Government needs to be transparent in its financial dealings

PALOCH - (VOA) PG.24Recently, an international watchdog has warned that the South Sudan government is getting into a dangerous cycle of borrowing for oil. Sadly, most of the borrowed funds will be used on the armed forces and not for infrastructural development.

According to its latest budget estimates for 2014-15, the government plans on borrowing SSP 3 billion ($1 billion) from oil companies. Global Witness says the amount is almost equivalent to the amount donors are spending to alleviate the humanitarian catastrophe that is unfolding.

Global Witness says that more alarmingly, the public have no idea on what terms the money is being borrowed. All the negotiations have been done behind closed doors.

Since it is the tax-paying members of the public who will repay this money, then the public has a right to know why the money is being borrowed, how it will be repaid and how it is going to be spent. As they say, there should be no taxation without participation in decision-making.

Only last month, a US-based organization, Fund for Peace, ranked South Sudan as the most fragile state in the world. Even though government officials have disputed this, it is a cause for concern, coming at a time when the crisis has turned the country from a development path to a humanitarian path.

This means that all development projects have been put on hold as government and humanitarian agencies concentrate on the most urgent humanitarian activities.

Media reports indicate that South Sudan has spent at least $1 billion on weapons and delivery
systems since the fighting broke out, according to a western diplomat in Juba. At the same time, humanitarian agencies have appealed for $1.3 billion to provide relief to people affected by the conflict.

Bloomberg reports that China is selling $38 million worth of assorted arms to the government. Analysts say that while the government and the rebels say they’re committed to a peaceful resolution to their dispute, both sides are still intent on resolving their differences on the battlefield and will continue to seek weapons.

South Sudanese Defense Minister General Kuol Manyang Juuk reportedly confirmed the arms purchase and said the consignment was ordered five months before violence broke out. He said that his role is to defend the nation and that is why he is equipping the army.

These reports, if true, are disturbing.

The fact that the government is buying arms at a time when humanitarian agencies working in the country are seeking for funds to support relief efforts shows a lack of intention to end the war soon. As some stakeholders have said, it seems that both the government and the rebels believe they can win the war in the battleground and not on the negotiating table.

What are the government’s priorities? Is it winning the war with guns or bringing the war to an end through dialogue? The same question can be asked of the rebels.

But, let me go back to where this argument began.

Lack of transparency and accountability on the part of leadership is one of the many reasons why the country is at cross-roads now. The government cannot afford to do things as they have been done in the past.

If government is borrowing money on behalf of the citizens, then the citizens have to participate in negotiating and making those decisions. That is one of the tenets of democracy, to which the government subscribes.

Otherwise, increasing the citizen’s debt burden behind their backs is fraud and will breed more trouble in the future.

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Poor man’s disease that is too costly to treat

ImageGetting Tuberculosis (TB) can be as cheap as being close to someone who coughs carelessly, but treating the disease can be so costly, especially if you get infected with the drug-resistant type.

To treat the normal TB, you simply walk into any government health facility, get tested and if found positive, treatment is free.

But that is not the case with treating or managing the drug-resistance type of TB.

Fourty-eight years old Ignatius Okech knows this only too well. Early last year, he began to experience bouts of weakness, loss of appetite and night sweats. For two months, he went to the hospital before he was diagnosed with multi-drug resistant TB (MDR-TB).

Multi-drug-resistant TB is resistant to the two main TB antibiotics (rifampicin (R) and isoniazid (H). This type of TB strain requires treatment for two years with at least six months of injections. This makes it more difficult and expensive to treat. Compared to six months’ treatment for a typical TB case, MDR-TB treatment is 100 times more expensive.

Indeed, treating the disease has been a tough battle and a costly affair for Ignatius.

After he was diagnosed with MDR-TB, he stayed for another two months before he could start his treatment.

According to Evelyne Kibuchi, Senior TB Advocacy Manager at Kenya AIDS NGOs Consortium (KANCO), to treat one patient with MDR-TB costs Ksh. 2 million for drugs alone. An MDR-TB patient takes drugs for 24 months, and an injection every day for the first six months. She says treating MDR-TB takes a heavy toll on families’ resources, and comes with enormous socio-economic consequences for families.

“A hundred percent of those who suffer from the disease lose their jobs because of the rigorous treatment process,” she says.

For majority of Kenyans who live on less than a dollar a day, getting infected with MDR-TB can be fatal.

When he was first diagnosed with TB in late 90s, Ignatious left his job at Kenya Railways, because he had to go home to Busia to seek for treatment at the Centre for Infectious and Parasitic Diseases Control Research (CIPDCR), in Alupe, Busia County. Last year, when he was found to be infected with MDR-TB, Ignatius again had to stop working as a night guard with a small security firm in Nairobi.

 “I had Ksh. 34,000 in my account, I have spent all that…I have nothing else even if I have to go for x-ray, I am not able…I have no money for fare to hospital…I leave my fate in doctor’s hands,” he says.

He is unable to provide for family

He is unable to provide for his small family that lives in Kawangware, Nairobi. His family was kicked out of their house early this year because he could not pay the house rent. At the time I was talking with him, he had been locked out of his house again for defaulting on rent.

KANCO came to his rescue the first time. They raised some money to enable him clear the arrears that were outstanding, before the landlord could allow Ignatious, his wife and four children to get back to the house. This second time, he could only raise Ksh. 2,000, hoping that the landlord would take that and allow them to continue staying in the house.

But that is not all; Ignatius says that his children have had to go to school without uniform, shoes, and they take only one meal a day because he cannot afford to provide them with a square meal every day. His wife washes clothes for other women to help put food on the table.

And that is not all; since he has to use a protective covering (surgical mask) over his mouth to avoid infecting other people, this too comes with social stigma. He uses the surgical mask, which is cheaper, because he cannot afford the N95 mask, which he should be using.

“Every time you will find me isolated,” he says.

Ms. Kibuchi says all this is happening yet every MDR-TB patient is entitled to an allowance of Ksh. 6,000, which the government is yet to give Ignatious despite donors having released the money to the government.

Dr. Kamene Kimenyi, the National Drug Resistance TB Coordinator, National TB, Leprosy and Lung Disease Unit, says delay to give support to MDR-TB patients was caused by reason of one of the donors withdrawing in mid-2012.

“So, the whole of 2013 we had a problem giving patient support, because we (government) ran out of money,” she says.

Initially, each MDR-TB got Ksh. 15,000 per month, but this has come down to Ksh. 6,000. The government settled on that amount (Ksh. 6,000), which is close to the government’s minimum wage level of Ksh. 7,000. The government says the amount is feasible, considering that different donors give different amounts for the programme.

The amount is supposed to cater for the patient’s food and transport to be able to visit the health facility where they get their treatment. The government recognizes that many of these people may not be able to work again once they start the 2-year treatment process. This is barely enough to meet a family’s needs.

TB on the increase

Statistics from the World Health Organisation show that cases of MDR-TB have been on the increase in the country.

The WHO Global TB Report (2013), released last year shows that 3.6 % of newly diagnosed and 20.2 % of retreatment cases of TB had MDR-TB. The report states that an estimated 450,000 people developed MDR-TB and 170,000 died from the disease in 2012, worldwide. It also reveals that less than one-third of the people estimated to have MDR-TB were detected in 2012.

“MDR-TB is a real and present threat to global health”, says José Luis Castro, Interim Executive Director of The Union. “It puts a greater burden on health systems and budgets, as well as the obvious harm it causes to MDR-TB patients and their families. Cases are found all over the world, irrespective of a country’s overall level of TB prevalence. We all have an urgent and vested interest in identifying MDR-TB and controlling its spread”.

Drug resistance can arise due to improper use of antibiotics in drug-susceptible TB patients; administration of improper treatment regimens and failure to ensure that patients complete the whole course of treatment. A patient who is sick with a drug-resistant TB strain can transmit this form of TB to other individuals.

The WHO admits that progress towards targets for diagnosis and treatment of MDR-TB is far off-track. Experts say that in high MDR-TB burden countries, increased capacity to diagnose MDR-TB will have to be matched with supplies of quality drugs and scaled-up country-capacity to deliver effective treatment and care. This will require more collaboration among partners, including drug regulatory authorities, donor and technical agencies, civil society and the pharmaceutical industry.

Previously, MDR-TB patients had to be isolated in a health facility for treatment. But this is now not the case, says Dr. Kamene, since treating them from home gives better results. Once a person has been found to have the disease, health workers visit the family, counsel them and also screen the family members. After that, depending on the patient’s condition, a nurse will visit the home every day, or they visit the health facility every day. Dr. Kamene says that only patients with serious side effects are hospitalized.

“It is estimated we have around 3,400 MDR-TB cases in Kenya, we have been able to diagnose slightly over 1,000, we have treated 850 patients with MDR-TB, with good outcomes, with a treatment success rate of around 78%,” says Dr. Kamene.

MDR-TB treatment success rate good, but more needs to be done

Even though the MDR-TB treatment success rate is good news for the country, a lot still needs to be done to ensure that the disease is eradicated and that new infections don’t occur, and that affected individuals and families, like Ignatious’, get support at the right time.

Ignatious, who is also HIV-positive, is skeptical about the government’s support since he has been receiving empty promises since last year at the health facility he goes to at Riruta Satellite in Nairobi. He says the government needs to ensure that the support reaches the intended people.

Worldwide, it is estimated that 9 million get infected with TB, a third of who (3 million) are “missed” by public health systems. Many of these “missed” people live in the world’s poorest, most vulnerable communities and include groups such as migrants, miners, drug users and sex workers.

TB is said to be a poverty disease, since it is mostly found in households with poor hygiene. In Kenya, it is mostly found in urban slums in cities like Nairobi, Mombasa and Kisumu.

As the world celebrates World TB day this year, the goal is to reach the unreached 3 million and ensure that everyone suffering from TB has access to adequate TB care, including diagnosis, treatment and cure.


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What is wrong with us Africans?

Africa is said to be one of the most endowed continents in terms of natural resources, compared to other continents of the world. And that is not all; Africa is also blessed with many people and a rich spiritual heritage.

Yet, the paradox isSA PARK that in spite of all these countless blessings and riches, Africa remains undeniably the most poverty-stricken and broken continent on the planet.

Hein van Wyk of Hope for Africa saysAfrica’s root problem is not material, nor is it primarily outside the continent. The root of the problem is inside; inside the minds of the people.

One of the factors that have been identified to be a big problem in Africa is tribalism and racism. This is the belief and thinking that says that my tribe or race is superior to your tribe or race.

And that is the problem afflicting South Sudan today.

The conflict engulfing the country now, that began as a political disagreement between political players in the Sudan People’s Liberation Movement has now taken a tribal angle, pitting fighters from the two main tribes in the country, the Dinka and the Nuer.

Political differences between President Salva Kiir, a Dinka, and his former vice president, Dr. Riek Machar, a Nuer, have ended up hurting other innocent bystanders from the two tribes.

It is sad that out diversity, which should be our strength, has now become a curse. We are forgetting that, according to God, each race or tribe is equal in value but wonderfully unique, and this should be celebrated.

South Sudan is just coming from two weeks of atrocity in two of its regions, in Unity state and in Jonglei, where hundreds of people have been killed, either because of their tribe, nationality or religion. This has been the lowest point in the conflict so far, with reports indicating that innocent civilians who were sheltering in churches or mosques, or in other seemingly safe places, were isolated, before those who were deemed to be ‘enemies’ or sympathetic to the ‘enemies’, were slaughtered mercilessly!

To make things worse, media, which should be a tool for positive mobilization was used by rebel elements in Bentiu, to arouse hostility and anger towards other people. What has happened in both Bor and Bentiu in recent days cannot be termed otherwise, other than crimes against humanity, for which the International Criminal Court should intervene!

What comes out clearly from this is that we as Africans are still stuck in the mindset that says that the life of an individual is insignificant, forgetting that God sees each individual’s life as significant, that is why He was furious when Cain killed his brother Abel.

The deaths that occurred in the Bor and Bentiu have not sufficiently aroused our anger to compel us to intervene in the conflict!

Other than issuing condemnations, the African Union has not done anything substantial to help bring the culprits to book. It is sad that the AU was very fast in calling for the International Criminal Court to withdraw charges against the Kenyan president and his deputy, yet it cannot raise its voice when innocent and powerless people are dying in South Sudan!

It is a shame and an indictment to the African people. The AU called an extraordinary summit to discuss the Kenyan cases, yet it cannot call for an emergency meeting when thousands and thousands of innocent Africans are dying. Is it because they are weak and poor, and are not the wielders of power?

It is ironic that many voices in social media from East Africa implored US president Barack Obama to intervene before many lives could be lost. Why is it that when Africans are in self-made trouble, they call for the West and the US, and yet the same Africans would castigate the West when it is convenient for them? We are so hypocritical and that is why we cannot solve our own problems!

Africa has come of age and Africa should be able to solve its own problems. Our problems don’t necessarily come from the West; they are a result of our own ineptitude, incompetent leadership, corrupt politics, and unjust economic systems, among many others.

Africans should rise up and tackle head on the problem of fatalism, which says that we are helpless and there is nothing we can do about it. We should get out of the “dependency mentality” which is outward-looking, waiting for someone else “from the outside” to come and solve our problems.

African leaders should tell the South Sudanese leaders who are the cause of suffering of their people that enough is enough, and that they will not tolerate any further the loss of innocent lives. One death is far too many!

Short of this, Africans will continue to spew out their racial laments about how the white man has brought trouble on the continent, as its people continue to suffer.

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South Sudan peace negotiations should not be left to politicians alone


For those who care for the interest of South Sudanese people, the news that formal negotiations have began in Addis Ababa can only be welcome news! As they say, a journey of a thousand miles starts with a single step. This is commendable, coming a few days after a stalemate while the situation in South Sudan was deteriorating.

It is my hope that the two negotiating teams will ease their demands in a true spirit of give and take, devoid of trickery and underhand dealings. Early reports from Addis Ababa indicate that the government has refused to heed to any of the demands that have been put forth by the team representing Dr. Riek Machar. Among other demands, they have asked for release for political detainees being held by government forces, withdrawal of Ugandan forces from South Sudan and uplifting of state of emergency which government imposed in the country.

All these latest efforts are good. However, I would like to throw a word of caution to those involved in the South Sudan negotiations. After the post-election violence that erupted in Kenya after the 2007 presidential elections, the international community, via the African Union, came to the rescue of Kenyans. Kenyan political leaders who were fighting for power at that time were forced to the negotiating table. The first item on the agenda was to call for cessation of hostilities. As we speak now, hostilities are still ongoing in South Sudan. That is regrettable.

Anyway, let me not digress. The point I want to make is that in the negotiations for peace in Kenya, we had two political sides that participated in the talks, mid-wived by AU representative Koffi Anan, former UN Secretary General. At the end of the process, one of the recommendations was that leaders should embark on preaching peace and reconciling the whole nation.

Unfortunately, once the politicians got what they wanted i.e. positions of power and influence, they forgot about reconciling the nation. Up to this very day, no one in Kenya has ever stood up and confessed for any wrongs that they did. Neither has the country seen any restitution of property for those who grabbed what was not theirs at the peak of the violence. Unlike the situation in South Africa immediately after the dismantling of apartheid in early 90s, or Rwanda after the genocide in 1994, the Kenyan situation has not achieved any serious reconciliation among communities.

During the 2013 elections in Kenya, two leaders from the two communities that were the most hostile in 2007 came together and the issue of reconciliation of the Kenyan nation has taken a backstage in their engagement. What is clear here is that as long as the politicians are satisfied, then every other person from their community, even those who were directly affected by the violence are assumed to be satisfied. This is a fallacy that should not be allowed to take place during the ongoing peace process in South Sudan.

Internally displaced persons inside one of the UN camps in South Sudan (UNMISS)

Internally displaced persons inside one of the UN camps in South Sudan (UNMISS)

South Sudan is much bigger than the two major tribes that are reported to be at the centre of the conflict. But more than that, there are many more stakeholders who need to be involved in the peace process other than President Salva Kiir and Dr. Riek Machar. I fully concur with a group of Nuer and Dinka in the Diaspora who over the weekend wrote an open letter to the political leadership of South Sudan, saying “We want you to do what is necessary to heal our wounds, without putting yourselves first”.

From the Kenyan experience, what is clear is that if the politicians are left on their own, they will make deals that only benefit them and their cronies. For now they may claim that they are speaking on behalf of their tribes but nothing is further from the truth. For many of them, it is about their own personal interest. Where is the Church and the civil society to speak for the voiceless and those who not fall in either of the two camps? Who is speaking for the youth, the disabled and other marginalized groups? Who is speaking for the small tribes like the Acholi and the Shilluk?

This is the time to involve all the other parties who also have an interest in the affairs. The South Sudanese themselves know what they want more than even the neighbouring countries and their leaders, some who are coming into the negotiation not with good faith, and whose interest is more economic than long lasting peace and stability in South Sudan.

The time is now to involve all interested parties in the peace process. If the negotiations are left to the politicians alone, they will only come up with self-serving, short-term solutions that only appease them and their local and foreign cronies.

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Health disparities between nations could be eliminated within a generation, say experts

A private health centre in Kibera in Nairobi, Kenya: Health disparities between nations could be eliminated in a generation.

A private health centre in Kibera in Nairobi, Kenya: Health disparities between nations could be eliminated in a generation.

A new report by health and economic experts on investing in health and health financing says that developing countries could see dramatic health and economic improvements by 2035, if the right investments are made today.

If the report’s recommendations for increased global investment in health are followed, the authors estimate that in the year 2035 alone, roughly 10 million lives could be saved in low-income and middle-income countries, bringing enormous social and economic gains for the countries most affected.

Through an ambitious, but feasible, investment plan, authors show how governments and donors could achieve a “grand convergence” by bringing preventable infectious, maternal, and child deaths in all countries down, to the levels currently seen in the best-performing middle-income countries, within a generation.

The ‘Global Health 2035: A World Converging within a Generation’ report has been written by a group of 25 leading global health experts and economists from across the globe, to commemorate the 20th anniversary of the 1993 World Development Report, a publication which aimed to help governments and development partners make choices in how best to allocate scarce resources.

“Now, for the first time in human history, we are on the verge of being able to achieve a milestone for humanity: eliminating major health inequalities, particularly inequalities in maternal and child health, so that every person on earth has an equal chance at a healthy and productive life…It is our generation’s unique opportunity to invest in making this vision real,” says Professor Lawrence H. Summers of Harvard University, the group’s chair.

The authors urge governments and donors to continue investing in health and to incorporate the “grand convergence” into the post-Millennium Development Goals Framework. Further, they recommend to policymakers to adopt a “full income” approach to measuring national income, combining growth in national income (GDP) with the value people place on increased life expectancy (the value of their additional life years or VLYs). Calculated using the full income approach – as increasingly advocated by economists – the benefits of achieving the grand convergence will exceed costs by a factor of 9-to-20 for low-income and lower-middle-income countries from 2015 – 2035.

Margaret Chan, Director General of World Health Organisation, says the concept of “convergence” proposed by the report is helpful as a trajectory against which to track future progress.

“The report’s conclusions on non-communicable diseases (NCDs) are most welcome, particularly the need for policy responses across government,” she said. However, she points out that achieving a coherent response across societies remains a key challenge in global health governance.

This is best exemplified in Kenya where a 2009 Modes of Transmission analysis by National Aids and Sexually Transmitted Infections Control Programme and World Bank estimated that female sex workers, men having sex with men and injecting drug users contribute 33% of new HIV infections, yet the Kenyan government has proposed amendments to the Public Benefits Organisation Act, which will limit funding to the civil society, which contribute 40% in the fight against HIV/Aids.

Different government agencies seem to be working at cross purposes. John Mathenge, a male sex worker, says there is alot of violence against male and female sex workers, from the general public and law enforcement officers, and stigma from health workers and even the media.

Dr. Sobbie Mulindi of the National Aids Control Council says that attitude change among health workers and other segments of society is key to succeeding in the fight against stigma.

Dr. Sobbie Mulindi of NACC and Peninah Mwangi, a representative of sex workers, participating in a health forum in Nairobi recently.

Dr. Sobbie Mulindi of NACC and Peninah Mwangi, a representative of sex workers, participating in a health forum in Nairobi recently.

“We have to build the capacity and change the attitude of health workers, of police, of the judiciary, of the journalists, so that we are all together…” he said.

The report says the international community needs to increase investment in research and development to develop new drugs, vaccines, and health technologies. Current global investment in research and development needs to be at least doubled, from current annual spending of $3 billion to $6 billion annually by 2020, with half of the increment potentially coming from middle-income countries.

While lauding the authors, World Bank president Jim Yong Kim lamented that more than a quarter of a million people are pushed into poverty every day as a result of paying for health care.

“…The new report…reinforces the case that investing in health is central to development and to achievement of the global goals to end extreme poverty by 2030 and boost shared prosperity,” he said.

The report outlines inexpensive policies and interventions which could curb the emerging burden of non-communicable diseases and injuries, prevent additional deaths by 2035, and raise significant new revenue for low-income and middle-income countries through increasing taxation on tobacco and other harmful substances, such as alcohol and sugar. Other interventions include subsidies on fuel-efficient stoves, housing legislation that requires mosquito-proofing features such as ceiling boards, and cash transfers that contribute to HIV prevention.

This report comes out when there are still many challenges facing implementation of universal health care in many developing countries.

Helen Clark, Administrator of United Nations Development Programme says that, even though investments in the health sector are welcome, they will not reap as many benefits if discrimination, bad laws, and other social determinants are not addressed.

“In Uganda, for example, stigma, poverty, and poor health-sector governance often prevent women from accessing breast cancer diagnostics and treatment,” she says.

As Kenya was celebrating World AIDS Day this week, Peninah Mwangi, a representative of sex workers, told a forum recently that sex workers fear police officers more than they fear contracting HIV or other sexually transmitted diseases.

“As a result of the stigma, sex workers are fearing to come out and say that they are positive and get medication…we need a lot of intervention on both the social aspect and the medical aspect,” she says.

Commenting on the report, Mark Dybul of the Global Fund to fight AIDS, TB and Malaria says improving health requires implementing effective interventions for the most-at risk and hardest-to-reach populations.

“This means thinking outside the box as we support and build the health systems that will deliver essential services, partnering effectively with civil society, and putting human rights and equity at the centre of our strategies and programmes.”

According to Richard Horton, Editor-in-Chief of The Lancet and one of the report’s authors, “Investing in health is also an investment in prosperity, social and financial protection, and national security.”

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Health disparities between nations could be eliminated within a generation, say experts

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Stirring up the hornet’s nest

Prof. Kiama Wangai, convenor of LSK's medico-legal and gender committe.Author and counselor Jimmy Evans says we have four basic human needs that drive us at all times: These are acceptance, identity, security and purpose.
These issues seem to be at the centre of the raging transgender / transsexual debate in Kenya today. The debate has been fuelled by the recent move by one Audrey Mbugua, who has gone to court to compel the government to recognize ‘him’ as a woman.
This is a new phenomenon in Kenya, and in Africa, where matters of sexuality are not openly discussed. But Audrey has broached a taboo subject, which many would not like to talk about.
Dr. Martin Wesonga, a Bible scholar and theologian says that in traditional African societies, no one came out to openly speak about their sex-related conditions like transsexualism or intersexism.
“In African tradition, that was considered a curse and the person would be an outcast. He/she was liable to be thrown in the forest and some communities even killed such people,” he says.
Audrey is a 29 year old lady. She is today the face of the transgender/transsexual community in Kenya. She was born a man and lived as Andrew Mbugua until later in life when she felt that she was living a lie. She says that she was a man on the outside but a woman in the inside. It is that uncomfortable feeling that led her to want to be identified as a woman.
But this has been fraught with challenges. All her official documents indicated that she was a man. Getting a job has become difficult. With time she started changing her way of dressing and looks to suit what she wanted. With that done, she needed to change her academic and identification documents. This led her to the high court in Kenya.
Audrey suffers from what is medically referred to as Gender Identity Disorder (GID).
Audrey’s case, among others, has forced the Medical Practitioners and Dentists Board to invite proposals on the way people with Gender Identity Disorder ought to be treated by the medical profession. It called a stakeholders meeting early this month to develop guidelines on sex change operations.
Currently, the Medical Board Code of Professional Conduct and Discipline states: “Gender reassignment is not permitted on demand. The specialist attending to the patient with gender problems shall constitute a team of specialists whose decision would be based on anatomical and special needs of the patients, but whose decisions must be based on the right to health and other fundamental rights in the Constitution.”
The constitution of Kenya 2010 in Article 10 outlines fundamental principles governing the relationship between the government and its citizens. Some of the values it espouses include human dignity, equity, social justice, inclusiveness, equality, human rights, non-discrimination and protection of marginalized groups.
This means that if the policy guidelines that will be developed identify GID as a medical and/or mental condition, then transgenders will have a right to be recognized as persons before the law and are equal and entitled without any discrimination to protection by law.
Article 43 of the constitution further states that:
“That every person has the highest attainable standard of health, which includes the right to health care services, including reproductive health care”. This would compel the government to make available to the transgenders all necessary health care services that they require.
Through the Transgender Education and Advocacy (TEA) organisation, Audrey has filed submissions with the Technical Working Committee of the medical board over the challenges faced by individuals suffering from the disorder. Audrey, in many media interviews, laments that the country lacks clear legislation and guidelines to ensure that people who suffer from the problem feel as part of the society.
She says that she has met over 40 transsexuals across Kenya. The meeting called by the medical board was to be attended by surgeons, psychiatrics, Kenya National Commission on Human Rights, gynaecologists, the Law Society of Kenya, pharmacists, and religious leaders, among other stakeholders. Audrey was not allowed to participate in the meeting since she was an interested party.
Some time back, she had gone to Kenyatta National Hospital requesting for an operation that would have removed her male organ so that it could be fashioned to female genitalia, and had also sought for therapy with female hormones. This did not happen and it prompted the hospital to seek advice from the medical board, lest they were found going against the medical code of practice.
The head of mental health services at Kenyatta National Hospital Dr. Margaret Makanyengo says the situation of the transgenders is unfortunate because it is a deep psychological problem. She says that it begins at between 2 to 4 years, and at adolescence, they start to manifest persistent strong feelings of discomfort about whom they are.
She says the situation can be so bad that some of them want to commit suicide because they have depression. The people around them may not understand them. Some are mistreated by family and friends; some are even physically assaulted by those who are expected to protect them like law enforcement officers.
The problem is not only personal to the transgenders; some family members are embarrassed about them and even abandon them. Institutions like banks don’t allow them to change their personal information once they decide to change their identity.
“We (mental health practitioners) are in a dilemma on how to handle them. We are seeking for policy guidelines to help us know how to deal with them,” she says, because there are currently no clearly-laid out laws on how to support or treat the transgenders.
“This is something we cannot ignore…we cannot mistreat them because of the oath that we (medics) took…we counsel and offer them support,” she says.
Audrey’s aunt, Mary Esther Wanjiku, however is sympathetic to her condition. She says that there are many parents who are living in denial because of the condition of their transgender children.
“Their children have the same condition but they don’t want to admit, they think it is witchcraft, “this is not a normal child”…we have to deal with such issues,” she said in a televised interview.
Identification is an important concern for transgender people, because until it reflects how they live, they can be subject to discrimination, denied services or assistance, sometimes jailed, or subjected to violence.
Closer home in Uganda, we have the case of Juliet Victor Mukasa, a transgender activist, who fled Uganda and launched a lawsuit against police who he claimed harassed him when he begun to speak out as a transgender person in 2005.
Transgender people (and some of the other groups that have overlapping issues) tend not to be treated very well. Physical violence and rape are the most visible issues that they face, but some of the less visible problems are also sometimes the hardest to deal with.
Identification documents (birth certificates, etc) pose the biggest problem, because it affects a person’s ability to live, find work, access health care, get police assistance, get an education, or access banking services. It might practically shut them out from several areas of day-to-day life. Health care is another concern, because for transsexual people who need to medically transition (involving hormone therapy, surgery or surgeries, and sometimes things like facial hair removal), it can be difficult or nearly impossible to find a doctor who is willing to help because of lack of guidelines.
And when transgender people try to form relationships, it doesn’t matter if their partner is the same sex or the opposite sex to the gender the person lives as, it’s often interpreted as a “same-sex marriage” from either direction, putting them in the difficult position of breaking laws if they try to marry at all.
Professor of Medical Law and Forensic Medicine Kiama Wangai, the convenor of the LSK’s medico-legal and gender committee, who participated in the medical board’s meeting, says that transgender/transsexualism is a biological phenomenon and a medical condition which needs a mode of therapy for its treatment.
He says that many transgender/transsexuals go through a lot of psychological torture and therefore they need to be managed during their transition from one gender to another. Currently, he says, there is no legal regime in place to deal with transgender/transsexual issues.
A document by LSK’s medico-legal and gender committee says that in America, GID is categorized as a psychiatric situation and listed in Diagnostic and Statistical Manual of Mental Disorders. It says that the medical world does not regard homosexuality and lesbianism as gender identity issues. It says that the interpretation of Kenya’s legal framework will depend heavily on the definition that will be assigned to the term GID once a policy is in place.
Wanting to put a distance between their cause and that of gays and lesbians, TEA says that being a transsexual is not an issue of who you are sexually attracted to (sexual orientation), but one of gender identity, the psychological awareness of one as either male or female.
The Registration of Persons Act Chapter 107, and Registration of Births and Deaths Act Chapter 149, both make ‘sex’ one of the particulars required before one can be issued with a national identification document, or before a birth or death can be registered. Both Acts do not provide room for any changes to be made once the documents have been issued.
This basically means that in Kenya, sex is either identified as male or female, making no room for identification of a third gender. And herein lies the dilemma for those who cannot fit in either of these categories (like the intersex) or those who want to change their gender.
In its presentation to the medical board, the LSK’s medico-legal and gender committee says that it is important that the guidelines that will be developed by the board outline what information will have to be transmitted to the Registrar of Persons for changes to be effected in identity cards and endorsement in the Birth Certificate.
It further adds that the guidelines for the management of GID should articulate international professional consensus about the psychiatric, psychological, medical and surgical aspects of care.
The medical board has planned for a follow-up meeting to process further the deliberations of the earlier stakeholders’ meeting, whose recommendations will be forwarded to the AG for further action.
As all this is happening, gender identity disorder remains a controversial subject. There is disagreement whether it is ethical or even medically appropriate to prescribe sex reassignment to persons “who feel trapped in the wrong gender”, and whether sex reassignment does not compound a psychological problem requiring a psychological remedy.
And this is where we find some who argue that changing gender is more an issue of crisis of identity rather than a medical or biological issue.
Reverend Matthew Okeyo, CEO of AIC Childcare, a Christian organization, while admitting that the intersexism (intersex refers to a number of medical conditions in which someone is born with ambiguous genitalia or chromosomally indeterminate or between sexes in some way) should be dealt with medically, he says that GID occurs because people do not know who they are and they do not accept how God created them.
“Whether one is an atheist or not, they need to ask themselves the question, who is God, who is this Supreme Being,” he says. “If you cannot define that, then you will not know who you are, and you won’t know your purpose in life.”
He says that those who want to change the way God created them are trying to be God because they don’t like the way they are. To him, this shows how depraved man has become, accusing God for creating them the way they are.
He advises that such people should seek to discover who they are first, adding that they cannot function properly as either male or female after transitioning from either gender.
While discussing the issue, it would be good to also consider the experience of transgender/transsexual people in other countries, which has been a bit different from our experience in Kenya.
In 2011, Australia allowed a new ‘third gender’ passport system where sex is indeterminate to give citizens a gender option. With a letter from a doctor, transgender/transsexual Australians are allowed to have their passport marked with an X and not M (Male) or F (Female) like before.
In the same year, two transgender people won an appeal in Australia’s highest court giving them legal recognition as men despite not completing sex-change surgeries.
Mercedes Adell, a writer and advocate for transgender/transsexual people in Canada says that Canada recently passed a bill to officially include trans people in human rights laws, which is awaiting ratification in the Senate.
“But the Human Rights Commissions here have recognized trans people to an extent, for several years already, so this will simply clarify and make the recognition official,” she says.
Various European countries have created legislation to address transgender issues. The UK issued the Sex Discrimination (Gender Reassignment) Regulations in 1999, which provide specific protections prohibiting employment discrimination for transgendered people intending to, or having undergone gender reassignment. The UK and Spain also have legislation allowing transgendered people to change their names and gender on official documents.
On the other hand, we have another group of people, the intersex, who are born with a medical condition that puts them somewhere between male and female. Some of these conditions are not immediately obvious, and a person might go through most of their lives without realizing it, unless a medical issue causes them to find out.
Intersexuality and transsexuality aren’t always thought of being the same thing, although both groups of people will face a lot of the same challenges. The South African runner, Caster Semenya, is an example of someone who is intersex, but not transsexual.
In 2010, the constitutional court in Kenya dismissed attempts by an intersex convict (Richard Musaya was serving a sentence in prison for robbery) to introduce a third gender into Kenyan law books, by holding that there are no such people.
Looking back, Rev. Matthew says that in traditional African societies, intersexed children (or deformed children or those born with albinoism) were not allowed to live because they were associated with bad omens.
“Because of superstition, such children were killed because they were thought to signal something wrong that happened in the spiritual world, or that their ancestors did something wrong for which they are being punished,” he says.
As Jimmy Evans avers, this issue is all about finding acceptance, identity, security and purpose in life.


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