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Reflections

Medical Malpractice and Patient Advocacy in Kenya

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Medical Malpractice and Patient Advocacy in Kenya
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In December 2010, my mother was admitted to an established private hospital in Nairobi for what we considered a routine surgery. This surgical procedure was the culmination of a series of medical tests that begun in July that year in Kisumu where she lived and ended up in a referral to a sister hospital in Nairobi. After several tests and doctor consultations, the second doctor confirmed that she was in the early stages of cervical cancer and the best course of action for a woman her age – 64 years – was a hysterectomy.

It all seemed straightforward really. Armed with health insurance, we accompanied my mother through hospital admission procedures a day before her surgery. What was intended as a three-hour surgery ended up with my mother being wheeled out of recovery at 11 p.m. It turned out that the surgeons had found a hernia, chose to repair it and then conduct the hysterectomy. On the third-day post operation – the day she begun to eat solid foods – my mother developed complications in the night. These complications included difficulty breathing, reduction in urine output, low blood pressure for a high blood pressure patient. All of these symptoms were red flags.

Thirty-six hours later, my mother died of an acute bacterial infection. The doctors told us they did not know the cause of the bacterial infection. We were told infections can be picked up anywhere, we were after all in a hospital. When we asked for a post-mortem, it was suggested that it was unnecessary. To cite one doctor – we would find nothing except a missing uterus. We went ahead and conducted a post-mortem. A relative had the presence of mind to encourage us to get an independent pathologist to observe the procedure. It is the results of the post-mortem that pointed us to the cause of the bacterial infection (septicaemia) tiny punctures to her large intestines that occurred during surgery. In essence the minute she started eating food, the contents of her large intestines leaked into her bloodstream and poisoned her.

The admitting doctor quickly vacated the scene and left us in the hands of the ICU doctors, only offering a full medical report in mid-January 2011, despite our requests for said report in December 2010. She went on holiday. It is both treatment and responses we received to our questions about whether anything could have been done to avoid my mother’s death that set us on a six-year-long process of looking for accountability.

In 2011, we returned to demand answers from the hospital management. At this stage, we were slightly more than angered by the callous treatment we were receiving from the hospital. Yet, even in this anger, all we wanted was an admission that they had failed in their duty of care and an apology. We had proof of the cause of death. We wanted an apology that would for us acknowledge my mother as a person whose life mattered. She was not simply a 64-year-old African woman in bed X. We wanted my mother to be seen and our grief acknowledged.

Instead, we met a management team that was preparing for the possibility of legal action. In that meeting, the two surgeons who had operated on my mother were missing. We were told they were busy. The head of obstetrics confirmed that the case was internally investigated and the outcome of said investigation revealed that a crucial window had been missed. The window being the moment between the observation of changes in my mother’s vitals by the nurses and the time the doctors offered a proper medical response, which was mid-morning the next day. I am familiar with the missed opportunity referred to because I became intimately acquainted with my mother’s hospital records in the months that followed.

By the time the doctors begun accelerating their medical response, the opportunity to take her back into theatre had passed and no surgeon would have risked such a move because she would have died on the table. They made her comfortable and waited for her to die. He also hinted at my mother’s weight and pre-existing medical conditions such as high blood pressure and old age onset of diabetes as factors that did not help her situation. They were not fully to blame, the now deceased patient had to take responsibility for being “unhealthy”. The hospital after discussion agreed to transfer a copy of the medical file to a doctor in a sister hospital in Kisumu for review. They would not hand over a copy of the file to us without a court order. It is the outcome of that review that led us to the Kenya Medical Practitioners and Dental Board (KMPDB) to file a malpractice case.

Pursuing Accountability: Some Lessons

There is often that one case that hits the Kenyan media that reignites public concern about the state of medical care in Kenya. In the recent past, most of these cases have been located at Kenyatta National Hospital (KNH), such as the case of Alex Madaga[1], the rape allegations at KNH[2] which are about institutional care and most recently the patient who had brain surgery for no apparent reason[3]. These cases have occurred in the largest referral public hospital in Kenya, which often leads to the assumption that medical malpractice is a problem confined to public hospitals and that this is a class question. It is not.

To be clear medical malpractice is not unique to Kenya. The scale is accelerated by weaknesses in accountability channels that limit remedial measures taken to address gaps in medical procedures and implementing personnel. Of course, medical malpractice cannot be understood outside the larger training and labour issues associated with the health sector in Kenya. Nonetheless, I want to focus on accountability as a critical pillar to medical practice that does not necessarily disappear or reduce when better labour conditions are put in place. There is a general “utado” attitude that sits at the heart of accountability questions everywhere. It is that daring people to act – a dare that is located in an acknowledgement of structural powerlessness – that must be dealt with.

This is Kenya

When we arrived at the decision to file a malpractice case, we received many responses from friends, the most common being “this is Kenya nothing will come of it”; “she is dead, this will not bring her back”. However, the most disturbing in my view, were the litany of medical malpractice examples recalled with ease, as though they were describing the decision to use Vaseline and not spirit on a wound. The casualness with which people spoke about patients who were given wrong medicine thus ending up dead, surgical items left in patient’s bodies and misdiagnosis was disturbing to say the least. In all the cases I heard, no one took any action, because either the patient had survived or they were dead. Beyond the costs – both emotional and financial – associated with pursuing accountability for medical malpractice, we are resigned to the fact that systems will fail us and if “you don’t know someone” why put yourself through the process of looking for justice. The number of medical malpractice cases that go unreported are anecdotally high, the number of cases reported at the board with limited response is equally high[4]. However, the failure to address these cases and therefore improve the system is deeply reliant on an unholy alliance between our silence and the collusion of legal and health systems to protect “their own”. Our experience with the KMPDB points to this unholy alliance.

Professional Accountability

In the KMPDB, the body charged with the responsibility of holding medical professionals accountable to the highest standards of service, we find a manifestation of all weaknesses of the medical sector in Kenya. The slow responses by KMPDB to cases filed before it is indicative of the lethargy that accompanies a real commitment to hold medical professionals ethically accountable. This lethargy is evident in the speed with which KMPDB will deal with cases that attract public attention such as the death of former IEBC commissioner Letangule’s wife[5] or Mugo wa Wairimu,[6] while keeping non-high profile cases waiting for six months to a year for a hearing date, if you are lucky.

Second, in most jurisdictions outside Kenya, institutions such as KMPDB are considered independent professional bodies. This means that legal orders cannot be used to stop proceedings within the board. However, if someone is dissatisfied with the outcome of the board’s process, they can file a civil suit. Even if there is a concurrent matter before a court of law, the two processes are considered independent. This is not the case in Kenya. The medical malpractice case we filed at the medical board was stopped twice by the hospital asking to be de-linked from the case, yet they were the admitting hospital. My mother did not have her surgery on the highway. Every time the hearing was stopped it meant that we spent time and financial resources fighting court orders that went unchallenged by the very hospital that had filed them. It also meant that we went into a longer waiting period for another hearing date at the KMPDB.

It is clear this was a tactic used by the hospital to frustrate us. Most disturbing though was what appeared to be a collusion between the hospital and the board. This was apparent on one occasion when the director of the board, shouted into the corridor where we sat: “the case of the woman who died at X hospital. We will not hear your case today because there is a court order on the way to stop the proceedings”. Our hearing was being halted by a court order that had not been served to anyone. The board members then took an extended tea break ostensibly to buy time for this court order to arrive so that they did not have to begin hearing the case. When we questioned board officials about this apparent collusion, they as would be expected denied that they had engaged in a stalling game designed to benefit the hospital and ostensibly the doctor.

Third, procedures at KMPDB remain opaque, which means that for families who do not have the requisite understanding of evidence collection and most importantly the resources to do so, most cases will not see light of day. On one occasion as I sat outside the KMPDB hearing venue, I spoke to a family whose case involved a deceased family member’s organs being harvested. This case was eight years in the making. I knew that case was not going anywhere because they were predictably asked for evidence. The family member had long since been buried, no post-mortem was ever conducted and all they had was a story.

Finally, the opacity surrounding institutional procedures is aided by the unwillingness of medical practitioners to hold each other accountable. Where malpractice cases require expert witnesses, finding doctors willing to offer evidence remains difficult. In our case, we found a doctor who agreed to provide an expert opinion not because his own medical record is squeaky clean because the assumption is that those testifying have never made any errors. He recognised that there was a major lapse in the duty of care and he knew the deceased – my mother. His motivation was therefore personal.

On collective accountability

Ours is not a tale that ends in triumph. After six years of running through the courts, lawyers and poring over medical evidence we chose to halt the process. As a family, we were suspended in grief for six years. Every time there was a court or board hearing, we were transported to those traumatic two days in December 2010 when we watched our mother’s body shut down one organ after the next. We decided that sending the message had been important and we stood up for her.

Accountability for medical malpractice is fundamentally a question of attitude. An attitude that recognises patients as human beings whose lives matter and that one mistake is a mistake too many. From my experience, the cycle of collusion that surrounds hospitals and medical personnel doing what is no doubt a difficult job, does not build any confidence in health institutions. There is need for collective accountability for medical malpractice in Kenya that goes beyond looking at individual hospitals and cases. There is a larger system based question that should generate a change process that targets all the actors responsible for medical care and ethics. A critical actor in this conversation is the patient. No one files a medical complaint because they are out to get doctors. Grief is too painful a process to prolong by choice.

[1] https://www.nation.co.ke/news/Ambulance-patient-Alex-Madaga-dies-at-KNH/1056-2906238-4pr29bz/index.html

[2] https://www.nation.co.ke/news/Outrage-on-Facebook-over-rape-allegations-at-KNH/1056-4270106-g9u9x2/index.html

[3] https://www.standardmedia.co.ke/article/2001271660/knh-on-the-spot-after-brain-surgery-is-performed-on-wrong-patient

[4] https://africahealth.wordpress.com/2012/07/02/medical-negligence-and-malpractice-is-rife-in-kenyas-health-facilities-a-public-inquiry-reports/

[5] https://www.nation.co.ke/news/Thomas-Letangule-Wife-Death-Family-Care-Medical-Centre/1056-2371320-bxxihlz/index.html

[6] http://allafrica.com/view/group/main/main/id/00038738.html. See also https://www.the-star.co.ke/news/2018/02/19/doctor-accused-of-rape-and-murder-attempt-still-at-work_c1716525

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By

Awino Okech has been involved in social justice work in East Africa, the Great Lakes region and South Africa over the last twelve years, focusing on women’s rights in conflict and post-conflict societies and security sector governance. She is a lecturer at the Centre for Gender Studies at the School of Oriental and African Studies.

Reflections

Nairobi, Nairobae, Nairoberry

Cacophonous, labyrinthine, gluttonous, angry, envious, charming, paradoxical, mysterious, confusing, alluring.

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Nairobi, Nairobae, Nairoberry
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Nairobi. A cacophony of matatu hoots and booming bongs from church bells. All in inexplicable harmony. Like a Beethoven piece. A muezzin’s melody moves the ummah from a minaret here, a bus conductor — shouting from the most pimped out mathree — moves umati there. A hawker here. An ambulance there. But there’s also a silent monotone. The sound of hope dying. Of someone stealing two billion every day, of the clock going tick-tock from your 9 to 5. There’s that saying: if a tree falls in a forest and no one is around to hear it, does it make a sound? But what if it’s in the middle of Waiyaki Way? Just because someone thinks giving us an expressway will absolve him of war crimes. While in reality, all it does is leave all the marabou storks homeless.

Nairobi. A labyrinth of lipstick-stained shot glasses and semi-filled ashtrays. Where a party starts regardless of where the limbs of the clock point. And only ends when everyone is browned out and on the brink of calling the one that got away. Nairobi is looking for coins during traffic because you want to help the beggar, who is patient enough to receive the donation before snatching your phone. It is being stagnant in that same traffic for long enough to buy crisps made with transformer oil and served in compact disk wrapping. And like clockwork, you put the window back up because Nairobbery isn’t just a play on words. But the ones that hurt the most are the conmen, because nigga I trusted you!

Nairobi. Where gluttony is second nature. A kaleidoscope of too much gold tequila and too many smokie pasuas. Of good pasta and wine in overpriced restaurants. Of ramen noodles and pre-cooked meat. Where nothing is ever enough. We drink and eat to our fill because life sucks. Why wouldn’t it? Our last president’s advisor was the bottom of a Jameson bottle and our current one’s advisor is Jesus. The spirit guides the nation either way, I guess. But still, Nairobi tastes like chances and do-overs. It tastes like anxieties and aspirations and I know it doesn’t feel like it but today you omoka na 3-piecer then one day you omoka, for real.

Nairobi. Reeks of piss and thrifted clothes. Fresh bakeries and Subway. Old currency and that one cologne every man in their early 20s wears. Smells like fighting your titans and sending a million job applications. Nairobi. Where you can go weeks without a lover’s touch but only days without a cop grabbing you by the wedgie into a mariamu because you shouldn’t be idle as you wait for your Uber outside Alchemist. Because of course in that time you should take up a sport, play an instrument, solve world peace, et cetera.

There are few occasions when pride will linger. Like when Kipchoge finishes a marathon in under two hours. When Lupita wins an Oscar. The hubris you feel when your copy makes it to the billboard on UN Avenue. Or when your lame joke gets five retweets because Kenyans on Twitter will massacre you if you think you’re the next Churchill. Orrrr that one time we were all watching Money Heist and so gassed that Nairobi was one of the characters.

Sadly, Nairobi pride also comes in with its individualism. Everyone is out here on their own trying to get some bread whether they’re in the upper class getting baguettes and rye bread or in the lower class getting Supaloaf. I get it though, the city doesn’t let anyone rest from the grind and the hustle and the drudgery. And the wealth gap is bigger than Vera Sidika’s bunda. But ironically, the city is a paradox. An optical illusion. Sometimes the people are so ready to convene in community that it kinda revives the fickle hope you have in humanity. From safe spaces to fundraisers to a simple hearty conversation with your Uber driver.

And there’s obviously that murky feeling of greed that comes from 90 per cent of our politicians. When you’re at the bottom of the food chain it’s called hunger, but the higher you climb the more you want and it becomes indulgence. Greed makes them say and do all kinds of things. Like apologising to Arab countries that are exploiting Kenyans because they don’t want to be cut off. Y’all know any juakali guys we can commission for guillotines? – Heads gotta roll. Because how will I steal cooking oil and flour and end up in a cold cell but they’ll steal billions and end up with a second five-year term?

I think wrath is the most Nairobi-esque of the cardinal sins. We’re angry at the police. At the government, at global warming, at nduthis, at KPLC, at Zuku, at Safaricom, at KCB, at each other. Agonizingly though, our anger fizzles out as fast as it blazes up. I don’t think we’re ever angry enough.

And then there’s the envy. You know you’ll get there eventually but that gets lost in translation when you see someone with better because that sparks something in you even though we are all on different paths at different paces. Whether it’s a BMW or an airfryer, the question stays: Why not me? And also I’m personally jealous of the people who’ve managed to move out of Nairobi to Naivasha, Watamu or wherever. It feels like they’ve figured their way out the maze while I’m still at a dead end wondering whether I can just hop out the sides. Doesn’t matter what it is, our eyes are as green as the parks and spaces we so desperately need in this godforsaken city.

Nairobi. The city of miniskirts and cheers baba jackets. Lust dripping down the sides of our mouths because we can’t seem to contain it under our tongues. I don’t even know why people bother to go to Vasha for WRC when they live in the city of sexual debauchery where the only thing that’s on heat more than the sun is whatever’s between people’s legs. Where even Christian Grey would pause and do a double-take. Where ropes aren’t just for skipping and leashes aren’t just for dogs. If you find ordered love in the city, you must have saved refugees and orphans in your past life. This is the city where the flesh is truly willing.

You know that intense sloth-like feeling when you wanna wake up for Sunday brunch at Brew Bistro or K1 and then later watch Hamilton race at around 4 when all the mimosas have hit your head and you’re surprised that your wig is still intact? Or the next day when you’re trying to get out of your covers and you’re thinking about that beastly Nairobi traffic you’re about to face and all you can do is tweet “Nimewacha pombe mimi”. Truthfully though, other than that and a few other instances, the pace is too fast for me. I just wanna be in a dera next to the beach drinking a passion caipiroska and eating viazi karai cause why are y’all always running?

And y’all are way too fast when coming up with new words too. There’s like a million words for currency, ass, sex, sherehe, et cetera. Truly, there is a certain linguistic je ne sais quoi when it comes to the Nairobian’s language. It stops being a transaction of random syllables and begins to become an understanding of feelings, emotions and behaviour. I, especially, like how we knead it into our art. We sneak it into our music and get phenomena like gengetone.

We compress it into our films and get Nairobi Half Life. We squeeze it into our visual pieces and get Michael Soi. One thing about Nairobians is we do not cower in silence, we have words to say and we shall say them. Even if that means running a president out of Twitter. That’s why our writers are as staggeringly sensational as they are. Ngartia. Sookie. Grey. Muthaka. Laria. Abu. And those are just my friends, dawg.

But it’s not just the writing. The fashion. Rosemary Wangari. Nicole Wendo. Samantha Nyakoe. The music. Mau from Nowhere, Vallerie Muthoni, Karun, Maya Amolo, XPRSO. Just a Band. The films. The painting. Muthoni Matu. Zolesa. The architecture. The cinema. The theatre. Too Early for Birds is back! et cetera. Man, I gotta tell ya, when God was cooking up the cauldron of this city, he went hard on the talent. Quote me on this: a lot of exceptional creatives from this city are gonna hit the world with a head-splitting bang in a couple of years.

Nairobi. Despite the crowds, the queues and the poor drainage, it still has a charm. Mysterious. Confusing. Alluring. Despite the fact that you can only truly enjoy the Nairobi experience if you’re a bird or an expat, me I love it still.

Nairobians, keep sinning, keep winning!

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Reflections

The Enemy Within

Death hangs heavily over people with cancer – it is always there, reminding you of your mortality.

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The Enemy Within
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So, this is what happens when a doctor tells you that you have cancer. The first response is disbelief (how can this be true?), followed by anger (I don’t deserve this, I never hurt anyone), and then a deep sense of grief and loss (what will I miss when I die, and how will my loved ones cope without me?)

They say cancer is the result of pent-up anger and resentment. Apparently, years of holding on to these emotions make your cells misbehave and become toxic. Cancer cells end up eating up healthy cells, leaving the body so full of poison that it collapses from lack of vitality. The jury is still out on whether lifestyle choices generate cancer in the body because people who lead healthy lives seem to be as prone to cancer as those who don’t. Nonetheless, when you find out you have cancer, your first reaction is to blame yourself. It is sort of like being told you have HIV. (Was I responsible for this? Was I reckless? Should I have used a condom?)

Friends and relatives will tell you that breast cancer is beatable, that they know so many women who had breast cancer and lived healthy lives years after treatment. What they don’t tell you is that all the literature points to a short life expectancy after the discovery of cancer. The chances of recurrence are high, even with chemotherapy, mastectomy or radiation, the traditional methods to “cure” breast cancer. I have read studies where women who had chemotherapy had an equal chance of recurrence as those who didn’t. So, death hangs heavily over people with cancer – it is always there, constantly reminding you of your mortality.

Most people are so afraid of cancer that they can’t even say the word. The receptionist at an oncologist’s office actually asked me what kind of “C” I had – never used the word cancer. Yet she deals with cancer patients every day.  Another oncologist I consulted couldn’t even make eye contact with me and rushed me through a diagnosis I couldn’t understand, perhaps believing that my cancer was contagious?

The thing is that cancer is not like any other disease that can be cured through surgery or drugs. It requires months of treatment and constant monitoring. It’s not like having malaria or a broken bone. It is like having an enemy residing in your body, hostile, predatory, waiting to pounce at any moment.

It seems a positive frame of mind is critical in recovering from cancer. I got calls from women who told me they bounced right back into their lives after months of treatment as if nothing had happened, that I mustn’t believe all the literature, that I should get all the treatments done and go back to living a normal life. They didn’t explain to me why they have been working from home since their treatment started and since their so-called “recovery”. Others are more honest about their experiences. A South African women called to tell me that her experience with chemotherapy had damaged her heart, and she is on life-long medication that makes her urinate every few minutes, which means she can no longer work in an office. Instead of destroying the cancer, the chemo destroyed healthy cells in her heart. She is cancer-free but now disabled in other ways. Another friend told me her aunt died not from the cancer, but from the chemo.

What the doctors and the optimists don’t tell you is that both chemotherapy and radiation have debilitating impacts on your body. They literally are poisons injected into your body to kill another poison. Sort of like a vaccine but not quite because they do not boost your immunity. Both chemotherapy and radiation therapies involve weeks of hospital visits that cost an arm and leg. Nausea, burns on your body, fatigue are common side effects.

A friend from Boston who has studied alternative ways of healing from cancer (including not getting any treatment at all) tells me that each woman with breast cancer has to make an individual choice about what kind of treatment she should get. Doctors trained in Western medicine will be quick to put you on chemotherapy and the other treatments without giving you other options. Desperate and eager to cling onto life, the patient with cancer readily accepts any treatment, not realising that not only is it a very long process, but very costly as well. Mental preparation and psychological support are also necessary before embarking on the long and arduous journey called cancer treatment. People become life-long patients; some recover well, others not so well. Some women opt for no treatment, preferring to lead a good quality of life before the disease ravages the body.

I am looking at alternative methods of healing, including Pranic healing that works on your energy fields and chakras. So far it seems to be helping me, but only time will tell if I will be a success story. I have certainly started eating more, and those dizzy spells in the morning seem to be getting rarer.

The biopsy results are not yet out, so I am still not sure what the oncologist will prescribe, but in Kenya, the modus operandi seems to follow the same script: mastectomy, followed by chemotherapy or radiation and some kind of hormone treatment. Am I ready to go there? Not sure. Women who lose their breasts speak of feeling like an amputee; the loss of an organ that defines their femininity impacts their identity and self-esteem. Others are more casual about losing their breasts, (“It’s just fat,” one woman told me). `

The other thing about cancer is that when you have it, you think of nothing else. Everything is a blur. Someone wants to make small talk, and all you want to do is look the other way or scream. (Can’t you see I have cancer? Do you really want to discuss the weather?) You think about your life in vivid film shots. Your past suddenly comes into sharp focus, both the happy and sad days. You begin questioning the meaning of life in ways you never did before. Cancer prepares you for death the way a fatal car accident doesn’t. Is sudden death preferable to dying slowly because you can’t see it coming? Not sure.

But let me not be the purveyor of doom and gloom. The reason I am writing this article is that I have learned wonderful things about myself and other people. One of the things I have learned is that people can be kind and generous when they know you are in pain. People I don’t even know and have never met have sent me good wishes, prayers and even money for my treatment. Friends and family have sent food and offered accommodation. An Indian friend called to say that if I opted to go to India for treatment, I could stay in his home for as long as I needed. These generous and kind offers have literally brought tears to my eyes.

What I also learned is that my life’s work has not been a waste, and that my readers love and admire me for my writing. I didn’t realise I had inspired so many people, not just in Kenya but around the world, through words I have penned. That is a really important things for me to know and hold onto right now – to realise that I had a gift that I used well, and which helped others. And to know that when I go, my writing will live on.

I also learned that life is very, very short. So, we must not postpone the things we need to do. If your job makes you unhappy, quit. If a relationship is toxic, leave it. If people around you are making you feel bad about yourself, walk away. Surround yourself with people who love and cherish you. Love is very important for human survival, so distribute it freely. Be kind and generous. This thing called life is temporary, so enjoy every moment and live it as if every day is your last.

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Reflections

Someone’s Grandmother Just Died!

It is painful to always have to consider the feelings of others while legitimate calls for acknowledgement of racial injustice and reparations are consistently ignored and dismissed.

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Someone's Grandmother Just Died!
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Following the death of Queen Elizabeth II, I watched the televised service at St. Giles’ Cathedral in Edinburgh attended by the royals and various Scottish dignitaries, as well as the many hundreds who came out to pay their respects or to be a part of this historical event.

As I watched the outpouring of public emotion, I couldn’t help but wonder what emotions the queen’s death would invoke in those whose lives have been blighted because of the British colonial policies that killed millions and left a legacy of misery and disenfranchisement in countries far too many to name.  

At first I was saddened by the news. But then came the reactions of global figures the world over, with some proclaiming outright that Queen Elizabeth had been a guiding light, a symbol of hope and stability in the world. One broadcaster went so far as to say “She was everybody’s grandmother.” My problem was that she wasn’t mine.

My grandmother, born in 1923, was just three years old when the Queen was born, my 81-year-old mother told me when I called to get her reaction to the news that the Queen had died. “She would’ve been 99 years old today if she had she lived,” my mom said. I could hear the emotion in her voice as she remembered her mother. My grandmother died in 1983; she was 59 years old. I was then just 18 years old.  I said, “Mom with all the things we know about the racist systems that have kept Black and Brown people oppressed, I really don’t know how I want to feel about the death of the British Queen.” Never one to mince her words, my mom replied, “She was a human being, and we, well you know, we mourn the loss of any life.”

Yes. She may have been a grandmother to many but to me she was a symbol of institutionalized racism in its clearest form. Images of British dynasty have been present in the education of every American who has gone through the public school system since the Second World War during which the United States allied with Britain in their quest for global power and dominance. Yet here was the evil of the Crown being portrayed in the media—as it’s always been portrayed—as providence, something divine. As I listened to a special broadcast by the popular British talk show host James Corden talking to an American audience about the Queen’s passing, his tone struck me as odd: “She will be missed, she was everybody’s grandmother,” he said, going on to tell us how well she had served the country and the world.

As I was listening to Corden and wondering why I was so irritated by his outpouring of emotion, it dawned on me that racism moves from generation to generation, falling back on the old practices of how to colonize a nation:  You teach them to love you more than they love themselves. Racism survives because the symbols of racism never die. We carry the symbols in our hearts and in our minds and once we have identified with them, we seek to justify their existence. While I could empathise with those that felt a special connection to the Crown, what I realized and felt most immediately, was the insensitivity I received as an African American who bears the scars of the legacy of slavery that has made the British Empire one of the richest and most powerful nations in the world today.

The next day I watched the funeral procession move through the streets of Edinburgh, the commentators conveying the solemn mood of the people who came out to pay tribute to their Queen.  All the while I couldn’t see past the 1989 image of Princess Diana hugging a child suffering from HIV/AIDS. On her first unaccompanied trip overseas, Princess Diana spontaneously broke with protocol and showed compassion towards a suffering Black child with all the world watching, at a time when the stigma of HIV/AIDS was as bad as the disease, and  Blacks were being impacted the most and no one else seemed to care. Diana’s humanity helped solidify her reputation as the “People’s Princess” and it radically changed the way AIDS sufferers were perceived.

While the news played on I thought about two recent exchanges I had had in Amsterdam, just outside my front door.  The first exchange took place in a cafe.

I was sitting at the bar having a coffee. Another Black male of Surinamese origin was sitting a couple of tables away. It was midmorning and we were the only ones there. In an attempt to start a conversation, as men do, he asked my opinion on the war in Ukraine. I told him I thought it was crazy, all too unreal. The white Dutchman behind the counter leaned over and candidly shared, “I don’t give a shit about the war in Ukraine.”  I didn’t speak again and left the bar so abruptly the young brother asked, “You leaving?”  I was in no mood to have that conversation so early in the day, having experienced the backlash of the “Black Lives Matter” protest with the counter-narrative that All Lives Matter; I’ve learned that sometimes it’s better to just hold one’s peace and walk away. (It literally is your peace.)

Shortly after that incident, a couple of days later, I had another encounter that made me realize that we simply can’t afford not to care. I had wandered into a tool shop  on the corner of my street that looks more like a men’s gift shop inside than a hardware store selling nails, drills and plywood. Behind me walked in a man who apparently knew what he wanted because we reached the cash register at the same time, he with a power drill in his hand. I moved aside to let him be the first in line, not sure if I was done.

The Dutchman behind the counter seemed not to have noticed that the man with the drill wasn’t Dutch and didn’t speak the language. But to his credit, he did know what he wanted: the drill and a bag in which to put the canisters of spray paint he had already placed on the counter. Being familiar with Eastern Europeans, I assumed the man was Polish and asked “Polske?” “No! Ukraine!” he said, then, smiling, added, “Close.”

Hij wil een tas.” He wants a bag, I said to the clerk; bags are not automatically handed out after a purchase these days.  The clerk then understood and reached under the counter. I was pleased I could help and the Ukrainian was happy as well. To my surprise, as I placed my items on the counter, the Ukrainian tapped my shoulder and offered a fist bump.

I say all this to say of the human condition that people appreciate what they understand.  And sadly enough, we rarely think about injustice until it is visited upon us.

Whose permission do we now need to talk about racism and the policies that still impact us today? Africa and the African diaspora’s historical issues are and always have been about racism and this is why members of this group, my group, will always hold a contrarian view when the West attempts to compel us to join them in their moment of grief.  My grandmother died in 1983, at the young age of 59, in a small southern town next to a river; there was no horse and carriage, no media. The British Empire once covered the whole world, a dominance that was achieved through suppression and oppression. Many atrocities were committed and entire communities decimated under the authority of the Queen.  I was raised never to speak ill of the dead because they aren’t here to defend themselves but I will submit this:  it is painful to always have to consider the feelings of others while legitimate calls for acknowledgement of racial injustice and reparations are consistently ignored and dismissed.  Where is the same fervour and energy for those issues that matter to us? 

When we as Black people keep the peace, we empower the presence of the historical lie that we are inferior and thus require control. When we remain silent we allow the systems of the institutions and the prejudices that block our collective growth to thrive. Why should we care about the death of the Queen when the Queen has stood for the oppression of our people? Why should we be guilt-tripped into silence, into not speaking out about the dead, into not pursuing our freedom? When will our emergency, the issues that impact Black and Brown people, become a top concern for the White world? When will I be able speak without fear of being branded just another angry black man, angry for what I don’t have that others do?

Sad as the Queen’s death is to those that survive her, honouring her service is a symbolic gesture that must be contextualized because, for many, and not just in the UK but all over the world, the English monarchy is a symbol of oppression. I recently listened to a podcast in which a Black podcaster scolded an guest who said this of the Queen: “She is the symbol of colonialism and racism for many; however much we want to romanticize the Queen of England’s long reign on the throne as a stabilizing force on earth, she has also allowed many human rights violations on her watch”. The podcaster’s response was a classic putdown, “Why do Black people have to always bring up racism? Someone’s grandmother just died!”

Racism endures because when we identify with its symbols, we will do anything and everything in our power to justify and defend them.

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