Medical doctors need to eat too

Story by LUKOYE ATWOLI Publication Date: 7/9/2008

It is open season on doctors again! It is increasingly becoming fashionable to attack doctors for engaging in ‘‘private practice’’. A recent media interest in the issue seems to have sparked a passionate commentary by one Mary Okello (DN, July 4), who seems to have a particular gripe with doctors providing radiation oncology services at Kenyatta National Hospital and has now generalised it to all doctors in public service who engage in private practice. Several allegations made in the article cry out for immediate clarification to make the debate better informed. The writer asserts that all doctors in public hospitals engage in private practice, and that this is poorly regulated, resulting in patients without money dying ‘‘while waiting to access services, while their richer counterparts are fast-tracked into treatment’’. Another serious allegation of an ethical (and even criminal nature) is that doctors refer patients requiring ‘‘specialised treatment… to their own clinics or to their colleagues’ private clinics’’. The writer also suggests that private practice is inherently unethical since most doctors in public service ‘‘went through medical school courtesy of loans made possible by taxpayers’’. She closes by asserting that the ‘‘current position is heavily skewed in favour of doctors’’, and is creating discontent among other health cadres who feel overburdened and underpaid. Not all doctors engage in private practice. Issuance of private practice licences by the Medical Practitioners and Dentists’ Board is tightly regulated, and there are clear guidelines on who is entitled to engage in private practice and who is not. Even highly-qualified specialists are required to work under supervision of senior colleagues. Doctors do not see their private clients at the expense of hospital patients. Any doctor who does this flouts the terms of his or her employment. The question of referal is vexed. Doctors are trained to deal with a host of common problems during their basic training. However, some undergo further training in specialised areas to provide expertise in dealing with more serious and less common problems that would be difficult for a doctor with basic training alone. In medical practice, it is expected that a doctor will only deal with conditions that he or she is competent in. When a doctor comes into contact with a condition that requires more expertise, the practice is to refer to a specialist in that area, or to a colleague with more experience with the condition. It should therefore not surprise anyone that they get referred from one doctor to another. Would it be prudent for the doctor to insist on treating conditions he or she is unqualified to handle? It would be unethical and even criminal for a doctor to do so. Private practice is encouraged by hospitals since some clients demand to be seen privately by highly-skilled consultants who are few and sparsely distributed. To serve such clients, many hospitals have private wings where their consultants can continue to offer private services within the hospital. The doctors are offering an important service, and anyone who has problems with how this is organised needs to give suggestions about administrative measures instead of launching an attack on the service provider. The Government appreciates that lack of appreciation of professionalism and commensurate remuneration is the major factor in brain-drain affecting the health sector. Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Scam a test for the Grand Coalition

Story by LUKOYE ATWOLI

Publication Date: 7/7/2008

WHEN THE GRAND COALITION Government was sworn in a couple of months ago, they promised Kenyans that despite the bloated size of the Cabinet, they would do the right thing to bring the country back on its feet economically and in other spheres.

They promised to rein in corruption and improve the business environment to achieve huge levels of economic growth. Kenyans were promised that any public official on whom even the mere suspicion of corruption was directed would be relieved of his or her duties.

Given the nature of the recent scandals and the personalities involved, it must be reasonably expected that in the coming days we will have a new Finance minister, governor of the Central Bank and other senior civil servants at the Treasury.

This is the big test for the grand coalition. If it fails in this, all its members will lose legitimacy in the eyes of the common citizen, and all talk about vanquishing corruption will be rightfully dismissed for the hot air it is.

It is not enough, or even exculpatory, for a minister to purport to ‘‘blow the whistle’’ on a Cabinet colleague. It is worse than tragic for the fellow on whom the whistle has been blown to go to the press to ‘‘praise’’ the whistle-blower while in the same breath defending the illegal sale of public property.

It betrays a view of the common citizen as a blundering fool who will accept anything from those in Government despite the contrary evidence.

Why was it necessary to complete the Grand Regency deal with such haste and secrecy? Why the apparent lies about the buyers and the amount paid for it? Why the use of force and threats to public servants in order to register the sale and transfer of ownership?

FOR GOVERNMENT TO BE SEEN TO be working, these issues must be resolved at Cabinet level, the culprits identified and punished, and the entire Cabinet speak the same language about corruption and good governance.

That being the case, Mr Kimunya will find it increasingly difficult to explain away the sale of the Grand Regency.

The minister is still grappling with public discontent over the handling of the Safaricom IPO and the refund process, and another scandal concerning printing of currency lurks in the shadows. There is no way he can remain in Government while these issues remain unresolved.

Whether there are others involved in these scams or not, he must be the first casualty. If this does not happen, then any other minister who shares a Cabinet meeting with him must be deemed to be guilty by association. None of them will retain any moral authority with which to rant and rave about official corruption or poor governance.

An argument that is beginning to gain currency is that these scandals in the financial sector are all machinations aimed at burying the debate over taxation of MPs’ allowances by deflecting attention to other matters that will keep the minister busy.

That may well be the case, but we must, in the Prime Minister’s words, be able to chew gum and ascend a flight of stairs at the same time. We can keep an eye on the MPs to ensure they pay their taxes while at the same time ensuring those that insult the taxpayer by selling our property for a pittance are held responsible.

Dr Atwoli is a consultant psychiatrist and lecturer at Moi University School of Medicine.

Tax: MPs must try better excuses

Story by LUKOYE ATWOLI Publication Date: 6/24/2008

KENYANS ARE ONCE AGAIN having to contend with avarice, double-speak and outright insults from those they have elected to be their representatives. The question of whether or not our MPs should pay taxes on their generous allowances is not new in our national discourse. Neither are the justifications they use to deny the Exchequer what rightfully belongs there. Outside of Parliament, when they are busily campaigning for the title “Honourable”, they argue that MPs earn way too much and their pay should be reduced and subjected to tax. Once they get in, they metamorphose into avaricious creatures that would do anything to line their own pockets. To be fair, some MPs have spoken out in favour of paying taxes on their allowances. Most, however, are adamant that the move is unacceptable to them and they are preparing to shoot it down. Words used to describe the measure include “populist politics… nonsense… punishment” among others. It is difficult to gauge the amount of time our MPs have spent thinking about this matter, but their output suggests that theirs’ are knee-jerk reactions to the proposal. The words they use to describe the proposal are indeed instructive. It is ‘‘nonsense’’, a measure meant to punish the targeted taxpayer and reduce his or her standing in society. The interesting thing is that some of these fellows sit on important parliamentary committees that vet public expenditure and pass levies to be charged on the common citizenry. Even as they complain about paying tax, they have already presented proposals to buy new cars for themselves (including a convoy for Mr Speaker) among other perks they already enjoy. Some have even threatened to increase their allowances if the tax measure passes. One reason they are using to reject the tax on allowances is that they spend most of their pay on their constituents. This is a very lame excuse, especially in view of the Constituency Development Fund (run by MPs!) and other funds meant to take over the functions of harambee and out-of-pocket expenditure for MPs. THAT THEY SPEND THEIR MONEY on their voters is therefore a personal decision, and nobody forces them to do so. Many Kenyans out of Parliament are doing exactly the same thing, yet they pay taxes on their income. We are educating members of our extended families, feeding those too poor to afford a meal, forking out money for neighbourhood security, paying bills for our friends and neighbours and even organising weddings and funerals for these MPs’ constituents, yet we also faithfully pay our taxes and fill out our annual tax returns to avoid paying huge penalties. What makes MPs’ expenses more important than those of the common citizen? Another reason they are giving is that they travel frequently to their constituencies and spend a lot of money on their fuel-guzzlers, and therefore they need tax breaks to deal with this. Others claim they work for 24 hours and have no weekends, and therefore their tax-free allowances are fair compensation. These are all ludicrous arguments that would not stand close examination. Common citizens also toil endlessly in order to afford a single meal in a day, and as for the cost of fuel and travel, all Kenyans have been hard hit. It is ridiculous in the extreme that Kenyans earning less than a quarter of what our MPs earn end up paying the same amount of tax as the MPs! It is time those MPs who care about the future of this country stood up to be counted. Let them pay tax so that they can feel the pain the common citizen feels when the Kenya Revenue Authority milks them dry. This may inspire them to find ways of reducing taxes and using the money collected more efficiently. But that is a very long shot indeed! Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Kenyan politicians not really ready for true democracy

Story by LUKOYE ATWOLI Publication Date: 6/12/2008 Daily Nation Page 11

IN A RARE MOMENT OF CANDOUR, a senior figure in the Grand Coalition revealed the true motivation for the Kenyan politician. Speaking at a campaign rally in Kilgoris, Assistant minister, Joseph Nkaissery was quoted as saying that parties are of no importance in Kenyan politics, and that he held the interests of his tribe above those of his party. He was justifying his refusal to campaign for a candidate from his political party and preference for a candidate from an opposing party. His only consideration was the ethnicity of his preferred candidate, and not the policies he espoused or his commitment to the welfare of his constituents. The scenario above represents the mind of the average politician, and has been replicated countless times in relatively cosmopolitan constituencies. People elected on various party platforms turn around and threaten to leave their respective parties unless the interests of their ‘‘community’’ are taken into account. The meaning of ‘‘community’’ in this context is often narrowed down to what the so-called leader feels is in his or her personal interest. STATEMENTS LIKE ‘‘KENYANS WILL not accept ABC’’ or ‘‘Kenyans are demanding XYZ’’ are common during thunderous rallies and news conferences, while in reality the Kenyans being referred to would not fill a room in one of the mansions occupied by our leaders. On the authority of this politician, we now know the truth about all those shouting themselves hoarse about ‘‘we in ODM’’ or ‘‘we in PNU’; they have no interest in the welfare of Kenyans, and are just looking out for their own interests. Many young people have been involved as foot soldiers in political campaigns on behalf of these politicians, and many have paid the ultimate price – their lives. Hundreds of them are languishing in police cells facing various charges mostly involving violent acts on behalf of these two-faced politicians. These young people engaged in these acts probably believing that they were serving a just cause, that they were righteous warriors (pardon the metaphor) in the interests of their community, political party or country. What a lie! When the politicians sat together across the mediation table, they agreed to prosecute all perpetrators of violence, which was described as bordering on war crimes and crimes against humanity. They then went ahead and shared posts in Government and started planning ‘‘home-coming’’ parties, forgetting that the soldiers for freedom and defenders of the community were wallowing in poverty all over the country. The tragicomic show on ‘‘amnesty’ is just another false front being opened by politicians to hoodwink their followers that they are fighting for their rights. The truth is that politicians on both sides are saying the same thing but emphasising different aspects of the argument. One side is amplifying the need for certain perpetrators of violence to be punished and turning a blind eye to others, while the other side is emphasising the need to punish all purported wrong-doers instead of doing it selectively. Both sides seem agreed on the need to deal expeditiously with all those in custody – releasing those whose rights have already been violated through inordinately long incarceration, releasing petty offenders arrested for blocking traffic and shouting slogans, and taking those who committed heinous crimes through the due process of the law. What is the future of our fledgling democracy then? It is clear that as long as we continue along the path of deceit and double-speak, we shall continue suffering pain and bloodshed as experienced at the beginning of this year. WE ARE NOT LIVING IN A DEMOCRacy, and we should stop deluding ourselves that we are. What we have is a hodgepodge of nation-states practically at war with each other, and at every election, we put up our best warlords to vie against the best from other groups. Until we start thinking about ourselves as Kenyans first and use values and principles in making political decisions, we shall continue falling prey to duplicitous politicians who pretend to be one thing when campaigning and become another in other settings. Kenyans will only demonstrate their commitment to democracy when they transcend the comfort zone of their tribes and define themselves by other values. Until then, one can only conclude that we are not yet ready for democracy. Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

We can’t just decide to go back to business as usual

Story by LUKOYE ATWOLI

Publication Date: 5/27/2008

REPORTS THAT THE RECONCILIATION talks are hitting a deadlock due to absenteeism do not come as a surprise to many who now understand the psyche of the Kenyan leader. To most of them, the crisis is over, and once the internally displaced go back ‘‘home’’, it will be business as usual.

In the same vein, it is rather too optimistic to expect that anything positive will come out of the Truth, Justice and Reconciliation Commission set to be established soon.

The Kriegler Commission, too, may also hit a dead end, and even if they do a sterling job, the political will to implement their findings may be lacking.

My pessimism is informed on the failure of successive regimes to implement findings of similar commissions despite their potential to forestall just the sort of conflagration we experienced following the December elections.

The Parliamentary Select Committee reports on the killings of J.M. Kariuki, Robert Ouko and others; the Goldenberg Commission of inquiry; the Ndung’u Land Commission; the Akiwumi Commission of inquiry into ethnic clashes – the list is endless.

IT APPEARS THAT SINCE INDEPENDENCE, Kenyans have been going about their lives wearing heavy veils and unable to see each other’s true faces. These veils are once in a while lifted by events that threaten to destroy the nation, but we soon go back to life as usual.

As soon as the genie is conveniently stuffed back into the bottle Kenyans go back to some semblance of ‘‘normalcy’’ and continue with their pretended civility and hidden hatreds and resentments.

After the eruptions earlier this year, many had hoped that we would be collectively stunned as a nation into action that puts the tragedy behind us.

Indeed, many celebrated a new beginning upon the signing of the deal between President Kibaki and Prime Minister Raila Odinga. Soon enough, however, our leaders’ true natures came through and the fighting began in earnest.

When they are not engaging each other over primacy, they are arguing about the need for a “Grand Opposition” or whether or not to resettle IDPs or give amnesty to those arrested in connection with those anarchic times.

The focus on the future has been lost, and the only future our leaders are discussing is their own – who will occupy what position come 2012. In case they have forgotten, there are issues that must be confronted.

First among them is constitutional reform to formalise the compromises struck and take them further to include the creation of secure institutions that can hold the State together even when politicians disagree.

Disengagement from personality-cult politics and reorganisation of our political landscape will go a long way in reducing the risks of further violent eruptions during election years.

Secondly, we must find a way of dealing with the question of impunity. Thieves of public resources and beneficiaries of corruption must never find their way into public office to continue their nefarious ways.

Similarly, perpetrators of illegal acts of whatever nature must face commensurate punishments, however big or small. Kenyans must stop viewing thieves and killers through the ethnic prism and instead recognise them for what they really are – vile criminals standing by for an excuse to commit crime.

Thirdly, employment creation and fair remuneration must be made an urgent priority. Giving Kenyans a stake in the economy will reduce their propensity to go on destructive orgies every time they feel slighted.

Gainfully employed people are less likely to rush to destroy such infrastructure as roads and railways as well as public utilities.

FINALLY, DISTRIBUTION OF RESOURCES must not be perceived to be concentrating on only certain regions from which key national leaders hail. Efforts must be made to ensure that all citizens feel they owe allegiance to one nation and not to sub-nations or even foreign countries as is the case presently.

The current perceived inequities in national development only serves to entrench the perception that development only comes to those whose leader is nearest to State House, resulting in the zero-sum political contests every five years in our country.

These are only some of the ‘‘burning’’ issues that our leaders need to be trying to solve, instead of falling back on to our favourite national pastime – bickering.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.