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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

Tributes to a Great African Mind: From Nyong’o, Mutunga and Shivji

Thandika will be sorely missed by the entire African intellectual community. His brilliance was matched by his humility, wit and willingness to mentor new generations of scholars to change the fate of the African people.

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Tributes to a Great African Mind: From Nyong'o, Mutunga and Shivji
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I remember one weekend in Dakar, Senegal, when Thandika and I had had a long afternoon talking and having some beer in his apartment. We were discussing Marxist approaches to the study of African politics which Thandika thought was rather deficient, with “everything being reduced to relations of production however poorly understood.” The year was 1979, and the African Institute for Economic Planning and Development (IDEP) was at its highest point of radical intellectual firepower, headed by Samir Amin, the eminent political economist of the “accumulation on a world scale” fame. The Council for the Development of Social Science Research in Africa (CODESRIA) had just been born literally on the ribs of IDEP, headed by Abdala Bujra, the well known Kenyan anthropologist. Thandika straddled between the two institutions, subsequently succeeding Bujra to ensure that CODESRIA became the springboard for most young African scholars as astounding social scientists.

I remember that afternoon very vividly. Thandika was full of innovative ideas and impatient with some pedantic social science scholarship on the African scene. I was surprised Thandika had hardly published on any of the innovative ideas he had which he expressed so convincingly. So I challenged him to stop being a typical African in love with the oral tradition and begin writing and publishing. It did not take long before he hit the road, leaving me miles behind in a very short time. Not long ago Thandika sent me the following mail:

“Here is an article I recently published in World Politics. Remember it is you who once challenged me to begin writing when we were in Dakar. I will never forget that.” The article was on “Neopatrimonialism and the Political Economy of Economic Performance in Africa: Critical Reflections” (World Politics, Vol. 67, No. 1, January 2015). I found this article perhaps one of the best analysis and critique of development theories in Africa, debunking theories of those who view the state as a pariah in Africa. Those who lump all African heads of state and government as “big men” out to eat state and society to the bone didn’t sit pretty with Thandika in this article either. Seeing the future of Africa as foretold, doomed and bereft of any meaningful development almost for ever is something that could pass as propaganda but not social science. On 25th of October 2013, Thandika wrote me as follows: “Early this year I met Willy Mutunga (later our Chief Justice) who reminded me of a meeting at your house where we drafted the principles of the Kenyan constitution. It is nice to see some things come true.”

Neither Willy nor I worked on these principles with any idea that after the constitution was promulgated we would occupy the positions that we eventually did. Thandika was, of course, miles away only to be happy eventually that his contribution to our struggle eventually paid some dividends in Kenya’s social progress.

That is why Thandika could never accept a “one shoe fits all” view in of Africa’s political economy. Not all African middle classes are “comprador” nor are all African states dependent in the same way on external forces. Class relations are historically given within social formations which can be subjected to analysis by the same theoretical models of political economy that are capable of bringing out their similarities and differences. This comes out very clearly in Thandika’’s World Politics article I have referred to above.

When I was writing the “Introduction” to a book I recently published on “Presidential or Parliamentary Democracy in Africa: Choices to be Made”(Nairobi: Booktalk Africa, 2019), I remembered that sometime in the mid-nineties, when we met as young Kenyan academics to discuss how we could advance the democratic struggle in our country, Thandika happened to be among us. As usual, he was always very ready to contribute productively to such discussions. We were so sure that the Moi regime was the only impediment between us and democracy.

But Thandika, always ready to be an intelligent gadfly at such times, posed the question: “Have you people thought about what kind of government you want to put in place after Moi which will be acceptable to the Kenyan people and which will achieve the democracy you seem to be looking for?”

From this statement one can see where Thandika’s theory of the “national democratic and developmental state” as a progressive alternative to the presidential authoritarian regimes of the Moi type came from. He had a deep commitment to democracy rooted in popular acceptance by the people because it is, among other things, capable of paying democratic dividends.

On a light note, we used to drink a beer in Dakar called “flag”. For Thandika, these letters stood for “Front de Liberation Alcoholic de Gauche.” We were definitely leftist Africans committed to the liberation of our continent. But we were not always drunk!

Rest In Peace Thandika.

P. Anyang’ Nyong’o is a public intellectual, educationist and is the current Governor of Kisumu county.

***

I first met Thandika in Nairobi in 1993. Kenya Human Rights Commission was then engaged in drafting a model constitution that was published in 1994. We used the model constitution to mobilise and organize Kenyans to demand a new constitution to breathe life into the then new political dispensation, multi-partism.

I have this great photograph of Thandika seated next to a dosing Peter Anyang Nyong’o. The two of them gave us a brilliant discussion on the ideology, politics, and economics of constitution-making. Thandika was wide awake through out. When Peter woke up he amazed all of us by responding to Thandika. This is the only time I have witnessed geniuses at work, one with his eyes wide open, and the other with eyes closed. The major difference between the two was not just the status of their eyes. Thandika was persuasive, calm, patient, always smiling, a present-day Socrates, and the very nemesis of what we used to call in Dar “academic terrorists.” (Let me be clear I do not believe Peter was one of those, but he can be at times intellectually intimidating and arrogant!). That Model Constitution owes a lot in its content to the advice both professors gave us. That critical education has accompanied me in my various careers. I have come to frown upon the lawyers professional refrain and brag that we are learned when we are, indeed,  very ignorant of other disciplines that are foundational to our discipline. Thus I have come to value multi-disciplinarities and inter-disciplinarities.

This encounter was long before I read Antonio Gramsci, the Italian exemplary revolutionary and philosopher who spent 10 years in Mussolini’s fascist prisons. We now know that Gramsci in his Prison Notebooks developed the theory of the organic intellectual, the intellectual Jan Ziegler in Foreword to Yash Tandon’s book, Trade is war: The west’s war against the world writes, “who, through his analyses, his visions, becomes an indispensable auxiliary of social movements.”

Thandika was an organic intellectual. He has died. However, his vision, writings, analysis, and his intellect are all immortal. He has, along with my other teachers (Issa Shivji, Karim Hirji, Ngugi wa Thiong’o, Micere Mugo, Angela Davis, Wangari Maathai, Yash Tandon, Paul Zeleza, Alamin Mazrui, Dan Nabudere, Samir Amin and many others) fundamentally educated me in the social movements I have been in since the 1990s, and in my careers outside those social movements, through his writings.

As we envision Africa and a planet that is just, peaceful, non-militaristic, non-violent, ecologically safe, equitable, prosperous, and socialist, Thandika’s immortal work will be among those that will help us resurrect radical Pan Africanism, think through a new free and emancipated Africa, and a new world without neoliberalism.

Dr Willy Mutunga is a public intellectual and former Chief Justice of Kenya

***

A renowned and well-respected Pan-Africanist intellectual, Thandika Mkandawire, joined the ancestors on 27th March 2020 in the early hours of the morning. Sadness enveloped his colleagues, friends and the African intellectual community at large. Issa Shivji could not find prose to express the loss – he just jotted down these words (a poem?) in Kiswahili on the same day. Ida Hadjivyanis translated it to English.

Thandika mpenzi wetu
Tunahuzunika
Tumetandika mkeka wa kuomboleza.
Thandika anatabasamu:
Ewe Issa, mkeka wa nini!
Sherehekeni maisha
Kifo ni usumbufu tu
Msisumbuliwe
Endeleeni na mapambano
Kukomboa Africa
Kuunganisha Afrika
Kujenga ustaarabu mbadala
Uliosheheni haki na usawa

Issa Shivji
Dar es Salaam, 27/03/2020

***
Thandika our beloved
We are grieving
The mat is laid for mourning.
Thandika smiles:
O Issa, why this mat!
Celebrate life
Death is but an interruption
Let it not unsettle you all
The struggle must continue
To liberate Africa
To Unite Africa
To create that alternative civilisation
That overflows with justice and equality

(Translated by):

Ida Hadjivyanis
London, 28/03/2020

Prof. Issa G. Shivji, author, poet and academic, is one of Africa’s leading experts on law and development, presently occupies the Mwalimu Julius Nyerere Research Chair in Pan-African Studies of the University of Dar es Salaam.

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Reflections

Coronavirus Outbreak out of Control in US

American social practices, as well as entrenched cultural values like individualism, have greatly contributed to the spread of coronavirus even as doctors struggle to contain the pandemic amid fears that there will not be enough beds or ventilators for the critically ill, nor enough supplies to protect healthcare workers.

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Coronavirus Outbreak out of Control in US
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If we covered coronavirus like we covered Ebola

In 2014, I spent more than six months covering Ebola in West Africa, two of them in the “hot zone” of Liberia. Global press coverage spurred clichéd response back home in the USA, from negative stereotypes about culture and hygiene to irrational panic. This is a piece of satire that imagines covering America’s global health emergency in the same way the US looked at one “over there”—revealing both the absurdity of imperial exceptionalism and the unwelcome fact that the weaknesses of the American “superpower” are not so different from those in so-called “s**hole countries.” But of course they are. Yet most of us are schooled to see the familiar as better than the foreign, and it’s easy to forget that we share the same weaknesses—and the same risks—as those we are taught, implicitly and explicitly, to see as less capable, less valuable, less worthy.

A new, deadly disease is exploding virtually unchecked in the United States of America, threatening the global economy and public health worldwide.

The US, as it is known, is the largest economy in the world, a position secured unfairly by its imposition of the US dollar as the global trading currency. The country regularly styles itself as “the leader of the free world”.

That leadership has failed miserably in recent weeks, as a pathogen known as SARS-CoV-2, or “coronavirus” for short, has spread, with very little detection, across the country of more than 300 million people.

“It’s spreading like wildfire from person to person,” said Papi Kabongo, a bus driver in Kinshasa whose uncle, Jean-Jacques Muyembe, discovered Ebola in 1976.

“There are clear, simple, easy things we know can help, but people there don’t listen. They don’t even wash their hands!”

The spread has largely overrun the country’s crumbling healthcare system and outmanoeuvred its byzantine insurance infrastructure. Doctors now fear there will not be enough beds or ventilators for the critically ill, nor enough supplies to protect healthcare workers.

“We’ve been telling them for years, ‘Your system is fragile. You need to be ready for this’”, said Albert Williams, Liberia’s minister of health during that country’s unprecedented Ebola outbreak. “But they’re deeply uninterested in international cooperation or advice”.

A frightened population has begun hoarding chloroquine pills following the recommendation of the American president, Donald Trump, who has acted as a kind of “witch doctor”, or traditional healer, during the outbreak. Trump has said he believes the pills may treat the disease. A supposed preventive dose has already killed one man, in the hot, dusty region of Arizona.

Some US government officials have made efforts to encourage or require people to distance themselves from each other—measures which are known to have helped contain or end outbreaks in China, South Korea and Hong Kong—but the US president, Donald Trump, is prioritising the economy over public health, and Americans themselves have largely refused official advice.

Meanwhile, traditional American social practices, as well as entrenched cultural values like individualism, have greatly contributed to the spread of coronavirus, whose carriers can be highly contagious even without showing any symptoms.

“If I get corona, I get corona. At the end of the day, I’m not going to let it stop me from partying”, said Brady Sluder, a student on spring break in the infamous party town of Miami, Florida. “I’ve been waiting, we’ve been waiting for Miami spring break for a while”.

Experts say that even young, healthy individuals can contract the disease without their knowledge, putting anyone they come into contact with at risk.

“Before you know you have it, maybe you’ve given it to five people. And who did they give it to? And if they are elderly, you maybe have signed their death warrant”, said Muhammed Abubakar, dean of humanities at National University in Abuja. “This is a sad example of American exceptionalism in its purest form”.

In addition to Americans’ almost magical belief in their immunity to rules of all kinds, the country has faced a serious erosion of trust in official institutions in recent decades.

“These people don’t trust their government,”, said Emmanuel Mawema, professor emeritus of political science at the University of Zimbabwe-Harare. “They still manage to hold what we would technically call elections, but the wider society has been broken for a long time.”

This breakdown in trust has a deep history. Though the country has not experienced violent conflict recently, the United States is wrought with long-standing political divisions between its urban and rural tribes, which have repeatedly renounced efforts to find common ground.

“It’s almost as if they are opposed to the common good on principle”, said Tesfaye Haile, who spent eight years as Ethiopia’s ambassador to the United Kingdom. “This kind of division and the institutional inertia it creates is simply the way of life there”.

Experts say the US is poised to soon look like neighbouring Europe, where cases of the virus have soared in recent weeks, and doctors in some countries are disconnecting life-support services from patients over 65.

“In countries like the US, where life is cheap, it can create painful choices”, said Simon Odhiambo, who directs the Global Human Rights Network, headquartered in Nairobi. “We’ve been saying for years that health is a human right all states must respect, or it can put everyone at risk. This is what we meant”.

Other countries, too, fear the failures of the United States will put their own populations at risk.

“We don’t have any cases right now”, said South Sudanese President Salva Kiir. “We’ve closed the airport and our land borders. This may create real economic hardship for our people, but we won’t allow anyone coming from or through the United States to put our people at risk. It’s a matter of national security”.

CORRECTION: Europe is not a neighbour of the United States. We regret the error.

Ends

All the names here are fictitious, unless otherwise indicated (with a link to verifiable, accurate information).

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Reflections

This is the Season We are In

This is a season. Its length and breadth we do not know. And if we all look at our respective lives, we’ve all been here before.

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January to March is my favourite time of year, despite the heat and the dryness, or the humidity, depending on which part of the country you are in. I’m a sun worshipper and this season accords me numerous opportunities to wrap around a kikoy or wear shorts and a vest almost daily. I like the blue skies even though I have to plan my movements to avoid the noonday sun.

When the rains do kick in—and they seem to have checked in almost on time this year—I’m ready for the grey leaden skies that pelt the earth with rain. A new season has come. It has to. Funny thing is, I get impatient when the rains delay because I know prolonged seasons come with their consequences. There has to be a time for everything. Acceptance is a tough word, I’ve discovered. A friend and I were talking about acceptance, and he reckons acceptance is giving up but I disagree with him. Acceptance for me is recognising the situation that you are in. Acceptance is recognising the now. This present moment.

There will be tomorrows but who knows what they will be like? Finish dealing with today first.

I’ve been social-distancing and moved into self-quarantine just over a week ago. For someone who works from home and is an ambivert, this situation is almost kawaida. I don’t like how it has been imposed and its indefinite nature, but I’m in a familiar space. This was an easy situation to accept. I can’t hit the shops the way I want to and nor can I go down to my local pub in the evening for a serving of human contact. I’m grateful that we aren’t on total lockdown and I have the luxury of going for a bike ride and staring out to sea. But again, I live in Kilifi town, where we as a community are on tenterhooks following the irresponsible actions of our Deputy Governor.

I was angry for two days. Very angry, because so many lives had been put at risk. But I’ve come to accept this situation for what it is and put in place measures that will not expose me to possible infection.

I won’t lie; it’s tough. Tough learning to accept and deal with a situation that is not of your own making. It was only this week that I was reminded that I have been in this place before and I hope that remembering that experience will see me through this period.

As a cancer survivor, I’m in the category of vulnerable groups. My immunity isn’t what it used to be and I need to protect myself. I’ve read about safeguards against COVID-19 in relation to myeloma and cancer, and I’m keeping tabs on other survivors like myself. My friend Muthoni has a way of articulating things in a very gentle “you-go-deal” kind of way and her words resonated very well in our WhatsApp group.

“We are back to the initial days of stressing and anxiety about not knowing what to expect. I joked and said the world is now having a taste of a typical cancer patient’s world. The anxiety, the seclusion, the insane fear of picking up an infection and reading all information coming your way with all manner of advice and tips (even the outrageous ones) and basically getting to the point of understanding that we are totally not in control of our daily lives. The best we can do is appreciate every minute/hour/day and this helps one slow down and appreciate the simple things in life. Dropping all the shenanigan things we bandika [put] on ourselves and prioritize the crucial aspect of being alive—building meaningful relationships and leaving a legacy and not a CV.”

Acceptance. It is important to live in the now. We don’t know how long we as a country or the global community will be in this period. Yes, it is unsettling and at times fearful. But this is the season we are in. Let’s be honest; as human beings we’ve had an uninterrupted good run on this planet for a while. The last time we had a worldwide pandemic was in the 80s.

Twenty-twenty was going to be my year. Seriously! It was not said as we crossed into the new year in merriment, with a drink in hand. Thought that night was something else. For me, Olympic years seem to hold wonder. This year, I’ve gone as far as creating a vision board for myself. This is the year. Now twenty-twenty is more like twende, twende, (let’s go, let’s go), the phrase you hear matatu touts use often. We’ve been shown dust and it is only the first quarter. They are many that want to cancel this year and have already written it off. Economically, the books aren’t looking pretty, I’ll admit. But we still have nine months to go and I’m still hoping that this year will still bring some wonder. I’m learning to be an optimist. Seeing the glass as half-full doesn’t come easy to me. So, this global pandemic is teaching me things and taking me to uncomfortable spaces internally. That’s where I am now. This season has taken me to back to October 2015 when, in a Nairobi hospital, I was diagnosed with Multiple Myeloma, a type of blood cancer. I didn’t know what lay in front of me, but I decided to accept my situation. It was tough. It was kinda rough, for I was thrown into a whole new season.

It takes a lot of strength to pick up those lemons and start making lemonade or whatever you choose to make with them. Those lemons represent the now. This moment. Our present.

Acceptance. June 2016, Mumbai, India. A room at the BLK Speciality Hospital. Kenyan patient, age 43, has been prescribed confinement to a room for at least fourteen days. The room temperature is strictly regulated. My only exercise was in the corridor outside my room. And whenever I left the room, I had to wear a face mask. I had a total of thirty minutes of exercise a day. I spoke to my visitors through a glass door. That now sounds familiar for a good many folks. The internet became a lifeline, I watched at least an hour of news and even started watching Cake Boss! And my phone and meds knew nothing about social distancing. I prolonged all meals (when I had the appetite), and in between those meals I was mentally writing and rewriting my five-year plan. By day five, I didn’t care about tomorrow. I just wanted to get through the day and deal with whichever side-effect came with the treatment that was given on that day. If I wasn’t watching the news, it was MTV India, Master Chef Australia or even more Cake Boss. Being quarantined isn’t easy. The toll it takes on your mental health cannot be overstated.

You may have the luxury of being in self-isolation or quarantine within your home, with your loved ones around you. If you are alone, you start naming the geckoes on the wall. I have a golden orb spider called Freda and two frogs that show up religiously each evening at six o’clock like askaris. I’ve tried kicking them out but I’ve been unsuccessful. It was only yesterday that I accepted that they are here for the duration of the curfew. I hope. Isolation can do that you. You may have resorted to spending a little longer in the loo or shower so that you can get a little more me-time away from either the partner or the kids. Count yourself lucky that your isolation isn’t within a hospital. During my sixteen days in confinement the “fun” activities were measuring my pee and recording its colour and describing my poo on a chart. You have no idea how excited I was when I started having solid bowel motions. It meant I was getting better. I appreciated each victory during this period when every day was just that, every day. Fortunately, I had my step-mom with me as my carer and roommate.

It was during this period that I willed my body to get better. Every day was another chance to fight on. There were battles with nausea, constipation and then diarrhoea. However, the main battle was willing my stem cells to be re-accepted by the body that they had been harvested from. Every day was hoping that my blood markers were better than the previous day. It was tough and all I could do was bide my time, wait and believe. Acceptance.

I’m back in that space of accepting the new normal. The difference here is that I’m not alone. There are billions of us in this place. But there are shed-loads of battles and fears that are being fought within the confines of our minds too. In these days of the University of YouTube, swiping left or right, Tik Toking, globetrotting and just-add-water happiness, the uncertainty of tomorrow is unsettling. There are fears about incomes and deals put on hold, separation from loved ones, not being able to touch or even sneeze or cough without getting stared at. We all just don’t know. I mean, even our election years now look tame! Many have cancelled the current season and would rather wake up in 2021. Sadly, life isn’t like that. We’d gotten used to the season of plenty to do, people to see and places to go. My vision board can testify to that. And I think along the way we overlooked the people, the planet and the peace that makes us human. I’m a fairly laid back guy, so when cancer came knocking on my door, I was told to pace it. Now, we are all being told to pace it.

“If you think about worry, it’s an energy that’s used up thinking about all the ways things could go wrong, or not happen or not go according to plan. But it’s just that, In your head. If it doesn’t translate into action or spur us into movement then it’s wasted energy . . . Which in our [cancer patients/survivors] situations is a precious commodity”, says my friend Muthoni. “Adversity will not change. Life will always throw us curveballs. Having been able to beat this monster has given most of us clearer perspectives of what’s important and what isn’t”.

Acceptance. This is a season. Its length and breadth we do not know. And if we all look at our respective lives, we’ve all been here before. It could be a cancer diagnosis or another malady, or a loss in the form of a death, a marriage, work, finances or even heartbreak. You’ve managed to get through it. There may be scars, there may be lessons learnt or not, but, man alive! that was one hell of a season then. You are still here now.

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