Monday, 8 April 2013


In my line of calling, I meet many deaths. I am surrounded by death. Everyone who comes to ask for my rituals is usually trying to reschedule this inevitable reality. Some die sooner, some die before I get to see them. Some just die anyway.

They die because being alive by itself is risk factor for dying in this part of the world’you may deduce that death is not a big transaction, of course, not unless it happens to someone close to you and its juncture is due to someone else’s neglect or inaction.

So today I wish to inform you that you will get killed. You and your family. And this will be because of someone’s inaction.

Might you argue that I am taking too long to go through the stages of death, that I am becoming a bad doctor. I shouldn’t be ‘dying’ with every patient that I lose; neither should I make a big deal of a natural event. That is exactly why my title is casual. I would inform you today that you will get killed. Your mother too. Sisters, brothers and daughters just so as  to complete the count. It has to be a perfect number. For records sake.

And a friend asked me, why not just go through the stages of death, and emerge on the other side. Here is what they teach to be the phases; I quote a scene from ‘Greys anatomy’,

"According to Elizabeth Kubler-Ross, when we are dying or have suffered a catastrophic loss, we move through five distinct stages of grief. We go into denial, because the loss is so unthinkable. We can't imagine it's true. We become angry with everyone: Angry with survivors, angry with ourselves. Then we bargain. We beg, we plead, we offer everything we have, we offer up our souls in exchange for just one more day. When the bargaining has failed and the anger is just too hard to maintain, we fall into depression, despair.
Until finally we have to accept that we have done everything we can. We let go. We let go and move into acceptance."

Not exactly true. It is different every single time; with every single situation.
Just this morning I lost a 29 year old girl. She had intestinal obstruction and had to keep it to herself for two weeks. She had to learn to trust the local drugs store more than the government’s health facilities and myself. Would you blame her? What would be the point anyway? Her past familiarities have been meeting very angry and hungry healthcare workers. Probably the red-eyed doctor who had been awake all night may not be too patient; or the nurse that slept hungry and had to walk to work in the morning. Not forgetting that most of the services would be paid from ‘out of pocket’ settlement.
She was simply on her own. The government had neglected her. She had been informed that she needed to pull herself up with her own bootstraps; even if she didn’t have boots. Hornbill’s problem is hornbill’s problem, it was said.

While this is happening the cabinet docket will be used to reward political loyalty. Given a choice between agitating for universal healthcare coverage and an increase in their pay our leaders will choose the latter. No batting of eyelids while feeding us with this false menu of cramped up choices.

Did you know that Kenya is listed as one of the nations with the highest disease burdens in the world?  While the rest of the world is bracing itself to tackle disease we have chosen to sit on our hands.

The stories may change but the effects remain the same, especially if you are taking it from the same podium as I do daily.

The baby I lost last week because it came too late, the mother that bled to death because there wasn’t enough blood due to shortage of reagents in addition to few screening centers, the father whose daughter saw the last of him as they could not afford an ambulance to rush him to ‘helps hand’, the mother that gave up the mêlée to diabetes because insulin is too expensive, the teenage mother that was ripped apart in a home-delivery attempt, the president that died because he forgot to equip the health centers in his country with emergency resuscitation drugs,  the son who wanted to be president but had diarrhea bury this dream with him, the community worker who despite dedicating her life to national service could not afford antibiotics. Who would forget the limb I cut and threw in the dust bin, whose owner was a 28 year old diabetic yet we thought amputations only do happen in wars.

These are real stories. They are only intriguing when you are on the other side of the divide reading them, when they happen to you, your world crumbles.  You deny it, get angry, get depressed, bargain and finally die within. And the cycle repeats itself. Almost exactly in the same way. The only constant is that my government will still allocate 4% of its budget to healthcare and appoints a politician to sort out this mess as they fly out to America to treat themselves. They leave you to be killed. And so you will be killed; you and your family.

As a civil servant you may dispute that my choice of words is seditious. Unbecoming. That I should keep the oath of secrecy. It is however within my prerogative to decide what would make me feel more guilty,  what would make me go through the stages of these deaths much more quickly;  to smile at this secret and keep my job or let it out and keep my sanity. I chose the latter. Given 100 chances I would make the same choice.
So you will be killed, you and your family. You will be left to rot one limb at a time if you are diabetic. You will be left to bleed one drop at a time during childbirth. You will be eaten by parasites and bacteria as you ‘build the nation’ one organ at a time.
Before the priest puts his cloak on and carries his tattered dog-eared bible to your filthy bedside, you will be killed.

Why should we invest in healthcare while the Kingdom of God is free. Let us be killed. let us be killed together. (this is the part you are supposed to clap and cheer for the Health System adorned on us is perfectly structured).

### I dedicate this to baby *Emma who gave a spirited fight after three major operations but still got ‘killed’, she had come late. Whose sin is this?