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Why Colonial-Era Edicts Will Not Defeat the Coronavirus in Kenya

8 min read.

In tackling COVID-19, the Kenyan government appears to be oblivious to the needs of the majority of citizens. What do “social distancing” and “self-quarantine” mean in urban areas where slum dwellers share a single room with half a dozen family members, and where the majority of people work in the informal economy?

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Why Colonial-Era Edicts Will Not Defeat the Coronavirus in Kenya
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Abraham Maslow once said that to those who only have a hammer, the whole world looks like a nail. The reactions of world governments to the coronavirus pandemic is proof of this. Around the globe, it appears that a one-size-fits-all basket of prescriptions – from closing borders to locking down societies – seems to be all the rage. Catchphrases like “social distancing” and “self-quarantine” abound in international media reports and political speeches and proliferate all over social media.

Not to be left out, African governments have followed suit. Last week, the Kenyan president, Uhuru Kenyatta, ordered all schools closed, forbade entry into the country to all but a few foreigners with residence permits and urged citizens to work from home, to wash and sanitise their hands, and to avoid crowding in public spaces, including transport. A few weeks ago, these measures would have seemed extreme. But not today, as the global advance of the virus sparks a stampede for the global system’s exits.

However, while the government’s rhetoric may make sense when viewed from a public health perspective, a closer look reveals the dangers inherent in blindly following the crowd. Take, for example, the situation in the Kenyan capital, Nairobi. Here, two-thirds of the city’s 4.4 million people are crammed into informal settlements, which cover just 6 percent of its land area. Within these crowded slums, entire families are forced to share single-room dwellings. With no running water, conditions are unsanitary and disease is rampant. Many slum residents work in the informal economy, running small businesses or providing casual labour to nearby rich and middle-class housing estates or to factories in the industrial areas. Few have job security or get sick leave.

The city’s public transport system is similarly crowded, unsanitary and chaotic. It is dominated by matatus – privately owned minibuses in which passengers are routinely packed shoulder to shoulder for journeys that, thanks to the city’s horrendous traffic, rarely last less than an hour. Another popular means of getting around are boda bodas or motorcycle taxis, where passengers share filthy helmets (when available) and can sometimes squeeze three to a bike.

In these circumstances, what do concepts such as “social distancing” mean? How practical is it to ask people to work from home? How exactly is someone who shares a single room with half a dozen other family members be expected to “self-quarantine” if they were to fall ill with symptoms associated with COVID-19? How are they to avoid infecting their neighbours or make it to the city hospitals – themselves hopelessly overcrowded and unsanitary at the best of times – without spreading the infection?

These practical considerations do not appear to have troubled President Kenyatta and his mandarins as they regurgitate the advice from the World Health Organization (WHO), which seems to take Western lifestyles as a template for life in the rest of the world. Perhaps this is because the government is fond of issuing “directives” when dealing with social issues, rather than consulting with its citizens. For example, researchers have noted that “approaches to reducing exposure to air pollution in informal settlements…have very little input from the people they target. As a result, they may have a low rate of acceptance”.

The people making decisions exhibit little awareness of or acquaintance with the realities of everyday life for the majority of urban Kenyans. Safely ensconced in their gated estates, accustomed to having the roads cleared for them and to being treated in well-equipped private hospitals (when they have opted not to fly abroad for medical treatment), these folks have no qualms about simply repeating the dictates from global elites. From where they sit, it can seem quite reasonable to propose that those in self-imposed quarantine have their own separate room and bathroom at a time when access to a flush toilet and piped water is a luxury for many of their fellow countrymen.

Public health in the colonial economy

The lack of appreciation for the circumstances of their fellow citizens stems from the fact that for over a century, Kenyan elites have been happy to exploit their poor neighbours for their cheap labour while doing little to invest in public services. The model was made during the colonial period. European authorities were not overly concerned with the health of the African population. In a 1987 paper titled “The 1920s Anti-Yaws Campaigns And Colonial Medical Policy In Kenya”, Marc Dawson notes that prior to 1920, “colonial medical officials were not responsible for the health of the bulk of the African population, only for caring for the health of government employees and European settlers and ensuring that epidemic disease did not disrupt the colonial economy”.

These practical considerations do not appear to have troubled President Kenyatta and his mandarins as they regurgitate the advice from the World Health Organization (WHO)…Perhaps this is because the government is fond of issuing “directives” when dealing with social issues, rather than consulting with its citizens.

Thus the focus of the colonial government was on ensuring that Africans did not carry diseases to work and did not threaten the health of Europeans, not that they were themselves healthy. For example, the outbreak of plague in Kisumu in the first decade of the 20th century elicited a quick response because of the potential for economic disruption, as well as the threat to the small European population. One can see a similar dynamic in the treatment of the poor in Nairobi’s slums today. Like the Africans in colonial Nairobi, their presence in the city is only tolerated because their labour is required. While typically their lives are blighted by disease and squalour, the government is not interested in them unless their illness poses a threat to the economy.

The response of the colonial authorities to the Third Plague Pandemic, which broke out of China’s Yunnan Province in the mid-19th century and spread globally via European steamships and merchant routes, is also illustrative. The pandemic reached Nairobi in 1902, where an outbreak led to the burning down of the Indian Bazaar, the city’s first business district. Nairobi would suffer frequent plague outbreaks over the next two decades. The persistence of the plague, according to Owaahh, “stimulated the first official town planning efforts for Nairobi, although most of the efforts were to segregate Indians whose sprawling townships were thought to be breeding grounds for carrier rats”.

In 1914, a report prepared by Prof. W. J. Simpson proposed not just the segregation of residential and commercial centres, but also, according to the book Indians in Kenya by Sana Aiyar, a “neutral belt of unoccupied land of at least 300 yards around European areas to ensure the healthfulness of the locality”. Following the outbreak of plague in Kisumu in December 1904, according to Health, State, and Society in Kenya by George Ndege, the Under Secretary of State for the Colonies declared that “great care should be exercised in the selection of sites for settlements, in keeping the native and European locations well apart”. Over the years, this segregation of the races has morphed into the class segregation that is a feature of Kenyan cities today.

To tackle the plague, the colonial authorities imposed harsh measures, including forced vaccinations, house burnings and quarantines. The Africans who bore the brunt of these measures were rarely consulted and quickly became loath to cooperate or to report plague cases in their homesteads, knowing it meant the destruction of their homes. This tendency to talk down to the people and to issue directives rather than consult with the citizens has been inherited by the current Kenya government.

Another colonial trait is the preference for quick, short-term fixes rather than long-term investments. When the first mass health survey of the African population was carried out in 1915 in the form of medical examinations of male conscripts for the Carrier Corps, the results sufficiently alarmed the authorities about the poor health situation in the African reserves from where they drew their labour. The main culprits were yaws and heart disease. The long term and more expensive solution would have been to improve the quality of life, especially as yaws has been described as a disease of poverty.

To tackle the plague, the colonial authorities imposed harsh measures, including forced vaccinations, house burnings and quarantines. The Africans who bore the brunt of these measures were rarely consulted and quickly became loath to cooperate or to report plague cases in their homesteads, knowing it meant the destruction of their homes.

However, while the 1920s anti-yaws campaign represented a first attempt by colonial medics to expand provision of healthcare beyond government employees to rural Africans, the government and physicians still chose to do it on the cheap. As Dawson notes, “rather than raising the living standards of the rural population (prevention), the colonial authorities tried to cure the population of yaws with injections of a drug of uncertain property”.

Similarly, to date the government has done little to raise living and sanitary standards in the slums. The big promises of slum upgrading have turned out to be little more than either looting schemes or empty talk. Many of the informal settlements that sprung up to house unwanted Africans when the colonials ran Nairobi persist to this very day. And while there will undoubtedly be a concerted effort to combat the coronavirus outbreak, it is unlikely that there will be any determined effort to improve livelihoods and eliminate slums.

The Spanish flu in Kenya

The next big foreign-born disease to hit Kenya in the colonial period was the Spanish flu, the deadliest pandemic in history. Originating in the United States and transported to the killing fields of World War I by American soldiers, the pandemic circled the globe, infecting between 3 and 5 per cent of the world’s population, including people in remote Pacific islands and the Arctic. It cut life expectancy around the world by about 12 years.

An interesting similarity with the current coronavirus epidemic is that the disease at the beginning was “mild, the mortality not unusually high”. Preoccupied with the events of the war, the first wave of the flu went largely unnoticed and it wasn’t until it started killing people in large numbers that the world paid attention. But by then it was too late. By the time it was brought under control, it had killed about 50 million people, more than had died in the war. And remember, this as all before the age of international commercial air travel.

The flu hit East Africa in two waves, the first beginning September 1918 and another in late 1919, killing at least 155,000 people, or an estimated 5.5 percent of the African population in Kenya. Again the reaction of the colonial authorities was largely driven by concerns over the loss of African labour. For example, as related by to Kirsten Moore in her 2013 paper, “Placing Pandemics: History of the 1918-19 Influenza Epidemics in Kenya and Uganda”, “the District Commissioner of Voi cited the influenza epidemic in arguments for a permanent native hospital, saying, ‘it is absolutely essential that adequate hospital provision be made to deal with sick labourers from […] Estates and Railways.’ A native hospital was up and running in Voi by 1921”. She points out that the pandemic was killing off African labour, “just as an influx of British settlers came to establish large, labour-intensive estates. Facing significant war debts and the prospect of bankruptcy, the administration depended on these new plantation enterprises to revitalise the economy”.

Again, it is clear that concern for the health of the natives was not the driving force behind the colonial provision of medical care to Africans. A century later, facing another epidemic, the Kenyan elite is showing itself to be similarly oblivious to the needs of the African majority and is really only concerned about its own economic and political interests.

Sink or swim together

Ironically, just as the colonials imported plague and influenza pandemics into Kenya, it is largely the wealthy, those with the means to travel abroad, who have brought the COVID-19 pandemic back to Kenya. Yet, as with the previous diseases, it is the poor, who did nothing to bring on the crisis, who will get to bear the brunt of both the disease and the government efforts to contain it.

However, there is a critical difference. As the pandemic exposes the systemic weaknesses in Kenya’s healthcare system, the shutdown of the global system means there is no escape for the wealthy who have profited from the plunder and neglect of public services. They will share the fate of the rest of the society. Thus, allowing the pandemic, whether through negligence or incompetence, to become established in the slums, will inevitably be fatal for the elite themselves.

A century later, facing another epidemic, the Kenyan elite is showing itself to be similarly oblivious to the needs of the African majority and is really only concerned about its own economic and political interests.

Since the virus threatens all, both rich and poor, it will require a whole society effort to confront it. Top-down directives will not suffice. In any case, after decades of hollowing out the state from within, the ability of the governing elites to enforce them is severely compromised. Thus it will be critical to work with communities to translate WHO advice into practical protocols that cater to the daily realities of the majority of the population rather than to the global imaginings of a privileged few.

In the short term, it is likely that the political elite will get its act together and do what is necessary to contain the pandemic. However, it is hoped that the lessons of history will not be quickly forgotten once the pandemic has passed. Maintaining a system predicated on inequality and the neglect of public services endangers everyone, not just those at the bottom of the pyramid. Kenyans, regardless of their station in life, will all sink or swim together. They can no longer afford to keep a colonial system where so few get so much at the expense of so many.

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

Politics

COVID-19: Uganda Must Take Robust Measures to Defeat the Coronavirus Pandemic

The coronavirus pandemic will end but without strong public services, Uganda will remain vulnerable to the next epidemic, pandemic or extreme climate event. The health, water and sanitation and all other sectors must be transformed into robust, life-enhancing government services.

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COVID-19: Uganda Must Take Robust Measures to Defeat the Coronavirus Pandemic
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The onset of the COVID-19 pandemic has challenged the public service infrastructure as never before. We commend the government for the efforts it has made to limit the contagion. In particular, we commend health service personnel for their tireless round-the-clock monitoring, testing and treatment of those affected by the disease.

I appreciate the 300 water points rolled out by the National Water and Sewerage Corporation and Kampala Capital City Authority on Friday 27 March. NWSC must be funded to enable them to continue to offer handwashing points in urban areas.

It is heartening to observe the positive public response to the Ministry of Health guidance and directives. I join the President of Uganda in emphasising that the contagion can only be stopped if we collectively practice physical distancing, frequent handwashing and avoiding touching our faces. These are the only preventive measures possible. There is no cure available so far.

The Director of the World Health Organisation, which is at the forefront of the fight against the pandemic, has described lockdowns as “extreme social & economic restrictions”.

In Uganda, our first confirmed case of COVID-19 was detected on 21 March 2020. As of Friday 3 April, Uganda had 48 confirmed cases. It is not easy for public servants and it is not easy for the ordinary citizen, but if we continue to cooperate, the pandemic will end. Uganda is among the countries with fewer than 100 cases and we stand a good chance of overcoming this crisis if we make the right policy choices now.

We agree with the WHO that the lockdown provides a window of opportunity to curb and finally defeat the disease but also to prevent a resurgence of infections once the lockdown is lifted. We believe it is necessary to “Refocus the whole of government on suppressing and controlling Covid19”, as Dr Tedros Ghebreyesus, Director-General of the WHO, has advised.

The World Health Organisation, which is at the forefront of the fight against the pandemic, has described lockdowns as “extreme social & economic restrictions”

We agree that “on their own, these measures will not extinguish epidemics”. We adopt the recommendation that, to be effective, the lockdown must be accompanied by measures aimed at strengthening the health service. It is our view that Uganda’s response to this pandemic can lay the foundations for a healthier and better-prepared country.

In everything we do, we must prioritise the safety of the health workers at the frontline. We therefore propose that they are provided with daily transport, risk and other duty-facilitating allowances, as well as personal protective equipment (PPE). In his address to the nation on 31 March, the President reported that health workers in upcountry facilities are avoiding suspected COVID-19 cases because they lack protective gear. This is unfortunate and must be addressed immediately at all Regional Referral Hospitals. It was shocking to hear in the Presidential Address on Friday 3 March that Uganda only has 10 per cent of the PPE required at this time.

We also support the call by some members of Parliament to pay health workers a motivational allowance, on time and during this crisis, not in arrears.

It may not be possible in the short term to expand, train and deploy our healthcare and public health workforce as recommended but the recruitment process can begin. The news that hundreds of healthcare workers are being recruited at all levels is welcome. Hopefully, the majority are clinicians and nurses.

What is possible in Uganda in the short-term is to continue efforts to “find, isolate, test, treat and trace” those who may have been exposed to the virus and who together with their families are at risk. Of the 48 cases, nearly all were incoming travellers and contacts of travellers arriving mostly from Dubai, 15 from the United Kingdom, three from the United States, one from Kenya. By 28 March, only three confirmed cases were not incoming travellers. We wish them all an easy recovery.

Uganda is among the countries with fewer than 100 cases and we stand a good chance of overcoming this crisis if we make the right policy choices now

In the two weeks prior to the airport closure, 2,661 high-risk travellers entered the country. Also, there are others that had not been identified before Dubai emerged as a high-risk country. Less than 1,000 of these people have been quarantined and tested. It would help to offer amnesty to the hundreds remaining to encourage them to come forward. The security services need only be deployed if there is further failure to cooperate after the amnesty is announced. In any event, the forces should endeavour to treat citizens with the respect they deserve. Wanton violence of the type we have seen contributes nothing to disease control and undermines faith in the government to lead us out of this crisis.

As has been noted, the more tests done, the greater the number of positive diagnoses. While we appreciate the donation of testing equipment from the WHO and Jack Ma, we note that we remain vulnerable as long as our capacity to test depends on donations. We recommend that Uganda seeks short-term measures to find funds for test kits. The public needs to be informed whether all the tests being used are WHO-approved. There is some concern about the potential for false negative results and, being a “fragile State” that is receiving multiple donations, we need assurance that all equipment is up to par.

Regional Referral Hospitals, and Naggulu and Mulago Specialised Hospitals, have been tasked with the management of COVID-19 cases. The input of the Uganda Medical Association, whose members are at the frontline of this battle, is required in signing off those entities equipped to take on the task. This will ensure healthcare workers at those designated facilities have adequate equipment, drugs and PPE. It is hoped that funds will be made available to provide testing facilities in hospitals outside Entebbe.

Wanton violence of the type we have seen contributes nothing to disease control and undermines faith in the government to lead us out of this crisis

Biosafety professionals should be involved in setting up any quarantine sites outside hospital settings to avoid healthcare-associated infections after the pandemic passes. The same should apply to General Hospitals and all Health Centre IVs if the need arises. Regional quarantine and treatment centres are needed to ensure everyone has a good chance of survival wherever in the country they may live as transporting patients across the country puts health workers at risk. Moreover, disinfection of markets, taxi parks and, where possible, other public places should take place before the lockdown is lifted.

Funding the fight

To fund the interventions we request that money currently allocated to Ministries, Departments and Agencies for non-essential activities be reallocated to increasing the number of tests carried out per day and providing transport and PPE for health workers. For example, fuel expenditure saved by grounding government vehicles and cancelling bench-marking trips, conferences, and treatment abroad for ailments that are treatable in Uganda, should also be reallocated to the health sector. Above all, we should minimise waste; expenditure on advertising in the media, printing official bulletins and so on, is not a priority. As WHO recommends, the way forward is “find, isolate, test, treat & trace”.

Most challenging, however, is the third recommendation from WHO: “Expand, train & deploy your health care & public health workforce”. Currently, we have five hospital beds per 10,000 people, 200 intensive care units and less than one (0.9) doctor per 10,000 people. To further complicate matters, other affected countries will seek to import our doctors to combat COVID-19 in their countries. The United States has already invited work visa applications from doctors. The US has 25.9 doctors per 100,000 people but 300,000 COVID-19 cases. Robust interventions on our part will serve in the current crisis and during any future health crises.

As WHO recommends, the way forward is “find, isolate, test, treat & trace”

The immediate sizeable source of funds would be the suspension of the Lubowa Specialised Hospital Project targeting health tourists. The total project cost is Sh1.4 trillion ($379 million). After the first payment of Sh327 billion ($87million), there remains a balance of Sh139 billion. These funds are needed to provide primary healthcare, intensive care and emergency care for Ugandans. (The existing budget for the 41 hospitals to be built in 39 districts is Sh1.3 trillion.) The reallocation from Lubowa Hospital should take place as soon as possible and should the lender decline, the rest of the loan should be cancelled.

Easing the Economic Impact of COVID-19

The majority of Ugandans are employed in the informal sector. In fact, 83 per cent of non-agricultural workers are in the informal sector (World Bank Databank). The majority of workers (75.2 per cent) are classified as being in “vulnerable employment” (Human Development Report 2019, UNDP). What this means is they do not have health insurance and are unlikely to have savings or any other form of social safety net. For the fishermen and small traders who pay annual licence fees, Uganda Revenue Authority could consider extending the validity of those licences to take account of trade lost during the pandemic.

Borrowers from the Youth Livelihood Programme and the Women’s Entrepreneurship Programme present a problem. The 83,000 participants in the government-funded loan schemes such as the Youth Livelihood Programme were already having difficulties making repayments and the majority defaulted. During this time we request that the government suspends the pursuing of defaulters and resumes collections when normal work resumes.

Those in debt to micro-finance companies can be assisted by freezing interest accumulation during the lockdown and extending repayment periods once work resumes. Boda boda riders who have bought their motorcycles on credit fall into this category.

Formal Small and Medium Enterprises face similar loan repayment challenges and require similar consideration. The Bank of Uganda has the responsibility to use those mechanisms as are within in its powers to maintain economic stability. It should ensure that SMEs are not forced out of business by enabling banks to extend repayment periods for loans. In this connection, borrowers forced to default should not be penalised and listed by the Credit Rating Bureau.

Both the formal and informal sectors increasingly use digital means to do business. To reduce the use of potentially infectious money, and to make transactions more affordable, we request that the government lift the OTT tax (excise duty on over-the-top services). The government is also urged to reach an agreement with Telcos to further reduce their rates for all telephony.

Mortgages and rent

Without work, the informal sector and struggling SME owners may be unable to pay rent and may face eviction. Bear in mind landlords too may rely on the rent to repay building loans and cater for their families. Therefore, for those in the informal sector we request that the government works out an arrangement with landlords to grant a month’s grace period for those forced to default on rent. The government could take on the debt for the period of the lockdown. For those in the formal sector, the government should consider guaranteeing the rent and mortgage payments and later recover them from salary or from the National Social Security Fund (NSSF) savings of the tenant. Moreover, the NSSF Act needs to be amended to give members access to their savings during emergencies in future.

Utilities

Payment of electricity and water bills will become more difficult in the days ahead. The National Water and Sewerage Corporation has explained that it is unable to waive water charges because it too must meet its obligations to employees and suppliers.

What is needed are subsidies for consumers in difficulty. Two options are possible for a fixed period: a VAT waiver on water and electricity or selective subsidies through Yaka credits and water credits for those most in need. It should be possible to apply online or to regional offices and be granted these credits according to criteria agreed upon between the government and the utilities providers.

Social protection of the most vulnerable

We note the relief being distributed to the vulnerable in Kampala and Wakiso districts. It is true that many urban dwellers have been suddenly deprived of incomes and require support. However, rural people in vulnerable employment are also affected by the lockdown through loss of income. Many depend on roadside markets between towns and cities, traffic which no longer exists.

The elderly are the most vulnerable because globally fatalities have been most prevalent among this demographic and also because their caregivers will be unable to provide for them as before. Yet many of the elderly are themselves caregivers to grandchildren and employers of farm workers. The government has already compiled a list of the aged to which it pays a monthly grant. This Senior Citizens’ Grant is vital in keeping the rural economy afloat and for children being cared for during this time and therefore it must be paid in full and in a timely manner.

The incapacitated and those whose caregivers are themselves incapacitated by illness will need to be added to the list of the vulnerable as will the unemployed who will lose caregiver support. Nearly all Ugandans are at risk of financial disaster if they were to become seriously ill. The Human Development Report states that 75 per cent of Ugandans are at risk of catastrophic expenditure – expenditure which wipes them out financially – were they to require surgery. COVID-19 may not require surgery but in the worst cases (should they appear) it will require intensive care. With a reported 200 ICU beds nationally and most probably all occupied, the situation is dire.

In the absence of public transport, a special public transportation plan for patients and expectant mothers travelling to hospitals and medical centres should be put in place. The beginnings have been difficult as travel passes have not been easy to obtain. We propose hiring and branding vehicles for delivering COVID-19 patients to health facilities. The modalities can be worked out by the Joint Task Force. People Power Co-ordinators will be available to assist in locating those who require transport to health facilities.

The 21 per cent of people living in poverty forms a large part of the vulnerable section of the population. Undernourishment (caloric intake below minimum energy requirements) has been steadily rising for the last 14 years, from 29 per cent to 41 per cent. We have been advised by the Ministry of Health that people have a better chance of surviving COVID-19 infection if they are adequately nourished. To exclude them from the lockdown-affected persons requiring assistance is unfair and counter-productive as they are more likely to succumb to infection.

Disaster preparedness

We cannot afford not to be prepared for other disasters. The shortage in medical masks, respirators, gowns and goggles caught Uganda unprepared yet this was forecast by the World Health Organisation on 27 February.

A resurgence of the desert locust plague in the region was forecast to begin in early May. A swarm entered Amudat district for the second time on 3 April. If it grows, there will be food shortages.

Extreme climate events such as mudslides this rainy season cannot be ruled out either. Our preparedness should reflect the seriousness of the situation and funds set aside to deal with any eventualities. A government statutory contingency fund must be put in place with immediate effect.

On an individual level, to increase food security, owners of uncultivated land are requested to either plant staple foods or allow food to be planted on their land during this rainy season. This arrangement would be limited to this season that is coinciding with the lockdown period.

Funding the safety net

To fund the social safety net, it will be necessary for the government itself to get debt relief on the national debt. Currently over 65 per cent of revenues goes towards debt payment. While we appreciate the World Bank’s call for suspension of debt repayments to development partners and offer of a loan package to finance the campaign against COVID-19, this is not a time to acquire more debt. Lenders are aware that Uganda is a fragile state and, therefore, negotiations for debt cancellation to enable us to provide a social safety net must go ahead and they must succeed. The absence of a social safety net is the direct result of ill-advised development policies.

Long-term interventions: Rehabilitation of the Health Care System

People Power has long argued that the stagnation in health and other services must be addressed as a matter of urgency, not in 2022 or in 2026 but now. This pandemic will end but without strong health and other public services, we shall remain vulnerable to the next epidemic, pandemic or extreme climate event. So we would like all interventions to go beyond the COVID-19 pandemic to cater for future needs.

The health, water and sanitation and all other sectors must be transformed into robust, life-enhancing government services.

Health expenditure

Our expenditure on health decreases nearly every year. That trend must be reversed. We must go from spending 6 per cent of GDP on the health service to spending the 15 per cent we signed up to in the Abuja Declaration.

Not surprisingly, a review of the hospitals around the country reveals that the majority have faulty equipment. To finance a health service that meets national requirements, the health insurance scheme that has been in the pipeline for over a decade needs to be rolled out.

We must go from spending 6 per cent of GDP on the health service to spending the 15 per cent we signed up to in the Abuja Declaration.

We need to develop the capacity to manufacture items for clinical use, e.g. protective gear for health workers. We have the capacity. In 2019 young Ugandans developed life-saving and cost-saving bio-medical equipment. All are important because of the nationwide shortage of medical equipment especially in rural areas. Olivia Koburongo and Brian Turyabagye developed the Mama-Ope smart jacket for digital pneumonia diagnosis. In 2018 Phyllis Kyomuhendo invented M-Scan a portable ante-natal ultrasound device. Brian Gitta and colleagues developed a bloodless malaria test (Winner of the Africa Prize for Engineering Innovation, founded by the Royal Academy of Engineering in the UK); we often cannot afford reagents used to test blood. In 2014 Dr Chris Nsamba developed an incubator for premature babies which he donated to the government. It is in use at Mukono Health Centre IV whereby last year it had saved the lives of 243 critically ill babies. Uganda has one of the highest rates of premature deaths in the world.

In 2019 young Ugandans developed life-saving and cost-saving bio-medical equipment

However, Dr Nsamba failed to get any government funding although a government agency later claimed to have sponsored the development. The government should make a firm commitment to support local innovators by buying their products while following procurement rules to give all innovators a competitive chance.

Water and Sanitation

Only 18 per cent of the population has access to basic sanitation services with which to keep themselves and their homes healthy. Of every 100,000 deaths, 31 are related to unsafe water and poor sanitation and hygiene services. Of every 100,000 deaths, 159 are caused by household and air pollution (Human Development Report 2019, UNDP).

In the long term, there needs to be an investment in the water sector that meets the needs of the 82 per cent without access to basic sanitation services.

We are grateful for the government’s transparency in admitting that the limited water supply to homes has been caused by “poor planning and implementation of programmes over the years”. As a result, the water and environment sector now needs at least nine times the present level of funding every year for the next 12 years to meet national development targets (Budget Monitoring and Accountability Unit Briefing Paper 30/19, Ministry of Finance, June 2019).

Environment

During the lockdown many will struggle to get fuel for cooking. Under normal circumstances, less than 1 per cent of Ugandans has access to clean fuels and technologies for cooking. Apart from being unsustainable environmentally, the daily search for firewood, like the daily trip for water, takes away time children would otherwise have spent in school, acquiring skills to innovate for our survival as a people.

Human Development

We have an opportunity to reflect on the type of nation we want to be. Are we willing to invest in our human development and well-being or will we forever belong to WHO’s category of “the most fragile and vulnerable countries”?

Human development costs money. We will only see a change if we manage our resources better, this goes both to government and to the population. We must eliminate non-essential expenditure; expenditure on salaries of political appointees and on electioneering – cash handouts in return for votes. We must eradicate waste; last year vehicles were bought at a cost of $5.5 million for the Commonwealth Parliamentarians Conference. It was said that they would thereafter be used for government work but they have not been surrendered to the pool for use in fighting COVID-19. The recent budget proposals for the desert locust emergency, especially by the ICT ministry, show that we have not learned this yet.

As a Nation, we need to reflect on the wisdom of splintering the country into tiny entities paying salaries for MPs, and public service but remaining financially unable to maintain decent health centres, hospitals or roads, or to deliver quality education in most local government institutions.

As individuals, each one of us must have as much integrity as we expect from our leaders. In the last four years, Uganda lost Sh28 billion in the Youth Livelihood Programme. An audit of a sampling of Youth Livelihood Project groups which received loans found that 64 per cent were non-existent (representing 71 per cent of the value of the loans). Another 25 per cent had embezzled the funds. This means that repayments were not available for re-lending to new Youth Interest Groups.

We must never again be found without sufficient medical facilities. We must never again find ourselves lacking water with which to wash our hands and prevent disease.

The physical environment in which we live and work can and must be transformed. Unsanitary working conditions in markets and other public places must be addressed beginning with the NWSC/KCCA handwashing points which we expect will become a permanent feature.

We must never again find ourselves lacking water with which to wash our hands and prevent disease.

A durable solution to the broken public transport system is needed, especially in cities and towns. This pandemic has taught us that public transport is a public good that must be supplied, regulated, maintained and sanitised by the government. Supplementary systems are well and good, but the primary responsibility for public transport lies with the government.

On behalf of the millions of People Power foot soldiers across the country, I call upon the government of Uganda and all Ugandans to reflect and consider the proposals I have laid out here.

For God and My Country.

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Politics

Harsh Economic Times, Political Uncertainty…and Now Corona

Kenyans were already struggling with tough economic conditions and political tensions when COVID-19 appeared. Lockdowns and dwindling incomes have now made their lives much more difficult, even as they pray for the virus to be vanquished.

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Harsh Economic Times, Political Uncertainty…and Now Corona
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Our live were ruined among the leaves,
We decayed like pumpkin in a mud field
~ Mazisi Kunene, South African anti-Apartheid poet

They say when it rains, it pours, and calamity comes with its brother. The revelation that the dreaded coronavirus had, about two weeks ago, finally found its way into Kenya threw the country into a state of pandemonium. Until then, Kenyans viewed the virus as a devastating but “alien” disease.

It was not until the quasi-lockdown was ordered by the government that Kenyans realised that beyond the confusion and panic, a much worse situation was threatening to compound and exacerbate an economic meltdown they have been experiencing for the last 20 months or so. The “alien” ailment has not only brought with it bewilderment, but is threatening to lock them down, literally, to starvation.

The virus, of the genus corona, was first detected in Wuhan Province in China in December 2019, hence the name COVID-19 (coronavirus disease of 2019). Three months later, when Kenyans first heard about a disease that was killing the Chinese quicker than flickering fireflies, they brushed it off as one of those phenomena that occur in far-off countries in the East.

The disease could not have come at a worse time for Kenyans. Experiencing harsh economic times and political uncertainty, many Kenyans concluded that the gods have conspired to punish them. “For how else do you explain the disease coming to Kenya at a time when we are faced with the toughest of economic hard times?” posed a woman.

That plane from China

“This is the modern Armageddon, the end of times is nigh because we’ve deviated from God’s ways. It is a message from God who is angry with us. We’ve sinned too much and this is a sign from God who is asking us to turn from our wicked ways and repent of our sins,” prophesied a street vendor in Nairobi selling tree tomatoes, popularly known in Kiswahili as matunda damu. But after this revelation of a messianic message, the woman admitted that the hint of a complete lockdown by the government was a sure way of strangling the livelihoods of people like her.

“Ndiraikara mucii nacio ciana irie ke?” You’re asking me to stay at home, what will my children eat? “Ako corona niguturaga, reke tukuire guku bara-ini”. If the coronavirus is going to kill us, let us then die on these streets, hustling. President Uhuru Kenyatta’s government has already killed our businesses, now he is asking us to stay at home – tumurie kana twikie atia? We feed on him? Or how does he propose we should fend for our families?

The vendor was angry that the president exhibited a laissez-faire attitude towards battling the deadly virus. “Why didn’t he stop the plane that came from China? If he had done that, we wouldn’t be in this bad situation and our livelihoods would not be threatened.”

The plane that she was referring to was a China Southern Airlines flight that was allowed to land at Jomo Kenyatta International Airport (JKIA) on 26 February 2019. The flight had arrived in Nairobi despite a directive forbidding flights originating in China to land in Kenya due to the outbreak of COVID-19 in China. Kenya Airways had also by that time suspended all its flights to and from China. This particular plane carried 239 passengers, many of whom were Chinese nationals. The airport employee who posted a video of the plane landing was suspended (and later reinstated through a court order), which suggested that the plane had the government’s permission to land. The reference to this plane and the anger it has generated among the people I talked to was evident throughout all my interviews.

The vendor was angry that the president exhibited a laissez faire attitude towards battling the deadly virus. “Why didn’t he stop the plane that came from China? If he had done that, we wouldn’t be in this bad situation and our livelihoods would not be threatened.”

The weekend before the quasi-lockdown decreed by the government on Monday, 23 March 2020, I was in Nakuru County. My first stop was at the Java House located in CK Patel House in central Nakuru town. It was 10.00 a.m. and there was absolutely no customer. I found the manager sipping her coffee latte. “What’s up?” I asked her. “There’s no one in the house”.

The nonplussed manager said the coronavirus was bad for business. “Look, it is mid-morning, a peak time when customers should be flocking in for their refill, yet we’ve an empty house.”

The coffee house closes at 5 p.m., which is normally a peak hour when commuters wait for the traffic jam to ease off before heading home. “This is not a harbinger of good times,” said one of the lady waiters. “If this situation persists long enough, who knows, the management could easily send us home…this, by the way, is not good at all.”

“The incompetence of this government and President Uhuru is mindboggling,” said a lady I was meeting in Nakuru town. “Why, in God’s name, did he allow the plane from China to land at JKIA?” she furiously wondered aloud. “He should have ordered the plane to turn back, the way it came and never to allow the passengers to disembark. Do we know how many of those passengers could have been infected all the way from China? Do we know how many people they, indeed, could have infected once here in the country? Who knows where those people are and which corner of the country they are in? Did the government ever track them down?”

The lady was convinced that if the government had refused the landing of that plane, it is probable that we would not be so afraid now and there would not really have been a case for a (quasi) lockdown.

“The government now is all over issuing edicts – it must always do the wrong thing first before it turns around to sound the alarm bells,” she said. People seem to be impressed by the new Cabinet Secretary for Health, Mutahi Kagwe, I’m not. What ordinary Kenyans want to know is how, in the event of a complete lockdown, they will earn a living. Period. Endless press conferences threatening us with damnation are neither here nor here. The President recently threatened us, saying the government will crack down on anybody not adhering to the stay-at-home edict. This is uncalled for as well as unhelpful. Does he have any concrete plans for ameliorating the situation and ensuring Kenyans who live from hand to mouth are cushioned?”

Later in the evening, I was at Garden Villa, located on the western side of town as you head to Shaabab residential area. It was completely empty and the waiters were just lounging around. Garden Villa is an expansive nyama choma eatery, as well as a “watering hole” with appropriate cushioned-seat cubicles for groups of people or couples. It was glaringly in its emptiness.

Beatrice, our waitress, was not amused by coronavirus coming to Kenya: “It is no longer a death scare; it has come to actually destroy our livelihoods. I’ve three children – two in university and one is finishing high school. My job has really sustained me, I’ve been able to educate my children so far with the tips that I collect here and there from patrons like you. When there are no customers, we are finished. I’m really worried. If this situation continues like this, we’ll all be declared redundant. What will happen to my children?”

Back in Nairobi, I went to one of my usual Java House haunts. The security guard was forthright: “Hii kitu itauwa watoto wetu. Sijui leo nita peleka nini nyumbani.” This thing called coronavirus will kill our children. Today I don’t know what I will take home.

The main work of security guards like one at Java House is to ensure that patrons enjoy their house coffee without probing eyes and disturbance from the city centre’s “undesirables”, and to usher patrons inside the coffee house. They help customers find car park spaces and guard the automobiles from hoodlums. They will also offer concierge services to patrons, such as carrying stuff to their vehicles. At the end of the day, they have enough pocket money to pass through the supermarket and buy some milk and bread for tomorrow morning’s breakfast. He told me the lack of patrons meant that he would go home empty-handed. “Mungu asaidie afukuze hii coronavirus, kama siyo hivyo tumeisha.” The almighty should intervene and clear this coronavirus as quickly as possible, otherwise we’re all finished.

Prayer warriors

In the city centre, at the famous Jevanjee Park, I met a group of four middle-aged women. They were talking with each other. On the day the government ordered the people not to leave their houses after 7 p.m., they disobeyed and trooped to town. “I’m staying in the house and then what happens?” posed one. “Are my children going to feed on me?”

The women were “professional” casual labourers. Lately they have been getting manual jobs from the Nairobi County as grass cutters and street sweepers.

“We live on a day-to-day basis” said one of the women. “How on earth does the government expect us to survive?”

“Tell you what,” ventured one of the women, “yesterday I went to church because our pastor had sent word around that we must not fail to go church.” She told me she attends a Kenya Assemblies of God (KAG) church. Their pastor told them that coronavirus had come to Kenya to remind Christians that, indeed, these were the last days.

Back in Nairobi, I went to one of my usual Java House haunts. The security guard was forthright: “Hii kitu itauwa watoto wetu. Sijui leo nita peleka nini nyumbani.” This thing called coronavirus will kill our children. Today I don’t know what I will take home.

“Coronavirus is not going to be defeated by worshippers staying at home,” claimed the pastor. “It is going to be wrestled down to the ground by prayer warriors. We must condemn the evil-doer, we must never doubt our faith. We must never doubt our God, Is this the time to let our able God down? Are we doubting Him?”

“I’m a Catholic and we went to church. The parish priest, through jumuia [small community groups], sent word that we must all be in church on Sunday without fail,” said one of the woman. “The priest said the body of Christ is asking us, ‘Are you not going celebrate with me? For is this the time to forsake me?’ It is always fundamentally important to remember to keep the faith.’”

“The churches cannot, even for once, pretend that they care for our welfare,” said another woman. “In these times of economic turbulence and the coming of the corrosive coronavirus, all what the churches can tell us is to still go and congregate in congested spaces. And all what this government can tell us is to sanitise our hands. The church and the government’s work is to fleece us, the people.”

In the evening, I caught up with the same quartet outside Charlies’ restaurant that faces City Hall. It was now past five and they were hungry and angry. “How are we going home?” asked one of them in concealed desperation. All of them lived in the sprawling slums of Nairobi. Seated on the stone bench of the restaurant, they resorted to begging money from any passing man they thought they could remotely recognise.

“The churches cannot, even for once, pretend that they care for our welfare,” said another woman. “In these times of economic turbulence and the coming of the corrosive coronavirus, all what the churches can tell us is to still go and congregate in congested spaces. And all what this government can tell us is to sanitise our hands…”

The following day, I found myself in bustling Kawangware, where the coronavirus threat is real. Kawangware was deserted – many businesses were shut and the human commotion that is usually associated with the sprawling residential area was absent. I dropped in at Sakina’s kibanda (food kiosk-cum-shed) in the Coast area (Mombasani) where she sells very pocket- friendly fresh food to construction workers, bachelors, spinsters, and all manner of casual labourers. Sakina shared the kibanda with her mother, but her mom was not there on that day.

“Where’s your mother?” I asked Sakina.

“She took the kids [her four children] to shags [her rural home],” she responded. (Sakina’s rural home is right in the middle of Nyeri town, at Meeting Point.) “Business is slowly grinding to a halt and we didn’t want to take chances. At least at cucu’s [grandma’s] place, there’s food to eat…this coronavirus has dealt us a huge blow…but alhamdulillahi, it is going to be defeated by Allah.”

In times like this, said Sakina, it’s important to be steadfast and to anchor your whole self in the great faith.

A disease of the rich

At Zambezi trading centre, 19 kilometres from the city centre on the Nairobi-Nakuru Road, Nyambura, a chicken legs and liver vendor, was preparing her foodstuff for her evening customers.

“Are you not afraid of the coronavirus?” I asked her.

“Indeed I am,” she replied. “But can I eat fear? Can my children eat fear? I cannot stay in the house. I must get out to fend for my family. My husband is a salaried worker. He has to wait for 30 days to be paid his paltry pay. We cannot wait for that. It is my responsibility to supplement the ugali he brings home,” said the lady with a great chuckle.

“[President] Uhuru doesn’t care about us small farmers. He has been careless and is playing dice with our lives. After ruining our lives, he has now let this coronavirus invade our country. Why couldn’t he stop that plane from China? Its good coronavirus is infecting the rich and the powerful. They should all perish. They have caused us enough agony,” said Nyambura.

“But trust me, this coronavirus is not going to finish us because our Lord Jesus Christ is on the throne. In the name of Jesus, I condemn the disease,” she added.

She said coronavirus, like the most incompetent government she had lived through, had conspired to kill the spirit of Kenyans. “Yesterday, I paid 100 shillings from 87 to here. Can you imagine? Ordinarily the matatu fare from 87, just after Uthiru to Zambezi, is 30 shillings. For how long can one afford that kind of fare?” She said that from the Old Nation House roundabout stage to Zambezi, passengers were being charged 150 shillings. I hooked up with my freelance tout friend Davy to confirm whether it was true.

“What do you expect when the matatus have been ordered to carry half the seating capacity of their vehicles?” said the freelance tout.(The government has directed that public transport vehicles observe social distancing among their passengers, which means that these vehicles are forced to carry fewer passengers per trip.) Davy told me that many matatu proprietors had grounded their vehicles. “Hakuna haja ya kufanya kazi ya kirai”. It’s pointless to engage in an unprofitable business.

From the city centre to Zambezi, the fare is ordinarily 80 shillings during peak hours and 50 shillings during off-peak hours. “Think about it,” explained Davy. “The matatus that have chosen to be on the road are being fair.”

A 33-seater is now carrying 16 passengers. So passengers are paying 150 shillings instead of 80 shillings in normal times. The Nissan shuttles that ferry 14 passengers are now having to carry just 8 passengers. Davy said if the government was considerate, it would, at least for now, reduce the price of fuel. That way the matatu owners would not be forced to adjust the fares.

“How many people can afford to be paying 300 shillings every day to town?” asked Nyambura. “What is it then you are working for? You’ve not even eaten. And President Uhuru, instead of telling us how the government can come up with ways of helping us alleviate this burden, has gone on air to tell us about the merits of 4G Internet speed. (On March 23, President Kenyatta addressed the nation live on air, extolling the virtues of the business deal between Telcom Kenya and Google Loon, which would now allow for faster speed and easy interconnectivity.)

In the political sphere, Nakuru residents believe that the coronavirus appeared just in the nick of time to save President Uhuru and the Building Bridges Initiative (BBI) team the embarrassment of a looming contest and showdown that was to take place in town at Afraha Stadium. On 21 March 2019, BBI had organised a rally to popularise its agenda. But every indication showed that this was not going to be a walk in the park for the BBI mandarins.

A 33-seater is now carrying 16 passengers. So passengers are paying 150 shillings instead of 80 shillings in normal times. Davy said if the government was considerate, it would, at least for now, reduce the price of fuel. That way the matatu owners would not be forced to adjust the fares.

“This coronavirus has just given the president some reprieve,” said a Nakuru boda boda (motorcycle rider) from Maili Sita trading centre (popularly known simply as Sita) on the Nakuru-Nyahururu Road. The rider opined that had the BBI rally taken place, the William Ruto wing of the Jubilee Party would, most certainly, have upstaged the BBI brigade. It was going to be battle a between BBI and the deputy president’s “Tanga Tanga” band of supporters.

When on 28 January 2019 President Uhuru was in Nakuru town to open a cement factory in Rongai, he detoured to Bahati constituency, where at Sita he lambasted the area MP, Kimani Ngunjiri. As he was castigating him, Ngunjiri was several metres away from the president’s motorcade. “When he left, the boda boda riders came to Ngunjiri and they were high-fiving him and laughing excitedly,” said the boda boda rider. “They promised him that when BBI lands in Nakuru, they would show President Uhuru who ruled Nakuru.”

With all the laments, speculation and tantalising gossip, it is still not clear what impact the coronavirus pandemic will have on the lives of ordinary Kenyans. Many are in still in disbelief and more worried about their livelihoods than about falling ill or dying. But what is clear is that Kenya after corona will not be the same again.

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Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Perhaps, it won’t take much longer before the country knows whether the mandatory quarantine strategy helped spread or stop COVID-19.

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Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined
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“We were flying over Juba when the announcement was made”. Chris*, not his real name, recounts to me his whereabouts when Kenya’s Cabinet Secretary for Health, Mutahi Kagwe, made the announcement that mandatory quarantining of all persons flying into Kenya would begin with immediate effect. It was early evening in Nairobi and a likely anxious nation tuned in for what was the tenth briefing from the ministry about the global COVID-19 pandemic that had made its way to Kenya, on the wings of an aircraft much like the one that ferried Chris back from a work trip to London.

Chris and I spoke a day after his arrival. He was in a hotel turned government-sanctioned quarantine facility, the Boma Hotel. The hotel, one of four Kenya Red Cross hotels that had just weeks before been placed under receivership, was dusty, with some rooms not having been cleaned for a while. Dead flies lined his windowsill. Chris complained that layers of dust on his pillowcase and bedsheets caused him discomfort. That was a minor inconvenience in comparison to the subject of our call.

Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Their flight, which arrived at the Jomo Kenyatta International Airport on the night of Monday, March 23rd, carried what was, in Chris’s estimation, about 60 people.

“After being screened and filling out immigration forms, we were told about the Ministry of Health’s directive. We protested the directive because some of us had made arrangements to self-quarantine. Among those on our flight were students who, I think, wouldn’t have taken the flight if they thought that they would be taken into mandatory quarantine.”

Their protests would seem vain in the face of the government’s efforts to slow the spread of the COVID-19 virus, which has overwhelmed some of the world’s best-equipped healthcare systems, but the response to these complaints from Ministry of Health officials was even more strange.

“The government relented and allowed us to leave the airport and go home, with orders that we report to the Kenya Medical Training Centre (KMTC) at 11:00 a.m for tests.”

Chris was picked up by his driver and recalls reaching his home at about midnight on the 23rd of March.

As he was falling asleep, Doris*, also not her real name, was on a fairly empty flight from Germany, a country hard-hit by the COVID-19 pandemic, via Amsterdam, back home.

“I was alone on my row, the two rows behind me were empty and the lady in the row next to mine also sat alone.”

Her flight touched down in Nairobi on the morning of 23rd March and taxied in. In the nine hours between the landing of Chris’ flight and Doris’, the information that passengers were given had differed.

“Our temperature was taken, then we filled a form saying that we would self-quarantine. Then we filled the older, yellow immigration form. As we did so, there was a lady shouting that we should all go to KMTC at 11:00 am for testing. That was it.”

Doris had already made plans to self-quarantine. She had found an apartment on an online booking site, AirBnB, where she says she was going to stay for the recommended 14-day quarantine. She booked an Uber, made the trip across town to her apartment in Kileleshwa, showered, changed and then booked another Uber to the KMTC.

Before they got to KMTC, if Chris and Doris were carriers of COVID-19 and were contagious, they may have spread the disease to at least three people each. Neither of them has been asked to account for their movements or the people that they came into contact with; termed by the World Health Organisation as contact-tracing. They do not yet know whether or not they have the virus, because they have yet to be tested for it. They weren’t alone on their flights home, and sadly, their experience was not unique to them.

Infection within the quarantine facilities

Both Doris and Chris are worried about the possibility that they contracted COVID-19 while they were in the throes of evident lapses and confusion that they found at the Jomo Kenyatta International Airport, and at the KMTC, where they would go as ordered, on the 24th of March, at 11 am.

“When we turned up at the KMTC, they closed and barricaded the gates behind us, and said that we were officially under mandatory quarantine,” Chris remembers.

Doris witnessed the furore of the now hundreds of passengers grow, with them crowding around Ministry of Health officials for answers, having just been stung by the news. She tried to hang as far back as she could to avoid coming into contact with the virus.

“We were then given three options for places that we would undergo quarantine. Boma Hotel (where Chris would eventually go), the KMTC and the Kenya School of Government (KSG) in Lower Kabete, Nairobi,” she remembers.

“Boma would cost us USD 100 (Kshs 10,000) a night (this figure was later revised downwards), and the conditions at KMTC were just awful, so I chose KSG. When we got to KSG the director of the campus told us that it would cost us USD 40 (Kshs 4,000) a night. People protested again and crowded around the officials telling us this. They then relented and said we would be charged USD 20 (Kshs 2,000) a night.”

A video taken by one of the passengers shows the proximity of the passengers to the officials, and to one another. Again, Doris wisely chose to hang back and wait until things calmed down so that she could get a room.

Chris chose to stay at the Boma hotel.

When Chris’s cohort of travellers arrived at the Boma hotel, he says there was just one receptionist at hand to meet them.

“We all herded around the reception area waiting to be checked in. I am very afraid that we may have been exposed while we were getting into quarantine!”

Later that evening, Chris heard the sounds of sirens outside his window.

A hotel staffer told him that ambulance workers in hazmat suits were there to evacuate a fellow traveller, an elderly lady who allegedly fell ill.

“We are all so worried”.

Even with the inconveniences they have experienced, both Doris and Chris’s worry extends to the unanswered question they both have – were they both complicit in some way in the spread of COVID-19?

“If the government was serious about a mandatory quarantine, why did they let us go home first?” Chris asks, the tone of his voice deep and serious, unfettered by the muffles and crackling on the phone line.

“There were people on our flight who took public transport from the airport and to KMTC. How many people have they been in touch with?”

The question of how the virus spreads is no longer in contention, but there are concerns about the handling of passengers who were being put in isolation in order to contain COVID-19’s spread in Kenya.

Dr Ahmed Kalebi, the founder and CEO of Lancet Laboratories, which is among Kenya’s first private laboratories to offer PCR tests for COVID-19 (Polymerase Chain Reaction tests detect the genetic material of COVID-19, called RNA), shares his worries about the possible contagion that people in the mandatory quarantine may be facing.

“For me, it is a big scare. I am privy to what has been going on in some of those facilities and it has been a bit of a mess.”

“If two hundred people go into a hotel and three or four of them have COVID-19, by keeping them in close proximity we are creating an incubating chamber (for the virus).”

Dr Kalebi believes that in late April, Kenyan cases of COVID-19 will have risen exponentially. Government models publicized on Monday 30th March put Kenya at possibly having 10,000 cases by that time.

Several accounts from persons currently in mandatory quarantine speak to the potential for this, especially as they were being transferred into quarantine facilities. Doris, who was being quarantined at the Kenya School of Government facility, Chris at the Boma hotel, and Caleb* (not his real name), a traveller who is currently in quarantine at the Kenyatta University Conference Centre, all give similar accounts about how risky the first day of their return was.

They were all supposed to be part of a Ministry of Health-led mass testing campaign of the over two thousand Kenyans currently in quarantine facilities, being carried out beginning the weekend ending March 29th.  Chris took a photo of a Ministry of Health official in a Hazmat suit from a common area at the Boma hotel.

Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Doris, Chris, Caleb and other travelers in quarantine that I spoke to all say that they feel healthy, save for a few coughs and sniffs which they hope are signs of a cold rather than COVID-19, but they may not be out of the woods, even as the days wind down to the end of their quarantine.

“The Coronavirus takes between two to fourteen days to incubate,” says Dr Kalebi.

“If tests were done at day seven, which is what the government is doing this weekend (weekend ending March 29th), you may have only a few people testing positive, who would be taken to more stringent quarantine facilities. Then you wait another week. Assume more people get infected. On day 14, when you are releasing them, people may have been infected in quarantine.”

Fears that the government quarantine facilities may become petri dishes for the spread of the virus are valid, but over-estimated, according to Professor Omu Anzala, who specializes in virology and immunology. He’s also part of the taskforce set up by the government to deal with the COVID-19 outbreak in Kenya.

“There is that possibility but we have not seen anybody go more than 14 to 15 days without having come down with the disease. We have not seen anybody who has gone more than 15 days who is not showing symptoms but is secreting the virus.”

He does say that these still are early days and that the government, like all governments, is learning as it goes deeper into fighting the virus.

It won’t be long before Doris and Chris get out of quarantine. Perhaps, it won’t take much longer before the country knows whether the mandatory quarantine strategy helped spread or stop COVID-19.

This article was first published by Africa Uncensored.

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