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Coping With the Crises: A Reflection From an African University

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Every university is unique and similar to other universities in its own way. This is especially evident in the types of challenges and crises it faces and how it deals with them, which is determined by its institutional contexts, capacities, and culture.

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The Possibilities and Perils of Leading an African University
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Every university is unique and similar to other universities in its own way. This is especially evident in the types of challenges and crises it faces and how it deals with them, which is determined by its institutional contexts, capacities, and culture. By the time I joined USIU-Africa as Vice Chancellor in January 2016, I had been in academia for more than forty years in six countries on three continents and the Caribbean region at nearly a dozen universities of different types.

So, I thought I was inured to surprises. As it turned out, I faced both familiar and unfamiliar challenges and crises over the next six years. The routine challenges in universities were of course there. The surprises reflected the larger national and international contexts in which the university operated and revealed our institutional strengths and weaknesses as crises tend to do.

The Sovereignty of Nations

The first major crisis erupted while I was in Cambridge, Massachusetts attending a training seminar on Advancement Leadership for Presidents at Harvard University. It was Saturday, July 8, 2016, when I got a message that land belonging to USIU-Africa had been grabbed by a property developer. I was on the way to lunch with an old friend who had kindly agreed to take me to the airport later that day. In my wildest dreams I would never have imagined that as vice chancellor I would be dealing with land grabbing!

The question of land is central in Kenya’s history, political economy, and social imaginary. The country’s settler colonial capitalism rested on the dispossession of large tracts of fertile lands in central Kenya and coercive mobilization of cheap labor around country. The struggles over land between the British settlers and indigenous people lay at the heart of the nationalist movement that culminated in the liberation war led by the Land Freedom Army in the 1950s.

Also known as the Mau Mau rebellion or uprising, the conflict crystallized and unleashed complex forces and negotiations that shaped the trajectory of Kenya’s decolonization and postcolonial dispensation. I had done my PhD dissertation on Kenya’s colonial economic history from 1895-1963, so I understood the dynamics of land dispossession, squatting, grabbing, and ownership, how land was a source of accumulation and wealth, and a powerful symbol of status, identity, and belonging.

USIU-Africa had purchased the grabbed land in 1990, comprising 30 acres, which was not too far from the main campus, from an insurance company that in turn had bought it from another company that acquired the land in the mid-1980s from the former president of the country, Daniel arap Moi. It was high stakes land politics. Before long, another claimant, a major tycoon, joined the fray.

On the long flight from Boston to Nairobi, I was concerned about how this tragic saga would pan out. Immediately after my return the management team and I made some crucial decisions. We visited the two nearest police stations and began planning a peaceful demonstration against the land grabbers to raise public awareness. There was overwhelming support rom the university community.

The march took place on July 13. The chancellor, then in his late eighties, and I together with the management team led the six kilometer demonstration on Thika Superhighway, one of the city’s major thoroughfares, from the campus to the Muthaiga police station to deliver a petition. We deployed marshals to ensure there were no outside agitators to cause mayhem, hired a music band to keep spirits high, brought lots of bottled water and an ambulance. We wore headbands, carried placards, and marched under the banner “Our Land Our Future.”

The demonstration was widely hailed as the most peaceful ever conducted by any university in the country. While we were proud of that, we knew the hard work of reclaiming the university’s grabbed land had only begun. Over the next several days and weeks we visited the ministries of lands and education, organized seminars on land grabbing in Kenya with NGOs, and above all, our internal and external legal counsel began to pursue the legal avenues available to secure the university’s interests.

Months turned into years. It soon transpired that the university’s external legal counsel had allegedly been involved in the company that bought the land from the former president, so we had to get new legal counsel, which introduced complications as the former tried to work with some members of the Board of Trustees and University Council behind management’s back. This was my first encounter with counterproductive interference in legal matters by some members of the governing bodies. Others were to come.

The court case moved at a snail’s pace. No legal resolution had been reached by the time I left more than five years later. In the meantime, we fenced the adjacent ten acres to the grabbed 30 acres that were not disputed, and enhanced security for all of the university’s undeveloped lands on the main campus by constructing perimeter walls.

Security was a paramount institutional consideration because Kenya lives in a dangerous geopolitical neighborhood. The country has suffered several terrorist attacks, the most heinous in recent times include the attacks on the US embassy in 1998 that killed 213 people, the Westgate Mall in 2013 that killed nearly 70 people, in Mpeketoni in Lamu county in June 2014 that killed more than 60 peopleGarissa University in April 2015 that killed almost 150 people mostly students, and on the DusitD2 complex in Nairobi in January 2019 that killed 21 people.

Consequently, campus security was a constant preoccupation for the university leadership. Regardless of where I was at any time of the day or night, I was reachable by our security team. Universities in Kenya are expected to maintain and constantly monitor high levels of security. The name of our university added to our potential vulnerability. In addition to our own campus security team and a contracted security firm, we worked closely with the police, other security agencies, and the immigration department. We conducted periodic security forums and drills for the university community.

In 2019, following instructions from the relevant government ministries we established a biometric system for the entrance to campus. With the outbreak of Covid-19 we introduced an RFID card system. We discovered that daily there were dozens if not hundreds of outsiders without campus affiliation who had been coming on campus to use our facilities including the sports gyms.

Some students protested as these security measures made it impossible for those who had not paid their tuition or taken up deferred payment plans to enter campus. As I noted in another reflection, affordability is a serious problem for many students in Kenyan universities including USIU-Africa. On this matter, the Board and Council unequivocally supported management.

Personally, I was troubled by the emerging surveillance regime, but as vice chancellor I was committed to ensuring utmost security and safety for the university community. However, I declined traveling with armed bodyguard or acquiring a gun as I was advised as xenophobic attacks directed at me escalated. I took pleasure in walking freely on campus and in the neighborhood I lived.

The Politics of Authoritarianism and Anti-intellectualism

As a long-standing academic, public intellectual, and creative writer I relish vigorous debate and abhor anti-intellectualism. As a lifelong activist for democracy and human rights, I detest authoritarianism and the cultures of intolerance, bullying, mobbing, and harassment which are all too rampant on many campuses in Africa and around the world. USIU-Africa was no exception in this regard.

In many contexts, authoritarianism and anti-intellectualism radiate from the top including the governing bodies, which are increasingly comprised of businesspeople and politicians with poor understanding of universities. They seek to impose corporate and partisan modes of governance that flout the core values of academic freedom and shared governance for universities. Aside from the president or vice chancellor, and provost or deputy vice chancellor for academic affairs, management bodies are also increasingly occupied by non-academics who are sometimes indifferent or even hostile to the culture of universities as epistemic communities.

There is now a vast literature on the corporatization and politicization of universities, the imposition of business models and autocratic leadership styles. However, while universities cannot be reduced to businesses, they must exercise prudent business management to survive and thrive. Moreover, universities have never been splendidly isolated from the political dynamics of their societies, nor are they immune from their own internal politics that often reflect and reproduce prevailing and conflicting tendencies and trends in the wider polity.

In many universities, anti-intellectualism manifests itself in a growing disdain for the “argumentative” and “useless” humanities and social sciences, and the valorization of the STEM disciplines and the marketable professional fields.  The devaluation of the liberal arts that prize critical thinking, inquiry, search for truth, humanism, ethics, justice, and the indispensable literacies for interdisciplinary, intercultural, international, information and interpersonal engagement is accompanied by the instrumentalization of knowledges, skills, and outputs.

A Kenyan scholar, Wanjala Nasong’o, laments in The Daily Nation of April 6, 2022 “the rise of anti-intellectualism that intensified in Kenya under Moi, and that has become ubiquitous in the world on account of the rise of right-wing populist nationalism. Its essence is a resentment and suspicion of the life of the mind and of those who represent it; and a disposition to constantly minimize the value of that life. The result of this is the current general disdain towards all forms of intellectual activity and a tendency to denigrate those who engage in it… Anti-intellectualism is identified with religious anti-rationalism, populist anti-elitism, and unreflective instrumentalism… Religious anti-rationalism is the belief in the superiority of faith over reason and the fear that scientific endeavors will lead to the elimination of religion. The growth of religious fundamentalism around the world and the popularity of new-age religions in the face of contemporary life challenges is a testament to this.”

It was not unusual for academic or professional meetings to be opened by Christian payers oblivious to the fact that attendees were multi-religious or even agnostic and atheists. As I noted in a previous reflection, at USIU-Africa I was struck by the lack of a vigorous academic culture outside the classroom. Serious debates in leadership meetings were rare, save for those in management and occasionally the Senate.

Another troubling dimension of institutional cultures in many universities including USIU-Africa is the growth of incivility. In a speech I delivered virtually on May 26, 2021 to the USIU-Africa community and other participants, titled “Higher Education in a Post-Covid-19 World: Challenges and Opportunities for African Universities,” I commented extensively on this problem. I urged the audience to seriously embrace the values of academic freedom, shared governance, diversity, equity and inclusion, respectful internal and external communication, civility and collegiality, the role of universities as generative spaces in the rigorous search for truth, and their social responsibility by eschewing institutional naval gazing for the higher purpose of social impact.

On civility I stated, “The academic bully culture, as Darla Twale and Barbara De Luca call it in their book by that title has grown. Some call it academic mobbing. Incivility and intolerance in universities has several manifestations. At a macro level it reflects the frictions of increasing diversification of university stakeholders, growing external pressures for accountability, and the descent of political discourse into angry populisms. Student and faculty incivility are also fueled by rising sense of entitlement, consumerist attitudes, emotional immaturity, stress, racism, tribalism, sexism, ageism, xenophobia, social media, and other pervasive social and institutional ills that universities must confront and address to foster healthier institutional climate.”

The culture of incivility at USIU-Africa was expressed in contradictory ways. There was exaggerated respect for authority, as evident in the pervasive reference and reverence for titles, undoubtedly a survival tactic from the legacies of national and institutional authoritarianism and anti-intellectualism. There was also fear to confront dysfunctional behavior perpetrated by peers. I would often be approached by faculty, staff, and students who disapproved the attitudes and actions of their leaders and colleagues, saying “we don’t agree with what they are doing.” I would always ask them why they didn’t say so and openly debate their opponents.

In the first few years, I found meetings of the Faculty Council, which I attended upon invitation, quite vigorous, before they descended into sterile monologues by an intellectually insecure and intolerant leadership that would only allow their supporters to speak. Similarly, student politics tended to be constructive, notwithstanding predictable, and understandable protests over tuition increases. Things changed when the government imposed a uniform way of choosing student leaders.

This was prompted by efforts to curtail the power of longstanding popular leaders at some public universities. Instead of direct elections, the new system required all universities to establish an electoral college that would select the student leadership. This introduced increasingly sectarian political mobilization at a private university like ours that had not indulged in such politics before in which the populist factional leaders, who were not necessarily universally popular, could enjoy more power than the selected leaders they sponsored.

One event captured rising anti-intellectualism among some students.  In March 2019, students in the recently established pharmacy degree program sued the university for not changing the grading system to lower pass rates, which other students had rejected! They lost the case with costs. Ironically, the case raised national awareness that the university’s grading standards were high, contrary to colonialist stereotypes about the laxity of private and American-style universities. The following year enrollment in the pharmacy program shot up!

Throughout this saga, the Management Board and University Senate remained firm, confident that the university would prevail to maintain high grading standards. A few disgruntled faculty egged the pharmacy students on. The Council was unnerved and called for an emergency meeting and demanded daily updates. I even had to cut short my vacation to Mozambique where I was visiting my son. The propensity for misguided interventions by the Council worsened during the Covid-19-19 pandemic.

The Wrath of a Pandemic

The outbreak of the coronavirus pandemic in early 2020 forced universities around the world to confront unprecedented challenges that simultaneously exposed and exacerbated existing deficiencies and dysfunctions. Six stand out. First, in terms of transitioning from face to face to remote teaching and learning using online platforms. Second, managing severely strained finances. Third, ensuring the physical and mental health of students, faculty, and staff. Fourth, reopening campuses as safely and as effectively as possible. Fifth, planning for a sustainable post-pandemic future. Sixth, contributing to the capacities of government and society in resolving the multiple dimensions of the COVID-19 pandemic.

At USIU-Africa management began preparing for the Covid-19 pandemic almost immediately after it erupted. I subscribe to key higher education magazines in the United States, Britain, Canada, such as The Chronicle of Higher EducationTimes Higher EducationUniversity Affairs Canada, that send daily updates, and regularly read other academic media including University World News. By the end of January 2020, it was clear to me the world was facing a major health crisis.

Management activated the university’s business continuity plan that had been created a year before, set up a task force for Covid-19 and mobilized the occupational safety and health administration (OSHA) committee, and the governance bodies. We also began preparing faculty, students and staff through a comprehensive communication strategy using multiple platforms and disseminating information from authoritative sources to curtail misinformation and mitigate panic. A training program for transition to online teaching and learning was launched by the recently established USIU Online. A survey showed 94% of the students had access to smart gadgets.

By the time the World Health Organization declared Covid-19 a global pandemic and the Kenyan government announced closure of all education institutions from March 19, 2020, we were ready. The campus closed on March 17, and the following day we started offering classes online. The Spring and Summer semesters were concluded successfully online, and so was the Fall semester, during which improvements were made based on the experiences of the previous two semesters. This continued for the first two semesters in 2021, while during the third semester we partially reopened the campus. The provision of essential services in ICT, Library, Finance, Admissions, Counseling, and other areas continued online.

The University’s relatively successful online transition can be attributed to four key factors: robust business continuity planning; massive investments in electronic infrastructure in previous years and new investments during the pandemic; remarkable commitment by faculty, students, and staff, facilitated by continuous training; and using experiences to make improvements. We managed the welfare of international students unable to leave immediately by keeping them on campus until end of the 2020 spring semester.

Management and I were committed to managing the pandemic as effectively as possible, as well as actively planning for the future, exploring how to turn the challenges into opportunities. The university became a national leader in Kenya on e-Learning as evident in its partnerships with the Commission for University Education in organizing forums on the subject, CUE’s approval of the first online degree program in the country at USIU-Africa in 2020, and the university’s selection as a lead partner of the Mastercard Foundation for a major e-Learning initiative for some of the foundation’s partner institutions including eleven in Africa.

Personally, I participated in numerous national and international forums on the implications of Covid-19 as chair of the Board of Trustees of the Kenya Education Network, the country’s NREN, member of the Administrative Board of the International Association of Universities, and the Advisory Board of the Alliance for African Partnership, a consortium of about a dozen African universities and Michigan State University, and numerous other forums. I began researching on and writing a series of papers on the implications of Covid-19 for various aspects of higher education in Africa and around the world.

However, we faced challenges. One was ensuring quality of instruction and delivery of essential services. In the first few months, management and OSHA conducted daily reviews. Another centered on connectivity and devices for many of our students and faculty. We engaged the two telcos, Safaricom and Telekom, to provide subsidized subscription Wi-Fi rates. The integrity of the assessment process posed a special challenge. The schools adopted various mitigation measures including open book exams, using projects, online presentations, and prorating existing assessments. In addition, we acquired appropriate technology tools, such as the Responders Lockdown browser and monitoring system.

One of the biggest challenges was financial. The closure of the campus resulted in reduced revenues from auxiliary services and some student fees. Most significantly, for the rest of 2020, student enrollments fell significantly, and as a tuition dependent institution our finances became severely strained. Enrollments dropped because students’ parents or guardians faced job losses and salary reductions. Further, national examinations for the Kenya Certificate of Secondary Education in 2020 were postponed so there was no new pipeline for the fall 2020 semester.

Management organized numerous meetings in which the Director of Finance and I informed staff and faculty, as well as the governing organs about the dire financial situation we were facing. We invited the Faculty and Staff Councils for detailed briefings. I spent several weeks calling individual staff and faculty members to find out how they were doing, offer support, and solicit their views on how we could catalyze lessons from the pandemic to make the university more resilient and effective in future.

Within months of the outbreak of the pandemic several Council members demanded drastic measures including immediate salary cuts and furloughs. Management preferred a more measured approach to begin in the 2020-2021 budget year to maintain essential operations, morale, and as part of the duty of care to employees. Unconscionably, when there was blowback from a minority of faculty to measures adopted in the 2020-2021 budget, those same Council members tried to distance themselves from the budget over which they enjoyed the sole authority of approval according to the university’s charter and statues.

Prior to and after the approval of the 2020-2021 budget by the Council various consultations and engagements were held with the schools, staff and the faculty council executive committees to brief them on why it was necessary to implement the anticipated austerity measures. This was part of a tradition of wide consultations with stakeholders by management as it drafted the university budget for Council deliberation and approval.

The measures included graduated salary cuts (6%-23), suspension of institutional contributions to pension payments, placing some employees on unpaid leave, and suspension of the Employee Tuition Waiver. We indicated the measures would be reviewed each semester and based on student enrollment adjusted accordingly.

In addition, management developed several mitigation measures, such as strengthening fundraising, external partnerships, student recruitment and retention, and the university’s customer service and support. It is instructive that we secured the $63.2 million dollars for scholarships from the Mastercard Foundation that I mentioned in another reflection during the pandemic, and later huge support from the Foundation’s e-Learning initiative.

Before implementation we asked all employees to sign-off their approval. The majority approved. However, a minority group of opposed faculty applied for a court injunction to stop the implementation of the measures. They argued, against all evidence, that the university had enough resources to navigate the crisis without undertaking any drastic measures. Their blatant dishonesty and shenanigans would have been hilarious if the implications were not so serious.

Management believed it had a firm case to prevail in court. Many employers in Kenya including universities had implemented similar measures, so had much richer universities in the developed countries, as I shared continuously in my presentations to faculty and staff. The court issued a temporary injunction against implementation of the measures and encouraged mediation. After several futile attempts in which the litigants refused to consider any of the cost containment measures, it was clear to management that the court case should proceed in an expedited manner.

However, some members of the Council preferred more negotiations which persisted for the rest of the academic year. The litigants succeeded in running down the clock. Informed advice from management and the external legal counsel to Council hit against a wall of an inexplicable fear of the court process. The university continued to bleed financially. By January 2021 nothing had come out of the negotiations and the university found itself in dire financial straights.

The university was forced to undertake two drastic measures. First, dozens of employees on unpaid leave were furloughed. I found this deeply painful. A suit against the redundancies by the two unions that represented a few dozen staff failed because we had scrupulously followed labor law and institutional policies and procedures. It was the exercise of such due diligence that made management confident of prevailing in the suit lodged by the faculty litigants.

Second, various options were explored to secure temporary revenues to sustain operations including bank loans. In the end, the Board of Trustees, which has fiduciary responsibility over university assets, approved the liquidation of more than a third of the university’s limited endowment. It had never been tapped before waiting for it to grow large enough for the conventional annual endowment spending rate of 4-5% to support institutional priorities such as student aid.

This crisis compromised the university’s financial future. Institutional culture, on which I will say more in another reflection, had eaten prudent management and made a mockery of an otherwise effective pandemic management strategy. It was a case of institutional exceptionalism, entitlement, self-sabotage, and financial illiteracy by a litigious minority run amok. I was deeply saddened.

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Paul Tiyambe Zeleza is a Malawian historian, academic, literary critic, novelist, short-story writer and blogger. He is the Associate Provost and North Star Distinguished Professor at Case Western Reserve University.

Politics

The Campaign that Remembered Nothing and Forgot Nothing

Once a master of coalition building, Raila Odinga killed his own party and brand, handed over his backyard to William Ruto, threw in his lot with Uhuru Kenyatta, ended up being branded a “state project”, and lost.

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The Campaign that Remembered Nothing and Forgot Nothing
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The Original sin

A seasoned Nairobi politician, Timothy Wanyonyi had cut a niche for himself in the Nairobi governor’s race that was filled with a dozen candidates who had up to that point not quite captured the imagination of Nairobians. Some candidates were facing questions over their academic qualifications while others were without a well-defined public profile. In that field Wanyonyi, an experienced Nairobi politician, stood out. On 19th April, the Westlands MP’s campaign team was canvasing for him in Kawangware. They had sent pictures and videos to news teams seeking coverage. But that evening their candidate would receive a phone call to attend a meeting at State House Nairobi that would put an end to his campaign. Before Tim made his way to State House, insiders around President Uhuru Kenyatta told reporters that Wanyonyi was out of the Nairobi governor’s race.

Wanyonyi’s rallying call “Si Mimi, ni Sisi”—a spin on US Senator Bernie Sanders’ “Not me. Us” 2020 presidential campaign slogan—distinguished him as a candidate who understood the anxieties of Nairobians. “They were looking for someone who would see the city as a home first, before seeing it as a business centre,” one of his political consultants told me. But the Azimio coalition to which Wanyonyi’s ODM party belonged was very broad, with several centres of power that didn’t take into account—or maybe didn’t care about— Nairobi’s political landscape. Wanyonyi’s candidacy was hastily sacrificed at the altar of the coalition’s politics. Former President Uhuru Kenyatta, the coalition’s chairman, had prevailed on Raila Odinga, its presidential candidate, to essentially leave Nairobi to Kenyatta’s Jubilee Party in exchange for ODM picking the presidential candidate.

That was the only consideration on the table.

However, it was a miscalculation by the coalition. Azimio failed to appreciate the complex matrix that is a presidential election in Kenya. While the top ticket affects the races downstream, it can be argued that the reverse is also true. It is ironic that Raila Odinga, a power broker and a master of coalition building who was running for presidency for the fifth time, was choosing to ignore these principles. His own ascension in politics had been based on building a machine—ODM—that he used carefully during every election cycle. Yet in this election he was killing his own party and brand. The Azimio La Umoja coalition party was built as a party of parties that would be the vehicle Raila would use to contest the presidency. However, the constituent parties were free to sponsor parliamentary candidates. It sounded like a good idea on paper but it created friction as the parties found themselves in competition everywhere. To keep Azimio from fracturing both itself and its votes, the idea of “zoning”—having weaker candidates step down for stronger ones, essentially carving out exclusive zones for parties—gained traction, and would itself lead to major fall-outs, even after it was adopted as official Azimio policy in June.

However, beyond the zoning controversy, Wanyonyi’s candidacy served as a marker for a key block of Odinga voters—the Luhya—assuring them of their place within the Azimio coalition. Luhya voters have been Odinga’s insurance policy during his last three presidential runs. With Nyanza and the four western Kenya counties of Kakamega, Bungoma, Vihiga and Busia in his back pocket, he would be free to pick up other regions. Odinga claimed 71 per cent of the Luhya bloc in 2017 but this time, western voters were feeling jittery about the new political arrangements.

There is also another consideration. The Luhya voting bloc in Nairobi is also significant, and Odinga had carried the capital in his previous three presidential runs. The Nairobi electoral map is largely organized around five big groups: the Kikuyu, Luo, Luhya, Kamba, and Kisii. For the ODM party, having a combination of a Luo-Luhya voting bloc in Nairobi has enabled Odinga to take the city and to be a force to reckon with.

However, it appeared that all these factors were of no importance in 2022. So, Tim Wanyonyi was forced out of the race. He protested. Or attempted to. Western Kenya voters were furious, but who cared?

Miscalculation

The morning after the State House meeting, a group calling themselves Luhya professionals had strong words for both Odinga and Azimio.

“We refuse to be used as a ladder for other political expediencies whenever there is an election,” Philip Kisia, who was the chairman of this loose “professional group” said during a press conference that paraded the faces of political players from the Luhya community. The community had “irreducible minimum” and would not allow itself to “to be used again this time.” Other speakers at that press conference—including ODM Secretary General Edwin Sifuna—laid claim to what they called the place of the Luhya community in Nairobi. The political relationship between Luhyas and Luos has not been without tensions; in the aftermath of the opposition’s unravelling in the 90s, Michael Kijana Wamalwa and Raila Odinga fought for supremacy within the Ford Kenya party. Wamalwa believed the throne left by Jaramogi Oginga Odinga was his for the taking. However, Odinga’s son, Raila, mounted a challenge for the control of the party, eventually leaving Ford Kenya to build his own party, the National Development Party (NDP). The Luhya-Luo relationship was broken. Luhya sentiment was that, having been faithful to Odinga’s father, it was time for Wamalwa to lead the opposition.

These old political wounds have flared up during every election cycle, and Raila Odinga has worked for decades to reassure the voting bloc and bury the hatchet. This time, however, he was different. He didn’t seem to care about those fragile egos. After the press conference, a strategist in Odinga’s camp wondered aloud, “Who will they [Luhyas] vote for?”

The next 21 days were to be pivotal for Kenya’s presidential election. Azimio moved on and introduced Polycarp Igathe as their candidate for Nairobi. A former deputy governor in Nairobi who had quit just months after taking office, Igathe is well known for his C-suite jobs and intimate links to the Kenyan political elite. His selection, though, played perfectly into the rival Kenya Kwanza coalition’s “hustlers vs dynasties” narrative which sought to frame the 2022 elections as a contest between the political families that have dominated Kenya’s politics and economy since independence. The sons of a former vice president and president respectively, Odinga and Uhuru were branded as dynasties while the then deputy president claimed for himself the title of “hustler”.

These old political wounds have flared up during every election cycle, and Raila Odinga has worked for decades to reassure the voting bloc and bury the hatchet.

But, William Ruto’s side also saw something else in that moment—an opportunity to get a chunk of the important Luhya vote. Ruto first entered into a coalition with Musalia Mudavadi, selling their alliance as a “partnership of equals”, and then followed that up with the offer of a Luhya gubernatorial candidate to Nairobians in the name of Senator Johnson Koskei Sakaja.

Meanwhile, Wanyonyi’s half-brother, the current Speaker of the National Assembly, Moses Wetangula, was a principle in Ruto’s camp. Up to this point, Wetangula had struggled to find a coherent message to sell Ruto’s candidacy to the Luhya nation. But, with his brother being shafted by Azimio, Wetangula saw a political opening; he quickly called a press conference and complained bitterly about the “unfair Odinga” whom he said the Luhya community would not support for “denying their son a ticket to run for the seat of the governor of Nairobi”. His press conference went almost unnoticed and it is not even clear if Azimio took notice of the political significance of Wetangula’s protestations.

Azimio had offered their opponents an inroad into western Kenya politics and Ruto wasted little time trying turn a key Odinga voting bloc. With Sakaja confirmed as the Kenya Kwanza candidate for the Nairobi governor’s race, Wetangula and Kenya Kwanza made Western Kenya a centrepiece of their path to presidency. Tim Wanyonyi was presented as a martyr. The Ford Kenya leader took to all the radio stations, taking calls or sending emissaries, to declare Odinga’s betrayal. In the days and weeks that followed, William Ruto would make a dozen more visits to Luhyaland than his rival, assuring the voters that there would be a central place reserved for them in his administration. In contrast, on a visit to western Kenya, Raila Odinga expressed anger that an opinion poll had shown him trailing Ruto in Bungoma. “He is at nearly 60 per cent and I am at 40 per cent. Shame on you people! Shame on you people! Shame on you!” he told the crowd. He would eventually lose Bungoma and Trans Nzoia to William Ruto.

To be sure, Odinga won western Kenya with 55 per cent of the vote, but William Ruto had 45 per cent, enough to light his path to the presidency. He would repeat the same feat in Nairobi and coast regions, traditionally Odinga strongholds where he would have expected to bag upwards of 60 per cent of the vote. Azimio modelling had put these regions in Raila’s column but Kenya Kwanza took advantage of the mistake-prone Odinga. And wherever Odinga blundered, Ruto mopped up. As Speaker, Wetangula is today the third most powerful man in in the country. Yet just four years ago, he was an Odinga ally who had been stripped off his duties as a minority leader in the Senate by Odinga’s ODM party. At the time he warned that the divorce “would be messy, it would be noisy, it would be unhelpful, it would not be easy, it would have casualties”. It was the first of many political blunders that Odinga would make.

Unforced errors

Looking back, Odinga’s 2022 run for the presidency had all the hallmarks of a campaign that didn’t know what it didn’t know; it was filled with assumptions, and sometimes made the wrong judgment calls. By handing over his backyard to Ruto and choosing to ally with President Uhuru Kenyatta, Raila ended up being branded a “state project”.

In 2005, Odinga had used the momentum generated by his successful campaign in a referendum against Mwai Kibaki’s attempt to foist on the country a bastardized version of the constitution negotiated in Bomas to launch early campaigns for his 2007 presidential run. However, this time, as the courts hamstrung his attempt to launch the BBI referendum, Ruto was already off to the races, having begun his presidential campaign three years early.

“He is at nearly 60 per cent and I am at 40 per cent. Shame on you people! Shame on you people! Shame on you!”

With the rejection of constitutional changes, which were found to be deeply unpopular among many Kenyans, Odinga was finally in a strange place, a politician now out of touch, defending an unpopular government, a stranger to his own political base. The failure of BBI as a political tool was really the consequence of Odinga’s and Kenyatta’s inability to understand the ever-changing Kenyan political landscape. Numerous times they just seemed to not know how to deal with the dynamism of William Ruto. He would shape-shift, change the national conversation, and nothing they threw at him seemed to stick, including, corruption allegations. For a politician who created the branding of opponents as his tool, Odinga had finally been branded and it stuck.

Bow out

In the final day of the campaigns, both camps chose Nairobi to make their final submissions. Azimio chose Kasarani stadium. It was, as expected, full of colour, with a Tanzanian celebrity musician, Diamond Platnumz, brought in to boot. Supporters were treated to rushed speeches by politicians who had somewhere else to be. Azimio concluded its final submission early and the speeches by Odinga and his running mate, Martha Karua, weren’t exactly a rallying call. It was as if they were happy to be put out of their pain as they quickly stepped off the stage and left the stadium. In contrast, Ruto’s final submission was filled with speeches of fury by politicians angered by “state capture” and the “failing economy”. Speaker after speaker roused the audience with their defiant messages. They ended the meeting an hour before the end of IEBC campaign deadline. A video soon appeared online of William Ruto sprinting across the Wilson airport runway to catch a chopper and make it to one final rally in central Kenya before the IEBC’s 6 p.m. campaign deadline.

Pictures of the deputy president on top of a car at dusk in markets in Kiambu were the last images of his campaign to be shared on social media. Ruto won because he wanted the presidency more than Odinga and was willing to work twice as hard as both Odinga and Kenyatta.

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Lagos From Its Margins: Everyday Experiences in a Migrant Haven

From its beginnings as a fishing village, Lagos has grown into a large metropolis that attracts migrants seeking opportunity or Internally Displaced Persons fleeing violence.

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Lagos, City of Migrants

From its origins as a fishing village in the 1600s, Lagos has urbanised stealthily into a vast metropolis, wielding extensive economic, political and cultural influence on Nigeria and beyond. Migration in search of opportunities has been the major factor responsible for the demographic and spatial growth of the city as Lagos has grown from 60,221 in 1872 to over 23 million people today. The expansion of the city also comes with tensions around indigene-settler dynamics, especially in accessing land, political influence and urban resources. There are also categories of migrants whose status determines if they can lay hold of the “urban advantage” that relocating to a large city offers.

A major impetus to the evolution of modern Lagos is the migration of diverse groups of people from Nigeria’s hinterland and beyond. By the 1800s, waves of migrants (freed slaves) from Brazil and Freetown had made their way to Lagos, while many from Nigeria’s hinterland including the Ekiti, Nupes, Egbas and Ijebus began to settle in ethnic enclaves across the city. In the 1900s, migrant enclaves were based on socio-economic and/or ethnicity status. Hausas (including returnees from the Burma war) settled in Obalende and Agege, while the Ijaw and Itsekiri settled in waterfront communities around Ajegunle and Ijora. International migrant communities include the Togolese, Beninoise and Ghanaian, as well as large communities of Lebanese and Indian migrants. The names and socio-cultural mix in most Lagos communities derive from these historical migrant trajectories.

Permanent temporalities

A study on coordinated migrations found that, as a destination city, Lagos grew 18.6 per cent between 2000 and 2012, with about 96 per cent of the migrants coming from within Nigeria. While migration to Lagos has traditionally been in search of economic opportunities, new classes of migrants have emerged over the last few decades. These are itinerant migrants and internally displaced persons.

Itinerant migrants are those from other areas of Nigeria and West Africa who travel to work in Lagos while keeping their families back home. Mobility cycles can be weekly, monthly or seasonal. Such migrants have no address in Lagos as they often sleep at their work premises or in mosques, saving all their earned income for remittance. They include construction artisans from Benin and Togo who come to Lagos only when they have jobs, farmers from Nigeria’s northern states who come to Lagos to work as casual labourers in between farming seasons (see box), as well as junior staff in government and corporate offices whose income is simply too small to cover the high cost of living in Lagos.

While people from Nigeria’s hinterland continue to arrive in the city in droves, the wave of West African in-migration has ebbed significantly. This is mostly because of the economic challenges Nigeria is currently facing that have crashed the Naira-to-CFA exchange rates. As a result, young men from Togo, Ghana and Benin are finding cities like Dakar and Banjul more attractive than Lagos.

Photo. Taibat Lawanson

Photo. Taibat Lawanson

Aliu* aka Mr Bushman, from Sokoto, Age 28

Aliu came to Lagos in 2009 on the back of a cattle truck. His first job was in the market carrying goods for market patrons. He slept in the neighbourhood mosque with other young boys. Over the years, he has done a number of odd jobs including construction work. In 2014, he started to work as a commercial motorcyclist (okada) and later got the opportunity to learn how to repair them. He calls himself an engineer and for the past four years has earned his income exclusively from riding and repairing okada. Even though he can afford to rent a room, he currently lives in a shared shack with seven other migrants.

He makes between N5000 and N8000 weekly and sends most of it to his family through a local transport operator who goes to Sokoto weekly. His wife and three children are in the village, but he would rather send them money than bring them to Lagos. According to him, “The life in Lagos is too hard for women”.

Since he came to Lagos thirteen years ago, Aliu has never spent more than four months away from Sokoto at a time. He stays in Sokoto during the rainy season to farm rice, maize and guinea corn, and has travelled back home to vote every time since he came to Lagos.

 

The second category of migrants are those who have been displaced from their homesteads in Northern Nigeria by conflict, either Boko Haram insurgency or invasions by Fulani herdsmen. The crises have resulted in the violent destruction of many communities, with hundreds of thousands killed and many more forced to flee. With many who initially settled in camps for Internally Displaced Persons (IDP) dissatisfied with camp conditions, the burden of protracted displacement is now spurring a new wave of IDP migration to urban areas. Even though empirical data on the exact number of displaced persons migrating out of camps to cities is difficult to ascertain, it is obvious that this category of migrants are negotiating their access to the city and its resources in circumstances quite different from those of other categories of migrants.

IDPs as the emerging migrant class in Lagos 

According to the United Nations High Commission for Refugees, two of every three internally displaced persons globally are now living in cities. Evidence from Nigeria suggests that many IDPs are migrating to urban areas in search of relative safety and resettlement opportunities, with Lagos estimated to host the highest number of independent IDP migrants in the country. In moving to Lagos, IDPs are shaping the city in a number of ways including appropriating public spaces and accelerating the formation of new settlements.

There are three government-supported IDP camps in the city, with anecdotal evidence pointing to about eighteen informal IDP shack communities across the city’s peri-urban axis. This correlates with studies from other cities that highlight how this category of habitations (as initial shelter solutions for self-settled IDPs) accelerate the formation of new urban informal settlements and spatial agglomerations of poverty and vulnerability.

While people from Nigeria’s hinterland continue to arrive in the city in droves, the wave of West African in-migration has ebbed significantly.

IDPs in Lagos move around a lot. Adamu, who currently lives in Owode Mango—a shack community near the Lagos Free Trade zone—and has been a victim of forced eviction four times said, “As they [government or land owners] get ready to demolish this place and render us homeless again, we will move to another area and live there until they catch up with us.”

In the last ten years, there has been an increase in the number of homeless people on the streets of Lagos—either living under bridges, in public parks or incomplete buildings. Many of them are IDPs who are new migrants, and unable to access the support necessary to ease their entry into the city’s established slums or government IDP camps. Marcus, who came from Adamawa State in 2017 and has been living under the Obalende Bridge for five years, said, “I am still managing, living under the bridge. I won’t do this forever, my life will not end like this under a bridge. I hope to one day return to my home and continue my life”.

Blending in or not: Urban integration strategies 

Urban integration can be a real challenge for IDP migrants. Whereas voluntary migrants are often perceived to be legal entrants to the city and so can lay claim to urban resources, the same cannot be said about IDPs. Despite being citizens, and despite Nigeria being a federation, IDPs do not have the same rights as other citizens in many Nigerian cities and constantly face stigmatisation and harassment, which reinforces their penchant for enclaving.

The lack of appropriate documentation and skillsets also denies migrants full entry into the socio-economic system. For example, Rebekah said: “I had my WAEC [Senior Secondary school leaving certificate] results and when Boko Haram burnt our village, our family lost everything including my certificates. But how can I continue my education when I have not been able to get it? I have to do handwork [informal labour] now”. IDP children make up a significant proportion of out-of-school children in Lagos as many are unable to get registered in school simply because of a lack of address.

Most IDPs survive by deploying social capital—especially ethnic and religious ties. IDP ethnic groupings are quite organized; most belong to an ethnic-affiliated group and consider this as particularly beneficial to their resettlement and sense of identity in Lagos. Adamu from Chibok said, “When I come to Lagos in 2017, I come straight to Eleko. My brother [kinsman] help me with house, and he buy food for my family. As I no get work, he teach me okada work wey he dey do.”

The crises have resulted in the violent destruction of many communities, with hundreds of thousands killed and many more forced to flee.

Interestingly, migration to the city can also be good for women as many who were hitherto unemployed due to cultural barriers are now able to work. Mary who fled Benue with her family due to farmer-herder clashes explained, “When we were at home [in Benue], I was assisting my husband with farming, but here in Lagos, I have my own small shop where I sell food. Now I have my own money and my own work.”

Need for targeted interventions for vulnerable Lagosians

“Survival of the fittest” is an everyday maxim in the city of Lagos. For migrants, this is especially true as they are not entitled to any form of structured support from the government. Self-settlement is therefore daunting, especially in light of systemic limiting factors.

Migrants are attracted to big cities based on perceived economic opportunities, and with limited integration, their survival strategies are inevitably changing the spatial configurations of Lagos. While the city government is actively promoting urban renewal, IDP enclaving is creating new slums. Therefore, addressing the contextualised needs of urban migrant groups is a sine qua non for inclusive and sustainable urban development.

“I am still managing, living under the bridge. I won’t do this forever, my life will not end like this under a bridge. I hope to one day return to my home and continue my life”.

There is an established protocol for supporting international refugees. However, the same cannot be said for IDPs who are Nigerian citizens. They do not enjoy structured support outside of camps, and we have seen that camps are not an effective long-term solution to displacement. There is a high rate of IDP mobility to cities like Lagos, which establishes the fact that cities are an integral part of the future of humanitarian crisis. Their current survival strategies are not necessarily harnessing the urban advantage, especially due to lack of official recognition and documentation. It is therefore imperative that humanitarian frameworks take into account the role of cities and also the peculiarities of IDP migrations to them.

Lagos remains a choice destination city and there is therefore need to pay more attention to understanding the patterns, processes and implications of migration into the city. The paucity of migration-related empirical data no doubt inhibits effective planning for economic and social development. Availability of disaggregated migration data will assist the state to develop targeted interventions for the various categories of vulnerable Lagosians.  Furthermore, targeted support for migrant groups must leverage existing social networks, especially the organised ethnic and religious groups that migrants lean on for entry into the city and for urban integration.

*All names used in this article are pseudonyms

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It’s a Nurses’ Market Out There, and Kenyans Are Going For It

Nurses are central to primary healthcare and unless Kenya makes investments in a well-trained, well supported and well-paid nursing workforce, nurses will continue to leave and the country is unlikely to achieve its Sustainable Development Goals in the area of health and wellbeing for all.

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It’s a Nurses’ Market Out There, and Kenyans Are Going For It
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Nancy* is planning to leave Kenya. She wants to go to the United States where the nursing pastures are supposedly greener. I first met Nancy when the country was in the throes of the COVID-19 pandemic that tested Kenya’s healthcare system to breaking point. She was one of a cohort of recently graduated nurses that were hastily recruited by the Ministry of Health and thrown in at the deep end of the pandemic. Nancy earns KSh41,000 net with no other benefits whatsoever, unlike her permanent and pensionable colleagues.

When the then Labour and Social Protection Cabinet Secretary Simon Chelugui announced in early September 2021 that the government would be sending 20,000 nurses to the United Kingdom to help address the nursing shortage in that country, Nancy saw her chance. But her hopes were dashed when she failed to raise the KSh90,000 she needed to prepare and sit for the English language and nursing exams that are mandatory for foreign-trained nurses. Nancy would also have needed to pay the Nursing Council of Kenya KSh12,000 for the verification of her documents, pay the Kenya Medical Training College she attended KSh1,000 in order to get her exam transcripts, and apply for a passport, the minimum cost of which is KSh4,550 excluding the administrative fee. Nancy says that, contrary to then Health Cabinet Secretary Mutahi Kagwe’s disputed claims that a majority of applicants to the programme had failed the English language test, most nurses simply could not afford the cost of applying.

Of the targeted 20,000 nurses, the first 19 left Kenya for the UK in June 2022. But even that paltry figure represents a significant loss for Kenya, a country where the ratio of practicing nurses to the population is 11.66 per 10,000. The WHO considers countries with less than 40 nurses and midwives for every 10,000 people to not have enough healthcare professionals. Nearly 60 per cent of all healthcare professionals (medical physicians, nursing staff, midwives, dentists, and pharmacists) in the world are nurses, making them by far the most prevalent professional category within the health workforce. Nurses offer a wide range of crucial public health and care services at all levels of healthcare facilities as well as within the community, frequently serving as the first and perhaps the only healthcare provider that people see.

Kenya had 59,901 nurses/midwives in 2018, rising to 63,580 in 2020. Yet in 2021, Kenya was proposing to send almost a third of them to the UK to “address a shortfall of 62,000 in that country”.

The growing shortage of nurses in the UK has been blamed on the government’s decision to abolish bursaries and maintenance grants for nursing students in 2016, leading to a significant drop in the number of those applying to train as nurses. Consequently, the annual number of graduate nurses plummeted, reaching the current low of 31 nurses per 100,000 people, below the European average of 36.6 and half as many as in countries like Romania (96), Albania (82) and Finland (82). Facing pressure to recruit 50,000 nurses amid collapsing services and closures of Accident & Emergency, maternity and chemotherapy units across the country, the UK government decided to once again cast its net overseas. Established in 1948, the UK’s National Health Service (NHS) has relied on foreign healthcare workers ever since staff from the Commonwealth were first brought in to nurse back to health a nation fresh out of the Second World War.

The UK government’s press release announcing the signing of the Bilateral Agreement with Kenya states that the two countries have committed  “to explore working together to build capacity in Kenya’s health workforce through managed exchange and training” and goes as far as to claim that “with around only 900 Kenyan staff currently in the NHS, the country has an ambition to be the ‘Philippines of Africa’ — with Filipino staff one of the highest represented overseas countries in the health service — due to the positive economic impact that well-managed migration can have on low to middle income countries.”

It is a dubious ambition, if indeed it has been expressed. The people of the Philippines do not appear to be benefiting from the supposed increase in capacity that the exchange and training is expected to bring. While 40,000 of their nurses worked in the UK’s National Health Service last year, back home, according to Filipino Senator Sonny Angara, “around 7 of 10 Filipinos die without ever seeing a health professional and the nurse to patient ratio in our hospitals remains high at 1:50 up to 1:802”.

Since 2003 when the UK and the government of the Philippines signed a Memorandum of Understanding on the recruitment of Filipino healthcare professionals, an export-led industry has grown around the training of nurses in the Philippines that has attracted the increased involvement of the private sector. More nursing institutions — that have in reality become migrant institutions — are training nurses specifically for the overseas market, with the result that skills are matched to Western diseases and illnesses, leaving the country critically short of healthcare personnel. Already, in 1999, Filipino doctors had started retraining as nurses and leaving the country in search of better pay.

It is difficult, then, to see how the Philippines is an example to emulate. Unless, of course, beneath the veneer of “partnership and collaboration in health”, lies the objective of exporting Kenyan nurses with increased diaspora remittances in mind – Kenyans in the UK sent KSh28.75 billion in the first nine months of 2022, or nearly half what the government has budgeted for the provision of universal health care to all Kenyans. If that is the case, how that care is to be provided without nurses is a complete mystery.

Already in 1999, Filipino doctors had started retraining as nurses and leaving the country in search of better pay.

For the UK, on the other hand, importing nurses trained in Kenya is a very profitable deal. Whereas the UK government “typically spends at least £26,000, and sometimes far more, on a single nurse training post”, it costs only £10,000 to £12,000 to recruit a nurse from overseas, an externalization of costs that commodifies nurses, treating them like goods to be bought and sold.

However, in agreeing to the terms of the trade in Kenyan nurses, the two governments are merely formalizing the reality that a shortage of nurses in high-income countries has been driving the migration of nurses from low-income countries for over two decades now. Along with Ghana, Nigeria, South Africa and Zimbabwe, Kenya is one of the top 20 countries of origin of foreign-born or foreign-trained nurses working in the countries of the OECD, of which the UK is a member state.

Faced with this reality, and in an attempt to regulate the migration of healthcare workers, the World Health Assembly adopted the WHO Global Code of Practice on the Recruitment of Health Personnel in May 2010. The code, the adherence to which is voluntary, “provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states.”

Article 5 of the code encourages recruiting countries to collaborate with the sending countries in the development and training of healthcare workers and discourages recruitment from developing countries facing acute shortages. Given the non-binding nature of the code, however, and “the severe global shortage of nurses”, resource-poor countries, which carry the greatest disease burden globally, will continue to lose nurses to affluent countries. Wealthy nations will inevitably continue luring from even the poorest countries nurses in search of better terms of employment and better opportunities for themselves and their families; Haiti is on the list of the top 20 countries supplying the OECD region.

“Member States should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers.”

Indeed, an empirical evaluation of the code four years after its adoption found that the recruitment of health workers has not undergone any substantial policy or regulatory changes as a direct result of its introduction. Countries had no incentive to apply the code and given that it was non-binding, conflicting domestic healthcare concerns were given the priority.

The UK’s Department of Health and Social Care (DHSC) has developed its own code of practice under which the country is no longer recruiting nurses from countries that the WHO recognizes as facing health workforce challenges. Kenya was placed on the UK code’s amber list on 11 November 2021, and active recruitment of health workers to the UK was stopped “with immediate effect” unless employers had already made conditional offers to nurses from Kenya on or before that date. Presumably, the Kenyan nurses who left for the UK in June 2022 fall into this category.

In explaining its decision, the DHSC states that “while Kenya is not on the WHO Health Workforce Support & Safeguards List, it remains a country with significant health workforce challenges. Adding Kenya to the amber list in the Code will protect Kenya from unmanaged international recruitment which could exacerbate existing health and social care workforce shortages.”

The WHO clarifies that nothing in its Code of Practice should be interpreted as curtailing the freedom of health workers to move to countries that are willing to allow them in and offer them employment. So, even as the UK suspends the recruitment of Kenyan nurses, they will continue to find opportunities abroad as long as Western countries continue to face nurse shortages. Kenyan nurses will go to the US where 203,000 nurses will be needed each year up to 2026, and to Australia where the supply of nursing school graduates is in decline, and to Canada where the shortage is expected to reach 117,600 by 2030, and to the Republic of Ireland which is now totally dependent on nurses recruited from overseas and where working conditions have been described as “horrendous”.

“Adding Kenya to the amber list in the Code will protect Kenya from unmanaged international recruitment which could exacerbate existing health and social care workforce shortages.”

Like hundreds of other Kenyan-trained nurses then, Nancy will take her skills overseas. She has found a recruitment agency through which to apply for a position abroad and is saving money towards the cost. She is not seeking to move to the UK, however; Nancy has been doing her research and has concluded that the United States is a much better destination given the more competitive salaries compared to the UK where nurses have voted to go strike over pay and working conditions. When she finally gets to the US, Nancy will join Diana*, a member of the over 90,000-strong Kenyan diaspora, more than one in four of whom are in the nursing profession.

Now in her early 50s, Diana had worked for one of the largest and oldest private hospitals in Nairobi for more than 20 years before moving to the US in 2017. She had on a whim presented her training certificates to a visiting recruitment agency that had set up shop in one of Nairobi’s high-end hotels and had been shortlisted. There followed a lengthy verification process for which the recruiting agency paid all the costs, requiring Diana to only sign a contract binding her to her future US employer for a period of two years once she had passed the vetting process.

Speaking from her home in Virginia last week, Diana told me that working as a nurse in the US “is not a bed of roses”, that although the position is well paying, it comes with a lot of stress. “The nurse-to-patient ratio is too high and the job is all about ticking boxes and finishing tasks, with no time for the patients,” she says, adding that in such an environment fatal mistakes are easily made. Like the sword of Damocles, the threat of losing her nursing licence hangs over Diana’s head every day that she takes up her position at the nursing station.

“The nurse-to-patient ratio is too high and the job is all about ticking boxes and finishing tasks, with no time for the patients.”

Starting out as an Enrolled Nurse in rural Kenya, Diana had over the years improved her skills, graduating as a Registered Nurse before acquiring a Batchelor of Science in Nursing from a top private university in Kenya, the tuition for which was partially covered by her employer.

Once in the US, however, her 20 years of experience counted for nothing and she was employed on the same footing as a new graduate nurse, as is the case for all overseas nurses moving to the US to work. Diana says that, on balance, she would have been better off had she remained at her old job in Kenya where the care is better, the opportunities for professional growth are greater and the work environment well controlled. But like many who have gone before her, Diana is not likely to be returning to Kenya any time soon.

*Names have been changed.

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