In the aftermath of the August 8, 2017 General Election, I received a telephone call from a friend two days after the peaceful elections.
“How are you feeling?”
“I am easy”
“Are you sure?… “Your person lost….yet again,” I could immediately follow her train of thought and already detected a sense of glee underneath her controlled tone of voice. It was the voice of a victor trampling, its authority over the vanquished.
Politics is like placing a bet. “I had placed my bet and I had lost.”
“We Christians believe it is God who gives people a leader,” she preached. My friend is a dyed-in-the wool Catholic. The Catholic God had spoken but not before the ethnic god had had his sway.
“We Gikuyus are a proud people, we do not pretend to be what we are not,” she averred. “And you know it. We do not vote for anybody else…it is not as if we are going to begin now.” In other words, the Gikuyu, were considered the sui generis of Kenya.
“I am a proper Gikuyu – born and bred, I cannot pretend to be otherwise. What else can I be? You must learn to be selfish. That is just how we Gikuyus are.”
The “royal we”, the “We” of a blessed people, the ‘we’ of a special type, a selfish type in large company, a people whose great, arable, fertile land “flowed with milk and honey” was alive in her voice. But I am jumping the gun.
“Why does Raila want this thing so much?” The question was rhetorical and disapproving. Was she implicitly suggesting that it was not in Raila’s make-up and pedigree to pursue the presidency? Was she insinuating the presidency could be a preserve of a certain breed? The tacit tone in her voice implied Raila’s push to be the president of Kenya was tantamount to a power grab. He was an irritant whose push needed to be stopped, once and for all.
We Gikuyus are a proud people, we do not pretend to be what we are not……. We do not vote for anybody else
She reached for local idioms to explain the negative effects of deep craving and desire followed by a brief political history of Raila Amolo Odinga.
“Yeenda muno ituaga rurira.”(If it is too eager, it will snap the umbilical cord)
“Weendi munene ndukinyaga.”(Great eagerness ends up in naught). Both were admonitions.
The first idiom has something to do with the birthing process. Rurira is the umbilical cord – of a cow. If the cow is too eager or impatient, to get through quickly with the birth process, it may end up dislocating the cord; in the process killing the youngling. Therefore, calmness and patience is demanded. The eagerly anticipated birth of a new life is a painful and slow process.
That Raila Odinga is impatient in his pursuit of the presidency is a sub-theme I had heard again and again, among the Gikuyu sub-nationalists. That he had exposed himself – possibly to the gods who dispense the presidency. That he has been unable to tame his unmitigated ambition. The total sum of all these “vices”, bordered on avarice. And therefore, ultimately, his pursuit of the presidency is ungodly.
“I will tell you why Raila never wins the presidency…will possibly never get to be the president,” she prophesised, “it is because he has been too eager – and this had ruined his chances.” She hastened to add: “I know (Mwai) Kibaki also longed for the presidency and tried three times, but he did not come off hungrily wanting to be the president.” I reminded her these were two different personalities with two distinct characteristics.
“Why does Raila want to be president so hard?” It was starting to sound like a soliloquy. “It cannot possibly be for a good reason. Let me tell you the (political) history I know of Raila. I was only two years old when I heard about Raila’s involvement in a coup d’état. Since then, he has always wanted to be the president. What does he want to do with the presidency?”
The stream of thoughts from the other end of the call sounded concerned and perplexed over this “vexing” issue of Raila’s presidency.
“Is this a person to entrust the future of the country?” I was not sure whether this was a question or statement. Or both.“I voted for Uhuru Kenyatta because I can entrust my children’s future with him,” she affirmed. “Corruption is bad – no doubt – but we (Gikuyus) must have a leader we can feel safe with.” I got the drift.
And this was the drift: Raila Odinga is not a Gikuyu. He cannot be trusted. He should not be allowed to be president. The future and security of our (read Gikuyu) children cannot be safe with Raila, the Luo. The qualification for becoming the president of Kenya to the Gikuyus was only one: the person’s ancestral origin must be from Gikuyuland. Full stop.
The presidential run was not a contest of ideas. It was not about re-evaluating the performance of the government against the promises it had said it would fulfil in its 2013 manifesto. It was not about wanton theft that had been perpetrated under its glaring watch. It was not about: four and half years later, what did the government of President Uhuru have to show to the people of Kenya. No. It was about – Uhuru is a mugikuyu – that really is all it boiled down to: to anyone who considered themselves a “true” mugikuyu– educated or illiterate, rich or poor, young or old, urban or rural.
Uthamaki nduneanagwo (leadership is not given away) has been a mantra that has been gaining currency among the ultra Gikuyu nationalists in the lead up to the August 8, 2017 general election. It is as if the presidential leadership of Kenya is a sacred right among the Gikuyu people.
Why does Raila want this thing so much?”
My friend who had plenty to say paused to ponder. “I would not say Uhuru is exactly young – but he has youthful ideas,” I gasped. Which of Uhuru’s ideas were young and which were old? How had his “youthful ideas” had any impact in his four years as president? I was not going to pursue a moot point. But the insinuation had been made, somewhat covertly: Raila is old, he has old fashioned ideas and therefore, should not be running for presidency.
Mwai Kibaki, the third president of Kenya assumed the reigns of presidential power at the age of 72-years-old. Mzee Jomo Kenyatta, the founding president of Kenya, the father to the fourth president of Kenya, Uhuru, become president at 73 years. Those facts were unnecessary here. So, I opted not to belabour the issue of presidential age dynamics.
“What we want is peace,” she cooed into the speaker. “The elections were peaceful and we need to go back to our normal lives. Raila has lost the election, let him not cause trouble.” The mantra “accept and move on” had since 2013, when it was coined by The National Alliance (TNA)/United Republican Party (URP) mandarins, after the coalition had won a Supreme Court case against Coalition for Reform and Democracy (CORD) achieved a definite political parlance. In not so many words, my friend was asking Raila to “accept and move on.” As indeed with the rest of his supporters.
History has a wicked sense of humour. My friend could remember Raila had ostensibly participated in the 1982 coup, but had conveniently forgotten to mention, that he had spent nearly a decade in detention? Fighting for the democratic space and a liberal political climate and culture that we all now enjoyed
How could she forget the role Raila played in Kenya’s second liberation that culminated in the return to the multiparty politics in 1991? In 2002, at Uhuru Park in Nairobi, in a historic moment, Raila swung the cavernous mood of Kenyans to vote for one Mwai Kibaki, resulting in a resounding ousting of Daniel arap Moi’s ancien regime that had tormented them for 24 very long years. How could she not remember this recent history?
The eminent historian E.H Carr in 1961 said: “History has been called an enormous jigsaw with a lot of missing parts.” There are a lot of missing parts in my friend’s political history, deliberately so, nevertheless. Of course, it is a revisionist history, which she is happy to carry along – in the full knowledge that any other history, would rock her worldview.
My friend had grown up in a village in Central Kenya. She was from Gatundu, President Uhuru’s ancestral home. From a young age, she was taught that she was born into a special lineage. That she came from an ethnic community that was God-fearing and abundantly blessed. She recited to me the first stanza of a poem, that she told me her mother used to recount to them growing up.
The poem went something like this:
Ngai niaheire Gikuyu bururi mwega,
Utagaga mai kana irio kana mbura, kana ithaka
Bururi uri irima, mikuru na ithima
Kuma Kirinyaga kinya Kirimbiruri
Uthereraga iria na uki.
(God endowed the Gikuyu people with a great nation
That neither lacks water, nor food, nor rain or land
A nation blessed with mountains, valleys and wellsprings
From Kirinyaga to Kirimbiruri
That flows in milk and honey)
“I have never forgotten that narration,” she proudly said. “I grew up knowing that I come from a privileged ethnic community and that we are a special breed.”Unapologetically, she announced: “That is my worldview, there is really little I can do about it.” In all of her 37 years, she said she was delighted to always carry that narrative with her. “I am a mugikuyu girl and that is how God willed me to be.”
The presidential run was not a contest of ideas…. No. It was about – Uhuru is a mugikuyu – that really is all it boiled down to: to anyone who considered themselves a “true” mugikuyu– educated or illiterate, rich or poor, young or old, urban or rural.
Today, my friend is a proud member of a wealthy upper class, living in the suburbs of Nairobi. “To be honest, I am not one to worry about the price of milk in the supermarket,” she said matter of fact. “It is not as if I plotted to be where I am. The Lord has been good. I thank him every day. What I want is peace and calm, so that I can go about my daily chores unhindered.”
Projecting an innate fear of the Luos and Raila, my friend had recently taken to totting the rosary. Appropriating the Christian God, the archetypal Gikuyu has conflated his ethnic beliefs with a Jewish God who must support his political cause: he scours the Old Testament to locate chapter and verse that vindicates his political maneuvering.
The Gikuyu language has an idiomatic expression which approximates the English language maxim: “Those who pay the cost are rarely those who reap the benefits.” That is a fact of life said my friend. “Some people are born to be leaders…others even struggle and suffer on behalf of other citizens, but if you are not lucky and, if God has not charted out a path for you, however hard you try, you will not make it.”
It was a long phone call that made me recall Apostle Paul’s first letter to the Corinthians, chapter 13:12 – “For now we see through a glass darkly; but then face to face: now I know in part; but then shall I know even as also I am known.” King James Version (KJV).
For now, we see a blurred image in the mirror. Then we will see very clearly. Now my knowledge is incomplete. Then I will have complete knowledge as God has complete knowledge over me.
By Dauti Kahura
Mr Kahura is a freelance journalist based in Nairobi, Kenya
Obviously They Are Fine With Mugabe
My identity straddles African borders.
I was born in Zambia to a Zimbabwean mother and a South Africa father.
Of the three countries, I carry South African citizenship.
On social occasions I have often been at loggerheads with my compatriots who self-identify as pan-African. There are, you see, African politicians they will not brook criticism of. And one of them is one Robert Gabriel Mugabe: truth-speaker to the West, the man who had enough gumption to take land back from the whites and whose truth-telling videos, in this age of social media, they shared every year after the United Nations General Assembly. Any attempts at telling these, my fellow ‘woke’ South Africans how rhetoric did not match action and how the man, his family and his political party had often treated Zimbabwe and its citizens with contempt was always met with disbelief and what my friend and writer Petina Gappah calls Zimsplaining from my fellow South Africans. Why, they would ask, was I taking aspirin for someone else’s headache? Obviously Zimbabweans are fine with Mugabe. If they weren’t, surely they would object, toyi-toyi and overthrow him? This was the criticism that brooked no comeback as it was something that I wondered secretly sometimes. I had grown up in a Zimbabwe that protested: not just university students full of pent-up early adult hormones but notably, the teachers’ strike of 1990. What had happened to that fire? And then last year I decided to have my 40th birthday party in my mother’s country en route to South Africa by road from the country I now call home, Kenya.
In Zimbabwe in the days after my birthday, I found out that the two currencies which had created some sort of stability, the US dollar and the South African rand, were now going to be scrapped. In their place would be bond notes which, on being brought in, would be valued one to one with the US dollar. The Minister of Finance, Patrick Chinamasa and John Mangudya, Governor of the Reserve Bank of Zimbabwe had decided that the bond notes would be back in circulation in October 2016.
Already, while I was there, people had started hoarding their dollars and some shops were refusing to accept South African rands.
It was in this context that on the evening of August 2, 2016 I got a poster via WhatsApp from a friend reading:
‘Do you want to destroy your business that you have worked for all these years? SAY NO TO BOND NOTES. Join hands and march against Bond Notes.
Date: 03 August 2016
From: Cnr Julius Nyerere/Jason Moyo
To: Ministry of Finance
#pullingtogether #notobondnote #Tajamuka/Sesjikile‘
I had already dealt with a cash crisis in the week that I had been there. My cash crisis meant I could not go and see a lot of aunts and uncles as one cannot use a Visa or Mastercard on public transport. But my inability to visit relatives seemed minor when I heard some heartbreaking stories from people who live in Zimbabwe. I was, after all, just a guest in Zimbabwe and had other places to go. What of those who stayed there on a regular basis?
I thought of the unemployed university graduates working as vendors because of unavailability of jobs. I was thinking of a conversation with my friend Tapiwa who told me he interviewed five graduates, one of whom had twenty years teaching experience and another who had a degree in Architecture – married with children – to tutor his nine-year old twins for $200 a month. What would happen to the prospective tutor in a city where a reasonably neat two bedroom flat in the low density areas cost $500 a month? What would happen to the cab driver I met who had a car and wanted to survive with his four children but could only charge three dollars because no-one was willing to pay more than that for a five kilometer trip, essentially making his cab rides cheaper than Uber in Nairobi, Lagos or Johannesburg without cheaper foodstuffs? I was thinking too of my cousin Abisai telling me that because of a lack of cash, if business people needed a thousand dollars to do transactions, they had to do a transfer to illegal cash traders by the bus station for $1,200 so that they could get the $1,000 they wanted. And this was when the dollar was still circulating in the Zimbabwean economy but people were hogging it because of fear of the threatened bond notes.
This was a protest I would sign up toyi-toyi for.
With the Zimbabwean courts having ruled against the police and the government in their quest to ban people from marching against the return of the painful notes into the economy, taking part in the protest was the right thing to do. Half of my family is, after all, Zimbabwean and the bond notes would impact them.
I had no idea who was organizing the event but whoever they were, I agreed with the reason for their demonstration and I wanted to do more than verbally support it.
On August 3rd 2016 as my fellow South Africans went to the ballot box to vote in the municipal elections. I was north of the border at a march against bond notes.
I arrived at the march just before it began. After a prayer and the singing of the old Zimbabwean anthem Ishe Komborera Africa whose lyrics and tune were taken from the late South African Enoch Sontonga, the organisers informed us of the route we would be taking. I asked one of the fellow marchers why we were not singing the current Zimbabwean national anthem and the wit responded, “it would be like listening to a speech by Grace after reading one by Sallie Mugabe.”
Until he was forced to resign on 21st of November 2017, when talking to many Zimbabweans, it was never quite clear who they resented more: their then senior citizen President, Robert Mugabe who stubbornly held on to power way past his sell-by date or his flamboyant and vituperative wife, Grace. Further, I sometimes wonder whether the affection that is given to the late Sallie by Zimbabweans who talk of her fondly would still be there if she were still alive. I also wonder whether Mugabe would have retired gracefully if she were alive. Random musings.
But back to the protest.
The organisers informed us of the route we would be using and we proceeded to march.
I noted that the face of protests had changed drastically. Prior to 2016, most protests consisted of either members of the opposition party or employees of non-governmental organizations who sometimes were both. While many people my age felt the pinch, they were members of what I dub The Sandwich Parents. When asked to boycott bread because it had become overpriced, for instance, their response would be something akin to, “Ah manje, my children need sandwiches. If I boycott bread for a week, what will my children take to school?”
But now, knowing how this may hurt them, they were among those who were taking part in the protest. A friend in the banking industry called in sick so she could take part in the protest. I encountered some high school friends during the march, among them a former classmate who, not only had actively spoken of the abuse of power by the Mugabe administration but who got thrown in jail together with her partner and others for daring to screen the Arab Spring when they took place. For her actions, Tafadzwa and her comrades were charged with attempts to overthrow the government. They received a suspended sentence “if they do not repeat it” by a court system that was largely state-captured.
Another high school friend was at the march because her brother-in-law, a former Zimbabwean liberation war veteran, was arrested and charged for speaking out against abuse of power by the political leadership of the governing party. Saner minds in Zimbabwe’s High Court, which now seemed keen to no longer be puppets to the puppet-masters that are ZANU government, prevailed and the case was struck off the roll. I saw friends who had returned from the diaspora with their savings hoping to invest in the country. Among those in the crowd too were unemployed university graduates in their gowns and grandmothers. There was something about this particular demographic that I had not seen in previous marches in Zimbabwe. There was a certain unity of purpose across age, gender and class that seemed to highlight that people were fed up. I did not know it then but I had just witnessed the beginning of the end for the Mugabe leadership which would topple a little over a year later.
The government had attempted to ban the march. The organisers went to court and the courts allowed it. Knowing that despite the court ruling, the law will not always act lawfully towards protestors, flyers were handed to the police reading:
OPEN LETTER TO THE POLICE
We are not your enemies, but we are your brothers and sisters, fathers and mothers. All we want from life is to be able to feed our families and to be able to send our children to school so that they can get jobs and do the same for their children. We want them to work in Zimbabwe, not outside the country as it is now. We want doctors and medicines in our hospitals. When we stand up to ask our government for these basic human rights, do not beat us, rather stand with us as we want the same basic human rights. Above all, we are all Zimbabwean, let us unite in demanding these rights from our government.
It was doubtful that the police would really care. They were there to do the bidding of their masters but it was good to see an attempt by the organisers to wake them up.
In Zimbabwe, there seemed to be questions about the government’s relationship with China as heard from the popular song on the march:
Bobo, watengesa nyika kumaChina
Tisu takakuisa, tichakubvisa
A song that accused Bob, the President of having sold the country to the Chinese and reminding him that they were the ones who put him in power and had the power to remove him. It was an entertaining song but I wondered just how much power these people with their energy had, to remove Uncle Bob from power.
By the time we got to Treasury, many had joined and there were now thousands in a march that began with a few hundreds. It was then that I realized that perhaps something had changed. Zimbabweans were not only talking in private about being fed up with Mugabe, they were coming out in the street and publicly declaring it.
And so, on 18 November this year, although I was at a literary festival in Nigeria, I locked myself up in my room for a major part of the day to root for and follow the #MugabeMustGo protest through updates on social media. Zimbabweans were showing, this time in the glare of international media, that they were done with their geriatric leader.
Mugabe is now gone. I heard this announcement in an anti-climactic moment while in Nairobi making dinner.
Mnangagwa is in the driver’s seat.
I am cautiously optimistic for my mother’s country as I reflect on the coup that was not a coup from my father’s country. I like to think that Zimbabweans have realized the power they have and will not surrender it easily now to any politician.
A Healthy Serving of Reality
I never thought I would be on the receiving end of gratitude until cancer happened. This show of kindness has kept me on the other side of Kenya’s health care system. I consider myself lucky. I am able to afford chemotherapy drugs, monthly tests and doctor’s visits and supplements.
It is common knowledge that cancer is not cheap and this is universal. At the height of my treatment, I was spending 140,000 shillings a month on treatment, the cost of my bone marrow transplant has more zeros and commas. It is thanks to family, friends, colleagues and strangers that I was and still am able to afford my treatment. Acknowledging this fills me with a sense of humility. I struggled with the kindness that was showered my way. My therapist who helped me grapple with the many twists and turns of this journey told me to be ‘open to kindness’. Pride stood in my way, but the bitter truth was that I could not have done this alone. We as a family, could not afford this alone.
Our healthcare system is us! It will be us, the people, holding one another until we have a public healthcare system that will be able to provide universal, affordable and quality healthcare services. My diagnosis gave me new eyes to accompany this new normal. I was hugely aware of the shortcomings of our public healthcare system and once you experience it, it scares you. And if you have private medical insurance, you will appreciate the cover. But these health covers are not bottomless pits. If anything, they cushion and if it’s excellent, it offers restful nights. During the two weeks of my hospitalisation, I spent over six hundred thousand shillings of my one-million-shilling in-patient cover. Thankfully, NHIF, knocked off another 100k. My outpatient cover was going to be blown in sixty seconds and I was tapping into my savings.
Alice Membao Tawa, was my nyanya, my grandmother. Sometime in 1999, she was admitted to the burns unit of the Kenyatta National Hospital (KNH). She spent many weeks there until she passed away. The burns unit is not pretty, but we made our visits to the hospital hoping nyanya would get better. That period introduced me to the harshness of our public health system.
It is functional, though not wholly efficient. Kindness doesn’t come easily for some members of staff. There is a tough-love, ji-sort, hii-ni-kazi and uta-do attitude that is harboured by some of the staff. I witnessed patients lying on mattresses on the floor, and there were patients sharing single beds. Beds were currency. There were no three-course meals like the Nairobi Hospitals, Maters or Aga Khans, the food was bland, stodgy and uninviting. It provided the most basic of nutrition. The hospital and the wards had a beaten and drab feel to them. They didn’t offer comfort or healing. I’ve been to Kenyatta many times after that, for several reasons, and there have been vast improvements, but it is far from perfect.
We work hard to able to afford private healthcare, but sadly not everyone in Kenya can access this. I don’t take this for granted. I was saddened by the many stories of patients being turned away or dying due to the lack of medical personnel during the doctor and nurses strike. I heard medics being described as selfish for downing their tools. I bet these critics made sure their health premiums were up to date nor had they slept or walked into a public health facility.
Let us not deceive ourselves, as we live in Kenya, we are not too far from experiencing the ‘other side’ of our health care. I keep on imagining what if I was to have an accident in public either in Nairobi or elsewhere? I would probably be rushed to public health hospital before my insurance provider is notified. I have thought about it constantly. What if the only place that I would have been able to afford or receive treatment for my cancer would have been from a public health facility? If I had to receive chemotherapy intravenously and not orally, I’d be making an early morning pilgrimage to KNH and camping on the hospital grounds as I wait my turn. It would be a process of waiting hours to see a doctor for minutes and hoping that on that day they would show up.
Over the last 24 months, I have met other cancer patients who have lived that experience of waiting, wondering and hoping. There was six-year-old Waithera who was scheduled for surgery on the day the doctors’ strike began. She was only able to get badly needed surgery when her father was informed about the Faraja Cancer Trust, but before this, the hospital in Nakuru had become a second home.
I learnt that it was faster and cheaper if you got admitted as an overnight patient at Kenyatta for chemotherapy treatment. I hope the new equipment at Kenyatta will reduce patient waiting times. I was told that it was faster for patients in the western part of the country to go to Uganda for radiotherapy treatment rather than coming to Nairobi. Yes, Uganda, whose only radiotherapy machine hit the global headlines when it broke down last year. Yet, there is a radiotherapy machine in Kisumu lying idle because there aren’t enough numbers to justify the cost of operating it. Apparently, there aren’t any oncologists in Kisumu. One must go to either Eldoret or Nairobi for treatment.
In rural medical centres, there are numerous stories of misdiagnosis because of some patients (some now deceased) were tested and treated for malaria or typhoid before the discovery of cancer or either a preventable or treatable malady. I still get angry thinking about this. Early diagnosis of breast, cervical and prostate cancer make these three cancers treatable and affordable. Being diagnosed with cancer doesn’t necessarily mean death.
Our healthcare system is us. ‘Naomba serikali’ does not cut the mustard anymore. The mode of referrals for specialists, surgeons, pharmacies, and hospitals both in Kenya and abroad is word of mouth. I created a spreadsheet of the different outlets that I could source my medicine from and the phrase, ‘naenda kutafuta dawa‘ became real. There was one time I went to three hospitals looking for a drug because it was in short supply. That was when I realised that there are many of us on this journey. A journey to find the best possible healthcare that our money can afford to buy.
I followed the doctors and nurse strike keenly, read the Collective Bargaining Agreement (CBA) and cried tears of joy when an agreement was reached. We need to put more into our public health system. I am sure we know of cases of patients being transferred to KNH from private hospitals because it was cheaper cost wise. Remember those bottomless pits? They don’t exist. We have a cadre of men and women who are passionate about their work in public health. We can only reward their duty by making sure that they work under the best possible conditions. I have seen it work in the UK, through the National Hospital Service. It is not perfect, it has its critics, but it works. I look forward to the day when we will have a system that we too can boast of. One can dream, right?
But until then, our healthcare system will continue to be us. Where we look out for one another, attend medical harambees or give towards Mchanga campaigns, share a referral or WhatsApp messages on cancer, diabetes and blood pressure cures! We cannot afford to have a health system that ‘others’ individuals or provides care that is dependent on the size of one’s purse.
For we all know that death and disease do not discriminate.
Counting People in a Broken Health System
I remember, a young woman, a freshly minted teacher named Leah- who was very fond of my father. I was a little boy then. She looked up to father as a senior teacher and a mentor to help her grow into the profession. My father and mother were fond of her and she was a common visitor to our house. In our young minds, age sets were binary: you were either nyithindo or jomadongo, children or adults. Children were the people you could play with, the people you called by their first names and complained about to your parents. Adults were a whole other matter, separated by a chasm that moved through time. They were people who even when informal in their manner, had to be treated with the formality that adulthood conferred.
Leah was confusing for my binary world. She was at a stage my elder siblings had not gotten to yet, somewhere in between a child and an adult. When she was around she cooked with us, referred to my mother as “mama”, and seemed more at ease with my teenage sisters and cousins. Yet she held adult conversations with my parents and could gently disagree with them in conversation. I probably had a little puppy crush on her. She straddled that space with some aplomb. My parents loved her. My elder brother’s eyes never left her swaying hips as she navigated the ten metres or so between our detached kitchen and the main house holding a tray of food or kettle of tea in her hands. My sisters could not wait to be her- she had all the big girl privileges: she could choose her own clothes, she wore jewellery, and she earned a salary at the end of the month!
Even after she moved to a different school further away, the warmth of her company whenever she returned to visit did not change.
One day, word arrived that Leah had died. The whole family was left reeling. My sisters cried. My brother went off to the simba- my second to last unmarried uncle’s house- lost in a daze of disbelief. Although my parents were stoic, they could not hide their pain. Nobody wanted to explain death to a little boy. Up until then death was an exciting and rare occurrence associated with screams tearing the bucolic night air from the direction of the home of an ailing elderly man. They were not people I knew. In my little sheltered, small town rural existence, I had never met anyone who later went off and died.
Leah died. She was the first person I had met, known, even loved, who died. She had died during childbirth. One moment she was full of life and carrying the promise of a brand-new life, the next moment she was dead. Cause of death. Maternal mortality. Leah had come up against maternal mortality and lost.
Maternal mortality is a sterile pair of words. It is impersonal and jarring. I did not know who the father of Leah’s child was but I felt for him. Maternal mortality is the sudden shot between the closed eyes, blissfully sucking on the lollipop of life. Maternal mortality is a rusty serrated knife piercing your back. One moment you are tingling with excitement and looking forward to holding a new life in your hands and looking at the incomparable poem of joy that is the face of a new mother. The next moment you are planning a funeral.
A woman went out, and two coffins came in. A big one and tiny little one.
I did not know these things then. But, I know them now. I became a pharmacist. Then I drifted, a journeyman into public health with a penchant for math. So I count things. I count ratios and rates, odds and people’s chances. I create pivot tables and run scripts. I find blips and upticks and trends. And to stay human I try not to think of counting Leahs and little babies who have not had the chance at a name. A simple name.
2017 has been a rough year for mothers, babies and families across the country. The year opened to a doctors’ strike that was a month old and would continue into March stretching for a 100 days. Public health facilities were on their knees. Clinical officers and nurses did what they could and sent those they could not handle to private health facilities, which sometimes is the same as being sent home to die. After a brief respite, the health system would once again go into the convulsions of massive labour unrest with the nurses’ strike. That strike would last 5 months before getting called off.
If doctors are the analytical mind of the health system, nurses are its beating heart. A formidable nurse-doctor team, with the backing of a working health system, is what makes maternal mortality quake in its shoes. For the better part of 2017, there has been no team. No team means that Caesarean sections and assisted deliveries are not happening. Blood transfusions and resuscitation are nowhere to be found. Incubators are not whirring; bleeding mothers are not stirring. Ambulances are running across the land blaring sirens of death.
One of the simplest pieces of health data that indicates the health of the health system is vaccination coverage rates. It is simple because vaccines are given at predetermined intervals and ages. When a baby is born they get BCG- the tuberculosis vaccine- and the polio vaccine. Kenyans have about 30 babies for every one thousand people every year. If there is a community of about 5000 people then we expect that a baby is born every two days or so and 12 children get birth vaccines every month. Vaccine coverage responds quickly, positively or negatively, to failures in the health system- when people cannot get to the health system for reasons such as flooding, when medicines or syringes are not available, when there is no energy supply for refrigeration and when staff are not at their posts because they are on strike.
Vaccine coverage has dropped precipitously in communities that rely primarily on the public health system. Less than 5% of Kenyans have private health insurance, so this means almost every mother who is not on Facebook. Vaccines protect children individually but also as a group in what is called herd immunity. The chances of a vaccinated child getting the infection they have been vaccinated against is lower than for an unvaccinated child and if they do get the infection it commonly runs a shorter course and is less severe and less likely to lead to death.
This means that they are less likely to spread it to other children who also, if vaccinated, are less likely to catch it. Vaccination is therefore equivalent to children locking arms and standing shoulder to shoulder against vaccine-preventable diseases. Unvaccinated children are a big hole in that wall- their own risk rises massively but they also increase the risk for vaccinated children.
More ominously still, falling vaccination coverage is an outward sign of an ailing health system. For four years of my working life, I kept verbal autopsy tables: Excel sheets where in a community the size of a small district it was my business to know who died, where, when, and why. I learnt what makes people die. In what seasons people killed one another and when people killed themselves. I got to know intimately how the health system fails babies, children, mothers, and other people and how the consequences are felt in communities are far removed from tables and graphs.
As the Kenyan health system convulses, children are dying from immunizable diseases. People are missing precious doses of chronic medications such as diabetes and HIV medicines. Women are bleeding to death in ambulances and that is one Leah, too many.
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