Not since January 25, 1986 had I felt the slow-burning, debilitating fever that I did on May 20 this year, a fever you would know if you are Iraqi, Syrian, or Ugandan over 20, or South Sudanese of any age or era:
Although akin to malarial lethargy, it is not a proper fever, its toll on your body and mind operating at a remove from the latter. It will neither ground nor kill you, but as with malaria, you are sapped of energy, you have no appetite, the joie de vivre by which you claim membership to life has flown away. You want to withdraw into a dark corner and curl up.
I am labouring to describe in unfamiliar, personal terms, the physiological experience of being caught up in a violent military coup. To live through such a moment, is to experience war compressed into hours, days or weeks. There is a prolonged bath in adrenaline that is physically and mentally draining. There is the upending of routine and rule that kills your spirit.
So on May 20 this year, when I left the house and went to town, and this fever suddenly broke out in me, I instinctively understood that Uganda had turned a corner from which return may not be possible. And yet the trigger could not have been more trivial: My telephone line had been cut.
I had expected that to happen. In fact, I had wilfully participated in the loss of my line. An announcement had been made in early April saying that all phone users must re-register their lines or be cut off in seven days. I refused to comply. On the sixth day, the Prime Minister’s Office said the deadline had been extended by a month. I stayed home. The month came to an end and promptly, the lines were cut.
The people at the mall trying to get their phones reconnected were largely upper crust, in government, in cushy private sector, NGO, UN, jobs – expatriates, well-to-do locals, denizens of Instagram, Snapchat, Facebook, well-fed and secure in their status. But now their faces reflected fear mixed with confusion
When I got to town, I was more staggered than I could have expected. There at the mall, standing in ragged lines with the sun beating down on them, was a mass of people, local and international, who could no longer make or receive calls. It was the look on their faces that reminded me of 1979, 1985 and 1986, the coup years. It was the look of people in the midst of a calamity beyond prevention.
Betrayal of the docile consumer
I had refused to comply with the directive. But those in the lines had complied; was it just inefficiency or had they been guilty of forwarding memes the state disliked? It mattered not what had happened. There at the mall, with its high-end branded products, something heartbreaking was happening:
The people there were largely upper crust, in government, in cushy private sector, NGO, UN jobs – expatriates, well-to-do locals, denizens of Instagram, Snapchat, Facebook, well-fed and secure in their status. But now their faces reflected fear mixed with confusion. This was their thing, this government and the economic ideology it espoused. Many had got their jobs by following regime diktats, not making noise, not being seen with noise-makers.
The economic encyclical they knew by heart had said that capitalist excess was good. Investors and consumers were protected by the regime. Yet now, the telephone, which had brought vast investments into the country, with its millions of dollars in taxes, had been switched off.
The regime had for over 20 years touted its openness. It had enthusiastically done what the IMF and World Bank had asked it to do, back in the early 1990s when it carried out what was then clothed in the euphemism of “structural adjustment policy” but today goes in the explicit nudity of “austerity”. It had punished its people with gut-wrenching impoverishment so it could please the Western powers and avoid regime change. Over the decades, barriers to “free trade” had come down. Uganda, the IMF told all who cared to listen, was business-friendly.
So to wake up that Saturday morning to the reality of a ham-fisted regulation, one that could strangle any multinational co-operation, was astounding. The faces in that mall asked all these questions but in the abstract: What had we done wrong? Had we not consumed (and done so conspicuously) like all well-brought up boys and girls are taught to? Had we not behaved like responsible adults by heeding Gordon Gecko’s dictum that greed is good? Had we not volunteered our energy and time on earth as a good, mostly Christian country and devoted our energy to making the rich richer? Why this punishment now?
In lieu of competitive politics, Museveni’s first decade in power had operated under a ‘broad-based’ system, a serious attempt at an ideology, a kind of reconciliation by which the soviets set up at parish level (going by the name of Resistance Councils) could also include, rather than execute, kulaks
To such exemplary behaviour were due such little rewards as walking into the most expensive restaurants, not so much to eat, as to snap pictures of the dinner for Instagram. Going out the door each day was a Facebook challenge. Now even that was no longer possible. I saw in their faces horror at the prospect of returning to the anonymity of the 1990s, to operating VCRs and having to twirl cassette tapes on a Bic pen to rewind them.
We always knew the military would turn around and bite us
The Museveni government had acted out of character. What had been concealed and contained for 31 years of his time in power had at last erupted, very publicly. We had lived with a military government for a full generation. One day, we always knew, it would turn around and bite us. If you had watched the Museveni regime for the past three decades, you would have noticed that at the close of each decade, his rule shifted gear in consequential ways. We were at the start of the fourth decade, which meant a new tempo had been embarked upon.
The first 10 years had been unchallenged rule by the complete set of ideologues he had brought with him from the bush war. They were the gushing, forward-rushing youthful stage during which the government could do no wrong and genuinely tried its best not to. That was the forward-rushing youthful stage. In lieu of competitive politics, the decade had operated under a “broad-based” system, a serious attempt at an ideology, a kind of reconciliation by which the soviets set up at parish level (going by the name of Resistance Councils) could also include, rather than execute, kulaks. The “good leadership”, “political will” by which Museveni has been described, were products of this period. Victory had brought goodwill and he was eager to show it.
The period ended with the passing of the 1995 constitution, the biggest goodwill of all. And then it started. Looking back, it would seem that Museveni’s longer lasting troubles began with that document. Ugandans had given the regime the benefit of the doubt in the first decade. Now they wanted something in return. The 1990s ended with the now famous “missive” Dr Kizza Besigye wrote in 1999 declaring Museveni a dictator. Besigye’s courage took Museveni aback, as did the massive crowds Besigye attracted when he first ran for president in 2001, dwarfing the numbers Museveni attracted, for the first time giving the president an undiluted assessment of what Ugandans thought of him.
The departure of Besigye from the war veterans’ camp opened the door for the haemorrhage of Museveni’s bush war colleagues, a bleeding he and the Movement were never to recover from; what was worse, the end of the second decade marked very emphatic victories against him from a Uganda Museveni thought he had vanquished.
Through a series of legal battles, lawyers of the Uganda People’s Congress and the Democratic Party, doyens of the anti-colonial years that had been banned from operating, revealed the contradiction between Museveni’s claim to have returned constitutional rule to Uganda, and his refusal to obey the same constitution. In an attempt to pre-empt the return of political parties, the government had organised the infamous Referendum of 2000, whose cloying rationale fooled few. The banned opposition parties, unwilling to lend political legitimacy to Museveni, refused to participate, whereupon the government propped up straw parties to act the part of the Yes side while it hogged the No role. In a poorly attended exercise, 90.7% of those that bothered to vote, estimated at 30 % of registered voters chose a “No Party” Movement system against the 9.3% who chose a “Multiparty” system.
To show how much it believed in multiparty democracy, the government needed a stronger Yes than the 90% garnered by its No side the last time. It allowed a Yes percentage figure of 92.44 %. Some 4 million democracy-shy Ugandans now resoundingly allowed multiparty politics to operate
The result served as legal cover for one-party rule (described now as “no party rule”). But in 2004 a seven-judge panel of the Supreme Court declared it null and void. As if to save face, to show that it had known what it was doing, the government organised a second referendum on the same question, in 2005. This time, it was a little tricky. The government decided it wanted parties back, which meant that it was now sentimentally on the same side as the parties it had banned. It therefore invited the parties, which by law did not exist, to take the government’s side in declaring that it, the government, had been wrong. The parties refused to agree whereupon the government stood alone in acting the Yes side. But for the suffrage to be legal, there had to be a No side. For two decades, the government had said No. Now the government was saying Yes and therefore no one was saying No. Once again, props had to be found and money found to fund their No.
To show how much it believed in multiparty democracy, the government needed a stronger Yes than the 90% garnered by its No side the last time around. It allowed a Yes percentage figure of 92.44%. Some 4 million democracy-shy Ugandans now resoundingly allowed multiparty politics to operate.
Nobody loves the jackboot
Having kept them under the military jackboot for 20 years, Museveni now castigated the parties for refusing to support their own return to life. They were “not contributing to Uganda’s development,” he said.
That was the spirit in which Museveni ruled for 20 years, that play-acting at magnanimity, the third-rate theatre by which he blarneyed his way through, year after year. He was after all a “good” leader and that called for “good” behaviour. It is easy to forget, but in the first two decades, Museveni cut a figure somewhere between a likeable clown and a deadly fighter.
The judicial humiliations of 2004-2005 were not isolated events. The end of his second decade in power presented Museveni with new realities neither he nor Ugandans could have anticipated. This period of irrevocable change started in 2003 and did not end until 2006-2007. Museveni’s perennial bogeymen, the figures he could invoke to frighten Ugandans into obedience, Idi Amin and Milton Obote, died (2003 and 2005), deaths that left him exposed. Suddenly, he was left alone. The shadows of the past gone, he would now be judged by his actions alone.
And then the war in northern Uganda jolted to an abrupt end. What had provided political ballast, the spectre of Nilotic rule that had made the Bantu southerners so uneasy, faded rapidly. To further complicate life for Museveni, the end of the northern war left him without a diversion to distract restless, politicised military officers, nor cover for the classified budgets to defence that had hitherto provided a useful slush fund.
But not as yet. An election was still looming in 2006 and Besigye had learnt nothing from the beatings and imprisonment he had suffered. Yet if the returned political parties were triumphant, the electorate did not share this triumph. The 92.44% voters who wanted them back did not show up for them. The crowded field of presidential candidates, which included Milton Obote’s widow, Miria Obote, played supporting roles to the protagonists.
Museveni, realising that the constitution he had nursed to life would not be on his side, began to make the moves that would lead to the funereal pall of May 20, 2017. He appointed one General Kale Kayihura as Inspector General of Police. The disastrous militarisation of the police had begun. Kayihura had made his name as commander of the Revenue Protection Unit, which went after smugglers and tax dodgers with methods that threw the operation into disrepute. He was not a nice man.
Kayihura, Uganda’s longest serving IGP
Footage courtesy of New Vision TV
Not forgetting what it had done to him, Museveni also moved against the judiciary through appointments and outright humiliation. In a striking display of what would characterise the next decade in power, the so-called Black Mamba squad invaded the High Court and rearrested 22 suspects granted bail by the judges. They were allegedly part of the People’s Redemption Army, allegedly linked to Besigye.
Newer global forces, particularly ‘terrorism,’ provided fresh nomenclature. Now Uganda was an ally in the ‘war on terror.’ Renewed support from Washington boosted the regime and may well have bought it a decade extra in power. Sending troops to Somalia served to divert the military and inject income-replacing lost revenue from Congo and northern Uganda
The drift away from constitutionalism had begun. It is still unbelievable, the degree of violence that the army and the police deployed in this, Museveni’s third decade in power, from the brutal actions on the streets during the 2011 elections, to the disarmament of Karamoja pastoralists. Whoever was in charge, was not of the calibre of Besigye, whose stewardship of battalions in the first decade of Museveni’s rule had won so much respect in most parts of Uganda. These were a raw, untempered lot. As the decades piled up, principled men and women refused to work with Museveni, leaving the dregs to exercise power.
The cost of doing politics in Uganda goes up
And then, 16 months before the 2011 elections, something exceedingly alarming happened. In September 2009, the King of Buganda, Kabaka Ronald Mutebi, set off to visit a district his kingdom claimed as part of its territory. Kayunga, home to the Baruli community, had been a vassal state in pre-colonial Buganda, so the visit provided ironies all around, not least for Buganda, which was demanding the return of its properties from the Uganda state, the same kind of demand the Baruli were making of the Buganda Kingdom. The government blocked the visit, upon which Buganda erupted. The extremely ethnicised nature of the riots that followed were a frightening demonstration of what people felt, that Museveni and his ethnic group were “oppressors” hell bent on a massive land grab. It brought out fears of the kind that lie just under the surface of African politics.
The cost of doing politics in Uganda had gone up. In the run up to the 2006 elections, plainclothes operatives had fired live bullets and killed a man, just yards from where the Kabaka stood next to Besigye. It had been the single most chilling episode of that campaign period, one which left the Buganda, long mass supporters of Museveni who had in the previous two elections voted overwhelmingly for him, in no doubt of what they were facing. The 2009 riots were a delayed reaction. The country became a less happy place, if it had been happy in the first place.
But newer global forces, particularly “terrorism,” provided fresh nomenclature. Now Uganda was “an ally” in the “war on terror.” Renewed support from Washington boosted the regime and may well have bought it a decade extra in power. Sending troops to Somalia served to divert the military and replace lost revenue from Congo and northern Uganda. The modus operandi of Museveni has been that there must always be a war; as rulers throughout the ages know, war enriches soldiers and is also a neat way to get rid of problematic officers.
The opposition had gained traction by now. The public had seen a side to the regime it would not forget. Only voter intimidation and rigging ensured the ruling party stayed in power in 2006. In 2011, in a bizarre move, Museveni courted northern Ugandan voters. The ballots returned significant gains for the Movement. It was a shocking event, for Museveni had always ignored the northern vote. But now, he had also lost southern support. The cost of buying the northern vote, as well as the amount of fear-mongering needed to secure it, was too high. It was not tried again in 2016, when the opposition returned to its previous sweep of the region.
Newer global forces, particularly ‘terrorism,’ provided fresh nomenclature. Now Uganda was an ally in the ‘war on terror.’ Renewed support from Washington boosted the regime and may well have bought it a decade extra in power. Sending troops to Somalia served to divert the military and inject income-replacing lost revenue from Congo and northern Uganda
However, it must be noted that faith in elections ended in 2001; whatever little remained burned out in 2006. What the government may have missed was that by participating in the 2011 elections, the opposition was in effect, simply looking for a casus belli – daring the government to show its hand – by which to justify its next move. The state duly obliged. The world and the judges agreed that the elections had been a sham. The demonstrations that followed (this was Arab Spring season) in the well-reported “Walk to Work” protests in which political leaders “siding” with the poor ditched their cars and walked to parliament, initiated a novel approach to Ugandan politics. It also neutralised the use of armed force. It was a battle of image for which Museveni the guerrilla-fighter could not have been more ill-prepared.
Neoliberalism begins to unravel
It was also in this decade that the economic policies adopted in the early days of the regime had so endeared Museveni to Western powers, began to unravel. The failure of neoliberal economics to deliver promised “trickle down” benefits had done its damage in the Third World countries forced to swallow it. But following the 2008 banking crisis, the failures of that ideology had crept up from its Third World laboratories into the heartlands of extreme capitalism. While it had never really had a chance to work in a country like Uganda, the crisis meant that the lifeline of foreign aid that had tube-fed the Museveni government suddenly ran dry. Incapable of providing the patronage he had once dispensed, and with poverty underlining the degree of income inequality, things had come to a head by the time the third decade in power was coming to a close.
Enter Amama Mbabazi. He had been Museveni’s co-tribune, a Movement pillar and prime minister from 2011 to 2014. It had always been rumoured that he had been the organiser, the man who made things work. He first publicly expressed his presidential ambitions back in 2000 when he accused Besigye of jumping the succession queue. Had there been a pact between him and Museveni that he would be president after him? And how patient was he going to be? In 2015, when it became plain that Mbabazi had presidential ambitions, the Movement machinery whirred into action to do what it had rarely, if ever, done. It turned against its own.
The crisis meant that the lifeline of foreign aid that had tube-fed the Museveni government suddenly ran dry. Incapable of providing the patronage he had once dispensed, and with poverty underlining the degree of income inequality, things had come to a head by the time his third decade in power was coming to a close
The subsequent ejection, failed presidential candidacy and fall of Mbabazi quickly faded out of sight and he was not to become a subject of public discussion afterwards. The essential rebellion had been Besigye’s 1999 missive. There was to be no repeat. Attention remained focused on the latter, whose arrests and trials continued apace.
That was on the surface. Underneath, the ouster of the cringe-worthily naive Mbabazi, as it is now turning out, was to provide the essential plot and character for Museveni’s entry into the fourth decade in power. It is the thread that led to the fear I read that afternoon of May 20:
The ouster of Mbabazi was accompanied by a purge of the government and of the Movement system of alleged Mbabazi supporters. The high-level paranoia that underneath his own system, rebellion was growing, denied Museveni trust in a system as complex as a government needs in order to function. And yet it had been that trust the knowledge technocrats had that the president was both reasonable and supportive, that had delivered the key achievements of his early days in office, like the economic recovery and the fight against HIV/Aids. These achievements had in various forms not survived beyond the first decade but the original impetus had created a momentum of goodwill, for the image of “good leadership,” once earned, is hard to lose, if only because society is desperate for it. At any rate, Museveni had always profited by the inexhaustible store of goodwill extended to him.
It was inexhaustible until it ran out. By 2014, when Museveni made the ill-advised and very public move to sign the so-called anti-gay Bill, there had been a considerable body of international opinion that he was not exactly a democrat. By inserting himself needlessly into the Western cultural wars, Museveni had blundered in a costly fashion. He may have calculated that it would improve his electoral chances back home, but his opponents were never going to support gay rights to start with. The advantage was cancelled out. His detractors in the West had their opportunity. They pounced.
Aid money was cut left, right and centre. They needed the money for their own people. What had been billed as economic recovery was revealed to have all along been baloney. Uganda under Museveni had never improved its productivity in real terms. It was an aid-money autarky all the time.
By the time the 2016 elections came and went, it was undeniable that the country was in serious trouble. Police and other civil servants, not least teachers, nurses and doctors, went months without pay. Medicine was unavailable in hospitals. At the same time, the internal witch hunt in government, and the air of fear and suspicion following the ouster of Amama Mbabazi was causing a cave-in from the other end: There was no money to pay public workers; at the same time, people in high office became afraid to work, in case they were seen to be ambitious.
Fear and intimidation take over
Museveni’s innate instinct, the use of force and intimidation, seems to have taken over. The perennial troubles of Kasese, the Rwenzururu Kingdom, which predated colonial Uganda, and which had been handled diplomatically since the Obote I government in the 1960s, now met military force. More than 100 people were gunned down. It was not as if such a small kingdom could have caused national damage (its cause remains obscure outside the Rwenzori region), but it reflects what one analyst told me is the mentality of those whom the president now puts trust in – use maximum force.
Every ministry, from Health, Education, to Energy, is feeling the chill wind of administrative paralysis, but not all of them have as yet displayed incompetence in the manner in which famine in eastern Uganda has shown up the Ministry of Agriculture. But it is coming
Without respect and trust in the seasoned technocrats who shepherd political masters through the jungles of laws and acts and regulations that are effectively the “system,” a number of odd things have been happening in Uganda. Foremost among them is the failure to manage a looming food crisis in eastern Uganda. The coming environmental crisis, the first of which is the developing collapse of fish stocks, could have been avoided had the civil service been allowed to do its work. Every ministry, from Health, Education, to Energy, is feeling the chill wind of administrative paralysis, but not all of them have as yet displayed incompetence in the manner in which famine in eastern Uganda has shown up the Ministry of Agriculture. But it is coming. The spectacular bungling of telephone registration brought these issues to the fore.
A boyish, almost flagrant informality
An order was given that telephone users “verify” their numbers. However, Ugandan citizens were told they could not use driving permits, passports, work IDs, local council IDs, only National IDs. It was a telling admission that the Ministry of Internal Affairs was inept, that its identity documents were a sham. A properly functioning government would have been advised against such a move for the demands of one arm of government must be reconciled across all government arms to ensure systemic uniformity. It is the reason there is a prime minister and a Secretary to the Cabinet. This one was a weird call, until it was revealed that the call came from the IGP’s office.
At his first press conference back in 2005, which I attended as journalist at The EastAfrican, I watched Gen. Kayihura’s demeanour. I observed his short attention span, his easily distracted manner, twiddling with his phone in the middle of taking press questions and his affinity for a boyish, almost vagrant informality. It was a frightening projection of things to come.
In 2017, you could see Gen Kayihura’s hand in that telephone debacle. A chess piece moved at the end of the second decade in power, had showed its own hand at the beginning of the fourth decade in power.
What it said, and what precipitated that fever that we felt on May 20, was the fact that the administrative state in Uganda, had been overthrown by the security forces. There had been a coup. The Office of the Prime Minister, which supervised the Ministry of Internal Affairs, which supervised the Police, was forced to humiliatingly “follow” the orders of a policeman; parliament recognised its own impotence by attacking the line minister who formally made the announcement, knowing well that the minister had simply been following the orders of the IGP, whom they dared not touch. Prime minister, parliament and line minister were all to be further humiliated when the NRM parliamentary caucus overruled all of them. Four days after shutting down phone lines, they switched them on back again, and said we would have three more months to comply with the registration order.
It has become clear now that, going into his fourth decade in power, Museveni has effectively shut down the Uganda state and is intent on ruling through a secret and sometimes not so secret cabal of gunslingers, chief among them his IGP
There is the misled belief that an Orwellian-sized national biometric database will give the state means to track everyone and prevent an Arab Spring-style social media uprising. Sources say the government’s investments in electronic surveillance have been extensive. When it first asked citizens to acquire National IDs in 2013, very few people bothered to register. Then someone had a brain wave – threaten to take away their phones, that will bring them running. And so for all of April and May, the entire country was thrown into turmoil. We wait to see what happens in August when the three-month extension runs out.
It has become clear that there are now two centres of power in Uganda, President Museveni and IGP Kayihura. Everyone else, from the vice president to district officers, has gone quiet. In a sign of how disastrous this leadership model is, the “old” model was forced to intervene after President Museveni jumped protocol and directly accused fictitious Chinese diplomats of ivory trafficking. The incensed Chinese put their foot down and the Ministry of Foreign Affairs, which had not been consulted when the letter of accusation was sent out by the president’s office, apologised publicly to China. What it demonstrated was the manner in which Museveni now micro-manages Uganda.
It has become clear now that, going into his fourth decade in power, Museveni has effectively shut down the Uganda state and is intent on ruling through a secret and sometimes not so secret cabal of gunslingers, chief among them his IGP Gen Kale Kayihura. But even in there, things are not going swimmingly, which may explain the ultra-violent execution of Gen Kayihura’s deputy, Felix Kaweesi, on March 17 this year. It was the killing that provided the justification for shutting down telephone lines. There is a deadly power struggle even within the securocratic redoubt into which Museveni’s fourth decade is retreating. The new front of cyber security and fear of the power of social media has meant that a new front of enemies has opened up; it is no longer just past leaders, Nilotics or opposition who are “against development”; it’s also now a teenager with WhatsApp who must be closely monitored.
There is a general realisation that time is running out. Those in positions of power and opportunity are taking as much cash out of the public and through their offices as they can while they still have the chance. Principled and seasoned individuals are opting out, leaving a bevy of the callow and ethnically loyal to take positions of authority. The centre retreats into self-serving fiction.
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It’s a Nurses’ Market Out There, and Kenyans Are Going For It
Nurses are central to primary healthcare and unless Kenya makes investments in a well-trained, well supported and well-paid nursing workforce, nurses will continue to leave and the country is unlikely to achieve its Sustainable Development Goals in the area of health and wellbeing for all.
Nancy* is planning to leave Kenya. She wants to go to the United States where the nursing pastures are supposedly greener. I first met Nancy when the country was in the throes of the COVID-19 pandemic that tested Kenya’s healthcare system to breaking point. She was one of a cohort of recently graduated nurses that were hastily recruited by the Ministry of Health and thrown in at the deep end of the pandemic. Nancy earns KSh41,000 net with no other benefits whatsoever, unlike her permanent and pensionable colleagues.
When the then Labour and Social Protection Cabinet Secretary Simon Chelugui announced in early September 2021 that the government would be sending 20,000 nurses to the United Kingdom to help address the nursing shortage in that country, Nancy saw her chance. But her hopes were dashed when she failed to raise the KSh90,000 she needed to prepare and sit for the English language and nursing exams that are mandatory for foreign-trained nurses. Nancy would also have needed to pay the Nursing Council of Kenya KSh12,000 for the verification of her documents, pay the Kenya Medical Training College she attended KSh1,000 in order to get her exam transcripts, and apply for a passport, the minimum cost of which is KSh4,550 excluding the administrative fee. Nancy says that, contrary to then Health Cabinet Secretary Mutahi Kagwe’s disputed claims that a majority of applicants to the programme had failed the English language test, most nurses simply could not afford the cost of applying.
Of the targeted 20,000 nurses, the first 19 left Kenya for the UK in June 2022. But even that paltry figure represents a significant loss for Kenya, a country where the ratio of practicing nurses to the population is 11.66 per 10,000. The WHO considers countries with less than 40 nurses and midwives for every 10,000 people to not have enough healthcare professionals. Nearly 60 per cent of all healthcare professionals (medical physicians, nursing staff, midwives, dentists, and pharmacists) in the world are nurses, making them by far the most prevalent professional category within the health workforce. Nurses offer a wide range of crucial public health and care services at all levels of healthcare facilities as well as within the community, frequently serving as the first and perhaps the only healthcare provider that people see.
The growing shortage of nurses in the UK has been blamed on the government’s decision to abolish bursaries and maintenance grants for nursing students in 2016, leading to a significant drop in the number of those applying to train as nurses. Consequently, the annual number of graduate nurses plummeted, reaching the current low of 31 nurses per 100,000 people, below the European average of 36.6 and half as many as in countries like Romania (96), Albania (82) and Finland (82). Facing pressure to recruit 50,000 nurses amid collapsing services and closures of Accident & Emergency, maternity and chemotherapy units across the country, the UK government decided to once again cast its net overseas. Established in 1948, the UK’s National Health Service (NHS) has relied on foreign healthcare workers ever since staff from the Commonwealth were first brought in to nurse back to health a nation fresh out of the Second World War.
The UK government’s press release announcing the signing of the Bilateral Agreement with Kenya states that the two countries have committed “to explore working together to build capacity in Kenya’s health workforce through managed exchange and training” and goes as far as to claim that “with around only 900 Kenyan staff currently in the NHS, the country has an ambition to be the ‘Philippines of Africa’ — with Filipino staff one of the highest represented overseas countries in the health service — due to the positive economic impact that well-managed migration can have on low to middle income countries.”
It is a dubious ambition, if indeed it has been expressed. The people of the Philippines do not appear to be benefiting from the supposed increase in capacity that the exchange and training is expected to bring. While 40,000 of their nurses worked in the UK’s National Health Service last year, back home, according to Filipino Senator Sonny Angara, “around 7 of 10 Filipinos die without ever seeing a health professional and the nurse to patient ratio in our hospitals remains high at 1:50 up to 1:802”.
Since 2003 when the UK and the government of the Philippines signed a Memorandum of Understanding on the recruitment of Filipino healthcare professionals, an export-led industry has grown around the training of nurses in the Philippines that has attracted the increased involvement of the private sector. More nursing institutions — that have in reality become migrant institutions — are training nurses specifically for the overseas market, with the result that skills are matched to Western diseases and illnesses, leaving the country critically short of healthcare personnel. Already, in 1999, Filipino doctors had started retraining as nurses and leaving the country in search of better pay.
It is difficult, then, to see how the Philippines is an example to emulate. Unless, of course, beneath the veneer of “partnership and collaboration in health”, lies the objective of exporting Kenyan nurses with increased diaspora remittances in mind – Kenyans in the UK sent KSh28.75 billion in the first nine months of 2022, or nearly half what the government has budgeted for the provision of universal health care to all Kenyans. If that is the case, how that care is to be provided without nurses is a complete mystery.
Already in 1999, Filipino doctors had started retraining as nurses and leaving the country in search of better pay.
For the UK, on the other hand, importing nurses trained in Kenya is a very profitable deal. Whereas the UK government “typically spends at least £26,000, and sometimes far more, on a single nurse training post”, it costs only £10,000 to £12,000 to recruit a nurse from overseas, an externalization of costs that commodifies nurses, treating them like goods to be bought and sold.
However, in agreeing to the terms of the trade in Kenyan nurses, the two governments are merely formalizing the reality that a shortage of nurses in high-income countries has been driving the migration of nurses from low-income countries for over two decades now. Along with Ghana, Nigeria, South Africa and Zimbabwe, Kenya is one of the top 20 countries of origin of foreign-born or foreign-trained nurses working in the countries of the OECD, of which the UK is a member state.
Faced with this reality, and in an attempt to regulate the migration of healthcare workers, the World Health Assembly adopted the WHO Global Code of Practice on the Recruitment of Health Personnel in May 2010. The code, the adherence to which is voluntary, “provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states.”
Article 5 of the code encourages recruiting countries to collaborate with the sending countries in the development and training of healthcare workers and discourages recruitment from developing countries facing acute shortages. Given the non-binding nature of the code, however, and “the severe global shortage of nurses”, resource-poor countries, which carry the greatest disease burden globally, will continue to lose nurses to affluent countries. Wealthy nations will inevitably continue luring from even the poorest countries nurses in search of better terms of employment and better opportunities for themselves and their families; Haiti is on the list of the top 20 countries supplying the OECD region.
“Member States should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers.”
Indeed, an empirical evaluation of the code four years after its adoption found that the recruitment of health workers has not undergone any substantial policy or regulatory changes as a direct result of its introduction. Countries had no incentive to apply the code and given that it was non-binding, conflicting domestic healthcare concerns were given the priority.
The UK’s Department of Health and Social Care (DHSC) has developed its own code of practice under which the country is no longer recruiting nurses from countries that the WHO recognizes as facing health workforce challenges. Kenya was placed on the UK code’s amber list on 11 November 2021, and active recruitment of health workers to the UK was stopped “with immediate effect” unless employers had already made conditional offers to nurses from Kenya on or before that date. Presumably, the Kenyan nurses who left for the UK in June 2022 fall into this category.
In explaining its decision, the DHSC states that “while Kenya is not on the WHO Health Workforce Support & Safeguards List, it remains a country with significant health workforce challenges. Adding Kenya to the amber list in the Code will protect Kenya from unmanaged international recruitment which could exacerbate existing health and social care workforce shortages.”
The WHO clarifies that nothing in its Code of Practice should be interpreted as curtailing the freedom of health workers to move to countries that are willing to allow them in and offer them employment. So, even as the UK suspends the recruitment of Kenyan nurses, they will continue to find opportunities abroad as long as Western countries continue to face nurse shortages. Kenyan nurses will go to the US where 203,000 nurses will be needed each year up to 2026, and to Australia where the supply of nursing school graduates is in decline, and to Canada where the shortage is expected to reach 117,600 by 2030, and to the Republic of Ireland which is now totally dependent on nurses recruited from overseas and where working conditions have been described as “horrendous”.
“Adding Kenya to the amber list in the Code will protect Kenya from unmanaged international recruitment which could exacerbate existing health and social care workforce shortages.”
Like hundreds of other Kenyan-trained nurses then, Nancy will take her skills overseas. She has found a recruitment agency through which to apply for a position abroad and is saving money towards the cost. She is not seeking to move to the UK, however; Nancy has been doing her research and has concluded that the United States is a much better destination given the more competitive salaries compared to the UK where nurses have voted to go strike over pay and working conditions. When she finally gets to the US, Nancy will join Diana*, a member of the over 90,000-strong Kenyan diaspora, more than one in four of whom are in the nursing profession.
Now in her early 50s, Diana had worked for one of the largest and oldest private hospitals in Nairobi for more than 20 years before moving to the US in 2017. She had on a whim presented her training certificates to a visiting recruitment agency that had set up shop in one of Nairobi’s high-end hotels and had been shortlisted. There followed a lengthy verification process for which the recruiting agency paid all the costs, requiring Diana to only sign a contract binding her to her future US employer for a period of two years once she had passed the vetting process.
Speaking from her home in Virginia last week, Diana told me that working as a nurse in the US “is not a bed of roses”, that although the position is well paying, it comes with a lot of stress. “The nurse-to-patient ratio is too high and the job is all about ticking boxes and finishing tasks, with no time for the patients,” she says, adding that in such an environment fatal mistakes are easily made. Like the sword of Damocles, the threat of losing her nursing licence hangs over Diana’s head every day that she takes up her position at the nursing station.
“The nurse-to-patient ratio is too high and the job is all about ticking boxes and finishing tasks, with no time for the patients.”
Starting out as an Enrolled Nurse in rural Kenya, Diana had over the years improved her skills, graduating as a Registered Nurse before acquiring a Batchelor of Science in Nursing from a top private university in Kenya, the tuition for which was partially covered by her employer.
Once in the US, however, her 20 years of experience counted for nothing and she was employed on the same footing as a new graduate nurse, as is the case for all overseas nurses moving to the US to work. Diana says that, on balance, she would have been better off had she remained at her old job in Kenya where the care is better, the opportunities for professional growth are greater and the work environment well controlled. But like many who have gone before her, Diana is not likely to be returning to Kenya any time soon.
*Names have been changed.
Why Azimio’s Presidential Petition Stood No Chance
In so far as the court had nullified the 2017 elections, the evidential threshold required for any subsequent electoral nullification was going to be substantially high for any petitioner.
Even before the 9 August general election, it was expected that the loser of the Kenyan presidential contest would petition the Supreme Court to arbitrate over the outcome. Predictably, the losing party, Azimio La Umoja-One Kenya Coalition, petitioned the court to have William Ruto’s win nullified on various procedural and technical grounds. Azimio’s case was predicated on, among others, three key allegations. First, that William Ruto failed to garner the requisite 50 per cent plus one vote. Second, that the Independent Electoral and Boundaries Commission (IEBC) chairman Wafula Chebukati had announced the outcome without tallying and verifying results from seven constituencies. Finally, that the commission could not account for 250,000 votes that were cast electronically.
As we know, Azimio lost the case as the judges dismissed all the nine petitions that the party had filed, unanimously finding that William Ruto had won fairly.
Adjudicating electoral fallouts
Since its inception in 2010, the Supreme Court has played a decisive role in adjudicating fallouts linked to contentious presidential politics in Kenya, with the court deliberating on the outcome of three out of the four presidential elections held after its inauguration. Prior to this, the losing party had no credible institutional mechanism of redress and electoral disputes were generally resolved through mass political action (as in 2007) or consistent questioning of the legitimacy of the winner (as in 1992 and 1997).
The Supreme Court’s presence has, therefore, been crucial in providing losers with an institutionalised mechanism to channel dissent, with the court operating as a “safety valve” to diffuse political tensions linked to presidential elections. It is, hence, impossible to conceive of the relatively peaceful elections held in 2013, 2017 and 2022 without the Supreme Court whose mere presence has been key in discouraging some of the more deadly forms of political rivalry previously witnessed in Kenya.
While the Azimio leadership were right to petition the court in the recent election, first because this successfully diffused the political tensions among their supporters, and second because the court was expected to provide directions on IEBC conduct in future elections, it was clear that Raila Odinga’s relentless petitioning of the court in the previous two elections, and the nullification of the 2017 elections, was in essence going to be a barrier to a successful petition in 2022.
In so far as the court had nullified the 2017 elections, the evidential threshold required for any subsequent electoral nullification was going to be substantially high for any petitioner. The relentless petitioning of the court and the nullification of the 2017 elections had in essence raised the bar for the burden of proof, which lay with the petitioner(s) and, therefore, reduced the probability of a successful petition.
The Supreme Court’s presence has been crucial in providing losers with an institutionalised mechanism to channel dissent.
The reason for this is both legal and political. Legal in the sense that the IEBC is expected to conduct the elections under the law, which, among other issues, requires that the electoral process be credible and the results verifiable before any certification is made, otherwise the election is nullified, as was the case in 2017. It is political because the power to select the president is constitutionally, hence politically, delegated to the Kenyan people through the ballot, unless electoral fraud infringes on this, again as was the case in 2017.
The court in its deliberation must, therefore, balance the legal-political trade-off in its verdict in search of a plausible equilibrium. For instance, while the majority of Azimio supporters had anticipated a successful petition based on the public walkout and dissent by the four IEBC commissioners, it seems that the decision to uphold the results displayed the court’s deference to political interpretation of the law by issuing a ruling that did not undermine the Kenyan voters’ right to elect their president.
While the settlement of legal-political disputes by a Supreme/Constitutional court is a common feature across democracies, and continuously being embedded in emerging democracies like Kenya, it does seem that in this election, the political motivations for upholding the vote outweighed the legal motivations for nullifying it. In essence, the court demonstrated its institutional independence by ruling against the Kenyatta-backed Azimio candidate due to insufficient evidence.
Supreme Court power grab
A counterfactual outcome where the evidential threshold for the nullification of presidential results is low would foster a Supreme Court power grab, in lieu with the 2017 nullification, by marginalising the sovereign will of Kenyans to elect their president.
In many ways, nullification of the results would also have incentivised further adversarial political behaviour where every electoral outcome is contested in the Supreme Court even when the outcome is relatively clean, as in the case of the 2022 elections.
It is this reason (among others) that we think underlined the Supreme Court justices’ dismissal of Azimio’s recent petition. The justices ultimately dismissed the evidence presented by the petitioners as “hot air, outright forgeries, red herring, wild goose chase and unproven hypotheses”, setting a clear bar for the standard of evidence they expect in order to deliberate over such an important case in the future.
In essence, the court demonstrated its institutional independence by ruling against the Kenyatta-backed Azimio candidate due to insufficient evidence.
Since the earth-shaking nullification of the 2017 elections, the Supreme Court transcended an epoch, more political than legal by “invading” the sovereign space for Kenyans to elect their president, thereof setting a precedence that any future successful petition to contest a presidential election requires watertight evidence.
In a sense, Azimio were victims of Odinga’s judicial zealotry and especially the successful 2017 petition. In so far as the evidence submitted to the Supreme Court by Azimio in 2022 was at the same level or even lower than the 2017 base, their case at the Supreme Court was very likely to be dismissed and even ridiculed as the justices recently did.
The precedent set by the 2022 ruling will, actually, yield two positive political outcomes. First, it will in the future weed out unnecessary spam petitions that lack evidence and rather increase needless political tensions in the country. Second, it has signalled to future petitioners, that serious deliberations will only be given to petitions backed by rock-solid evidence.
From the recent ruling, it is evident that the judgement fell far below the precedent set in 2017. The 2017 Supreme Court ruling that the IEBC should make the servers containing Form 34A publicly available, was crucial in improving the credibility of the 2022 elections, by democratising the tallying process. At a minimum, the expectation was that the justices would provide a directive on the recent public fallout among the IEBC commissioners with regard to future national tallying and announcement of presidential results.
By dismissing the fallout as a mere corporate governance issue, the justices failed to understand the political ramifications of the “boardroom rupture”. What are we to do in the future if the IEBC Chair rejects the results and the other commissioners validate the results as credible?
Additionally, by ridiculing the petitioners as wild goose chasers and dismissing the evidence as “hot air”, the justices failed to maintain the amiable judicial tone necessary to decompress and assuage the bitter grievances among losers in Kenya high-octane political environment.
In a sense, Azimio were victims of Mr Odinga’s judicial zealotry and especially the 2017 successful petition.
The Supreme Court ought to resist the temptations of trivializing electoral petitions, as this has the potential of triggering democratic backsliding, where electoral losers might opt for extra-constitutional means of addressing their grievances as happened in December 2007. It is not in the petitioners’ place to ascertain whether their evidence is “hot air” or not, but for the court to do so, and in an amiable judicial tone that offers reconciliation in a febrile political environment.
The precedent set by the 2017 ruling that clarified the ambiguities related to the IEBC’s use of technology to conduct elections, set an incremental pathway towards making subsequent elections credible and fair, and increased public trust in the key electoral institutions in Kenya.
The justices, therefore, need to understand that their deliberations hold weight in the public eye and in the eyes of political leaders. Therefore, outlining recommendations to improve the IEBC’s conduct in future elections is a bare minimum expectation among Kenyans. In this case, while they provided some recommendations, they failed to comprehensively address the concerns around the walk-out by the four IEBC commissioners.
At the minimum, chastising the IEBC conduct was necessary to consolidate the electoral gains made thus far but also recalibrate institutional imperfections linked to how elections are to be conducted and, especially, contestations around the role of the commissioners in the national tallying of results in the future.
This article is part of our project on information and voter behaviour in the 2022 Kenyan elections. The project is funded by the Centre for Governance and Society, Department of Political Economy, King’s College London.
GMOs Are Not the Only Answer
In a country where agricultural production is dominated by smallholders, the decision to allow genetically modified crops and animal feeds into Kenya as a means of combatting perennial hunger ignores other safer and more accessible alternatives such as Conservation Agriculture.
Newly elected President William Ruto has, to use a much abused expression, hit the ground running. I am, however, not certain that he is running in the right direction. On 3 October 2022, during the second meeting of his recently (and unconstitutionally) constituted cabinet, Ruto announced that his government had authorized the cultivation and importation of genetically modified crops and animal feeds, sweeping aside the grave concerns raised by Kenyans and lifting a ten-year ban with the stroke of a pen.
The decision was made at a time when Kenya is facing the worst drought in four decades that has left over four million people facing starvation. According to President Ruto, the adoption of GMOs is the solution to the recurring cycles of drought and famine that Kenyans have been increasingly experiencing.
I shall not go into the merits and demerits of what some call Frankenfoods here. However, it seems to me that Ruto’s decision is driven solely by the political imperative to bring down the price of maize through cheap imports of GM maize following the withdrawal of the maize subsidy.
Already, back in November 2018, the Route to Food Initiative (RTFI), the Kenya Biodiversity Coalition (KBioC), the Africa Biodiversity Network (ABN) and Greenpeace Africa had issued a joint statement raising “concerns over recent disconcerting developments in the country, that [suggest] the Government has made [a] unilateral decision to adopt genetically modified crops”, and adding that “an all-inclusive nationwide discourse through public participation, which addresses whether the technology is appropriate for us, is being circumvented”.
The group also voiced their suspicion that the report of the Task Force to Review Matters Relating to Genetically Modified Foods and Food Safety that was set up by the Ministry of Health in 2013 was being withheld because it was against the adoption of GM foods. This suspicion may well be founded since, in making the announcement, State House said that the decision to lift the GMO ban was “made in accordance with the recommendation of the Task Force”, while failing to make the so-called Thairu report—which was submitted in 2014—available for public scrutiny.
The cabinet said that in reaching its decision to lift the ban it had also referred to reports of the European Food Safety Authority, among others.
The European Union’s policy on GMOs “respects the right-to-know by ensuring clear labelling and traceability of GMOs. This requires reliable methods for the detection, identification and quantification (for authorised GMO) in food, feed, and the environment”. There is zero tolerance for unapproved GMOs and stringent regulation of products originating from or containing GMOs.
A detailed risk analysis and the availability of a validated method for locating, identifying, and quantifying GMOs in food or feed are prerequisites for authorization. For any GM launch, biotech businesses that want to market their product in the EU must submit an application. A very precise way of detecting each unique GMO is included in the application dossier.
The terms of reference of the government’s GMO task force included, among others, assessing Kenya’s infrastructural capacities to monitor genetically modified products in the country; assessing the adequacy of qualified human resource capacity to monitor research, use and importation of genetically modified products into the country; and recommending approval procedures for imports of GM foods.
If we are to look only at the procedures established by the National Biosafety Authority for the importation of GM products into the country, then we may conclude that Kenya lacks the infrastructural and qualified human resource capacity to monitor their research, use and importation. In effect, an entity wishing to import a GM product into the country is merely required to provide the particulars of the supplier, the nomenclature of the GMO, proof that the GMO has been registered in the exporting country, its use in the country of origin, its intended use in Kenya, a summary risk assessment, methods and plans for safe handling, storage, transport and use, and the emergency response foreseen in the event of an accident with the GMO. The second of the two-page the application document is reserved for the applicant’s signature before a commissioner for oaths, a magistrate or a judge. Means of detection of GMOs are not mentioned.
It would seem then that Ruto’s government has fully devolved the responsibility for Kenya’s biosafety and biosecurity to the authorities of foreign nations. This is very frightening when you consider, for example, that the European Union Regulation EC304/2003 allows EU companies to produce and export to other countries pesticides that are banned or restricted in the EU. This double standard is the reason why active ingredients which have been withdrawn in the EU find their way to Kenya, poisoning our bodies and our environment, and destroying our biodiversity.
Maize is not the only ugali
The lifting of the ban on GMOs may have sounded the death knell for Kenyan small-scale maize growers; GM maize is to be found on the international markets at prices that defy all competition, which will now prove to be a boon for well-connected maize-importing cartels.
But maize, a staple in the majority of Kenyan households, is a relatively recent arrival on our national menu, becoming a major staple during the First World War when disease in millet led to famine.
As Noel Vietmeyer observes in the foreword to the first volume of Lost Crops of Africa,
“Lacking the interest and support of the authorities (most of them non-African colonial authorities, missionaries, and agricultural researchers), the local grains could not keep pace with the up-to-the-minute foreign cereals, which were made especially convenient to consumers by the use of mills and processing. The old grains languished and remained principally as the foods of the poor and the rural areas. Eventually, they took on a stigma of being second-rate. Myths arose—that the local grains were not as nutritious, not as high yielding, not as flavorful, nor as easy to handle. As a result, the native grains were driven into internal exile. In their place, maize, a grain from across the Atlantic, became the main food from Senegal to South Africa.”
But with initiatives such as the Busia County Biodiversity Policy, which recognises the role that biodiversity can play in addressing food insecurity, the tide is turning and Kenyans are rediscovering and embracing the culinary habits of our forebears. You would think then that the GMO decision will not, in the main, affect the choices we make in the foods we consume. That those of us a tad squeamish about eating foods that have been genetically interfered with can opt out.
Were it that simple.
Many Kenyans are unaware that the Seed and Plant Varieties Act Cap 326 of 2012 prohibits farmers from sharing, exchanging or selling uncertified and unregistered seeds. Yet, to mitigate against the effects of perennial droughts and the escalating costs of hybrid seeds, community seed banks have been conserving indigenous seeds—that are demonstrably more climate-resilient—for sale during the planting season, in contravention of the law and at the risk of a one million shilling fine, or two years’ imprisonment, or both. Criminalising a system through which small-scale farmers acquire 90 per cent of their planting material does not augur well for Kenya’s food security, or for our biodiversity. Small-scale farmers are fighting back, however, with a group from Machakos recently going to court to challenge the legislation. It remains to be seen who between David and Goliath will prevail.
But maize, a staple in the majority of Kenyan households, is a relatively recent arrival on our national menu, becoming a major staple during the First World War when disease in millet led to famine.
What is clear is that Kenya’s David, while remaining impoverished over the decades since independence, is the mainstay of the country’s agriculture in terms of productivity. The Economic Survey (2021) of the Kenya National Bureau of Statistics reports that,
“The share of marketed agricultural output for small farms increased marginally to 73.3 per cent in 2020. This is a reflection of the continued dominance of the smallholder sector in the marketing of agricultural produce during the year under review. The value of sales through small farms increased by 9.4 per cent from KSh 341.4 billion in 2019 to KSh 373.6 billion in 2020. Similarly, the value of sales by large farms increased by 8.9 per cent from KSh 125.0 billion in 2019 to KSh 136.1 billion in 2020.”
The survey defines large farms as those above 20 hectares.
The small-holder has consistently outperformed the large-scale farmer despite government policies that have since the 70s viewed smallholders as without agency beyond adopting technologies that are presented as capable of transforming agriculture and building livelihoods. The adoption of GMOs is likely to be yet another of these technologies that, together with unjust seed legislation, will increase rather than decrease Kenya’s food insecurity.
President Ruto worries about food insecurity but fails to consider the very ready solution available to his administration and recommended in the Agricultural Policy (2021) of the Ministry of Agriculture, Livestock, Fisheries and Cooperatives, namely, conservation agriculture.
The Food and Agriculture Organisation (FAO – also quoted in Ruto’s decision to lift the GMO ban) recommends conservation agriculture as it is a sustainable system of production that conserves and enhances natural resources; enhances biodiversity; assists in carbon sequestration; is less labour and fertilizer intensive; improves the health of soils; and increases yields over time.
Criminalising a system through which small-scale farmers acquire 90 per cent of their planting material does not augur well for Kenya’s food security, or for our biodiversity.
The very promising results obtained among the small-scale farmers that have adopted the system following training under the FAO beginning in 2015 show that the government would do well to promote conservation agriculture among smallholders as a means of mitigating both against food insecurity and the effects of climate change, rather than hastily reaching for GM technologies that the country is ill-equipped to safely handle.
But clearly, the president is not on the same page as his Ministry of Agriculture and so, like others, I can only conclude that Ruto’s lifting of the GMO ban is for the benefit of the seed multinationals and their clients, the large-scale farmers who have taken over most of the productive land to grow cash crops for export, leaving small-scale farmers to exploit marginal lands for the production of food crops for local consumption. And for the benefit of maize-importing cartels.
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