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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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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

An Encounter With Blackness in Amsterdam

Observing the largest gathering of black people I had ever seen in Amsterdam, I realised that their pain was familiar, yet we knew so little of each other, separated not just by geography and language, but also by a suppression of our stories.

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An Encounter With Blackness in Amsterdam
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The Dam square, a major tourist trap in Amsterdam, is one of its busiest locations, often teeming with visitors flowing from the streets of Kalverstraat, Damstraat and Nieuwendijk in the heart of the Amsterdam canal zone.

Dam Square is within walking distance of the Red-Light district and the Amsterdam Central Station. On the east side of the tram tracks is the Amsterdam national monument, a prominent obelisk erected in 1956 in memory of the World War II soldiers, that I hardly noticed when I arrived in Amsterdam in September 2019 from Nairobi, Kenya.

Dutch historian, Leo Balai, author of the book Slave Ship De Leusden, noted that there are two stories of the Amsterdam canal zone. Amsterdam’s Golden Age in the 17th Century, is a story of pride and prestige but also one of astonishment shrouded in shame.

The Dam square is an architectural marvel that is of great historical significance to the makeup of the city. Built as a dam in the 13th century at the mouth of the Amstel river to hold back the sea, the city grew around it and the modern metropolis of Amsterdam would emerge from these origins. This square was considered the birthplace of capitalism when the 1st Stock Exchange in the world opened in 1611.

These were to be my impressions of Amsterdam’s history were it not for two significant events that happened in 2020. The first was the coronavirus pandemic and the second was the murder of George Floyd. The Dam square morphed into an intriguing site of conflated memories, depending on who you asked.

At the height of the coronavirus health restrictions in early June, I broke protocol to join a massive crowd that filled every inch of the square in solidarity with the BLM protests in America following the lynching of George Floyd in Minneapolis. Despite stringent public gathering restrictions, residents of Amsterdam showed up in full force. The gathering was in violation of the 1.5m distance rule and despite the pragmatic Dutch sense, it was impossible to observe the social distancing demanded by the organisers.

The protest, galvanised by a collective of anti-racism activists in Netherlands, attracted a multicultural crowd. Young Dutch nationals of all extractions gathered to listen to fiery speeches from a group of select speakers, the most prominent being the organisers of the KOZP (Kick Out Zwarte Piet, Black Pete) campaign in the Netherlands. All of the speakers were black. Activist after activist, reiterated the same message, Black Lives Matter in America and in the Netherlands too. An African American man who had lived in Amsterdam for 27 years, said this kind of black agency was unprecedented in the Netherlands.

Out of the many stories of the black experience in this country, it is the story by Jennifer Tosch, a Dutch cultural historian and the founder of the Black Heritage Amsterdam Tour, that enlightened me the most, being one of the few English speakers. I did not know that slavery was a central part of Amsterdam’s legacy. The city hall that overlooks the Dam square was built in 1648 and became the home of the Society of Suriname, established in 1683, when the city of Amsterdam became a share holder in the colony of Suriname.

A month earlier, another unprecedented event occurred in this same square. On the 4th of May, the king of Netherlands, Willem-Alexander, walked into an empty Dam square, to lay a wreath. (The 4th of May is a day of remembrance of fallen war heroes in the second World War.)

King Willem-Alexander asked for an apology pointing out that the profiling of the Jews started with a sign in the famous Vondelpark that said ‘No Jews Allowed Here’.

My Afro Dutch friends pointedly maintain that the black people of the Netherlands are still waiting for their apology. Presently many Dutch people like to say they do not see race and express great pride for being a society that espouses high social principles.

As an African categorised as a black person, it is easy to recognise racial undertones in a series of cultural mannerisms that define relations with non-white Dutch citizens. Perhaps none more jarring than the Dutch cultural phenomenon of Zwarte Piet, the helper of Sinterklaas, where white people traditionally appear in black face being the highlight of the festivities. This tradition is so deeply embedded in the Dutch cultural psyche that I have met several Afro Dutch citizens who grew up loving Zwarte Piet as a benign folk festival character, being none the wiser to the racial stereotypes it reinforced. In 2020, Prime Minister Mark Rutte stated that the government had no role in banning Zwarte Piet, which was described as a folk tradition, even as he empathised with the sentiments of those opposed to it.

As an African from Kenya, examining the demographics of the city, one can recognise institutional racism, based on where the black immigrants stay and how they slot into society as labour, basically essential workers on the lower tier. Europe’s black presence is tolerated as long as black people do not challenge the established status quo or as James Baldwin famously put it, “As long as you are good”.

Observing the largest gathering of black people I had ever seen in Amsterdam, I realised, their pain was familiar, yet we knew so little of each other, separated not just by geography and language but also a suppression of our stories.

In Africa, we identify with ancestry and nationality and typically develop race consciousness when we travel abroad and discover we are ‘black’. In the Netherlands, I was confronted with the politics of color and belonging. In my regular commute, I often ask black Uber drivers, if they are Dutch. Typically, the reply would be: “I am born and raised in Netherlands but my parents are from Morocco (Suriname, Aruba, Curacao or Ghana)”.

One generally identifies with where one truly belongs, all others just become labels, necessary for navigation in an unequal world. I see a generation of young Dutch who hail from immigrant backgrounds, grappling with nationalism of the country they were born. Where the notion of belonging is beholden to whiteness as the singular representative of authentic Dutch nationality.

In July, one month later, I returned to the Dam square, this time as a participant in a tour organised by Jennifer Tosch. She organises tours presenting the reality of Black experience in Amsterdam hiding in plain sight, in the built architecture as a testament to a memory from another time, a past hauntingly never really vacating the city.

It is fascinating to discover that just a little above eye level are symbols to the city’s past held in time. The tour starts at the Obelisk in Dam square where Jennifer points out that black contribution to the struggle against Nazi-occupation is notably minimised. The history of the Dam square is a tale of two peoples, one held glorious in time and another forgotten and erased.

Jennifer’s tours are borne out of her search for belonging, as a child of Surinamese parents who immigrated to America, and a desire to reconnect with her Dutch heritage. She was soon to discover that memories accorded to Black people of the Netherlands are sparse and only recently getting mainstreamed.

The tour involves an interrogation of Amsterdam’s architecture from the Golden Age and how the city remembers its black presence revealing how racial superiority can be built into architecture. Coming from Kenya, where colonial records were expunged and burnt, Amsterdam’s slavery heritage seems treasured as valued memory, representing an age of prosperity.

As Jennifer poses, what does one do with this knowledge? What does one do when one becomes aware of what these symbols mean and represent? In Dutch schools, like in Kenyan schools, the critical colonial history is scantly taught. It is more the reason why we need new stories to help us bridge these gaps in knowledge.

The aim of a story is to give root to cultural foundations but stories have to be true even when they are painful to recollect. Institutionalised racist systems are still a challenge given the various ways they manifest around the globe.

Our duty should be to challenge stories that have been weaponised against people of colour. The goal of solidarity is enhanced by access to stories that open up avenues for cross cultural perspectives on shared histories. As novelist Arundhati Roy noted, “There’s really no such thing as the ‘voiceless’. There are only the deliberately silenced or the preferably the unheard”.

The Black Heritage tour ends at Rokin street, a few metres from the Dam square. Here we are confronted with the tableau of a black figure on the gable of a city house facing the street. Jennifer tells us that it is the figure of a black moor owned by Bartholemeus Moor, who was a slave trader and original owner of the property. This is about all the information she has managed to gather on this individual so far.

I stare at this unknown figure and in it, I see a waking reminder of why we have to look back into our past with critical eyes. In the spirit of the Twi-Ghanaian tradition of Sankofa, look back for that which is forgotten to gain the wisdom and power needed to craft a new future.

This article was first published by ZAM Magazine.

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Reflections

Letter from the New American Pariah State

Our flaw is that we denied we ever had any; vanity and pride will kill off the American century in a hail of faux arguments, overwhelmed COVID wards and conservative values.

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Letter from the New American Pariah State
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American values during the coronavirus pandemic have become a contagion unto themselves. The very ethos of the country has become clear now, crystallised over six horrific months that will only fully have their gravity realised somewhere around October of 2025. To paraphrase James Baldwin, simplicity and immaturity are the values of this country, especially if one is sincere. I’m now 31 years old and throughout my entire life, the all-American concept of “liberty” has been elusive to me. Now, in the age of corona, as I hear it more frequently, I understand that it means ignorance, and because I am a white American exempt from consequence, it is inherently my liberty to refer to “liberty” as a term used exclusively by the ignorant.

The US right now is more clearly the location where ignorance and immaturity intertwine as cultural norms, sustained by the righteous rich to keep us all in line and the world turning as it does. When you look at this country, in its white-enough-for-history-books form, it makes more sense: America as a colony was made up of a bunch of puritans — White Christians — too uptight to remain in 17th century England.

They came here and stewed for years, decades, centuries in their self-righteous stiff ignorance; and let no one impede their ideals, especially those endowed with melanin. That heavy-handed colonialism-tinged brand of Christianity requires one to adhere to it; rocking the boat can get you ostracised, or, if you are non-white, you could face a more sinister fate. When unfettered capitalism grabbed the reins then realised that the two rigid parameters, puritanical Christianity and the profit motive, could be melded, those ideals distilled into a marketing ploy called the American Dream. Buyer beware however; normalcy in the American context is continuation of subservience. Ignorance is bliss as long as someone above you gets “theirs”.

Keep the wheels turning. Die for it. Be a Patriot. Do your job.

All resistance to these parameters must be swiftly struck down by the American soldiers of God. Bucking the system, bucking one’s own ignorance, is not a part of the plan; “How dare you not buy the newest Nikes? How dare you question their methods of slave labour? Are you some kind of subversive?” As we pushed globalisation forward into the late 20th century, it came with some resounding grace: “Through accessing information, we’re closer together than we are apart” while also realising that “since we all have so much in common, everyone on earth can (and should) become addicted to Kentucky Fried Chicken.” Clearly, the latter ideal has won during COVID-19.

It is a pandemic that cuts across race and ethnicity, gender and nationality. But that is for future historians. Blacks and other people of colour have less and less access to capital, and this systemically reinforces their position as disposable to the capitalist mantra. They have died in greater numbers during this crisis, forced back to work at corporate entities that are now pushing for protection from any sort of liability from a bought-and-paid-for Republican Senate. The pandemic suddenly became less urgent as it became evident who were the majority that were dying from it. Arguments about wearing masks are still going on in the media while some politicians tell us all is well and we should continue spending money we don’t have on things we don’t need that benefit people infinitely richer than us. Otherwise, we’re too lazy to work at jobs that don’t exist.

Proposals about how to handle the situation have become mired in bickering and weirdness since March, as the richest country in the world nickel-and-dimes the poor for short-term profit margins that don’t actually exist outside of Jeff Bezos and about 157 other random nameless titans of industry. “Economic stimulus, for who? Well, that will disincentivise the poor”. We don’t understand yet that this could be our fall. Rome wasn’t built in a day but it came undone in a generation or so. Machismo and stupidity ushered in the Asian century; cruelty and lies will be America’s exit.

We have done so terribly in this crisis that our once privileged passports are now handled with latex gloves and sanitiser. We are unwanted and deservedly so. For Americans it’s an unfamiliar position — we are used to having doors opened to us, smiles granted, courtesies extended, to being hurriedly ushered through customs checkpoints. At this point, one of the only regions that will accept Americans through their points of entry is East Africa; as of 1 August 2020 we can enter Tanzania, Kenya and Rwanda. Our creeping financial reach carries us through checkpoints but such allowance is disgraceful international relations. It is telling of Kenya, of how deeply the market-capital Kool-Aid has been drunk; only 24 hours after taking America off the non-quarantine list, Americans were back in the good graces of the non-quarantine camp.

How will letting red-blooded Americans back into East Africa go in the coming months? Don’t worry about it, they have dollars to spend. Other nationalities have money, so what is so special about American dollars? From every corner there is new money and old, black market and “market share” money. The paradigms have shifted since March 2020 and it is hard to see them rapidly changing back to the global “norm”, at least in any sort of respectable sense. That’s where the globalisation bandwagon of the latter half of the 20th century can get ugliest; we were just too good at marketing our failing model.

The dramatic shift over the past year begs heavy questions, ones that the “developing” world will hopefully learn from and flee as though they were the coronavirus itself. These questions range from “what if one ethnicity gets to ask constant questions while another gets beaten for merely raising their hand?” all the way to “is everything in the modern system a lie?” Because things are impossibly worse than you ever thought possible.

In this doomed nation, 199,000 had died by the 21st of September. Meanwhile we are mired in our own filth; the richest economy in the world decries public assistance even as we are lapped by nations like Germany, New Zealand and Rwanda.

At the right Nairobi embassy party, a keen eavesdropper will hear frequent mention of the Singapore model, a “developing state” becoming a first world economy in one generation. Do-gooder development types speak of Singapore as though it is a miracle; “How could they impress, adhere to and benefit the West? What a progressive little country they are”.

The inverse is much more plausible and frequent; ask a Kenyan about the differences between Moi in 1979 and the 1989 incarnation of the same man, paranoid and sliding deeper into ill-fated financial dealings.

The only difference? That Americans literally have a theory of thought called “American Exceptionalism” that is easy to instill when you give examples of mediocre daddy’s boys somehow turning 35 million dollar fortunes into 50 million dollar caches.

In that sense, the Trump administration is the most quintessentially American of all; Trump is us at our most base. He is the embodiment of deadly privilege wielded through stupidity and a misplaced sense of manifest destiny. The Trump administration represents global entitlement just as white America does — a gathering of aging idiots who think the stripper is really into them. Our desire to be special has led to global norms becoming horrific injustices; masks-turned-fascism, lockdowns-turned-atrocity, public good-turned-Stalinist Russia. Inconvenience doesn’t equal oppression unless you make it so.

The very awkward leader of our doomed little experiment has to date held the biggest indoor gathering since the pandemic hit in March. Stalin himself once plucked a chicken alive, leaving it writhing in pain, only to lead it begging and bleeding around the room by feeding it stale bread crumbs. The masses, he explained, would put up with any injustice just as long as you gave them something little. Millions of Americans have long considered kernels as grand gestures, ones that they probably don’t deserve.

During all of this, schools are looking to open in many districts, often at the urgent behest of a Republican leadership calling for “normalcy” in vastly odd times, clinging to the belief that “normalcy” in the modern context is a good thing. The next six months will bring this government’s dereliction into sharp focus; the Republicans will probably lose in about six weeks, then immediately sit on their hands and blame the Democrats for winning. For some, the strategy will even work, but the damage may just be too great to bear this time round. Make America Great Again, surely.

I must admit that it is a strange feeling to have my dark blue American passport looked at with suspicion. it was an undue golden ticket in the age of globalisation, opening any door I knocked on as long as I could make the nut to afford a flight. Now, the hoops are mounting, rapidly and consequentially. And deservedly so.

If for nothing else, it may be prudent to start to look at what the future of global travel will look like. Not in any “tech” sense but in terms of the biases that travellers face. If as of August 13th anyone can fly into Rwanda provided they can provide negative COVID-19 certificates, isn’t that a model worth following? The merit of one’s health and ability should trump nationality, and now that the cat may be out of the bag as some nations beg to regain a tourism foothold, it is unlikely to go back.

Even now, as schemes and plans come together, anyone seeking to leave the US feels like a rat escaping a sinking ship where all the passengers remain stuck in denial. Our flaw is that we denied we ever had any; vanity and pride will kill off the American century in a hail of faux arguments, overwhelmed COVID wards and conservative values.

East Africans must have been reading the tea leaves of the last four years of American politics with a feeling of “I-told-you-so”. But in the US it was never understood — as the people of this region have long been aware — that no one is beyond the grip of a truly corrupt system. I used to get side-eyes from a wide swath of American acquaintances with my constant compare-and-contrast-Trump-with-various strongmen but such people are now sheltering in place, out of a job or being forced back to one.

“It is what it is”. I don’t think Trump has ever spoken truer words throughout his entire wretched political career. Now he floats ideas like banning Americans from returning home — with the obvious subtext of suppressing the vote of those at large.

Now steeped in our jingoism, it is impossible to look inward. It is impossible for us to distinguish that the “profit motive” that drives capitalism is the same motive that keeps us turned inwards, ignoring our greatest problems whilst elevating our lesser ones. Blissful ignorance has never been quite so putrid. Modern America is to be studied as a cautionary tale as the world shifts away from coronavirus towards a more equitable future. Beware a failed experiment.

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Reflections

In the Shadow of a Liberation War: Ethiopia, Kenya and the Oromo Quest

The Oromo Liberation Front leadership views Kenya as an important player and believes that peace will come sooner if Kenya steers the talks between the Oromo and Ethiopia.

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In the Shadow of a Liberation War: Ethiopia, Kenya and the Oromo Quest
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A Kenyan Journalist was arrested in Addis Ababa in the wake of the assassination of Haacaaluu Hundeessaa, a popular Oromo musician. Yassin Juma was arrested alongside prominent Oromo opposition political figures like Jawar Mohammed, the founder of the Oromo Media Network. Juma was later charged with “incitement and involvement in violence, plotting to create ethnic violence and plotting to kill senior Ethiopian officials”.

A court freed him but the police continued to hold him.

Yassin Juma is perhaps the only Kenyan journalist to show interest in the Oromo liberation movement. In Kenya, both the media and government functionaries view the Oromo Liberation Front (OLF) as a security threat, with journalists rehashing half-baked arguments about what the OLF means in the region’s conflict.

It was Yassin Juma who introduced the Oromo cause to a larger Kenyan audience with his TV documentary, Inside Rebel Territory, 10 years ago. In it we follow Yassin as he goes in search of OLF fighters: “It was a journey that finally yielded [the] faces of one of Africa’s longest albeit low-key rebellions . . . the OLF was for decades a mystery”.

Inside Rebel Territory earned him the respect of the Oromo and the ire of Meles Zenawi’s regime. Five months ago he was invited to Finfinnee Radio’s 5nan Show where he spoke about the state of the media and reflected on his coverage of the Oromo movement.

My reason for being here is to make a follow-up documentary to [. . .] Inside Rebel Territory . . . I am doing a documentary about the rebels I met then, their life now, after Dr Abiy took over [as Ethiopia’s prime minister] . . . how they find life and so forth.

We can already guess what the new Ethiopia looks like. Guracho, who featured in Yassin’s documentary, is now in jail. Falimatu, a woman he had interviewed, may have been killed two or three years ago. He was in Addis Ababa when Haacaaluu Hundeessaa was killed and the country erupted into violence. Ethiopia prefers to hide its face from the roving cameras of the likes of Yassin Juma.

On Finfinne Radio Yassin reveals who he is, how the story he had done on the OLF was almost killed. How he was offered $150,000 by the Zenawi regime to kill it. How he had received threats. How the owners of Nation Media Group had not been happy with that coverage. How it had caused a diplomatic row between Kenya and Ethiopia. How it triggered a series of events that eventually led to his leaving NTV. How since then his life and that of his family has not been very secure: “In 2009 I was almost shot dead twice in front of my house . . . In 2016 I had to move to Uganda for three months for helping to organise Oromo protests in Kenya”. He was officially banned from entering Ethiopia.

Yassin Juma had covered the Oromo Liberation Front at a time when the movement badly needed the coverage. Ethiopia’s notorious media laws, stemming from the US-backed antiterrorism law, had forced its outspoken journalists into prison. That coverage was important on many counts; it came out at a time when the Oromo cause was transitioning from armed rebellion to an ideological youth- and artists-led movement at around the same time that Haacaaluu was breaking onto the music scene. A scroll through Yassin Juma’s Facebook page shows how important a player he had become in the Oromo cause; he is seen posing with Jawar and Haacaaluu and appears in most Oromo events held in post-revolution Ethiopia.

Kenya, Ethiopia and the Oromo question

For Kenya, Ethiopia is a landlocked market of 100 million people, a destination for goods from its ports and, more recently, a partner in the LAPSSET (Lamu Port, South Sudan, Ethiopia Transport) corridor project. In this context, complex stories such as Yassin Juma sought to tell were to Kenya an unwelcome initiative, going against sixty years of close cooperation built around keeping Somalia’s aggression in check. For their part, both the OLF and successive Ethiopian regimes have recognised the strategic importance of Kenya.

As an immediate neighbour, Kenya was important for the Oromo cause—as a refuge for thousands of fleeing Oromos and as transit territory for Oromos escaping oppression at home. Kenya’s importance in the Horn’s geo-politics, it’s appeal as a regional “bastion of peace” and as the regional capital for all manner of international media outlets and posh western think tanks, as well as Kenya’s role in Somalia’s pacification efforts and its shuttle diplomacy in South Sudan’s independence, have fuelled the Oromos’ desire to secure Kenya as an important ally. But how Kenya perceived and portrayed the Oromo struggle spoke volumes about the liberation movement’s international image.

In Kenya, the roots of the OLF rebellion were whitewashed and a truncated history was often told, the Oromo liberation struggle being portrayed as a threat to regional peace. The Kenyan media has reduced the OLF in the Kenyan mindset to illegitimate militias out to destabilise the region. Ethiopian ambassadors have reinforced the local political and media narrative that the Oromo cause is a quest to establish an Oromo super-state stretching all the way to Tana River, a narrative intertwined with other stories about the skirmishes between the Gabra and Borana in Marsabit. The OLF thus became the regional insecurity scapegoat, blamed for the October 1998 Bagalla Massacre in which 140 people were killed in Wajir and the July 2005 Turbi Massacre in Marsabit in which almost 90 people perished, and for the proliferation of arms in the north, for banditry, and even for livestock rustling.

Yet, this conclusion glossed over the complexities at play; the Ethiopian army’s harassment of Kenyans at the border was either ignored or the frequent abductions, killings and harassment of Kenyans by the Ethiopian military were dismissed as being the work of locals.

Following the Turbi Massacre, the OLF’s Dr Fido Ebba said that the OLF’s image was wrongly tainted and that the problem in Marsabit is two-fold, some of the raids are purely tribal. They pit civilian communities against each other over scarce resources and cattle. The rest are diversionary tactics by militias engaged by authorities within Ethiopia’s ruling class. They aim at inciting communities on the Kenyan side and possibly the government into fighting the OLF back.

Ethiopia also issued a similar counter-argument, for example in April 2006, when the OLF was blamed for the killing of two herders in Dukana. Ethiopia’s then acting ambassador to Kenya, Mr Ajebe Ligaba Wolde, insisted that it is the OLF that provokes and incites people along the border with Kenya. “They [OLF] put on Ethiopian soldiers’ uniforms to defame Ethiopia . . . OLF is not only a threat to peace in Ethiopia, but also to Kenya and the whole region. They want to destabilise the region”, said Mr Wolde.

Oromo Liberation Front ideologues and leadership view Kenya as an important player to whom they look with hope, believing that peace will come sooner if Kenya steers the talks between the Oromo and Ethiopia. “If Kenyans mediated between the Ethiopian government and the Oromo they would understand the problems better, just like they did with Sudan and Somalia”, said Dr Fido Ebba.

Ethiopia, which contributed to the liberation of Kenya’s struggle for independence (and was gifted an embassy in appreciation), has enjoyed a long, peaceful diplomatic relationship with Kenya, having signed a defense pact and a treaty of friendship and cooperation in the 1980s. Dr Fido Ebba wishes that the OLF could have its administrative base in Kenya, and not in the US (Washington) as is currently the case. “Our push for liberation would then be coordinated from close proximity”, he says.

Incursions into Kenyan territory by the Ethiopian army in search of the OLF are very common. In 2015 the Ethiopian army crossed into Kenya six times, once even taking over a police station in Illeret, Marsabit. Cross-border massacres—like the March 1997 Kokai Massacre in which 80 people including 19 police officers were killed—have been raised with the Ethiopian regime.

The OLF pointed an accusing finger at the Kenyan government and army, claiming that the Kenyan army has supported the Ethiopian army to wage war against the OLF, that Kenya had broken with several international protocols to abduct and repatriate legitimate Oromo refugees and that Oromo activists have been assassinated by Ethiopian security agents on Kenyan soil.

The decades-long struggle and the fraught relationship between Kenya, the OLF and Ethiopia seemed for a brief moment to be water under the bridge when the Oromo Media Network (OMN) was launched in Nairobi in the wake of the Qeerroo revolution. During the launch, Jawar Mohammed said:

I have come to this place many times before. I had to change my name and look. I am happy that we now can reveal our names and faces to each other. We didn’t plead for this . . . We fought for it . . . We threw those who made us hide our faces in a hole and came out . . . It’s not play that brought us here . . . We lost people like Jatani Ali to arrive here . . . I would like to say thank you to the government of Kenya even though they were not open and fully supportive of our struggle . . . There cannot be liberation for Oromos or for Ethiopia without its neighbours.

Mohammed spoke of how the OMN would lead to the establishment of a bridge between the two countries by bringing the Oromos in Kenya together and by connecting the Oromos in Kenya with the Oromos in Ethiopia through listening to the OMN.

In the constructed narrative, this talk could easily be misconstrued as alluding to the establishment of an Oromia republic stretching into Kenya.

The Oromos of northern Kenya

When Dr Abiy Ahmed became the Ethiopian premier, there were celebrations in Nairobi and in the streets of Isiolo, and a commemoration for all the slain Oromo people was held in Marsabit.

The Marsabit County Woman Representative, Safia Sheikh Adan, organised a memorial day for slain Borana heros and waxed lyrical about the Oromo liberation—Bilisumna—weeping as she recited a poem and read the names of leaders slain through political machinations.

But one name was repeated again and again by Governor Mohammed Ali, by Jawar Mohammed and by the Woman Representative. Mebastion Jatani Ali Tandhu, the former Provincial Governor of Borana Province in Southern Oromia who was assassinated by Ethiopian security agents on 2 July 1992 at Tea Zone Hotel in Nairobi. Jatani Ali Tandhu had been in Kenya to seek political asylum from Zenawi’s Ethiopia. Over the past three decades, he has become an Oromo political liberation martyr and cultural icon, his words revisited in songs and Oromo protest poetry. In commemoration, a message was carried in Kenya’s Daily Nation on the 10th anniversary of his death: “Exactly 10 years since you were brutally murdered by the operatives of Tigre Peoples Revolutionary Front (TPLF)/Ethiopian People’s Revolutionary “Democratic” Front (EPRDF). The course for which you died is still alive”. With Abiy in power, his glory was resurrected and an equestrian statue was installed in the centre of his hometown of Yaballo. New songs were composed in his praise. Jatani Ali Tandhu had been buried in Marsabit and when Abiy came to power, his grave at the Marsabit cemetery was repainted.

It was Safia Sheikh Adan who financed the commemoration day. She spoke about Jattani Ali Tandhu’s contributions and mentioned other prisoners like Jatani Kunu who she said was still being held in an underground prison in Ethiopia. “We have lost many brave and strong people . . . Jatani Ali Tandhu, Galo Wolde, Qala Waqo, Sheikh Hassan, Hussein Sora Agole, Mohammed Halakhe Fayo and Hersi Jatani”.

In her overly sentimental tributes, Safia Sheikh Adan mentioned the names of slain former Kenyan parliamentarians like Guyo Halakhe, Philip Galma and Isacko Umuro. Their assassinations, like that of Daudi Dabasso Wabera (the first African Colonial District Commissioner who was assassinated by the Shifta in 1963), were unrelated to anything Oromo.

But the poem Safia Sheikh Adan recited, her tears and her actions were out of sync with the local politics and current feeling. A few understood her but most people watched her and wondered where her emotions were coming from and her efforts were finally without significance or consequence, dismissed as part of the initial euphoric joy that an Oromo was finally the Ethiopian premier.

Marsabit, music and protest poetry

When popular musician Haacaaluu Hundeessaa was killed on 29 June 2020, our hearts were broken and the sense of grief that engulfed us had a familiar weight. As Ethiopia descended into mourning and chaos, in Marsabit I listened to Haacaaluu’s albums anew. My friend and I paused and replayed certain songs to try to decipher what he meant and our sadness was deepened by the raw honesty of the injustice he described. That this was the soundtrack of a now stolen revolution added to the feeling that Ethiopia was a place of great injustice.

I remembered the image of Haacaaluu bursting onto the music scene about 10 years ago, a skinny boy in oversized shirt and trousers. We spoke about his music and his political education, his 5-year jail term when he was just 17 years old. We revisited the words of the Oromo liberation struggle as if we were reminiscing, as if it was about us. And we said aaaayyyiii, expressing the turmoil in our hearts. But at the end of the day, none of the political pathos and calls to action were about us, and nor were they happening on our doorstep. The deep articulation of the injustice that we listened to was in our own language but that struggle was not ours.

The aftermath of Haacaaluu’s death and the blowback in Oromia leads me to thoughts about what the Oromo struggle means to those of us who have come of age under its shadow.

To grow up in a liminal space like Marsabit is to be in an endless interregnum of something not quite yours. The earliest memory of the Oromo liberation struggle for me dates back to when I was six years old in mid-1990s Marsabit. Back then, a tape of a poet would be shared across the town, and we would listen alongside our parents, picking up words that sounded funny and made no sense to us.

It was hard, then, to link those words to concepts like oppression and injustice. But over the years, the OLF became the subject of whispers in Marsabit. OLF stories circulated in the manner of a secret; tales of disappearances were told, of men whose wives were taken in the night, of people whose lips had been cut off for snitching. The whisper was a mix of many fears, of the Kenyan Special Branch, of District Commissioners who had lists of OLF sympathisers, of the OLF itself, of Ethiopian spies. In Marsabit some of the murders in the town were linked to these fears.

In our home, the land of our grandparents’ past, Ethiopia, was the unspoken and unacknowledged thought. But its music was the future we aspired to; our heartbreak, our love, our longing for elusive dreams were in those lyrics.

Once, my dad came home with a small OLF flag, with the tree in the middle and the star above it. He stuck it up one side of our wall. It was the first symbol of the OLF as something good that was forbidden.

Many years later, I asked my Dad what that flag had meant to him and where he got it from. He had been in a car heading to Nairobi when he met a man who had engaged him in talk, telling him how liberation for the Oromo would benefit us all, how my dad in Kenya had to be conscious too, how the war being fought needed him.

My inquiry was short but in my father’s clipped answers I found an explanation I could relate to. I knew what his words meant and I knew what his silences meant. He had, like me, grown up on the poetry of Oromo oppression and on the songs of their hopeful salvation. Yet this long political induction had never called him to any action.

What did the Oromo of Kenya want for Oromia?

Calls for independence have a liberatory romance about them that is inviting to sympathisers. And nowhere is the Oromo call for liberation, and the reason for this call, and the status of this call, as articulated as it is in the music of the Oromo. The Oromo songs we listened to in Moyale, Marsabit, Isiolo and Nairobi arose from the liberation struggle. They were songs and poetry that articulated Oromo suffering and encouraged resistance. Through the songs, the turmoil and suffering of the Oromo was transmitted to us in Kenya. But in Kenya, we seemed to run away from it all, not learning how to speak of the injustice that followed us.

In Marsabit we carried other stories of Ethiopia in our hearts, stories of an unacknowledged past as we forged new Kenyan identities, stories of the Amharas and how the gabbar system had forced our grandparents out of Ethiopia. Stories of slavery and of Abyssinian expansionism into southern Ethiopia.

We followed the Qeerroo protests keenly and vouched for them. But stolen revolutions break the heart even more. Haacaaluu’s murder was testament to a stolen revolution, an encore to the 1974 Derg, when the army through Mengistu stole another revolution. How many of the men in Marsabit escaped conscription in Ethiopia’s many wars with Eritrea and on its own people? How many had had hopes that their suffering would come to an end before the revolution was stolen from them in 1974, in 1991 and again in 2018?

I sit with a local musician in Marsabit and try to understand the influence of Oromo music on the Borana music produced and consumed in Kenya. How devoid of politics the songs in Kenya seem. I ask, “how come Borana musicians from Kenya haven’t contributed to the Oromo protest tradition?”

He says, “birds from different places speak a different tongue”.

It is a common saying about how things that look similar can be unrelated. In his answer, I understood so much. It is the caged bird that sings better of freedom.

A social-cultural state that defied the Westphalia model did exist in a section of northern Kenya and southern Ethiopia. A cultural state called Oromia did exist but, more than political aspirations, it was language, music, traditional political institutions and contiguous populations that marked its boundaries.

Is the Oromo cause over? Is it legitimate? How has their struggle progressed? Which parties speak for the Oromo? Where are they? What’s happening in Ethiopia? Asking Kenyan Borana/Oromo these questions is asking them far too much. None of these questions have been considered before. Yet somehow, a version of the Oromo pain has been inscribed in the psyche of the Kenyan Oromo through the Oromo music and protest tradition. The revolutionary spirit is appealing but there is no substance beneath the thin veneer of solidarity.

It was thus easy to romanticise the struggle itself. To hung posters of Lemma Megersa in khat shops while not knowing which party speaks for who. Yassin Juma had tried to put a story to this romantic idea of a political rebellion.

The Kenyan government’s choice of silence as a strategy and its hush-hush attitude towards the Oromo or the Ethiopian army’s repeated aggression on the border is just a convenient excuse, as is the simplistic idea peddled by security analysts that Kenyan Oromo also desire an Oromia super-state. It is reading too much into a romantic idea.

I know now that sympathy for—or identification with—the Oromo cause became intertwined with local politics as early as the 1990s, and allegations that local politicians had begun enlisting the services of OLF fighters were rife in Marsabit and that that there was some truth to these allegations.

For the states of the East African region there is a need to understand the Oromo cause and what is happening in Ethiopia. The Oromo call and the Ethiopian regime’s response to it should not be considered inconsequential, for the response is an indicator of how oppression, inclusion and participation of the marginalised are viewed in those states.

The old pattern in the region’s attempts at reform has been to gain one kind of political progress and lose another. To allow for the judiciary to be pseudo-independent but to cut it back when it does its work. Extrajudicial killings, mass arrests, clamping down on the freedom of association and freedom of speech, the arbitrary arrest of journalists, torture and detentions without trial, draconian and controversial laws like the social media tax in Uganda, the controversial hate speech law in Ethiopia, Internet shutdowns in Uganda and Ethiopia, declaration of a state of emergency to suppress legal and peaceful protests, all these speak of identical regional infirmities. For activists, pseudo-revolutionaries and politicians there are lessons here on the pitfalls of revolutionary nationalism in mainstream politics.

For the people of northern Kenya, whether viewed as potential citizens of a future “Oromia” or as relatives of disenfranchised, broken OLF fighters, or as the inhabitants of places invoked in Oromo songs, the sooner Ethiopia addresses the Oromo plight the better for the region. But even as Ethiopia sorts out its politics, the region also needs to formulate the ways in which the armed fighters are going to fit back into the community and not become a security threat by being enlisted to serve Marsabit politics.

In August 2017, four days after Ethiopia lifted its 10-month state of emergency, and as Kenya was in the throes of post-electoral violence, I crossed the border into Ethiopia at Moyale. In southern Ethiopia, in towns like Mega, Yaballo and Soyama, I counted a few T-Shirts adorned with the portraits of gubernatorial contestants in Marsabit. My grand-aunt was very worried that Kenya would burn with her daughter in it. After 10 days of drinking copious amounts of Ethiopian bunna in many towns and even in a restaurant at Akaki Kaliti, a sub-city of Addis Ababa, I returned to Kenya. On the way to Yaballo, political campaign songs about Marsabit’s politics played on the matatu’s stereo.

Back to Yassin Juma

It is in this larger context that Yassin Juma found himself in a prison in Ethiopia. He has since been released and is back in Kenya and we are waiting for his documentary about what Ethiopia is doing to its youth.

Parallels can be drawn between the struggles in Ethiopia and the situation in Kenya, how a minority wields economic and political power, keeping out the majority of citizens by means of elaborate political machinations. Keeping Kenyan youth in check with guns is not any different from the Ethiopian government’s incarceration of its youth and its heavy-handed reaction to dissent.

But there is something markedly different in the civil response in Ethiopia; 10-year-olds are active in the streets of Ambo.

It was important to observe Kenya’s reaction to Yassin Juma’s arrest and his release as this could be a signal to northern Kenya of a change in the government’s attitude towards the killings and assassinations that have been perpetrated in the name of the OLF in Kenya, and that the border regions will finally be treated with the seriousness they deserve.

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