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We Are Doctors, We Don’t Die: A Damascus Moment on a Kenyan Highway

“Daktari amesema mulete pesa ya mafuta.” (The doctor says bring money for fuel.) The officer in charge said this in a matter-of-fact way. We knew we had to do what he had requested; he had all the power over the ambulance – the same power we wielded in Siaya.

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The Unkindness of Strangers: Death, Disease and Disillusionment in Siaya
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September 18 is my younger brother Kevin’s birthday. I was in Siaya, and I wanted to travel back to Nairobi to celebrate with him. There was not much to do in Siaya after dark. The town turns ghostly after sunset. The local traders in the market slowly wrap up their wares in a choreographed fashion and walk together, mostly as a band of women to their households in the villages. The men stay a little longer on their motorbikes waiting for customers or catching up with the day’s political gossip. The shopkeepers and butchers quickly follow the women, trying to close before the scheduled power blackout. It’s strange, but electricity supply from Kenya Power consistently disappears between 7pm and 9pm. Both of these times are crucial for the few people with televisions who tune in to listen to the local news broadcasts from Nairobi. When there’s power, Siaya residents religiously watch the news broadcast, tuning into both the Kiswahili and English broadcasts, two hours apart, even when it is a repetition of the same broadcast.

In any case, darkness brings most things to a standstill. Siaya hospital, where I worked, is flung into total darkness. The generator often lacks fuel and it takes partners like the organisation I was working for to chip in monthly with some sort of supplementary funding. It was this darkness that we were running away from. I made a few phone calls to my colleagues Vinnie, Christina and Eric and we all huddled in Vinnie’s brand new Toyota and set off for Nairobi. We were in high spirits. We had had a long week of providing care to hundreds of children, and collecting terabytes of data to support licensing of our malaria vaccine study.

Local communities in Siaya are magnets for public health research. A rural community, with basic infrastructure and poor health indicators is fertile ground for local research organisations like the Kenya Medical Research Institute (KEMRI) and Centers for Disease Control and Prevention (CDC) to set up shop, attract funding and conduct research.

The men and women of Siaya are probably more famous than they will ever know, though mostly as statistics in peer-reviewed papers and publications. The educated world of infectious disease probably knows much more about these households through malaria and HIV data than the local chief does. A PhD student at an American university could probably model an accurate predictor of mortality in these villages from the troves of personal data collected from these people.

I had worked in Siaya hospital for a few years. I had very little business going into any wards except the paediatric one, where children participating in our vaccine study were hospitalised. We worked hard to make “our side” (the research side of the ward) live up to the required standards expected by the donor. Five feet away, on the government side, was a sad reminder of what lack of funding and resources looked like. It was cold and uncertain, and had a perennial shortage of essential supplies. The “research side” and “the government side” were on the same floor, yet they were worlds apart in terms of resources and health outcomes.

I wonder what went on in the minds of the mothers in the “government side” when they walked through the “research side” to use the bathrooms. I wonder what they felt when they noticed no one was sleeping on the floor, or sharing beds with strangers. Or that kids on the research side received a better diet, or that the process for discharging patients recruited in research was efficient, and no family would spend an extra day or two detained for not having enough money to cover their hospital bill. On the research side, there was always an ambulance on standby to get participants to Kisumu for specialised care when needed. Our side had the facilities, equipment and adequate staff; the government side had hope as the only sure intervention within crumbling infrastructure. I knew this reality, though it seemed so distant to me outside my privileged life.

My colleague Vinnie was driving that day. We were probably speeding when we lost control and plunged into a huge ditch off the road. We managed to get out with the help of a few well wishers who rushed us to a nearby paramilitary camp for first aid. I had sustained minor head injuries. My colleague Christina had significant back injuries. Vinnie and Eric had minor scratches. The car was extensively damaged.

The clinic at the camp was managed by a nurse, whose first aid box only contained cotton wool and methylated spirit. We were surprised – this was a paramilitary camp after all and we had expected a little bit more. These supplies were too basic to manage our conditions. We had to move to a better facility so that my head could be examined and attended to. Christina was also in excruciating pain and we were worried she had extensive injuries that needed urgent attention.

The reality of our situation started to dawn on us. The only transport option available to us was a Land Rover with a flat, open bed at the back. The officer in charge of the camp was gracious enough to offer us the Land Rover, though we were worried that a ride at the back of it would aggravate the injuries Christina had. We thought of trying our luck stopping random vehicles on the road but it was late, and very few people would have risked stopping for strangers at that time of the night. The camp officer suggested that we reach out to the medical officer in charge of Molo District Hospital for help. The hospital had an ambulance that was better suited for our needs. Besides Christina’s injuries, my head was swollen and throbbing wildly. I feared that I may have extensive head injuries and I knew I needed to get to a hospital fast and get a CT scan. Whatever privilege we had in Siaya was nowhere in sight in Molo. The more helpless we were getting, the more paranoid I was becoming.

***

One of the thoughts that engulfed my swollen head was about a close encounter with a patient from my past. I didn’t know him, but I remember him because he shouted my name from the male ward where I had gone to see a friend. I am not sure how he had come to know my name. I went and sat next to him in the bed, feigned acquaintance and lent him an ear, preparing myself for the usual request for some sort of financial or social help within the hospital. He was quiet for a long time. I noticed there was a thick discharge from his ear; there were stains of discharge on his bed sheet too. I called out to the nurse to alert her about the discharge. She told me that a doctor had already done ward rounds and made plans with him and his family for treatment. He had been a victim of a motorcycle accident and had been brought in a few days ago.

The man was obviously not doing well. I asked the nurse what I could do to help and she told me he needed to get to Kisumu for a CT scan and specialised care. I asked the man what the plan was, but he was lost in thought and I did not want to interrogate him before understanding his situation. I left with plans to return to see him the following day.

The next day, I did not find him. I was told he had sneaked out of the hospital and no one knew where he had gone. Apparently his family had left to go look for money for a CT scan and two days later they had not returned. He had also not received any message from them, so he apparently left to go and find them. In such circumstances, the family needed money for ambulance costs, on top of treatment costs and any other extra costs. A simple accident can have major financial ramifications for poor families. They were probably trying to sell an animal or some property to get him the help he needed. Or they had lost hope and abandoned him. I don’t know. I learned from one of the doctors we worked with that the discharge was from cerebral-spinal fluid forced out by intra-cranial pressure from his head injury. The man was facing imminent death. He left and never came back. So I knew I had to get a CT scan urgently.

While at Siaya, we were privileged to hold senior positions and so we could always put in a request and two SUVs, sometimes three, would be at our disposal for project work. We also had a fully equipped ambulance that responded to emergency needs and facilitated emergency transfers of staff and study participants from Siaya to Kisumu. A few months before this accident, I had received an emergency phone call from one of my staff members in the field requesting for an ambulance to pick up a father of one of children enrolled in our studies and rush him to Siaya Hospital. My colleague had been at the home when the man was hurriedly brought in by his friends. From the commotion in the background, I could discern distress. My staff member’s voice was also strained and heavy with emotion. The father had been bitten by a snake, and his condition was deteriorating rapidly.

There is a lot of pressure that comes with having the responsibility of deciding if a person has access to a service, such as transport to a hospital, which has the potential to save his or her life. We had reached a compromise with the main management of the research study that I could make a call for community use of the ambulance if one of our study participants was in danger and needed urgent rescuing. But technically speaking, this man wasn’t a participant in our study – his child was. We had the ambulance, but the challenge was how to manage urgent requests from the broader community and respond to them while not jeopardising our good relationship with the community.

We had decided that such requests would be escalated to the transport management at the headquarters. This though was a unique call because my colleague was stuck in this situation. He was at the home, at the heart of this emergency. I quickly called the ambulance driver and told him to be on standby. I also reached out to the headquarters and it took me some time to get through with the request. While we were still sifting through the bureaucracies, peeling off one layer after another, there was commotion at the emergency entrance of the hospital. A woman I could faintly recognise was crying her lungs out while others tried to hold her back. It was the man’s wife; she had brought him to hospital but he did not make it. He died on the way to the hospital on the back of a motorcycle where he was precariously balanced, hanging onto dear life.

This particular case woke me up to the reality and complexities of health care and research in rural settings. There was death and chaos hidden behind the quiet grass-thatched houses and one never knew when it would spring out and grasp the next victim. I would later call the field staff to enquire if the wife had said anything about us. A sense of guilt hung over me every time I thought about him. I deliberately started to avoid this particular woman whenever she brought her child for routine check-up at our study clinic.

It came as a relief when I later learned that not much could have been done in this particular case. It was not easy to get anti-venom in this hospital and considering how quickly the man had succumbed to the snake bite, I was told there was little the hospital could have done to save his life. I took comfort in this; any guilt for personal failure was quickly erased by the glaring failures in the health system.

***

The officer in charge of the camp placed a call to the medical doctor at Molo hospital. It was midnight, so there was no guarantee we would find the doctor awake. Luck was on our side though. He picked up the call. The officer in charge explained the situation to him. From this end of the call it seemed that the two were agreeing on a lot of issues. This was a good sign. The call ended and we waited for the good news.

“Daktari amesema mulete pesa ya mafuta.” (The doctor says bring money for fuel.) The officer in charge said this in a matter-of-fact way. We knew we had to do what he had requested; he had all the power over the ambulance – the same power we wielded in Siaya. We also knew we could bargain over the amount, but we could not escape paying for it. But we also had no doubt he actually needed fuel. This was a government hospital; everything is hard to come by and everything costs money. We had some money in our Mpesa accounts in our phones.

However, unbeknownst to us, there had been another development with our belongings at the accident scene. While were worrying about Christina and my swollen head, our friend Eric had made his way back to the car to salvage our belongings. He had encountered two men rummaging through the wreckage of our car. These men had taken our phones and Eric’s efforts at negotiation failed to get back the phones. One of them – he said his name was Biwot – actually sympathetically assured Eric that at a fee, he could come back for the phones the following day after we had received care. There we were, unable to send money to the medical officer in Molo because a stranger called Biwot had stolen our phones. We thought quickly and borrowed the officer’s phone, called a colleague who sent 6,000 shillings to the doctor’s phone number. An ambulance was promptly dispatched. We immobilised Christine and set off for Nakuru.

The next day, all of us, except Christina, were discharged. But I was angry at how callous and soulless this Biwot guy was. How he had robbed Eric when all we needed was help. The thought of him getting away with this act bothered me greatly. My brother Kevin had come to Nakuru to pick us up, and I requested him to drive us to Molo police station to file a report.

As we were waiting for the officer commanding station (OCS), we started to tell one of the policemen about Biwot and our unpleasant encounter with him. The police officer’s face lit up. It turns out he knew this Biwot. He called his colleague and we quickly set off to find the man. The police officer quickly located Biwot’s house that was not very far from the accident scene. He kicked the door and demanded to see him. A woman who I suspected was some form of acquaintance in the single room that served as a kitchen, a bedroom and a living room, all in one, told us Biwot had left just moments before we arrived. It did not take much persuasion from the policemen for the woman to admit that Biwot was hiding in a neighbour’s house. The two policemen quickly fetched him and used whatever methods they learned in training to coax out our phones. Violence of any form is hard to watch. But it is also hard to understand why anyone would steal the belongings of accident victims in need of desperate help. Biwot produced our phones, which appeared to be damaged. We exchanged glances as the policeman slid them in his pocket. They were now evidence under his care. I was eager to have to have my phone back so this was a bit disheartening.

Back at the police station, my friend Vinnie had already met with the OCS. Vinnie told us that the OCS has generated a small list of items that he wanted Vinnie to “authorise” him to salvage from the wreckage for his personal use. He wanted the tyres, the car battery and the radio. He promised not to charge any of us with careless driving and assured us that the insurance people would receive a great report in exchange. We did not care. Neither Vinnie nor anyone else wanted anything to do with the badly damaged car, but the veiled power play was distasteful – he kept telling us he wasn’t going to charge anyone and reminded us of the powers and options he had at his disposal.

While listening to Vinnie, the policeman who had our phones showed up and requested to talk to me privately. He wanted me to show him some appreciation for getting our phones back. I reached into my pocket and fished out crumbled notes amounting to Ksh300 and gave them to him. He looked a little surprised and quickly demanded for more. He wanted Ksh3,000. My head was aching, and here I was negotiating with a police officer for my phone. Our accident had turned into a huge enterprise for a number of people. I was also surprised by how little charity we had been accorded by these strangers so far. It looked like every corner we turned, someone saw an opportunity to make a quick profit from our circumstances. We were getting introduced to a Kenyan reality that our status had insulated us from for very long.

We eventually made it to Nairobi. The CT scan was performed by a doctor who we exchanged jokes with throughout the process, another privilege afforded to us by our medical insurance cards. A radiologist quickly read through my files. My card was on file so there really was nothing to worry as far as my ability to pay was concerned. I was a little nervous when she looked into my ears, but she smiled and told me she saw no fluids except some need for ear cleaning. She gave me a clean bill of health.

I was ready to go back Siaya. I was also hoping to meet two people. I was hoping to run into the guy who had the fluid flowing from his ear. I knew this was impossible but I was hoping for a miracle of sorts. I learned that no one ever heard from him since he left the hospital. And no one had his contacts either. I wanted to tell him I understood.

I also wanted to meet the mother of our study participant whose husband died from the snake bite. I wanted to let her know I was sorry, and to explain how the system works and that I had followed a protocol I did not believe in.

But first I needed a phone. We all needed new phones. We had paid the policeman three hundred shillings for our phones. The only problem was that the phones had also died.

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Norbert Odero is a Kenyan author, writer and scientist based in the USA.

Reflections

Like a Building With a Large Red X: The Stigma of Divorce

Where do you start when you only went to school up to Class 5 and you belong to a culture where women have no right to ownership of land, or livestock, or anything else except clothes and jewelry?

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Like a Building With a Large Red X: The Stigma of Divorce
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In the Borana and Gabra communities, garob is a slur used to describe divorced women, who are ostracized by the community and blamed for the ‘failure’ of their marriages, regardless of what their husbands did or did not do. This is the reality for many women in Kenya, not just those from these communities. I spoke to two women, Halima and Zamzam, whose friendship is seeing them through this most difficult of circumstances. Here is their story, in their own words.

Halima Qabale

“It never crossed my mind that I would end up this way. The truth is, no one ever knows exactly what turn their life will take, only Allah knows. Playing in the dusty streets of Sololo, Marsabit County I never imagined myself that one day I would find myself in Wing B on the 8th floor at the Kenyatta National Hospital.

As a Borana girl, I was assumed to be ready for marriage once I had my first period at the age of twelve. Soon after, suitors began to approach my family with offers of marriage, and two years later, one with the ‘right price’ came looking and the deal was sealed. In the fortnight leading up to the wedding, all the older women around me had much to say about the do’s and don’ts of marriage. Overall they made it seem like it was such an honour to be married. What made it even more memorable was that my dearest friend, Zamzam Guyatu, had just got married three months earlier, though further away in Garbatula, Isiolo. I was eager to become a wife too.

My husband was ten years older and I counted myself lucky to be his only wife. On our first night in marriage, he had a lot to tell me but heavily insisted on one particular rule – no interaction with garobs. Garob in Borana and Gabra means a divorced woman. The name itself carries a negative connotation and just like a stench, no one wants to be associated with them. It was their fault that their marriages did not work out. I was instructed that on seeing a garob headed in a certain direction, I should go the opposite way, lest I become influenced into being a ‘bad’ wife. My husband didn’t need to convince me much, I wanted to have nothing to do with them.

In the extensive list of advice that my aunts gave me, perseverance ranked high. My husband liked to drink, and when he was drunk he would hit me, blows and kicks in the name of ‘discipline’ for taking too long to open the door at 3a.m. But I held on to hope that he would change, all I needed to do was to persevere. Vumilia.

By the time I was giving birth to my third child, I had run out of excuses to give the neighbours for the bruises on my body. I wanted out, I wanted the beatings to stop. When I confided in my mother of the painful and harrowing experiences I had been going through, and proposed divorce as a choice, her reaction was one of pure disbelief. She told me marriage is a sacrifice, that I had to keep things together so that we could be provided for, that I needed to keep my honour intact. Most importantly she said that the last thing she ever wanted to see was her daughters ‘lighting two fireplaces’ (i.e. being promiscuous) and that she had raised us to be anything but that. Divorce, in her mind, was synonymous with promiscuity and immorality.

My husband became more and more of an alcoholic, which meant he was spending most of his income on drinking. It meant that he was not providing for our needs at home. I had had enough and decided to report the matter to the community elders. This came as a shocker to many who were left wondering where I had gathered such strength and confidence to report my husband before the elders. Only a handful of women would dream of daring such. To my disbelief reporting him to the elders further worsened the situation. I was rebuked by my husband, alongside family members from both sides, for airing our dirty linen. He even went ahead to marry a second wife as a way of punishing me for my ‘disrespect’.

By this time financial commitment lessened to zero, he stopped coming home and before I knew it I had been totally neglected. We would have starved were it not for the pennies I gathered from moving around the wealthier homesteads of Sololo as a mama nguo. Needless say it was a tough and rough time, and I threw in the towel. It was time for a divorce! It was now me and my kids versus the whole world. I was now one of the garobs I had been taught to detest and avoid. My mother, in her sadness and disappointment, reminded me of her admonition: ‘don’t light two fire places’. There was nothing to say in return, but my spirit was high. I was ready to move on even though my previous identities of in-law, friend, agemate, niece or neighbour were all eclipsed by one name – garob. That was all I was now.

By asking for the divorce I had already convicted myself of being a terrible wife who could not take care of her marriage and lacked contentment. Appeals to my husband for the children’s upkeep brought replies like, “You thought yourself smart by getting the divorce, now why don’t you use the same smartness to take care of them.”

They say when life gives you lemons, make lemonade out of it, but what do you make when life gives you nothing? Where do you start when you only went to school up to Class 5 and you belong to a culture where women have no right to ownership of land, or livestock, or anything else except clothes and jewelry? Women themselves are owned and their ownership changes from that of their fathers to husband. You have no source of income, security or status if you are neither under your father’s or husband’s roof.

The easiest way to secure a future for your kids is to get married again. But here again, you come face to face with ruthless stigmatization. For the Borana and Gabra, attempting to marry a garob is no different from buying a building marked X in red by the Kenya National Highways Authority (KENHA). The fact that one is divorced marks them for life, and the women are thought to be forever defiant and disrespectful.

I met Ahmed Kimani and he gave me hope. He had come to Sololo as a trader and opened a shop where I frequently bought household items, and we became good friends. He had converted to Islam seven months before my divorce and this made us even better friends. I admired his hard work and determination in business. Ahmed was looking for a Muslim woman to marry, but with tribalism being the devil that it is, no one wanted to give their daughter to a charer (someone with hard kinky hair, as he did). I felt as if my prayers were being answered when he offered to marry me with my three children. I was twenty-one and did not want to be lonely for the rest of my life, thus with lots of enthusiasm, I agreed to his proposal.

A week after his proposal, Ahmed grew cold feet about the marriage. I would walk into his shop with a smile, only to meet a gloomy face. I gathered that when he told his friends and fellow traders about his marriage plans, they warned him to stay away from ‘trouble’. The talk of my disrespect, defiance and discontentment swirled around in his mind until he turned around his earlier decision. It was heartbreak untold.

Overwhelmed by the stigma, I took the ten-hour journey from Sololo to Nairobi with my three children and just a yellow polythene bag containing our clothes. I hoped to get a job in the city to better the lives of my kids who were now entirely my responsibility. A distant cousin, Rukiya, had agreed to host me in Eastleigh till I could get myself together. Rukiya introduced me into the miraa business and in two months I had moved to Kariokor, living on my own. I used to walk to Pumwani to buy khat at a wholesale price for resale. With rent, food and school fees all on my shoulders, the little income from miraa wasn’t sufficient, and I had to look for another way to make ends meet.

Securing a job in Nairobi is no mean feat. I was desperate to provide for my children, and so I turned to sex work. At first I only did it during the last week of the month so as to raise rent, but then it advanced to a daily job. My single room house served not only a home but also business premises. The income from both businesses brought stability, but it came at a cost. Though the younger kids Galgalo and Boru didn’t really know what was going on, Rufo was old enough to notice the different ‘dads’ I brought home daily. I still wonder what she thought about it. It is a conversation I dread having with her.

Three years into the business and raising my kids comfortably, I have been diagnosed with HIV/AIDS and the symptoms are getting worse. I have been in and out of Kenyatta National Hospital. It is getting the best of me and I feel it’s all crumbling down. I am most worried for my kids but I know my friend Zamzam has my back. She and I have been through so much together, ever since those days when I admired that she had gotten married. To some, I made a terrible choice and yes, maybe I did, but only the wearer knows where the shoe pinches. I had to do whatever I could otherwise my children would be sleeping hungry or we would have got kicked out of the house. They have been fed, housed and educated from the work that I do. I pride myself in the strength and courage that I had to say no to an abusive and depressing marriage, though it came along with an unfair price. But no matter – I am paying the price with my head up high.”

Zamzam Guyatu

“In the three times a week I come to check on Halima, I can’t help but keep reminiscing on what we have both been through. If it wasn’t for Halima I honestly don’t know where I would be. I have been living in her house for the past nine months, taking care of her kids alongside my two daughters. This is Halima’s sixth month in hospital; I come to the ward to clean her up, bring some food and most importantly add more firewood to the flame of hope in her heart for mostly we garobs only have each other and no one else.

I was married off three months before Halima and left for Garbatula in Isiolo. Miraa ruined my marriage. Nothing was closer to my husband’s heart than alele (red-brown khat). Perhaps things went south when he came across taptap (a tablet-like drug that stimulates consumption of khat). This took a hit on his financial commitment to our two daughters. The more khat he consumed, the less money we had for our daily needs. He also became less active in bed and I wondered if he really loved me.

Numerous attempts to save my marriage through dialogue and involvement of third parties proved futile. I had lost my dad when I was six, and my mum through the help of my paternal uncles, saw me through to marriage. I was about to walk out of my marriage when my mum passed on. Overwhelmed by the sorrow, I shelved the idea of divorce, but only for a while. With time I realized that it would only take a miracle for my husband to change course, and I wasn’t a miracle-worker.

After my divorce, just like Halima, the stigma was toxic and raising my two daughters on my own became an uphill task. My in-laws took our separation as a joke and ridiculed me that how could I, an orphan, be able to raise two kids on my own? To them, it was just a matter of time before I would go back with my tail between my legs begging them to take me back.

I was out to prove them wrong. News of Halima living in Nairobi came in handy and with my childhood friend I found comfort, away from the harsh and unfair world. I joined her in the miraa business despite hating it for contributing to the fall of my marriage. Life can take a toll on you especially if you are poor, uneducated and alienated as we were. But I choose to be patient and trust in Allah that things will be better.

I am preparing to go to Qatar for work as a domestic help; I’m just waiting for my passport to be out. At least in Qatar I can make a better income. I can be able to secure a future for my kids and Halima’s. Her children are my responsibility now that she is not able to work. I know it might be hard being out there, but I am lucky to have this chance that many other garobs don’t. It is a blessing. Probably a way out.”

Garobs are victims of a patriarchal system that condemns women into putting up with unhealthy marriages with the fear of never getting married again and their children suffering out of neglect by fathers. In Kenya there exist affirmative action funds for widows and persons living with disabilities, but what of neglected and abandoned groups like garobs? It is high time that they too are empowered.

Ultimately we must understand, as Chimamanda Ngozi Adichie said, that cultures are man-made. Cultures don’t make people. People make cultures. And we can change.

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Reflections

Walking on Eggshells Into an Empty, Judgmental Faith

In the Bible study I attend in one of the mega-churches in Nairobi, not once have I had instances where the Bible verses we discuss reflect on the issues we face in life. It is instead a quick pasting on of solutions, which fall apart in the face of daily living.

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Walking on Eggshells Into an Empty, Judgmental Faith
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I got ‘born again’ some time in 2009, a few months to August when I was supposed to join college for my undergraduate studies.

The message that I had been born again came as good news to my father, with whom I had been having a difficult relationship with while I was in high school. In fact, he had initially objected to my joining a university as a self-sponsored student, since I had failed to attain the points that would see me join a government-sponsored student.

His argument was that my record in high school as a rebellious student and my ‘lack of focus’ was all because I had dropped out of the Christian Union while in school, that this to blame for my poor results. And so, I had to pay for my sins.

So, when I got saved, the news came as a relief to him. He would occasionally use me as an example to my sisters. Being born again also came as a relief to me at the time, because it helped me mend some of my broken relationships.

I continued with this newly acquired status to college, where I practiced my Christian faith with much pride and gusto. Soon, I was thrust into the top most leadership position in the Christian Union while still in first year, a feat not achieved to many people.

But my reason for writing this article is to demystify some of the biblical teachings I was exposed to as a child, throughout my youth, and even now as I work on becoming a better man. These teachings in my view only worked towards instilling in me a guilty conscience and a judgmental attitude that could only see others for the sins they committed, and how unworthy they were for the gospel and the saving grace of Christ.

Consequently, these Christian teachings, also failed to mold me into the man I was to become, but instead forced me to become something that was only appealing to my parents, our Christian family friends and my Christian friends. Deep down, I had struggles with identity issues and esteem. And in the process of trying to live on the straight and narrow, I also lived a double life, full of guilt and hypocrisy.

I was raised in a Christian home, where both my parents were born-again way before we were born. My exposure to this religious way of life therefore started as far back as I can remember.

In Sunday school, we would be taught memory verses, most of which we recited in front of the congregation during services, to much applause. During open-air services hosted by our church in the town centre, we would occasionally be asked to recite these verses to the audience. And therefore, to my parents and peers, we were model children, brought up the right way and in the fear of the Lord.

But what I do not recall are instances where we were taught how we could navigate some of life’s toughest phases. My problems began at adolescence. Science says that it is at this stage where one starts to experience changes in their body, mind and emotions, as they transition through puberty and later into adulthood.

All I was taught as an adolescent was that interacting with girls and having them as friends would lead me to sin. What I was not taught was how to love myself, practice self-control and create boundaries. How I wish I was also taught how understand my body and the changes I would experience. Instead we were merely bible-slapped on the consequences of befriending girls.

The problem I have with the Christianity that most practice today, and even the one I was exposed to as a child, is that it lacks wholesomeness. The teachings are either meant to guilt-trip us into behaving in a certain way or judge others for not practicing the same faith and living by the virtues we ascribe to.

Growing up, my father – in an attempt to instill in me what he then believed, and still believes are Christian values – considered sexual sin, drinking alcohol, as well as smoking cigarettes and bhang as some of the biggest sins one can commit against God. And to drive his point home, he would use his brothers who were heavy smokers and drinkers, as the bad examples that I should not emulate. His examples would also include some of our neighbors.

The issue with this approach, as I would later learn in life, is the fact that instead of my parents guiding me through life based on the teachings of the Bible, only pointed to me how sinful others were. And that to become a better Christian, I should never emulate them. My moral compass therefore, was that I should focus on what they were doing wrong and try not copy them. The idea was to create in us the perfect Christian, devoid of sin and flaws, who would grow up to become model adults.

While it is worth noting that these warnings kept me away from ‘bad company’, my struggles were on whether these practices borrowed from of anything in the Bible. We focused so much on what the Bible says so little about, if we are to be honest. It also sparked in me questions of what grace and forgiveness was all about. I wondered if it was in our place to determine the fate and destiny of others based on their present circumstances.

The Bible in fact, teaches us that all have sinned and fallen short of the grace of God. All I was told and taught was how sinful others were, and not how I should live based on the teachings of Christ.

My father, in this endeavor, had become the moral judge of who was committing more sin that the other. While it was not explicitly clear to me then, now I am beginning to question whether he had the moral authority to judge others, given the many flaws that I experienced first-hand and saw in him.

My childhood, as I had indicated in a previous article published here, was marred by violence where my father at any slightest provocation, would beat all of us including my mother. Therefore would it not have been right for him to make peace with my mother first, before pointing out the sins of others, just as Jesus teaches us not to point the speck of sawdust in our brother’s eye and pay no attention to the plank in our own eyes?

And beyond the teachings in my household, this trend also extended to the churches we attended. Back then, while growing up, the Christian gatherings we were part of were closely knit ones, where everyone was regarded as family. But if my memory serves me right, my parents moved us many times from one church to the other, simply because of differences in ideology and even principles with the leadership of one church.

Often times, these differences would split the church almost in the middle and would be fights over money or the exclusion of a part of the congregation because they were not of the same social class as the rest. What then, does that teach a child like me growing up, about the fact that before God all are equal before irrespective of their status in the society? It was certainly not practiced in the churches that we were a part of.

What of the teachings of the Bible that implore on husbands to love their wives just as Christ loved the church? Yet for me, all I witnessed growing up was a father beating up my mother even for the simplest of mistakes like putting too much salt in food or coming home late.

It is worth noting that I still believe in God, and religiously so. I say my prayers and go to church. But the problem I have with the Christianity of today is the hypocrisy I saw growing up, and that it has become so irrelevant and out of touch with the realities of modern times.

I recently had a conversation with a friend with whom I fellowship with in the same church about why men in church do not date or marry women in church and vice versa.

Her reasoning, and mine too, was that part of the reason why people in church opt to date and marry outside is that our Christianity lacks authenticity. The church has become a place where one cannot be vulnerable about their struggles in life. We have become judgmental, to the extent that one would find it hard admitting that they struggle with say jealousy, depression or even addiction.

Most Christians, especially the born-again lot, have also increasingly become detached from the realities of life. Some of them, based on the teaching that ‘two cannot walk together unless they agree’, would rather not associate with non-believers, lest they become contaminated by the sins of the world.

Our teachings in church, in my view, have failed to speak to the problems that we as millennials face, like struggles with esteem, identity, building good and lasting friendships and relationships, dealing with the pressures of life which have been magnified by the advent of social media, just to mention a few.

In the Bible study I attend in one of the mega-churches in Nairobi, not once have I had instances where the Bible verses we discuss reflect on the issues we face in life. It is instead a quick pasting on of solutions, which fall apart in the face of daily living. It makes me wonder what the very essence of the church is if it cannot be the place where one finds solace and refuge, where the broken-hearted go to find healing. And especially to my agemates, millennials, who have been judged and ridiculed for the life choices we have made, from careers, to social and even political inclinations. What has the church got to say to us, about the life we find ourselves in?

But what I did not realize then was the fact that my salvation was one that I practiced with guilt, and the fear of not wanting to fall into temptations and sin. The result of this is I always felt like I was walking on eggshells. And part of this fear is what had been instilled in me by my father, and my failure to live the Bible on my own, make mistakes, ask for forgiveness from God, and soldier on.

I never experienced a childhood of forgiveness, or seen forgiveness practiced, even in the Christian Union that I served in. Committing a sin would expose one to a life of ridicule and judgment, especially from the conservative Christians with whom we fellowshipped together and to whom sin was not to be tolerated, no matter what.

In my capacity as an executive committee member – the senior most leadership position in the Christian Union – I was in charge of a small group of young, vibrant, urban and born-again men and women. But more often than not, we would clash with more conservative members of the fellowship.

These frictions would be about the slang language that this group used, their type of music, which mostly included reggae and rap music, their dress code, which included women wearing trousers to church, among others. But surprisingly though, while some of these conservative Christians maintained their reputations until they graduated, some would later be accused of cheating, having multiple relationships, while others were involved in pre-marital sex that they abhorred and preached against.

So while I am in no way trying to cast the first stone, instead I want to understand the intolerance and hypocrisy. Why is it that some who were adamant about the preaching and practicing ‘the born-again life’ still happened to fall short of the glory of God?

I still maintain that I am a child of God, a Christian and a faithful one at that, but who still drinks alcohol and parties once in a while. The problem I have with these ‘born-again’ demands is that they are mostly for self-gain and self-righteousness. In my view, many preachers, Christians and churches today would rank very low on living lives that are Christ-like, which the Bible they carry around and profess teaches.

My belief is that Christianity, just as Jesus taught while on earth, should be one that speaks into the issues and problems that people face, lest all we do is Bible-slapping people and guilt-tripping them into living lives devoid of fulfillment, purpose and love.

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Reflections

When Shame Kills: Cervical Cancer and Fear of the Vulva

Even for those who are educated, it is still uncomfortable as we are taught to regard parts of our bodies as ‘bad manners’. We grow up embarrassed, fearful and ashamed of ourselves and at no point is there a shift to include these parts of our bodies in conversations, even as we mature.

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When Shame Kills: Cervical Cancer and Fear of the Vulva
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Through the blinds, a dull gleam illuminates the room. The tension in my shoulders begins to dissipate as I sit down to go through a pre-counseling session before my pap smear. I made the decision of having the test done early this year, though it’s taken months to actualize it. I have made two appointments and cancelled them both. The first time was because I hadn’t timed the appointment correctly – you are supposed to have a pap smear about two weeks after the start of your last period and I wasn’t in that time frame. The second time I just couldn’t go through with it; having gone through sexual assault in the past, the test was intimidating and I was afraid to stir up old ghosts.

For months I was trapped by indecision. From what I had read about the pap smear tests, there is nothing graceful about it, but I knew it was important to have it done. Finally I showed up for my third appointment.

I was oblivious of my vulva until the age of 20; I mean, I knew it was there but I really didn’t think about it, or my reproductive system in general, except through feelings of shame. In school we are taught about our reproductive system but usually teachers just want to get through the material and don’t want to answer questions, and so becomes relegated to a kind of blurry knowledge – sort of familiar yet without certainty.

That year I was 20, a friend shared a TED talk video and something the speaker said stuck with me, (I’m paraphrasing) women always feel they owe someone their beauty, their sexuality and body, but they never own it; we are the stewards of our bodies, not its beneficiaries – a truth I could identify with. I wanted to reclaim that for myself and I had to start somewhere. But I had many layers to shed – the fear, and shame, most of it irrational, that my body, my vulva especially, was somehow gross and shameful. This is a reality for many, if not most women. These fears were heightened by the fact that I had been sexually assaulted some time in the past.

When I was setting up the appointment for the third time, I made sure I was very specific that my preference was a female medical officer, though I did not divulge why and they assured me that it’s okay. I got to the hospital just a few minutes past noon, though I was up way earlier. I had spent most of that morning juggling between thoughts like does my vulva look right and am I really ready to have a stranger look at it. The sun was blazing that morning as I walked to the hospital, which made the walk seem even longer; a part of me wanted to back out, but somehow I made it there – anxiety, nerves and all.

In the waiting room, a medical officer asked me what brought me in, and when I told her I wanted a pap smear she seemed startled, but quickly cloaked it with a smile. She explained that women my age rarely voluntarily come for screening unless when mandated by a doctor. There was no queue ahead of me so I walked into the doctor’s office. After the usual introductions she also asks me if I have been referred by a doctor. I tell her I haven’t, but she doesn’t make a big deal about it. She goes on to brief me on the things I need to know – a pap smear is not a test for cancer but a test that can detect abnormal cells that could result into cervical cancer. So if abnormal cells are detected, then they could be treated to prevent cancer from developing.

I am led to a space behind a curtain and asked to lie down. The doctor puts a pillow behind my back and tells me to place my feet on peddle-like structures so that my legs are raised and apart. I’m telling you, there is no more vulnerable position for a woman than on her back with her legs open, and this reality sinks deep even as I try to find something to focus on to distract myself. I have this powerful desire to run away, or to disappear.

She says it will be just uncomfortable – the famous phrase doctors use to understate pain. She gets the speculum, the device they insert into the vagina in order to view the cervix and keep it open. She tells me a cotton wool-tipped brush will then used to collect cells from the inside the opening of the cervix. The cervix connects the vagina and the uterus; its function is to produce cervical mucus that changes in consistency during the menstrual cycle to prevent or promote pregnancy. It also acts as a physical barrier between the vaginal canal and the uterus.

Are you ready? she asks. Of course I wasn’t, but what can one say at that moment? I had come this far. I know doctors and nurses have seen it all, yet this does little to abate my nerves. I focus on my breathing to relax the muscles; she says this will ease the discomfort. I mention the assault just as she is about to insert the speculum. She empathizes, promises to be gentle and tells me to forgive and forget. I start thinking about that, forgiving and forgetting, and while engrossed in my thoughts I barely notice when she starts inserting the speculum. She’s patient and gentle though it all. I keep apologizing what the waves of anxiety hit me; she listened to me and made me feel very safe. When it is all over she tells me that there can be three results – “normal” which means negative for abnormal cells, “inadequate” meaning the cells could not be viewed and so another sample is required within a period of three months, and “positive” to indicate presence of abnormal cells which could be mild, moderate or severe.

The test results were negative, and that was not the only thing I was thankful for. I was grateful for having such a patient and understanding doctor, she made me feel comfortable to ask questions and it never felt like a fuss to her.

According to GLOBOCAN 2018, Kenya has a population of 13.45 million women aged 15 years and older who are at a risk of developing cervical cancer. The current estimates indicate that every year 5,250 women are diagnosed with cervical cancer, and 3,286 die from the disease. Cervical cancer is rated as the second most frequent cancer among women in Kenya, and leading cancer among women between ages of 15 and 44 years. About 9.1% of women in the general population are approximated to harbor HPV-16/18 infections. The human papillomavirus accounts for 99.7% of all cervical cancer and HPV is sexually transmitted. But it is treatable and can be vaccinated against thus greatly reducing incidence of cervical cancer. The current estimates are that only 12% of the population at risk have gone through screening and contributes greatly to the high mortality rate. Screening allows for treatment in the asymptomatic precancerous stage; early treatment is highly effective. At the advanced stage – when most diagnoses in Kenya are done – treatment is difficult and expensive, the chances of cure are low.

In my native language, there is no word for cervix; even the words that do exist for the female reproductive system have been sexualized making it clear that the female body is seen from a male gaze. Women too have internalized this objectification; the language used in reference to the vagina or vulva is made to seem vulgar making it a very uneasy conversation to have with someone who is not literate. Even for those who are educated, it is still uncomfortable as we are taught to regard parts of our bodies as ‘bad manners’. We grow up embarrassed, fearful and ashamed of ourselves and at no point is there a shift to include these parts of our bodies in conversations, even as we mature.

Language is extremely important especially when you need people to focus on a particular issue. The flippant way the female reproductive system is regarded is a huge problem. There is also the culture of how slow or apprehensive we are about prevention mechanisms, which include medical checkups. We have been socialized to only go to health facilities when you are feeling unwell and so if you consider yourself healthy, most of us think it is unnecessary to go for a screening. But the reality is that a checkup could save your life, as most of the life-threatening diseases when detected in asymptomatic stages can be treated and cured.

For women especially, our bodies remain mysterious, with some parts regarded as gross, leaving us anxious about how we look in them rather than how we feel in them. You will think with a generation that grew up with the wave of body positivity and empowerment, the percentage of women between the ages of 25-35 years going for screening will be the highest; sadly the opposite is true.

Any woman who has ever had sexual intercourse is eligible for an annual pap smear; the target population for screening is women aged 25 to 49 years. Older women aged 50 – 65 years are still at risk of cervical cancer and can therefore receive screening every five years, according to Kenya National Cancer Screening Guidelines 2018. The success of a screening program depends on its achieving adequate coverage, in this case of 70% of women nationally. But a majority of women I talked to had no clue where these services are being offered or what the costs are. As I was preparing for my pap smear I discovered that the tests are available in all public health facilities at no cost, though I was very fearful of getting the test done in a public hospital due to the disrepute of services rendered.

The truth is you do not wake up one day and suddenly have a new appreciation for your body. It is a process and some of your perceived flaws would probably never go away; it is only when you embrace them that they stop lurking in the shadows and consuming you. You might think you are alone in battling insecurities, but we all go through it. The wall that goes up in the fight against screening for cervical cancer will come down when we overcome perceptions and attitudes about our bodies.

The test is definitely one of the least preferable things I have done, it was anxiety inducing and uncomfortable. But I would do it again because I know those few minutes could save my life. There are so many ways to make the test easier, you could go with a friend to hold your hand, ask for a smaller speculum to be used, or a plastic instead of a metal speculum. You could speak up when is too uncomfortable or painful, have a session before you have the test and have your concerns addressed, bearing in mind no concern is too silly or small. Ultimately we have to re-examine our relationship with our bodies, so that women can stop dying of ignorance and fear.

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