been opposed to the new Constitution. They
have now repackaged themselves into protectors of our national
expenditure, and are proposing moves meant to improve our economic
position. Their real goal, as is now becoming evident, is to
subvert the currently established constitutional order and revert to the
authoritarian model in which all authority vested in the president, who
was considered for all intents and purposes to be above the law.<br />
<br />
This
whole venture is extremely dishonest. Over the last three years or so,
health workers have engaged the government in dialogue aimed at
rationalising the national health workforce in order to improve service
delivery to Kenyans. To this end, they have repeatedly suggested
the need to have a health service commission that would register,
recruit and deploy all health workers in the country, based on needs
identified by the counties. (READ: <a href="http://www.nation.co.ke/news/Team-set-up-to-cut-costs-starts-work-/-/1056/2250752/-/woqhmqz/-/index.html" target="_blank">Team set up to cut costs starts work</a>)<br />
<br />
The
stock response from the government has been that such a move would
require a constitutional amendment allegedly because the Constitution
has vested all public human resources in defined constitutional
commissions, and the health service commission is not one of them. Further,
the Cabinet Secretary for Health is on record claiming, fallaciously
one must add, that all health services have been devolved under the
Constitution.<strong> </strong><br />
<br />
<strong>BREAKNECK SPEED</strong><br />
<br />
The point of
this example is that the political establishment has determined that it
is next to impossible to enact legislation addressing key human resource
concerns in the health sector, but is now attempting to legislate
far-reaching changes in the constitutionally provided structure of
government.<br />
<br />
Predictably, these bills will move at breakneck speed
through the Houses of Parliament as long as they enjoy the support of
the ‘owners of government’. (EDITORIAL: <a href="http://www.nation.co.ke/oped/Editorial/Government-wastage-has-become-appalling-/-/440804/2252106/-/7bt028/-/index.html" target="_blank">Government wastage has become appalling</a>) Politicians
have indicated that even if it takes a referendum to enact the changes
they are interested in, then that is the route they will take.<br />
<br />
All this
action is being taken, of course, in the interest of reducing the wage
bill. One wonders if anyone else can see the ludicrous chain of
reasoning behind such moves.<br />
<br />
As has been argued before, more
immediate measures can be taken to control expenditure, including
cutting fraud, waste and abuse in government offices. Streamlining
procurement procedures and consistently punishing corrupt officials
will definitely yield dividends that will see the economy grow
sustainably. More importantly, though, taking measures to increase
our national income and productivity will be the key drivers of
economic growth. Cutting public workers’ pay will not.<br />
<br />
It would
therefore serve our legislators well to focus on keeping the Executive
on its toes, instead of wasting time singing the Executive’s chorus
whenever they are called upon to do so. All this bickering is only
serving to reduce investor confidence in the state, and no amount of
wage bill cuts will bring this back.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-54115243079619188852014-04-01T09:15:00.003+03:002014-04-09T12:03:11.166+03:00Marriage Bill harms rights of the mentally ill<div>
By Lukoye Atwoli<br />
Sunday Nation 30 March 2014<br />
<br />
Two things caught my eye this past week, and both are worthy of comment. First,
our National Assembly passed a Marriage Bill that has elicited all
manner of comment, ranging from polygamy to gay marriage. Unfortunately,
combing through the Bill, one comes across several instances of
senselessly discriminatory clauses, chiefly against people with mental
illnesses.<br />
<br />
For instance, the effect of Clause 12(a)(ii) of the
Bill is to prohibit people with chronic mental illnesses characterised
by recurrent episodes from getting married. Similarly, Clauses 66(6)(g)
and 73(1)(g) make such mental illnesses legitimate reasons for voiding
or annulling a marriage.<br />
<br />
The net effect of the Marriage Bill as
debated and passed in Parliament is to ensure that a diagnosis of a
chronic mental illness would mean that the individual cannot legally get
married. It also means that even if one is already married, if
they are found to have had a chronic mental illness with a chronic
recurrent course, their spouses could legally petition for the marriage
to be annulled.<br />
<br />
The problem with this bill, as with all
legislation that purports to use mental illness as a reason to restrict
people’s rights, is that the originators clearly do not have an
understanding of what constitutes mental illness.<b> </b><br />
<br />
<b>CONDEMNED TO A LOVELESS LIFE</b><br />
<br />
Current
research evidence suggests that between 10 and 25 per cent of our
population suffers from a serious mental illness. The import of the
Marriage Bill is that this large segment of our population would be
condemned to a loveless life in which any attempt at a long-term
relationship would be null and void.<br />
<br />
Before he assents to it, the
president must subject this bill to thorough scrutiny by mental health
professionals in order to cure it of these discriminatory and
unconstitutional provisions. However, if he agrees with the intent
of the bill, which is to prevent the mentally ill from contracting
legal marriages, he must demand a clause that requires that everyone of
marriageable age undergo periodic psychiatric evaluations that shall
determine whether they can get married, or if already married, whether
the marriage may continue to be recognised under the law.<br />
<br />
This, of
course, means that he will have to budget for the training and
recruitment of a huge number of mental health specialists in the coming
years to help implement these provisions. Perhaps this is not such a bad
thing after all!<br />
<br />
The second issue that caught my attention were
media reports alleging that Catholic Cardinal John Njue had raised
misgivings about a tetanus vaccine aimed at preventing maternal and
child illness and deaths related to childbirth. He allegedly termed the
mass immunisation campaign “fishy”, and urged his followers to further
interrogate this vaccine.<br />
<br />
The cardinal, when he speaks, is assumed to be speaking for the Catholic Church. Devout
followers of the Church are expected to hang onto his every word, and
look up to him for spiritual guidance. When he suggests that a vaccine
may be dangerous, at least some of his followers will take him seriously
and start refusing it. The result will be potential illness and deaths that would have been prevented by the vaccination.<br />
<br />
Before
making such potentially harmful statements, religious leaders would be
well advised to seek competent guidance from experts in the field, many
of whom may be found among the faithful of the church.<i> </i><br />
<br />
<i>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</i></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-59890371533990025812014-03-17T16:15:00.001+03:002014-03-17T16:15:22.639+03:00‘Ballooning wage bill’ the latest national fad<div>
By Lukoye Atwoli<br />
Sunday Nation 16 March 2014<br />
<br />
As is the fashion in this country, the attention of all and sundry is now riveted on the latest fad, the ‘ballooning wage bill’. We
have now forgotten about the issues surrounding the standard gauge
railway, which was given the green light to proceed despite serious
misgivings about its cost and viability. We are no longer talking about
the starving people in the north. We have moved beyond our outrage after
the Auditor-General reported that over Sh300 billion in government
expenditure could not be accounted for.<br />
<br />
As we now embark on
long-winded discussions on the ‘ballooning wage bill’, we are still
planning to spend billions of shillings to pay what the government calls
‘ghost workers’. We are going to spend billions to pay the parallel
county governments under control of the national government, also known
as the ‘provincial administration’ despite the envisaged scrapping of
this system by the Constitution.<br />
<br />
In each county, several people
are doing the job of one person. For instance, in the health sector,
each county has a member of the executive committee in charge of health,
effectively the county minister for health. Under each of these
individuals, there are chief officers in charge of health, effectively
the county principal secretaries for health. They control a multitude of
staff under them responsible for county health functions.<strong> </strong><br />
<br />
<strong>PARALLEL FUNCTIONS</strong><br />
<br />
Interestingly,
the national government has also deployed county directors of medical
services and directors of public health to each county, under whom there
are district (sub-county) medical officers of health. In many
instances, these officers have a parallel bureaucracy under them,
effectively duplicating the roles and functions of the county-appointed
officers. This confusing structure is duplicated across all the
purportedly devolved functions.<br />
<br />
So our national government has
assembled all the experts in economic affairs, and correctly diagnosed
the problem behind our slow economic growth and difficulties meeting our
recurrent obligations. The problem, of course, is the ‘ballooning wage
bill’! Different percentages are cited, all in an attempt to demonstrate
that we are paying our workers way more than they deserve, leading to
inadequate funding of development projects and over-reliance on aid from
the bitterly-hated West.<br />
<br />
And our government, after correctly
diagnosing the problem, has come up with the very best solution possible
under the circumstances. We must reign in the ‘ballooning wage bill’ if
we are to survive imminent economic collapse.<br />
<br />
This is because we
are unable to shepherd the economy to grow in ‘double digits’ as naively
promised during the campaigns, while paying our lowly workers as much
as we are currently doing. It has proved difficult to rein in the
corruption that costs our economy hundreds of billions of shillings
annually, because we are paying our workers way too much.<br />
<br />
We
cannot deliver on the health, security, infrastructure and education
promises to our population, and at the same time pay the health workers
the salaries they demand. In fact, according to the brilliant economists
advising our government, we may need to retrench some of those workers
in order to improve efficiency in service delivery.<br />
<br />
According to
the government, making the private sector the preferred employer for our
top brains is the top priority. The first step, of course, is to
institute a pay cut across the board and tame the ‘ballooning wage
bill’.<br />
<br />
Brilliant, revolutionary stuff, if you ask me!<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-61733143569161984172014-03-11T16:11:00.004+03:002014-03-11T16:11:28.334+03:00Voters sold their right to health for Sh20By Lukoye Atwoli<br />
Sunday Nation 09 March 2014<br />
<br />
Kenya’s health sector is in a shambles. Hundreds of health workers
have now worked for over two months without pay because the national and
county governments cannot agree on who is responsible for them. Shortages
of medicines and important supplies are rife, even as governors try to
outdo each other in ‘flagging off’ lorryloads of medications in their
counties. As a result, ordinary Kenyans are suffering.<br />
<br />
A few
weeks ago, a middle-aged man from my village suddenly collapsed and had
to be rushed to hospital. The local hospital could not manage his
condition because he needed intensive care facilities that were not
available. The nearest referral facility was over a hundred kilometers
away in another county, but the family organised quickly to transport
him there.<br />
<br />
When they got to the hospital, all the intensive care
unit (ICU) beds were occupied, and they were informed that the next
available ICU beds were at a nearby private hospital. The relatives
agreed to have him admitted at the private hospital where after more
than a week in the unit, and despite the best efforts of the team
managing him, the patient died.<br />
<br />
This is when the problems began
for the family. Intensive care is very expensive business, and the
family was asked to raise over a million shillings to clear the hospital
bill. This poor family could only raise a fraction of the cost and had
to beg the hospital to release the body for burial. This took a
while to happen, and in the meantime the family looked around for
someone to take responsibility for their conundrum. Of course doctors
and other health workers bore the brunt of their criticism.<strong> </strong><br />
<br />
<strong>TURN AGAINST HEALTH WORKERS</strong><br />
<br />
This
is not a scenario unique to my village, or indeed to any one part of
our country. This is a story every ordinary family of Kenyans has had to
live through at some point. Unfortunately, when it happens, we turn
against the very same health workers who have struggled in very
difficult circumstances to save lives, and accuse them of all manner of
ills.<br />
<br />
In my discussion with the bereaved family, it struck me that
they all could not make the important connection between their own
choices and the fate that befell them. I asked them if they had informed
any of their elected representatives about their problem. They
informed me that the politicians had done their duty before elections,
and owed the electorate nothing. Their twenty and fifty-shilling
handouts had bought these villagers’ votes, and there was no use
approaching them to solve such ‘small’ problems as the health of their
constituents, among others.<br />
<br />
Flabbergasted, I attempted to
demonstrate that if they had voted based on policies and not because of
clan, family and handout considerations, perhaps their local hospital
would have been better equipped to save their relative’s life. Perhaps the county referral facility would have had well-equipped ICU facilities, with adequate beds to help all those in need.<br />
<br />
Perhaps
they would have had functioning ambulance services that would have
arrived a few minutes after the patient collapsed, and carried out
onsite procedures that would have prevented further damage and improved
his prognosis. If they had used their vote better, perhaps their
relative would not have collapsed in the first place.<br />
<br />
I do not know if I
managed to convince them, but I hope I did.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-56791196702440623022014-03-03T16:30:00.000+03:002014-03-03T16:30:51.690+03:00Anti-gay law: Lots of smoke and no lightBy Lukoye Atwoli<br />
Sunday Nation 02 March 2014<br />
<br />
The Ugandan parliament recently passed legislation outlawing
“homosexuality” in the country. The law provides for life imprisonment
for anyone committing or promoting the “offence of homosexuality”, among
many other penalties and prohibitions.<br />
<br />
It has been argued that
the fact that the Ugandan parliament passed this law and the president
assented to it is sad, but does not merit more than just passing comment
from anyone who is not Ugandan or directly affected by it. (READ: <a href="http://www.nation.co.ke/news/africa/John-Kerry-Yoweri-Museveni-Anti-Homosexuality-Bill/-/1066/2226398/-/14op5yx/-/index.html" target="_blank">Kerry calls Museveni over anti-gay law</a>) This
is fair enough on the face of it although, in such a digitally
connected world, it is difficult to isolate a country and argue for
internal self-determination on laws such as this that criminalise
behaviour that responsible scientists in the field do not consider
abnormal or even harmful.<br />
<br />
More pertinent, though, is the fact that
the Ugandan action is part of a wave of intolerance being propagated
across the continent by forces intent on forcing their own particular
brand of morality on African countries. Nigeria recently passed
similar legislation, and efforts are gathering pace in Kenya to
introduce similar legislation in our parliament. This is the
reason I think it is important to make the following points so that when
the legislative debate gets here, nobody will argue that we did not
raise any opposition to it.<br />
<br />
I have encountered, on social media
and elsewhere, arguments that opponents of homosexuality are disgusted
by the behaviour, or that it is somehow un-African and un-Christian.
Many of those supporting such legislation use these arguments to back
their viewpoints. We have, before this legislation was even contemplated, discussed all these points with vigour and often agreed to disagree.<br />
<br />
However,
in order to fully appreciate this matter, it is useful to understand
what “homosexual” means. First, it is a form of sexual orientation
referring to someone who is sexually attracted to persons of the same
sex. Second, it is a form of social identity, whereby an
individual identifies with people of homosexual orientation, and perhaps
also refers to themselves as being homosexual. Third, it is a
form of sexual behaviour involving intercourse or other sexual activity
between individuals of the same sex. (READ: <a href="http://www.nation.co.ke/lifestyle/Uganda-newspaper-names-200-homos/-/1190/2221484/-/f7dj4wz/-/index.html" target="_blank">Uganda newspaper names 200 'homos' after anti-gay law signed</a>)<b> </b><br />
<br />
<b>SAME SEX</b><br />
<br />
It
is important to appreciate that a person may meet one, two or all three
definitions of homosexual. For instance, one may have homosexual
orientation but never identify themselves as homosexual or engage in
homosexual behaviour. Similarly, one may engage in homosexual
behaviour without identifying themselves as being homosexual or even
while having primary sexual interest in members of the opposite sex.<br />
<br />
It
is instructive that these “anti-gay” laws are often informed by the
third definition only, and criminalise the behaviour on the assumption
that this will end the orientation and social identities. Unfortunately
mountains of research on this topic suggest that such moves are futile,
and homosexuality cannot be “cured” by such moves.<br />
<br />
It is also
true that the arguments about homosexuality being “disgusting,
un-African or un-Christian” are also informed by visualisations of
homosexual behaviour, often between males. While I can understand
some people’s disgust with this kind of behaviour, it is difficult for
me to link this disgust with the law-making process.<br />
<br />
We simply do
not go out and legislate against behaviours solely because they disgust
us. How then is homosexuality different? Surely even the “crime” of
homosexuality needs a victim?<i> </i><br />
<br />
<i>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</i>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-7525384186610831582014-02-25T09:19:00.001+03:002014-02-25T09:19:25.359+03:00Mental health philanthropy is good, but …<div>
By Lukoye Atwoli<br />
Sunday Nation 23 February 2014<br />
<br />
Two weeks ago in this column, we discussed the need for a high
profile advocate for mental health in this country. I was at the point
of despair, having given over and over again the reasons why it is
important and even profitable to invest in mental health. Despite
these noises, the Ministry of Health had gone ahead and illegally
disbanded the division of mental health, at a time when such a division
should have expanded to address the mental health challenges of Kenyans.<br />
<br />
A
few days after the article was published, I spoke with the Cabinet
Secretary for Health, who assured me that the government was aware of
the challenges facing the sector, and was doing something about it. As
it turns out, First Lady Margaret Kenyatta did visit Mathari Hospital
accompanied by benefactors from the Safaricom Foundation who donated
Sh50 million to help rehabilitate the facility.<br />
<br />
The
donated funds will go towards renovation of some wards and purchase the
necessary equipment and necessities to improve patient care. One must
necessarily thank Safaricom Foundation and the First Lady for taking the
initiative to highlight the plight of the mentally ill and their
carers. One also hopes that Mrs Kenyatta has, through
this kind gesture, accepted to be the voice of the mentally ill and look
out for their best interests.<br />
<br />
Unfortunately, however,
the Mathari situation is emblematic of our treatment of the mentally ill
in our country, in our homes, and in our social circles. We do not plan
for their needs, and instead “out source” them to charitable
individuals and organisations. Most activities aimed at improving the
mental health of Kenyans are funded by donors and private individuals.<br />
<br />
I
hope that with the involvement of the First Lady and the well-heeled
donor fraternity, the government’s conscience will be sufficiently
pricked, encouraging those responsible to take mental health more
seriously. If I had my way, I would ensure that a few steps with huge
gains are implemented immediately to obviate the need for Safaricom
Foundation to make a similar visit this time next year.<strong> </strong><br />
<br />
<strong>MENTAL HEALTH ACT</strong><br />
<br />
The
Ministry of Health would move to fully implement the Mental Health
Act’s provisions on funding of mental health services and creation of a
board to advise the government in this area. The
Division of Mental Health would be revitalised and facilitated to enable
it to handle emerging mental health problems, including suicide,
homicide, road crashes and substance use, such as alcohol related
problems.<br />
<br />
A vote for mental health services would be
created in the Health Ministry budget in order to adequately fund mental
health services, including mental health research, health promotion,
prevention of mental illnesses and treatment services for the mentally
ill. All government programmes and policies would be
examined for their mental health impact, and those that pose a risk to
the mental health of the population would be refined to reduce or
eliminate this risk.<br />
<br />
Doing these things does not
constitute a favour to Kenyans. It is a right guaranteed to all those
residing in this fair republic by the supreme law of the land, under the
right to health. It is a responsibility bestowed upon our elected
governments, and cannot be ceded to well-meaning philanthropists.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com1tag:blogger.com,1999:blog-6486718881865623994.post-23895277066540834372014-02-20T09:09:00.002+03:002014-02-20T09:09:25.263+03:00‘Secular’ hypocrisy on show in KisumuBy Lukoye Atwoli<br />
Sunday Nation 16 February 2014<br />
<br />
Last week I was forcefully reminded by a friend of mine that Kenya is
a secular state that is proud of its freedoms enshrined in our hallowed
constitution. This happened in the context of the riots and
demonstrations that beset the lakeside city of Kisumu over what the
demonstrators argued was an attempt to erect a satanic monument in the
centre of the city.<br />
<br />
According to news reports, a group of
businessmen who happened to subscribe to the Sikh faith had commissioned
a monument to commemorate a hundred years of the community’s presence
in Kisumu. The county government allegedly approved the project and the
businessmen commissioned a local sculptor with instructions about the
message they intended to convey.<br />
<br />
It is in fact said that the
construction of the monument continued openly, and nobody took any
notice of it until a band of religious zealots linked its presence to
some environmental phenomena going on in Kisumu at the time. They
quickly determined that the monument was satanic and had to be
demolished before fire and brimstone rained on the city.<br />
<br />
They organised
protests and demonstrations, culminating in a very public “lynching” of
the figure. The Sikh businessmen eventually removed the image “in order
to avoid further trouble”. The ensuing debates took on a shrill
tone, with some commentators equating the Sikh religion with
devil-worship, and others tarring all Kenyans of Asian origin with the
same “devil-worshipping” brush.<strong> </strong><br />
<br />
<strong>SECULAR STATE</strong><br />
<br />
This
is the genesis of the assertion that Kenya is a decidedly secular
state, and no religious symbols must be allowed to occupy public spaces.<br />
<br />
Those
that hold this position are a variegated collection, so it would be
unfair to accuse all of them of the same sin, so to speak. There are
those who have always held this position, and are against any display of
religious symbols or rituals in public spaces. They are against
prayers during public functions, religious services or symbols on public
property or display of the same by public officers.<br />
<br />
A second
section of this group, though, only discovered their indignation at the
desecration of Kenya’s secular nature when the “satanic” symbol was
hoisted in the “Christian” city of Kisumu. This is the
hypocritical bunch that organise religious ceremonies in public schools,
open public functions with prayers, teach religious studies in schools
(often no more than proselytising ventures), and have no apologies
peppering official speeches with praises for their deity. They
remain oblivious of the feelings of others, and their secular
sensitivities are only aroused when a competing faith gains prominence
with some assistance from officialdom.<br />
<br />
We must make up our minds
in this country on whether we are a truly secular state, in which case
religious symbols and rituals should be banned from all public spaces,
or a multi-religious society in which all religions are given equal
space in the eyes of the state. The second option is difficult to
maintain given the multiplicity of religious claims, many often
contradicting others, that would inundate the state under those
circumstances. The default, then, is for us to bolster our secular credentials and ban all religious expression in public spaces and functions.<br />
<br />
In
conclusion, one must note that the sponsors of the Kisumu sculpture
have vehemently denied any religious connection to the work, making its
take-down all the more ridiculous.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-56479753601886333412014-02-20T09:04:00.001+03:002014-02-20T09:04:18.408+03:00Mental health needs high-profile advocateBy Lukoye Atwoli<br />
Sunday Nation 09 February 2014<br />
<br />
There has been a flurry of prominent and influential personalities
selecting and supporting causes they hold dear to themselves and to
Kenyans at large. They have taken up roles in advocacy and support of these causes, organising activities and raising funds for them. For
instance, the President and his Deputy have taken agriculture very
seriously and have invested heavily in programmes aimed at bolstering
food security in our country.<br />
<br />
The Deputy President’s wife has
taken women’s empowerment to the next level, with her most prominent
activity being in support of women’s groups across the country. And
just last week, the First Lady launched preparations for a
half-marathon in support of programmes to improve maternal and child
care. She has also been involved in raising funds and awareness
for HIV/Aids initiatives, and supporting orphaned or abandoned children.<br />
<br />
In
short, the top leadership in our country is involved in charitable
initiatives aimed at empowering Kenyans of all walks of life. All these causes are equally worthy, and have far-reaching impacts on this country’s socio-economic situation.<br />
<br />
But one thing is missing.<br />
<br />
In
my opinion, the most vulnerable members of our society, male or female,
rich or poor, young or old, are those suffering from mental disorders. Wherever they are to be found, they are ridiculed, discriminated against, ignored, hidden or abused most savagely. So, for instance, people with HIV/Aids and mental illness have worse outcomes than those without mental illness.<br />
<br />
It
is in realising this that about 10 months ago I attempted to recruit
such a high-profile personality through an open letter published on this
page. I wrote the letter to the then newly-elected President
Uhuru Kenyatta while he was still celebrating his victory in last year’s
General Election.<br />
<br />
In that letter, I challenged President Kenyatta
to make his presidency count for health and, more specifically, for
mental health. I pointed out the challenges facing the health
sector as well as the consequences of neglecting the mental health of
our people. I indicated to him that a decision to invest in
health and mental health would make it much easier to address other
sectors of our economy.<br />
<br />
Unfortunately, most of the things I said
then clearly still need to be repeated, which is why I am constrained to
make this appeal again. I am looking for a high-profile Kenyan to take up an advocacy role for mental health in Kenya. If
it pleases the President or any other similarly well-connected person, I
would like to invite them to take up the cause of improving the lot of
Kenyans suffering from mental disorders.<br />
<br />
Any little thing done in
support of this cause will go a long way in improving the lot of all
Kenyans, not just those that are mentally ill. Such an advocate
could team up with mental health advocates and give talks, participate
in walks and marathons, help raise funds and try to influence the
decision-makers at the heart of this government in favour of better
mental health for all Kenyans.<br />
<br />
Currently mental health workers,
advocates and patients have few friends, and are considered queer,
weird, or even misplaced whenever they appear anywhere in public. A high-profile advocate will help to change this situation, and improve the quality of life for these vulnerable individuals.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-33525018734094284192014-02-20T09:00:00.004+03:002014-02-20T09:00:39.652+03:00Mentally ill deserve equal job opportunitiesBy Lukoye Atwoli<br />
Sunday Nation 02 February 2014<br />
<br />
Last week there were numerous newspaper reports about a mentally ill
doctor being nominated and interviewed for a top post in a county
government. While most reports were factual and reported events as
they actually happened, some were outright sensational and insulting
both to the candidate and mentally ill people in general.<br />
<br />
One
newspaper headlined the story using the term “mad doctor”, while another
referred to a previous case in which the doctor was alleged to have
killed someone during an episode of illness. Almost all the
stories had an incredulous tone, expressing surprise that a mentally ill
individual could be nominated for such a post in a county government.<br />
<br />
But what are the facts?<br />
<br />
Mental
illness can only be diagnosed by a qualified professional after taking a
detailed history of the patient, and a physical and mental state
examination. In many cases, investigations have to be carried out
to establish the exact cause of the symptoms and, in some instances,
physical causes are identified and treated, eliminating the mental
illness totally.<br />
<br />
Many people with mental illnesses are unaware of
this fact, and continue to suffer from serious symptoms without knowing
that they can be assisted to live a happier, healthier life. These “silent sufferers” are to be found at all echelons of society, from the poorest community to the most affluent groups. It
follows, therefore, that even at the top levels of our many governments
it is possible that some leaders are mentally ill but are unaware of
this fact.<br />
<br />
Most people think that mental illness is so obvious that it is easy to identify an individual suffering from such an illness. Unfortunately this is not the case. Mental
illnesses run the entire gamut of human experience, from mild forms of
anxiety disorders through moderately severe depressive episodes to the
more obvious psychotic episodes that many identify with the term
“madman”. It is, therefore, unfair to target an individual and
label them negatively simply because they suffered a severe episode of
mental illness and displayed their symptoms in public.<br />
<br />
Obviously we need to articulate a policy on employment for people with mental illnesses. Such
a policy must be careful to avoid falling short of the constitutional
injunction against discrimination on the basis of one’s health status. Such
a policy may prescribe, for instance, that a person suffering from
mental illness is entitled to equal opportunity when seeking employment
based on their ability and experience.<br />
<br />
The only caveat that may
be employed is that such a person must produce evidence of continued
treatment and follow-up by a mental health specialist in order to ensure
that their mental illness does not interfere with their work. This
would mean that even after employment, should an employee develop a
mental illness, they would be entitled to receive treatment and continue
working once the treating physician gives the green light. Assuming that one is unable to work by virtue of having a mental illness is abusive, discriminatory and downright inhuman.<br />
<br />
Should
we decide that people with mental illnesses should not occupy certain
posts in government or elsewhere, we must begin by conducting a mental
status evaluation of everyone in those positions to ensure that they do
not have a mental illness that interferes with the execution of their
duties.<br />
<br />
Only after doing this would we be justified to lock out any fresh applicants with mental illness.<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-19726365565533114622014-02-20T08:55:00.000+03:002014-02-20T08:55:10.829+03:00Why it is healthy to encourage dissentBy Lukoye Atwoli<br />
Sunday Nation 26 January 2014<br />
<br />
In Kenya, there is always a scandal involving huge sums of taxpayer money going on. There is no doubt in my mind that this has been happening every year since independence, and perhaps even before. It
is also very clear to me that if this were not the case, our country
would be soaring in the league of developed countries, lending money to
our poorer neighbours and helping others make good choices that would
make them prosper like us.<br />
<br />
Does this failure make Kenyans a strange breed among humans? I would argue that it does not. Human
beings are by nature selfish and accumulative, and the few who overcome
these base instincts are knighted and sainted, depending on the
circumstances. Most of those that actively seek and attain
positions of power do so for purely selfish reasons, despite the clothes
of altruism they wear for public consumption.<br />
<br />
Even for those who
seem to “have it all” before they go for leadership positions, Abraham
Maslow created a hierarchy of needs at whose apex he placed the most
selfish need of all, self-actualisation. This selfish and
accumulative need is a by-product of the survival imperative that has
been with us since our ancient predecessors rose to their feet and began
their journey across the then unexplored world. We needed to survive first, before we could be of any use to anyone else.<strong> </strong><br />
<br />
<strong>TRADE-OFF</strong><br />
<br />
Evolutionary
psychologists argue that even apparent acts of altruism are often
driven by a completely unconscious trade-off for future gain or
survival. That is an attribute that is common among all things that are considered “living”, and humans are no exception.<br />
<br />
How
then do some countries prosper while others lag behind, mired in
obscene corruption and impoverishment of the majority in favour of a
privileged minority? Working on the assumption that all people are
selfish and, given a chance, they would mortgage the entire country for
their personal gain, prosperous countries ensure that no single
individual has unfettered powers or the opportunity to make such
decisions.<br />
<br />
They ensure that every decision a person in power makes is second-guessed and discussed endlessly and often negatively. And
whenever evidence emerges that this person has misused state resources
or attempted to fleece the nation, the punishment is swift and
unrelenting. They lose office and lose face, and spend a huge
amount of resources to rehabilitate themselves, serving as an abject
lesson to their successors and others in power.<br />
<br />
This is the story of any country we look up to, any society we consider “successful”. And this is the reason Kenya seems to have stagnated and even retrogressed in some areas. The dominant voice in public discourse in this country is the silencing voice of Big Brother.<br />
<br />
Whenever
anyone expresses doubts about a decision by senior government
officials, they are reminded to be patriotic, and often asked what a
“nobody” like them has done for this country. They are asked to mind their own business, and in the past, we have even been asked, “Whose goat has he stolen?”<br />
<br />
If
we intend to prosper as a republic, we must encourage dissent, and urge
our leaders to deal with the issues raised by the dissenters, however
obnoxious, rather than demonising the dissenters themselves. A nation of meek sheep cannot roar like a pride of lions, no matter how loud they bleat!<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em>A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-59537879910470786992014-01-21T18:16:00.002+03:002014-01-21T18:16:38.394+03:00Insurance ‘exclusions’ a breach of the law<div>
By Lukoye Atwoli<br />
Sunday Nation 19 January 2014<br />
<br />
People with mental illnesses tend to be poorer than those in good mental health for several reasons. First,
poverty appears to increase the risk of several mental illnesses,
especially the more severe, debilitating ones. This is because the
social environment plays an important role in determining an
individual’s mental health, apart from their physical and psychological
condition.<br />
<br />
Second, mental illnesses inevitably interfere with an
individual’s ability to attend to their daily activities, reducing their
potential to earn an income and achieve prosperity. Obviously,
then, poverty and mental illness create a vicious cycle that obviates
the need to attempt to discover which of them came first.<br />
<br />
Eventually,
in order to address either condition, one must deal with the other.
Thus in treating mental illnesses, measures must be taken to ensure
continued productivity of the patient and, similarly, poverty
eradication must build in measures to address mental ill-health.<br />
<br />
In Kenya, most people pay for their health care out of pocket, and only a tiny minority can afford medical insurance. This
is more so for those suffering from mental disorders. Getting a chronic
illness, such as a mental disorder, is therefore often a ticket to
poverty for most Kenyans.<strong> </strong><br />
<br />
<strong>EXCLUSION CLAUSE</strong><br />
<br />
Unfortunately, it is now emerging that even having medical insurance is not enough for many people with mental illnesses. Many
insurers are getting into the habit of using the flimsiest of excuses
to exclude payment for the treatment of mental illness. The commonest
excuse is that there is a mental illness exclusion clause in the policy.<br />
<br />
Other insurers, who purport to cover mental illnesses as well, often refuse to pay for treatment of specific conditions. The
most commonly encountered “exclusions” are alcohol and substance abuse
and suicidal behaviour. It is time we put an end to this inhumane
behaviour that causes so much suffering for families that are already
distressed.<br />
<br />
Section 46 of the Mental Health Act, Cap 248 of the
Laws of Kenya, provides that “no insurance company shall make any
insurance policy providing insurance against sickness, which excludes or
restricts the treatment of persons suffering from mental disorder.”
Part two of this section makes it an offence to make such an insurance
policy.<br />
<br />
What this means is that every person in Kenya who has any
insurance against any sickness is covered for treatment of mental
illness. No insurance policy can reverse this. Therefore all those
purported “exclusions” are in breach of the law, and any insurer who
engages in such behaviour can be sued and compelled to pay for the
treatment of mental illness.<strong> </strong><br />
<br />
<strong>LEGITIMATE EXCLUSIONS</strong><br />
<br />
As
to the argument that alcohol and other substance-related disorders can
be legitimate exclusions, this is what Section 2 of the Mental Health
Act has to say:<br />
<br />
“Person suffering from mental disorder” means a
person who has been found to be so suffering under this Act and includes
a person diagnosed as a psychopathic person with mental illness, and <i>
person suffering from mental impairment due to alcohol or substance
abuse</i> (emphasis mine).<br />
<br />
In other words, alcohol and substance abuse
(and related disorders) are rightfully considered as mental disorders
for the purposes of Section 46, and no insurer can refuse to cover them
for any reason whatsoever.<br />
<br />
Unless insurers stop this
discriminatory behaviour, they must prepare for the flurry of litigation
that will inevitably come as Kenyans increasingly become aware of their
rights!<em> </em><br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em></div>
A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0tag:blogger.com,1999:blog-6486718881865623994.post-19877183792604146692014-01-13T15:59:00.002+03:002014-01-13T15:59:53.685+03:00Enough of blaming others for our mistakesBy Lukoye Atwoli<br />
Sunday Nation 12 January 2014<br />
<br />
Observing social discourse in Kenya, one notices a subtle shift in
explaining the distribution of poverty and under-development in certain
areas and among individuals. In the past, within relatively
homogenous groups of Kenyans, the discussion invariably veered towards
“marginalisation” by the dominant tribe(s) in government.<br />
<br />
One community,
or coalition of communities, would be labelled as oppressors of the
majority, and all members of this group would be accused of all sorts of
ills that resulted in most others sinking into poverty and want.<br />
<br />
Among
the so-called “oppressors,” however, the explanation for the opulence
in their midst would be put down to hard work and innovative
entrepreneurship. They would argue that they worked as
individuals to build their wealth, and that those who enjoyed any
favours from the State were in the minority and often transcended the
tribe barrier.<br />
<br />
They would cite examples of people from other
tribes who have been engaged in large-scale looting of State resources,
and were extremely wealthy, while their own communities remained largely
dirt-poor.<strong> </strong><br />
<br />
<strong>REPETITION OF INCOMPLETE NARRATIVES</strong><br />
<br />
This
group was also more likely to explain the high poverty levels in the
rest of the country as being a product of laziness, excessive
politicking, or lack of the entrepreneurial spirit.<br />
<br />
Both these
groups exemplify how insulating operating in an echo chamber can be.
Repetition of these obviously incomplete narratives turned them into
some sort of fact, gradually growing into self-fulfilling prophecies. Many
otherwise able-bodied youth would resort to begging or extortion, or
other more serious criminality, arguing that due to “marginalisation”,
they were unlikely to make it legitimately in this country.<br />
<br />
Almost
all members of the “marginalised” group would be astounded whenever one
expressed a contrary opinion placing the larger share of the blame on
the complainers themselves. On the other hand, the wealthy
“oppressors” would be shocked to learn that there are genuinely
hard-working Kenyans who had been shafted by the system, whose property
had been looted, and whose opportunities had been shrunk by operation of
the largely ethnic-based system of cronyism.<br />
<br />
The long and short
of this piece is to demonstrate how things have changed today. A new
coalition of “complainers” is emerging, and it has succeeded in
resurrecting an old ghost to aid its cause. Today, the
colonialist and his neo-colonialist ally are the main cause of our
problems, and any indigene who thinks otherwise is dismissed as their
lackey simply doing the bidding of his “foreign masters”.<br />
<br />
Growing up in the 80s and 90s at the peak of Nyayo’s power, one was made acutely aware of the actual meaning of such terms. Being
called a subversive under the influence of foreign powers always meant
the withdrawal of the privileges of citizenship, and existence at
“president’s pleasure”.<br />
<br />
Critically examining the re-emergence of
this phenomenon leads one to only one conclusion: We are constantly
looking around us for scapegoats that can explain our failures in life,
and we are averse to taking responsibility for the negative consequences
of our actions.<br />
<br />
In 2014, one can only hope that we shall discard
this time-wasting habit, examine our own actions and resolve to make
better decisions and accept the concomitant results. In order to develop
this lovely country of ours, we must leave the West (or the “other”
tribe) out of it!<br />
<br />
We determine our own destiny!<br />
<br />
<em>Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com</em> A Kenyan Psychiatristhttp://www.blogger.com/profile/10847761525347498412noreply@blogger.com0