Post-Election Violence in Kenya: Part 1
Medical student, Paul Park, was in Kenya when the violence started. In the first installment of his experiences, he explores some of the ethical considerations of his evacuation
Tension ripped across an entire nation on the 29th of December, 2007, just two days after the Kenyan presidential election, when the election results were surprisingly announced to be “too close to call.” In Eldoret, Kenya, the majority, being of Kalenjin ethnicity, were ready for a new beginning with the expected victory of their presidential candidate, the challenger Raila Odinga of the Orange Democratic Movement (ODM) party. News of riots breaking out in other cities of western Kenya began trickling in as Eldoret citizens anxiously continued to wait. As the day progressed, accusations against Mwai Kibaki, incumbent candidate for the Party of National Unity (PNU), of election fraud gained credibility as his popular vote deficit of 900,000 was reduced to 100,000 out of 8 million votes, while Odinga’s numbers remained virtually unchanged. That afternoon, I received a text message from the manager of my housing compound: DO NOT GO INTO TOWN, RIOTS.
As a medical student in my final year, I decided to take a year of leave in Eldoret, Kenya in order to provide services and gain experience in TB care in a resource-limited setting. Work had been progressing well, and I was excited for the prospect of establishing the first public MDR-TB treatment program in Kenya. As I felt very welcomed by my new friends, I elected to spend the holiday season in Kenya. In the months leading to the election, I thoroughly enjoyed the vibrant atmosphere of political discussions at every corner. The ethnic minority of Eldoret, the Kikuyu, strongly supported PNU and were oftentimes outnumbered and left to defend themselves in animated debates, but the discussions always seemed to end in laughter. The violence in Eldoret from post-election day 2 turned out to be relatively minimal. Langas, a small town on the outskirts of Eldoret, produced two casualties and several stab wounds, but central Eldoret (my residence) only produced a few angry crowds. I text messaged a friend, who is a medical officer of the local hospital, to inform me if the casualty ward became overwhelmed.
On the 30th of December, Kibaki was announced the winner and was unceremoniously sworn in as president within just a few hours. One of his first orders of business was to ban all live news feeds (radio and television). Kenya was quickly spiraling down a dangerous path. Langas produced eleven deaths. The local hospital reported 30 stab wound patients. However, central Eldoret remained relatively peaceful. I informed my staff attending that I was prepared and desired to assist at the hospital in any way possible.
I received a phone call in the early afternoon of New Year’s Eve stating that all personnel of our program, other than my attending and his wife, were to be ready in 45 minutes for evacuation. Immediately, my heart sank. I saw the decision as an over-reaction that was robbing me of an opportunity to continue my TB work, especially with the MDR-TB program. I approached my attending and made two requests: first, that I be allowed to remain in order to provide any needed assistance in casualty, and second, that two of our mutual Kikuyu friends be taken with us, if the situation truly is becoming too perilous. He rejected both requests stating that my presence would become a burden to his focus and capacity to manage the hospital and provide a safe haven for Kenyan friends. In regards to the Kikuyu friends, he stated that they would be safe at the housing compound and that he would go down together with them if it came to that point. I understood and respected his decision, but I was still not convinced of the gravity of the situation. However, torn with guilt by leaving good friends in uncertain times, I could only leave them with what I had: food, money, and insufficient apologies.
We were to travel by road to the Eldoret airport, and then fly to the capital, Nairobi, which was considered highly secure due to police presence. I asked the driver to find an alternate route to the airport in order to circumvent Langas. We took small dirt roads and at one point passed a group of four men sitting on the side of the road with machetes, makeshift spears, and bows and arrows. I was initially amused by the sight, especially when they smiled and waved as we drove by. We then approached another group of men similarly armed, but they were greater in number (approximately 20) and blocked the road demanding that we stop. Our transport contained four U.S. citizens and four Kenyans, including the driver. They peered in our vehicle, asked the Kenyans for their names and tribes, and verified tribal identification by conversing in the respective native tongue. As none of our passengers were Kikuyu, we were allowed to pass. Less than a minute later, we approached another group. This time the mass was over 100 armed men strong. They chanted support for ODM…some in anger, others with excitement and smiles. We were made to stop our car. They surrounded the vehicle inspecting every crevice by peering through the windows. Some were unsatisfied and tried prying open our doors and hitting our windows. The driver calmly answered all questions, showing them his national identification card which states his tribe. Yelling and accusations ensued as the mob continued glaring in our car with blood-thirsty smiles. We were finally cleared, and the mob immediately treated the U.S. citizens as they normally would, waving, smiling, yelling “mzungu!” (”foreigner!”), and chanting “ODM!” Trying to appear as normal and unsuspicious as possible, I managed to wear a smile and wave back with a few yells of “ODM!” We would ultimately navigate through four more mobs of similar character on backroads and main roads. All were marching towards central Eldoret. We all knew the town was about to explode. The flight to Nairobi did not bring relief as I peered out the window and saw fields of burning homes, which were not adjacent, but scattered. The Kikuyus were being targeted. I kept asking, “How has humanity come to this? What would have happened if we brought my Kikuyu friends? Why am I the one fleeing Eldoret?” As the countdown to the new year came and went, I could only sit and worry for my Kenyan friends as I tried to analyze everything that happened and the choices I made.
The ethics of evacuation consumed me for my entire week in Nairobi. The first question I asked myself was: What utility do I have by remaining in Kenya? Perhaps the more difficult question would be: What utility would I have had if I remained in Eldoret? A day after arriving in Nairobi, I received a text message from my medical officer friend requesting my immediate presence in casualty to assist. I was torn. All I could do was ask my attending in Eldoret for permission to return, and he promptly, understandably denied my request for the same reason. While one can make the argument that I acted selflessly by being a “team player” and listening to my attending, I must concede the fact that I will never know if my presence could have preserved the life or quality of life of at least one individual.
The second ethical question dealt with differentiating between credible threat and misguided fear. The very same day I evacuated, Eldoret endured violence on a large scale, including the infamous church burning, which killed mostly women and children. Nairobi was persistently threatened by mass protests in the heart of the city as the police used controversial techniques to block off armed mobs attempting to march into the city. However, the truth remained that the violence was completely driven by tribalism. As a Korean-American, I may very well have been one of the last people targeted. The drive to the Eldoret airport did not produce a single request for money, even though monetary requests are very common occurrences for any foreigner walking through town. At the same time, however, Kenya’s reputation for stability made the current situation very unusual and equally unpredictable.
The last ethical dilemma regarding evacuation was the argument to seek safety as an investment for future utility. As a medical student, I recognized that my future as a licensed clinician held greater potential for impacting patient care in comparison to the short term, however vital, services I could provide in violence-torn Kenya. However, my personal belief is that you always should be mindful of the future but never at the cost of the present.
With so many conflicting ethical issues running through my head on top of the worries for my Kenyan friends who were being targeted and living in fear, I lost a sense of clarity, and not to mention sleep. Not even the urging of my family, friends, and university to evacuate the country provided clear direction. In the end, I decided to evacuate Kenya. I knew that my personal safety was relatively secure in both Eldoret and Nairobi, however, I did not want to be a burden to the essential humanitarian work of my attending by returning to Eldoret and perhaps be consequently removed from the program for being a liability. Remaining in Nairobi seemingly provided no opportunity for utility. Thus, with no utility, the additional, however minimal, risk of personal safety became unnecessary and avoidable.
As expected, I could not sleep the night before my departure to Kampala, Uganda. I got out of bed and checked my email, which included a message from a close friend. The email did not answer any of my ethical dilemmas. He simply challenged me to “do the right thing.” He pushed me to make sure that I was honestly considering all possibilities of utility. That extra effort to re-evaluate my capacity for care was the least that I could offer. Before going to sleep that night, I became a registered member of the Red Cross. Within 48 hours of landing in Kampala, I was on a mini-bus heading back towards Kenya. My destination was the border town of Busia, Uganda where the Red Cross had established a refugee camp for displaced Kikuyus. Before departing for Busia, I had made sure with the Red Cross office that there was need for additional personnel. I was greeted upon arrival and taken to the refugee camp site on the back of a boda-boda (taxi bicycle). To my surprise, I was the only volunteer with any medical background at a site of over 2,000 hungry, exhausted, and devastated refugees.
Paul H Park
4th year Medical Student
Indiana University School of Medicine
Indianapolis Indiana
USA
park.paul.h@gmail.com