The communication Imperative

Chapter 2The Communication Imperative: Relationships in Education on HIV and TB

In health education, messages are developed so that they can be beacons of communication. It is because there is a breakdown of communication, or there are factors that strangulate communication, that giving the right message to the right person in the right way for the right results is important and has been the subject of many models of education on health in kenya, from Magnet Theatre to Peer Education. Organisations and consultants have used such frameworks as BCC (and now I am told ACSM) as the currency.

In this chapter, we are going to deal with the issue of relationships of key players in health education. It is easy to identify the following communication key players: the policy makers, the health workers, the patients, the care providers and the community. The communication barriers that exist between these groups are huge and have a cultural as well as historical bearing – depending on which community and the level of awareness and exposure they have on both TB and HIV. There are 10 generic relationships (grouped into six) to be addressed in message development for interventions in health education( see Figure 1 below)



Figure 1: The Relationships Matrix in Health Education. © kawive 08
(Though the framework was developed in 2008, the relationship notes were re-written in 2011.)

(a) Relationship 1: Policy makers and Health workers
This relationship constitutes a desired common planning, education and sensitization. The developers of policy must widely consult with health worker to harvest challenges and narratives from the actual implementation process. The challenges that health workers face must be addressed in policy and in designing of implementation initiatives.

(b) Relationship 2 and 3: Health workers and Patients
The patient, procedurally, (by design or default) discloses his or her status to the health worker. The expertise of the health worker endears him/her to the patient. Ideally, there is no other way.


The health worker must therefore have the requisite social skills to gain the confidence of the patient. This is important so that the patient is prepared to “share” his/her health situation. At the point of first exposure, the patient needs understanding and support from the health worker. That the health worker will know the results (or the condition) of the patient before the patient does not help matters. The health worker therefore must be prepared to “walk the journey” of health with the patient by providing both health care and health information. Of critical importance is confidentiality: if the health worker betrays this, the patient will most likely die of stress rather than of HIV or TB related illnesses.

(c) Relationship 4and 5: Patients and care providers

Both HIV and TB have elaborate care and support mechanisms that have been stipulated over time. Invariably, a relative or another person close to the patient will be required to provide this care and support. This person will of necessity have to get all relevant information on the illness and of the expected care and support. This is a second disclosure. It is important to understand that such a person is “affected” by the same disease and needs a lot more guidance on what to do or say to the patient during the course of the illness. How to protect the care giver form infection is critical information that should be given.

(d) Relationship 6 and 7: Care providers and the community

The community, consisting of contact persons, needs to be enlightened on two things: one, the cause, symptoms, spread, prevention and cure/treatment for both TB and HIV and AIDS. This is important to curtail the gossipy abandon of village wisecracks who know it all. Secondly, since both the patient and the care givers live in the community, it is important that the community knows what is expected of them. Where communities understand all that there is to know about HIV and TB, they will be most supportive of efforts aimed at cure, treatment, care and support. Where they do not understand, the community can easily isolate and demonise patients and care providers. Community members do understand that “they could be the ones” in the place of the patient. This is not blackmailing, it is reality.

(e) Relationship 8 and 9: the community and health workers

Health workers have a responsibility to take advantage of all opportunities (open days at the hospital, public meetings, opportunistic gatherings, community outreach sessions etc) to discuss with communities on various aspects of both HIV and TB. This is because health workers fall in the trusted category because of their expertise. The community on the other hand will provide the health workers and other intervention seekers with appropriate idiom, channel and forms that are effective in their context. Indeed most community members are willing to volunteer to take part in and shape interventions The health worker therefore give education on health and the community gives them education on communication.

(f) Relationship 10: patients and the Community

Though in the diagrammatic representation above the community has been located as an entity, it is important to note form the onset that all the other entities are part of the community – either of interests or of people. The patient is a member of the community and shares this space with the health care givers, other patients, the health workers and the policy makers. Yet the patient has a special role as a behaviour change agent, a motivator for sustaining of behaviour and as a pedestal of courage (where he/she discloses status) and of fortitude.

In developing and deploying messages, these relationships should be at the fore. They are the social dynamic of interventions and where they are not well handled, it is possible that the education initiative will achieve little if any results.

© kawive, wambua
Musings on Communication in Health. (Unpublished) Nairobi, 2008

An Amendment Now will Adulterate the Constitution

The article below was carried as an opinion in the DN 21st Sept 2011... but here is the unedited text

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I have a lot of respect for honourable members, and much more if they hold cabinet positions. But i have absolutely no respect for anyone who wants to do themselves a favour by subverting the collective will of all Kenyans. Indeed, this is the reason why we negotiated this constitution. We did not want a few people (or one person if you remember Presidents Kenyatta and Moi), to make decisions for us, decide what is good for Kenya, and go ahead to do it because they have the power and instruments of government.

Let all Kenyans know that the proposed change of date is symbolic, it is indeed the first adulteration of the constitution. If it works, then it will be possible to adulterate everything in the constitution. And the cabinet is very clever, they are just testing the waters. If they and parliament win, wait for a flood of demagoguery. The next thing you will hear is that the threshold for a presidential candidate s too high and what we need is a simple majority vote. We must fight it by all means.

The change of date is being tied to the resolution of the crisis that is wont to happen is article 81 b is not realised. The women sector has been hoodwinked to support this amendment. Please be warned my sisters, do not take a bite at the carrot. It is laced with a poison so lethal it can dismember this society. Remember the story of the ogre that transformed itself to a handsome graceful dancer and won the confidence of the beautiful girl and even offered to marry her? He and his friends were going to feast on her flesh that night. Were it not for the deux ex machina, the small bird that told he to run for the hills and the frog that swallowed her as the ogres came carrying wood, she was on her way to the roast. I am that bird, and i am speaking to you.

If you listen to Hon Mutula, you will still be wondering what the difference is between implementation and amendment, and which of the two is the mandate of the CIC. A friend of mine said in a meeting that Mutula is treating the CIC as if it were a small department he established by gazette notice. Bw Waziri, kindly be advised that the CIC is a constitutional body, and anything that happens to the constitution is their business. In the event that they are not consulted or informed of the actions of any institution (as long as that action relates to the constitution), and then they develop a consultation mechanism for citizen’s participation, such actions are part of the impunity we are so keen to abandon.

The spirit of the constitution is one of national dialogue and we do not ever again want to go back to the times when our leaders are talking down on us. It is because of the arrogance of leaders that we have fought, that people have dedicated themselves to the liberation of this country. We are not there yet, and even some ideologues and architects of repression are posing as reformers, but we have started the journey.

That having been said, let us turn to the issue of the election date. It is not ambiguous. It is now becoming important because the two principals are using cabinet to legitimise their continued stay in the arbitrary marriage called a coalition government. It is very convenient for them. And therefore the delay in establishing the IEBC. They know, as we do, that no Kenyan wants to go to elections without a well functioning body because of our experience in 2007. And they are exploiting our fears by delaying its establishment. That it will not be ready to carry out elections on 14th of august 2012 is utter nonsense. We know that if a government wants something to work, they will put everything in it, and we have the capacity to make IEBC work very well. The problem is the two principals do not want an election that early, period.

And so our focus should go to Dr A Ekuru and his team. When they are doing the interviews, the key question they need to ask is: how will you ensure that the elections in August 2012 are properly done? A candidate who mentions the “cabinet proposal on election date” should automatically be disqualified. He or she belongs to the impunious system and is an hindrance to reforms.

A talk to the IFP alumni on 10 9 2011

The Role of Citizens in the Implementation of the Constitution

Speaking to intellectuals, the members of the middle class, is a challenging task. This is because there is evidence that our middle class is perhaps one of the most compromised and detached community in Kenya. Their limbo arises out of the fact that they are people in waiting for appointments to government and other senior positions or are already settled in life and a system of ideas.

But since we got the new constitution, the role of the middle class has become even more apparent than it was when Dr Willy Mutunga, wrote a book that showed the middle class as providing leadership in the reform agenda in Kenya – where he refered to the Civil Society and the Clergy as the epitome of this class.

I will concentrate on two areas: how we came about this constitution and the lessons on the implementation process.

The renegotiation of a new Kenya can be summed up in four broad historical phases:

1. When after independence the government of President Kenyatta changed the constitution to kill ‘self-governance” by the people, by mutilating the provisions to provide for a powerful presidency and the de-facto one party state, many of the reformers in the political field (led by Odinga Oginga) and those in the academia started through parliamentary protests, theatre and nationalist education to refocus the nation on the need for a more inclusive leadership

2. After his ascension to power and the coup that followed, President Moi outlawed multi-party politics and the country was treated to the “KANU ni baba na mama” sloganeering, the citizens organised themselves into cells to discuss how to open the democratic space. Mwakenya was one such outcome of citizens’ mobilisation. In 1985, Rev Timothy Njoya gave the first sermon calling on the need to renegotiate the governorship of Kenya.

3. The late 80’s and early 90’s saw citizens organised around Mageuzi and FORD to pursue liberation of this country. The repeal of section 2A in 1991 was a direct fruit of citizen activism. Then there was the realisation that plurality in politics without changing the rules of engagement was useless as the incumbent could rig themselves to perpetually stay in power. The civil society under the leadership of the KHRC developed a model constitution for Kenya in 1994. The “No Reforms no Elections” movement in 1997 was compromised by the IPPG where leaders sought to benefit themselves as opposed to the whole country

4. The formation of the CRC in 1999 and subsequently the CKRC (that combined both the CRC and the Ufungamano Initiative as Prof Ghai had demanded) in 2000 was the key step in started a national dialogue in Kenya. The key betrayal of the Bomas conference was realised on 16th March 2004 when the AG refused to take the adopted report of the conference for further processing in Parliament. After the acrimony of leadership that prevailed then, the rejection of the Wako draft in Nov 2005 and consequently what happened in 2007/8 was to a large extent inevitable. The Post Election Violence provided us with an opportunity to agree to renegotiate our basic instrument of governance and thus we got a new constitution

After the constitution was promulgated, the key challenge for the nation has been how to implement it. The constitution provides for a location of sovereignty on the people(Preamble and Art 1), has principles and values upon which the new kenya shall be built (Art 10), provides for a mechanism on how it can be interpreted (art 159), has progressive provisions on socio-economic rights (article 43), provides for strengthening of the various arms of government to make them independent and able to check one another and identifies access to justice (Art 22 and Art 48) as key to citizenry enjoying rights and undertaking responsibilities.

The constitution letter and spirit faces many challenges of implementation. Some of the key lessons we learn from other places include:

• The need to strengthen institutions
• we should ensure a independent and impassionate electoral management body
• The judiciary should be independent.
• we should do everything to avoid interference by politicians
• civic education should to be continuous and be issue based
• as a country we need to develop and sustain a consistent national morality (drawn from the values) and use it to measure all aspects of governance
• make all efforts to ensure that the people take ownership of the constitution

Any engagement therefore by citizens, in my view, should be guided by these seven factors.

I must add a note on civic education.

The constitution envisages that the citizens will be expected to “respect, uphold and defend” the constitution (Art 3). For the citizen to be able to do this, all people must be empowered not just with the knowledge on the constitution, but on the actions that are both possible and desirable for them to effectively play this role. Developing a programme that tells people about the constitution is definitely irresponsible at this time and it is not only too little, but also too uninformed by current thinking on the pedagogy of community education.

Thank you.

10 09 2011

Civic Education: Getting it Right

My article the other day entitled “Civic education could still go quite wrong if the whole truth is not told” (DN 4th August 2011) elicited all manner of interest. Some people asked where this education i was talking about was, while others said that i was slighting the role that civil society has historically played to bridge the knowledge gap left on citizens by the government. People have a right to their opinion, and i respect those rights. I won’t even defend myself or try to answer the many queries. I as well work for civil society and i have been engaged in civic education for over 15 years now. This is an overdue discussion, and I am happy that it’s on. I want to respond to one challenge: what are the solutions to the problems that have beset civic education?

There are many theories of community education and development, many models of practice, many shades of success and how it is measured. Civic education has been said to be necessary for developing a democratic culture, for good governance, for cohesion and national development. All these theories and terminologies that have for the last two decades surrounded civic education are indeed as misleading as they are vain; i am convinced that they have been part of the lie, a big part of the 47 years of national disempowerment of Kenyans. Why? Because if this was the case, we would not have witnessed the current increase in disparities between households in Kenya.

One reader wanted to know why there has not been civic education at the Coastal region – amid the poverty, the apathy, the illiteracy, the land issues, the insecurity, the complacency of the population and the impunity of state actors. There is the frustration here, just like we know of the warped logic of the Turkana, who in frustration, say “we are the barbed wire of Kenya”. There is clearly an ideological frustration of educators and CSOs that carry out civic education, and there is frustration of people in rural Kenya who have ideally been left alone to their own devises with “the government” coming in as a machinery for oppression and aggravation .

Where should civic education come from? Nairobi? Government Ministries? No. It should not, and it clearly will not. And if there is ever a pretension that it does, it will be superficial (and ONLY dealing with awareness), it will not rooted in community dynamics, it will not communicative of the needs and aspirations of the people, it will be empty (with no resonance to the psyche of the people) and then, it will return to wherever it came from – in bags of the Government operatives or civil society groups. Now, this is NOT civic education.

I say it is not civic education because the residual impact is negligible: the implementation is both temporal and spasmodic; the purpose is determined else and the results are only looked at from the immediate. You will find them written all over in monitoring reports by CSOs, donors and government departments, but you will hardly hear them mentioned by the local people. There are classic examples of CDF reports given by MPs and outcome reports given to donors that people hardly get to either know or attest to.

How many people are aware that by adopting the Sessional Paper no 10 of 1965, the government condemned certain areas to poverty and neglect? Now, who expects the government to tell the people of Turkana, North Eastern and parts of the Coast region that they do not plan for development with them in mind? Thank God there is the County Governments coming up and the Equalisation Fund has been established by the Constitution of Kenya 2010.

A police officer will not be interested to tell you about your rights since if you know you may not allow yourself to be victimised. A headmaster may not tell parents that it is their right to seek full disclosure of decentralised funds because this may work against his/her plans. And this has something to do with the national psyche we have developed over time: we hide behind blades of grass like the proverbial dog. Surprisingly, we, most times, manage not to be seen – indeed a particularly Kenyan quality that is rare elsewhere.

Civic education in my view is a citizen led process, a process by which citizens discuss, adopt and carry out certain actions at the individual and collective level to better the way they are governed. It can be initiated by citizen groups and individuals in reference to a particular issue (and NOT the grandiose panorama of concepts and abstract terms we are treated to). Civic education resonates with an issue that is at the heart of a community – like the lack of medicine at the local clinic or a potholed road. On the issue, a citizen has the responsibility to find out how much money was allocated to medicine, who the responsible person is, how much of the medicine was brought, how many people have been treated, what the balance is and where it is kept.

Hardly will citizens get this information easily. There will be resistance. Neither will the government (police/administration/ministry) like or be friendly to the citizen who asks such questions. But the moment one starts telling their family, friends and workmates about it, this is the beginning point of civic education. When then people around you start seeing the connection between the lack of medicine and corruption, the lack of service and the inefficiency of their governance system, the link between a bad low and the lack of accountability; citizens are getting to know what ails their society. The moment the p move a demand to be told what happens at the hospital (and it may take long for this to happen), this now is civic responsibility. A process of this nature is a civic education experience gone towards civic engagement.

Granted, the problem of illiteracy exists in many parts of the country, and especially illiteracy of the civic sense; yes this is the cause for a lack of connectivity by citizens of and ID card and their civic duty; yes it is the cause of an attitude of complacency towards life; yes it is the cause of fear and reverence for government and leaders; i agree. But you don’t need to be literate to know that you were not given medicine in hospital. Civic education (the one i described above) is not a solution to this. It is the next step.

Lessons on Constitutional Implementation from South Africa

Yes, we got a new constitution on August 27th 2010, and yes, we are struggling with the implementation ... with an unwilling Parliament ( which actually is not a Mosque or a Church ...quoting Ababu, and therefore has no way of enforcing morality... a vicious group of the LORDS of impunity, and to cap it all, a populace that has not understooooood the document, its spirit, its implication: the only thing that people were clear about is that they needed one, a new one, one that captures what they may want to call their aspirations...a nd indeed it does, by and large

so i went to this national conference, and there he was, Hon Mohammed Bhabha, a South African politician who shared the following lessons:

1. politicians come and go, and so we should ensure that they do not hold us at ransom



2. the strength of institutions is primary...all our efforts should be there



3. we should ensure a independent and impassionate electoral management body



4. the demarcation process should be above board...citizens should not perceive, be witnesses to or be victims of gerrymandering



5. the judiciary should be independent ...presidents should be able to comfortably go to court to seek justice



6. we should do everything to avoid interference by politicians



7. civic education should not at any time relay information that there is a problem with the constitution ... every constitution provides for a mechanism to redeem itself



8. develop and sustain a consistent national morality (drawn from the values) and use it to measure all aspects of governance



9. do not remove protections that favour others today, they may favour you tomorrow



10. make all efforts to ensure that the people take ownership of the constitution



11. the constitution must be used to protect citizens from the practice and use of power

Phew! sounds like the eleven cardinal principles, but well ... damn good

Haraambeeee!

the diaries of the dead

contrarily to popular opinion, the dead are perhaps some of the most prolific diary keepers


you just got to define what death means to you, and vuala! there you got it.

a bible reader and believer is dead to African spirituality
satanic worshippers are dead empty evil spirits
a drunkperson is dead to the world
a moralless person is dead to the spirit of God
those who profiteer from causing death are dead at heart

SO
governor scott walker is dead to wisconsin workers' plight

AND

a kenyan politician is dead to the unga crisis


may we all be alive
may we live
may we cherish life
may we create life

mmmmmh, yes!!!!!!!!


plant!

I am back

Last time i checked that i had said this was in 1993 after the hospital experience after "The Cork Curse"...later called "The Wailing Wall" had been finalised.

I said to my friend: i am back.

Indeed eight years later i was back, two years after that i went to the wilderness and since then, it is only today that i can say....I AM BACK.

and this aint the last you hear, i will be raiding spaces and creating demigods, sacrificing them and and deifying them.

If you know what i mean, I have had the avocado tree experience, i loved it, i still wish for it, but the world has moved, and i with it.

I am back!

No, not in the office, no no no no!

I am back where i belong.

See?

this political thing

I, actually, forgot what this was all about, so i had posted a blank for a long time...

chewing political blanks?
not knowing a thing?
idle?
waster?

I fail to know. what is this political thing? political and thing in one sentence can only create an oxymoron.

yaani, a moron that is so bullish it has the character of an ox...hence oxy

now surely, if you really are totally pissed off with our politics in Kenya...Shout!

of course you know i have not heard you... but shout some more!

can you imagine guys dragging politics to the judiciary, constitutional appointments, the death of people, the birth of a nation, stolen maize, inflated dams, shuttle idiocy, ignoramic pronouncements around a boy ( i am avoiding the word kihii like a plague!), 2012, 0campo, death in the desert etc

...what stupefactionality!?

ok, there u are, you had said we invent english, and now you are aghast!

politician wewe!

I almost forgot you

i almost forgot you,
in the mad rush of who

waiting calmly by the well
wanting to calm my hell

i am well
i did yell

and so i remembered you
and then wanted to sue

wanted to sue for defamation
assassination
undue delay
non implementation
impunious acts
ignominy
corruption
adulteration

yes!
i wanted to sue.

but i could not
where is the court that you could not adulterate
where is the judge that you could not corrupt
where is the lawyer that you could not pay off
where is the witness that you could not assassinate
where is the file that you could not disappear
where is the law that you could not repeal
where is the case that you could not nolle proseque

so i forgot you, almost

but my memory has broken the dams
and as the angry waters flood the farms

i wait in bated breath

for you are in the waters
riding with the shivers

coming coming coming

i am the fisherman
and i know your appetite for bloody meat

the hook that will send you to the sunshine
is well hidden under the flesh of a bovine

i am waiting to forget you!