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Kawempe Babies and Uganda’s Health Care Crisis

7 min read.

A shocking photo of newborn babies stacked on hospital beds has highlighted the pathetic state of public health facilities in Uganda. MARY SERUMAGA reports on the crisis.

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Kawempe Babies and Uganda’s Health Care Crisis
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As a whole, public medical facilities in Uganda have been in the gutter for quite some time. In Kampala, the government attempted to shield us from this fact when it ambushed and took over the two new hospitals built under Jennifer Musisi’s tenure as Executive Director of Kampala City Council Authority. The city already had a number of health centres inherited from Kampala District; it was some of these that were to be transformed to branches of the National Referral Hospital.

Kiruddu and Kawempe hospitals are big, flashy and captivating at first sight but reality sets in once you enter them. They have essentially become the hospitals for the have-nots while the newly renovated Mulago has more or less been transformed into a private hospital catering to a different market.

The process was gradual, not based on consultation, and the changes were communicated in public announcements. Chiefly, that maternity care at Mulago Hospital, once free of charge, is now a chargeable service. Considerably higher rates were listed alongside the new charges in order to make them more palatable.

“Services will be classified as standard, VIP and VVIP; clinical services offered to all patients at all levels irrespective of pay. (Dr R. Aceng, Minister of Health). Charges at the Mulago Specialised Women and Neonatal Hospital begin at Shs.50,000 or US$ 13.57 for consultation, a sum equivalent to one-third of the minimum monthly wage and way above the actual average daily earnings of between US$1 and US$2. The upper limit for specialised treatment is Shs. million or US$ 814, which is twenty months’ pay at minimum wage. Accommodation alone costs Shs.80,000 per day. A Caesarian section goes for Shs.2 million ($542), with an extra Shs.200,000 for tubal ligation.

For neonates requiring surgery, charges are between Shs.1.5 and Shs.3.5 million. To clear a newborn baby’s airways costs Shs.300,000 (two months’ minimum wages) daily and to keep the baby on a ventilator (once the airways are cleared) costs Shs.1 million or US$271 per day. We shall return to the care of neonates later.

This arrangement was aimed at reducing maternal mortality, which is 336 maternal deaths per 100,000 live births compared to the global rate of 216 per 100,000 live births. The new Women’s Hospital built on the campus was meant to decongest Mulago National Specialised (formerly Referral) Hospital and enable women with complicated reproductive health problems to be treated and to reduce referrals abroad (Ministry of Health). However, since the launch of the privatised Mulago Hospital, the government has continued to fly public officials abroad for treatment, notably the Speaker of Parliament who was treated in Kenya for exhaustion.

Where the introduction of charges at Mulago has been successful is in decongesting it by driving women to the understaffed, under-equipped and overcrowded “national referral hospitals” at Kawempe and Kiruddu where between 80 and 100 babies are delivered daily.

This arrangement was aimed at reducing maternal mortality, which is 336 maternal deaths per 100,000 live births compared to the global rate of 216 per 100,000 live births.

Who are these displaced women? In 2003 the Health Sector Strategy review showed only about 20 per cent of women use government maternity facilities. These women are predominantly the poor without options, meaning that those displaced from Mulago are not the ones who would otherwise have opted for private domestic healthcare or care abroad. They are not in the market for in vitro fertilization and the other specialised treatments now offered at Mulago but primary health seekers. Their issues cannot be transferred out of existence. The rest of the birthing population who use hospital maternity services – say 80% if the statistic still holds – will continue to use private services and may or may not use Mulago or go abroad. A large number of women (25%) of those giving birth are simply not attended to by qualified birth attendants (2016, World Bank databank).

Kampala City Council Authority did not design Kiruddu and Kawempe Hospitals to take the spillover from Mulago, which explains the current crisis at Kawempe. Truth be told the situation has been dire for a while now. By the time the photograph of neonates stacked on beds and plastic chairs in nappies and nothing else except cannulas and nasal tubes caused a public outcry, medics who have been complaining about this for ages had grown weary and moved on. Following the outcry, the babies were transferred to Mulago Hospital and offered free services. Even then, there were complaints about the unaffordability of the meals, which remained chargeable.

The Ministry’s initial reaction was to deny the crisis and then raid Komamboga Health Centre III for cots, which did nothing to reassure the public and reportedly caused Komamboga staff to down their tools. When they finally bought cots it begged the question: if the money was available why were cots not bought in the first place?

It is hard to blame hospital management; since the hospitals opened, the directors and staff have strenuously reported their grievances to the Ministry of Health and other relevant authorities to no avail. That one photo has in many ways been a blessing in disguise; it has held a steady spotlight for longer than is usual on the state of health services.

The Ministry’s initial reaction was to deny the crisis and then raid Komamboga Health Centre III for cots, which did nothing to reassure the public and reportedly caused Komamboga staff to down their tools.

The Labour Suite at Kawempe is unbelievably busy, having essentially inherited all the clientele that used to go to Mulago; most health centres (such as Komamboga and Kisenyi) refer their patients there. It is not uncommon for Caesarian section kits to run out, with expectant mothers still in the queue. Consequently, we are always overwhelmed by the huge numbers in the nursery/Special Care Unit/Neonatal Units.

The inevitable result is that try as we might, even with triaging [prioritising the most serious cases], the general delays in patients’ seeking healthcare and the modes of transport of expectant mothers to hospital mean many babies are born with birth asphyxia. Birth asphyxia is basically poor oxygenation of the foetus occurring mostly during the period of delivery (parturition). Depending on its extent, the outcomes can range from Hypoxic Ischaemic Encephalopathy (HIE) Grade II which may leave the child with some deficits and conditions like epilepsy. In the worst cases, referred to as HIE Grade 3, if the neonate survives, the baby will develop cerebral palsy (CP). CP involves loss of muscle control which can affect mobility, speech, swallowing, bladder control etc. and is often accompanied by epilepsy. In our setting, in which support services are fewer than elsewhere, its impact on parents, whole families, not to mention the economy is devastating. While CP can be caused by diseases such as meningitis, cerebral malaria, encephalitis and even traumatic brain injury, in Uganda birth asphyxia is the main cause. One of the busiest children’s clinics at Mulago is the neurology clinic that sees children with CP.

It is hard to blame hospital management; since the hospitals opened, the directors and staff have strenuously reported their grievances to the Ministry of Health and other relevant authorities to no avail.

Many babies are born prematurely due to dangerous diseases like preeclampsia. These and other neonates at Kawempe Hospital require delicate care: daily antibiotics, two-hourly feeds, and the cannulas through which they are medicated (seen in the photo) may need to be changed. Emergency cases need nasogastric tubes, which help breathing, along with respirator bags and resuscitation.

Impact on staff

All this often falls on the shoulders of just three nurses. Understaffing at Kawempe is exacerbated by the return of some midwives to the Women’s Hospital at Mulago. In fact there is a national shortage of midwives

On International Midwives Day 2019, the plight of the midwife in the current environment was revealed. A midwife at Bwizibwera Health Centre IV, which delivers an average of 150 babies a month, described their predicament. They face constant shortages of gloves and mama kits. Sometimes there is no fuel for the ambulance. All these are shortages to which the staff frequently contribute out of their own pockets and ask those mothers who can to pay, often leading to accusations of corruption.

We need to be helped, I have worked for 15 years and what I have witnessed in health facilities is not good for us. They are always blaming midwives for charging money which in those cases it is unavoidable.” – T. Atukunda (New Vision)

The adverse effect on staffing levels is that many medics, specialists in particular, spend more time in private practice and research.

I rotated through that place last year and it was horrible. I can’t say I enjoyed it because most of what we were doing was a charade. The morale of those that remain is low.” – (Doctor whose name has been withheld)

The Medical School has also been adversely impacted. While training used to take place at Mulago (close to the student accommodation), Obs/Gyn students must now make the trip to Kawempe and Internal Medicine students must travel to Kiruddu at a substantial cost.

Had there been adequate consultation and planning, Mulago would not have been fully shut down for renovation, certainly not for five years. Or at least a whole new private structure like the Women’s Hospital would have been built alongside it. Government has secured the US$350 million to build such a structure – Lubowa Hospital – while the renovations at Mulago only require US$9 million to complete. It is claimed that the Lubowa Hospital budget could have enabled the renovation and equipment of all Uganda’s regional hospitals as well as Mulago. As it is, US$35,874,800 has already gone missing from the Lubowa funds and is the subject of an inquiry.

Health insurance

In theory the Health Insurance Bill tabled in August 2019 will address most of these issues by making the cost of treatment affordable to government. A first attempt with a pilot scheme under the District Health Project ended without success in 2003, principally because of issues internal to the project i.e. an unrealistic timetable that led to the abandonment of the pilot and unsuccessful roll-out of untried interventions. There was also a lack of a monitoring and evaluation component. In the event, none of the health insurance schemes turned out to be appropriate.

As a final nail in the coffin, the government failed to top up the US$45 million loan with the US$17.5 million co-financing required. The co-financing shortfall is exactly half the amount that has now vanished from the Lubowa Hospital construction account. If anything indicates the lack of political will to deliver services, it is the failure of the District Health Services Scheme brought about by the failure of government to finance it.

There has been criticism of the public response to the crisis. True it should have come earlier, for example when the health insurance scheme failed to materialise fifteen years ago, or more recently in mid-2017 when the Auditor General reported, “Health facilities were experiencing persistent stock-outs of the 11 sampled Tracer drugs. […] Noticeably, Mama [safe delivery] Kits were out of stock for 320 days.” The very few medics who have commented on social media confessed boredom at the (short-term) public outrage coming decades into the problem.

Given the graphic view of the impact of haphazard and under-funded health services afforded by the Kawempe Hospital babies, the new Health Insurance Bill should be scrutinised very carefully by medics and laypeople alike working together to ensure that the interventions proposed have been rigorously pilot-tested and that the design faults that existed in the unsuccessful District Health Project proposals have been adequately addressed in the current ones.

This article is based on conversations with a Ugandan doctor about his experience as a clinician in public health in Kampala. Mary Serumaga takes responsibility for the statistical and archival material incorporated and any errors.

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Mary Serumaga is a Ugandan essayist, graduated in Law from King's College, London, and attained an Msc in Intelligent Management Systems from the Southbank. Her work in civil service reform in East Africa lead to an interest in the nature of public service in Africa and the political influences under which it is delivered.

Politics

Asylum Pact: Rwanda Must Do Some Political Housecleaning

Rwandans are welcoming, but the government’s priority must be to solve the internal political problems which produce refugees.

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The governments of the United Kingdom and Rwanda have signed an agreement to move asylum seekers from the UK to Rwanda for processing. This partnership has been heavily criticized and has been referred to as unethical and inhumane. It has also been opposed by the United Nations Refugee Agency on the grounds that it is contrary to the spirit of the Refugee Convention.

Here in Rwanda, we heard the news of the partnership on the day it was signed. The subject has never been debated in the Rwandan parliament and neither had it been canvassed in the local media prior to the announcement.

According to the government’s official press release, the partnership reflects Rwanda’s commitment to protect vulnerable people around the world. It is argued that by relocating migrants to Rwanda, their dignity and rights will be respected and they will be provided with a range of opportunities, including for personal development and employment, in a country that has consistently been ranked among the safest in the world.

A considerable number of Rwandans have been refugees and therefore understand the struggle that comes with being an asylum seeker and what it means to receive help from host countries to rebuild lives. Therefore, most Rwandans are sensitive to the plight of those forced to leave their home countries and would be more than willing to make them feel welcome. However, the decision to relocate the migrants to Rwanda raises a number of questions.

The government argues that relocating migrants to Rwanda will address the inequalities in opportunity that push economic migrants to leave their homes. It is not clear how this will work considering that Rwanda is already the most unequal country in the East African region. And while it is indeed seen as among the safest countries in the world, it was however ranked among the bottom five globally in the recently released 2022 World Happiness Index. How would migrants, who may have suffered psychological trauma fare in such an environment, and in a country that is still rebuilding itself?

A considerable number of Rwandans have been refugees and therefore understand the struggle that comes with being an asylum seeker and what it means to receive help from host countries to rebuild lives.

What opportunities can Rwanda provide to the migrants? Between 2018—the year the index was first published—and 2020, Rwanda’s ranking on the Human Capital Index (HCI) has been consistently low. Published by the World Bank, HCI measures which countries are best at mobilising the economic and professional potential of their citizens. Rwanda’s score is lower than the average for sub-Saharan Africa and it is partly due to this that the government had found it difficult to attract private investment that would create significant levels of employment prior to the COVID-19 pandemic. Unemployment, particularly among the youth, has since worsened.

Despite the accolades Rwanda has received internationally for its development record, Rwanda’s economy has never been driven by a dynamic private or trade sector; it has been driven by aid. The country’s debt reached 73 per cent of GDP in 2021 while its economy has not developed the key areas needed to achieve and secure genuine social and economic transformation for its entire population. In addition to human capital development, these include social capital development, especially mutual trust among citizens considering the country’s unfortunate historical past, establishing good relations with neighbouring states, respect for human rights, and guaranteeing the accountability of public officials.

Rwanda aspires to become an upper middle-income country by 2035 and a high-income country by 2050. In 2000, the country launched a development plan that aimed to transform it into a middle-income country by 2020 on the back on a knowledge economy. That development plan, which has received financial support from various development partners including the UK which contributed over £1 billion, did not deliver the anticipated outcomes. Today the country remains stuck in the category of low-income states. Its structural constraints as a small land-locked country with few natural resources are often cited as an obstacle to development. However, this is exacerbated by current governance in Rwanda, which limits the political space, lacks separation of powers, impedes freedom of expression and represses government critics, making it even harder for Rwanda to reach the desired developmental goals.

Rwanda’s structural constraints as a small land-locked country with no natural resources are often viewed as an obstacle to achieving the anticipated development.

As a result of the foregoing, Rwanda has been producing its own share of refugees, who have sought political and economic asylum in other countries. The UK alone took in 250 Rwandese last year. There are others around the world, the majority of whom have found refuge in different countries in Africa, including countries neighbouring Rwanda. The presence of these refugees has been a source of tension in the region with Kigali accusing neighbouring states of supporting those who want to overthrow the government by force. Some Rwandans have indeed taken up armed struggle, a situation that, if not resolved, threatens long-term security in Rwanda and the Great Lakes region. In fact, the UK government’s advice on travel to Rwanda has consistently warned of the unstable security situation near the border with the Democratic Republic of Congo (DRC) and Burundi.

While Rwanda’s intention to help address the global imbalance of opportunity that fuels illegal immigration is laudable, I would recommend that charity start at home. As host of the 26th Commonwealth Heads of Government Meeting scheduled for June 2022, and Commonwealth Chair-in-Office for the next two years, the government should seize the opportunity to implement the core values and principles of the Commonwealth, particularly the promotion of democracy, the rule of law, freedom of expression, political and civil rights, and a vibrant civil society. This would enable Rwanda to address its internal social, economic and political challenges, creating a conducive environment for long-term economic development, and durable peace that will not only stop Rwanda from producing refugees but will also render the country ready and capable of economically and socially integrating refugees from less fortunate countries in the future.

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Politics

Beyond Borders: Why We Need a Truly Internationalist Climate Justice Movement

The elite’s ‘solution’ to the climate crisis is to turn the displaced into exploitable migrant labour. We need a truly internationalist alternative.

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“We are not drowning, we are fighting” has become the rallying call for the Pacific Climate Warriors. From UN climate meetings to blockades of Australian coal ports, these young Indigenous defenders from twenty Pacific Island states are raising the alarm of global warming for low-lying atoll nations. Rejecting the narrative of victimisation – “you don’t need my pain or tears to know that we’re in a crisis,” as Samoan Brianna Fruean puts it – they are challenging the fossil fuel industry and colonial giants such as Australia, responsible for the world’s highest per-capita carbon emissions.

Around the world, climate disasters displace around 25.3 million people annually – one person every one to two seconds. In 2016, new displacements caused by climate disasters outnumbered new displacements as a result of persecution by a ratio of three to one. By 2050, an estimated 143 million people will be displaced in just three regions: Africa, South Asia, and Latin America. Some projections for global climate displacement are as high as one billion people.

Mapping who is most vulnerable to displacement reveals the fault lines between rich and poor, between the global North and South, and between whiteness and its Black, Indigenous and racialised others.

Globalised asymmetries of power create migration but constrict mobility. Displaced people – the least responsible for global warming – face militarised borders. While climate change is itself ignored by the political elite, climate migration is presented as a border security issue and the latest excuse for wealthy states to fortify their borders. In 2019, the Australian Defence Forces announced military patrols around Australia’s waters to intercept climate refugees.

The burgeoning terrain of “climate security” prioritises militarised borders, dovetailing perfectly into eco-apartheid. “Borders are the environment’s greatest ally; it is through them that we will save the planet,” declares the party of French far-Right politician Marine Le Pen. A US Pentagon-commissioned report on the security implications of climate change encapsulates the hostility to climate refugees: “Borders will be strengthened around the country to hold back unwanted starving immigrants from the Caribbean islands (an especially severe problem), Mexico, and South America.” The US has now launched Operation Vigilant Sentry off the Florida coast and created Homeland Security Task Force Southeast to enforce marine interdiction and deportation in the aftermath of disasters in the Caribbean.

Labour migration as climate mitigation

you broke the ocean in
half to be here.
only to meet nothing that wants you
– Nayyirah Waheed

Parallel to increasing border controls, temporary labour migration is increasingly touted as a climate adaptation strategy. As part of the ‘Nansen Initiative’, a multilateral, state-led project to address climate-induced displacement, the Australian government has put forward its temporary seasonal worker program as a key solution to building climate resilience in the Pacific region. The Australian statement to the Nansen Initiative Intergovernmental Global Consultation was, in fact, delivered not by the environment minister but by the Department of Immigration and Border Protection.

Beginning in April 2022, the new Pacific Australia Labour Mobility scheme will make it easier for Australian businesses to temporarily insource low-wage workers (what the scheme calls “low-skilled” and “unskilled” workers) from small Pacific island countries including Nauru, Papua New Guinea, Kiribati, Samoa, Tonga, and Tuvalu. Not coincidentally, many of these countries’ ecologies and economies have already been ravaged by Australian colonialism for over one hundred years.

It is not an anomaly that Australia is turning displaced climate refugees into a funnel of temporary labour migration. With growing ungovernable and irregular migration, including climate migration, temporary labour migration programs have become the worldwide template for “well-managed migration.” Elites present labour migration as a double win because high-income countries fill their labour shortage needs without providing job security or citizenship, while low-income countries alleviate structural impoverishment through migrants’ remittances.

Dangerous, low-wage jobs like farm, domestic, and service work that cannot be outsourced are now almost entirely insourced in this way. Insourcing and outsourcing represent two sides of the same neoliberal coin: deliberately deflated labour and political power. Not to be confused with free mobility, temporary labour migration represents an extreme neoliberal approach to the quartet of foreign, climate, immigration, and labour policy, all structured to expand networks of capital accumulation through the creation and disciplining of surplus populations.

The International Labour Organization recognises that temporary migrant workers face forced labour, low wages, poor working conditions, virtual absence of social protection, denial of freedom association and union rights, discrimination and xenophobia, as well as social exclusion. Under these state-sanctioned programs of indentureship, workers are legally tied to an employer and deportable. Temporary migrant workers are kept compliant through the threats of both termination and deportation, revealing the crucial connection between immigration status and precarious labour.

Through temporary labour migration programs, workers’ labour power is first captured by the border and this pliable labour is then exploited by the employer. Denying migrant workers permanent immigration status ensures a steady supply of cheapened labour. Borders are not intended to exclude all people, but to create conditions of ‘deportability’, which increases social and labour precarity. These workers are labelled as ‘foreign’ workers, furthering racist xenophobia against them, including by other workers. While migrant workers are temporary, temporary migration is becoming the permanent neoliberal, state-led model of migration.

Reparations include No Borders

“It’s immoral for the rich to talk about their future children and grandchildren when the children of the Global South are dying now.” – Asad Rehman

Discussions about building fairer and more sustainable political-economic systems have coalesced around a Green New Deal. Most public policy proposals for a Green New Deal in the US, Canada, UK and the EU articulate the need to simultaneously tackle economic inequality, social injustice, and the climate crisis by transforming our extractive and exploitative system towards a low-carbon, feminist, worker and community-controlled care-based society. While a Green New Deal necessarily understands the climate crisis and the crisis of capitalism as interconnected — and not a dichotomy of ‘the environment versus the economy’ — one of its main shortcomings is its bordered scope. As Harpreet Kaur Paul and Dalia Gebrial write: “the Green New Deal has largely been trapped in national imaginations.”

Any Green New Deal that is not internationalist runs the risk of perpetuating climate apartheid and imperialist domination in our warming world. Rich countries must redress the global and asymmetrical dimensions of climate debtunfair trade and financial agreements, military subjugation, vaccine apartheidlabour exploitation, and border securitisation.

It is impossible to think about borders outside the modern nation-state and its entanglements with empire, capitalism, race, caste, gender, sexuality, and ability. Borders are not even fixed lines demarcating territory. Bordering regimes are increasingly layered with drone surveillance, interception of migrant boats, and security controls far beyond states’ territorial limits. From Australia offshoring migrant detention around Oceania to Fortress Europe outsourcing surveillance and interdiction to the Sahel and Middle East, shifting cartographies demarcate our colonial present.

Perhaps most offensively, when colonial countries panic about ‘border crises’ they position themselves as victims. But the genocide, displacement, and movement of millions of people were unequally structured by colonialism for three centuries, with European settlers in the Americas and Oceania, the transatlantic slave trade from Africa, and imported indentured labourers from Asia. Empire, enslavement, and indentureship are the bedrock of global apartheid today, determining who can live where and under what conditions. Borders are structured to uphold this apartheid.

The freedom to stay and the freedom to move, which is to say no borders, is decolonial reparations and redistribution long due.

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Politics

The Murang’a Factor in the Upcoming Presidential Elections

The Murang’a people are really yet to decide who they are going to vote for as a president. If they have, they are keeping the secret to themselves. Are the Murang’a people prepping themselves this time to vote for one of their own? Can Jimi Wanjigi re-ignite the Murang’a/Matiba popular passion among the GEMA community and re-influence it to vote in a different direction?

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In the last quarter of 2021, I visited Murang’a County twice: In September, we were in Kandiri in Kigumo constituency. We had gone for a church fundraiser and were hosted by the Anglican Church of Kenya’s (ACK), Kahariro parish, Murang’a South diocese. A month later, I was back, this time to Ihi-gaini deep in Kangema constituency for a burial.

The church function attracted politicians: it had to; they know how to sniff such occasions and if not officially invited, they gate-crash them. Church functions, just like funerals, are perfect platforms for politicians to exhibit their presumed piousness, generosity and their closeness to the respective clergy and the bereaved family.

Well, the other reason they were there, is because they had been invited by the Church leadership. During the electioneering period, the Church is not shy to exploit the politicians’ ambitions: they “blackmail” them for money, because they can mobilise ready audiences for the competing politicians. The politicians on the other hand, are very ready to part with cash. This quid pro quo arrangement is usually an unstated agreement between the Church leadership and the politicians.

The church, which was being fund raised for, being in Kigumo constituency, the area MP Ruth Wangari Mwaniki, promptly showed up. Likewise, the area Member of the County Assembly (MCA) and of course several aspirants for the MP and MCA seats, also showed up.

Church and secular politics often sit cheek by jowl and so, on this day, local politics was the order of the day. I couldn’t have speculated on which side of the political divide Murang’a people were, until the young man Zack Kinuthia Chief Administrative Secretary (CAS) for Sports, Culture and Heritage, took to the rostrum to speak.

A local boy and an Uhuru Kenyatta loyalist, he completely avoided mentioning his name and his “development track record” in central Kenya. Kinuthia has a habit of over-extolling President Uhuru’s virtues whenever and wherever he mounts any platform. By the time he was done speaking, I quickly deduced he was angling to unseat Wangari. I wasn’t wrong; five months later in February 2022, Kinuthia resigned his CAS position to vie for Kigumo on a Party of the National Unity (PNU) ticket.

He spoke briefly, feigned some meeting that was awaiting him elsewhere and left hurriedly, but not before giving his KSh50,000 donation. Apparently, I later learnt that he had been forewarned, ahead of time, that the people were not in a mood to listen to his panegyrics on President Uhuru, Jubilee Party, or anything associated to the two. Kinuthia couldn’t dare run on President Uhuru’s Jubilee Party. His patron-boss’s party is not wanted in Murang’a.

I spent the whole day in Kandiri, talking to people, young and old, men and women and by the time I was leaving, I was certain about one thing; The Murang’a folks didn’t want anything to do with President Uhuru. What I wasn’t sure of is, where their political sympathies lay.

I returned to Murang’a the following month, in the expansive Kangema – it is still huge – even after Mathioya was hived off from the larger Kangema constituency. Funerals provide a good barometer that captures peoples’ political sentiments and even though this burial was not attended by politicians – a few senior government officials were present though; political talk was very much on the peoples’ lips.

What I gathered from the crowd was that President Uhuru had destroyed their livelihood, remember many of the Nairobi city trading, hawking, big downtown real estate and restaurants are run and owned largely by Murang’a people. The famous Nyamakima trading area of downtown Nairobi has been run by Murang’a Kikuyus.

In 2018, their goods were confiscated and declared contrabrand by the government. Many of their businesses went under, this, despite the merchants not only, whole heartedly throwing their support to President Uhuru’s controversial re-election, but contributing handsomely to the presidential kitty. They couldn’t believe what was happening to them: “We voted for him to safeguard our businesses, instead, he destroyed them. So much for supporting him.”

We voted for him to safeguard our businesses, instead, he destroyed them. So much for supporting him

Last week, I attended a Murang’a County caucus group that was meeting somewhere in Gatundu, in Kiambu County. One of the clearest messages that I got from this group is that the GEMA vote in the August 9, 2022, presidential elections is certainly anti-Uhuru Kenyatta and not necessarily pro-William Ruto.

“The Murang’a people are really yet to decide, (if they have, they are keeping the secret to themselves) on who they are going to vote for as a president. And that’s why you see Uhuru is craftily courting us with all manner of promises, seductions and prophetic messages.” Two weeks ago, President Uhuru was in Murang’a attending an African Independent Pentecostal Church of Africa (AIPCA) church function in Kandara constituency.

At the church, the president yet again threatened to “tell you what’s in my heart and what I believe and why so.” These prophecy-laced threats by the President, to the GEMA nation, in which he has been threatening to show them the sign, have become the butt of crude jokes among Kikuyus.

Corollary, President Uhuru once again has plucked Polycarp Igathe away from his corporate perch as Equity Bank’s Chief Commercial Officer back to Nairobi’s tumultuous governor seat politics. The first time the bespectacled Igathe was thrown into the deep end of the Nairobi murky politics was in 2017, as Mike Sonko’s deputy governor. After six months, he threw in the towel, lamenting that Sonko couldn’t let him even breathe.

Uhuru has a tendency of (mis)using Murang’a people

“Igathe is from Wanjerere in Kigumo, Murang’a, but grew up in Ol Kalou, Nyandarua County,” one of the Mzees told me. “He’s not interested in politics; much less know how it’s played. I’ve spent time with him and confided in me as much. Uhuru has a tendency of (mis)using Murang’a people. President Uhuru wants to use Igathe to control Nairobi. The sad thing is that Igathe doesn’t have the guts to tell Uhuru the brutal fact: I’m really not interested in all these shenanigans, leave me alone. The president is hoping, once again, to hopefully placate the Murang’a people, by pretending to front Igathe. I foresee another terrible disaster ultimately befalling both Igathe and Uhuru.”

Be that as it may, what I got away with from this caucus, after an entire day’s deliberations, is that its keeping it presidential choice close to its chest. My attempts to goad some of the men and women present were fruitless.

Murang’a people like reminding everyone that it’s only they, who have yet to produce a president from the GEMA stable, despite being the wealthiest. Kiambu has produced two presidents from the same family, Nyeri one, President Mwai Kibaki, who died on April 22. The closest Murang’a came to giving the country a president was during Ken Matiba’s time in the 1990s. “But Matiba had suffered a debilitating stroke that incapacitated him,” said one of the mzees. “It was tragic, but there was nothing we could do.”

Murang’a people like reminding everyone that it’s only they, who have yet to produce a president from the GEMA stable, despite being the wealthiest

It is interesting to note that Jimi Wanjigi, the Safina party presidential flagbearer is from Murang’a County. His family hails from Wahundura, in Mathioya constituency. Him and Mwangi wa Iria, the Murang’a County governor are the other two Murang’a prominent persons who have tossed themselves into the presidential race. Wa Iria’s bid which was announced at the beginning of 2022, seems to have stagnated, while Jimi’s seems to be gathering storm.

Are the Murang’a people prepping themselves this time to vote for one of their own? Jimi’s campaign team has crafted a two-pronged strategy that it hopes will endear Kenyans to his presidency. One, a generational, paradigm shift, especially among the youth, targeting mostly post-secondary, tertiary college and university students.

“We believe this group of voters who are basically between the ages of 18–27 years and who comprise more than 65 per cent of total registered voters are the key to turning this election,” said one of his presidential campaign team members. “It matters most how you craft the political message to capture their attention.” So, branding his key message as itwika, it is meant to orchestrate a break from past electoral behaviour that is pegged on traditional ethnic voting patterns.

The other plunk of Jimi’s campaign theme is economic emancipation, quite pointedly as it talks directly to the GEMA nation, especially the Murang’a Kikuyus, who are reputed for their business acumen and entrepreneurial skills. “What Kikuyus cherish most,” said the team member “is someone who will create an enabling business environment and leave the Kikuyus to do their thing. You know, Kikuyus live off business, if you interfere with it, that’s the end of your friendship, it doesn’t matter who you are.”

Can Jimi re-ignite the Murang’a/Matiba popular passion among the GEMA community and re-influence it to vote in a different direction? As all the presidential candidates gear-up this week on who they will eventually pick as their running mates, the GEMA community once more shifts the spotlight on itself, as the most sought-after vote basket.

Both Raila Odinga and William Ruto coalitions – Azimio la Umoja-One Kenya and Kenya Kwanza Alliance – must seek to impress and woe Mt Kenya region by appointing a running mate from one of its ranks. If not, the coalitions fear losing the vote-rich area either to each other, or perhaps to a third party. Murang’a County, may as well, become the conundrum, with which the August 9, presidential race may yet to be unravelled and decided.

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