View from Africa

Abandoned by the state, self-organized health workers in Kenya are absorbing the brunt of the pandemic, writes Nanjala Nyabola.

Health workers demonstrate
handwashing techniques to Mukuru community members. Photo: Victoria Nthenge

I recently went off-grid for a few days because I started to feel like social distancing was taking its toll. In Kenya, we’ve been in some form of Covid-19 lockdown since March: separated from friends and family, watching the government make a hash of the public-health crisis. Even though the numbers on paper tell a positive story, we know that this administration has a tendency to misrepresent facts for political gain, for example under-testing to report low overall numbers.

This is the sobering reality that many people around the world are dealing with today as governments fumble with pandemic responses. I think it is partly why so many of us are feeling tired. There’s no shared responsibility; the citizen is doing the work of both the governing and the governed. The saying goes, ‘when all you have is a hammer, every problem looks like a nail’.

Well, governments around the world, rooted in militarized patriarchy, are finding that all they know is how to start wars and they will not divert enough energy away from that space to give the current crisis the attention it needs. At the beginning of 2017, the Government of Kenya bought 12 fighter jets, two trainer aircraft and weapons from the US for $418 million. Still, we only have about 500 intensive care unit beds for a national population of 47 million and they cannot find the funds to pay doctors and nurses enough to stop them from going on strike.

The countries that have starved their hospitals, underfunded their medical professionals and siphoned off money meant for investing in community health structures are having the worst Covid-19 outcomes. For developing countries that have lived under scathing cutbacks proposed by international finance organizations, the pain stings even harder. We had already been impoverished; now we are facing a pandemic with hobbled health systems and a privatized global health system that already threatens to cut us out of access for a possible vaccine, a cure, or even treatments.

The proposition behind Structural Adjustment was that it would make our governments leaner and more efficient: it just made our governments leaner, and less capable of responding to crisis.

Human ingenuity in the face of state failure should be celebrated but not normalized

In Kenya my great hope lives in the community health structures that we have built for ourselves. As underpaid doctors and nurses fled the country and public-health systems, individuals in various communities across the country came together to form organizations and associations that have been the frontline health system in the country for years. Midwives, nurse practitioners, mental-health counsellors – often trained and working in the communities they live in – are absorbing the brunt of the pandemic.

I spent my week off the grid in some of the most remote parts of the country – at least two straight days of travel from the capital. Everywhere I went there was health messaging about the pandemic in local languages, free handwashing points at every mud and thatch kiosk. There were people coming together to fill the gap the state left behind.

Of course we still need public-health systems and that is what our taxes are supposed to build. Human ingenuity in the face of state failure should be celebrated but not normalized.