August 13, 2017
SEVEN: Post, post-election. The bursting open of the vast abyss beneath the veneer of ‘nation’. The mournful gushing of blood torrents. The turbulent groans of the lost, the soundtrack of a beautiful mother’s keening over her red-shirted son’s still, still body, miasma of teargas from canisters flung into homes through doors and windows, (the absence of media in their role as witness). Along the edges of the crevice, in awe of ruins and a thousand anonymous bullet cartridges (all used), are the ribbon-decked many who giggle, and baptise the torrents ‘streams’, and the groans, ‘thin gasps of the failed’ (failed: those other people, disposable, unmournable, Kenya bodies, renamed ‘criminals’). Moving on, yes, but remember, there are 360 degrees to choose from. There is no guarantee that our steps will converge. So…anyway…sometimes before an awful mystery that wears the face of existential dread, silence. Silence. There are destinations we reach where questions are not possible. So, again, silence. And watch. The clouds; watch them too. At some point, they might let the light in again. In the interim, to those who now must, Safari njema. And if you will, if you get there, do let me know the name of the country where you, at last, safely build your hearth. It is still winter in August here.
ONE: The unmournable, the disposable, and the uncountable. Those who counted differently. Those whose voices do not count for much. Now, their lives, we are told, do not count for much. Silently, we are called upon to watch. Incredulously, we apprehend their pain. Their death. Our imminent death. For three days ago, they were told not to stay home. They were told to go out and do what counts. They went. Willingly.
Being peaceful, it seems, has been reconfigured, as a first order question of the human being
Now, the streets are an abyss. A limbo. A space of abeyance that is too treacherous. Too dangerous. But some went out after the count. Some obeyed and stayed indoors, in the supposed safety of their homes, where they heard the darkness of the night pierced by jubilant vuvuzelas, hushed complaints, and then gunshots.
Now, their hearts are pierced by the fear that a bullet might pierce their walls…maybe their flesh, if not their souls. As they sit in silence, they wish something could pierce ‘our’ conscience. But all they get is orders and snide remarks about their own criminality.
How, my sister, did the place of abode become a marker of criminality? How did the finger marked in indelible ink become so trigger-happy? Become so quick to point and judge. So eager to stand in front of pursed lips so as to stifle the tongue of the (M)other…Shhhhh. Silence!!! It is a tragedy that for some, the ballot becomes the bullet so easily. In spite of this horror, there is hope. Life is resilient. It persists. Exuberantly. Painfully. Even when it is still. Even when it is silent.
ZERO : Has it come to naught, all our talks of peace? Maybe it was doomed to be so from the beginning. From the very first time, we agreed to disavow our old leanings, and their world of meanings. From the time, we agreed to forget. To forge on peacefully. Deceitfully. For what we were fed as peace was indeed a program of pacification. A formation that puts people and things in their assumed proper places – homes, offices, shops, factories, booths, and then graves, cells, exile – in their proper order. Sometimes, beyond the border.
We are pacified when our peace songs negate our humanly gains as they claim to sooth or obliterate our pains
Being peaceful, it seems, has been reconfigured, as a first order question of the human being. Here, being is being as peacefulness…we become peace beings. Partakers of a first order egoism that disavows justice, love and ethics. A self-referential mode that disavows any form of experimental altruism and the whole set of things or ways of being that peaceful cohabitation is predicated on. This peaceful order conceals the violence that produces it. It justifies the violence that sustains its. It glorifies the violence that it creates and sustains.
Whither peace and peacefulness when we remember that there are 360 degrees to choose from? When many are at point zero where it is clear that peace as pacification imposes itself upon us today. That peace as pacification dwells in our fear and the desire to silence the intense mirima (fury) of the other in the name of security. In the name of peace. Yes, we are pacified, even ossified, when the quest for peace quickly mutes our sister’s scream as the armoured thorax presses against her back. Against her face.
We are pacified when our peace songs negate our humanly gains as they claim to sooth or obliterate our pains. Songs that drown out our sister’s involuntary sigh, that cry that escaped her lips when a bullet stung her thigh and a boot was set to her eye.
To apprehend her pain. To mourn for her and those who we are told do not count, is to refuse this pacification. This Faustian pact and its sacrificial bargain. To mourn with her is refusing to negate others. It is refusing to be counted consensually even when we disagree. It is refusing to be drawn into a faux moral calculus where we are always invited to partake of the least of all possible evils in the name of normalcy. It is refusing the false dichotomies that make us inattentive to the pain of others.
…anyway….sometimes before an awful mystery that wears the face of existential dread, silence. Silence. There are destinations we reach where questions are not possible
So Scream!! Your voice is a refusal to participate in this sacrifice. This blood-bath that baptizes us. Sacrifices us. Sets us apart.
“…anyway….sometimes before an awful mystery that wears the face of existential dread, silence. Silence. There are destinations we reach where questions are not possible.”
But question we must. Even silently. We must question this peace that disavows life. This pacification that tells us that questioning perpetual peace will lead to perpetual war. We must question this false bargain that imposes itself upon us. A bargain that threatens to constitute us anew by calling up old formulas.
First silently, then virtually, and now with actual boots, batons, and bullets that I must flee. I flee if only so survive. To find a space where I, no we, can thrive.
But if I ever get there, know that I might not let you know the name of this country where I build my hearth. For you might follow me there…with your whispers and your habits. Our old habits and ghosts. Our old passions and affiliations. In my hearth, I want silence, maybe loneliness. Maybe stillness. I want to mourn for those who lie still.
For those who know it is still winter in August here and know the pains and the tragedy of what happened Sometimes in April…elsewhere.
So, again, silence. And watch….
TWO: Yes, I have arrived here. It is cold. It is still. It is a place devoid of certitudes and moral platitudes. But it is lonely. Silent. I yearn for the everyday laughter. For the familiar cries, confusion, hustles, and sufferings. I yearn for some place shared with others, if only for a moment. Even with a stranger. I yearn for my home before the teargas from canisters [was] flung through doors and windows.
Yes, I still dream of my home and it possibilities; its fragile hospitality; its banal hostilities. These that I had learnt to live with day by day with the hope of surmounting if only by counting.
If you will not join me here my friend, I will return home. Not like a thief in the night, but like a friendly visitor. Unannounced, yet pleasurable. For I still believe in you. I believe in us. In our home. Its flaws, notwithstanding. So please Speak! Please whisper. In this strange country whose name I have kept secret lest you follow me, I have tried to safely build my hearth.
As justification for his death. His is a necessary demise. A sacrifice, we are told. One that makes it possible for ‘us’ to return to normalcy. To return to reason. To return to raison d’état. To Peace, Love, and Unity…in the guise of development.
But my heart is elsewhere; it is there where It is still winter in August. It is there where the turbulent groans of the lost pierced my ears.
Where the witnesses sat silently as the beautiful mother keened over her red-shirted son’s still, still body.
It is there, where we were baptized…not once, but over and over again in blood. Our own blood. There, where brothers and sisters remained unmournable and uncountable because of how ‘we’ liked to count and Account. But I am returning. I am returning even if there is no guarantee that our steps will converge. I will try. For many before us have tried. Many more have cried. And many have died. So please stay. Stay at home when you can. Please walk, walk out if you must. Talk!!
Yes talk. Let your tongue exorcise our demons. Question, knowing that sometimes before an awful mystery that wears the face of existential dread, silence [abounds]. Silence that marks those destinations where questions are not possible.
But it is in this impossible place that we must dwell with others. With ourselves…maybe otherwise.
EIGHT: Like me, she returned home. She had hope and took the leap of faith. She gambled. She now kneels….
along the edges of the crevice, in awe of ruins and a thousand anonymous bullet cartridges (all used).She is a sign of our national game/gaming :
“pata potea. Kura ni karata. Mla samaki na uthamaki.”
You choose. You blink, you lose. She watches the sleight of hand, the genius of counting, and the terror of slippery algorithms. The error of our everyday rhythms. Little things that seek to determine the value of her life. To undermine her strife. To subject her to their values and evaluations. To their way of counting, praying, and playing (with fire).
For some, it is Lotto and tithe; for others, the wheel of fortune and kamari; for her, it has always been ballots, and then bullets. A perverse Russian roulette. A rigged bet. Sometimes, its just bayonets.
Her shame runs deep and wide…… It is a shameful old problem. It is our little family secret. One that remains unspoken.
But she still went out and queued. She hoped it would be otherwise. She paid her debts and hedged her bets. She risked, knowing that we bet on anything. That we gamble with everything. Even with life. With her life. With maize and highways…with plays. Yes, this land is a casino. A small betting house. “Mi casa, su casa” (my house is your house), they tell their friends. “Come here and play. Come here and prey.” From Shanghai to Dubai, from Cancun to Quangzhou, casino capitalism has its day. This foreign game that is now our own, renders her life cheap. She is superfluous.
“Ballot OR bullet,” the revolutionary of days of old told her. “No, it is Ballot AND then Bullet” …she bets. She knows her causality. She knows she will be the casualty. She always gets the bullet slot. It is not an either / or game. It is a question of if/ then/ when. Here, hope of winning against the odds is fatal. So she gets the bullet over and over. Last time it was her man, now it is her son. But she is hopeful. She knows that life will change. She knows that this game will change. So, she rises again, plays the game…hoping that one day…yes, one day… things will be otherwise. That ‘we’ might become otherwise. She waits. She watches. She counts. Silently…
Eight:As she waited, her hope turned into horror. Horrific Hope!! Her hands are up in the air. In prayer. She is a supplicant. She is pleading. She is bleeding. She hopes that her knees, now raw from kneeling, and her arms, stretched up high in the air will make her voice audible. That her prayer will save her. But her voice is noise.
Athumani and his boys swarm in. His armored convoy, his exo-skeletal thorax puffed out, his abdomen sucked in, his compound eyes seeing through walls, through holes. His antennae feeling for her, or for others like her. For all those unlike him. He hopes to crash her hope. To Horrify her. Like a locust, he arrives every five years. When it is winter in August. This is his season. But she is hopeful…For,Mungu si Athumani. Na… Athumani si Mungu.
She looks at Athumani’s ink stained finger, it looks just like hers. She focuses on his bloody trigger finger. First fear, fury, then shame. Deep shame. For she knows this man has been elsewhere before. She knows that he has been in someone else’s home. Invited. “Your home is my home…my playing field.” He tells her.
She can smell another woman’s perfume on him. She can smell someone else’s blood. All mixed with pungent teargas. How, she asks herself, does this man go back to his family after breaking so many homes? After breaking so many hearts. After wreaking so many lives. After taking Carol, Msando, and Baby Pendo. Does he remember that baby he kicked when he kisses his own? Will he remember her kneeling down and pleading before him when he kneels down to pray for his mother? To his heavenly father… Shame!!
Shame. Not only for the Athumanis in her house, but for all who gloat as they point at her wounded body. For all who condemn her son’s bloated body. She is ashamed for those who have chosen to forget our history of violence. For all those who, even before they listen to her story, assume that they know her fully.
Her and her type. That they know her value and values. That they know her son’s pathology; “he does not obey. He does not pray. He loves stones, more so in this country where stones are best left unturned,” they say.
Worse still, “he threw a stone yesterday, he drilled a hole in two of them and put a bar between them instead of piling them on top of each other and pouring mortar between them.” He is a fool, “he built his body instead of a house.”
He is gullible, “he fought to build a better body politic instead of a bigger house of ones own.”
He is a criminal…“he does not stay at home. He went out to the streets.”
He is a man-child. A crybaby… “he has too much Skin down there. He does not respect the sanctity of private property. He does not care about his own life or treat it like his own private property.”
Unlike Athumani, he is not a man. More so in this space of capital, his existence, his resistance, is a cardinal sin. A crime. So his life is cheap. Dispensable. Disposable. Unmournable.
Her son does not say ‘Me-I’ over and over again. He does not know the value of this egoistic style of accounting, so his life does not count for much. And a song of reason is sang, as the basis of peace. As justification for his death. His is a necessary demise. A sacrifice, we are told. One that makes it possible for ‘us’ to return to normalcy. To return to reason. To return to raison d’état. To Peace, Love, and Unity…in the guise of development.
Her son was moving too fast. He spoke back against those who want to retrace and revive old footsteps…those with nostalgia for the old man’s footsteps knowing full well where they already led us before. Knowing what they turned us into. Knowing how those footsteps turned us against each other. How these footsteps made the index finger supreme. How with the footsteps and index finger, we pointed each other… we judged and informed on each other. How this index finger was shaken in the air…triumphantly. Threateningly. How it judged, and then slid into the trigger and shot. How this index finger pointed and stood in front of men and women’s lips and commanded their silence. Their disappearance. She is ashamed for we forget how this same index finger that points at her son’s body today had rendered our little fingers useless. How the index finger’s blood stain is always fighting hard to erase the little finger’s indelible ink.
Point…point again. Her son’s death is not a mere spectacle. It is a spectre. A symptom, and a judgment.
Her shame runs deep and wide. She feels intense shame for those who smile from miles away assuming that these things only take place elsewhere or only took place in another time. “What are you laughing at?…you are laughing at yourselves.” She restrains her quote. Her ire, her fire, turns into cold shame. She knows that what is happening to her has taken place elsewhere and will soon take place elsewhere. This, she knows, is not just her problem, it is ‘our’ problem. It is a shameful old problem. It is our little family secret. One that remains unspoken.
“ watch them too. At some point, they might let the light in again. In the interim, to those who now must… Safari njema.”
But now, it is no secret that some do not have to commit a crime, they are the crime itself. They are an existential or ontological infraction. She cries for us all. She cries for her kith and kin. For those who persist. For those who say that “whether you kithni or ndekni” ( wiggle or shake) they will change the way we count.
She cries for those who obey and never question. For those who pray and then prey. For those who anoint and appoint. For those who point…and then smile. For those who celebrate any type of tyranny…She cries silently. For the false professors turned false prophets. She cries for those who count.[…]7,1,0,2,8,8…She counts slowly and watches the clouds to which Athumani might dispatch her. The clouds to which he has dispatched many others and hidden many figures. She keeps counting and says;
“ watch them too. At some point, they might let the light in again. In the interim, to those who now must… Safari njema.”
By Yvonne Adhiambo Owuor with Sam Okoth Opondo
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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