Saturday, July 24, 2010

Not a Grain in His Stomach

“Why did you open the door?” “Why didn’t you just move on, being nearest doesn’t make you any more responsible than the other ...”. “It’s not your responsibility to get this man transferred to another hospital”. “This man can put you in trouble, you are asking for trouble.” “Why did you not let the hospital just discharge him and leave?” “You have received enough security tips, trainings and updates to know that you do not do this.” "If it means anything, I am proud of you."

These are some of the questions, advices and comments that I came across between Thursday and Friday, the last week. All those who questioned my action stand vindicated. The incident runs like this: on Thursday 22 July 2010, I left home in the morning to office. I usually leave earlier to avoid traffic but that day I was delayed and so had to fall in the long queue of cars that begin from Westlands going all the way from there to Peponi Road, Thigiri Ridge, Red Hill Road and finally connecting to the Limuru Road. Nairobi roads are long, mostly two-lane and this route is no different. During peak traffic, if you are in a lane, there is no way you would jump the lane; unless, you are a matatu driver who would get into ditches, drive on road barriers, etc to complete so many rounds everyday to get the payment and so is willing to risk own and passengers’ lives. So on this day, the row of traffic moved like a snail ... may be like a caterpillar ... yes, like a caterpillar, if somebody were to look at the two rows of traffic moving in opposite direction from the sky, the rows would have looked like two caterpillars.

I reached Thigiri Ridge and Red Hill Road T junction and was waiting for the traffic on the Red Hills road to stop so I and the cars in front of me coming through Thigiri Ridge could take the right turn. All of us had the indicator on the right of the cars, blinking like जुगनू (fire-flies) in the night. There was a long queue behind me too. I was looking around as I waited for the queue to move. I am afraid of driving but the not-so-bad orderliness of Nairobi city traffic encouraged me to drive. People are polite, honking is rare. Nairobians do not think so. According to them, the traffic on the roads is unruly and matatus are a nightmare and those rare honks, are noise pollution. If only they knew traffic in South Asia, in particular, my homeland, Bharat Varsham! When my gaze moved to the left side, I saw a man staggering up the road, he was some 5-6 feet away from my car. He was looking at me too, straight, unblinking. I saw he was holding a little packet of groundnuts in his left hand. His unblinking gaze, unnerved me a bit and I looked away. But suddenly I saw him near my car’s left passenger window looking sideways inside the car and within a few seconds, I saw his body slowly move backward and forward as if he is one with the wind, his left part of the body rubbing against my car door, and finally and going face down forward.

It took me a few seconds to react. I put the car lever to parking and leaned to open the left door and see what happened. This man lay parallel to my car, his left hand up stretching beyond the back left wheel of my car and the right sprawled in the 4-5 feet space between the left side of my car and the edge of the road. He had blood on his lips. I moved to the left passenger seat with half my body out of the car and shouted to the people in the cars ahead and behind me to come and help me take the man to a hospital. Some from the front and back looked towards me and soon looked away. I heard a shout, “Lady, don’t be foolish, get in and move”. Before I could think or react to this advice, there was a young man, holding my open door and asking me to come out. Soon there was a crowd of workers who generally use the mud footpath along the edge of the road and those who get off the matatus at the junction on the Red Hill Road. Some were telling me that I should pay and settle the case then and there, some asking me to take the man to the hospital, some to call the police . I asked the young man holding the door to leave the door and bring the man inside the car so that I could take him to the hospital but he wouldn’t let go the door. The crowd was swelling. Soon a short middle aged man joined the young man. They seemed to know each other as well as the man on the ground. I told the young man that if he doesn’t let go of the door I will call the police first. The short man reacted and told me not to talk of the police and take the man to the hospital. The young man listened and left the door. I closed the door while the two helped the man get on his feet and get inside the car.

Moving back to my seat, I noticed that the traffic on the Red Hill Road had stopped and the cars in the front had begun moving. The cars at the back also had begun looking for opportunity to pass my car. I opened the door on my side and asked the one immediately behind me to come forward but he and the other one behind him didn’t and moved away. In fact, the second one was visibly upset and raised both his hands in irritation before driving out of the lane and taking off. I looked at the third car and asked the person driving to please come forward. He asked me if I am all right and came forward. The fact that he responded while the others drove away, made me feel immediately grateful to him. I told him to call my office security and inform them that I will be at Aga Khan Hospital. By now, the man was seated at the back seat of the car with the young man and the short man who assisted him. The short man was accusing me of having hit him. The T junction where the Red Hill Road meets Limuru Road, I saw the traffic police person. I have been seeing him there regularly for a year and half now. I shouted asking him to come near. The short man was objecting and telling me that I am causing delay and that this is not a police job. The traffic police person came and as soon as he looked at the back seat he got into the front passenger seat. The short man at the back continued his tirade and at one point before the Muthaiga Mini market roundabout told me that the man has died. I almost panicked and sped fast but the traffic police person asked me to calm down, slow down and that the man is all right. I asked him to either get the short man out of the car or tell him to shut up. The short man didn’t need to be told, he was quiet now.

We reached the hospital and the man was assisted to walk into the emergency while I took the car to the parking. When I came back, a doctor and nurse were examining him and the traffic police person told me that the man has a catheter/needle unit that is used for administering intravenous fluids attached to his left arm. We heard the doctor and nurse ask for his name, age, and when he ate last. A few minutes later, the nurse came out and gave me his name and age asked me to go to the reception and register him. I did so and came back. Two security staff members of the organization where I work, joined the short man, the young man, the police person and me. We learnt one-another’s names – though I could never capture the name of the short man because of the way he spoke – and some more details about our lives while waiting for the doctor to finish and tell us what is wrong with the man.

A good while later the doctor came out and told us that the man says he was hit by a car but actually he is completely dehydrated, hasn’t eaten for the last two days and suffers from ulcers in his abdomen. After examining him, the doctor informed the man that he does have some tenderness on his left side whether it is from hitting the ground or the car, it cannot be said conclusively but he doesn’t have any bruise or anything else. The doctor said that she cannnot explain the blood coming from his mouth wihout putting him under some more check-up, which the man resisted. The man vomited a lot of blood while he was being examined. When further check-up was completed, the doctor and the nurse realized that he has a long pending illness, abdominal ulcer. They treated him for dehydration and gave him a painkiller to ease his stomach pain. About the ulcer, the man finally informed the doctor that he has been vomiting blood for a long time and was hospitalized in a place called Radiant Hospital in Eastleigh where his ulcer was being treated. Since he didn’t have the money to pay the hospital bills, he removed the IV fluids on his own and ran away from the hospital.

The man wanted to be paid some money and discharged. The doctor told him they cannot treat him there any further as a road accident case and that he needs longer term treatment for which they will transfer him back to the hospital where he was being treated till about a week back. The man was petrified. He pleaded to be discharged because if he goes to that hospital, they will ask him to pay up. He informed that his house-owner has thrown him out of the house because he hasn’t paid the rent for a few months now. He said he did not eat because he has no money to buy food. The doctors said that after discovering severity of his abdominal ulcer they cannot just discharge him unless he wants to be discharged against medical advice. The man wanted to be discharged.

I asked the doctor if it is possible that they refer him for further treatment elsewhere to a relatively cheaper place than a private hospital. The doctor suggested Kenyatta National Hospital which is subsidized. The man was not ready to go anywhere. I was told by the traffic the police that my responsibility ends here as the illness of the man has nothing to do with the incident but because the man says he was hit by my car, I will have to bring the car for inspection and we need to go back to the site for investigation. I couldn’t understand why the man would do this but his condition prevented me from thinking anything nasty about him. Rather it made me feel responsible to help him. The short man and young man were also now pleading with me to help the man and that if I leave him, he would die.

Together and with the doctor we argued with the man to come to Kenyatta Hospital. He was not ready. He only wanted the money and kept asking me to give him what I would spend on his treatment. I refused to give him money but told him that I will take him to the Kenyatta Hospital and help him with his treatment. His two friends – the young man and the short man – also told him to prioritize his health. They had heard the doctor telling him that if he doesn’t allow treatment, he can vomit himself to death and that if he falls again tomorrow he may not find somebody to bring him to a hospital. I asked the police person to come with me to the Kenyatta Hospital before we go for the inspection of the car and investigation at the site. The two security staff members from my organization left because they said they have official duties to attend to. The police person agreed and also informed that the Kenyatta Hospital is on the way. I took the transfer form from the doctor and we went to the Kenyatta Hospital.

At the registration desk in the Kenyatta Hospital, the man again insisted he was hit. He was registered as such and as he waited for a doctor to examine him, I went with the police person to get the car inspected. When we came back the man was already examined by the doctor and prescribed medicines for ulcer and advised about the kind of food he should eat. He was told that the medicines are strong so he has to follow the advice closely. I wondered why the doctor didn’t give a written advice and only prescribed the names of the medicines in writing. But looking around at a few hundred people waiting to be examined, I understood that writing is a luxury that the doctors working in this hospital cannot afford unless unavoidable. The man was looked better but tired. I bought his medicines on the ways and we got back to the site for investigation. The man accurately described the condition of his health, where he fell, that there was a jam, and where my car was at the time he collapsed but he again mentioned that he was hit. The police person asked him how could he be hit by the side of window and what was he doing near the car so far away from the edge of the road. The man informed that he came to the car window to sell his groundnuts to me and that he doesn’t mean any ill except that he wants some money. He was still hungry though the saline water given at the Aga Khan hospital made him look a bit better. We agreed that the statement recording will take place tomorrow. The short man wanted some money too saying he has spent his time helping this man instead of selling the newspapers. I felt torn. Indeed, the man needs money to buy some food and the friends are too poor to get him anything but I also felt that I would be doing something wrong by giving money. In the end, I gave the short man some money to buy food.

Next day, when we met at the police station the young man didn’t come. The statements were recorded with the man saying he was hit and then describing the rest of situation accurately and the short man saying he didn’t see what happened but he came near my car when he saw a crowd. He described the situation accurately too. The police person said that based on the man’s complaint, they have to give me a note about careless driving and the intention to initiate court proceedings. He explained that this is not to accuse me but to let me know that an accusation has been made and that further investigation will take place. He explained the process. I was frustrated but I signed and accepted the note.

If I looked frustrated, the man looked worried. He didn’t want an investigation. He had come with the notice that his house-owner had sent before throwing him out. I asked him that if he wants my help why he didn’t ask for help directly rather than using a false claim. He informed that nobody helps otherwise. I understood his insistence on the false claim; he is a hungry man with three dependents in the village and needs money, he doesn’t want to rely on goodness. The police person told him that nobody will help him in the future. When he realized that I would not give him any money, he said that he would withdraw his complaint because he doesn’t mean to put me in trouble but only wanted some money. He gave a statement to withdraw the complaint. He promised to take his medicines regularly with a reminder that he has no money to buy food and that he can keep his promise if he has something to eat. Again, I gave some money. It wouldn’t help him pay his overdue rent but may help him buy food for a month or so and he has full dose of medicines.

I am still not clear if I did the right thing or by helping him I played into his game of using his misery to extract money. But I feel all right about the fact that the money will help a person who is forced to sell eatables but cannot afford to put a grain in his stomach. At the same time, I cannot take away the annoyance I feel towards the man for getting me a note from the police.

On the first day of the incident, when I got back to office, a colleague told me that poor people sometimes play this trick on the road to get some money. She informed me about an incident when an impoverished person threw himself in front of a car. I was not surprised. I have seen the worst kind of abject poverty in India but the combination of poverty and segregation of the rich and the poor that I have seen in Nairobi, I hadn’t seen anywhere else before. Kenya is the most unequal country in Eastern Africa compared to neighbouring Rwanda, Uganda, Tanzania and Burundi. In the Kenya, the richest 20% take 61% of rural and 51% of urban incomes. 60% of Nairobians live in slums. The bottom 20% of the country’s rural population get only 3.5% of rural income. The bottom 20% in the country’s urban areas get 5.4% of urban income. These disparities have widened since 1982 and the implementation of IMF structural adjustment programmes in the 1980s. More than 50% of Kenya's poor live on less than 1 dollar a day. The child mortality is high with 1 in 10 children dying before the age of 5 years. It is said that the AIDS patients occupy 50% of all hospital beds. More than 25% population is illiterate. Check the links at the bottom for more details on poverty and inequality in Kenya.

The incident that I described earlier and the figures given above point out that Kenya cannot be necessarily described as a poverty ridden country. Rather it is an inequality ridden country. This inequality renders majority of its population poor and prevents them from being able to afford basic service needed for a living. The man I encountered, has completed education up to ‘O’ level, is very well aware about the issues in the country and the world but his inequality induced poverty makes it impossible for him to access higher education, health, and housing. In fact, it is pushing him towards what would be termed as a criminal behavior. The short man, as a result of being an ‘inequality refugee’, does not even have political and citizenship rights because he doesn’t have the national identity card. He, therefore, would not be able to vote on the 4th of August 2010, when the country votes in a referendum on the proposed constitution.

Given that the current constitution of Kenya does not even grant equal civil and political rights to women citizens, one can only imagine the plight of poor women in this country. The political growth of the country has not only favoured the rich but has further marginalized the poor in particular women from the political gains. Public policy remains highly influenced by the churches and traditional power structures which were strengthened during the period of colonization. The public policy and practice of patrimonial inheritance of property has also made the entire state machinery patrimonial. It allows progeny of those who made their money historically and established themselves further when Kenya was a colony to inherit the patriarchal booty. Women were never given inheritance rights by the Kenyan society. Women have not been a part of the scheme in which one could gain economic rewards by showing political loyalty so they remain excluded from the economic right, representation and decision-making. Since politics of the country has encouraged loyalty based economic rewards, which in the current times, are not easy to obtain from the public exchequer directly, it is given under-the-table in the form of corrupt payments or the tolerance for money-making at the cost of public good and social services. This detouring of the funds to people who have not earned it also contributes to inequality. It creates and sustains a system in which only those who can make the under-the-table payments can receive benefits or grow further. Those who are already victims of inequality, like, men from marginalized communities and women who are denied equal economic rights, do not have the ability to pay for their way into the system. They have no choice but be victims twice, ie, once a victim of inequality induced poverty, and second, victim of corruption.

Loyalty based politics has been promoting also a system of patronage in which those who are already powerful get favoured over the weak because of their ability to serve the rulers' interests better. Illicit profit-making is another pillar on which the system of patronage rests, ie, in addition to loyalty, patrons also like to receive value for money from the persons they patronize. Poor definitely are not in a position to optimize the profits for a patron even if they were to be patronized. The system of patronage ensures that the weak, including women, are not able to access the opportunities. This is a serious impediment to the exercise of equal opportunities and to the capability to benefit from an apparently well laid out system of governance.

The second pillar of patronage, ie, illicit profit-making, also has negative consequences for the regional development within Kenya. Inequality caused by the system of patrimonial inheritance is more severe in areas which are resource rich because resources like forest and fertile land are concentrated in a few hands. The patrimonial state prefers to invest in regions which are likely to bring greater returns over the regions where investment may benefit the people in terms of their survival but would not contribute to a much faster growth rate. As a result, increasing the inequality among the citizens on the basis of their location. The situation further deteriorated in 1980s when structural adjustment was pushed by the IMF. The country has not given a thought to developing diverse opportunities to address economic inequality rather continues to focus on comparable opportunities. Creation of comparable opportunities in a country with geographical diversity like Kenya is only going to leave the regions which do not have comparable resource base and geo-conditions further behind. This sort of regional disparity cannot be blamed on to nature or geography because it is possible to resolve it with good economic development policy and investment in citizens across the country.

Kenya, like many other countries, which have undergone structural adjustment, needs to revert the trend of inequality by recognizing that basic needs such as education, health, food and nutrition, representation and participation have to be assured to all who live within its geo-political boundary, irrespective of their sex, gender, religion, region, origin, ethnicity, etc. It has to recognize that certain groups of people, based on one or the other ground, have been disadvantaged for centuries. If they are not supported through affirmative action they would not be able to participate effectively in the development processes because generations of disadvantage cannot be wiped off by creating equal opportunities on paper. They would need supportive systems to make them stand for their development.

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