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Reflections

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

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“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
Photo: Vittore Buzzi on Unsplash
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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

To the Brothers and for the Women in Our Lives

We were made husbands before we became men, and it might benefit us a great deal to restore the trust we once had in the guidance given to us by the women in our lives.

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To the Brothers and for the Women in Our Lives
Photo: Flickr/Ninara
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Since childhood, my great aunts, my grandmothers and the older women of my clan have referred to me fondly as their husband. “Nga uyu mundu wange,” here is my man, here is my husband, they would always remark in Maragoli whenever we met, never failing to claim this very unusual relationship to me with the biggest village smile on their faces. This, if you can imagine, was one of the few things that didn’t exactly excite my curiosity as a teenage boy. They were women in whom I had unquestioning trust, but what kind of humour! I could not understand where the grace of a woman that old had gone for her to say such a thing. Why? How? It was something too big for my brain to bother with at that time. Now that that boy is a few years older, the message is decoded from the different words of another group of Maragoli women in a closer space and time.

Highrise Estate Kibera is a special place to me. Apart from being my refuge during times when “the situation” seems unbearable in the adult world, where I retreat to the cradling love and care of my aunt and my cousins, it also happens to be a space where I get to experience the village from my interactions with Maragoli laundry ladies. There are a lot of Maragolis here, and most of them live on the other side of the wall in Soweto Kibera — where the real ghetto is. The lives of the people of Kibera, how they make a living, you will find very interesting.

In the early hours of the day, Mbagathi Way’s pedestrian paths might easily be mistaken for the venue of a serious racewalking event as Kibera residents — Nairobi’s labouring class —  race past each other as they trek to Industrial Area. At around mid-morning, the journey becomes shorter for some, those opting to make stops midway as others turn back all the way. While it might seem like a foolish thing for them to do, it is a well-informed decision.

Some of those who woke up earlier are on their way back, they need not say anything about where they’re coming from. Neighbourhoods such as South C, Nairobi West, Madaraka Estate and finally Highrise Estate become their checkpoints; you never know, someone might need a parking lot swept, a house cleaned, some laundry done, some dishes fixed. No functioning human being wants to gamble with energy they lack the resources to replenish. So they change direction, reversing from an industrial vision to a domestic one.

Women are the majority among those changing direction, coming back home, not because their muscle mass will not allow them to finish the race early enough, but because it has made them unsuited for the roles industrial work provides for the labouring class.

So, what is the significance of the relationship between Highrise Estate Kibera, Soweto Kibera and this labouring class? Or, what is left of it in this story? It is more or less the same significance my great aunts, my grandmothers and the older women of my clan share with the laundry ladies of Highrise Estate K. in my life.

When the COVID-19 pandemic hit us in early 2020, a lot of women in the employment class just above the labouring class started working from home; a good number of them were sent on compulsory leave without pay. With less cash at their disposal and more time to spend around the house, many of them had to let go their domestic workers. Were they to go back to the ghetto? In Highrise, at my aunt’s and the neighbouring blocks, these women sit outside their sources of employment.

A keen eye will easily lead you to the Maragoli laundry ladies’ base in the area. You will see them seated next to water jerrycans and buckets, stoically bearing the Nairobi heat as they wait for the few opportunities available to them. When the pandemic was at its peak in mid-last year, some of them would go for days without finding a single client, but still, they would not ask for anything from the people they knew. Rather, they hollered out at them like friends and would only insist on us promoting their side-hustles. One such woman is Maggie.

Maggie, a middle-aged woman with a son she recently disclosed to me was in medical school, would shout out to me, “Maragoli!”, caring nothing about whether I was a block away or just on the other side of the road. She would easily convince me and my cousins to buy a few of the avocados she was selling, it mattering not to her whether we had ready cash; we would pay when we had it.

From being her customers, our relationship with Maggie grew over the months to that of neighbours who have no problem commenting about how the other is looking today — not flattery, just raw, honest village banter brought to the city. Recently, Maggie made a personal comment about me; she said, “Sahizi mwili wako unaonekana vizuri, last year ulikuwa unaonekana na wasiwasi sana”, now your body appears alright, you had lots of worries last year. This was weeks after another powerful remark made on the first day of February 2021. Remarks that decoded the message in the words of the women who claim me as their husband back in the village.

“Genye’kana munyo’re zi’gasi mtange’ kuhinzira.” You are supposed to find jobs and start working, functioning, Maggie said to me and my older male cousin late that February afternoon. I had no idea what observations led her to utter such remarks, but they were delivered in a tone so light that we almost laughed. So detached was her position as she made them that it would have been really easy to miss the concern and interest she had for us. And it bugged me, more than the thought of being my grandmothers’ husband bugged me as a young boy. It did not help that both of us had quit our jobs a few months before the pandemic exploded to “focus on our art”. What humour! Why would she say that to me? Now this appealed to my sense of curiosity just as it confounded me. Was she simply asking us to find jobs so that we could in turn provide employment opportunities for her? Was she encouraging us to keep on looking for opportunities and not give up? Or was it a witty rebuke to Maragoli youth walking around the estate in the peak of the afternoon, pretending to be in the same position as her, lacking opportunity?

I remain unable to place these remarks. Nevertheless, if Maggie Maragoli sees me essentially as a Maragoli man then, truly, I am her husband. The women of my clan must have been teasing me with the responsibility that comes with being a man in the community. That as a Maragoli man you are answerable to more than one woman in your life; your functioning does not just benefit the woman you raise a family with, it is essential for the whole community’s prosperity. It might also be that we fit the image of the man Maggie would like the daughters of the community, her daughters, to have, and that she is playing her role in moulding these functional partners. Whatever the meaning of the remarks, they remain a response given in an attempt to show direction.

Only one message is clear.

A deep concern seems to be building up among a group of women from the ghetto. Not about themselves, not about their children, not about anyone really close to them. Just their husbands. A concern that manifests itself as a wound, an old wound, a very visible wound which regenerates into the painful thing it was many years ago when it was first inflicted by our fathers. We, their husbands, are that wound.

In the ghetto, Kibera at least, based on the selective principle industries apply in recruiting workers of the labouring class and the number of women in domestic work, there are more men in meaningful employment than there are women. Is it, then, beyond us to say that when the vision for women is reversed from industrial roles to domestic roles in the labouring classes of capitalist systems — worse in a corrupt country — the people become poorer?

Oftentimes, I find myself promising to give something back to these women in the future. I want to make them happy, these distant but very present wives of mine, these very close but physically distant wives of mine, for the priceless education they have given and continue to give me. But time is limited, and it would break so much to go beyond oneself, I am just one among many men of the community. And what makes me think that I carry the key to their happiness!

The surest thing I could give is my ear.

I get it, I think, I feel as though I have gained understanding. I have to function.

We were made husbands before we became men, and it might benefit us a great deal to restore the trust we once had in the guidance given to us by the women in our lives. Our mathes, our sisters, our senjes, our gukhus. These women whose presence, physically, emotionally and in memory, has never failed to check us at every stage of our growth as human beings. We should trust the women in our lives to give us direction, not answers, on what proper manhood looks like.

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Reflections

Life on the COVID-19 Frontline: The Use and Abuse of Kenyan Nurses

Nancy’s cohort was not trained in the care of COVID-19 patients. They were dropped in at the deep end – the deep waters in which they outnumbered their colleagues of long standing who have permanent and pensionable contracts.

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Life on the COVID-19 Frontline: The Use and Abuse of Kenyan Nurses
Photo: Marcelo Leal on Unsplash
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As the novel coronavirus traversed central China and made its way across the seas to wreak havoc in Europe and the Americas, there were those in Kenya who wished the calamity would also befall us. My cousin Lyn, who works for a medical charity, was appalled to hear an official of the Ministry of Health express the hope that SARS-CoV-2 would arrive on Kenyan shores “tupewe pesa” — so that we can be given money. That was in February 2020; less than a month later, that maleficent official’s prayers had been answered and the funds soon followed in COVID-19’s wake, to be swiftly embezzled by Ministry of Health officials in cahoots with the directors of hastily incorporated tenderpreneurial companies. It can be safely assumed that the avaricious official was well positioned to be a prime beneficiary of the windfall.

It seems a long time ago now, when a wave of indignation swept through the nation as the news broke that funds and equipment meant to help Kenyans weather the COVID-19 storm had been stolen. Here in the Nyandarua County countryside, hawkers of hastily tailored cloth masks selling at a hundred shillings apiece soon exchanged them for the now ubiquitous sky-blue face masks once they became more readily available on the market, selling the prophylactics at ten shillings each.

The initial anxiety brought on by news of the sudden death of a middle-aged woman in May from COVID-19 two dozen kilometres further down the road from us gradually abated as it became evident that her death did not augur a hecatomb. Little by little, as the year wore on, life returned to a semblance of normal; the masks slipped off, the soap and water dispensers in front of the shops stood unused, market days returned and the police retreated to their usual occupation of extorting matatus and boda bodas. Pandemic fatigue had set in.

Over in Laikipia West, in Marmanet, my friends Patrick and Dorothy had been fanatical about sanitising ever since the news broke that the pandemic had reached Kenya. You were met with soap, water and sanitiser at the gate, a good hundred yards from their house, and the exchange of news about the weather and the state of the crops took place on the veranda under the shade of the creeping jasmine and honeysuckle.

Then early this January Dorothy called to tell me that Patrick had been hospitalised with acute pneumonia and I feared the worst. Patrick wouldn’t go to hospital when he first felt unwell and by the time it became obvious that he needed urgent medical attention, he couldn’t walk. He’s a very big man, overweight, and so Dorothy put a mattress down in the back of their pick-up truck, laid Patrick on it with the help of neighbours and drove through the night to a private hospital 30 kilometres away. Updates from the hospital were not reassuring; Patrick had contracted COVID-19 and his lungs were in pretty bad shape so he was put on oxygen. Tests also found his heart deficient and his liver malfunctioning. Miraculously, ten days later, Patrick was discharged from hospital with strict instructions to drop weight.

I was relieved to hear the good news and selfishly thankful that Patrick and Dorothy are an hour away from me; to my knowledge, no neighbour of mine had yet contracted the deadly disease. Then in mid-March my friend Isaac fell ill. Aches and pains all over the body, shortness of breath, dry cough, raging headache, no appetite. All COVID-19 symptoms. Isaac is an ordained pastor and missionary, bringing help and succor to the least among us, his days filled with meeting people and finding solutions. A week of treatment did not improve his condition and Isaac was hospitalised at a private clinic in Nyahururu. I feared for him and I feared for all of us who have been cozily ensconced in our personal cocoons that have given us a false sense of security that we shall be spared the COVID-19 scourge.

The small private hospital where Isaac was admitted is not testing for COVID-19. Patients also have to go to a private facility in Nyahururu town for chest x-rays. But the level of care is beyond reproach and the medical staff attentive. The young woman doctor treating Isaac seemed experienced beyond her years, explaining Isaac’s prognostic profile with clarity and taking critical decisions with authority, all the while imparting a sense of hope that Isaac would make a full recovery.

Hearing that Isaac had been taken ill and hospitalised, a young woman who had been a beneficiary of Isaac’s sustained efforts to uplift the lives of the poor of Ngobit and give their children a fighting chance by supporting their education, came running to his bedside. Nancy* had successfully completed her nursing course and was now stationed at the Nyahururu County Referral Hospital, a stone’s throw away from where Isaac was laying on a hospital bed fighting for every breath. She arranged for Isaac to be tested for COVID-19 at the government facility and insisted on paying for the cost herself.

That Nancy offered to pay for the cost of the test is testament to the regard with which she holds Isaac. Nancy has not been paid since early December 2020 when she received five months’ salary arrears. She is one of a cohort of nurses that was hired by the Ministry of Health in June 2020 in the face of the pressures brought on the medical sector by the COVID-19 pandemic. A Zoom interview was quickly followed by a job offer and Nancy arrived at the Nyahururu County Referral Hospital in early July to find that the Kenya Medical Training School lecture rooms had been converted into COVID-19 wards. But they were soon closed down and COVID-19 cases returned to the general wards once the KMTC students resumed classes in January.

Nancy tells me that there is no isolation ward at Nyahururu County Referral Hospital; surgical and medical cases are housed under one roof in the male ward and the same goes for the female ward, where female patients with gynaecological issues are also admitted. Patients with COVID-19 are “put in beds in a corner of the ward”, as Nancy heartbreakingly put it. There they wait until a doctor with Personal Protective Equipment can attend to them, administering the care that the nurses daren’t, for fear of contracting the virus. There is not enough PPE for the nursing staff; the county surveillance officer doles them out as parsimoniously as he does the COVID-19 test which is reserved for patients displaying symptoms and those with whom they have been in close contact. Nancy says that their only protection is “prayers, masks and sanitising”. Nancy says that “we are not doing things the right way but it is the management that is failing us.”

There is no critical care unit at Nyahururu County Referral Hospital. In fact, there is no critical care unit in the whole of Laikipia County. Not in the public hospitals. Not if CCU is understood to mean the availability of life support equipment and medication, and highly trained physicians, nurses and respiratory therapists specialised in caring for critically ill patients.

At the Nanyuki Teaching and Referral Hospital — the only other major public hospital in Laikipia County — there is a building whose façade bears the name Critical Care Unit but that is all the building is, a façade. Speaking at the facility on the 23rd of June 2020, Laikipia Governor Ndiritu Mureithi announced to the press that “we are preparing a 6-bed ICU and a 12-bed HDU”, adding that “the most important issue is ventilators, five of which were already at the Nanyuki hospital while another five were foreseen for the Nyahururu facility. Well, Nancy says that between June and December 2020, the only ventilators in use in the temporary isolation wards set up at the Nyahururu County Referral Hospital had been borrowed — together with the beds — from other public medical facilities in Laikipia County. The beds and ventilators were to be returned whence they came when the isolation wards were shut down in January.

The January to March 2021 issue of the Nanyuki Teaching and Referral Hospital Quarterly  publication reports that “we now have also completed at 17-bed critical care unit with 6 beds reserved for intensive care unit (ICU) and now have just obtained an anaesthesiologist to get the service set up and running. A nurse has been sponsored by the hospital to specialise in critical care, and more will continue to be developed in this manner.” It is unclear which “ultramodern intensive care unit” was “unveiled” by Governor Muriithi in June 2020.

Nancy tells me that, because the Nanyuki hospital does not have the facilities, critical COVID-19 cases at the Nyahururu hospital are referred to Nakuru Level 6 Hospital in Nakuru County. If there is no room there, patients are pointed in the direction of the Kenyatta University Teaching, Referral and Research Hospital. But relatives must first deposit KSh200,000 with KUTRRH before the patient can be admitted there. The elderly mother of a colleague of Nancy’s who contracted COVID-19 last November could find no help beyond being put on oxygen at the Nanyuki hospital and so the family raised money and had her treated at a private facility in Thika. She survived.

Nancy’s cohort was not trained in the care of COVID-19 patients. They were dropped in at the deep end – the deep waters in which they outnumbered their colleagues of long standing who have permanent and pensionable contracts. Nancy and her colleagues were offered 3-year contracts with a basic salary and no benefits take it or leave it. They took it.

Last December Nancy’s cohort was split in two and she found herself in the Universal Healthcare group (UHC), falling directly under the Ministry of Health. She has not been paid since, while her colleagues who fall under the responsibility of the Laikipia County Government have been receiving their salaries every 27th day of the month like clockwork. Nancy says she doesn’t know the criteria that was used to split the group. She says that she and her UHC colleagues often call on the understanding of their colleagues who are on the county government payroll for financial help. Which is why her offering to pay for Isaac’s COVID-19 test is so significant.

Now it seems that the Ministry of Health has lost their paperwork. Their files have “disappeared” and so they cannot be paid. Nancy and her UHC group have been asked to resubmit all their diplomas, certificates and all other supporting documents. Each document must be certified by a magistrate as conforming to the original. The magistrate at Nanyuki charged 50 shillings the copy, a small enough sum until you take into account the number of documents that must be submitted and the number of nurses submitting them. And the fact that none of them have been paid since the 4th of December 2020. The county government took possession of the resubmitted documentation for onward transmission to Afya House but could not tell Nancy and her colleagues when they might expect their salary arrears to be paid.

Thankfully, Isaac tested negative for COVID-19. He had suffered a particularly nasty bout of pneumonia. He is out of the woods and back home where he haltingly (talking still makes him breathless) admitted to his wife that in the dark hours of a particularly difficult and frightening night he had yielded to his God, leaving his family in the care of the Almighty.

* Name has been changed.

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Reflections

The Paradox of Choice: Just Another Family Tale

I am thinking about the miracle of being born, a one in 400 trillion chance. Even without this statistic it is hard for me to consider that my birth might have no meaning beyond the self-constructed value I give to my experiences of life through you; the fact that your death was not the end of your life, that you continue to live through me.

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The Paradox of Choice: Just Another Family Tale
Photo: Unsplash/Aditya Romansa
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Say something to me
What does one who grants you the kindness of a living body
want from you in return but an understanding of what it means to feel alive?

~ Forough Farrokhzad

I was told that I was born a healthy baby at Consolata Hospital in Nyeri. My father, who is of the Kuria people of southwestern Kenya, was working on a project in central Kenya as an agricultural engineer. I was named Boke after his mother. In Kuria tradition girls were not as celebrated as boys, but my father looked at me as keenly, with that same sense of indebtedness, as he would at his own mother. 

We thank our parents for the gift of life. Our parents expect us to thank them. Each and every day you should demonstrate gratitude for this special gift; no matter your experiences, you owe it to the givers of life – for better and for worse.

We lived in Nyeri for two years. And then I was taken to my maternal grandmother in Russia, where I spent two, three years with her in Krasnodarsky krai in that southern part of Russia that borders Crimea to the west and Georgia to the south. Krasnodarsky krai is in the Caucasus, a popular getaway because of the warmer climate, the ski resorts and the seaside. But I didn’t get to visit any of these places then; only later in my life did I spend time on the Black Sea while living there as a teenager.

While everything before this time remains with the custodians of the stories, my first memory is that of abandonment, my mother taking me away from Nyeri at only two and leaving me with my grandmother. Her soft long fingers slip away from mine and I realise that I am not going with her. I break into a cry but it is too late; the tram is moving away and we are separated.

There is something about knowing that you have no choice that leaves more room for acceptance. How that acceptance, or rebellion, manifests itself is a different story. Days went by and I settled into a routine in my grandmother’s home. In the winter we would light firewood to keep warm and in the summer we would eat strawberries and crimson cherries, and pickle cucumbers for the coming winter. I had no real sense of time other than day, night and seasons, and I do not remember thinking as much about being left behind as I did about what would be happening in my day to day life – fighting with my twin boy cousins, their mother bringing us hot dog treats overflowing with tomato sauce and mustard, taking a bath in a bucket, picking walnuts (fallen from a tree I still miss as my connection to the roots it held), running to the river, walking to fetch water from a nearby well, my tattooed uncle getting me out of the cupboard where I hid when I was upset, his golden teeth shimmering back at me. “Katyusha”, dearest Katya, he’d say.

Every so long, babushka would announce the arrival of a letter and she’d read out words that came from the heart of my “real” family in Kenya: my father, mother, older sister and newborn brother. But of my family, I remembered only my mother, so potent was that first memory living a life of its own somewhere at the bottom of my soul’s well: an unprocessed flashback of her hand slipping away from mine.

Whatever else, I cannot say it was a dull childhood.

This taught me that I did not find places but places found me.

My life was stable. Days, seasons, letters. Until one day, the strangest looking man walked into my grandmother’s house. He was black. I could not hide the shock on my face. Living in a neighbourhood where I only saw white people, I fell prey to the thought that all people were white. Ironically, I did not acknowledge my own difference from those around me – the honey-coloured skin, brown almond-shaped eyes and unruly hair. “Your papa has come for you,” babushka said. The four-year-old me could not fathom how this alien looking person could be my father and want to take me away. Deeper than that, though unable to name it, I felt a sense of betrayal from my grandmother, who seemed so ready to give me away. I hid behind her and refused to approach this stranger, who interestingly enough, spoke “our” language so fluently. In an effort to persuade me to approach him, she tried to bribe me with my favourite treats, “You can have as many pickled cucumbers as you like and more sugar in your porridge.” When that did not work, babushka said that if I left with this man, I would meet my mother who was waiting for me on the other end, where it was always summer. That triggered something in me and I felt the need to touch my mother’s hand again and mend the separation. I planted that seed in my mind and it held me together for what would turn out to be a longer trip than I had imagined.

This taught me that my life was choosing me rather than me choosing my life.

The journey back to the land of my birth started with a long train ride. The longest trip I remember ever taking was from my grandmother’s home to the Christmas show children attended at a theatre in the city centre and this took no more than 30 minutes. The one day on which we dressed up. After the show, the Russian version of Santa, who wore blue (not red) and whom we called Ded Moroz, Father Frost, would give us a bag. In it was an orange (a special fruit in that part of the world at that time) and chocolates. I reflected on this memory on the train, my only source of comparison as I embarked on another long journey that filled me with anticipation. The ride from Krasnodar to Moscow, which today takes 18 hours on the fastest route, was a very long ride indeed.

When we reached Moscow, we spent the night at an old couple’s home. Merry making over dinner revealed an awkwardly jovial side to my father. He was laughing and speaking loudly. I noticed white teeth as a distinct feature for the first time in my life; they sparkle in contrast to his dark complexion. And even though he spoke Russian, my language, all I could do was stare as I tried to fathom that this was my father and that suddenly, my life had completely changed.

I am in a strange place, with strange people, and when I wake up the next morning, the first sound will not be that of my grandmother at the stove yelling that we should all get up and be useful, bellowing a-ya-yai ya-yai! if we didn’t move.

A sofa bed is pulled out for my father and I. We sleep side by side in this open space. He quickly falls asleep as I cuddle myself on the other side thinking about what’s to come. Will I really meet my mother? Will I be safe? When will we arrive? Is this a dream I am about to wake up from?… My thoughts are abruptly interrupted as my father, having made too much merry for our own good, vomits all over me. It’s putrid, lukewarm and slimy but he continues to sleep, unperturbed. I get up and walk down the corridor not knowing what to do. The old lady hears the movement and finds me in the corridor. She cleans me up and takes me to sleep somewhere else. I do not recall if she woke my dad up or what happened next but it took me 25 years to get rid of that pungent smell that it seemed would follow me around for the rest of my life, until someone told me that I had a choice, and I listened.

This taught me that sometimes the world expects too much of humanity.

There was nothing memorable about this trip, and certainly not the nausea I experienced from flying. Perhaps this should have served as a premonition. I most vividly recall my first impression: arriving at the Jomo Kenyatta International Airport in Nairobi made this long uncomfortable journey seem like it had been the road to heaven. First it was the black and white striped animals by the roadside as we left the airport; magical creatures. I thought only dogs and cats existed in this world. Then the sun hits you, it is all green and lush, and further out into the busier roads are trees shaped like umbrellas and huge birds with prominent beaks comfortably perched on the slender branches, making sounds that could almost pass for frogs croaking. But mainly it was the sun, it felt so close that I could hold a portion of it in my hand, and I instantly fell in love with this country, forgetting for a moment that my main goal was to mend my separation. We ride in the car with the windows open, the warm breeze kissing my face.

And there she is. Mother. The glorious delicate being I wanted to attach myself back to. I notice that the sense of familiarity embedded in my mind has faded and I have to find her again. While I mend this separation, a new one is born, as I try to get further away from the scent spreading distance between my father and I.

Years went by and in them father remained a source of … interruption … between my mother’s wholeness and I, even if the gift he gave us – Kenya – was something none of us could afford to take for granted.

This taught me that one separation leads to another; like a chain necklace.

Mother

I write this on a warm morning in March. I wake up to the beautiful Kenyan landscape luring me out of bed. I stare out of the window; the crescent moon presents itself just slightly behind a tall old tree on the left, and on the bottom right the sun is slowly awakening and beginning to brim its rays subtly into my day. I watch them both and I am thinking of you. I am thinking how much you would have savoured this morning. I am thinking that it has been two decades since you left. I am thinking I was thirteen. I am looking at my thirteen-year-old daughter and I am seeing a child who needs her mother next to her, and I am feeling empathy for my younger self. I am thinking how father left nine months before you did and I am realising that we were both delusional in our thinking – that the interruption was gone and life would give us a second chance to truly mend that separation. I am thinking, you did not deserve that cancer, yet it was your lot. The lot that your genes gave you. I am thinking I had to grow up to understand that inheritance was not a choice. I am thinking of the time the doctor told me that if I test positive for the gene, it is not a matter of “if” but a matter of “when”. Boom!!! I am looking at your grandchild, this our daughter, who has her mother and I wonder – how will I make her understand that I can save her from a rainy day with shelter, I can save her from hunger by the work of my hands, but I cannot save her from our inheritance. I cannot promise to stay, I cannot, like a sculptor, reshape her genes.

This taught me that this life had to be enough.

Father

What I really have been wanting to say is, I am sorry. Sorry I never learnt to love you like a daughter should love her father. Then I passed that on to my daughter by raising her alone. I am sorry you could not give me a safe space to grow in love. Or maybe you could? You know, there were always the remnants of that scent and your small dark eyes like darts, staring at me accusingly. I reflect on what I did not understand about you then. You were happy but you did not have happiness. That is why your eyes seemed hollow. Why it was hard to find a photograph of you smiling or laughing. Why merry making was your way of leaving yourself but the failure to do so was your source of anger.

The end was not only physical pain but the intangible pain of knowing you messed us all up, that your PhD ultimately did not get to live up to the glory it aspired to. Still, I thank you for this country. What more can you really give someone than a whole country! So that when you both left, I still found a nurturer in its landscapes. The warm breeze kissing my face, the sun holding me at its centre, the croaking birds reminding me that I am never alone.

This taught me there is more than one way to be left; many forms of abandonment.

Epilogue

I am thinking about the miracle of being born, a one in 400 trillion chance. Even without this statistic it is hard for me to consider that my birth might have no meaning beyond the self-constructed value I give to my experiences of life through you; the fact that your death was not the end of your life, that you continue to live through me. That I perpetuate your education, that I display mama’s sensibilities. That which I inherit and that which I pass on. The miracle itself.

Everybody wants somebody to be their own piece of clay
~ Marvin Gaye

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