YAP proposal #117: Greenhouse Agribusiness for Kenyan Youth (Lizian Auma Onyango, Kenya)


Tomatoes grown in a greenhouse - credits Step Up Social Enterprise

I am Ms Lizian Auma Onyango, Kenyan, 22. I am in my final year of a Bachelor of Arts in Development Studies at Jomo Kenyatta University of Agriculture and Technology, Nairobi. I am a native and resident of Suba Sub-County of Homa Bay County in south-western Kenya. I am a community development enthusiast and my vision is to gain global knowledge, skills, and experiences in international development for practical, local impacts—starting with my community.

I want to work with and help rural youth 18–35 years (as defined by the Kenyan constitution) in my community to be decently self-employed and generate income through technology-oriented and market-driven farming as a business. That is, agribusiness. Poverty and unemployment are endemic in my community: in excess of 52% and 40%, respectively. Youth unemployment is even higher, estimated at more than 70%, leading to migration from this rural community to cities in search of elusive…

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It’s Okay to be an eight-five

It is almost 5 pm. The hours have been dragging with some notorious pace. You would think the clock doesn’t want to meet its fate at the other end of the day. Robert has been sitting behind his desk. Staring. He doesn’t realize that he’s been lost in a train of thoughts.

“I hate being employed”…he mutters to himself. “If only my business would pick up..”, he continues.

“I have to be rich by the time I reach 35. This wretched work environment cannot take me there…” .

Robert is not alone.

Many young Kenyans today yearn to be entrepreneurs. They long to attain financial freedom. They want to influence things and attract fame. They want to make lots of money. With money comes the easy life and social recognition. How we so hate living in obscurity!

As with Robert, many young Kenyans often have the wrong objectives for wanting to venture into entrepreneurship. Their sole objective is to make money and become famous. Granted, every business launched is in it to make money. That is the core design of capitalism. But when your sole aim of establishing a business is to amass wealth and become socially acceptable, then you are setting yourself up for a very big disappointment.

Social pressure

Many young Kenyans have been conditioned to believe that unless they launch their businesses and become self-employed, then they have not achieved anything. It is almost the same as being conditioned to believe that unless you own a parcel of land somewhere, then you have not achieved anything yet. So what happens is that young people like Robert live with a heavy weight on their shoulders. They want to fit in. They want to become somebody. It does not matter whether they have a passion for entrepreneurship in the first place. So long as he or she can introduce him or herself as an entrepreneur, then the details will follow later. But hey, there is nothing wrong with working eight-to-five for the rest of your professional life. Many millions of professionals have lived fulfilling lives knowing too well that entrepreneurship was not for them. So they made a conscious decision to plan their finances within the realms of formal employment. With that comes delayed gratification. Financial discipline is needed to make delayed gratification a success.

Every day social media and online material is inundated with young people who pontificate about how aspirations to build careers out of everyday eight-to-five is to have one’s vision in the wrong lane. These young men and women posit that one cannot attain professional fulfilment unless they are running their own enterprises. And so the race heats on. People are registering business with blistering pace as the race to become the next entrepreneur heats on. And part of the consequence is that majority of these businesses end up making the wrong statistics.



SME Sector

Studies done in the past have shown that out of every 5 small and medium enterprises that launch their operations, only 3 live to celebrate their third birthday. That is a 60% success rate, considering that youth unemployment stands at a staggering 67% of the total unemployed workforce. However, the SME sector’s contribution to the GDP is promising and thus youth enterprises should be encouraged. The SME sector has an employment absorption rate of between 12% – 14% and this figure is expected to grow considering that 98% of all registered business are from the informal sector.

But why do many young enterprises fail? The pressure to become entrepreneurs perhaps is too great for some to weather the storm. Many young minds will launch startups without enough managerial experience to help navigate the murky waters of the business world. When this happens, what follows is an array of poor business decisions, one-man show approach and a tendency to suffer founders’ syndrome. Coupled with poor financial management, since most can barely afford to hire financial experts to manage their books, the businesses’ only path is an assured oblivion.

In today’s start-up ecosystem, investors want to not only invest in businesses. More than that, they want to invest in people. When the people presenting their ideas have no known track record of business management, or any work experience, then getting an investor’s money becomes a hard-sell. What follows is frustrations with getting financing capital to plug any deficits that the business might be experiencing. Matters are not helped by the fact that financial institutions will only finance business that have gained some traction.

One foot in

A considerable segment of the young population will run businesses on the side as they also juggle with formal employment. For most, it is a means of making the extra bucks. I have been in that bandwagon. For some, it is a matter of waiting for the business to gain some traction before they can quit and run their outfit full time. But often, the result of such experiments is failed deliveries, disgruntled customers, and missed deadlines leading to missed opportunities. The biggest source of business is happy customers. When you fail to deliver because you could not convince your boss that you had to dash out to attend to an ‘emergency’ then your customers will find the next available service provider. When this starts happening, what follows is the cancer that has led to many business failing to celebrate their third birthdays.

We all have a role to play in our beloved Kenya. It is unfair to yourself and your customers to give expectations you know you may struggle to meet. Running a business requires a full time commitment. You cannot have it both ways and succeed. Those who quit formal employment to set up their outfits seldom fail. Why? They have the benefits of experience and the much needed time to form a personal relationship with the businesses and their clients.

If entrepreneurship is not for you, you need not apologize to anyone or feel like you are not an achiever. If running a business as a side job is too much work for you, then you owe it to everyone to quit and concentrate on the one thing that you know can give you fulfilment. If you feel a whole load of weight from your peers and mentors about launching a business, remind yourself that it is still okay to be an eight-to-five person.


Celebrating World Entrepreneurship Week 2015

November 20 2015 was just another ordinary day for millions of Kenyans. For the employed, they were now counting days to pay day. In a matter of weeks or days, their bank accounts would swell…and the vicious cycle of spending, borrowing and waiting for end month to repay debts would begin all over again. At the Strathmore University auditorium, young, ambitious Kenyans were busy selling their business ideas to potential investors and partners for possible funding and mentorship. The Hook-up Dinner, a monthly business networking event, has helped young entrepreneurs formulate and build business partnerships for young and budding entrepreneurs.

Launching a business today is much easier than it was 10 years ago. Technology is fuelling innovation in ways never seen before. As countries grow more and more towards knowledge –based economies, people are not leaving anything to chance. Businesses today are springing up and the internet has helped to bridge the information gap. Young university students take delight not in finding white collar jobs but launching start-ups. This trend should be encouraged. Granted, not everyone can become an entrepreneur, but those with any ounce of interest should be propelled to do something for themselves.

As the start-up scene has continued to grow, so also have we seen more rural-urban migration as young Kenyan entrepreneurs come to Nairobi either to find jobs or launch their dream. Sometimes this is inevitable. But oft times, this is deliberate, as over the years the country has been conditioned to believe that we can only make it when we operate our dreams from Nairobi. But I believe there is an opportunity that needs exploiting.

Kenya’s rural population stands at about 75% of the total population – according to the 2013 census. The number might have grown or shrunk. But that is beside the point. That percentage implies that the rural population stands at around 30 million. For business and startups, this provides a huge opportunity for market exploitation. There is no indication that business formed, bred and run from rural countryside cannot compete, excel and prosper in the global market place. On the contrary, global estimates indicate that the total market potential for this market stands at about USD 4 trillion. Which business leader would not want to tap into that market potential?

The obvious allure of the urban settlements acting as the preferred Launchpad for business cannot be ignored. Rural markets have their own share of challenges, from low literacy rates, to credit access challenges and access to financial services. However, tremendous leaps have been made, especially in the financial sector, to promote financial inclusion through digital finance and agent banking.

The rural economy is largely dependent ton agriculture. Agriculture accounts for a large share of Kenya’s GDP at about 32%. Sectors like fish farming, transportation, real estate and ICT can provide adequate avenue for business innovation. Transportation still remains a big challenge, largely due to poorly developed road networks. However, some of these challenges can be addressed within the framework of public-private partnerships.

Rural markets need not lag behind in fuelling economic development. Business innovation should not only exist within the realms of information and communication technology and the internet. Those who want set up new business can consider the rural population as valuable partners in the local market-based economy. The health sector can tap into this potential through eMedicine to provide simple online tools that can bring medical information closer to the people. The agricultural sector can play its part by providing innovative tools and platforms for knowledge sharing, knowledge management and collective bargaining for competitive prices. Those interested in distribution need to understand that there is a huge potential in the agricultural and dairy sector to build mutually beneficial services between farmers and the distributors. Those who want to address challenges in education can harness the huge potential in ICT to make learning fun and provide tools for real-time feedback.

The switch to rural-focused entrepreneurship will not happen overnight. The conviction will not be built quickly in entrepreneurs. However, those who already see the potential are already engaging rural markets as partners in the market place. Those who still remain lackadaisical will opt to adopt a wait-and-see stance. The global diffusion of the internet has enabled even people in the remotest of places to connect, engage and contribute. Business networking events like the one on Friday at Strathmore can begin spreading their wings to regional hubs to encourage citizen participation. Start-up accelerators like SPARK need to go out more and bring service delivery to the people. However, citizens also need to play their role and get their ideas out for criticism and panel-beating.

Rural markets have only one trajectory – growth. The opportunist have already struck while the iron is still hot. The naysayers will want to join the gravy train while the station has bolted.

There’s a new threat and it’s not ISIS.

As I write this article, France has just experienced a massive attack by terrorists who blew themselves up and injured scores of others in the process. The threat posed by ISIS, Al Shabab and other religious militia in the global arena is threatening to destabilize world peace and co-existence. But there is another threat that also threatens growth and progress. Like the ones already mentioned, it operates in subtlety and quiet. You never know when it hits you. And when it does, most people and organizations are left with nothing but a lot of egg in the face. Welcome to the world of cyber-terrorism.

Three weeks ago, I attended a cyber-security briefing at the Nairobi Serena. The study had been conducted by local security think-tank, Serianu, in partnership USIU. The report provides some revealing details at the level of preparedness and compliance by different organizations on matters security. Cyber-security and cyber-terrorism are nothing new. As the world has continued to advance in technological knowledge, so has cyber-threats continued to mutate and grow in sophistication. Out of the study, I picked two or three risk factors that I want to highlight.


Last week, proton Mail came under a sustained distributed denial of service attacks (DDoS) that knocked out an entire data centre and put other organizations as far as Russia off-line. The company, based in Switzerland, offers end-to-end email encryption services. Their cryptographic algorithms are so robust and sturdy that the attacks could not affect clients’ data. However, proton Mail had to pay ransom , in Bitcoins, to the attackers in order to regain service. The fact that Proton Technologies’ email platform would be under attack should be a cause for worry for every right thinking Chief Information Officer (CIO) and CEO. Cyber-security has become a market place and taken a commercial trajectory,  where hackers and organizations trade crypto-currency in exchange for data. The emergence of Bitcoin is a major factor in the proliferation of ransomware as a threat to online space. Bitcoin allows encrypted currency trading and hackers see this as a safe way to receive ransom without leaving traces. The Serianu study found that out of the total of 275 organizations surveyed, 21% are completely not concerned about cyber-security. This could only portend disaster in the offing! Ransomware is here to stay and will keep mutating in order to stay ahead of security systems. The question is: what are you doing to minimize the risks?

Social Engineering

Another threat worth mentioning is social engineering. Social engineering blends science, psychology and art. And it is extremely simple. That social engineering largely relies on human interaction is telling. The hacker will manipulate the other person into breaching regular security protocols and gain access into the system. Consider this. You receive a call telling you that you have won a jackpot. The caller proceeds to guide you through the procedure on how you can claim your reward. Because right now your mind is fixated on the ‘jackpot’ money, you do not pay attention to what is happening. Before you know it, you have logged into your m-pesa platform and transferred whatever amount was there to the social engineer. This is just a simple case of the phenomenon at play. Others are more sophisticated. Organization can and should worry about this threat to their data privacy. The best chance for mitigation is employee awareness. How many organizations in Kenya have a security policy? How many have conducted awareness training to their staff? Well, you would be shocked to find that the study reveals only 36% have conducted such training. A staggering 64% of the respondents have not conducted any awareness campaigns within their organizations. With such statistics, cyber-invaders don’t need any friends to gain access. In fact, it was reported that up to 20% of the respondents do not review current cyber-security news or threats. Most rely on social media for news.

Bring Your Own Device (BYOD)

Bring your Own Device policies should no longer just be restricted to computers and laptops. The mobile devices ecosystem has emerged as the new frontier for launching cyber-attacks. BYOD policies should extend to smartphones and tablets. How many of your employees use their smartphones to gain access to your local area network? What is the extent of their awareness to the security threats posed by such activities? While BYOD policies have been shown to increase productivity while reducing company costs on procurement of equipment, much should be done to ensure that privileged company data is not accessed through such devices. However, this is fast emerging as another channel for data breaches. It is not surprising that a high number of respondents, 97%, reported that their main concern on matters of cyber-threats is the financial systems. Only 3% reported having serious concerns with mobile devices as channels of breaches.

Way Forward

As a country, Kenya has not shown any level of preparedness to guard against attacks. Organizations are restricting budgets of security spending. Chief Technology Officers (CTOs) are not adequately updating their knowledge to keep up with the ever changing anatomy of the technological ecosystem. The Internet of Things (IoT) is gaining momentum and will soon be with us. We will see smartphones communicating with our television sets and our vehicles issuing commands to our water heating systems. How prepared are we to take advantage of technology? How prepared are we to mitigate risks and protect customer and organization data? Kenya cannot afford to treat cyber-security casually.

Clean Fuel: How do we create sustainable impact?

 At the height of the grand coalition government, then Prime Minister, Raila Odinga, came under vicious attacks from allies turned foes. The sin he had committed was the fact that he had decided to be the poster child of the Mau forest reclamation program. As we all now know, that was one of the biggest contributors to his political waterloo come election day.

Looking back, from this point in time, I can fully appreciate that the government efforts at the time were a part of a wider attempt to address the issues of declining forest cover in Kenya.

Today, many social business have set up shop to try address this problem through enterprise. As explained earlier in this forum, social business run on a triple bottom line model of people, profits and planet. That means they practice socially responsible businesses that can give out financial as well as social returns.

Many social entrepreneurs have developed a keen interest in the clean energy sector, and are setting up shop at a rate higher than we can say amen. The scramble for the African market by social enterprises is both incredible and interesting. Those eying the clean energy sector have a mission to address one impending global catastrophe – dwindling forest cover! By promoting clean cook-stoves and solar products, these companies offer alternatives to kerosene, wood fuel and charcoal. That they solve critical social challenges through business and enterprise is something worth lauding. However, sometimes the numbers presented can mislead.

Social Impacts

A number of companies dealing in clean cook-stoves have posted numbers of trees they have saved by selling non-traditional wood-based fuel like charcoal. It is typical of social enterprises to measure the positive impacts of their ventures by giving numbers and figures as a measure of the scale of impact created.


The numbers look good, especially from a social impact perspective. You cannot simply ignore the socio-economic impacts of such initiatives. Whereas women and children would spend countless hours collecting firewood, now all they need to do is refill their cook-stove and go. It’s like a plug and play system. This act itself frees up hours running into their millions each year. The economic value created for the country and its workforce is also invaluable. That is not to leave out aspects of knowledge and skills transfer that come with working in such environments. However, amidst all these positives, I believe there is one glaring gap.

Dwindling forest cover

Kenya’s forest cover currently stands at less than 2%. The country’s forest cover has seen a reduction of 8% between 1981- 1988, while another 14% reduction was recorded between 1990 till the mid 2000’s. This trend does not augur well for the country’s as well as the global climate.

Measuring the level of forest cover reclaimed as an impact of selling clean cook stoves is easier. Crunching the number of hectares saved based on the number of people adopting cleaner cooking methods is straightforward. But does measuring this impact based on the total number of units sold paint a factual picture of what is happening? Do people stop cutting forests to burn charcoal because others have found alternatives? Do traders see these clean cook stoves as a threat to their business? How many clean cook stoves will it take to completely wipe out illegal logging? I believe that while the mission is critical and noble, most companies are addressing these issues from the wrong end. So what should be done?

Supply-side Considerations

The current players in the clean energy sector cannot out-compete those dealing in traditional cooking fuels. Industry statistics posit that 84% of the Kenyan population is still using traditional cooking methods. A study conducted also revealed that only 7% -9% of the population have access to LPG fuel and the majority are situated in Kenya’s urban and per-urban centres. What this means is that as long as illegal charcoal traders continue to satisfy the demand of the rural folks, adoption of clean energy cooking methods will take time. I would argue that if social businesses keen to address this catastrophe were to make any meaningful impact, then they must tackle this problem from both sides. Market-based approaches to solving such problems hold much promise. Incorporating charcoal traders as business partners and suppliers of clean fuel like pellets would be a good place to start. Other companies like SAFI who promote industrial ethanol as an alternative to kerosene can also start by building a community of suppliers on one end, thus inhibiting the growth of the supply side of charcoal, at the same time, driving adoption of clean cook stoves through timely supply, pricing, demos and civic education, and thus addressing the demand side by accelerating demand. However, to concentrate in the urban informal settlements is to miss the point. Majority of the slum dwellers will use electricity which is available cheaply and sometimes – illegally.

Way Forward

I strongly believe that as long as we address critical social challenges from the wrong ends, for example, the boardrooms, nothing tangible will be registered. The clean energy sector has so much promise and the potential to drive Kenya to a middle-income economy. What is required is for all the players to play their part diligently and avoid cosmetic prescriptions to such problems.  Community as well as government participation is very crucial in promoting buy-in and driving adoption. With a double-pronged strategy attacking deforestation and charcoal trade from both the demand and the supply side, forest regeneration will no longer be a question of if but when.

Can Kenya change this narrative?

“Africa is an article of faith. I believe in this continent” ~~ Sunil Bharti Mittal

Africa is experiencing a kind of revitalization in the entrepreneurship sector, thanks to social enterprises. Businesses that focus on the triple bottom line, that is, people, planet and profits, are springing up every other month. Focus has shifted to Africa. Kenya is having its fair share of attention from founders, co-founders, investors and other such expatriates.

Expatriates are experts of European or Caucasian extraction who come and apply their skills in the developing world. On the other hand, experts of African extraction who go abroad to lend their skill to the developed world are not called expatriates but ‘immigrants.’ I still wonder where the big deal or the big difference is. But that is a story for another day.

Social entrepreneurship is the buzzword today. The new kid on the block has come up with vengeance. It is threatening the hegemony enjoyed by NGO’s and civil societies in attracting funding. Social enterprises attract people who have achieved self- actualization and are just seeking to regain social returns on their investment. These people with deep pockets inject copious amounts of funding to startups throughout the world. But they don’t just splash money around just because they have it. If getting these people’s attention is an arduous task, then getting their money is a ‘camel through the eye of the needle situation.” But the big problem is not attracting the funds. The issue that has been nibbling at me is the kind of message portrayed out there to get these monies.

It has generally been accepted that Africa is an ironical tragedy. Classic curse of luck, or lack of it. That the richest continent could also be the poorest is a story that should only be discussed in hushed tones. But the biggest tragedy for me, is that Africa has become the poster-child for attracting funding. And the only one reason that makes Africa so appealing for investors to quickly part with their cash is – you guessed right – POVERTY. It is a tragedy that Africa has generally accepted the fact that it will be the face of poverty and that dirty children and unkempt mothers’ photos will be displayed in air-conditioned, high-ceilinged, sound-proof convention centers through power point in order to get business capital.


The numerous social enterprises that set up shop in Kenya always have one rider – “women and children”. You hardly ever go to any social enterprise convention without being inundated with stories of how children suffer poverty and how women bear the biggest brunt of social evils. These are stories that are attractive to the investors. You see, investors might have spent their lifetime accumulating wealth either through legal or unscrupulous means. What social investing does for their ego is to assuage it. Gives them the feel good factor. “After all, I gave back.” They would say. But that does not and should not lend credence to the fact that the only African story told at these social enterprise conventions is that of poor women and malnourished children. Countries like India, as are many other countries in Asia, have even more poor populations than Kenya. Out of India’s 1.2 billion population, 55% live in poverty. That is about 650 million people living from hand to mouth. An oxford study found that one third of the global poor live in India. Other countries such as Cambodia, Laos, Vietnam among other Asian countries live in abject poverty. In Europe, poverty is measured in relation to the median living standard of each country. That means that it is not possible to compare the poor in Europe versus the poor in Asia or Africa. But the truth is that European populations also experience poverty, based on the living standards there, just as Africa also does, based on our living standards. Overall, 80 million people in the European union ( 16.4%) live below the poverty threshold, with countries such as Greece, Romania, Bulgaria among other Eastern European countries experiencing the heaviest poverty pangs.


A Market Place

The most basic reason why Africa has become lucrative for social enterprises is that it offers a ready market place for goods and services. Yes, the startup environment must be very competitive in the west. The same applies to South Africa. But elsewhere in Africa, Kenya in particular, markets remain unexploited. Starting a business locally is much easier, but sustaining the same is the problem. A study conducted by the World Bank reported that out of every five small and medium size enterprises that launch in Kenya, only 2 live to see their third birthday. The reason for this a startup environment that is not even or favorable. Therefore, for the social entrepreneurs from the west, east or Europe, who come with streams of financial backing, best-in-class mentorship, streams of data and data-driven approach as well as international community of business networks, the going certainly seems much easier.

Changing the narrative

While it is true that social enterprises are modeled on the triple bottom line of people, profits and planets, the same might not be the case especially when you lift the veil off some of these operations. I believe it is time that most businesses looking for funding changed their narratives. Yes, Africa is poor, but then that would mean giving more of handouts than goods for a price. The poor in Africa can also afford some basic utilities and that is why they need to be engaged more as business partners or customers rather than recipients of free ground-breaking and innovative goods or services. It is not true that social enterprises exist to help the poor in slums. For helping means providing support without expecting anything in return. Social businesses actually exist in some form of symbiotic arrangement with the poor – their customers. The base of the pyramid is a $5trillion business opportunity. As much as the markets are informal, it does not mean that they will always expect handouts. They are willing to pay for the solutions that solve their problems. In a nutshell, Africa must refuse to be the poster child for poverty in those investor-dominated conferences. The trend must be reversed, one mind at a time!

Spina Bifida: Curse or Ignorance ?

Striking doctors. Nurses on a go-slow. Patients sharing beds and beddings. Health equipment in crutches. Successive governments steeped in lethargy and arrogance. Expensive medical supplies as well as astronomical surgical fees. Such adjectives cannot inspire much promise if they are what one can find to describe a health sector. But that is exactly the case for Kenya’s health sector, which continues to dangle precariously between hopeful promise and total collapse. But Kenya’s case is not all gloom, to be fair to the level of incompetence that hogs our health sector boardrooms. Her Excellency The First Lady, Margaret Kenyatta, has catapulted the health sector into the national and global limelight with her #BeyondZero campaign.  Beyond Zero is about promoting maternal health throughout Kenya which would translate to lower infant mortality.

Maternal health is very critical to the well being of both mother and child. The periods prior to conception, to the time of conception and the succeeding months can determine whether a woman would bring forth a healthy baby, or a child imbued with health complications and financial burden.

Kenya is grappling with myriads of health-related cases every single day. Cancer has become a ubiquitous thorn in the flesh in our medical parlance. Diabetes is increasingly becoming commonplace and diseases such as cholera and dysentery have an almost assured presence in our midst. When these kinds of ailments are what one has to deal with on an almost daily basis, then conditions such as spina bifida and hydrocephalus are wont to take a back seat.

Spina bifida is a congenital condition that affects the spine, causing it not to close completely. This happens within the first 28 days of pregnancy. Doctors and researchers have posited that spina bifida comes about due to lack of enough folic acid in the system. If that happens, then spina bifida for the foetus is almost inevitable.  There are not many reported cases of spina bifida or hydrocephalus. Bethany Kids, a paediatric unit based at Kijabe Hospital, reported 1893 cases of hydrocephalus and 1032 cases of spina bifida between 2004 and 2008. The cases could be more, especially if such conditions occur in far flung areas such as Mandera, Garissa or even Lamu.  But why is it that there is only a few thousand cases reported of this condition? Could it be that Kenya mothers are generally healthy during pregnancy? Or are we witnessing a reduction in the number of children borne with this congenital defect? There could be a number of reasons as to why there is only a handful of cases reported of this birth defect.

Lack of Information

“In Kenya no data exist on countrywide prevalence due to high mortality rate, infanticide in rural communities, and the concealment of children with the disabilities. The data available demonstrate a steady rise in the number of cases treated each year. This may be attributed to increased awareness of the diseases and treatment options.” ~ Johanna Christensen.

When one of my twin sons was borne and we discovered he had spina bifida, we were at loss as to why this would happen. Pre-natal visits had indicated that he had a swollen forehead (indications of hydrocephalus) but nothing had prepared us for what was to come. At Aga Khan Hospital, in Kisumu, the paediatric surgeon informed us that the boy had spina bifida (myelomeningocele) and that we needed to give the boy 6 months for the back to heal before surgery could be considered. The good surgeon insisted that nothing could be done at that state. He also informed us that after 6 months, the boy would undergo shunting, an invasive surgical procedure that has a pipe-like device inserted under the skin running from the brain and terminating into the abdomen to drain excessive cerebro-spinal fluid (CSF). He informed us that the “wound” would have to be dressed every alternate day for the next 6 months. Over the next few days, as I internalized the magnitude of what I was facing, and the realization that one of my boys had a birth defect that would render him disabled, I decided that I needed to gather as much information as possible. Thanks to google and the internet, I spent countless hours scouring internet pages reading about the condition and treatment procedures. I suddenly felt like an authority in the field of this kind of birth defect. One thing kept coming up though: that this defect was treated as an emergency and kids born with spina bifida and hydrocephalus had to go through emergency surgical treatment. Other hospitals in the developed countries performed emergency surgical procedure in utero (inside the womb). Faced with a local paediatric authority talking about one thing, and online articles advising another, I decided to seek a second opinion – from the country’s best neurosurgeon. His verdict was the same. Surgery after 2 weeks – shunting first, and then closing the protruding spine later. I was not convinced, for online articles had indicated that there were ground-breaking technology in this field that were minimally invasive while at the same time boasting high success rates.

This experience alone revealed to me that when a patient or care-giver lacks information, they will jump at the first opinion. They will be more convinced if it is an authority. In my conversations with people who had gone through similar situations, I got to learn that thousands who went to Kenyatta had to wait up to six months before they could get a surgical ward. Perhaps by this time, they would have given up altogether, or their kids having passed on to the after world. The situation is also not helped by doctors out for a kill, who will not volunteer any useful information that would help such patients receive the best medical care at minimal costs.

Social Stigma

During our stay in Uganda, as the boy awaited his date with the surgeon, we were subjected to endless counselling sessions with a social worker and a chaplain. What came out of these interactions was that many parents suffered stigma as a result of bringing forth children with congenital spina bifida. There were reported cases of husbands neglecting their families altogether, or chasing away mother and child. Certain tribes in Eastern Uganda treated this as a curse and had to kill the child to avert further calamities.  Johanna Christensen, in her journal, Marginalization & Stigmatization: Spina Bifida & Hydrocephalus, writes about families in the coastal region of Kenya who hide their children suffering from hydrocephalus. She reveals in her article how some husbands refuse to provide money for treatment, or run away from home altogether. The study reveals how kids who suffer this condition face stigma and ridicule from their peers, especially if they have to deal with incontinence. My conversations with the social worker also brought about issues of witchcraft. The good lady kept asking me if I thought my son was cursed, or somebody from my village had bewitched him. All these issues point to a society that feel ostracized when faced with these kind of social problems. Dr. David Chapman, who reviewed 164 cases of spina bifida in Durban, South Africa, wrote:

“The baby is a source of exceptional anxiety for the parents. How are they to manage the sac, ulcerated, weeping cerebrospinal fluid, and likely to rupture? They are constantly reminded of their guilt. The burden is heavy. One parent may reject the child while the other shows special love. The outcome of treatment involves the clinician in complex moral and ethical tangles.”

Social Class

My visit to Uganda exposed me to the kind of social class that has to bear the biggest brunt of spina bifida and hydrocephalus. I increasingly saw pictures of poor rural women and absentee husbands. I was one of the few husbands who accompanied their wives to seek medical treatment for their kids. This could point to a few issues. Either, the family could be in dire financial constraints, that they have to trade off the little there is, with both parents going to the hospital. It could also be that the husbands are just plain stubborn. In Kijabe’s Bethany Hospital, many people who come for treatment, from all over the country, are families of modest means. That is not to say that spina bifida is a poor man’s condition. But there are indications that those who cannot afford folic acid supplements during pregnancy face the biggest risk of bearing children with the condition.

It is also possible that few cases are reported because families with modest financial means cannot afford medical attention. Others who believe that their children are under a curse seek the opinion of traditional healers or “waganga”. All these factors combine to deny the country much needed information on the condition.

In conclusion, lack of information is driving families to make uninformed choices and costly mistakes. Lack of medical know-how is causing families lots of trauma when they have to see their children under-go multiple surgical procedures to correct this and that. Through my internet research, I discovered that hydrocephalus could be treated through a minimally invasive procedure called Endoscopic Third Ventriculostomy or ETV, with choroid plexus cauterization. I also discovered that no hospital did this best other than Cure Children’s Hospital in Mbale Uganda. Kijabe’s Bethany Children also conducted the procedure, but at a limited level. Many close associates could not understand how I would leave Kenya, a country at a higher economic level than Uganda, and go and seek treatment there. But if there were other hospitals that performed this ground-breaking surgical procedure in the country, the information was just not there. And this is best captured by Dr. M Miles when he writes:

“In his major survey of African neurosurgery, Adeloye (1989) made no direct mention of third ventriculostomy; but in 2001 he discusses recent improvements in neuroendoscopic technology which might suggest that third ventriculostomy for hydrocephalus could have a revival in East Africa, fifty years after Jarvis’s reports of it in Nairobi, but now with vastly more effective instruments, technique and an evidence-based theory of ventricular functioning.”

Note: This blog has been inspired by the challenges I have gone through as a parent raising a son born with the congenital defect Spina Bifida and Hydrocephalus.