A chat with Prof Lukoye Atwoli, Dean, AKU Medical College

Medicine is one of the hallowed professions in the country with only engineering, architecture, actuarial science and law being in the same league.

Kenya has about 14,000 registered medical doctors against a population of close to 50 million. In the medical field exists the little known sub-field of psychiatry. Kenya has, give or take, 120 psychiatrists against more than a quarter of a population suffering from one kind of mental illness or another.

Prof Lukoye Atwoli, Dean, Aga Khan University’s Medical College, East Africa, is one the few psychiatry professors in Kenya. He is also a former Dean of the Moi University School of Medicine. He talked to Higher Education on matters medicine and the status of mental health care in the country.

Who is Professor Lukoye Atwoli?

I am many things. I am a husband, father of four and a son who is part of a large family where I play the role of the eldest of them all. I am also a mental health professional.

Who is a psychiatrist and what does one need to be a good psychiatrist?

A psychiatrist is a qualified medical doctor who specialises in the diseases of the mind. This is after doing a master’s of Medicine in Psychiatry. This means that to become a psychiatrist, you must begin by studying medicine.

A good psychiatrist is a person who is analytical, observant and uses his ears more than his mouth. On the side of care, a good psychiatrist must be committed in the long term and patient. Put the patient at the centre and design a care system around them.

When did you know that you wanted to practice psychiatry?

I wanted to be a neurosurgeon when I joined Moi University for a Bachelor of Science in Medicine and Surgery degree, but this changed during an elective period at Indiana University School of Medicine. My fascination had always been with the brain but I could not get the chance to work on the brain as much as I would have liked as a neurosurgeon. I then began disliking the field because of how things worked.

Noticing this, the programme director asked me what my interest was and I told her I was interested in how the brain works and how to fix it when it is not working. Then she told me that my interest was in psychiatry. She gave me a textbook on psychiatry and told me to read it, and if I liked it, then that was my area of interest.

That is when I decided I would pursue psychiatry, and when I went back to Moi University, I concentrated more on studying mental illnesses and enjoyed the differences I made in the life of the mentally ill. The rest is history.

What's the status of psychiatry in our universities in terms of teaching, research, training and funding, and what more needs to be done? 

The medical field in Kenya has generally been under-resourced and training is poorly done. For psychiatry, only Moi University had a curriculum full of components on psychiatry and mental health at the same level as other fields of medicine.

Currently, only Moi and the University of Nairobi offer postgraduate studies in psychiatry, while the Aga Khan University is setting up foundations for the programme. So many people either do it here or in Makerere in Uganda or abroad. The research domain has also lagged behind. We haven’t done a national survey to have a full picture of the burden of mental health in Kenya.

Has Kenya trained enough medical doctors and if not, what’s the gap?

We only have around 14,000 registered medical doctors and they are not enough for the population and even the few doctors who exist are confined in Nairobi, Eldoret and Mombasa, then few of them in those other areas.

For psychiatry, the number is around 120, yet about 400,000 people in the country are suffering from schizophrenia. Data shows that only five percent of this number has seen a psychiatrist.

Interestingly, schizophrenia is not one of the commonest mental illnesses, rather, depression, where about 25 percent of the population is affected. A recent study done in Nairobi and its environs showed that half of the people who sought treatment had some form of depression, but only about four percent were on any kind of treatment.

Which medical fields (specialisations) are worst hit by specialist shortages?

Psychiatry is one of those worst hit as it has among the fewest medical specialists in the country. Stigma around the field has also made it hard to have more people interested in the field.

What would you consider the greatest challenges to the training of medical personnel in Kenya?

The lack of enough funding by the government. Reduction of funding by the government to educational institutions has made it hard for universities to offer proper training as most of these institutions are reeling under huge debts.

What is the status of mental health care and treatment in Kenya?

Before 2019, we were at zero, but then in 2019, President Uhuru Kenyatta declared we have a mental health crisis, citing depression, suicide and substance abuse as some of the problems bedeviling the country, adding that something has to be done.

Towards the end of 2019, a taskforce on mental health was formed, which I was part of, and recommendations from the taskforce’s report are currently being implemented by the government.

Over the past five years or so, the landscape has changed. At the top level, things have improved, as they have at community level. People are now more welcoming of people with mental illness than before when it was difficult to come out.

What are we/have been doing wrong in terms of mental health and how can we improve? 

We have done a lot wrong. From before independence, we have handled each other with a lot of violence, inculcating a culture of violence in the entire society, which has now festered.

This has resulted in scars in our minds that will not heal unless we take deliberate efforts to stop the violence and start healing those who have experienced trauma and violence.

The created structural violence cannot be navigated by the vulnerable. Everything is war from politics to all other spheres of life. One has to have the access to wealth to access opportunities, leaving those without to resort to violence to have same access. This is the single biggest threat to the mental health of this country.

Is the recent surge in suicide cases in the country an indictment of a failure to prioritise mental health care?

Experiencing trauma and growing up in an environment full of the same constitute adverse childhood experience that grows into adulthood, resulting in all sorts of mental illnesses and psychological problems.
The reckless driving, road traffic crashes, suicides, and drug abuse are mental ill-health eruptions manifesting from the psychological injuries people have received over the years in this violent society.

What’s our mental state as a country? 

Kenya is an intellectually challenged toddler. We throw tantrums and resort to violence whenever we don’t get what we want, for instance burning tyres in the streets. Our engagements are “me first”, like two year-old toddlers. This is because we were founded on a lie which we have perpetuated through structural violence. We need to grow up, and soon.

You played a stellar role at Moi University’s School of Medicine. What were your achievements at the university? 

My greatest achievement was bringing institutional order, building institutions and protecting professionalism, establishing a reputation of excellence around the School of Medicine. We had the highest research output and some of the most innovative programmes in the region.

We set up the second master’s in medicine programme in Moi after the one in UoN and a new programme in the region, Bachelor of Science in Medical Psychology. There was also a master’s programme in clinical psychology and put in place a foundation for a PhD programme in the same.

My vision was to set up the school as a research and post-graduate institution that can compete with the best in the world, tapping from the best undergraduate programme that was already there.

We streamlined the post-graduate programme teaching, examination schedule, established innovative curriculum and begun the first clinical fellowship programmes.

Do you have any regrets regarding this period?

We didn’t grow to our fullest potential because of external forces, the biggest being shrinking government support. We had to look for external sources of funding to keep the medical school at the level required. Even salaries could not be paid on time.

What led you to The Aga Khan University and what's your vision for the university? 

I came here last year - AKU has been offering only post-graduate programmes, and I saw an opportunity to set up an undergraduate programme that will not only be a beacon for this region, but for the entire continent.

My vision is to set up a programme that will produce globally competitive doctors who will benefit from the best technology, resources that the world can offer. This will be possible through redesigning the medical curriculum to produce medical doctors of the 21st century.

What are the joys and pain of being Francis Atwoli’s son?

I grew up before the world knew the name Atwoli or associated it with my father, having had an average Nairobi Eastland’s upbringing.

His name began showing up when I was in medical school at Moi University, but over time, I have developed an identity that is quite different from that of my father. In public life, we do occupy completely different spaces that rarely overlap.

There has been no benefit or harm of being an Atwoli as I have charted out a path on my own before the name came up in public imagination. No interference but plenty of support. I have risen through the professional ladder without depending on the name or suffering because of carrying the name.

What is one quality that people do not know your father for?

My father is passionate, values and respects academics with education being the biggest contribution to our inheritance. He recognises education as an opportunity for people to start off better in life. It is something that he holds dearly.

There are many things you can argue with him about, but if you went to him asking for money for school fees, he will go out of his way and find the money. And this he does not only for his children, but also for hundreds of other people seeking support for education.

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