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(D)EVOLVED HEALTHCARE: Makueni’s trailblazing experiment in providing universal health coverage

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(D)EVOLVED HEALTHCARE: Makueni’s trailblazing experiment in providing universal health coverage
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Universal health coverage is by many measures considered to be the Holy Grail of delivering quality healthcare. In fact, achieving universal health coverage by 2030 – ensuring that all people have access to the health services they need without the risk of financial hardship – was included as part of the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. Writing a year later, Marie-Paule Kieny, Assistant Director-General at the World Health Organization (WHO), described it as “the linchpin of the health-related SDGs; the one target that, if achieved, will help deliver all the others by providing both population- and person-centred high-quality services that are free at the point of delivery and designed to meet the realities of different people’s lives.” WHO estimates that about 150 million people around the world suffer financial catastrophe annually from out-of-pocket expenditure on health services, while 100 million people are pushed below the poverty line.

According to the 2013 Kenya Household Health Expenditure and Utilisation Survey, medical expenses account for more than 40 per cent of non-food bills in over half the counties in the country.

In Kenya, though access to quality healthcare is a constitutional right, the scarcity of quality public and private health facilities, as well as the high cost of care even when it is available, means that universal health coverage remains little more than words on paper for much of the population. President Uhuru Kenyatta has made achieving universal health coverage by 2022 a major part of his second term agenda and indicated in his inauguration speech that this would be achieved by expanding coverage under the National Health Insurance Fund (NHIF). The president said that half a century after it was established in 1966, the Fund has only attracted 6.8 million beneficiaries. The World Bank estimates that only a fifth of Kenyans have any sort of medical cover, which means that as many as 35 million Kenyans are vulnerable to the financial devastation occasioned by a medical emergency.

Related stories: Behind the Makueni Healthcare Revolution

When illness eventually strikes, it takes a huge financial toll. According to the 2013 Kenya Household Health Expenditure and Utilisation Survey, medical expenses account for more than 40 per cent of non-food bills in over half the counties in the country. In fact, direct payments by citizens accounted for a third of the country’s total health expenditure in the same year, according to Dr. Izaaq Odongo, the head of the Department of Curative and Rehabilitative Health Services at the Ministry of Health, with the balance being made up by government (36 per cent), donors (20 perc ent) and employers (10 per cent). As a result, many Kenyans are forced to resort to selling off property, relying on networks of relatives and friends, or even making desperate appeals on social media to raise the necessary funds. Hence the large, and seemingly never-ending appeals all Kenyans make when clearing medical bills. Despite this, according World Bank Country Director, Diarietou Gaye, the number of those thrust into poverty by medical expenses is close to one million.

Kenya’s network of public healthcare facilities has traditionally been hierarchically organised into 6 levels, with the lowest unit being community health workers embedded within communities. At level 2, dispensaries and clinics provide the link between community-based healthcare and the formal health system. Together with level 3 facilities – health centres, maternity clinics and nursing homes – these make up the primary healthcare units. Levels 4-6 are sub-county, county and national referral hospitals. It is at the lower levels that the majority of people interact with the healthcare system and it especially at the primary healthcare facilities that national government interventions with regard to cost have been most consequential.

Since independence, Kenya has blown hot and cold on the abolition of user fees and decentralisation, both of which, given the economic circumstances of most Kenyans as well as the devolution introduced by the 2010 constitution, are prerequisites for universal health coverage. In 1965, according to the paper “Reforming health systems: The role of NGOs in decentralization – lessons from Kenya and Ethiopia by Richard G. Wamai of the Harvard School of Public Health, “a free access policy abolished the KSh5 co-payment operative in the colonial healthcare system… [and] proposed expanding coverage through centralizing the delivery responsibilities from the counties and municipalities to the Ministry of Health”. Eighteen years later, the provision of health services was again decentralised as part of the District Focus for Rural Development programme and in December 1989, user fees were reintroduced in an effort to inject money into crumbling health facilities. The “cost-sharing” programme was part of a comprehensive health financing strategy that also included social insurance, efficiency measures and private sector development. The fees would, the argument went, generate additional revenue, incentivise use of low-cost primary healthcare services rather than the more expensive referral facilities and improve targeting of resources by reducing unnecessary demand.

Still, implementation problems led to the suspension of the policy less than a year later though it was gradually reintroduced in 1991. A 1996 study found that despite revenue increases and facilities being allowed to budget for three-quarters of the money they remitted to the districts, this did not necessarily result in improved quality of care because the funds were used to offset a fall in government funding for basic care. As evidence mounted that despite a waiver policy to protect the poor and children under five, user fees were proving to be a significant barrier to access, the government – in what came to be known as the 10/20 policy – again reversed course and in 2004 eliminated all fees in dispensaries and health centres, save for a minimum registration fee of KSh10 and KSh20, respectively. By 2007, it had instituted a maternity waiver allowing for free deliveries in public health facilities and introduced the Health Sector Service Fund (HSSF) to compensate these facilities for lost revenue.

Since October 2014, Makueni has been offering its one million residents free healthcare across all its public facilities, including county and sub-county hospitals.

However, as a study published in 2015 showed, this was largely ignored by health facilities for whom user fees represented almost all the cash income they used to cover basic operating costs. As a result, most patients ended up being charged for more than the specified amount while very few received waivers. In 2013, the government abolished all user fees in public dispensaries and health centres and allocated KSh 700 million to the HSSF.

The picture was further complicated by the fact that health is one of the services devolved by the 2010 constitution. This means that while the national government is still responsible for policy and managing two Level 5 referral facilities, namely, the Kenyatta National Hospital and the Moi Teaching and Referral Hospital, the bulk of public healthcare in Kenya is delivered in facilities run by county governments. A history of skewed investment that marginalised some counties, as well as the lack of policy coordination between the various counties and between the counties and the national government, have left a rather confused picture of access to healthcare across the country.

There have, however, been some wins. For the first time since independence, residents of historically marginalised counties, such as Lamu and Mandera, now have access to Caesarean section procedures within their county. There have been problems too: from the controversy arising from the national government forcing counties to lease equipment they neither wanted nor had the resources to use, to ambulance purchases that seemed more about burnishing a governors’ image than delivering care to constituents, to the First Lady’s much trumpeted Beyond Zero initiative that today is in shambles, with many of the facilities either abandoned or turning patients away.

The Makueni model

Nonetheless, an ambitious experiment in the provision of universal health coverage is underway in Makueni, a county that borders Kajiado, Machakos, Kitui and Taita-Taveta counties. Since October 2014, Makueni has been offering its one million residents free healthcare across all its public facilities, including county and sub-county hospitals. It is a model well worth examining if President Kenyatta is serious about expanding access to medical care across the country.

“When we took over in 2013, we realised that 40 per cent of the people of Makueni would sell land and exhaust family income to pay medical bills for relatives,” says Makueni’s Governor, Prof. Kivutha Kibwana. Given that medical services in dispensaries and health centres were already free and paid for by the national government, the county government figured that if it doubled the 100 million that its Level 4 sub-county hospitals were collecting in user fees, it could offer free, across the board healthcare to its residents.

Thus MakueniCare, as the county government has labelled it, was conceived. It piggybacks on the national government’s free primary healthcare policy and the national coverage provided by NHIF to plug the gap in between with the aim of providing seamless cover across all public health services.

Thus, for an annual subscription of KSh500 per household, which covers parents and all their children under the age of 18 years (or up to 24 years in case of students), Makueni residents can access free primary healthcare at dispensaries and health centres courtesy of the national government, free treatment, including inpatient care and ambulatory services, at the 13 level 4 hospitals within the county paid for by the county government, and, if they’re subscribed to NHIF, free care at referral facilities outside the county. The Level 4 hospitals provide free care and bill the county government, which also supplies them as well as the primary healthcare facilities with drugs, equipment and medical staff.

LISTENBehind the Makueni Healthcare Revolution

However, universal health coverage is more than eliminating out-of-pocket expenditure; it is also about ensuring access to healthcare. According to Dr. Cyrus Matheka, the head of the county’s Health Promotion Services, MakueniCare took two years to plan and was preceded and piloted by a programme offering free care to those over the age of 65 without a requirement for registration. Within that time, the county government invested in expanding facilities, from dispensaries and health centres to sub-county hospitals, and has continued to do so. In under five years, it has more than doubled the number of health facilities built by the colonial and national governments over the last 50 years. Apart from an additional 113 dispensaries and health centers, the county now boasts 13 Level 4 hospitals and has employed 160 doctors, compared to just 38 doctors and 3 hospitals in 2013. At KSh2.3 billion, health is the county’s single largest budget item.

All this means that the county can offer a wide array of free services to residents, from hospital admission, surgical procedures, X-ray imaging, laboratory testing, to dental and counselling services. Even in death, patients benefit from 10 days of free mortuary services. However, the cover does not apply to specialised care and equipment that are not available at the hospitals, including dialysis for patients suffering from kidney failure, intensive care units, implants, as well as auxiliary devices, such as wheelchairs.

Insurance schemes are essentially funds where people pay into a pool when they are healthy – in this case through both taxes and direct contributions – which they can draw on when sick. The Makueni recruitment model reversed this, thus courting adverse selection, or the tendency of people to get insurance only when they are seriously sick, which can consume huge resources.

Dr. Andrew Mutava Mulwa, the County Minister of Health, estimates that MakueniCare covers at least 93 per cent of the county’s healthcare needs. He says it is built on a platform of ensuring adequate provision of primary care by increasing facilities, improving services and ensuring that medicines are available. “Someone who is sorted at the dispensary will not find their way to the hospital,” he says, adding that only 35 per cent of patients in Makueni need to seek care in the secondary institutions covered by MakueniCare or in tertiary referral facilities outside the county.

Challenges

However, the programme has had its share of challenges. The first, rather surprisingly, was low uptake. In March last year, when The Elephant visited Makueni, less than 10,000 households had signed up for the programme out of a potential 200,000. The scheme had a mere 30,000 beneficiaries. Part of the reason for this was the decisions taken to make the coverage voluntary, to register subscribers at county hospitals when they sought care and to make the cover active immediately upon registration and payment. Initially there did not seem to be much of a public campaign to get residents to register: there were no posters announcing the programme in all the hospitals The Elephant visited and, despite officials claiming to advertise on vernacular radio, most residents we spoke to had not heard about MakueniCare.

Julia Musau of Kaselia village, who we met at the Tawa Sub-County Hospital, is a typical case. She had been unaware of the scheme until a month prior to our visit. She found out about it after she took a patient to the Makueni General Hospital in Wote, and had difficulty settling the bill. It was another woman whose child had been admitted there who told her about MakueniCare. That was when she enrolled her family immediately.

However, even those who know about it opt to wait till they or their dependents get ill to register since there is no penalty as the cover is activated immediately and registration is done at the hospitals, anyway. This made registration vulnerable to industrial action by medical personnel. For example, during the nationwide strikes, first by doctors and then nurses, fewer people went to the hospitals as there was little expectation of receiving care. In any case, According to Dr. Matheka, less than 5 per cent of the county’s population seeks medical care at any one time, and many of these are over the age of 65, a group that already enjoys free care. This means registration will inevitably be slow unless there is a serious epidemic.

The Makueni model also faces other challenges. Insurance schemes are essentially funds where people pay into a pool when they are healthy – in this case through both taxes and direct contributions – which they can draw on when sick. The Makueni recruitment model reversed this, thus courting adverse selection, or the tendency of people to get insurance only when they are seriously sick, which can consume huge resources. This brings into question the sustainability of the programme. However, in more recent times, according to Wambua Kawive, a former Makueni County Minister, the county government has ramped up its recruitment efforts and has now launched a mass registration exercise targeting 100,000 registrations by the end of the year.

Another challenge the system needed to cope with was an initial influx of patients into hospitals once the policy was implemented. Tawa Sub-County Hospital Administrator, Justus Kilonzo, told The Elephant that the workload at the hospital had increased, which necessitated the recruitment of more staff. Further, there has been an influx of people from neighbouring counties who sought to take advantage of the system. Geoffrey Kirui, the Health Administrative Officer at Makindu Hospital next to the busy Nairobi-Mombasa highway, spoke about having to filter out patients from other counties, especially Taita Taveta, Kajiado and Kitui. Still, trying to determine someone’s place of residence using identification cards, birth certificates and a ward administrator’s or chief’s letter is an inexact science and one gets the sense that this too was not well thought through.

MakueniCare also faces a hazard where, having paid the subscription, patients will head to the hospital for even minor complaints that can be addressed at lower levels, adding stresses to the system.   They may also engage in risky behaviour knowing that there is the safety net of free care. Such behaviour may be inadvertently complemented by a shift in focus from preventative to curative care by hospitals seeking to generate more revenue and county officials seeking to make political hay from the scheme.

The latter is particularly important. It is crucial to note that MakueniCare is undergirded by an administrative structure that was created to deliver a different type of healthcare where users contributed directly. Suddenly eliminating such fees can have unintended deleterious effects on both the facilities and their ability to deliver quality services. One study on the effect of the removal of user fees found that although the revenue generated was generally low, it served to ensure that facilities met the costs of services and salaries for support staff not directly funded through the government’s budget.

There is also a legitimate fear that the political priority placed on MakueniCare may be diverting resources from primary and preventative care at the health centre and dispensary levels.

In Makueni, a doctor-turned-administrator who did not want to be named told The Elephant that MakueniCare had created a mismatch of skills, with doctors having to do administrative tasks rather than attend to patients. When MakueniCare was first proposed, the doctor told us, there was much resistance from hospitals, which were concerned about the lack of a clear system as well as lack of necessary training and preparation. “Why the rush to launch in October 2016?” asked the doctor, concluding that the timing had largely been influenced by the interests of county politicians vying in the August general election.

MakueniCare essentially transfers control over funds and decision-making away from hospitals to bureaucrats at county headquarters in Wote town. Hospitals not only have to worry about delays in receiving reimbursements for resources spent in providing care – which can happen if, for example, the national government delays disbursements to the county governments – but also about losing their largely autonomous decision-making power on the equipment they need to procure and the staff they need to recruit. Similarly, where and when new facilities are built may reflect more the political priorities of those running the county government rather than the genuine health needs of the populace. Lastly, as with all government-driven procurement decisions, the spectre of corruption is never far away.

There is also a legitimate fear that the political priority placed on MakueniCare may be diverting resources from primary and preventative care at the health centre and dispensary levels. Ilatu dispensary, which was built by the Kenya Pipeline Company and opened in March 2014, may be a case in point. In September 2015, the facility was handed over to the county government that provided staff and equipment. Adjacent to a settlement scheme, it is the busiest facility in Kibwezi West and offers outpatient, maternal and child health, family planning as well as HIV testing and counselling services. The staff of two nurses and one laboratory technologist attend to between 70 and 100 patients every day. The county government is upgrading it to a health centre and building a 40-bed inpatient facility.

Jacinta Mbula is the nurse in-charge. She says staffing and resources are big challenges. When The Elephant visited the facility, her fellow nurse was on maternity leave and she was running the facility on her own. She said that there is only enough accommodation for one nurse to stay at the facility and take care of overnight maternity cases, and that nurse still has to report to work the next day. Although they receive adequate supplies of essential medicines from the county government, they do sometimes run out of non-essential drugs.

Further, she only gets KSh60,000 – “peanuts” – every quarter from the county government to pay casual labourers and purchase essential supplies. She currently employs one casual worker and one watchman but says she actually needs – but cannot afford – two casuals and a groundsman to manage the 10-acre facility. And because it was not built by the national government, the dispensary is not entitled to access the HSSF, despite its workload, though other less busy facilities do. Ilatu does, however receive, as all facilities do, reimbursement from the national government for maternal deliveries –KSh2,500 each.

Dr. Matheka says the average distance to a health facility has been nearly halved, from 9km to 5km in the last 4 years. However, having more facilities will not necessarily improve health outcomes for the people of Makueni if the quality of care they provide begins to decline as a result of underinvestment.

So as the county keeps building more dispensaries and health centres, questions must be asked about whether underfunded facilities can truly serve as the bedrock for universal health coverage even though access has been improved. Dr. Matheka says the average distance to a health facility has been nearly halved, from 9km to 5km in the last 4 years. However, having more facilities will not necessarily improve health outcomes for the people of Makueni if the quality of care they provide begins to decline as a result of underinvestment. Further, especially as the county expands the number of Level 4 hospitals, one must wonder whether this is being done at the expense of funding primary healthcare.

Makueni officials say some of the potential pitfalls are ameliorated by enhancing public participation. Governor Kibwana says local committees of citizens participate in co-supervision of projects and must, along with technical people and administrators, give approval. This, Kawive asserts, removes politics from the equation and makes bureaucrats and hospital administrators directly accountable to citizens. While it is definitely a good idea to involve local communities, true accountability must be accompanied by real access to information as well as consequences for those who are implicated in wrongdoing.

Though MakueniCare faces its share of challenges, everyone The Elephant spoke with in Makueni who was aware of the programme was full of praise for its ambition, including those who were critical of its implementation. The fact is, as Kenya ponders the way to achieve universal health coverage, the country would do well to pay attention to the lessons from Makueni. The expansion of NHIF cover by itself will not suffice; the national government must work with county governments to outline a plan that creates a seamless spectrum of cover at every level of care and provides the necessary resources at the appropriate time.

Further, there should be horizontal cooperation among counties in providing healthcare and any plan must strive for equity but without punishing the counties that have taken serious strides. Criteria for eligibility for county programmes should be clearly spelt out and counties should be encouraged to collaborate in designing their schemes within the framework of the national plan.

Thirdly, the system should primarily invest in and direct resources towards building the capacities of the public health sector, not in creating opportunities to generate private profits. It should embrace a rights-based approach that seeks to deal with health as a human right rather than an industry. That shifts the focus away from the needs of “investors” to those of citizens. As Ann Wanyoike notes, “an expanded role for the private sector became a health sector reform theme of the 1990s” but this resulted in “a dichotomous health structure that was characterised by the rich opting for high-cost private healthcare providers, with a majority of the populace who had no such means relying on the publicly run health institutions”. This means that those who can contribute the most to a national universal health coverage scheme have little incentive to do so, especially if such contributions are voluntary. More on that later.

In addition, it does no good to simply superimpose universal health coverage on a system designed for hospitals to generate revenue. The latter must be fundamentally retooled to suit the former and this will take both time and resources.

Fourth, the plan must prioritise prevention and care at the lower levels. In 2013, according to the Kenya Service Availability and Readiness Assessment Mapping report, less than 6 out of 10 health facilities in the country have the capacity to provide the Kenya Essential Package for Health (KEPH) – a standardised comprehensive package of health services – and less than half have the basic amenities to provide healthcare services. And while two-thirds have half the basic equipment required, 59 per cent do not have essential medicines. Only 2 per cent of facilities are providing all KEPH services required to eliminate communicable diseases. Providing universal healthcare on such a foundation would be building on sand.

Universal healthcare requires a substantial increase in the resources both levels of government commit to health. The point is not that both levels of government should spend more on health at the expense of other social services; rather they should increase spending on the full range of human rights and social determinants of health. For example, Kenya’s Health Policy identifies reducing the burden of violence and injuries as one of the top objectives and notes that this will require addressing causes. Given that road crashes account for between 45 and 60 per cent of all admissions to surgical wards, comprehensively addressing the problems on our roads would free up considerable resources in the health sector.

According to Djesika Amendah, an associate research scientist at the African Population and Health Research Centre, Kenya spends most of its health budget on salaries, allowances, drug supplies and other recurrent costs; only 7 per cent of the budget goes towards capital expenditure to improve the quality of healthcare by building new facilities or purchasing equipment to care for more people in the future.

How the money that is allocated to the health sector and how it is spent should also change. According to Djesika Amendah, an associate research scientist at the African Population and Health Research Centre, Kenya spends most of its health budget on salaries, allowances, drug supplies and other recurrent costs; only 7 per cent of the budget goes towards capital expenditure to improve the quality of healthcare by building new facilities or purchasing equipment to care for more people in the future.

In addition, the country spends nearly four times as much on curative care as it does on disease prevention and “we devote a higher share of our health shillings (20 per cent) on governance, health system and financing administration; in other words, paying people in the ministries of health who actually do not see any patients rather than spending money on preventing diseases or promoting health.” Further, although most Kenyans live in rural areas, government health expenditure has in the past tended to favour urban areas. Given the country’s limited resources, more prudence will need to be exercised if universal access to care is to be guaranteed to all.

Along the same lines, there should be an emphasis on getting Kenyans to pay into the system when they are healthy and not to wait till they get sick to get the cover. This also means making it easier for people to register and pay. For example, one can currently download a registration from the NHIF website but one then has to deliver it physically to their offices. There appears to be no way to pay via mobile money or credit/debit card. With nearly all Kenyans able to access the internet though their mobile phones, allowing online registrations and payments would be an easy way to bring in more registrations.

Further, whether the scheme should be voluntary or compulsory is a matter for serious debate. While Makueni’s system is completely voluntary, the NHIF is compulsory only for those in formal employment. Yet the WHO’s 2010 World Health Report titled “The Path to Universal Coverage” says that “there is strong evidence that raising funds through compulsory prepayment provides the most efficient and equitable path towards universal coverage. In the countries that have come closest to achieving universal health coverage, prepayment is the norm, organised though general taxation and/or compulsory contributions to health insurance.”

Makueni teaches us that universal health coverage is doable and that we do not need to have the resources of an industrialised country to achieve it.

There is also the question of whether, like in Makueni, everyone pays the same amount regardless of income, and whether wealthier people are asked to pay a little bit more in order to lighten the load on the poor. As the WHO notes, “financial risk protection is determined by how funds are raised and whether and how they are pooled to spread risks across population groups” and “rais[ing] funds equitably … usually implies a degree of progressivity (where the rich contribute a higher proportion of their income than the poor)”. The NHIF, rather strangely, only has a graduated scale for contributions from those in formal employment; others who join pay a flat monthly fee regardless of income. This is curious for a country where, according to the United Nations’ Economic Commission for Africa, only a quarter of workers are in the formal sector.

Fifth, accountability must permeate the entire system. Implementation of the scheme should not become, as we have seen with the free primary education reintroduced in 2003 and the Standard Gauge Railway, hostage to political priorities. Kenyans must accept that if it is to be done well, it will not be done overnight. Public participation at every stage should be encouraged and resources, especially human resources, should be utilised in the most appropriate and effective manner. Effective public participation as well as transparency will be indispensable if the country is to avoid universal health coverage becoming another avenue for looting by the state.

While universal health coverage focuses on reducing the financial burdens of patients, more will be required if access to the healthcare system is to be expanded. As the World Health Report notes, “eliminating direct payments will not necessarily guarantee financial access to health services, while eliminating direct payments only in government facilities may do little to improve access or reduce financial catastrophe in some countries. Transport and accommodation costs also prevent poor people using services, as do non-financial barriers, such as restrictions on women travelling alone, the stigma attached to some medical conditions and language barriers.”

Finally, Makueni teaches us that universal health coverage is doable and that we do not need to have the resources of an industrialised country to achieve it. All that is needed is a belief that Kenya should be run for the benefit of all Kenyans and that Kenyans are just as capable as any other people of imagining and creating better worlds and better futures. This may be the greatest lesson we can learn from Makueni County.

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Mr. Gathara is a social and political commentator and cartoonist based in Nairobi.

Politics

My Sons Are Dead: A Mother’s Cry for Justice

As Kenya’s forgotten mothers get worn out by the load of a nation’s collective misdeeds in pursuit of political power, a day shall come when the Mama Victors will no longer be in a position to continue doing national duty as national trauma-bearers.

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My Sons Are Dead: A Mother’s Cry for Justice
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It was around 2 pm, 9th August, a day after the 2017 general election. Bernard, 25, and Victor, 22, alighted from different matatus in Nairobi’s Mathare neighbourhood. Bernard got off at stage number 10, while Victor, who was technically his younger brother, was dropped off hapo kwa vitanda (at the roadside kiosks)according to their mother’s account. Born to sisters, Bernard’s mother passed away when he was barely in his teens. He then moved in with his aunt, Mama Victor, who raised him alongside her three sons and daughter.

‘‘They grew up together,’’ Mama Victor told me when I met her in Mathare. ‘‘They were both my sons.’’

Bernard was back from Gikomba, where he worked as a tailor. Victor, a casual labourer, had come from his place of work in Westlands. They had voted in Mathare the previous morning, before reporting to work a little late than usual. On reporting to work on the 9th, they were both granted a day off, seeing that the country was on edge awaiting results of the hotly contested presidential election. Upon arriving in Mathare, the brothers found the roads blocked by protestors coming from as far as Dandora and Kayole, held back by a police cordon. That is why both Bernard and Victor disembarked from their matatus before arriving at their designated stage.

‘‘When they got off the matatus,’’ Mama Victor narrates, ‘‘they found huge crowds gathered in front of them.’’

After quickly reconnecting, Bernard and Victor looked around, recognizing familiar faces. Curious to know what the hullabaloo was all about, they walked over to their friends, asking what the matter was.

‘‘They liked asking each other Rada?Rada?’’ Mama Victor tells me, Sheng for, what’s the plan?

‘‘They didn’t even get too far into the crowd,’’ Mama Victor recollects being told by witnesses what happened.

‘‘Bernard was suddenly shot in the head, his brains blown out. Victor was shot in the stomach. I believe Victor was shot twice, though the medical report says he was shot once. His intestines spilled out. He had to hold them back using both his hands.’’

‘‘When Victor’s intestines fell out,’’ Mama Victor says and pauses, drifting away in thought…‘‘You know there are those things which if they happen to you, your body suffers a huge shock. I think when both Victor and the policemen saw his intestines hanging, they were all terrified. So Victor tried holding his intestines back, as the policemen rushed to where he was, as if they had just realized whatever damage they had done.’’

‘‘He succumbed before getting to the local hospital,’’ she says, ‘‘where the police were rushing him to.’’

Bernard, who Mama Victor says died instantly from the shot in the head, was left lying at the scene. There was nothing to salvage, with his skull shattered. A third young man, who Mama Victor says was called Paul Omena from Huruma area, and whose parents she hasn’t been able to locate to date, was also shot dead. A fourth, the luckier one of the lot, survived with a bullet wound.

Mathare had swallowed her sons alive

News reached Mama Victor at her Mathare Area 4A home that kuna vijana wameangushwa ( Some young men have been shot dead). What no one told her was that two of those vijanas were her sons. At about 3 pm, a sympathetic eyewitness knocked on her door and broke the news. Her two sons were dead.

‘‘I didn’t understand what they meant when they said my sons had been killed by the police,’’ Mama Victor remembers, ‘‘They had never had any run-ins with law enforcement. I even wondered why they had to kill them both. It didn’t make sense. Families in Mathare lost sons, but losing two sons at one go was strange.’’

By the time she got to the scene, Bernard’s body had been taken away. There was heavy police presence at the scene, Mama Victor recollects. Mathare was uninhabitable and inconsolable.

Permission to Mourn

Amid the chaos that followed the August 8 general election ( 2017) – protests by opposition supporters and police crackdowns in informal settlements like Mathare – Mama Victor had to find a way to hurriedly fundraise before transporting the bodies of Victor and Bernard to their rural home in Western Kenya for burial.

‘‘I was lucky because at least the police allowed us to mourn my sons,’’ she says. ‘‘Others are not so lucky.’’

One may wonder why anyone would need permission from the police to mourn their loved ones, usually shot dead by the police. But in Mathare’s stark reality, when young men are shot dead by the police, families have to negotiate with law enforcement for them to be allowed to either hold vigils, publicly fundraise or even erect a tent where mourners gather to condole with the family.

Amid the chaos that followed the August 8 general election ( 2017) – protests by opposition supporters and police crackdowns in informal settlements like Mathare – Mama Victor had to find a way to hurriedly fundraise before transporting the bodies of Victor and Bernard to their rural home in Western Kenya for burial.

‘‘Here in Mathare,’’ Mama Victor explains, ‘‘if your son is killed and the police label him a criminal, they won’t allow you to mourn him. You can’t have any gatherings. They won’t allow it to happen and if you insist on going ahead with one anyway, they will walk in and arrest you. Everyone here knows that much”.

Besides the ‘privilege’ of mourning Victor and Bernard, neighbours warned Mama Victor that she had to transport the bodies of her sons out of Nairobi before the Supreme Court ruled on the validity of the August 8 presidential election. By this time, the opposition coalition was in the final stages of arguing its petition against what it considered an irregular presidential vote. Kenya continued to be on tenterhooks.

‘‘There were fears in Mathare that whichever way the Supreme Court ruled,’’ Mama Victor remembers,‘‘a fresh wave of protests and police killings would break out, meaning no one would risk coming out to help me with either fundraising or funeral arrangements. I had to move fast. I was mourning and simultaneously thinking on my feet. You carry the pain of unfair deaths in your heart, but still keep your head functioning.’’

By this time, Victor and Bernard had already stayed in the morgue for close to a month, due to lack of money to transport their bodies home for burial. The meetings in Mathare could not raise a substantial amount of cash in good time, meaning they had to continue holding mini-fundraisings. In the end, Mama Victor made do with whatever little she had managed to raise, lest the Supreme Court ruling found her in Nairobi.

‘‘It was a quick burial,’’ Mama Victor narrates. ‘‘By the time we got to Western Kenya, we found the graves had already been dug and went right ahead with the internment. My sons had overstayed at the morgue.’’

By this time, Victor and Bernard had already stayed in the morgue for close to a month, due to lack of money to transport their bodies home for burial. The meetings in Mathare could not raise a substantial amount of cash in good time, meaning they had to continue holding mini-fundraisings. In the end, Mama Victor made do with whatever little she had managed to raise, lest the Supreme Court ruling found her in Nairobi.

The Pursuit of Justice

There was no doubt in anyone’s mind in Mathare that Victor and Bernard were killed by the police. Hundreds of protestors witnessed their shooting.The police themselves went as far as attempting to save Victor’s life, seeing that he hadn’t died instantly. In an ideal scenario, the case should have been an open and shut matter, with the National Police Service owning up to its officer’s excesses. Even more encouraging was the fact that there now existed the Independent Policing Oversight Authority (IPOA), a civilian agency created by an Act of Parliament (2011), which is mandated with ensuring civilian oversight on police action.

However, to the surprise of Mathare residents who have been following the case, justice remains elusive.

‘‘There are people here in Mathare who have video recordings of the police either summarily executing or beating someone to death,’’ Mama Victor tells me. ‘‘If you asked people to bring those video clips today,they’ll come forward. But what we have learnt is that no matter what amount of evidence you have, there are no guarantees that justice will be done. I have waited since 2017 for something to be done to get justice for my sons. To date, nothing has been done by either IPOA or the numerous human rights organizations.’’

After the shooting of her sons, the Mathare Social Justice Center (MSJC), one of the pioneer grassroots documenters of extrajudicial killings, reached out to Mama Victor. In a sense, MSJC has become the last line of defense for Mathare residents, where beyond just securing and preserving evidence in the form of detailed statements, young men have literally sought refuge at the center while being pursued by killer cops. However, for a community-based organization, MSJC, like other social justice centers across Nairobi’s informal settlements, has huge limitations, starting with budgetary and capacity constraints. MSJC therefore acts as a conveyor belt for IPOA and more established human rights organizations, to whom they hand over statements and evidence, with the expectation of an escalation of matters; prosecution and compensation.

MSJC was therefore Mama Victor’s first port of call, from where she was assisted to lodge her case with IPOA and a number of human rights organizations, whose mandate includes seeking legal redress in cases such as hers. Mama Victor must have been mistaken to imagine that her case would be given first priority, because of the available evidence and the enormity of her loss. The death of her two sons. To date, IPOA is yet to present her case to court over a year and a half later.

‘‘A lot of times these women don’t even have bus fare,’’ Wangui Kimari of MSJC, tells me. ‘‘Yet we try to convince them to miss a day’s work for them to record statements with IPOA or attend follow up meetings. Sometimes we take their cases to human rights organizations with capacity to prosecute, but after going through the motions, they send us back to IPOA, citing one technicality or another. It gets extremely tiring and frustrating for these women. It starts to feel like justice is a mirage.’’

‘‘Being a witness in a case against the police can be difficult,’’ Mama Victor tells me. ‘‘You can be killed either before or after you testify. Yet if you go to IPOA, it doesn’t matter if you have video clips. They want witnesses, yet everyone is afraid. Why don’t they use other methods like examining bullets found in the bodies of victims and determining whose gun they originated from? People are totally afraid of testifying.’’

If you asked anyone in Mathare to testify in a courtroom against a policeman, they will most likely remind you of the case of Christopher Maina, where the lead witness was assassinated. Maina, a twenty-something year old who was picked up from Pirates base in Mathare just before the 2017 general election and shot dead by a plain clothes policeman. The summarily execution was witnessed by one of Maina’s friends. In the course of justice for Maina, the friend became a voluntary witness, going as far as recording a statement with IPOA. It was not long before Maina’s friend was murdered, a murder that Mathare residents attribute to a notorious killer cop.

‘‘If they can kill an IPOA witness,’’ a Mathare resident posed, ‘‘then who is safe to ever testify?’’

Organizations such as the International Justice Mission (IJM) have taken up some cases involving police shootings, which complaints were originally with IPOA. However, there is discontentment in the manner the cases are selected. Mathare residents wonder, why some cases are seemingly more equal than others.

‘‘We want the police prosecuted and our families compensated,’’ Mama Victor offers. ‘‘That’s all we want.’’

In the process of speaking to residents of Mathare, I learn that there are more families whose loved ones were shot during the 2017 general election. However, due to the amount of fear the police have instilled in Mathare, these aggrieved families have opted to suffer in silence than dare step up and speak up against police brutality. They won’t even record statements, suffering from a mind numbing mix of fear and trauma.

‘‘The other reason why some mothers and wives choose to live quietly with the pain is because they feel that even if they speak up, justice can never be done,’’ Mama Victor says. ‘‘They can see the trouble some of us have gone through, yet to date, nothing has happened. Not even a mere court case has been opened.’’

‘‘Some of those who are suffering the most are survivors of police shootings during the elections, from the campaign period,’’ a resident who sought anonymity tells me. ‘‘We have some who can’t even afford healthcare. They are rotting in their houses, straining their financially incapacitated families as they await death. Majority have become disabled. In fact there’s one who is still living with a bullet. Doctors said if they remove it, he would die. He is traumatized because he knows death is only a matter of time. Another one was shot on the shoulder. He was released from a moving police vehicle, and as he was running into his home when he got shot. We have all these cases in Mathare. But IPOA doesn’t want to come and setbase here.’’

Mothers and Widows

United in grief, Mama Victor joined a number of women and widows whose sons and husbands were either killed or injured by police bullets during the 2017 general election. They formed an association, the Network of Mothers and Widows of Victims and Survivors, borrowing a leaf from the hundreds of mothers and widows across Nairobi’s informal settlements, who have lost loved ones to extrajudicial killings over time.

‘‘Currently, my network has mothers and widows of 35 survivors, 12 victims and 12 orphans,’’ Mama Victor tells me. ‘‘The victims are the dead, survivors are those who were shot but didn’t die. Some are disabled.’’

Mama Victor, who is the group’s coordinator, tells me that after she met the mothers and widows inside the network she realized how dire things were for these women, not only for her who had lost two sons.

‘‘The youngest widow in my group is an 18 year old,’’ she says, ‘‘who lost her first husband to police bullets before she was 16. On turning 16, her second husband was shot during the 2017 general election. She’s now raising a three year old without a job or anyone to fend for her. Her own mother is bed ridden. Imagine that.’’

Aside from Mama Victor, the group, which has representation from various informal settlements in Nairobi including Dandora, Kayole, Mukuru, Kiambio, Kibera, among others, has a 27 year old who is raising two sons, a 12 and 7 year old, as the oldest member. The median age of group members is below 25, with majority of their children aged under 5. This terrifying reality is a function of a poverty stricken environment, where early marriage becomes a way out of destitution for most young girls.

On the passing of Victor and Bernard, Mama Victor was left with two young widows to cater for.

‘‘Both Bernard and Victor left a wife and a child’’ she says, ‘‘and so for the months following their killing, I had to support the young wives as much as I could. But in the end, I couldn’t manage to keep them afloat. Bernard’s wife, who was an orphan, remarried. She now has a two month old baby from her new marriage. Victor’s wife, who lost her mother, retreated to her village. They’re both just trying to move on with life.’’

From time to time, women in Mama Victor’s network have to make tough choices. One of the more common ones is the decision whether to work or pursue justice for their husbands and sons. But seeing that most women from Mathare work as domestic workers, it becomes difficult for their employers to allow them consecutive off days, especially when they need to interact with either human rights organizations or IPOA, in pursuit of their cases. Therefore a good number of the women end up either losing their jobs, or not earning enough to support their young families.

‘‘I had to quit my job because I had to seek justice for my sons,’’ Mama Victor says. ‘‘My employer couldn’t allow me to keep missing work. It became difficult chasing two birds at one go. I had to let go of one.’’

Even for those willing to work, Mama Victor tells me of kukaa kwa mawe (Sitting on stone blocks), where women go looking for work, but because the economy is doing badly, they end up sitting on the roadside the whole day, waiting for families to call them in for menial work. When the jobs aren’t forthcoming, it means families sleep hungry.

‘‘I visit them and feel their pain,’’ she says, ‘‘just to make them know we’re in this together. Someone should come to the rescue of these women, even if they’ll just take care of the kids. We’re already well organized.’’

‘‘I am sorry to say this,’’ Mama Victor opens up, ‘‘but the most heartbreaking thing I have had to live with has been knowing that some young widows have had to turn to prostitution. As a mother, nothing hurts me more than seeing young women resort to selling their bodies for survival. It tells you they have reached the end of the road and given up. They come to me hoping I can offer them something, anything. But when they get to my house, they realize that I am also literally living hand to mouth. We are really suffering.’’

‘‘My heart hurts deeply,’’ Mama Victor tells me. ‘‘It’s just that I can’t always display my heartbreak.’’

Being Mama Victor

After telling and retelling her story, either to human rights organizations documenting extrajudicial killings or to investigators at IPOA, Mama Victor has gotten to a point where all she can afford in terms of emotional giveaways is to strike a forlorn look. She tells me she has run out of tears, to a point where she now speaks about her sons’ deaths as if it were a distant occurrence from a faraway dream. She is a lonely spectator, burdened with nightmarish enduring memories.

Three weeks after burying her sons, Mama Victor was back in Mathare. She would have wanted to stay in the village longer, but things were a little complicated. Following Baba Victor’s death in 2010, she had run into problems with her husband’s family over her children’s inheritance, land. A helpless widow, she lacked financial or other muscle to push back against errant family members. She surrendered to her fate.

‘‘The entire village was on my side,’’ Mama Victor tells me, ‘‘but at the end of the day, there’s nothing they could do. The immediate family had the final say on the matter, and no one could overrule them. I lost out.’’

Mama Victor first came to Nairobi with the sole intention of pursuing her husband’s pension. He worked as a civil servant, but on investigating what had happened to Baba Victor’s retirement benefits, she was informed that the money had been disbursed to his bank account by the government, but that someone had mysteriously withdrawn the entire amount. There was no way she could be assisted, unless she pursued the matter with the police. Broke and dejected, Mama Victor retreated to a church in Eastleigh, where she was urged by a group of women congregants to start afresh, lest the weight of her tribulations overwhelmed and killed her.

‘‘I started doing domestic work for families in Eastleigh,’’ Mama Victor recalls, ‘‘earning 2,300 shillings per month. At the time, my children had moved in with my parents at their rural home in Busia.The money was so little. I felt stuck, unable to provide for my children in any meaningful way.’’

With the help of women from the church, who donated household items; a blanket here, a mattress there and a few sufurias, Mama Victor managed to start all over again. Her plan was to stabilize before bringing the children over, to join her in Nairobi. With a meagre salary and chattel from the women, she rented a place.

‘‘Rent was 1,300,’’ she says. ‘‘The deposit for the house was another 1,300. That means on the first month when I rented the place, I was left without a coin. In fact, I had to look for an extra 300 to clear the payment.’’

In her little house in Mathare, Mama Victor lived with her daughter and four sons, among them Victor and Bernard. They were joined by two sons born to Mama Victor’s brother in-law. It was a full house in the literal sense, but Mama Victor had no complaints. They were all happy together. With time, the boys started getting work, marrying and moving out. Other than her youngest son, who is now 12, Victor was the youngest of the lot, much as he seemed older than everyone else due to his impressive height.

‘‘He was handsome and tidy,’’ she says of Victor. ‘‘Everyone wanted to be like him, to imitate him. He loved cleanliness from the time he was a little boy. He always stood out. He was such a lovely boy.’’

Mama Victor runs out of adjectives describing her son. There is no doubt that Victor was his mother’s pride.

‘‘Bernard and Victor loved to fool around,’’ she says, ‘‘you can’t say they were violent. Bernard was talkative whenever he was with Victor, but wouldn’t talk much ordinarily. He used to stutter. They loved each other, but beyond that, they had so much love and respect for me. I wish you saw how they behaved around me. If they had passed here and seen me, they’d have come running, saying mathe, mathe, we hadn’t seen you. ’’

Listening to Mama Victor talk, there is no doubt that something truly precious was brutally taken away from her. She speaks fondly, especially of Victor, as if he left with some unfulfilled promises, possibly to work hard and lift his mother out of the precarious existence of his birth. Despite her stoicism, one cannot miss the moments of frailty in Mama Victor’s voice. No one can bring Victor and Bernard back to life but they should at least be consensus that their deaths were unfair and unjustified.

‘‘Vitu zilienda mrama,’’ she says, things went south.

‘‘Sijui nitafanyaaje.’’ I don’t know what to do now.

Tell Uhuru and Raila

On the day I am meeting Mama Victor, she has just come back from her last born son’s school, where the 12 year old is facing a disciplinary case. The teachers have refused to allow him back in class, demanding a considerable sum of money as compensation for whatever damage the boy caused at school. Mama Victor doesn’t have that kind of money, and therefore the headteacher turned her away, refusing to give her back her son’s school bag or allow him anywhere near the school.

With her is Terry, Victor’s three year old daughter, who keeps pulling at her dress, calling her shosho. After Victor’s wife retreated to live with her father in the village, Mama Victor was left with the responsibility of raising her grandchild, who was pretty unwell at the time of our meeting. Looking at Mama Victor nursing Terry – holding her in her lap, giving her water as if breastfeeding and offering her a sole ten shillings coin to buy candy at a nearby kiosk when the little one got restless, one is extremely moved by the plight of a woman, who has had to bury her sons and now single handedly raise their little children.

‘‘Sometimes I feel like I am going crazy,’’ Mama Victor tells me. ‘‘Look at a day like today. I am coming from my son’s school where the teachers are being unreasonable. Then I have to deal with Terry’s health complications, keep pursuing justice for her father and uncle and still find a way to earn a living. Feeding these children is the toughest task because they can’t understand that sometimes one lacks even a cent.’’

After our long chat, Mama Victor tells me she has a message for two individuals; former Prime Minister Raila Odinga and President Uhuru Kenyatta. According to her, Victor and Bernard, among tens of others – over 100 individuals according to the Kenya National Commission on Human Rights (KNCHR), including a six-month infant and a 9 year old – all died because the two men were fighting for Kenya’s presidency. But after the dust settled, Uhuru and Raila made peace, and are now bosom buddies. Mama Victor’s question is, were Victor and Bernard, and the many others, mere collateral damage in a game of political chess? She wonders how the country can ever heal yet the bearers of the nation’s collective terminal pain and wounds have never spoken to it. Are they a sore reminder, to be erased and forgotten?

Sometimes I feel like I am going crazy,’’ Mama Victor tells me. ‘‘Look at a day like today. I am coming from my son’s school where the teachers are being unreasonable. Then I have to deal with Terry’s health complications, keep pursuing justice for her father and uncle and still find a way to earn a living. Feeding these children is the toughest task because they can’t understand that sometimes one lacks even a cent

‘‘I want them to come here,’’ Mama Victor says. ‘‘We want nothing from them. We want to see them with our eyes, for them to see us and know that we exist. They need to know curses come in different forms. Our pain alone is a curse to them. We want absolutely nothing from them. But they must come here and see us.’’

Are Mama Victor’s words a warning shot, a threat, a plea, or all of them rolled into one? Will the big men and their peace-architects listen, or will Mama Victor’s cries and those of others go unheeded? As Kenya’s Mama Victors get worn out by the load of a nation’s collective misdeeds in pursuit of political power, a day shall come when the Mama Victors will no longer be in a position to continue doing national duty as national trauma-bearers. That day, the chain holding Kenya together shall surely break.

 

Postscript: The network of mothers and widows of victims and survivors invited the Independent Policing Oversight Authority (IPOA) to the Mathare Social Justice Center (MSJC) on 04 July, to ‘‘reflect on case management, witness protection, advocacy and psychosocial support.’’ IPOA didn’t show up. 

A criminal human rights reporting project by Africa Uncensored (AU) and the Institute of War and Peace Reporting (IWPR)

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Borders versus People – Part II: Congo – A Classic African Tragedy

The spat between the Rwandan and Ugandan leaders may have more to do with their interests in their neighbour Congo than with any ideological or political split, argues KALUNDI SERUMAGA in this second of a three-part series. How long will the DRC remain the hunting ground for foreign predatory forces? And what does this spat say about the future of Pan-Africanism and regional integration?

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The borders between Uganda, Congo and Rwanda were drawn in the early 1900s. This was not an African decision. A joint team made up of officials representing the German, Belgium and British empires surveyed the hills of the region and made a decision. It was not a simple matter. At one point, they were attacked by a party of rebels led in 1911 by the anti-colonial Nyabinghi warrior Muhumuza, who ambushed a joint Anglo-Belgian-Germany Boundary Commission. It was to be her last operation. She was injured, captured and imprisoned by the British in Buganda for the rest of her life. Forty of her fighters were killed.

But that is the story for Part III of this series.

For now, the story is this: Those white man’s borders still eat African lives. On 27th March this year, a Rwandan national named Elizabeth Mukagarukwiza collapsed and died on the Ugandan side of the closed border while running from Rwanda security officials trying to take her back to Rwanda. She was reportedly in search of medication related to her pregnancy.

On May 24th, two men, one Ugandan, one Rwandan, were shot dead after being intercepted on a goods run into Rwanda. Like many others, they were not carrying anything ordinarily illegal.

First, as usual, it will be the peasants. The rest of us, all things remaining constant, will be caught up with later.

Borders versus People - Part I: The Tribe Conundrum

Read Also: Borders versus People – Part I: The Tribe Conundrum

Both incidents were immediate victims of the increasingly absurd bouts of megaphone diplomacy between the two countries. At one point, in a bid to deny their border incursion, some Rwandan officials even found themselves claiming that the smugglers – one Ugandan and one Rwandan – had been shot dead inside Rwanda, despite their bodies being found on the Ugandan side.

Overall, the crisis has enabled us to more clearly discern two things previously held tight by the now unsettled inner circles.

First, the people of Rwanda, for all their country’s reported developmental progress, remain seriously poor. Many will continue living outside their country, or seek to do so, for economic reasons, rather than political ones.

Second, President Yoweri Museveni’s support to the 1993 Rwanda Patriotic Front (RPF) rebel invasion of Rwanda, and the eventual overthrow of the regime in Rwanda was much more extensive and explicit than many thought at the time.

Third, that the enmity between these two hitherto sister regimes is rooted in their joint sojourn in the Democratic Republic of Congo (DRC).

Having been repeatedly assured that Eastern Africa’s future lies only in ever-greater regional integration, the sight of the principal proponent of this view, and the principal product of its attempted implementation standing now at loggerheads, will be most confounding to those genuine Pan-Africanists in support of that great expression of their ideals – the East African Federation.

Let me put it this way: Who holds the legitimate voice of the various peoples of East Africa? That question is critical to the future of the idea of a regional integration.

Having been repeatedly assured that Eastern Africa’s future lies only in ever-greater regional integration, the sight of the principal proponent of this view, and the principal product of its attempted implementation standing now at loggerheads, will be most confounding to those genuine Pan-Africanists in support of that great expression of their ideals – the East African Federation.

First, who exactly is in conflict with whom, in this instance? Clearly, it would not be correct to call this a conflict between Uganda and Rwanda for the simple reason that despite grand claims to the contrary, neither government can prove they actually represent the will and aspirations of their citizens. Yoweri Museveni of Uganda and Paul Kagame of Rwanda came to power through armed might, relying on narrow ethnic-favouring armies, and have been energetically stage-managing presidential elections – not to mention constitutional controls on their tenures – ever since.

On the other hand, neither can we call this a conflict between two men. Clearly there are interests broader than the personal views of the two principals involved, not to mention the hundreds of minions that have been scurrying about in their name, arresting, deporting, vilifying, abducting, counter-deporting and spaying on each other.

This is a clash of regimes, and the corpus of the respective crony interests that have built up around them over the decades.

Ironically, it is also unavoidable, given that both leaders chaperone exactly the same competing global ambitions and interests in the Great Lakes region, which is exactly what led to the great falling out between their respective armies in the Democratic Republic of Congo. Until then, it did not seem possible to imagine any kind of disagreement ever-emerging between them or their leaders, certainly not in the Pan-African mind.

Congo: Heart of dark foreign forces

But Congo is not the “heart of darkness” of Kurtz’s rendering. Congo is the beating heart of Africa, long excised from her body by a series of venal occupiers: first King Leopold of Belgium, then his state, then Marshal Mobutu as the nyapara for Western corporations there. Finally, our liberators moved in, and the real story of the Uganda-Rwanda border is actually the story of whether they ever actually left.

In that sense, Congo is the heart of light, in that it illuminates all the dark places of a person’s soul, and lays bare their true character, as Joseph Conrad’s Congo did with Kurtz. Ugandan and Rwandan armies entered the DRC as liberating heroes. Today, they are rightly seen as the villains who brought the place to final ruin.

But Congo is not the “heart of darkness” of Kurtz’s rendering. Congo is the beating heart of Africa, long excised from her body by a series of venal occupiers: first King Leopold of Belgium, then his state, then Marshal Mobutu as the nyapara for Western corporations there. Finally, our liberators moved in, and the real story of the Uganda-Rwanda border is actually the story of whether they ever actually left.

It is this centrality to the continent, bordering nine other countries that led Frantz Fanon to call Congo the “trigger” for the coming African revolution. The whole bounty of Africa’s riches seems to lie within her reach.

Along with its current membership of the Southern African Development Community (SADC), and the Economic Community of Central African States (ECCAS), Congo, if it so wished, could be a member state of the East African Community (EAC) and technically even of the Economic Community of West African States (ECOWAS). Its size seems to match only its sheer known mineral wealth, upon which this historical procession of predators feast.

If there is one population on the entire continent least deserving of further depredations, robberies and violence, it is the people of the DRC.

Before even Leopold, so much of its population was fed into the ships of the transatlantic slave trade for centuries that there is even a location called “Congo Square” in what is now the American city of New Orleans, in which the building blocks of American jazz were shaped by enslaved Africans on their occasional days off.

There followed a slavery-in-place, as Belgium’s Leopold organised the extraction of rubber and cocoa through forced labour camps.

William Lever, the British industrialist, was so impressed by the economic efficiencies of the slave labour system that he went into partnership with Leopold for the steady supply of the palm oil he needed to massively expand his soap manufacturing business.

This classic African tragedy, however, did not stop the two great Pan-African armies from clashing there three times, and in the process, basically laying waste the eastern city of Kisangani. Some truly epic levels of energy were expended in the stealing of minerals, lumber and other valuables from the DRC. This progressed from the mere looting of mining company stores to the taking over or establishment of artisanal mines, and even the importation of slave labour made up of “idle” ghetto youth swept off the ghetto streets from as far away as Kampala.

The International Court of Justice’s 2005 ruling against Uganda, as well as a United Nations report on Rwanda, carries the outlines of the criminality, despite furious denials from the culprits. The 10-billion-dollar penalty against Uganda remains unpaid, but the wider crime is to have created the conditions that have led to the deaths of an estimated six million Congolese people.

It would be a mistake to see any of these crimes as events that happened a long time ago, and far away. Lever’s company lives on today as Unilever. Find a moment to go and check how many of the manufactured items on your kitchen and bathroom shelves are made by this company. Congo’s long misery put Unilever in a position to be able to put them there.

The International Court of Justice’s 2005 ruling against Uganda, as well as a United Nations report on Rwanda, carries the outlines of the criminality, despite furious denials from the culprits. The 10-billion-dollar penalty against Uganda remains unpaid, but the wider crime is to have created the conditions that have led to the deaths of an estimated six million Congolese people.

And by taking the role of Mobutu, these two friends’ occupying armies and proxy militias have enabled other Western corporations to hold Congo in that position ever since. The quarrel is about which of these twins will be the principal instrument in the facilitation of this plunder, with more than a little benefit to itself.

Either this Pan-African idea does not really exist, or these leaders have never believed in it.

This is simply the story. Now we need the story behind the story, which I will explore in Part III of this series.

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Borders versus People – Part I: The Tribe Conundrum

Post-colonial Africa’s historical ideological trajectory has been to insist that all the peoples found within any given set of colonial borders at independence could only be considered as “tribes”. In this first of a three-part series, KALUNDI SERUMAGA examines tribal or ethnic identity in the context of shifting political alliances and loyalties.

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Africa’s borders are one of Pan-Africanism’s foundational obsessions. Are they ours, or Europe’s? Do we keep them, or erase them? Did we ever have our own?

Since just before the February decision by the Rwandan government to prevent access to its side of the border with Uganda, we have witnessed a shadowy quarrel between the presidencies of the two countries conducted in shorthand. The border closure was the first openly physical expression of this private argument. Since then, the language has become more robust, and the actions more direct, and even deadly.

With that act, Pan-Africanism came up against the realities of the European-designed political power upon which its member states rest. Perhaps, it will finally now look for an answer to its foundational riddle.

Some background may help here.

Yoweri Museveni, first as anti-Amin rebel activist, and later President of Uganda due to the bush exertions of his National Resistance Army (NRA), was seen –and saw himself – as the embodiment of the Pan-African ideal. Among his victorious soldiers were not insignificant numbers of refugees from Rwanda, some of whom had joined his crusade as far back as the days of General Idi Amin (1971-1979).

Museveni’s embrace, and even promotion to high office, of these excluded Africans was seen as real pan-Africanism in action. Paul Kagame was Uganda’s Deputy Director of Military Intelligence, and Major Fred Rwigyema (who died and was replaced by Kagame as the head of the Rwanda Patriotic Front [RPF]) was the Deputy Minister for Defence.

All this was celebrated, not least by the then luminaires of the attempted revival of the global Pan-Africanist movement led by the magnificently deluded Nigerian activist Tajudeen Abdul-Raheem, who went on to hold what was to be a major re-organisational 1994 conference in Kampala, which was gifted with a permanent secretariat afterwards.

Finally, the notion was cemented by the generous assistance Museveni’s NRA lent to the RPF invasion of Rwanda. In fact, the array of names of the Rwandan personalities (some now deceased) now quarreling among themselves contained a few alumni of Uganda’s Makerere University, as well as former employees of the Ugandan government. During broadcasts, if it were not for the bloodletting, it would be almost amusing watching them dispute in their Ugandan-accented English.

The genesis of the current stand-off

After the RPF victory in Kigali, one would have thought that the Pan-African flower had now bloomed. The RPF was viewed as part of the NRA but under a more focused leadership of the austere-looking disciplinarian Paul Kagame, with none of the shortcomings NRA have so venally displayed once in power.

The current stand-off is, therefore, a culminated development in a political history reaching back over four decades, which has come to define how a generation or two understand politics, war and regional diplomacy. The details of all the attendant schemes, betrayals and illegitimate victories, are theirs. The implications, however, belong to all of us. If these two peas-in-a-pod cannot get on, then who in the region will?

After the RPF victory in Kigali, one would have thought that the Pan-African flower had now bloomed. The RPF was viewed as part of the NRA but under a more focused leadership of the austere-looking disciplinarian Paul Kagame, with none of the shortcomings NRA have so venally displayed once in power.

But perhaps the problem is precisely that many were seeing something that was not really there?

For its part, Kigali eventually made it known that it believes Kampala had already been offering support to a nascent armed rebellion being assembled, it claims, in the forests of the Democratic Republic of Congo (DRC), and led by Kayumba Nyamaswa, a former RPF general. This was flatly denied by Uganda’s long-standing Minister of Foreign Affairs (and even longer-standing in-law to the president), Hon. Sam Kuteesa, who said: “Uganda cannot allow its territory to be used to threaten the security of a neighbouring country.”

Given the military role of the government in which Kuteesa serves in changing the governments of the DRC twice, South Sudan (through helping the secession), and of course Rwanda (by which means Paul Kagame became president in the first place), this must be the ultimate demonstration of diplomat-speak.

And given the fact the President Paul Kagame willingly accepted assistance offered by the Ugandan government (in which he was serving at the time) in that interference that led to the collapse of the regime of then Rwandan president Juvenal Habyarimana, perhaps this alleged assistance to his erstwhile General Nyamwasa should not be a cause for surprise, let alone outrage. He will certainly know what may follow.

The rebellion against the regimes of Idi Amin and Milton Obote basically involved arming refugees and exiles, among others, to help wage a war of the government of the country that was hosting them. This was followed by the arming of refugees to invade a neighbouring country, and then arming refugees and ethnic minorities to march against two DRC governments in Kinshasa, where the armies of Uganda, and Kagame’s Rwanda were to work together in driving the armed movement that removed the regime of Marshal Mobutu from the DRC, and backstopped events around the death of Mobutu’s first replacement.

After a lifetime of breaking rules and flouting the procedures and principles of International relations, President Kagame can hardly suddenly expect them to be upheld in respect to his own regime. And especially not by his former accomplice in such conduct.

President Kagame has a long and complex relationship with the Uganda-Rwanda border. At a personal level, he has been responsible for its security and integrity not from one, but both sides, first, as a very senior Ugandan military intelligence officer, and now as President of Rwanda. He has also crossed it in illegal fashion, first as a child in a family seeking refuge, and lastly as a Ugandan-based armed rebel. And now he has shut it down.

Between the countries, the story becomes even more complex. In the last major constitutional revamp, Uganda included a group defined as “Banyarwanda” in the schedule of “tribes” or ethnic groups of the country. This came about for two main reasons: first, there are significant communities of Ugandan citizens in the far southwest of the country that are of the same ethnicities as those found throughout neighbouring Rwanda. This is a common African situation.

President Kagame has a long and complex relationship with the Uganda-Rwanda border. At a personal level, he has been responsible for its security and integrity not from one, but both sides, first, as a very senior Ugandan military intelligence officer, and now as President of Rwanda.

The other reason is that the NRA’s struggle for power did – as the case of President Paul Kagame shows – take on board very many Rwandan refugees (largely of Tutsi origin). These refugees’ initial attempts to obtain Ugandan citizenship after the 1979 fall of General Amin’s government were opposed by many indigenous Ugandan politicians. Despite that (or perhaps as a result of it), they had gone on to swell the ranks of the NRA as it battled the regime of the then President Milton Obote following the stolen 1980 elections. The NRA’s control of full state power on its own standing ushered in the change in their status.

Much as it has enabled Ugandans of Rwandan ethnicity from the Uganda side of the border to stop having to be named after the nearby mountains or to have other labels (sometimes epithets) foisted upon them by their neighbours, this situation only creates further complications for Pan-Africanism, which as yet remain unacknowledged conundrums, but that will be significant in the future.

To complicate matters further, Uganda also has many people of Burundian origin who migrated to the country in the decades following the establishment of the colonial state. How come they have not been recognised as a separate “ethnicity”? More closely, there has been the argument, in the case of the Rwandan “ethnicity”, that perhaps Uganda should have recognised Rwandan Hutus and Rwandan Tutsi as separate groups, as had historically been the case back in Rwanda.

A similar question has been raised about the Asians settled in the country for nearly a century who have made sporadic requests for “tribal” recognition. In their case, will it go back to the Hutu and Tutsi question: will they be labelled the “Asian tribe”, or will they get registered as the various ethnic or caste groups that they identify with in India or Pakistan?

Tribe or nation?

Post-colonial Africa’s historical ideological trajectory has been to insist that all the peoples found within any given set of colonial borders at independence could only be considered as “tribes”, the raw material out of which the new nation would be built. This an extremely deeply entrenched mindset among almost the entire African political class, irrespective of country, and whether in government or in the opposition.

But here’s the thing: In the case of the members of the relatively newly-established Rwandan tribe of Uganda, one only has to cross the border (once re-opened) to morph into a member of a nationality, without a change in ethnicity.

Between the countries, the story becomes even more complex. In the last major constitutional revamp, Uganda included a group defined as “Banyarwanda” in the schedule of “tribes” or ethnic groups of the country.

The question arises as to how a European-drawn border developed the magical power to transform the same African ethnicity into either a “tribe” or a “nation”, depending on which side of that border it stood.

Other “tribes” in Uganda, such as (famously, or perhaps infamously) the Baganda, remain trapped. Their pre-colonial status as a nation cannot be as easily re-actualised, as they have no such border they can cross. These designated “tribes” have a dubious status within the given polity. Their rights are ephemeral at best. Their continued existence is viewed with official suspicion, a sort of pre-colonial hangover that must be progressively extinguished, through political means if possible, but by naked force, if necessary. They present in public life often as an abused bargaining tool by members of the petit bourgeois class found among them, as they blackmail those holding state power. “Tribalism” is the destructive political habit that results, and is then used to further stigmatise native identity.

Perhaps Kampala’s problem – evidenced historically by the belittling and patronising attitude towards Kigali since the RPF took power there – is that it cannot shake the thinking that the Kigali regime is little more than a Ugandan “tribe” that happens to control another country. In short, an extension of the attitude it holds towards all the ethnicities within the ambit of its own borders.

All these realities and events strongly suggest that the border is the least of our worries; it is what lies beneath, and before. This is what we shall examine in Parts II and III of this series.

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