DEMOCRACY IS NOT THE PANACEA; WE NEED GOOD LEADERSHIP WHICHEVER WAY IT COMES

The picture painted by those democratically elected to our leaders portrays the end of democracy as an illusion that we will never get to touch. While we thought that democracy and its anticipated end should serve to offer if not better lives then lives desirable by the citizens, it has not been further from reality.

The world over, the unaudited claim of democracy is that which makes the people get leaders they desire. The end of this is supposed to be an acute translation of services and leadership as fairy as it should be.

Like the bad proverbial mother that eats up her own children, our kind of democracy is proving to be our Achilles heel.  It is, day by day confirming that it is an extra burden with no transposed results to the ordinary mwananchi. How be it that the leaders you stood in long spiraling queues to elect turn your back against you the very moment you cast your vote? The ink still wet and the brow still drowned in sweat.

The first thing the members of the lower house ganged up to do was to unceremoniously coerce the structures of the country to increase their pay. Never mind not a single bill had been passed as yet. Concurrently, the county governments; meant to bring services closer to the people resulted to join in the financial gymnastics and the governors too were not left behind.

Further gapping the already eclectic poor-rich divide while being hopelessly clueless on real issues that concern the people.  In a good country (and that’s probably Wonderland where Alice lives) we would expect that the penultimate leadership would play tough ball and direct the coterie of leaders who hide under mass impunity and bring them back on track. What happened was that they chose to handle them with kid’s glove and opened a further Pandora’s Box that is now spiraling out of control. If our leaders can be allowed to dip their fingers in the honey jar then everyone else must be allowed to do it. As a representation of the general population, they ought to be a reflection of what we are. What they want and need should extrapolate what we want and need. There should be no doubling of standards.

Teachers were the streets for three weeks, putting a not-so-enviable focus on the prospects of education in our country. An education system characterized by uncertainty and poor stewardship breeds youths that are uncanny and unnecessarily abrasive. These, while our peers are embracing the dancing lights of modernization.

Nurses and doctors might also be sitting on the edge, waiting for their turn to pounce. Characterized by poor pay in a sector that is as hazardous to work in as was the battlefield of World War 2, we are left with few probable guesses.

The most nauseating thing however is not our leaders’ unfairness but their indifference. As it is said, you would rather an unjust god than an indifferent one. They chose to almost deliberately ignore the obvious displeasure of the people and chose to with religious discipline adorn political correctness as a means to their selfish ends.

In all these confusion, the obvious question becomes ‘what is it that they claimed was the magic in the wand of democracy?’ Why should those who embrace it be glorified and those who think against it be castigated.

In a population where many people live miserably below the benchmark of poverty, it would be wise to guide democracy into its right path. We have to get back into the lane. Define astutely what it is that we need as a country and brand our own path to get there. 

I SIT HERE WRITING

His liquid petite eyes told a story. Delicately emblazoned on his seemingly decrepit face would tell you of the tales in his short life. His nose sticking out and letting out a camber like a whip. His temporals sunk to an almost meeting distance. The skin on his brow and cheeks established thin creases as he changed from one facial expression to another. While his neck struggled to hold up the weight of his head, you could see monstrous veins threatening to let way occasionally distracted as he swallowed saliva.

Cupping his left hand to support his cheek, he looked at the floor as if reading it. You could easily tell how deeply in thought he was but never guess the filling. He momentarily shifted his eyes from the floor to the empty ceiling and back to the floor again. Avoiding as much as he could our eyes being caught in the snare of the silent tête-à-tête.

When I just thought he would open up and mumble, he ended up calmly swaying his right hand and noisily scratch the dorsum of his left. Letting out white skin marks. He would then look underneath his nails as if he expected something different.

I sat there pensively. Wondering what in his one decade of experience in life had disturbed him to this extent.

“Mmmmmmhh…” he finally started.

I leaned forward to encourage him on. Our skulls almost touching. I could smell the sweat of his once white T-shirt.

“I wish she could love us as much as my mother did,” looking from his left side then to his right side he continued. This time creases formed on my forehead as I tried to read his opaque minds. His disturbingly slow let-out sending out an avalanche of thoughts and conclusions.

He continued to narrate the ordeal of his life. His spongy penetrating voiceand  girlish fidgeting informing me of a distressed mind.

So he narrated.

He had lost his mother two years back while she was giving birth to his sister Shida. She had bled to death, doctors told his father. He was eight years old then when his father came home carrying a noisy shrilly bundle of a baby and some clothes in a paper-bag. He ran out of the house to see if his mother was taking her shoes off to get into the house, but no one was there. Then his father broke it to him.

 His father, a man who used to labor in the rich neighborhoods, would shortly get married and bestow them to his new wife. He would then be ‘lucky’ as he got a job as a truck driver in the United Arab Emirates. Time to time, he would send them money for food and clothes. He can only bare witness for the food bit as he never saw any for the clothing. I could tell. Perhaps you too could tell.

Earlier that week, he said, Shida’s body was increasingly becoming hot. She would sweat in the middle of the night. Cold water did her no good. She would now get seemingly strong thrusts in her chest and let out everything she ate. She couldn’t sleep at night. Not that she could but also because he wouldn’t let her. What if she slept and never woke up.

Little Maneno had come to ask for dawa for his sister. The hospital was half a day’s trek in good weather. He couldn’t have come with her because thin as she was, she was still too heavy for him.

It was at this point that I sat back. My pen subconsciously tipped at the edge of my mouth.

I remembered our empty shelves. The circumstances. We would have to get this girl and have her checked up. The machines that were donated by the Chinese government had broken down just around the time Shida’s mother died. So we would have to send them away to get the investigations done elsewhere. Then come back for a prescription.  Then send them away to go buy the dawa.

It was now, like it had started. When we started he was dumbfounded. Now, I am dumbfounded.

It’s been twelve hours since; you might not be interested in how the situation was sorted out. I chose to sit out in the lawn. Gaze at the endless ocean embrace the sky. A sky so starless and lifeless. A sea so selfish and quiet despite having a lot to itself.  Just as endless as the ocean and its infinite love for touching the sky at the horizon, my thoughts race as to the exact meaning of the word FREE.

From the moment of the evening when grayness replaced the earthly colors. When that same grayness was itself consumed by the dark of nothingness. Throughout the sulky sky and quiet sea. I have had nothing to say but just sit and wonder.

So I sit.I sit here writing.

 

UNDERSTANDING THE PROSPECTS OF FREE MATERNITY SERVICES IN KENYA

The president has finally launched the ambitious free maternity services for all Kenyan women. This is a program that needs to be graduated with caution and intense planning because its effects cut across several sectors and affect our sanctity of life

It is estimated that approximately 1.5 million children are born in Kenya every year. Such a program would see to it an end where it would be intended that all these births be conducted in hospitals. Our economic profile only favors that a small proportion would afford private facilities. The rest will deliver in our public institutions.

To better understand the ramifications of this, let me paint to you a picture of our health system as avidly as I can.

The Kenyan health system operates on the concept of cost sharing. Patients are required to pay a much subsidized fee for these services. On their part, the hospitals through their management boards use these funds to keep them running; paying for consumables and employing casuals who are requisite for the running of our health system.

It therefore would be untenable to scrap off this fee without providing an alternative way for the hospitals to survive, they would simply close shop. As a result therefore, the free maternity policy outlines that for every birth conducted, the hospitals would be entitled to a blanket Ksh 5000. As earlier agreed, a majority of the 1.5 million births conducted in Kenya fall in the lower socio-economic quadrant. This is to say that many of them would be anticipated to take up this form of scheme. We are therefore approximating that we would need approximately 7.5 billion Ksh to start off the project.

It cannot be ordered that the money will be reimbursed after services are rendered; the money will be needed to render these services. Where else would the hospitals get the consumables?

Another important aspect to look at would be how often these reimbursements will be made. Making them an annual event would glue our hospitals to year-long debts and in some way incapacitate them. This is likely to affect the quality of services.

While it would be easy to increase the demand for the services through scrapping of the user fee, efforts must be made in the immediate to address the projected increased demand. We still suffer an acute shortage of both nurses and doctors. Increasing the work capacity without adequately addressing this shortfall will definitely injure the quality of health care provision. At present, it would be prudent to employ more nurses and retain the few who were on contract through the economic stimulus program. It would also be far-sighted to increase capacity of both doctors and clinical officers to address the expected surge in demand for these reproductive health services.

While the government allocated just about 2.8% of its GDP to health sector, it is quite obvious that dedicating more than a third of it to just a single sphere of the country’s health strata would have negative end effects on health provision as a whole. More funds need to be channeled to this ministry to better achieve this noble objective.

We also hope that the government will jump over the legal challenge that is the fourth schedule, which clearly stipulates where the mandate of running the affected facilities lie. It is the absolute mandate of county governments to decide the happenings in all public hospitals in Kenya, save for the two referral hospitals.

In the end, we hope for better statistical and substantive result that would pale the dangers of child delivery in Kenya. If that is done, we will surely be many steps ahead of our peers.

THE FUNNY STORY OF HOW I KILL PEOPLE EVERY DAY

When I was fresh new in the profession, I thought I would employ my go-getter, type A personality to get things going. To get things done. To prevent that mother from going home childless after nine heavy months. To save that leg from amputation. To stop cancer cells from growing. I pretty much believed, like many class 8 kids would after KCPE results, that I am the change I was looking for.

I do not know anymore.

In my first year, I was thrown into the deep end of things, without a floater and expected to be seen alive at the shore. In between my failed attempts to save lives and certify the ones I had lost, I was in utter confusion.

I could no longer tell whether the wetness down my face was sweat from my brow or tears of exasperation. I remember keenly my seniors warn me not to die with every dying patient, not to be too attached. That would affect my service-rendering. I was supposed to move on swiftly like batman from one death to another potential one. Struggling amidst limited or no resources to work. And work we did.

As an intern at the largest referral south of Kenya, I happened to rotate alone for 2 months in obstetrics and gynecology and surgery departments. It was my mandates to do all the night calls, find sleep at the25th hour of the day, and return early morning to memorize my patients’ menstrual cycles. Accurately. More like an illicit lover would need to do to prevent unwanted…well you know what. My routine life had changed without realizing it. In a quick spark, I had begun dying with every dying person, witnessing and officiating needless deaths. I would develop a deep sense of guilt.

The dewy mornings to work would more or less be like an eternal walk to a funeral. Funerals. Sending patients to buy essentials and hiding my guilt with a straight face. A face that masked the inner me, the deep personality that would ever so often, almost always be crying out for change. I would, and still do, work an an average of 10 straight hours. In risky ambiance. Expose my throat to that TB patient who had defaulted treatment and only God knows if he now has Multi drug resistant TB. Happy and eager to help him too nonetheless, after all I get paid for it; the government makes sure that I have a medical allowance of $7 in case it gets me as well. I would hug the infected air, I still do, knowing pretty well I would come back home and my loved ones would run to hug my dirty self. Isn’t that what they see the neighborhood do, why would I deny them this.

A patient would cough straight into my lungs as I struggle to fix the improvised chest tube, my motto; this man must live, the ink to certify a death is too expensive.

I would be left to explain to that woman with fibroids why she would have to do with blood on her bed sheets for a further month or two, the autoclave machine had broken down. To the child with cancer, I would pray and hope that the donors would show up again, like they did 3 months ago, if they didn’t I would sit and pray that the cancer cells would stand still like Joshua’s sun, invariably, this was a useless prayer. I often choked up tears, to maintain a strong face, as I saw them steadily walk towards death. I wondered whether they were scared to die. Were they like me?

Sometimes it got me too angry, and I would run to my room listen to gothic beats and promise myself never to go back to that place again. That place-the hospital. This would only last as long as the anger. Pent up emotions.

Some patients would shout, scream at me, I saw one slap a lady doctor colleague. They just cannot understand how you would stand and do nothing as they lose a loved one. Aren’t you a doctor? Isn’t your work to save lives? What they did not notice were the empty shelves. They also wouldn’t remember when I had to take antiretrovirals for an entire month that time I had an unimpressive contact with blood from a HIV patient. That I bore alone. Not even the people I live with knew why I would rush to the sink to vomit my intestines out  ever so often  thanks to the side effects the drugs had on me. My heroism had handed me a near death deal. Like a bolt.

Sometimes our health administrators would do their rounds, we all know who Dr.Kimani is. The man with his own ideas of how doctors’ lives should be. Some say he is a sadist. How else would you describe a man who made sure hell was always so near. Autocratic and clueless.

I became angry. Every time I would run around, get blood sample, rush up the the stairs that were built by the Chinese to the lab and back to get my seniors to teach me the art of this science, I would break down when all that was in vain. When my pen would be needed in the death certification book; this happens very many times. In just a year, I had witnessed a ‘genocide’ of sorts and  certified it. While the entire nation of Rwanda had to go through mass counseling for their genocide, I was left alone and in the dark. I had to deal with it myself and wake up the next day fit as a fiddle. I had to fit in society too.perfectly.

I was not particularly waiting or hoping to develop a thick skin. A kind of skin that makes me indifferent to deaths. I thank God I am not even close to that.

While this was happening, our country was up in political flames. When I tried to say I need someone who has gone through the experiences that I have to manage the system, I was quickly shut down. Remember how my female collegue was slapped, it felt like that. A million times. When our hopes were sky high with the new government, they cut down spending on health. That to me means, more hazardous working conditions. More empty shelves. More resignation letters from collegues who simply choose to save their own lives.

Today I was at work, even now if I am called I will be there in a split second. Tomorrow too. But I am not sure whether I will be of any help. It is not well with my soul. Maybe we need to go on strike again. It is said, that sometimes to move forward we have to take few steps back. But who will we do it for?  With Kenyans, at least the vocal ones, it is well with their souls.

SYSTEMATIC GENOCIDE IN KENYA

With 34 billion shillings out of the expected total budget of 1.65 trillion Kenya Shillings, our government has yet again relegated your health and mine to a forgotten corner. The above figure translates to 2.01% of our total budget and about 2.8 % of the National GDP.

This represents budget ‘cutting’ of close to 60% from what was allocated last financial year. With the dwindling resources, come additional responsibilities for the Kenyan doctor, the promise of free maternal care in all government hospitals and free health care in all health centers and dispensaries. This free healthcare, for your kind information, would be approximated to cost about 20 billion shillings.

The amount allocated gives you just 850 shillings as the per capita allocation for health, meaning your government will only spend that much for your health, in all these programs that not only focus on treatment but prevention of maladies.

WHY is this? I know why. Simply because death and disease-disability are usually very much private affairs. You die alone, away from the glare of the public. Unlike roads which remain beautiful and soaring and therefore a very ‘real’ benchmark for seeking re-election.  To our leaders, it’s all about the next elections, I suspect.

I am still waiting, no abated breath though, for Kenyans to learn and act, probably react, like they did in social media a few days ago. As a doctor, I can only give the services I am facilitated to give. Demand for this right, it is your responsibility.

Study of a peculiar society, that loves pain- Kenya

"Oh ye foolish Galatians, who has bewitched you?" a voice cries from the desert. The annointed one remarked at the thought of the stupidity of his people.

Applies to all of us just right about now. The hue and cry about our politicians literary fists-on-the collars of the salaries team is a scene to adore. I mean it. We, the people so fondly in love with quick fixes and aversion of the truth. A people embalmed in the romance of collective amnesia which recurs every five years is a comedy of  sorts. Get a jar of popcorn and watch it replay in an exact same manner.

Here is the reality your eyes will see once you become honest with yourselves, foolish Galatians (oops..Kenyans)...

We get the leaders we deserve. Our leadership is a reflection of our society. The rot in our leadership is a direct mirror image of the rot in the most basic unit of society- the family.

How many of us are honest at our workplaces? How many make sure they work for the last coin paid even when nobody is watching? How many of you still yell at the top of your voices how you are underpaid yet you spend significant amount of time paid for, mostly by taxpayers for the civil servants, sipping lattes and catching up on bogus stories while serving the public an enhanced menu of impunity?

The difference between our leaders and us is that they are in the glee of the media. The reel always rolls at their actions.

Speaking of the same leaders, an alien in Kenya would be forgiven to think that our leaders are manufactured from some exclusive depot and fed on us without our say. False. We elect them. Given many choices, we make the wrong ones. Again and again.

Our leaders remain better than us. At their point of need, like salary increment, they speak in one voice. At our point of need,like  the elections, we disintegrate into un-useful tribal shadows.

We get the leaders we deserve. Change comes from us. From within us. The only thing that changes from top down is food as it evolves into you know what. Our change must be from bottom up. You know how.

As a society that always votes against its own interests every other 5 years, who would sympathize with us.