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Reflections

Medical Malpractice and Patient Advocacy in Kenya

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

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

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

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

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

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

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

Pursuing Accountability: Some Lessons

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

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

This is Kenya

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

Professional Accountability

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

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

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

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

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

On collective accountability

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

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

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

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

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

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

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

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

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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

Our Grandmother’s Miniskirt: A People’s History Through Photographs and Stories

8 min read. It was the women of that time that intrigued me most and I was watching their lives with the impatient envy of a child. I wanted to grow up and wear those cat-eye glasses and cute kitten heels, burn my hair straight, drink Babycham and laugh like they did, with a hand full of bangles held out at just the right angle.

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Over the past few weeks, I’ve been inviting people to share photos of their mothers, grandmothers and aunties looking stylish in the fashion of the 1960s, 1970s and 1980s. The idea, which we are calling “Our Grandmother’s Miniskirt”, is simple enough, crowdsource photographs from Kenyan homes of women dressed in the style of that era; the photographs will be accompanied by reflections, essays, short stories or poems. The aim is to capture a history of ordinary people and to share this history through physical exhibitions, an online archived exhibition, and a coffee table book. I see the project as a celebration of Kenyan women and gives a snap shot of the emergence of the modern Kenyan woman.

By the time we staged the first mini-exhibition with a selection of 27 photographs submitted by people from around the country, I had come to understand that projects are not easy in that they all require planning and careful execution, even if they excite people. Getting people to send their scanned photographs from precious family albums has been challenging. The project goes into the intimate spaces of families and asks them to override their tendency towards privacy and share their lives with strangers. Of course this was always going to be a trial. It was not surprising that although the daughters or granddaughters were enthusiastic to participate in the project, their mothers and grandmothers — the subjects of the photos — sometimes refused to allow them to share these images. But I’m glad the images are trickling in.

Implementing the project over the last few months has helped me see its possibilities and expanded its scope in so many ways. Most important I am now looking for photographs before the 1960s and of Kenyan women wearing a variety of dress and hairstyles. The secret to the power of the project has furthermore revealed itself in the act of crowdsourcing. This approach has allowed people to connect and own the project, much more than if the photos were purchased from a media source.

My Childhood: 1960s and 1970s

The photographs have unleashed a collage of memories for me. I was a child in the 1960s and the 1970s watching Nairobi slowly emerge from its colonial yoke and my parents seemed to be at the centre of it all. They were amongst that group of Africans who were literally stepping into the shoes left by our colonial powers. My late father’s (William Ndala Wamalwa) career developed quickly and after only two or three years in government service, he stopped driving himself and moved to the senior government ranks.

But it was the women of that time that intrigued me most and I was watching their lives with the impatient envy of a child. I wanted to grow up and wear those cat-eye glasses and cute kitten heels, burn my hair straight, drink Babycham and laugh like they did, with a hand full of bangles held out at just the right angle. But most of all I wanted to wear those glamorous clothes that I saw women wear to parties and dinners – there seemed to be a party or dinner every other weekend! Miniskirts, bell-bottom trouser suits, halter tops, maxi dresses, stilettoes, kitten heels. I wanted to dance to the very dangerous James Brown, the elegant Supremes, the cool Fadhili William, the revolutionary Miriam Makeba, and the handsome Harry Belafonte. I thought all these musicians were my parents’ friends. Imagine my shock when I grew up enough to understand that these were distant celebrities.

Burning Hair

For African women, hair means everything. Women spend large sums of money on our hair and even more woman-hours on styling it. Braiding can take eight hours. Typically a myriad of products are used on African hair, from oils, pomades, sprays, gels, dyes, treatments, conditioners and shampoos. How seriously do African women take their hair? Well in the days when we still had plastic bag around, Kenyan women could be seen risking their reputations by wearing plastic bags on their heads in broad daylight, to stop their hair from getting wet during an unexpected downpour.

But when it comes to hair, there was a simpler time. In the early 1960s, hair straightening was not yet fashionable and chemical relaxers had not yet arrived in the country. Kenyan women still wore their natural hair and fashioned it using African hairstyle traditions that involved elaborate cornrows, braids and plaiting. Saturday was the day when hair was dressed, typically with the help of skilled friends or relatives. Hair salons were still a faraway concept and the hair industry was a rudimentary affair and not the billion shilling industry of today.

In our home, many Saturdays found Aunty Truphena dressing my mother’s hair. Aunty Truphena was not my mother’s sister. But she and my mother were closer than sisters. They came from one of the smallest of the eighteen Luyhia sub-tribes, the Abanyala ba Ndombi, who are located in Navakholo division, north of Kakamega forest, in western Kenya. At that time, not many people seemed to have made it out of my Bunyala and it was rare to meet a Mnyala in Nairobi.

Sometimes Aunty Truphena straightened my mother’s hair using a hot comb heated on a charcoal jiko. She divided the wet hai,r drenched it in liquid coconut oil, and burnt it straight with the hot comb. Next she rolled the hair onto pink rollers and pinned it down. I wondered how she had learnt to dress hair like that. Her own hair was forever hidden under the flowered scarf that she always wore.

Nigerians Come to Town

The late 1960s were marked by an influx of Nigerians who came with their loud laughter, outsized personalities and strange food. They were mostly Igbos who had fled to Kenya as refugees from the Biafran War (1967-1970), but there was nothing “refugee pathetic” about them. In fact they came and took over our live,s adding flavour and passion like I had never experienced. I remember the names of one family in particular: Chief Jerome Oputa Udoji[1], his wife Mrs. Uzoamaka Udoji (Aunty Uzo) and their three children Scholastica, Osita Paul and Peter Ebelechukwu. The photograph of my mother below was taken at that time, and it was Aunty Uzo who made me realise just how beautiful my mother was, when she loudly exclaimed that my mother looked like Miss Kenya.

Mrs Rose Nanjala Wamalwa (Sitawa Namwalie’s mother) as an executive secretary at the Ford Foundation in Nairobi, Kenya (early 1970s). Photo Credit: Studio One.

Aunty Uzo was a force of nature. She and the other Nigerian women introduced me to a different way of being African. They were militant in taking on any vestigial racism that still had the temerity to cling on and even fight back, so soon after Kenya’s Independence. Aunty Uzo often regaled us with stories of the many battles she fought when white people dared to assert their colonial-era privilege. For us Kenyans, would so often acquiesce to everyday racism from the British, but not a Nigerian and definitely not Aunty Uzo. She fought with the priests at St. Mary’s school in Lavington where her sons were enrolled and she fought when white people tried to jump queues in banks or supermarkets and she argued with African waiters who tried to ignore her in restaurants. She was strong and assertive, always encouraging Kenyans not to be cowed by white people.

There were days when Aunty Uzo took over our kitchen and taught my mother how to cook Nigerian food, subjecting us to strange new flavours and aromas. Every so often our kitchen was overwhelmed by the strong smell of a dried fish imported direct from Nigeria which was even more pungent than our sivambala catfish dried in the hot sun of western Kenya. I learnt that Nigerians waste very little, cooking all parts of the goat,:the skin, meat, innards and hooves. The one dish that really tested my rather narrow palate as a child was a soup that combined beef, fish and chicken which Nigerians seemed to particularly love. When the war in Nigeria ended, our Nigerian friends left, leaving us changed for ever. But soon their place was taken by Ugandans fleeing the abuses of Idi Amin who began his rule in 1971, but that is a story for another day.

About the Exhibition

These photographs have triggered so many memories for me and it is my hope that they will do the same for all who see them. They document the social history of ordinary people in Kenya. I’ve learned that the past can be another country, sometimes a more interesting country than the narrow ideas that populate the present. I shared the premise of “Our Grandmother’s Miniskirt” with a young man, Basil Ibrahim who taught me the word hagiographic when he wrote the following in an email about the project;

“…a particularly interesting deviation from the hagiographic custom of The Great Men model of history-making…It is a model for bringing the archive to life, using memory, popular culture…in an experiment to provoke us to think about the implications the past has on the future we want.” (17 August 2019)

What he meant was that we tend to make saints of certain “great men” of the past (hagiography means the making of a saint), while ignoring the stories of ordinary people, who lived through those times. I hope that this project will correct that tendency towards hagiography.

When arranged chronologically, the photographs begin with one from1945 of a woman named Gatoro Ndugi M’Chabari, dressed in the traditional dress of the Tharaka ethnic community. The type of dress she wears was worn by married women. The unmarried ladies had their breasts left uncovered. The photograph was submitted by Mr Simon Mitambo, Gatoro’s nephew and shows her in what can only be described as a brief miniskirt. The photo was taken in Meru town in 1945, after entertaining the then colonial governor of Meru. In discussing her traditional dress, Gatoro Ndugi M’Chabari — who is over 90 years old — had the following to say: “Although we looked almost naked in miniskirts, there were no cases of sexual harassment.”


Gatoro Ndugi M’Chabari,
from the Tharaka ethnic community. 1945, Photograph submitted by Mr Simon Mitambo.

In another story entitled, “The Village Woman and Son, Bound for England” John Sibi-Okumu pays tribute to his mother Maria Ajiambo, wa Agostino Munika nende Sarah Mbaye (the names of her parents.) She was also addressed as Naliali, her clan name from the Samia of Western Kenya. John estimates that she was born in 1936.

Maria Ajiambo wa Agostino Munika nende Sarah Mbaye, mother of John Sibi-Okumu. The photograph was taken in 1958 at Noble Studio in Nairobi when John, her first born son, was four years of age.

John’s story of his mother reveals many intriguing circumstances, first being that his mother was born on a sisal estate in Juja, Kalimoni, where his grandfather worked as a nyapara or ‘overseer.’ John notes that Tom Mboya was born in similar circumstances, showing the country had already started to change with people migrating from their homes and making new homes in different parts of the country.

Rosalie Kere wearing a “Stiff” skirt and her “Beehive” hairstyle (1961). Photograph submitted by Caroline Kere.

Caroline Kere shared the photographs of her mother Rosalie Kere – the first photo above – who had the distinction of being a poster girl for soap called “Nakasero” and “Lux” in the early 1960s. Caroline’s tribute story to her mother has the intriguing title, “The Amazing Story of How my Father Found my Mother”. Her mother and father’s story is such an improbable romance story worthy of a blockbuster Nollywood film, that you can read for yourself at the exhibition, the online archive or in the coffee table book that is to come.

What follows is an exhibition of selected photographs.


Grace Ntini, from Narok County. The photograph was taken in Nairobi in 1969. Grace was 24 years old and worked for Avis Rent-A-Car Company. The photograph was submitted by Grace’s sister-in-law, Rosemary Mesopirr.


Rosemary Mesopirr, who
was 14 years old and a primary school pupil in the rural areas of Narok County. This photograph was taken in Mombasa in 1974. This was the first time she travelled to the Kenyan coast to visit her father who was a civil servant then. It was her first time to board a bus.

 

My Stylish Mother
By Doris Rutere

My mother Cecilia Kanyoe was a copy typist at Marimanti Rural Training Centre back in 1975. She was always detailed and careful in her choice of office wear. In this photograph she is wearing closed toe heels and has broken her suit with a turtleneck that matches her head gear, a chain and a wrist watch. I think they present a level of sophistication making her refined and chic. Next to her is Esther Muthoni, who was my mother’s friend. In the picture, she wears a wide belt on her cute mini-dress to create contrast while matching her head gear partly with her shoes. 

Both women are quite careful in how they let their hands rest on their thighs.

 

Joyce Akoth, pregnant with her fifth born in 1973. This picture was taken in the early 1970s when Joyce worked as a teacher and before joining the Ministry of Public Works. The photograph of Joyce Akoth was submitted by her daughter Esther Adiambo.

***


Nancy Wanjiku Kimani , the photo was taken outside Kijabe Nursing Institute, where she was undergoing training as a nurse in Kijabe Town (1969). The photograph was submitted by her daughter Ruth Kimani.

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Reflections

A Letter to Stella Nyanzi: “You Teach Us to Lay Blame Exactly Where It Belongs”

6 min read. Too often we are willing to believe that if we are calm enough, if we are silent enough, polite enough, eloquent enough, poised enough, then the tyrants will listen. We believe that if we are ‘’well mannered’’ then we will be heard. You remind us that this is deception.

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A Letter to Stella Nyanzi: “You Teach Us to Lay Blame Exactly Where It Belongs”
Photo: Facebook/Stella Nyanzi
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My sister Nyanzi,

I used to think tyranny means one-party rule, one media station and army garrisons everywhere. Now I know tyranny also means that who we love, how we live, how we die and even the speed of our death is chosen for us by people that never have to face us, by people that have learned not to fear our wrath or our collective pain. You have taught me this, because both of us live under tyrannies. As I write this, you are in Luzira Maximum Security Prison contending with the tyrannies of the prison authorities, the judicial system, the police, Makerere University, Museveni and his state and personal machinery. We live under multiple tyrannies at once, some more immediate than others, all of them intent on silencing us.

I am writing this from Kenya. I am writing from a country reeling through an economic recession that the state’s press statements will never admit exists. A manmade recession fueled by the looting that seems to grow more arrogant with each day. As I write this, many Kenyans are dying in public hospitals because there is no medicine or the doctors have not been paid or someone stole the money for the equipment. As I write this, there are young people attending endless seminars on entrepreneurship because they face grim rates of unemployment, this too is manmade disaster. I don’t know how many young men the police have killed today; I don’t know how many women have been sexually abused or killed by a country that just seems to hate its women. There are also the university students who are teargassed and beat up every time they try to march, and the many communities unhumaned by the state. I don’t know how many queer people have been stripped or raped or mocked or told to prove they are human beings today. These are the tyrannies I live under.

We share some of these tyrannies and for this, I call you sister. Allow me to call you Stella.

When you staged your first nude protest at Makerere Institute of Social Research (MISR), several academics gave media interviews to say that they condemned your protest and found it to be ‘’too much’’, they mockingly asked if negotiations had failed for you to go to such lengths. More insultingly, some said while they agreed you had legitimate grievances, you could have been more civil. They seem to think that you should have spoken more sweetly. I laughed when I heard them. You know how tyranny works Stella, how it works especially well in bureaucracies. You know how good bureaucracies are at silencing and ignoring. You and I know that bureaucracies move at exactly the speed dictated by tyranny, no faster and no slower.

It is a maddening thing to realize that even in the hallowed halls of universities, we are ignored and insulted and treated anyhow, as our people say. It is more maddening to know that our emails, our eloquent letters and our pleas will go unheard when tyranny is present, as it was at MISR. Tyranny often wears a nice suit and can be well spoken and well respected. At Makerere, you used the tools at your disposal in defense of yourself. The tools on that day were red paint, cellotape, your body, your voice and camera. Those were the tools available to you. The other important tool in your arsenal, arguably the most potent, is your refusal of respectability.

So often, women are only celebrated when we protest in service of the men in our lives — our brothers, our fathers, anyone but ourselves. I think of all of us who are scared of speaking in our own defense, scared of organizing for our own wellbeing, our reproductive freedom, our sexual freedom, our safety. I think of how we have been intimidated to believe that this is entitlement, as if being entitled is a bad thing. How many of us have swallowed indignity after indignity because the only person being humiliated is us?

Here, I pause, in the middle of my letter to acknowledge and greet you in the movements you come from, the movements that have shaped you and supported you. We know that often people are isolated from their movements in order to make them messiahs. But messiahs always fail because they don’t really exist. I greet you in the name of the #RotAtMISR , #WomensMarchUG , #ThisTaxMustGo , #PeoplePowerMovement and the many offline political actions you have taken. From standing in solidarity with students of Makerere when they protested arbitrary inclusion of fees, to caring for the Arua 33 that were victims of state violence, to dealing with menstrual injustice through the #Pads4GirlsUG movement.

It is from your movements that you have dealt with the effects of Museveni’s tyranny intimately, by seeing how your comrades are brutalized and seeing how relaxed the dictators can be even in the face of impassioned pleas for even a small measure of justice. You have seen your movements forced to wait on the dictator’s time. We all do so much waiting after all. We wait for enough money to take our relatives to decent hospitals and decent schools, we wait for courts to vindicate us and for the churches to speak for justice and for the police to stop killing. On both sides of the Malaba border, we wait. A feminist sister, Mumbi, has written about how we are forced to wait on the state’s time, wait on tyranny’s time, in order to live as human beings. Mumbi considers that one of the ways we can disrupt the state’s time is through the communities we build and how we care for each other.

You have given us another answer to how we can disrupt the state’s time; by abandoning respectability and politeness. After all, the tyrants know exactly what they are doing when they abuse our humanity. From your political actions, your Facebook posts, and your court appearances, we learn to call the tyrants by name and declare their shame to them. I read somewhere that your father died because of the poor healthcare system in Uganda, and in your writing, you lay the responsibility for this on Museveni’s head. Rightfully so. Another feminist sister, Sunshine, says that this is reminiscent of what Fela Kuti did when his mother (and our feminist ancestor) Funmilayo Ransome-Kuti died from injuries she got after the Nigerian police raided Fela’s home. Fela took his mother’s coffin to the army barracks, to Olusegun Obasanjo, who for all intents and purposes had killed Funmilayo. When you call Museveni a pair of buttocks, that is exactly what you are doing, connecting the tragedy of all the deaths and suffering caused by a sick state to the head of the state. Truth telling can start there, by us clearly naming the tyrants and abusers.

For some reason, tyrants hate this. They are shocked at the idea that we might call them what they are: abusers, misogynists, sexists, thieves, robbers, murderers, homophobes. You teach us to lay blame exactly where it belongs, to practice the radical truth telling that refuses to be distracted by bureaucracy. Stella, you say that politeness has been held captive, and the powerful don’t listen anymore, and sometimes we have to say fuck it and then people will listen.

Too often we are willing to believe that if we are calm enough, if we are silent enough, polite enough, eloquent enough, poised enough, then the tyrants will listen. We believe that if we are ‘’well mannered’’ then we will be heard. We think if we bend ourselves enough, the tyrants will feel some pity for us. You remind us that this is deception. Good manners are decided by the powerful, and after all — isn’t it the worst manners to steal and oppress? Yet no one accuses tyrants of having bad manners. No, bad manners are left to be a cross for us to carry to hasten our own silencing, our own internal and final deaths. Respectability protects the comfort of the tyrants. Your political actions show us that when we shed politeness, we can disturb their peace in potent ways.

You, like Audre Lorde, know that our silence will not save us. Not only that, but politeness and niceness cannot save us either. You know that we only get silent to work out our internal convictions and from there, we use whatever tools we have to shout, be it our bodies, our phones, our voices. We shout. We shout because we are being killed either way. Your poetry, court appearances and nude protest are all political actions, asking us what we are still afraid of. What do we gain by protecting the comfort of these tyrants to enjoy their theft, their tyranny unoffended?

Stella, you are a woman who has reached into herself and taken joy, taken brazenness and categorically refused shame. Your body is your manifesto, as you say, and with it, you declare and live your radical queer feminist politics every day. We are affirmed by you.

Some people think you are fearless, others believe you are unashameable, I don’t believe either of them. Even with the best intentions, they are trying to make you iron, invulnerable, and otherworldly. I know different. You are not otherworldly Stella, you are fully human.

In care and love,

Karwitha

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Reflections

A Letter To Stella Nyanzi: The Revolution Lives in You

7 min read. I want, like you, to steadily and surely offend anything that stands in the way of freedom, of liberation, of love, of justice, of truth, of humanity. Let me be rude, let me be all these things, if all they are trying to say is that I am free, unbound.

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A Letter To Stella Nyanzi: The Revolution Lives in You
Photo: Flickr/Chapter Four Uganda
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My sister Nyanzi,

We grew up on folktales and stories that spoke on the value of truth, of clarity, of assertiveness. We read about scheming animals always having to face the consequences of their actions, while those characters that upheld the truth were the examples that we were meant to emulate. Yet, somehow, these stories were supposed to remain suspended in our minds, perhaps as pieces of entertainment. No one wanted a truth teller, especially not a primary school going child. I have gone through most of my life being called rude, difficult, entitled or spoilt, by aunties, by cousins, by teachers, and by neighbors who cautioned their children against associating with me. Most of my life, I thought there was something wrong with how God made me.

Why did my teachers punish me for speaking truth? Why did I go home, my body tender from a caning because I asked the teacher to explain the logic behind making students kneel on gravel? Why did my cousins whisper behind my back, saying that my opinions were rude, that my parents had spoilt me, and that I was too entitled? I questioned a lot, yet I did not see any other way to live. I knew the truth to be good, even when it seemed a heavy weight on my heart. Each one of us owes ourselves the truth. The truth is our duty. It is my duty, a duty that you have taken on and stood by, even when the very ground is threatening to betray you.

I am writing this after returning to Kenya from a visit to Uganda less than 24 hours ago. I thought about you a lot during my stay there. I thought about all the Ugandans who have lived their lives silencing themselves, their truth, their pain, their desires, their ability to want to imagine freedom because of fear, fear not born of themselves, but of tyranny, from the ways in which their society has dealt with ‘rude’ individuals. I saw children going to school, with heavy bags and tender spirits. I thought of all the stories, the theory, the language they are being taught about morality and truth, knowing that they are probably being short-changed. I thought about how they are being taught that truth depends on who holds the power to instill fear.

Are the children being told that truth is silence? Are they being told that truth is folding the pain in their hearts into smiles? Are they being told that truth is accepting state and religious terrorism? Are the children carrying fear in their heavy bags? Are they rushing home to be cautioned against following in the footsteps of Dr. Stella Nyanzi? I thought about your multiple arrests, and how that has been weaponized to further silence, to further disregard, and to further trample on the possibility of individual and collective expression. What do the children think when they see you on television? What do they say about you in their private conversations?

It is no secret that we live in a world that rewards complacency. The systems we live under: economic, social, and political, are so fragile and fickle that they have made us scared of ourselves. Of course, all this is deliberate, to maintain control. We live under the giant lie that we get to choose. We choose which schools our children go to, what we will purchase, how we will spend our time, how we will interact with authority, what and how we teach our children, yet all this exists under tyranny. We have been robbed of our humanity, of our ability to make decisions guided by what aligns with truth, with courage, with kindness. That is why, Stella, the children are being taught politeness, one that will rob them of their ability to speak up in the face of injustice when they are told that they cannot love who they want to love, when they are told that they don’t belong, when they are told that their lives are not precious, when they are lied to over and over, when they are made to wait for their rights, when they are killed, when they are hurt, when their education is used to oppress them, and when their lives become small residues of what freedom might have looked like, when they are reduced to small ‘maybes’ and ‘could have beens.’

That is why many people may be blind to the importance of your protest, which is in effect, a protest to your protest. Is this the tragedy of having a heart constantly pursuing freedom?

When I first read about you, I felt so affirmed that I cried. When I saw you speaking, how you spoke, what you spoke about, I remember feeling small eruptions of heavy joy inside me amidst the pain of seeing how the state responded to you. I prayed for the courage to want, so intently and so intentionally, the kind of truth abiding freedom that oozed from your heart. I prayed that I am brave enough to bare it all in the face of millions of odds stacked against me. I prayed that I may never steer away from a life tied to imagining, wanting and working towards freedom, towards a life unbound by fear. They have used your truth to call you obscene, to call you indecent, to call you lascivious, and to say that you are profane. They say you hold no remorse, but why should you? They call you untamed, rude, vulgar, and reckless; they call you intolerable. In the churches, they are saying that you are sinning against god. In truth, all they are trying to say is that you are free. Unbound. Your spirit can never be contained. They do not have the language for any of this because they speak the language of fear. The voice of truth makes them afraid. Your life is testimony that freedom is possible. Unbounded freedom. Freedom that is safe from tyranny, freedom that tugs on the heart and forces you to run towards the what is right, what is eternal, and what is true.

So let me live a vulgar disrespectful life. Let me be seriously and gloriously profane. Let me be intolerable. Let the people say that no man will marry me. Especially that. Let me be disagreeable. Let me be a sinner. Unapologetically. Let me be ungovernable. Let me be untamed. Let me be unremorseful. Let me be untethered. Let my life insult them. Let me be offensive. Let my freedom live as critical evidence that truth exists, that it always sits sharp and intentional, between my joy and my pain. I am shameless. I am unafraid. I am a manifestation of defiance. Let my life be shaped by defiance and resistance. I want to steadily and surely offend anything that stands in the way of freedom, of liberation, of love, of justice, of truth, of humanity. Let me be rude, let me be all these things, if all they are trying to say is that I am free, unbound. Let my life be grandly disruptive. That’s what I want. Let us all be grandly disruptive, in our small ways, in standing up in our small pockets of possibility. May we be the embodiment of radical rudeness.

Manners always end up on the shelves, next to civility, collecting dust and making the silence louder. This is why the despots love them. This is why we are told to use ‘respectable civil channels,’ when that in itself is an injustice: to be told we will be heard by the very tools which ensure we remain unheard. You live in a country under dictatorship, under tyranny, under evil rule. So do I, so do so many people on this continent. They have arrested our freedoms, kept them locked up. They lie, they steal, and they laugh at us for wanting to live. They deny us belonging, they want to take away everything, our voices, the voices of the children, even before they break.

Stella, they want us to beg them. They want us to lick their feet, grateful for the smelly crumbs. They want us to crawl on our bellies, waiting for permission to sit on our buttocks, then to kneel before them, and then finally, maybe, to stand, when they will it, how they will it, for their benefit. I refuse. Let these tyrants sweat in terror at the mention of your name, let them tremble at the sound of your song, your poetry, your protest, your truth, your prayer, your defiance. Let all the despots shake and fear at the sound of our collective lament. Let peace be least of their experiences. Let them tremble. May they tremble.

I refuse politeness. I dedicate my life to unlearning respectability, because at the end of it all, divine freedom is fearless. It is not neat and pretty and dainty. It is rude, it is vulgar, it is naked, it is wild, it is unashamed, it is raw, it is profane, it is indecent. It is loud. It is demanding and disrespectful. It is you. You are divinely free, and they cannot take that away from you. The entire revolution has already happened inside you, and we get to experience that, from your life, your words, your work, hoping that we can meet you, where you are, in whatever capacity we can. You have taught me that when we are silent, we are more at risk of pain, of suffering, of living lives suspended on insubstantial strings of fear, always waiting on where our next small redemption will come from. You have taught me that the process of truth is rewarding, not in the ways in which the world rewards, but the ways in which the spirit rewards. The process is indeed the shortcut. It is the homage to freedom, to the channels between us and liberation.

So I am writing this to you, and to my 15 year old self, to my 10 year old self, and to the black children who will live after us. I am writing this to myself, before I accepted that I am brazen, before I accepted that nothing is wrong with me, that maybe everyone who called me rude for speaking the truth was just afraid and cowardly, because this world thrives on the fear of people. I am writing this to my sisters, to my mothers, to everyone who has housed silence and shame in their hearts. I am writing this to you, hoping that you can rest in the knowledge that there are so many of us who are holding your spirit, your soul, your heart, your dreams, in our spirits, in our souls, in our hearts, in our dreams, during this time and always. We stand in solidarity with you, with your defiance, and with your dreams of freedom. Your life has affirmed us in so many ways, and knowing that you live an absolutely unapologetic life has sustained the bulk of my ability to imagine freedom. I hope like you, I can show up as my highest, truest self, always. May your words continue to be the fuel that will sustain the fire that will consume all these tyrants, all these despots, all these oppressors, all these dictators.

Thank you for refusing shame, for refusing fear, for embracing love, for embracing the call of truth and freedom. Thank you for always showing up as your full self, thank you for making it possible to for so many of us to imagine other ways of living, of being. Thank you for your poetry, for remaining tender, for remaining you.

In love and solidarity,

Kedolwa

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