Two years ago, possibly almost to date, it was crunch time at the offices of Kenya Medical Practitioners and Dentist Union, KMPDU, spread across the republic. Secretary General Dr. Ouma Oluga and Co., the infamous CBA7, faced the unenviable twin task of marshaling their troops whilst minding their own state for the hell ride ahead. Health justice must have been the vision, or part of it. The mission: better remuneration and working conditions for the 5000 doctors slaving in a broken health system. The strategy: good old withdrawal of labor. The tactics: information warfare helped on in no little terms by strategic alliances with influential Kenyan social media activists – who for the period dropped every other social justice cause to leverage their social media reach for health activism.
With the slogan #LipaKamaTender, Kenyan doctors in public service fought for implementation of a 2013 collective bargaining agreement. The doctors fronted the CBA as a roadmap to needed health care reforms in Kenya. As expected of governments when they can’t match their promises, the Kenyan government at both levels denied being party to the CBA, terming it illegal.
Emboldened by fever high campaigns for office as Kenya readied herself for a general election in August of 2017, the doctors’ timing was a masterstroke. Spurred on by an equivocal message that being doctors, the striking medics knew what was best for the patient, the government time and again found itself on the back foot.
The doctors’ message of greater societal well-being resonated better than the narrow political rhetoric that characterizes campaigns for office at such a late stage. When rivals went for each other, smearing opponents as partisan in their aspirations, talk of better health for all (#CBAForKenyans) was an oasis in the desert.
A Still Born Revolution: Health Activism in Kenya
The 100 days that followed the start of doctors’ strike that December in 2016 will make it to the annals of Kenya’s labor movement as necessary reading for future union leaders. However, with the benefit of hindsight, this unfortunate period should have meant more to the numerous, oft parallel, ongoing conversations on a better Kenya tomorrow. A transfiguration in the revolution – to a shape envisioned by the late Dr. Eunice Songa, a fallen solider of that struggle two years ago who had redefined #LipaKamaTender as #TheNewMauMauRevolution – would have been just what the doctor ordered.
If the cause had evolved this way – a rallying call against wider social injustice fed by corruption – the more #LipaKamaTender would have mattered today.
This is because health disparities are bed rocked in faulty social contracts between rulers and the ruled. Moreover, the social justice movement in Kenya has undoubtedly more institutional memory than health activism. Therefore, when an opportunity presented in 18 Hours to align activism for health with other movements fighting for social and health justice as it had momentarily happened with #LipaKamaTender, we should have grabbed it.
Our opportunism would have seen health activism in Kenya gain needed momentum feeding off the larger pool. Sadly we missed the peak of that big wave. But that doesn’t mean we won’t ride other waves as activism is a river that ebbs and flows.
Two Years On The State Of Health Activism in Kenya
The flash-in-the-pan manner by which Kenyans celebrated the acclaimed Kenyan drama film 18 Hours serves as worthy reminder of what could have been. As the steady gains by pro-life movement has demonstrated, such gifts from pop culture are akin to serum treatments to a struggle. They breath new life to causes.
The call for health justice in Kenya has been drowned by political rhetoric that has succeeded in wrongly painting NHIF Supa Cover as universal healthcare. Such dereliction of duty by the ruling class would have been more improbable had the health activism movement in Kenya found its voice in 18 Hours. That 18 Hours received press for its artistic exploits rather than its weight as tool for creative advocacy is a damning indictment on the state of health activism in Kenya.
18 Hours, Kenya’s John Q Moment Wasted
You haven’t watched Denzel Washington until you’ve watched John Q. You can’t begin a discussion on health reforms in America without John Q. In undergraduate and graduate lecture rooms of the IVY league campuses to community collages, John Q is everyday fodder in discussions on health reforms in America.
You’d be hard pressed to say the same for 18 Hours. Thousands of young minds being crafted to be sharpers of Kenya’s future in her institutions of higher learning may never even watch, leave alone dissect the questions it raises on designing a health system for Kenya for prosperity.
How impactful would it be to be ask future doctors, nurses, other health professionals and professionals in health to hand in for their end terms, a two page essay on the ethical dilemmas presented in 18 Hours? What would featured screenings of 18 Hours across the dozens of medical schools and tens of Kenya Medical Training Collage campuses mean for the ethics of future medical practice in Kenya?
It could be that the casual relationships that we trace here with these prescriptions may fail to hold. But in the world of health activism, such stunts are home. Glenn Laverack in the paper ‘Health Activism’ published in the journal Health Promotion International offers:
The most effective strategies of health activists use a combination of conventional and unconventional tactics. In particular, legal action, media advocacy and the mass media combined with mass protests or media stunts can have a dramatic effective in changing public opinion.
The Power Of Film In Conveying Complex Messages
Beyond the recognized ‘megaphone properties’ of the silver screen, the opportunity lost by Kenya’s health activism by its lukewarm reception of 18 Hours lies in the challenges that face any activist action. A History of Medicine Symposium at Yale University School of Medicine in October 2010 identified the crux at the heart of impediments faced by health activism:
What became a unifying theme across the podium was that activist groups were seldom monolithic entities, but often complex microcosms playing out the very social dynamics of a larger society against which they agitated.Jean Huang in Defining Health Activism: From MADD to Mad Activists-Health Activism in the 20th Century. Published in Yale J Biol Med. 2011 Mar; 84(1): 51–53.
Published online 2011 Mar.
Film has proven to be an effective way of moving beyond the strain posed by such social dynamics. Especially in circumstances where science needs to engage communities on emotive, even taboo subjects. Nonetheless whichever discussions that may have arisen from creative advocacy activities grounded on 18 Hours, would only have been meaningful if contextualized. Context in health activism, as this Lancet article describes, is the challenge that lies in settling the disparity between increasing opportunities for health in the 21st century and inequalities in access to those opportunities.
Solving The Health Opportunity – Health Inequality Mismatch
Recent advancements in the utility of the gene editing technology, CRISPR, to health is one such example of opportunity tamed by risk of increasing health disparities. For more on how CRISPR presents this paradoxical reality, our article on CRISPR and the future of man is an apt starting point. Pop culture portrayals of real life situations as the case in 18 Hours offer a bridge to crossing this valley in health advocacy.
The unique offerings of film can build the power and ability people have to make choices about health inputs and to use these choices towards health as prescribed by WHO’s 2008 Commission on Social Determinants of Health.
Why Film Is A Powerful Tool For Health Activism
Film takes the conversation from the undue influence of health professionals – which can be a good thing in health activism. Whilst health professionals have an undeniable role in health activism, they face certain limitations. Key is the biomedical approach that they are likely to utilize may be ill suited to the task of building people’s agency .
Moreover, unequal power relations inherent in the doctor-patient relationship may stifle critical voices. Censorship can have the ripple effect of limiting other forms of power necessary for health – such as the power to make healthy choices like exercising or quitting to smoke.
Principally though, health advocacy in its purest is a way for those without power to influence debate on health determinants and access to health care. By being the custodians in power in traditional models of health service delivery, the role of health care professionals should therefore be framed at empowering other actors in health advocacy.
By embedding emergency health care professionals through out its production, 18 Hours covered several yards. In enlisting the star power of David Rudisha in a promotional stunt, the guys behind 18 Hours took the conversation beyond hospital walls.
The task for health activism players in Kenya is to deepen and widen this play by 18 Hours. To marshal the soft power of this film beyond what it takes to make and sell a credible medical drama. let’s take 18 Hours to the lecture halls and into social halls. We should be running with this one.