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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

MAN ENOUGH: Journeying Through Millennial Masculinity

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MAN ENOUGH: Journeying Through Millennial Masculinity
Photo: Usama on Unsplash

The problem with becoming a man is that no one really teaches you how to live it out, partly because everyone will do masculinity in their own unique ways. But most importantly masculinity is really about the humanity of men and like all personhood, it carries in it the glories of personal questions, angsts, fears, and the pitfalls of a fallen soul in a complex world where up is sometimes down and down is sometimes up.

Masculinity is about being human. It is a core aspect of the male identity. My own personal journey of identification has always been a constant fight to shed off the resultant outcomes of falsely understood masculinity as a medal granted after fulfilling a ‘real man is’ kind of to-do-list. It does not help that for the most part the social hyper masculine man has been treated as the ideal while we of the nerdy, bookish, sensitive type males are seen as less masculine. Falling for the trap that sees ideal manliness as a forceful, public demonstrative role has forced many of the younger males who don’t fit the macho image to incessantly pursue ways to caricature a gendered identity. This in turn renders male identity to be posturized and performative rather than authentic and human.

It’s honestly a murky struggle navigating a world which observes the role of manhood as a performance rather than a human identity. The maxim, ‘a real man’ lends credence to manliness as a status; a hierarchical symbol achieved through jumping through subjective, socially instigated loops is disingenuous in character and practice. I personally consider maleness in all its variations as a complex identarian facet with different idiosyncrasies, insecurities, shortcomings, and desires.

According to J.R. Macnamara, in, Media and the Male Identity: The Making and Remaking of Men, less than 20% of media profiles reflect positive themes in depicting men and manhood. Violent crimes, including murder, assault, and armed robberies account for over 55% of all media reporting of what we males are thought to do. He also opines that over 30% of all male sexuality discussions in the media tend to be in relation to paedophilia, moreover, male heterosexuality is seen as violent, aggressive and domineering.

Over six months, the study involved a detailed analysis of over 2,000 media articles and program segments and an extensive content analysis of mass media portrayals of men and male identity focusing on news, features, current affairs, talk shows and lifestyle media.

By volume, 69 per cent of mass media reporting and commentary on our identity as males was unfavourable, compared with just 12 per cent favourable and 19 per cent neutral or balanced. Some of the recurring themes in the media content portrayed men as violent, sexually abusive, unable to be trusted with children, ‘deadbeat dads’, and commitment phobic and in need of ‘re-construction’.

We are predominantly reported or portrayed in mass media as villains, aggressors, perverts and philanderers, with more than 75 per cent of all mass media representations of men and male identity showing men in on one of these four ways,” Dr Macnamara says.

These perceptions and archetypes of manhood that are repeatedly endorsed by the media fraternity are incredibly damaging to the younger men whose concept of being a man is still forming. They live in a culture that continually treats them like defective girls according to Christina Hoff Sommers. This is a culture that equates masculine gender with propensity to violence, corruption, and other social ills. I empathise with men who are younger than me because the slant reporting and onslaught adds psychic violence to the neglect.

So acceptable has it become to view our male identity as a modern day pathology that even though fatherhood, we are often told, is important, few fathers tend to be home. Even then you’d think that fatherlessness is solely about derelict dads. It isn’t. Father absence is primarily about a culture that has little regard for the male parent and the role they play in children’s lives.

This modern society has no qualms publishing titles like ‘Are fathers necessary? right on the front page of global dailies, and ‘The End of Men’. This same society is influenced by gushing, well-resourced militant and hostile attitudes in academia, media fraternity and the public sphere more broadly, which are filled with manufactured performative rage, misplaced resentment and sentiments that share in a collective hatred for anything male or masculine.

As young Kenyans, it’s even harder to centre our male identity within the global paradigm that views African masculinities through the lenses of fetishism on a good day and pathology every other day and twice on Sunday. It has become acceptable to ignore any male struggle denying it human empathy and identification because men, we are forever reminded have historically oppressed women. What is preferred is to ignore or downplay the role that reinforced trauma has done to African masculinity through the triple axis of slave trade, colonial racism and modern day criminalisation of blackness, and male blackness in particular.

These traumas for the most part accompanied by the muddled-and murky-gender power dynamics and relational confusion thanks to the “hook-up” culture and its societal wreckages have left my generation of men grappling with listlessness. I see this quandary all the time; the pressure to demonstrate material capacity within the gendered mating dance; the irony that in the dating market patriarchal men still rule the roost. Surprisingly male desirability is still tied to patriarchal ideals and pretensions, top among them displaying alpha tendencies, and hyper-maleness both in personality, phenotypically, and socioeconomic capacity.

Being countercultural as a man means getting comfortable with not having to embrace these popular, pre-packaged male identities and making peace with the fact that the alpha/beta males theory after all only applies to wolves, peacock, and maybe in the crab patriarchy, but not humans.

That, my masculinity is informed by my personality, history, worldview, messiness, pain and relief, answers (or lack thereof) and a litany of endless variables has meant that I’ve had to learn to be comfortable in who I am as a millennial man in a world that wants to mass produce men within a fetishized hyper-masculine ideal. Eff it! Sounds like my attitude and honestly, it’s the relieving end-point in my journey of trying to be a millennial man or often just a man.

Looking at my father’s generation their role(s) largely imploded into one bucket, that of providers. However, the changing relational dynamics has meant that this role within modern coupling has been split three-ways to accommodate the distinct aspects of functional responsibility for males; economic providers, good fathers, and active lovers/mates.

As an African man in a fast-changing social environment where gendered spectrums get widened by the day, I’m keenly aware of the stark portrayal of masculinity as a problem to be fixed; as a pathology; a flawed notion in its entirety, suspect and prone to incivility and violence. This is such a disempowering legacy and it exasperates me daily on how it’s politically correct to talk about men in animalistic precambrian references. Truth is, every time we, young men feel emasculated and disempowered we are likely to react with passivity or perversion; an outcome that further entrenches the belief in the inherent evil(ness) of masculinity. The perversion often takes the form of gambling, alcoholism, porn, lewdness, and sometimes-outright violence.

Contra intuitively we seem to regard femininities as inherently good, that’s why we tell men to get in touch with their feminine side; a call word for becoming good in a rather twisted view of virtue, identity and vice. Thanks to this incessant demonization, by now, it’s becoming manifestly clear that more and more young men-tired of the vilification-are opting out of any meaningful economic or social contribution to society.

These are the reasons as to why I am often skeptical of these programs seeking to mentor young men. Most of them fall for the misconstrued idea that it is we the young males, rather than our environment which is the problem. It is of little use to encourage young men to be healthily masculine and noble in a culture that continually treats masculinity, in all its forms as bothersome, defective and unnecessary.

Growing up in a rural working class community, my upbringing and economic opportunities though markedly fewer, still count as a lot compared to the massive underclass of millennial men that I see around me. There also exists this massive contrast between the economic capacity expected of males as sold by advertisements and mass media vis-à-vis my economic fortune and that of the many males my age. Between commercialised manliness and the everyday lived experience of your average man, there exists this wide chasm filled with despair and depression among those who don’t see themselves fitting into the popular archetype of the wealthy male. Then there are also those who see in themselves the need to play capitalist racketeering to shore up their masculine desirability within the romance market and greater society.

My fortunes look a bit better compared to the boys I used to mentor in Gaza, Kayole a few years back-some of whom got felled by the dreaded Flying Squad. In them, I saw providence having placed me a little above their lot-which ties them to the perennial tag of suspects. The irony within Kenyan masculinities is that while criminal masculinities is top heavy, made up of who’s who in the politics, trade, academia and civil society, the actual criminalised masculinity is made up of faceless, often nameless teenage boys in slums – pinned down by economic racism, negative ethnicity, and classism – who linger awaiting the anti-crime police units to snuff their lives under any pretext.

Meanwhile, with my university education, relative exposure, a bit of socioeconomic wiggle room and social stratification I exist in the eye of that quandary, while playing the role of a temporary arbiter with my fate tied to whether I effect an upward or downward mobility.

No doubt that the successive generational trauma tied to black masculine pains and tragedies often goes unacknowledged and sometimes derided. I have had to unshackle myself from the toxic strain of manhood that comes with the stiff stoicism manifested by our father’s generation. I talk about my mental health when I need to and I reject the idea that women are more emotionally attuned and expressive. I see emotional expression not as a feminine ideal to grasp for, but as a mere human instinct.

I have alongside friends and acquaintances explored the complexities of PTSD as a natural mental and emotional reality. Depression, especially in men my age-late twenties-often goes unnoticed, and rarely acknowledged. We have no problem getting in touch with the humanity of our male identity and the occasional need for remedies in moments when mental stress reflects through too much or too little sleep, physical pain and stress, irritability, and even unprovoked aggressiveness.

There exists 3.6 billion masculinities out in the world, and any attempt to tie any man down to clustered and cloistered stratifications masquerading as manliness whether through media portrayal, functional roles or fetishized notions is violence. As a man I am free to explore, live, interact and interpret my male identity based on who I am and view myself, disregarding all the ‘a real man does/is…’ sensibilities that populate popular conversations about the male gender.

I see being a man as being true to self, embracing it as such and flatly rejecting any populist social constructions that seek to replace character with achievement as the standard for manliness; a prospect that has many young men killing their souls in pursuit of insane wealth and power. Thankfully more young men are becoming accepting of their own versions of maleness and stubbornly deflecting the pressure that comes with materialism as the standard for masculine desirability especially in the marriage eco-system.

Living up to your values as a millennial man means standing up to-not toxic masculinity, first and foremost-but demonisation of manliness. Gendered identity is about context and the context we live in-much as male privilege remains a popular epithet-it only seems to work for upper class men. These powerful men are the manufactured native elite that not only does the bidding of the foreign white man but has an insatiable desire to be like them.

To further complicate modern African male identities, the economic deprivation, thanks to the current mafia state upheld by the three criminal dynasties and the rising impetuous ‘hustler dynasty’, limits opportunities to a select few. Accepting that I still live in a largely poor, largely rural, largely young, largely uneducated society where few males get to achieve their dreams is a tragic spectacle especially in a still largely hypergamous nation.

Maybe we are the generation of men that will finally demand the humanization of manliness, and put an end to the demonization of masculinity-though this will be hard because it pays bills in some quarters. We’ll have to acknowledge the successive traumas inflicted on our African manliness and end the misperceptions that have riddled the African male identity in all its forms and fashions. At the end of the day, there’s no such thing as a real man, there is just every man existing in his own contradictions, aches, triumphs and complexities the best way he knows how.

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Reflections

Confessions of a Football Widow

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Confessions of a Football Widow
Photo: Alamy

I first started suspecting that I was a football widow when, on a romantic night out with my husband, I noticed that he kept peeking at the TV screen at the bar which was showing a match between Arsenal (his favourite team) and Manchester United. As you might expect, the evening did not go well. I think at one point I might have even suggested that he stay behind and finish watching the match while I go home in a taxi.

There were other signs that indicated to me that I was joining the millions of other women who lose their husbands to the English Premier League every weekend and to the World Cup every four years. Like the time when my husband rushed out of a family gathering to go to his local to watch a football match. Or the time when he sunk into a mild depression when Arsenal kept losing.

Being a football widow – defined as “a wife whose husband spends the majority of his free time engrossed in football during the football season” is one of those unrecognised maladies that afflict many, many women around the world, but is not spoken about openly because football, like religion, has become a sacred sport whose adherents view those who are not converts as belonging to a subhuman species.

Yet, I imagine there are millions of women and children out there who are denied a husband’s or a father’s presence in their lives because of football. How many dinners did these football widows and orphans spend alone? How many conversations were not had because the TV was on? How many relationships were not cemented because there just wasn’t the time to talk, hug and cuddle? As one football widow put it, “At first I couldn’t understand how he could be so obsessed with a game that HE is not playing but just watching…and how does he remember each player on every team and their stats and not remember to pick up our clothes from the drycleaner?”

I have never enjoyed football. I do not support any Premier League team, and I am not among those people who stay up till the wee hours of the morning watching World Cup matches. I do not check the scores of any team on my phone, and as I write this, I don’t even know how many national teams have made it to the knock-out stage at the World Cup in Russia. It’s not that I hate the game; it’s just that I don’t understand the fanatical fascination people (especially men) have with it.

Maybe I just don’t get it. A Google search shows that men have been playing versions of football for centuries but that it only became a formal game with set rules around the 19th century. Some say it was invented in Scotland some 500 years ago; others believe that the Chinese invented it a couple of thousand years ago. What is clear is that men and boys have been chasing balls across fields in almost every culture and society, and that at some stage the game known as football became the most popular sport in the world.

It seems that football’s appeal has even extended to terrorist groups. It appears that Al Shabaab – which has in the past banned football, along with movies and music in the Somali territories it controls – couldn’t resist the “beautiful game” and invented a “halal” version of it, according to a report by Al Jazeera published about four years ago. Many Al Shabaab fighters are Arsenal fans, according to the report, and secretly yearn to play and watch the game. So they have “halalised” it with their own rules.

In an Al Shabaab football match, none of the players are allowed to wear shorts; they must wear tracksuits. Women are not allowed to watch the game, which must finish 15 minutes before prayer time. Team players are expected to abandon the game when there is a call to prayer. Al Shabaab referees don’t give out red cards – players who violate the rules can expect a public flogging. When a team scores a goal, players are not allowed to break into a jig or hug fellow team members. They must chant “Allahu Akbar”. (I wonder how many Al Shabaab members are watching the World Cup this year.)

It’s not like I hate all sports. For instance, I like watching Wimbledon tennis. It just seems like a more mature sport with just two individuals competing with each other. There is brain and brawn in tennis. It is an elegant game, with etiquette. Spectators clap quietly when a player wins; they don’t shout or burst into song. And they don’t beat each other up after a game and go on a beer binge afterwards. There’s no pushing and shoving, no spitting or swearing on the court (US tennis champion John McEnroe being an exception to the rule). But football? Well, it just seems so childish. Grown men running after a ball and bursting into tears or dance when the ball enters a net. And fans screaming and shouting and cursing.

In my opinion, the reason men obsess so much about football is because, like religion, it has become the “opium of the masses”. It numbs people, makes them think less about things that really matter. If everyone is watching football, then maybe they will not notice or worry too much about the billions of shillings being stolen from the Treasury? Politicians prefer it when citizens are in pubs watching football instead of on the streets protesting.

Football is a form of escapism. Men watch football to avoid uncomfortable feelings – it allows them to disappear into a world where they do not have to deal with problems, like a sick family member, the high cost of living, corruption or why their kids are doing badly in school. Maybe football is the cave that men enter to block out the rest of the world.

Football also makes people feel like they belong. Manchester United fans – regardless of tribe, nationality or race – around the world become one community when their team is playing, and go into collective mourning when it loses. While I support the unifying influence of the game, and the camaraderie that it generates, I also question whether it has been invented and promoted to prevent people from confronting real-life issues.

What most football fans don’t realise is that football is a big business that only benefits the players, the coaches, the team owners and sports gambling outfits. The English Premier League, in particular, is a big money-making scam. Millions of dollars are spent in buying players, getting sponsors, advertising and the like so that billions around the world can watch Europeans (with a sprinkling of Africans and Latin Americans) chase a ball across a field. None of this money trickles down to the spectators. Some Kenyan football fans have even committed suicide when their team loses. And now with the online sports gambling craze, many Kenyans are also most likely losing their savings.

In his defence, my husband says that I should be glad that he is only addicted to football, and not to drugs or other harmful habits, and that he only goes to sports bars to watch football and not do things that would truly hurt me – like be with a mpango wa kando. I guess he is right.

But how to fill the lonely hours? My niece, who is a fanatical football fan, tells me I should learn to love the game and watch it with my husband, at home. I tried that and it didn’t work. I was bored within the first 20 minutes.

Stacey Taylor, a football widow writing in the BMWK (Black and Married With Kids) website suggests various things you can do when your husband is glued to the television, such as read a book or two, learn a new language, redecorate the house (except the TV room, of course), take up dancing classes or start a support group for football widows.

I find that writing helps. So does watching Hollywood and Bollywood movies. Nothing beats a good movie with a glass (or four) of white wine while waiting for your man to come home.

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Reflections

AFRICA AND THE WORLD CUP: A Beautiful Tragedy

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AFRICA AND THE WORLD CUP: A Beautiful Tragedy
Photo: Fauzan Saari on Unsplash

2nd July 2010. Soccer City, Johannesburg. The score is 1-1 at the 2010 FIFA World Cup quarter-final between Ghana and Uruguay. In the 120th minute, Ghana have a promising free kick at the edge of the box. Some panicked Uruguayan defending, a proper goalmouth melee. Hang on, what’s this? It’s a penalty. Luis Suarez just saved a certain Ghanaian goal. The only problem is he’s not a goalkeeper, but a forward. He is shown a red card for his troubles.

Asamoah Gyan steps up. Could this be the moment an African nation goes to the semi-final, in Africa’s World Cup? Gyan is Ghana’s top scorer at this World Cup, with three goals – two of which were penalties against Serbia and Australia in the group stages. If there was someone you could bet on to have the sangfroid and the cojones to do it, Gyan was that guy.

The weight of a continent’s expectation is on his shoulders. He fires a shot, which cannons off the crossbar. Instead of winning it, he condemns Ghana to a needless penalty shootout which they late go on to lose – John Mensah and Dominic Adiyiah miss for Ghana and Sebastian Abreu hits a cheeky Panenka to send Ghana out of the 2010 FIFA World Cup.

This memory is so vivid because I watched every heart-rending minute of that match, cursing at Suarez- the ready-made pantomime villain who dashed a continent’s hopes; but more so at Asamoah Gyan? How could he miss? Why was he such a choker?

This is the story of Africa and the World Cup as we have always known it. A tale of the valiant underdogs who, like Icarus, flew too near to the sun and paid the price with their naivete. It is also a tale of self-sabotage, incompetence, gulfs in class and institutional racism.

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The story of African football is about politics.

In 1934, Egypt became the first African country to participate in the World Cup, which was hosted by Italy. They qualified for the sixteen-team tournament by beating Palestine (then under a British mandate) and Turkey (who withdrew from the qualification round). In the World Cup, Egypt lost 4–2 in the first round against Hungary. This was to be the last time an African team participated in the World Cup, until Morocco did so in 1970.

In the 1950s and 1960s, many African nations became independent and naturally, as independent nations, they joined global bodies, like the United Nations, and of course, the Fédération Internationale de Football Association (FIFA), which at the time was dominated by northern European and South American nations. This posed an existential threat– the FIFA Congress operated on the basis of one nation, one vote, irrespective of footballing ability. The Kenyas and Zambias, in the eyes of FIFA, had an equal say in world football, the same as two-time world champions Brazil, Uruguay and Italy.

Paul Darby, in Africa and the ‘World’ Cup: FIFA Politics, Eurocentrism and Resistance published in the International Journal of the History of Sport (Vol. 22, No. 5, September 2005, 883 – 905) observed that the Union of European Football Associations (UEFA)“made several attempts during the late 1950s and early 1960s to introduce a pluralist voting system that would more adequately reflect their self-perceived standing in world football”. When these efforts failed, they chose to assert their dominance in the FIFA World Cup. FIFA’s Executive Committee decreed that to qualify for the 1962 World Cup, Morocco, the winners of the African preliminary round would have to play a further qualifying match against Spain – a match they duly lost. In 1964, they made it worse by marginalising the Asians and Africans by pitting them against each other: the winners of the African zone would play the winners of the Asia/Oceania zone to qualify for future World Cup Finals.

Kwame Nkrumah, the-then Ghanaian president and pan-Africanist, persuaded CAF (Confédération Africaine de Football) to have its members boycott the 1966 World Cup. CAF’s Secretary General, Mourad Fahmy, argued that “the allocation of one World Cup slot to three continents (with more than 65 members)was absurd and did not adequately reflect the prevailing situation in world football.”

In 1974, João Havelange, a Brazilian, ran for the FIFA presidency on a pledge to improve the situation of Asian and African football – by increasing the World Cup final places from sixteen to twenty-four, and by increasing funding to improve infrastructure in African and Asian countries. He won handily, beating the incumbent, Sir Stanley Rous, who was widely resented by African nations for, among other things, supporting the inclusion of South Africa in the FIFA family despite their apartheid policy.

Under Havelange, Africa got two World Cup spots, which later became five under the expanded 32 team format that began in 1998. But it was under his protégé, Joseph ‘Sepp’ Blatter, that the African continent came to the fore. For all his faults, Blatter ensured that the dream of an African country hosting the World Cup became a reality. He backed South Africa over Germany in 2006. He backed it again in 2010. It later emerged that the win was not entirely legitimate; the 2015 indictments of FIFA officials by the United States’ Department of Justice showed that Jack Warner, a FIFA Vice President had accepted $10m from South Africa in 2008. Danny Jordaan, the chairman of the 2010 Local Organising Committee clarified it was not a bribe but a contribution towards the CONCACAF (Confederation of North, Central American and Caribbean Association Football- of which Warner was President at the time) “development fund.”

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The story of African football is about incompetence.

Zaire’s team, the Leopards, were Africa’s representatives at the 1974 World Cup in West Germany. The reigning African champions had been funded lavishly by the kleptocratic dictator, Mobutu Sese Seko Kuku Ngbendu wa Zabanga; he had given each member of the team a house and a green Volkswagen. Things had looked promising when they lost 2-0 to a Scottish team with the talents of Kenny Dalglish, Billy Bremner and Dennis Law. But it was the next match against Yugoslavia that will live on in infamy.

Before the match, Mobutu, or one of his minions, had assumed that the team’s coach, Blagoje Vidinić, a Yugoslav, of planning to deliberately throw away the game so as to favour his home team, so he was “secluded” from the team for that match. It later transpired that the players had not been paid their allowances – a story that will become all-too familiar – and they were in fact planning to strike before the match. The team lost 9-0 in the second-worst World Cup performance of all time (el Salvador holds the dubious record, losing 10-1 to Hungary in the 1982 World Cup, held in Spain).

Mobutu, predictably, was not amused. He gave the team an ultimatum: don’t bother coming home if you lose by more than four goals to Brazil. That was the Brazil – the defending champions who had thrilled the world with their canary yellow shirts and an exuberant display of swashbuckling football. Zaire creditably lost 3-0, not without its mishaps and led to arguably the most bizarre moment in World Cup history – Mwepu Ilunga rushed out of the wall and hammered the ball away before Rivellino could take the free kick. BBC match commentator, John Motson, termed it, “a bizarre moment of African ignorance.” But that was not the truth; Ilunga later claimed he was wasting time because Mobutu’s threat was all too real. In fact, on the team’s return to Kinshasa, they were briefly detained at the presidential palace for four days while Mobutu decided what to do with them, before he eventually released them. Minus their allowances, of course.

The singularly African spectre of disorganisation always seems to strike at the World Cup. In 2014, the Ghanaian team refused to train and were actually contemplating going on strike before their match against Portugal unless they received their bonuses. It took the personal intervention of President John Mahama Dramani, who ensured that the players received their money – in cash. The players did not trust their officials to bank it for them, so the cash (all $3 million of it) was put on a chartered flight to Brazil and delivered to the players in a police convoy. Later, Ghana’s star midfielders, Kevin-Prince Boateng and Sulley Muntari, who had shone so brightly in 2010, were kicked out of the squad for “vulgar verbal insults.” Cameroon also threatened to go on strike at the same World Cup and duly delivered another bizarre World Cup moment – Alex Song’s bizarre elbow on Croatia’s Mario Mandžukić. Nigeria went on strike and boycotted training too, and despite their woes, they made it to the last 16.

Which begs the question: why always Africa?

Endemic corruption is a way of life in Africa, and this extends to football. The sums of money in football make it a particularly lucrative feeding trough: during the 2011-2014 financial cycle, FIFA gave each member association an extraordinary Financial Assistance Programme (FAP) payment of US $ 1,050,000. Such sums in the hands of local football officials find more convenient uses. A week before the start of the 2018 World Cup, Ghana’s FA President, Kwesi Nyantakyi, was implicated in a corruption expose by Ghanaian journalist Anas. He has since resigned. Aden Range Marwa, a Kenyan assistant referee who was due to officiate at the 2018 World Cup, was also netted in the sting for allegedly taking a bribe of $600.

Poor youth development also plays a key role in Africa’s underperformance at World Cup. This is a direct result of poor investment in coaching and infrastructure. African teams are usually powerhouses at under-17 and under-20 level – Nigeria and Ghana have won FIFA tournaments several times. Football at the Olympic games are considered an under-23 event. Nigeria won the gold in the 1996 Olympics in Atlanta, Cameroon followed suit in Sydney 2000. However, there doesn’t seem to be a clear transition for most of the youngsters into the main national team. Take the 2005 U-20 final between Nigeria and Argentina: only John Obi Mikel can be said to have had a successful career. The Argentine side, on the other hand, had Lionel Messi, Sergio Aguero, Pablo Zabaleta, Ezequiel Garay and Lucas Biglia, who are bona fide global superstars today. Here’s another interesting statistic, Nigeria won the U-17 World Cup, beating Spain in the final. None of the Nigerian players have been capped to date. That Spain side had David de Gea in goal. Only Ghana’s U-20 side of 2009 seems to buck the trend – some of the youngsters formed part of the successful 2010 squad.

Another reason could be the perception that sport should not be taken seriously in Africa; it is usually a means to pass time or a political tool. This is why you can have a whole Sports Principal Secretary claiming that Kenya was ready to host the African Nations Championship (CHAN) because “we had the best hotels and roads, the only thing we lacked were the stadiums.” This attitude is hard to eradicate and shows up at the most inopportune moments. Sven-Goran Eriksson, a former England manager, was appointed as Cote d’Ivoire manager for the 2010 World Cup. Eriksson was appalled by the general disorganisation surrounding the preparations. An hour before a warm-up game in Switzerland, the players had no kit. One of the players couldn’t play because the kitman forgot his boots at the hotel. His captain, Didier Drogba, fresh from winning the Double with Chelsea that season, was not surprised. “Sven, it’s Africa. It’s like this.”

Which brings us to another question: why do African teams always prefer foreign coaches? Most African teams that make it seem to have foreign coaches. Of the African teams participating in the 2018 World Cup – only Tunisia (Nabil Maâloul) and Senegal (Aliou Cisse – captain of the 2002 Senegal side) are local. The perception by our football administrators, is that African coaches do not seem to know what they are doing. Yet, there are instances which prove that, with the right support, local coaches can hold their own. Egypt’s Pharaohs were led to three consecutive African Cup of Nations (AFCON) titles in 2006, 2008 and 2010. Stephen Keshi, the legendary Nigerian defender, won the 2013 AFCON and reached the last 16 of the 2014 World Cup with the Super Eagles. Kenya qualified for the 2004 AFCON under a local coach, Jacob “Ghost” Mulee. Kenya achieved its highest ever FIFA ranking, 68th, under a local coach, Francis Kimanzi. This is another interesting fact for you – to date, no foreign coach has ever won a World Cup.

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The story of African football is about triumph in the face of adversity.

Some of the most memorable moments in World Cup history have been by African teams. Can you forget Ghana in 2010, who carried Africa’s torch brightly in 2010 in Africa’s World Cup? But before Ghana, there was a Cameroon at Italia ’90 with the iconic Roger Milla celebratory jigs at the corner flag during Italia ’90. Those were the lasting moments of Italia ’90 – neither Paul Gascoigne’s tears nor Toto Schillaci’s prolific form for the home side came anywhere close. François Omam-Biyik’s header at the San Siro against the world champions, Argentina, led by the captain, leader, legend and once-in-a-lifetime genius of Diego Maradona, was the biggest upset in World Cup history. This was bigger than the United States beating England 1-0 in 1950. Much bigger than West Germany beating the Magical Magyars of Hungary in the miracle of Berne. This was an African team, from you know, Africa. Beating Maradona’s Argentina with nine men – two deserved red cards for playing typical “African” football). Roger Milla, all 38 years of him, was summoned by Paul Biya (he’s still President to date) and in true African dictator fashion, ordered to play at that World Cup. Their preparations were shambolic- Cameroon’s training camp was rocked with the usual complaints of allowances not being paid. Their goalkeeper, Joseph-Antoine Bell, was an egomaniacal divisive force.

And yet, they hung on, match by match and were merely a Gary Lineker penalty in extra time from doing the impossible – reaching the semi-final. The Indomitable Lions inspired a whole new generation of footballers, both in Africa and elsewhere – Bell was dropped for the relatively low-maintenance, Thomas N’kono, who had a superb tournament and inspired the legendary Gianluigi Buffon to become a goalkeeper. In fact, Buffon named his son, Thomas, after N’kono.

Do you remember Senegal following an eerily similar script in 2002? The Lions of Teranga, making their first appearance in the World Cup, humbled France – defending World and European champions in Seoul with Pape Bouba Diop scored the scrappiest of goals to cause yet another upset. A Henri Camara golden goal in extra time against Sweden took Senegal to the quarter-final against Turkey, where the Lions too, succumbed to a golden goal. Fate, it seems, had a touch of cruel irony.

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The story of African football is about hope.

Despite all the challenges that football in Africa faces, never have I been more optimistic about its future. A lot of good things are happening: Nigeria’s 2018 World Cup kit, manufactured by Nike, was sold out within three days of its launch; which goes to show that there is money to be made in the African game if things are done properly. Mohammed Salah, Liverpool’s Egyptian King running down the wing, is one of those you-have-to-see-it-to-believe-it talents. He could potentially be the first African Ballon d’Or winner since George Weah, now President of Liberia.

Gianni Infantino has pledged to expand the World Cup further. The 2026 World Cup, to be held in the United States, Mexico and Canada, will have 48 teams, with Africa having 9 teams and Asia 6 – not a bad start to his presidency. He has also promised to end the culture of corruption at FIFA, but this is to be taken with a pinch of salt – after all, Blatter is still attending the 2018 World Cup as President Vladimir Putin’s guest.

For youth development and a solid technical foundation, we can look to Germany and Belgium for assistance. These two nations rebooted their whole approach to youth development, investing in coaching and better facilities. Germany’s squad which won the 2014 World Cup, demolishing home favourites Brazil 7-1 along the way, was the fruit of careful planning. England have caught the bug a bit too late, but they are catching up. All African countries should follow suit. Maybe we should do one of those benchmarking trips, with actual results.

Finally, we should get more organised and drop the “this is Africa” mentality. Oh, and stop the looting.

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