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The East African : Feb 14th 2015
22 The EastAfrican OPINION FEBRUARY 14-20,2015 Mu≥de≥ gangs ≥ule the st≥eets, so ou≥ leade≥s c≥y: Give us mo≥e bodygua≥ds scribable horror. Live or still pictures of people in The audaciousness Muchai’s slaying wa staggering, gunned down in an area gu by armed police.” ryone very worried about the country’s future, for if this slide towards gangland is not halted urgently, then Kenya is in danger of becoming an African version of Honduras, where murderous gangs and assassins rule the roost, and life is “nasty, brutish and short.” In that country, just as in Mexico to T the north, the police, left to rot by the political leadership, gradually ceded ground to drug traffickers and other merchants of death. In parts of those two countries, mayors and police who refuse to toe the gangsters’ line are routinely gunned downed. In rural towns, schoolchildren on their way to school step over bodies lying on the porches of their impoverished homes. Townspeople find bloodied corpses of their loved ones lying in the potholed streets, in bushes or in shallow mass graves in their yards. Widows and orphans go about their lives, zombielike, haunted by memories of inde- Tee Ngugi he murder of Kabete MP George Muchai and the reaction of Kenya’s parliamentary leadership should make eve- these towns capture the weariness of a populace cowed by the ever present smell and sight of death. Violent crime in Latin American countries is now a major factor of emigration. The audaciousness of Muchai’s slay- ing was staggering. He was gunned down in the Nairobi CBD, in an area guarded by armed police and with CCTV surveillance cameras, facts which his executioners must have known about. He had two armed bodyguards and he himself was armed. Again, facts the assailants must have known. In view of these circumstances, one appreciates the magnitude of the vulnerability to violent crime of ordinary people who have no bodyguards or guns, and who live in unlit towns and villages with non-existent police presence. This vulnerability is not hypotheti- cal. Almost every day, business people in rural towns are murdered, and schoolchildren raped and killed. Every so often, villagers in central Kenya wake up to find decapitated heads on A question that must form the basis of national introspection is: Why do we burden ourselves with this impossibly incompetent and narcissistic leadership? their gates. In western Kenya, gangs move from village to village, leaving death and maiming in their wake. In other regions, rampaging cattle rustlers leave scores of people dead, including police officers dispatched to catch them. All over Kenya, droves of people abandon their rural homes to rent houses in big towns. Relocation to the big towns, how- ever, is not a guarantee of safety, a fact gruesomely emphasised by the MP’s murder. There are carjackings at night. There are numerous cases of contract killings. Babies are kidnapped for ransom. Gangs attack even in well-heeled estates with police patrols. There are daring daytime robberies of shops in the Nairobi CBD, captured by CCTV cameras. In the slums, police themselves are attacked and robbed of their guns. Add to this countrywide criminal mayhem, the frequent terrorist attacks, and what you have is a national crisis screaming for an urgent national conversation. Yet the solution to this crisis, as ex- pressed by parliamentarians after the Muchai murder, points to a more fundamental crisis that afflicts the country, one that, if not addressed, will lead this country to self-destruction — a crisis of leadership. Instead of calling for an audit of policing policies, practices and infrastructure, and demanding the removal of administrative and other obstacles to police reforms, our MPs and senators called for their own security to be beefed up! Already, governors, MPs, senators, constitutional office holders and other wenyenchi are assigned police protection for their persons and their homes (safer neighbourhoods are those where a VIP lives!). Police commanders themselves have complained that VIP protection puts a strain on police personnel resources. After the murder, the chairman of the Parliamentary Committee on Security, the same fellow who denied, even in light of video evidence, that security forces had looted at Westgate, announced that his committee would check whether the costly security cameras in Nairobi were working. Should he not have done this ages ago as a routine part of his job? A question that must form the basis of national introspection is: Why do we burden ourselves with this impossibly incompetent and narcissistic leadership? Forensic officers at the scene of the crime after Kabete MP George Muchai was shot dead on Nairobi’s Kenyatta Avenue on February 7. Pic: File China’s plans fo≥ ketamine cont≥ol a knockout blow fo≥ EA A pregnant woman in Uganda who needs an emergency C-section in a small rural hospital. A man carried into a field hospital in Haiti, his legs crushed by a collapsing building in the earthquake. A girl hit by shrapnel in the Democratic Republic of Congo’s armed conflict. Each requires surgery and each is likely to receive a cheap anaesthetic called ketamine that can be used safely under difficult conditions. “In emergency situations, ketamine is the anaesthetic of choice,” says Dr Jannicke Mellin-Olsen of the World Federation of Societies of Anesthesiologists, who has worked in war zones and relief efforts in Lebanon, Pakistan, Serbia and more. “It is safe, cheap and effective.” But an upcoming UN vote could make it hard to come by. What makes ketamine so good for emer- gency situations is that it puts the patient to sleep without significantly affecting vital functions such as breathing and blood pressure, making it the safest anaesthetic option. Even in non-emergency surgery, it is of- ten safer than other anaesthetics, particularly when there is no monitoring equipment, well-trained anaesthesia personnel, reliable electricity or supplemental oxygen available. In fact, in low-income countries, many hospitals face those challenges as well. But a Chinese government proposal to classify ketamine as an internationally con- People requiring emergency surgery are likely to receive this cheap anaesthetic, which can be used safely under difficult conditions.” Diede≥ik Lohman trolled substance threatens to significantly complicate the medication’s use. The World Health Organisation expert committee that recently examined both the misuse risk of ketamine and its medical value has recommended against adding it to the list of internationally controlled substances. Yet, the UN Office on Drugs and Crime has scheduled a vote on China’s proposal at the next Commission on Narcotic Drugs in March. So what will happen if ketamine becomes If ketamine availability is restricted, it could become the next medication after morphine that cannot be taken into many disaster or conflict zones a controlled substance? The situation with morphine, a strong painkiller that is controlled internationally because of the risk of misuse, serves as a cautionary tale. Every aspect of the life cycle of the medication is controlled: The UN requires strict administrative control of poppy cultivation and of the amounts of raw material produced and kept in stock in every country; transportation across international borders requires import and export licenses; and in many countries physicians may prescribe — and pharmacies sell it — only if they get a special licence. On top of that, any mishandling of the medication, including sometimes unintentional errors, may expose healthcare workers to criminal sanctions. Is it surprising that the availability of mor- phine is very limited in much of the world? Or that physicians are worried about prescribing it? Or that pharmaceutical companies have lost interest in supplying a medication with a small profit margin and a big hassle factor? There is broad consensus that non-medical use of morphine and other strong painkillers can have significant adverse public-health consequences, including drug dependence and overdose deaths, that justify control of its use. Ketamine is a different story. Although there are reports of misuse from some countries, according to the WHO, ketamine dependence and lethal overdoses are rare. Moreover, many countries in fact have no significant reported problems with non- medical use of ketamine. Yet, if ketamine becomes a controlled sub- stance, many of those countries are likely to face big challenges in their healthcare systems. A recent Institute for Health Metrics and Evaluation study in Uganda found that ketamine was available in all district hospitals and in 77 per cent of health centres; morphine in just one-third of district hospitals and 15 per cent of health centres. If ketamine is restricted as morphine is, what will happen to the woman who needs an emergency C-section? In disaster relief, the consequences could be equally dire. Although WHO’s Interagency Emergency Health Kit, a recommended list of medications and medical supplies to be used in emergency response, includes morphine, WHO staff say that it is routinely taken out because it cannot be legally transported across borders without permits or be used by physicians without appropriate licences. As a result, in many emergency situations physicians cannot properly treat pain, even when people have limbs ripped from their bodies by shrapnel or natural catastrophe. If ketamine availability is restricted, it could become the next medication that cannot be taken into many disaster or conflict zones. Countries that rely on having ketamine for many surgeries should make it loud and clear that they oppose China’s proposal. Diede≥ik Lohman is associate health and human ≥ights di≥ecto≥ at Human Rights Watch.
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