When survival is the only option

Guest Writer
18 September ,2018

Ed’s note: On the eve of publishing this piece the governor of Nairobi found 12 bodies of infants hidden in boxes in Pumwani hospital. 

Rationally, I think it’s more profitable for this country if I stay breathing. I was – until recently – gainfully employed. A large chunk of that salary went to various government bodies. I file my tax returns on time. I am, by most accounts, good for the economy. If asked on a date and/or job interview, I would say I’m also a good citizen: I read the papers and watch news; I reflect on national politics/gossip, and often argue about it.

And yet, all this considered, I have a sneaking suspicion that Kenya is trying to kill me off.

Certainly, living in Kenya today has its inherent risks: you could die in the hundreds of accidents that happen monthly; your kiosk could be demolished and your entire family uprooted; you could be robbed and killed; you could die in some natural and/or manmade tragedy like your apartment building could collapse with you and your entire family inside, and so on. Let’s think of these as congenital Kenyan problems; if you are born here, perhaps there are some ground assumptions you must* eventually accept.

These congenital dangers are not what I’m talking about right now. I’m talking about what happens when a good samaritan pulls you from the wreckage and rushes you to the nearest hospital. Or when your children are get cholera and you take them to the local clinic. I’m talking about what happens when your wife goes into labour a month before your loan comes through, when your sister has a mental breakdown and must be committed. I’m talking about what happens when you start coughing up blood and need to see a specialist.

Let me explain.

Our national health policy is straightforward: don’t be sick.There is no gesture more characteristic of our medical infrastructure than a silent shrug. Raced over here at 3am with a sick baby but don’t have cash? Shrug. Performed major surgery on the wrong patient, or neglected them? Shrug. Have to travel across the country from your village to access one of the three specialists in Nairobi? Shrug. Raped women who just gave birth in a national medical institution? Shrug. Can’t bury your family until you clear the enormous medical bills? Shrug. Require access to medication or equipment not available in-country? Shrug. Seriously injured in an accident but medical staff on strike? (your guess)

For all the people who have been advocating for better healthcare for decades, this is old news. In fact, it’s in line with what appears to be our broader national ethos: don’t be poor. The difference between our congenital Kenyan problems and the growing urgency of our (lack of) medical infrastructure may not be too large. Both are engineered and sustained for profit. Both are wide-ranging and seemingly intractable. But I do sense a difference, minor perhaps, but enraging. While both problems are stealing Kenyan lives, the health crisis disgusts me primarily because it strikes me as so profoundly preventable as to be malicious. If I survive a car crash only to die in a queue at a referral hospital, hiyo ni uchokozi. If a nurse gives me the wrong name tag and I don’t receive appropriate care, hiyo ni uchokozi. When a pregnant woman dies giving birth in a rural clinic because there was no ultrasound machine, that is preventable.

Here’s what we know: we don’t have even a third of the required number of medical specialists in the country. The current staff are underpaid and overworked. Those in public hospitals, in particular, are decamping at an alarming rate. All the same, the future workforce – medical graduates – are not finding placements. Of those being placed, the distribution across the counties is uneven despite decentralization; over half of medical specialists are in Nairobi alone. Only a quarter of  all Kenyans are covered by health insurance. The National Health Insurance Fund (NHIF) recently downgraded its cover to a maximum of four hospital visits per family for an entire calendar year. In the region, Kenya spends a comparatively small fraction of its GDP (~6%) on healthcare. The entire sector is rapidly becoming privatized, with marked government support for foreign investment. All this is to say: we are nowhere close to achieving universal healthcare. Yes, several other countries are in a similar position. However, given our current resources, and varied happy coincidences of history, our failure is not justified.

But remember, don’t get sick. If you are a patriotic Kenyan, you’ll get malaria, or a bad sore throat. You’ll go to a chemist, pick up coartem or strepsils and be on your way. If you are a rebel, you will break your arm, or contract an STI. You’ll go to a clinic near you, wait, pay, see a GP, get a quick diagnosis, pay again for the medication, and be on your way. If you are at my point or higher then you make it to enemy of the state, and you’ll do something our government seems unwilling to consider but happy to profit from: you will acquire a chronic and/or severe illness.

I used to consider myself lucky. When I first fell ill, I was a consultant and could thankfully afford my own health insurance. In the time I began to worsen, I had shifted to work that provided me with medical cover. Throughout this time, I was still paying monthly for NHIF. Over the past two years, I have been foisted from one doctor to another, crawled from one hospital to another, first trying to get clear diagnoses, and then to find effective treatments, and compassionate care. I’ll spare you the horror of the inbetween. From January to July this year, I accessed over half a million shillings’ worth of healthcare. This does not include the ‘experimental’ or ‘unconventional’ treatments I tried, like additional physiotherapy and testing, that I had to pay for out of pocket.

I have stopped calling myself lucky because I was employed, had insurance, got diagnosed relatively faster than others, received passable care, and responded well to the treatments. Luck should not have to factor here. Let’s go back to the quick maths I started with. Maybe my frame is too narrow. Taxes on my income, and each of my individual purchases may not be enough to earn my keep as a Kenyan citizen. Maybe I’m worth more sick; my being constantly unwell certainly profits a few big clusters: pharmaceutical companies, private hospitals, government official and unofficial coffers. Don’t be sick.

If this country isn’t deliberately trying to kill me, it is, at the very least, not actively trying to keep me alive and healthy. Something has to give. We will continue to be frail humans and if the government insists on not only ignoring but profiting from this fact, then we are playing a fatal game of chicken; whoever blinks first loses. If you don’t get sick, you win. If you don’t get in an accident, you win. If no one in your circle gets ill or injured, you win. Lucky or not, those odds are tough to beat – and no one wins.  I did not.

Alexis Teyie is a writer and editor at Enkare Review

A Health Agenda in Jeopardy

Guest Writer
5 June ,2018

by Dr. Sakulen A. Hargura

Universal health care is a noble idea that is long overdue. For it to bear fruits and build a permanent home in our system, certain fundamental pillars that must be erected. The most important are sound healthcare policies, and adequate expertise to execute the plan contained in those policies.

Kenya has never been short on laws and policies (our constitution attests to our ability to formulate laws and policies). However acceptance, implementation and execution of these laws and policies has always been our weakness. Health is a basic human right. The post independence regime, and subsequent ones as well, laid the foundation for self sufficiency in health. The walk to self sufficiency, however, has been painstakingly slow. So much so that 55 years after independence, we do not have a fully functioning health care system (the kind of which Cuba is renowned for).

Kenya has had shortage of doctors since independence because for a very long time, it relied on only one institution (the University of Nairobi) to train both general physicians and specialists. This hampered the efforts to attain sustainable health care and ensured a constant injection of a low number of doctors into the system, which tried to maintain the distribution of specialists and general medical officers to all corners of the country.

Through remuneration that was commensurate with work environment, for example hardship allowances, and prioritization of doctors in hardship areas for masters study scholarships, the government gave doctors an incentive to move to the far off areas. These scholarships were systematic and deliberate so as to ensure not just constant supply of specialists, but to give the government the leverage to post the new graduate specialists to areas of need as well, be it in the major cities or rural areas. All the original blue print needed was expansion of capacity by giving more universities the resources and mandate to open medical schools in order to expand the inadequate human resource.

The change the Kenya’s public health care system needed to thrive finally arrived at the turn of the millennium with “parallel” degree programs. Medical degrees are long and expensive, and most public universities opened Schools of Medicine to benefit financially. Just as the first batch of these new graduate doctors joined the system, devolution happened. While devolution was meant to attain equity in resource sharing, it was mired by political hogwash that resulted in decisions that were not entirely aligned with the spirit of our constitution. Health was earmarked for devolution, but how to do it without deflation of the existing weak healthcare infrastructure and systems hadn’t been well thought out.

Kenya’s health care was a casualty in the territorial wars pitting Uhuru Kenyatta’s national government against the 47 county governments. To devolve health in its entirety, including human resource, without first holding forums to educate the governors and county health executives on the internal workings of Kenya’s health system was a wrong move. What county government needed was the control and management of the health facilities and infrastructure, as well as the health workers sent to their hospitals by the central government. The core hiring, distribution and training of health workers should, however, have been left at the Ministry of Health until such a time when devolution had been tested and matured.

Right after the hasty devolution of health, many doctors (especially specialists) exited public health care. Many of the counties affected have yet to attract them back despite concerted efforts. The chaos that followed resulted in a disgruntled work force as salaries delayed, the state of health facilities worsened, and the agreements signed with central government prior to devolution were disowned. The county governments not only failed to absorb new graduate doctors churned out by our universities but also refused to release those selected for masters study scholarships. The result was unnecessarily long strikes as central and county governments quarreled over who was responsible

At the moment, we are in a debate about the Cuban doctors joining our healthcare systems. While their credentials and proficiency are not in question, does Kenya need the Cuban doctors or does it need their healthcare system?

Kenya has a shortage of doctors, yet governors have persistently failed to absorb new graduate doctors who have completed their internships leaving them jobless. The same governors have refused to release countless doctors who have been given scholarships to study for their masters to add to the dwindling specialist numbers, with the excuse that they will be absentee employees. This not only denies citizens access to health care, but also derails Kenya’s ability to reach sufficient specialist numbers in the future. The system borne of hurried devolution is gutting Kenya’s public health care.

The Cuban doctors may be appealing, but their presence will not contribute to Kenya’s long term plans of sustainable universal health care. According to the government, they will serve at the grassroots level. This means they will not contribute to systemic education of new specialists in the country, nor will they help drive national policy at the helm. What happens after two years when the Cuban doctors bid us farewell? Do we then have the same program with India?

To bring in Cuban doctors with our existing system, or lack there of, is to transplant a branch of a flourishing tree onto a dry tree. Moreover, to base Kenya’s universal health coverage on a borrowed work force is to throw the seeds of a noble idea on to the rocks.

I believe that Kenya needs to restore the pre-devolution health care system in terms of training and distribution (posting) of doctors so as not to leave the fate of Kenyans in the hands of individual governors. Only then will we see the fruits of the increased numbers of doctors in the country. A body like the Health Service Commission (HSC) could be put in place as a bridge between the county and central governments to enable smooth movement of doctors through the two arms of government for training and posting.

We also need to borrow Cuban health policies, and some of their policy-makers, to duplicate their health care system. If at all their specialists are also brought in, they should be posted to universities and teaching hospitals to help train our doctors, not just to counties where upon the expiry of their tenure they will leave little in terms of long term impact.

Uhuru Kenyatta’s intent and will to implement his big four agenda should be well-informed and concerted. Instead of this public relations exercise, those entrusted with the duty of implementing this agenda should dig deep and consult concerned stakeholders so as to bring holistic and sustainable policies that will see us through another half a century.

Sakulen Hargura is a medical doctor presently pursuing masters in surgery in Turkey. He loves to read, and writes poetry as well as a weekly opinion piece for the Marsabit Times.

Kenya’s Perpetual Drought

Brenda Wambui
10 April ,2018

We suffer from a range of disasters as a country: flooding, fire tragedies, terrorism, corruption, diseases and epidemics, and drought – these reduce our quality of life, destroy our infrastructure, disrupt our economy, and cause a diversion of resources intended for other things. They also ensure that we remain underdeveloped.

Our country is particularly drought prone. Only 20% of our country receives high and regular rainfall. The other 80% is classified as Arid and Semi-Arid Land (ASAL), where annual rainfall is low, so drought is a regular thing. Currently, four counties (Isiolo, Garissa, Kajiado and Tana River) are classified in the alarm phase according to the National Drought Management Authority (NDMA) in February 2018. Ten counties have moved into the alert drought phase up from six in December, with most counties reporting a worsening trend. Only four out of the 23 ASAL counties (which make up a majority of Kenya’s land mass) recorded a stable trend.

The Kenya Red Cross also said that about 3.4 million people concentrated in 10 ASAL counties are facing food insecurity, and possibly famine, as a result of prolonged drought and failed rainfall. As a result, they are seeking KES 1.044 billion to fund their 2018 drought response and recovery program which is projected to reach 1,373,294 people.

In many ASAL areas, the October-November-December 2017 seasonal rainfall started late, had poor temporal and spatial distribution, was below average in total amount and stopped earlier than usual. This has affected the major harvest that was expected as a result of these rains in February 2018. In almost all counties, the vegetation situation was worse in January than it was in December. This may mean that most people, including subsistence farmers, will be relying on markets for their food. This scarcity and high demand will lead to much higher food prices.

Considering that the drought hits pastoral areas the hardest, their livestock will be malnourished, given the unavailability of water and forage. They won’t be able to fetch their usual prices. This means that pastoralists, too, will need food aid. It also means higher meat prices, because much of the livestock will die, as we have already began to see.

Drought is a weather condition. An extended period of dryness. We cannot prevent it, though we can predict it and prepare. There are three kinds of drought. Meteorological drought, which is when rainfall falls below a certain level that would lead scientists to consider it a drought. This could be seasonal. There is hydrological drought, which is often caused by meteorological drought. This is when water body levels fall below a certain amount. Finally, there is agricultural drought, which is when there is a significant reduction in crop yield, such that it may fall to a certain level considered to be a drought. This is also usually caused by the first two types of droughts. Kenya experiences all three types.

Famine on the other hand, is an economic condition. It is man made, because it is caused by a failure to plan. A failure to manage food supplies. For famine to occur, there has to be unavailability of food. Which does not necessarily need to happen when a drought occurs, because it is not like drought comes out of nowhere. It is not a surprise. Famine leads to hunger and starvation. A drought need not lead to famine, but in Kenya, it always does. We have a long history of famine and drought.

In 1997, we had a drought that affected the lives of 2 million people. In 2000, Kenya had its worst drought in 37 years. It affected 4 million people, who all needed food aid. In 2004, the long rains (normally expected between March and June) failed, leaving 2.3 million people in the need of aid. In 2005, famine was declared a national catastrophe, affecting 2.5 million people in Northern Kenya. In 2010 and 2011, we had our worst drought in 60 years. Across Kenya, Ethiopia and Somalia, 13.3 million people were affected. In 2014, we had a drought that affected 1.6 million people. In 2015, approximately 1.1 million people needed food aid because of rainfall shortages.

In 2017, over 2.7 million people were in need of food aid according to the NDMA. This number represents around 20% of the population in pastoral areas, and 18% in marginal agricultural areas. Maize yields fell by 50%, beans by 40 to 50%, and sorghum by 30% as compared to 2015. Some places experienced as much as a 70% drop in crop yields, and livestock was selling for as much as 25% less than 2015 prices. Because the February 2018 estimate is that more people will need food aid (at least 700,000 more people), we can project that the situation may be even worse this year.

Drought is one of the reasons we are unable to achieve the sustainable development goals – such as the ones related to attainment of food security, poverty eradication, and promotion of environmental sustainability. It makes no sense that we continue to rely on rainfall in our agricultural sector, knowing that our country is mostly arid and semi-arid. Whenever our rains fail, we have drought, followed by famine, which causes hunger and starvation. This continues to happen yet agriculture is a key driver for our social and economic development. This continues to happen even when we have an early warning system, and a drought management authority.

This is baffling. Most water for human consumption and other uses is derived from rivers whose recharge depends on rainfall. Our grid is also largely powered by hydroelectricity, so drought also leads to power shortages. In the year 2000, Kenya Power lost USD 20 million, and the national GDP contracted by 0.3%, because of drought. Drought also accelerates the process of desertification and biodiversity loss. People lose their jobs when industries shut down as resources get depleted, children drop out of school because their parents can’t afford to pay their fees because of the economic impact of drought, as well as the suspension of school feeding programmes when there is a famine.

The funds the Red Cross is seeking will go to nutrition, cash transfers, food vouchers, rehabilitation of watering points and animal slaughter. Which is odd, because this is the sort of thing a country with a government should be able to do for itself. While we cannot let people starve, if we continue to fundraise from our already overtaxed pockets to cover things we already pay taxes for, aren’t we encouraging our government to continue with its corruption?

Drought is an all-round disaster, and it is sad that we continue to take it lightly. Or government, and not the Red Cross, should be able to have enough food relief for affected people with special food formulas for the most affected, such as children, the elderly and mothers. They should have in place resources for human disease control and treatment, as well as animal feed and supplements. They should have enough water reserves for both humans and livestock, and allocate cash for all this because drought is not a surprise. They should plan for livestock disease control, shelter for these animals, debt relief for their owners, destocking, restocking, distribution of seed, the list is long.

We also need to have the government championing practices that will help the average Kenyan in such times. For example, promotion of water harvesting and storage (which is illegal in Nairobi), training water user associations, planning for new water sources, deepening wells, removing silt from water pans, and planning future interventions. They also need to promote animal production and drought resistant crops, improve extension services, and develop our cereal banks. They need to ensure we have enough pasture & water for livestock, building up, strengthen networks between herders, develop livestock markets, conserve and protect pasture.

They also need to establish a common approach to disease control for livestock, vaccinate, deworm, and maintain cattle dips. The crops they promote should be drought resistant, early maturing crops and indigenous plants that require little water. They also need to promote agro-forestry for fruits, fuel, fodder and medicine, and have proper pest and disease control in place. This is their responsibility.

They may claim that many things “begin with us” as citizens, but famine definitely begins with them.

The Elephant in Kenya’s Room

Brenda Wambui
20 February ,2018

We, the people of Kenya, claim to recognize the aspirations of all Kenyans for a government based on the essential values of human rights, equality, freedom, democracy, social justice and the rule of law. We also claim to promote the values that underlie an open and democratic society based on human dignity, equality, equity and freedom; and state categorically that our state shall not discriminate directly or indirectly against any person on any ground, including race, sex, pregnancy, marital status, health status, ethnic or social origin, colour, age, disability, religion, conscience, belief, culture, dress, language or birth. We lie.

In February 2018, the Kenya National Bureau of Statistics (KNBS) launched the Women and Men in Kenya booklet, contrasting the status of women and men in Kenya when it comes to population, health, education, employment, governance, domestic violence, decision-making, and Persons with Disabilities (PWDs). As at 2016, Kenya had an estimated 22,498,000 women and 21,870,000 men (making the total population 44,368,000). According to this estimate, women form 50.71% of Kenya’s population.

However, according to the booklet, women provide 80% of Kenya’s farm labor and manage 40% of the country’s smallholder farms, yet they own only roughly 1% of agricultural land and receive just 10% of available credit. Despite bearing the burden of pregnancy and child rearing, fewer women than men across all age groups have access to family planning messages through radio, television and newspapers regardless of their level of education. Despite this, women bear the burden of contraceptive use, with uptake of the male condom at a measly 0% in North Eastern region, 2% in the Coast, Eastern, Central and Rift Valley regions and 3% in Nairobi, Western and Nyanza regions, while that of injectables (mainly Depo Provera which has been proven to have several health risks for women, such as increasing the chance that they will contract HIV by 49%) for example being 19% at the Coast, 2% in North Eastern, 38% in Eastern, 22% in Central, 27% in Rift Valley, 28% in Western, 29% in Nyanza, and 24% in Nairobi.

362 out of every 100,000 women who give birth die as a result of complications of pregnancy and child bearing. An overwhelming 37% of childbirths are at home, coming second only to deliveries in public hospitals at 46%. The conditions at public hospitals are dismal, and childbirth at home is dangerous. Women who give birth at home rarely have access to a skilled healthcare worker. The reason Rwanda was able to reduce maternal mortality by 77% between 2000 and 2013 is because of the increase in skilled providers (especially midwives) during childbirth. In 2010, 69% of the child deliveries in Rwanda were by a skilled healthcare provider.

It bears repeating that we have yet to pass the Reproductive Health Bill since it was tabled in 2014, yet it aims to provide for the recognition of reproductive rights, set the standards of reproductive health, and provide for the right to make decisions regarding reproduction free from discrimination, coercion and violence. The Bill aims to promote women’s health and safe motherhood, rapidly and substantially reduce maternal and child mortality rates in Kenya, as well as ensure access to quality and comprehensive provision of health care services to women and children. So much for our commitment to SDG 3, which aims for the achievement of good health and well-being (one of the ways is through reducing maternal mortality) and SDG 5, which aims for the achievement of gender equality.

When it comes to diseases, more women than men have been diagnosed with non-communicable diseases such as diabetes and hypertension. Women across all age groups and levels of education also have lower comprehensive knowledge about HIV/AIDS (which is a communicable disease) than men.

Men have higher levels of enrollment in all levels of education overall than women. This gap begins in secondary school, where it is slightly under 5%, and grows significantly in university where it is around 20% in public universities. The booklet does not state the cause, but possible reasons include early marriage and teen pregnancy.

Fewer women than men (up to 10% fewer) also apply for and receive loans for education in public universities. There is a 20% gap between men and women when it comes to enrollment in technical institutions, and a 10% gap when it comes to enrollment in TVET (Technical and Vocational Education and Training) Institutions.

The situation is even starker in employment: Men are employed at almost double the rate of women in modern sector employment, where workers are 66% male and 34% female. In wage sector employment, men are employed at over double the rate of women in agriculture (the workforce is 67% male and 33% female), manufacturing (the workforce is 84% male and 16% female), and wholesaling (the workforce is 77% male and 23% female). In public administration wage employment, the workforce is 64% male and 36% female. The only wage employment sectors where there is almost parity are the education sector (the workforce is 53% male and 47% female) and service activities (the workforce is 48% male and 52% female).

Despite the existence of the Protection Against Domestic Violence Act (2015), women continue to experience high rates of abuse, mostly at the hands of current partners (57% of women who have been abused were abused by their current partners) and former partners (24% of women who have been abused). Almost 40% of women aged 15 – 49 have experienced physical violence (for men, it is under 10%), almost 15% of them have experienced sexual violence (for men, it is under 5%), and almost 35% of them have experienced emotional violence (for men, it is just over 20%).

Our Constitution states that women and men have the right to equal treatment, including the right to equal opportunities in political, economic, cultural and social spheres. It also states that not more than two-thirds of the members of elective public bodies shall be of the same gender. This has yet to happen, and legislation enforcing this constitutional requirement has yet to be passed despite the Jubilee party having a parliamentary majority and constantly claiming it is committed to the empowerment of women. Across most public and elective posts (such as MCA, governor, deputy governor, senator, member of national assembly, cabinet secretaries, diplomatic corps, Supreme Court judges, and Court of Appeal judges) women are fewer than 33.33%.

The situation is even worse in the private sector. Over 80% of the members of boards of private sector companies, chairpersons of these boards; directors in the registered companies listed at the Nairobi Securities Exchange and the chairpersons of the boards of these listed companies are men.

Women experience high levels of crimes against morality at the hands of men. Men commit up to 80% of the reported crimes against morality (women commit slightly over 20%), and are the key perpetrators of rape (over 80% of all reported rapes, including that of children, are committed by men). Men also commit 80% of all homicides, robberies, theft, offences related to drugs and other criminal offences. Because of this, men account for slightly over 80% of the prison population.

So much for the boy-child being left behind.

These figures paint a stark picture. They explain why Kenya’s Gender Equality Index is 38%. We still have light-years to go before we can live up to the ideals embodied in our Constitution. We have to close the gender gap across all areas: in employment, in healthcare, in education, and in payment for their work (women in Kenya earn 38% less than men on average). We have to strive to end violence against women, and we have to guarantee the representation of women in public and private institutions. Until then, when we claim to promote the values that underlie an open and democratic society based on human dignity, equality, equity and freedom in our Constitution, we lie.

Devolution and The Shisha Ban

Guest Writer
30 January ,2018

by Elizabeth Kabari

On 28th December 2017, the Public Health (Control of Shisha Smoking) Rules were gazetted and came into force. These rules effectively banned the manufacture, importation, sale, and use of shisha by criminalising these acts. Anyone found doing any of the above shall, upon conviction, be liable to pay a fine of not more than KES 50,000 or be imprisoned for a term not exceeding 6 months, or be made to pay the fine and serve the sentence. If you continue to repeat any of the above offences, you also get fined KES 1,000 for every additional day you continue to break the law.

The rules were made by the Cabinet Secretary for Health, Dr. Cleopa Mailu. The CS explained that the rules were made to protect public health – he claims that, in addition to being harmful in itself, shisha is a gateway to other drugs such as heroin. He therefore made the rules pursuant to his power under the Public Health Act, specifically Section 36(m).  

These rules have caused a lot of uproar both online and offline, with former Chief Justice Willy Mutunga tweeting that the ban “smirks of hypocrisy and dictatorship” and shisha traders moving to court to get the ban lifted. However, what I find most striking about this ban is that it shows that the government still doesn’t fully understand how devolution works. Here’s why:

Eight years ago, Kenyans adopted a new constitution. It was hoped that this constitution would usher us into a new era of citizen-centred governance which focused on human rights, true democracy and equitable distribution of resources. To this end, a key element of the new constitution was devolution; that is, the separation of the government into two levels: the county level and the national level. Powers and functions were then divided between these levels so that we can improve the delivery of public services to wananchi and enable Kenyans to effectively govern themselves.  

One of the functions that was devolved was health. The Fourth Schedule of the Constitution devolved health as follows: the national government was tasked with creating health policies and managing national health referral facilities (that is, Kenyatta National Hospital and Moi Teaching and Referral Hospital). The county government was tasked with managing county health services which includes all other hospitals and pharmacies, ambulances, primary healthcare etc. The counties were also tasked with controlling drugs and pornography.

The transfer of the function of health from the national government to the county governments was completed in August 2013. However, to date, many of the laws which existed before 2013, have not been amended to reflect the changes brought on by devolution.

The Public Health Act is one of these laws – it still has provisions that are not in line with the Constitution and therefore have no force in law because the Constitution supersedes all laws. Unfortunately, Section 36 of the Public Health Act is one of these sections. It empowers the CS to make rules where “any part of Kenya is threatened by a formidable epidemic, endemic or infectious disease.”  

The function of preventing epidemics is a part of primary healthcare which makes it a county government function. This means that the powers given to the CS under Section 36 are, in this new constitutional dispensation, not actually his to exercise. The only power the CS has is the power to create policy (not law) to guide counties on how they should deal with such diseases.

Even if the above was not the case, and prevention of epidemics was a national function, the rules would still have been based on shaky legal ground. This is because Section 36 of the Public Health Act applies to formidable epidemic, endemic or infectious diseases. To clarify which diseases these are, the Act provides a list. They include smallpox, plague, Asiatic cholera, yellow fever and sleeping sickness or human trypanosomiasis (basically, serious diseases that are be passed by air, contact, being bitten/stung etc).

The diseases caused by shisha include cancer, heart disease and respiratory problems. None of these are diseases that the Public Health Act considers formidable epidemic, endemic or infectious diseases. Therefore, they are not covered by the powers given to the CS in Section 36.

The purpose of the rules, as their title succinctly puts it, is the “control of shisha smoking.” The rules then proceed to define shisha as “…tobacco products that may be flavoured or unflavoured…”. As we all know, tobacco is a drug. In a nutshell, the purpose of the rules is to control a drug. Control of drugs, as we’ve already seen, is a county function. The Cabinet Secretary cannot perform it. The most he can do is issue a policy to guide the counties on how the they should tackle the issue.

Despite all these legal barriers, the rules were made and gazetted into law. Consequently, we now have a law that has been passed by an organ of government that had no power to pass it, which regulates a matter that the organ has no power to regulate. This puts us, as a country, in a very confusing place: do these rules have the force of law? Are we bound by them? Assuming someone is arrested for manufacturing, selling or smoking shisha, can they be tried?

Hopefully, the courts shall answer these questions and give us a precedent for how we should proceed when such circumstances arise (because they surely will). Until then, it seems we’re confined to a life without shisha.

 

Elizabeth is an advocate with a passion for human rights and a love for research and reading.

How is This Even a Discussion?

Michael Onsando
23 January ,2018

“Disposability is a long word. It speaks about the value of an object within a certain space. Say, for example, the wrapper of the chewing gum that you just had. That is very disposable. Unless  you collect chewing gum wrappers. The idea of disposability of people within a community works the same way. How can society work with or without, say, you? Are you collectible, or disposable? Do you have value?”

One only needs to google “Kenyatta Hospital Screenshots” to read about the atrocities that have been happening at Kenyatta Hospital recently. But, if you don’t want to google, and are yet to hear, there are allegations of all sorts flying at the hospital. These allegations have nothing to do with poor services rendered (something that we can talk about), but of robbery, people being drugged and rape. There’s something especially wrong when we are discussing whether you are safe at a hospital (before even discussing whether they are getting treated).

Still, this is where we find ourselves.

Disposability shows its face in many ways. When a place is made for you, it is created to enable your continued survival. To be disposable is to speak of the attitude of the state towards a people. It is more than neglect, because if it was neglect, the state would at least acknowledge the responsibility held. To be disposable is to live in a state where the assumption of responsibility itself does not exist.

“We wish to state that there is no mother or patient who has reported being raped or attempted rape at Kenyatta Hospital”

““Did you report?” as the first thing a victim is asked does not address what the victim has just gone through. It does not deal with the violation. It does not allow the sexual assault victim control of what happens next. Reporting will only help a victim if they are allowed to make this decision.”

But, what do we want? By the time the screenshots were hitting peak circulation KNH had responded. In typical fashion blame was shifted to the victims but an investigation was promised. We are now in the stage where we wait for some action(and forces push for something to happen). We can speculate that this will go round on social media, pressure will be increased and soon the public declarations by government officials will start. Once this has happened a report will be generated that will be given to parliament, who will discuss this report over 90 to infinity before it slowly slips out of the public conscious. Part of a Facebook post reads:

“My wonder, after 6years, is this. If the KNH story hadn’t been told on social media, not many would have known nor cared. Ignorance has been blissful.  Pia, inakaa Akili nyingi imeondoa maarifa mengi. (…)Those that need that social revolution the most, are not ardent social media users. Aren’t nearly well-enough read to comprehend this post. And yet we, who have that luxury.  We talk. Sensationalize issues for a bit; months, even. Then, more often than not, forget. “

This reminds me of the discussion we had a few months back about travel. We see a series of road accidents, then national outcry, followed by a decisive declaration which is soon overturned because it really isn’t a policy. Even with the NTSA – we saw them on the road, then a quick sudden death meant they aren’t on the road anymore.

Is anything really being thought through?

I ask this in light of Sonko’s various squads as well. Who is on these squads? What is their mandate? (especially because one squad is also meant to help with security. Do they use force? Under whose authority?) I ask because women aren’t safe going to give birth. Because this isn’t really even a large policy question – rather a simple question of security and efficiency. How, and when, will we demand to receive the services that we need?

“Yet what is baffling to me is that we continue to think of these moments as glitches; flaws in the system that runs Kenya, as opposed to proof that it is working exactly how it was designed – to keep the majority poor, hungry and desperate, never with enough time to realize that their dignity is inherent; that they are deserving of rights; that it has never been about tribe, but about class and power, and that ultimately, the power was always theirs to use and give. We continue to sacrifice our nation’s most vulnerable at the altar of corruption and anyhowness, and we can only get away with it for so long.”

As I write this essay, I realise that I am working towards showing the nuance in something that, honestly, isn’t quite nuanced. It is important that the oldest and, arguably, most accessible hospital in the country be safe. Hospitals are the place we go when our bodies have failed us. When we are at our weakest. I’m not equipped to do it – but I’ve heard that giving birth is hard and both physically and mentally straining. Surely, we need not add insecure and unsafe to, what is already, extremely difficult.

It’s 2018, the city is Nairobi and we’re discussing mothers giving birth without being raped. Seriously though, how is this even a thing?

 

The #LipaKamaTender Movement

Guest Writer
21 February ,2017

by Dr. Judy Karagania

Kenyan doctors have been on strike since 5 December 2016. That is 79 days. This strike has historical parallels to what is considered the longest strike by medical practitioners in 1994 that lasted 105 days. Three thousand doctors were sacked fighting for the registration of the Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU) and salary increases.[1]

In the last 2 years alone, there have been 42 strikes in various counties, following the hurried devolution of the health sector in January 2014. [2] However, this strike is different because we are fighting for the enactment of the Collective Bargaining Agreement (CBA) that was signed between the doctors and the government in June 2013, yet the government has delayed its registration and implementation for the last three and a half years.

The CBA captures issues varying from doctors’ remuneration, promotions, transfer and training of doctors; improved working conditions such as functioning medical equipment, increase of number of doctors and support staff; benefits to doctors such as ‘workmen compensation and retirement.’ In October 2016, following an 18 month case the doctors’ union had lodged against the government, the Labour court ordered for the registration of the CBA, but the Ministry of Health remains defiant. Our struggle takes place in a context where various government ministries have been mired in corruption scandals by paying for inflated tenders for services and commodities that are rarely delivered.[3] It is with this same speed that doctors want the CBA to be paid, hence the hash tag #lipakamatender which means “pay it like a government tender.”

“Daktari unahitajika ward.” The nurse sounds tired. She is overworked, being one of two nurses there caring for a ward with 80 patients. This is far from the WHO recommended nurse : patient ratio of 1:6/10. I find a patient convulsing, an empty emergency tray and the pharmacist informs me that we have been out of anti-convulsants for more than a month. The patient is dead when her kin returns with the drug from a private pharmacy in town.

For years, Kenyan doctors have been reduced to supervisors of patients’ deaths and we see this strike as the beginning of the path to redemption. One could easily trip over several patients lying on the floor because all the beds already are occupied by two patients. On display are archaic blood test machines and x-ray machines which haven’t been working for the last two weeks. The donated ambulance at the parking lot has also been out of service for the last 2 months. A mother mourns her deceased new-born because she went into obstructed labour at home, and the only means for her to get to the hospital, 60 km away, was on a bodaboda (motorcycle).

It is with an air of irony that doctors noted that the First Lady, Margaret Kenyatta, once again announced her annual Beyond Zero marathon which has been held for the last 3 years to raise funds to improve maternal and child health. Yet her husband heads a government that is constitutionally mandated to address this need and has failed to support its doctors. To add to the irony, the Ministry of Health, using taxpayers’ money, are also large donors to this private campaign. Due to the politicization of the agenda, the First Lady issued a statement cancelling this year’s marathon. The quest to have fully equipped hospitals is constantly hampered by ingrained corruption and government inefficiencies. For example, KES 30 Million worth of medical equipment was returned to its Swedish donors after the donor declined to pay out KES 2 million in kickbacks to have the consignment cleared at the port.[4]

At the beginning of the strike, the Cabinet Secretary of Health, the Deputy President and the President all insisted that there was no money with which to pay doctors. Yet the same government spends KES 16 billion in annual salaries for members of parliament and senators, who are the second highest paid lawmakers in the world after those in Nigeria. They receive 76 times of Kenya’s GDP per capita of KES 86,624[5], and a further KES 4 billion on their travel allowances. In 2015, the president’s travel cost the taxpayers a whopping KES 1.2 Billion.[6] Adding insult to injury, whilst doctors have been on strike Kenyan MPs have awarded themselves send-off packages worth KES 36 billion and are to receive KES 11 million as “gratuity.”

In light of all this extravagance, the doctors’ demands for the new pay structure will set back the government only KES 8.1 billion annually for 4,500 doctors in public service. Despite this, the government in the last 11 weeks,has undermined the CBA and repeatedly offered a 40% increase in the emergency call allowance and a “presidential gift” of KES 10,000 as a risk allowance. This is very different from what was painstakingly agreed upon in the CBA that involves special banding of doctors’ remuneration, because of the unique nature of our work as civil servants, working odd hours and repeatedly endangering our own health and lives. Furthermore, there is the ongoing suspended prison sentence for the top seven union officials, which has been used to blackmail them to call off the strike.

The integrity with which the government has handled negotiations with doctors has also been called into question. The Telegraph India reported that the Indian government through their Prime Minister Narendra Modi had “sidestepped” a proposal from Kenya to fly doctors from India to fill the gap created by the strike during a state visit to India by Kenya’s president, Uhuru Kenyatta. The other proposed source of doctors was Cuba, who have remained silent on the issue. Even though the government has denied these claims, we question the seriousness and commitment that they bring to negotiating with doctors.

The Minister of Finance recently admitted that the reason why they do not want to pay doctors a decent salary in the public sector is because this would cause an influx of doctors from the private to the public sector, hence private hospitals would collapse. With more than 95% of Kenyans relying on public facilities, it should go without saying that health is a public function. From the approximately KES 50 billion our National Health Insurance Fund (NHIF) receives, KES 33 billion goes to private hospitals, KES 10 billion goes to India for treatment of Kenyans there and only KES 7 billion goes to public hospitals, of which only KES 4.2 billion goes towards free maternity care.[7]

Government interests are clearly skewed away from catering to the public’s needs. On the other hand, private hospitals are known to exploit doctors, paying them as little as KES 55,000 a month. While the public provision of health services is thus undermined, international investment companies are flocking in, seeking to invest in private healthcare in Kenya, because it is a “honey pot” for a rising middle class. Our very own private facilities are also investing billions of shillings in expansions. Does this mean that access to healthcare will become a privilege and not a right?

The vultures are circling around the carcass that is public health care, but doctors shall continue fighting for the ordinary citizen to have access to the best attainable health in this country.

Dr. Judy Karagania is a Kenyan medical doctor currently working in the largest referral hospital in the region, Kenyatta National Hospital, while pursuing her postgraduate studies in Ophthalmology. She obtained her medical degree from the University of Nairobi and afterwards went straight into the public health service at the second largest referral hospital in Kenya, Moi Teaching and Referral Hospital, in Eldoret, then later worked at a smaller hospital in Naivasha.

Ed: A version of this essay was initially published on Review of African Political Economy.

References

[1] The Star, 8 December, 2016, Kenyan Doctors’ Fight for Better Pay started in 1994. Doctors were deemed un-unionisable then because the law categorized them as being in managerial positions. The Union was only registered in 2011

[2] Section 138 of the County Government act and part 187 of the Kenyan constitution. The transition authority had advised that devolution of Health should be done slowly, but it was very quickly executed.

[3] Two recent examples of major tender issuance corruption scandals in Kenya in 2016 alone can be read at: The Daily Nation, 27 October, 2016, Questions raised as Kshs 5 Billion missing at Health Ministry; AllAfricanews.com, 30 September, 2016, Kenya: Sh1.8bn Lost in NYS Scam, Lawmakers Told

[4] The Daily Nation, July 9, 2016, Donor takes back Sh30m equipment after refusing to give out kickbacks

[5] Business Daily, July 23, 2013. Kenyan Legislators emerge second in global pay ranking.

[6] Business Daily, Oct 12, 2015. Uhuru foreign country visits cost taxpayers Sh1.2bn

[7] KMPDU Secretary General’s Speech January 31, 2017

It’s all in Your Mind

Guest Writer
19 January ,2016

This essay is taken from Brainstorm’s second e-book, (In)Sanity: What “Crazy” Looks Like, which is on mental health in Kenya and is available for free. DOWNLOAD IT HERE to read more such essays.

by Kevin Rigathi

In Kenya, we want the best for the mentally ill. It’s not a debate. It’s not controversial. We all agree that they should have our support. Ask anyone and you’ll get the same answer. We should help them.

Unfortunately, we don’t all agree on how we should go about giving that help.

Even more unfortunate, we don’t even agree on what classifies as a mental illness.

If you’re screaming and ripping apart your clothes in the street then you pass the social test fully certified. Your credentials have been verified. You may be on your way you mad naked man. You are indeed mentally ill.

However, if your condition is not quite so obvious then you’re going to run into some resistance. You will find that people have a list of expressions in store just for you. A language for the mentally ill. Are you depressed, bipolar or suffering from some other form of anxiety disorder? Then you can count on some phrases working their way into the conversation.

It’s all in your mind. It’s not that big a deal. You just need to ignore it.

Worse still, if you have the temerity to actually have an eating disorder like anorexia or bulimia, then not only will you not be considered mentally ill. You’re…

An attention seeker. A spoilt brat. Ungrateful for what you have.

The prevalent opinion seems to be that if it is not plain and clear then it is not truly mental illness. It is not an issue about your health but, at the most charitable, something you can overpower with nothing more than will. Because it is in the mind, it is less real. Less harmful. Less in need of real attention. And when you try protest this point of view that’s when they will trot out the next phrase in the list.

Just get over it!

Every time I hear someone say this I’m tempted to grab a shovel, whack them over the head and (quite sympathetically) say “don’t worry about it. It’s all in your body. Just ignore it. You’ll get over it.” Unfortunately, shovels are never lying around when you need them and I don’t have that kind of courage anyway. Also, that’s not the right way to deal with things (or so I’m told).

I understand that this reaction to mental illness is a lot less sinister than it comes across. It is not moustache twirling villainy that leads people here. It is the consequence of bad lessons. Cultural assumptions that have shaped who we are more than we’d like to admit. When they say these things they actually think they’re helping. It’s just tough love. I know this because I was once one of those people.

It’s not that hard to understand when you think about it. Every one of us has picked up habits and mannerisms without knowing where we got them and we all hold some things to be true without knowing why. It’s part of life. I’d even go so far as to say that it is not the problem. The problem comes about when it’s time to let go of those false beliefs. We talk a big game about wanting change (ask Obama) but when it’s time to actually walk down that road we’re a little more hesitant.

When it comes to mental health, the reason many of us are so reluctant to change our minds can be chalked down to how we see ourselves. We’re the good guys. To admit that some of these people have legitimate problems is for most of us an admission that we’ve behaved poorly. An admission that we may have failed them. That we may have been cruel. That we may have made things worse. In the end, it is so much easier to imagine that they are either weak or spoilt isn’t it? Even the simple things, like admitting many of us use the word ‘retarded’ offensively, become a massive problem. We could easily change how we talk but the effort of arguing that it’s not offensive seems worth never facing the implications that we’ve been wrong all this time.

It’s called the Semmelweis reflex. The stubborn refusal to acknowledge fault because it supplants what we’ve always known and done, especially if it means you’ve been at fault. The reflex is named for Ignaz Semmelweis, a doctor from the 1800s. His claim to fame was discovering and putting forward an idea that seems so obvious to the modern mind that it’s almost impossible to imagine that it was ever controversial. His radical belief was that doctors should sterilize their hands before performing medical procedures. In fact, it was even more obvious than that. What he was actually saying was that “if you’ve been handling dead bodies, you should wash your hands before you attempt to help a woman give birth.”

Can’t argue with that, can you?

Apparently, you can. Doctors were outraged by the mere suggestion that the deaths in question could have been their fault. After all, anyone could clearly see that a gentleman’s hands could not possibly transmit disease. What more evidence could they need? Even after Dr. Semmelweis demonstrated the efficacy of his theory there was still opposition. In the end, his measures were not even adopted within his life time. To bring this full circle, the good doctor died in an asylum.

While the above case certainly had more nuance than I’ve presented (this was before they even knew germs were a thing) the major cause of the conflict was that it was against what was understood at the time. Even after successful experiments, people did not want to let go of what they had always known. How they had always acted. The cost for this stubbornness was paid in lives

Fast forward to today. Physical health is much less of a problem. It’s still got its flaws but now concern about it is ubiquitous. It’s not restricted to hospitals anymore. Almost everyone accepts that you need to be healthy all the time. It’s almost impossible to avoid hearing about what to eat or what exercise you should be doing. I know of a certain organic food stand with a tag about being part of the “health fashion trend.” I’ve always found it an odd choice for a slogan but you can’t help but admit that there’s some accuracy to it. Healthy living is now fashionable.

Here’s an illustration to demonstrate just how far the health initiative has seeped into society. I once admitted to a friend I had eaten fries for lunch every day for a week. She was horrified to say the least. She, who I have never heard say more than two consecutive sentences without a joke, sat me down and gave me a lecture. It was a pretty comprehensive one too. All the “whys” “whats” and “hows” were covered in great detail. She even bought me (a healthy) lunch. I was touched, slightly bothered and if I’m being entirely honest wondering if I could pull this off with different people and never pay for lunch again.

That case is slightly more than you get ordinarily but it’s not all that surprising. People don’t just care about their own health, they care about the health of those around them. Sometimes so much that it creates new problems with diets and fat shaming but that’s a discussion for another time. This all leads me to the inescapable conclusion that many of us don’t consider mental health to actually be a part of health. We don’t treat it with that level of seriousness. We aren’t willing to be so helpful or even to put that much work into its prevention. If anything, we foster a climate that seems almost designed to make things worse.

If you’re mentally ill in Kenya, it would probably seem to be in your best interests to shut up about it. You don’t want to appear weak. You don’t want to be mocked and scorned. You don’t want the stigma associated with it. All of which will without a doubt be accompanied with no help whatsoever. So you hide it. You keep it to yourself and that’s not a safe place to be. You might need support. You might need counselling. You might need medication. The lack of these things will in all likelihood make your condition worse and worse until it can no longer be concealed anymore. By then, it is more difficult to deal with and sometimes the necessary measures aren’t pleasant to any of the parties involved.

So what can we do? For starters, you don’t have to do much. The first step, which is both easier and harder than it sounds, is to starting to take mental health seriously. In the same way you wouldn’t immediately dismiss a child complaining of some persistent pain, do not do so with depression or anxiety. These conditions are not, contrary to popular opinion, habits teenagers are picking from “the west”. If you stop and think about it, a Kenyan child has a lot to be stressed about.

Whenever I think back on my own primary school life it never ceases to baffle me. The whole time I was convinced that KCPE was the most important thing I had ever encountered in my existence. In my mind, failure meant that my life would be over. I didn’t study to learn, I studied to pass exams. I strained to achieve what now seems to be a fairly minor (and particularly useless) accomplishment. When was the last time anyone even wanted to know what I got in KCPE? I don’t think I could even tell you what my individual grades were now. Three months. That’s entire span of time that grade held any value for me. Was it worth all the stress it caused me?

For all that, I had it a lot easier than some. Unlike many children in this country, I wasn’t considered the lucky ticket. The entire community wasn’t counting on me to pass that exam and indicating that I was the one who was going to save them. That was not a burden I had to carry on my 13 year old shoulders. I can’t even imagine what that’s like. Seeing as this is the climate that we raise children in, Is it really so surprising that so many of them commit suicide after receiving their results? And even when they don’t, exactly how much damage is being caused here? If you have some pre-existing conditions already, what does that do to you?

My parents tell me they sometimes have recurring nightmares when they’re stressed. There’s different ones but the worst has to do with exams. Sitting in that room and realizing you don’t have a geometrical set or your pencil breaks and you don’t have a replacement. More than thirty years have passed, they’ve been through so much but their minds still associate stress with exams. Exams that were used to get college degrees they don’t even use anymore (or do anything related to what they studied in the first place). That’s what has them waking up with a fright.

This, to me, is a large part of the problem. Schooling in Kenya takes negatives and frames them as positives. Unbelievably tired? You’re supposed to be. Stressed? You’re supposed to be. Panicking? That’s normal. You’re not allowed to complain about these things. I compare it to being in some (hypothetical) athletics program and you sprain your leg. You talk to your trainer about it and he blows up in your face. “You’re a track star. Leg injuries are to be expected. What are you whining for? Get back to practice. Do you see your friends whining? You think they have it any easier? Get over it.” So you run on that leg and to no surprise, it gets worse every time, but now you’ve learnt not to say anything. You just bear the pain silently until you can’t do it anymore. As for your companions, the ones without injuries? They learn an important lesson too. Don’t speak up. A lesson they carry on to their careers. For themselves and for others. It’s all part of the job right?

I’m talking about schools because change has to start somewhere. If we’re going to spend such a significant portion of our lives in them don’t they owe us a little something in return? Something besides a multiple year course on how to pass exams? I believe that schools right now not only make existing mental conditions worse, they encourage attitudes that cause a lot of the problems I’ve pointed out in this article. Not only is there little useful learning on the academic front, the social attitudes being learned are damaging.

Now, I don’t believe that schools can “fix” mental illness. That’s way beyond their purview. But part of what makes being mentally ill so difficult is that people believe that it’s somehow your own fault. That because of some weakness in you, you called this upon yourself. You’re not sick. You’re weak. School has a lot to do with this line of thinking. If we can fix that attitude, then we’re already halfway there.

It’s all in your mind? Then raise the alarm.

Kevin Rigathi is a writer, artist, blogger, programmer and professional mad man

A Madness Foretold

Guest Writer
1 December ,2015

This essay is taken from Brainstorm’s second e-book, (In)Sanity: What “Crazy” Looks Like, which is on mental health in Kenya and is available for free. DOWNLOAD IT HERE to read more such essays.

by Awuor Onyango

Part 2

Location: Nairobi, Kenya. April 2013 and beyond

Dad picks me up from the airport. I am sure to apologize for the trouble and let him know it’s not his fault. We don’t hug, and I do not cry too loudly. My mother hugs me; my sisters are home to look at me and ask what is wrong. I have lost weight, I am not eating, I cannot sleep. I had practiced what I would say when they asked…because they were going to ask! Looking at them, I think of all my childhood nicknames…weirdo, demon child, crazy daisy.

“Do you even have emotions?”

My sister had asked me once.

“Of all my children, only you can do a PhD. PhDs break people’s minds…and yours is already broken.”

My father had said to me as my sister went for her masters. Why are they shocked that it came to this? I tell them about the Asperger’s and the schizotypy.

“Not everyone is a hundred percent upstairs.”

My crying sister assures me.

Nairobi is blurred and beautiful through my uncontrollable tears, full of things that make me anxious; noises, people, smells, sunshine that threatens to pierce your skin with thorny rays. It feels like someone painted it a slight sepia tint. The ground seems too alive. I haven’t seen ants or felt grass rub itself against my ankles in months and it all makes me want to scream at nature to leave me alone! Here, everyone and everything is watching everything I do and I am trying to smile and pretend, but I woke up and there was a red broom in my room which looked like a vein and I thought the wall was pulsating and closing in on me, and I tried my best to hold back the screams.

I miss the darkness of Canada, the silence, the lack of humanity, the lack of eyes. My mother comes to check up on me, standing there with her concern wielded like a bat, beating me back into shape. I always leak out though, as soon as she leaves I leak out and search for a darkness to hide in.

I can’t go outside…I don’t trust outside.

I can’t sleep when I can hear the neighbour’s dog breath as if it was right in my ear and when every car that passes bye assaults my senses.

Dad hasn’t been around and it has been weeks of me uncurling myself and crawling out of dark places to appease my worried mother. I trick him into taking me to the hospital and beg the doctor to refer me to a psychiatrist. The doctor is reassuring;

“You don’t look Schizotypal at all…and Asperger’s is something you can just look at someone and say they have. You’ll be fine. I’m referring you to a psychiatrist; she’s a nice lady. You will like her.”

I always wanted someone to love me for my mind…but this psychiatrist is crazy! No…apparently I am crazy. I thought it was not possible to be more depressed. She arrived late. I was there, sitting in a room full of people, drawing my niece so that I wouldn’t have to interact with them or smell their life stories and wonder after them as I usually did. The woman next to me is impressed by my charcoal drawing. She announces to everyone that I could draw everyone in this room!

You are not my family. I do not care for you. If you try and prod me into normalcy I will hiss at you!

I want to say this, but I smile.

The nurse asks me a few questions; I can’t answer them.

“Any history of mental disease in your family?”

My family is mental

She smiles at this, as if her family is too.

My Aunt Hellen committed suicide. My sister is named after her.

That is all I know. I who asks people for their deepest pleasures have never asked my family for our deepest secrets…looks like my dad will be the one to answer her questions.

The psychiatrist apologizes for being late and stares at me as if she is looking through my soul. I know she isn’t and I do not play along. There is no art in her office, no sign of books, no photographs, no whispers of humanity. I had practiced what I was going to tell her…I had traced my weirdness to its very roots and was going to lay them bare before her and say “How can we put this together without blunting my edges. I do not want to fit in a box” but sitting there with her looking through me, I just wanted a pat in the back and a send-off.

Actually I would like a short stay in a mental ward…It’s very Sylvia Plath, I know, but it would give me some space from my family and their constant need to see me up and running again.

“We don’t do asylums anymore.”

She says when I ask casually.

So…the Canadian Psychologist thinks I may have Asperger’s, I have always thought of myself as functionally schizotypal like Dali, she thinks I am schizophrenic, and my sister took it upon herself to find me another psychiatrist, one whom I could like and relate to, and this one thinks I am bipolar; fine! I am not mentally sound! I get it! How I am not mentally sound is subject to great intellectual debate apparently.

I thought my visit to the psychiatrist would be a relief… I only feel a solid dislike for her. She gave me a prescription and asked to see me in a week. This worried me because the person before me was being seen after three months. I stared at the pills for a long time… I even thought of taking them, a perfectly functioning individual could rise from five pill bottles. I would need five bottles of pills for the rest of my life just to keep my feet on the ground. Who needs feet!

“You look worse.”

I shake my head.

What does she want, that I spring out of depression in a week? That I run through a meadow with my coconut bra and loin cloth singing praises to Ra and Hathor?

“Did you take the medication?”

No.

I want talk therapy…but not with her; so I don’t say anything.

“If you don’t take the medication then we will have to inject you.”

She smiles.

I do not fear injections.

I don’t have the energy to tell her that that’s not a threat.

The nurse notices that I am a human being and not a brain that needs to fit into a DSM definition of some kind of psychosis or another. She speaks to me softly. She has a daughter (fictional or real) about my age and thinks I am just too young to be in this position. I can put my life together and get past this.

It is important in life that you function…otherwise society will have no use for you; and society is dangerously utilitarian.

I look up schizophrenia. I only remember Halle Berry in a movie where she was a “crack whore” that had left her child in a dumpster during a schizophrenic episode; she was in court fighting for custody. I look like a crack whore who would leave her child in a dumpster. I watch “Perception” with my sister….the main character has the same symptoms I have…he is schizophrenic, so maybe I am. My sister says I was special from the very start, that it is a gift not a burden; that my senses are seventeen times as alive and I should use their screams for something. Dr. Pierce in Perception seems to be dealing with his shit quite well. I research Schizophrenia, so does my mother, she thinks she does it secretly but computer history and the folder downloaded on her desktop with the title Schizophrenia sell her out.

My father thinks it’s because I haven’t been to church in a few years. He is also the only person who dislikes the psychiatrist more than I do. I think she asked him some uncomfortable questions. How dare she diagnose his precious future ICC judge with schizophrenia? He is always threatening to find me a new psychiatrist, and I am always hoping he does; as long as it’s not my cousin. He always shouts at her during my visits at the psychiatrist.

Once I went with my mom, because my psychiatrist asked nicely. We sat in the waiting room when I recognized someone. I sat there for a while, staring at him as discretely as I could, until I was too excited to be quiet! My mind was roaring with possible meanings to this coincidence.

Mom!

Mom!

My mom leaned in

That’s Billy Kahora!

“Who?”

Billy Kahora!

“Billy Kahora?”

My mom can’t whisper and he looks up. I almost jump out of the window but my mom won’t let it go

“Who is Billy Kahora?”

He’s a writer mom.

Okay.

You sat next to David Rudisha during an eight hour flight, looked at photos of him on a dias receiving a gold medal in a Kenya uniform and still had no idea who he was; but now you’re sitting in a psychiatrist’s waiting room excited about a writer no one else in here knows. Do you see the world you live in?

She doesn’t say this, of course; but I hear her think it.

I smile apologetically, wonder if I should walk up to him and ask if he’d like to see my writing.

Why would he want to see my writing? What good will it do me? I can’t even write anymore; impulsive writing is a sign of schizophrenia!

I met this girl at the psychiatrists and she said she could write; I picture him saying. He’s not here to see my psychiatrist. He’s seeing a dermatologist who shares the waiting room. I saw Billy Kahora today!

I have to go outside with my sister and two friends by my side; it’s embarrassing. I am usually the strong one. We end up at The Nest for a chill movie night where the rest of my friends are.

“What are you doing home?”

I quit Law School. I’m also depressed and possibly schizophrenic

Silas carries me off my feet and says

“About goddamn time! What were you doing in Law School anyway?”

Someone else says

“Oh my god! You have to watch ‘A Beautiful Mind!’”

These are the problems with intelligent, creative people! You, Van Gogh, Jack Kerouac…y’all need to keep your shit together! Keep your shit together!!!!!

These were my friends! I could be a raging lunatic of a post-coital murderer and they would be okay with that; not just okay, but supportive.

No one has explained why I am home. My mother told her friends that I was sick and they all prayed for me. My sister and I had a misunderstanding and I cried for an hour; she had to apologize, but I was so overwrought with the thought of losing the one family member who sometimes understood me that she was just left sitting on my bed riding out my sobs until I fell asleep.

My mom always comes home and asks ‘How is she doing today?’ and they discuss me in silent voices…except my mom can’t whisper and I have the hearing of a bat because of my reduced latent inhibition. What happens is the brain usually picks out what to block out and what to pay attention to, sieving which stimuli to reply to and which one to ignore. My brain has basically decided ‘screw that’ and lets in almost everything. I can look at a fly, hear it buzz, feel its rough skin without touching and see its proboscis pulsating even hear its eyes move; imagine how I feel being in a room full of people!

I have managed to guilt my father into paying for Art School. I watch him cry. This is the second time in his life that he has cried; both times I have watched him. The day I arrived home from London for the summer, my uncle died in a helicopter crash; it was in the news when I woke up from the excitement of home. My father was sitting at the dinner table with tears in his eyes. I apologized, he said we had to go see Aunty Margaret, he and I, because my uncle had always taken a special interest in my education and we had to show respect.

This time he was seated on his bed, his hands covering his eyes as he cried.

“Of all my children why you?”

He felt guilty, confused, lost…he didn’t understand what had happened. He feels as if he traded me in for his aspirations. If only I could feel the pain he felt! He hasn’t even told my uncles; just one or two to ask for recommendations about psychiatrists that could heal me.

On an ordinary day I would heal instantly and be there for him, but today I feel an indignant rage.

I am the one who cannot trust my own brain! Me! And I have been here before and I have survived it, and I am trying to survive it this time with your help. You either offer it or watch me degenerate! Whichever you choose, do it in silence!

I leave him there crying. I would never do that to my father, yet there I was without remorse.

He pays for art school, after letting me know that the Dean of the Law School said I could join Nairobi if I wanted. Almost a year later, he gets me a psychiatrist I can stand. When I have to take the day off from school to see the psychiatrist I always say I am going to see the doctor; I have a kind of terminal illness and I have to go for a check-up every once in a while.

Once in a while I tell someone that I suffered from depression; I never mention the schizophrenia. I am still too attached to the Schizotypal personality disorder to believe the schizophrenia. I also still picture myself as a crack whore who leaves her baby in a dumpster during a schizophrenic episode. I am not free from it…at some point something will happen and I will be back on my bed, rowing my way through the turbulent carnivorous seas. It does not leave you…depression, Schizotypal personality disorder and schizophrenia…they stain your being, ever threatening to spread across your face and silence you forever.

Sometimes I walk through Harlem in search of Langston Hughes. He once asked what happened to a dream deferred; I would like to add to his question the fate of a madness foretold.

Awuor Onyango is a former reader of Laws who now has a vested interest in the creative industry with a focus on Fine Art, Photography, Fashion and Film. She is currently studying Fine Art and Film at Kenyatta University while also writing, taking photograph assignments and using her legal background to navigate the complicated arts, culture and societal murk through organizations such as African Art Agenda, which she co-founded, and others.  

This essay is taken from Brainstorm’s second e-book, (In)Sanity: What “Crazy” Looks Like, which is on mental health in Kenya and is available for free. DOWNLOAD IT HERE to read more such essays.

My Funk

Guest Writer
25 August ,2015

This essay is taken from Brainstorm’s second e-book, (In)Sanity: What “Crazy” Looks Like, which is on mental health in Kenya and is available for free. DOWNLOAD IT HERE to read more such essays.

by Maryanne Nderitu

The simplicity of my 12 years of age ensures my first suicide attempt does not work. I dare myself, in front of my friends, to swallow eight tablets of Panadol. Beneath the courage of the dare, I am tormented by life. I try again a year later, this time after mixing household chemicals. My younger sister walks in on me as I am about to drink it. I tell her I am doing a science experiment; she buys into the idea. I pour the concoction down the drain. I never tell anyone what I was trying to do, or what agony I am going through.

I have no name for it.

I top the class in the national examinations at the end of primary school. That was what everyone expected of me; success. My achievement masks any worries I have. They will go away. I proceed to a prestigious secondary school. But here, I am always ill. Today it is nausea, tomorrow a migraine. I am wrongly treated for pneumonia, because of the panic attacks I suffer. The shortness of breath sends me to cardiologists; it must be a problem with the heart. I spend more time in hospital than in school. To date, the hospital is a second home to me. When I walk in, I engage in small talk with everyone, from the doctors to the janitors.

I am an outgoing child, the leader of the gang, usually the cheeky gang – the one that gives nicknames to teachers and plays pranks on others. The hottest guys know who I am. I choose one.

The teenage romance doesn’t last long. I am smart, pretty and witty. With time, this changes. I become withdrawn but keep up appearances. I pretend to like school, continue to lead in activities and clubs yet I am just living through the motions. My grades take the hardest hit. The teachers begin complaining; I am branded an emotional attention seeker, a pretender who even faked her illnesses so that she could get away from school. Nothing much will come from me, they say. Those four years are nothing but torture. I stick through it and stumble out with an A-. The teachers are dumbfounded.

Until one doctor mentions it, depression is not a word I am familiar with. I am 19, at the height of my teenage years when this lifesaver realizes there is more to my numerous physical ailments. I am glad to put a name to it. I can now identify with the sense of worthlessness, guilt and never ending shadow of grief.  But the battle has just begun.

I am put on one of the mildest antidepressants. It is a pretty, pink tablet. It is akin to swallowing smarties with water. These do not seem to work, so I am switched to a stronger brand. When these do not work, the dosage is increased. And so it is, until I have literally gone through all the drugs that exist.

“How much should I give her?” a nurse asks her colleague.

“The whole dosage,” the reply comes.

I get an injection and go home. The oral tablets were not effective.

A week later, I am back to hospital.  A doctor dismisses me as catatonic. I cannot talk or walk. The dentist attempts to keep my jaw in place with a bandage, but it won’t sit still. My whole body suffers from involuntary movements. Two weeks later, after a series of tests and medication, a psychiatrist says the injection that was administered to me was too much for my age and weight.

In campus, hours of study still don’t help as I fail test after test. This is a first in my life – the overdose affected my short term memory. I take a semester off and move to a different university, to study a different course.

I start again

The drugs pull me down. I battle to get out of bed every morning. Each morning is a rush to get to class. The psychiatrist suggests electroconvulsive therapy. The drugs have no effect. I cringe at the thought of having electric current rushing through my brain. I switch doctors. I still cling on to hope of recovering. Another cycle of drug therapy begins. It does not get better.

Everyone says I have it all (the dean’s list and student leadership is meant to bolster this). I do not believe them. I have nothing. I am not pretty, I am not smart. I am barely living. I graduate with a first class degree. What does it matter?

I want to die.

Out in the real world, there is no shelter from pain. Few people know the secret of my life. I dread the low self-esteem. I yearn to have others understand me; those who matter to me, as well as insignificant others, and the society, who I think need to know what has caused the delay in the advancement of my life. I seek to explain the increase in weight, the eruption of rashes on my forehead, my inexplicable absences from social life, my inability to cope with post graduate school work, and the reluctance to get a job, which I am qualified for anyway. I spend a tremendous amount of time trying to make whoever I meet understand their curiosity; this way I feel understood, loved and accepted. At least ‘they’ now see why I can’t forge ahead.

But what happens if they do not understand? What happens if they think I am just a spoiled brat who hides under the covers as soon as the first inklings of difficulty show up? This happens all the time. No one really gets why I have gained so much weight, and the daring ones suggest I should abstain from the pizza offers on Tuesdays and Fridays. I battle with feeling accepted and hate comparisons with other people who have life handing them snags but are able to keep going.

Do you see that lady selling tomatoes there? Her husband cheated on her and left her to raise their three kids alone. It is hard yet she moves on. What about you?

I loathe myself for not being like them, for not being able to deal with my ‘simple’ problem, or to others, one that does not simply exist. I suffer for not being able to do what these people suggest.

“God loves you, and he surely doesn’t want you to kill yourself. If only you loved him more. You have to want to live, really, life is so beautiful. It is up to you. If you want, you can get out of this,” those from church say.

I now think God has left me.

Surely, where is he?

Why does he let me cry alone?

My life is at a standstill. I am the bridesmaid who never catches the bouquet of flowers. There is no one who will love me, not with the dark clouds I move around with. I hide in my room and close the shutters. I survive three months of vacillating between wanting to live and wanting to die. Within the darkness, I read and research.

I have had enough with the drugs, which seem to give me no relief. Why am I suicidal whilst still guzzling down these chemicals? Why aren’t I getting better? At the height of what others call lunacy, I give up the drugs cold turkey. I wake up one morning and flush the stash all away. The reward is a month of intense withdrawal symptoms. I suffer from paraesthesia and spew away my excess weight. I resemble a drug addict. I spend Christmas day shivering and drenching my sheets in sweat. I listen to the others making merry. But I am determined. I would rather die than go back to the drugs.

I replace the drugs with a healthy diet and natural healing practices. I am introduced to mood mapping, a method propagated by Dr. Liz Miller. She is a trained Neurosurgeon and Occupational Health Physician. I am encouraged by her personal experience. Through her method, she was able to overcome her bipolar depression. Every day, four times a day, I plot my mood and my energy. I keep track of the cycles. I jot down short notes on how I feel at those moments. I learn to differentiate between feeling anxious and depressed. I discover ways to stay calm and active. I see patterns in my moods.

I am not a morning person; I prefer to work late into the night. I despise sad movies and people who only have sob stories to tell. My morning cup of coffee makes me depressed, as does the occasional glass of wine. I give them up and devise ways to make fish, water and milk taste good. I thank God I have never liked sugar.

I can barely outrun a tortoise, so I begin to walk. I get activities that move me out of the house to get my daily dose of vitamin D. I declutter my room and place a desk next to the window. I sit and stare out of it as I take in the beauty of nature. I unleash my kitchen prowess and experiment with baking.

I arrange for a weekly date with a therapist. I talk about what triggered the depression in my teen years; I talk about what it meant to me. I talk about the neighbour’s dog that keeps me up at night and the boy that told me that I was fat. I talk and talk and talk. I then connect the dots. I realise these are the events that have been bogging my sanity down all these years. They are looking for an outlet. I have found it, and I am not letting it go.

This essay is taken from Brainstorm’s second e-book, (In)Sanity: What “Crazy” Looks Like, which is on mental health in Kenya and is available for free. DOWNLOAD IT HERE to read more such essays.