Lucy Wairimu Mukuria was at home going about her chores when she heard some minor explosions.
She ignored them, reassuring herself that it was just the neighbourhood boys playing, but was in for a surprise.
One of the boys thought it would be funny to set off a the fireworks near her. When he did, Ms Mukuria broke into tears and only regained her composure after her daughter and hugged her.
“That incident was humbling. I thought I was doing well. I felt disappointed as I wasn’t doing any better,” the retired army major said.
Ms Mukuria suffers from Post-Traumatic Stress Disorder (PTSD). What might seem like a minor incident brings back bad memories from Somalia, where she often travelled. She was a military psychologist for 11 years.
Initially, Ms Mukuria was reluctant to admit that she had been scarred by war.
Then tragedy struck her family. Her brother, who had also been to Somalia with the army, killed his son.
Ms Mukuria’s own reactions to the trauma she witnessed in Somalia brought the realisation that something was seriously wrong.
Psychologists in the military work with the soldiers and are also called upon to support their families when they are killed or injured in war.
“I used to go to the hospital. My palms would start sweating when I went to the wards or as I took family members to the mortuary. Then I would cry,” she recalled.
She would be virtually dysfunctional in those times. The USIU — Africa graduate later realised that she needed help.
“I denied suffering from PTSD. That wasn’t good. I took the easy way out. Nobody is immune to psychological suffering. Not even the psychologist herself,” she said.
She attributes her denial to the way she had been trained to approach her job.
“It was negatively framed. Like you’re supposed to be mawe (tough), but that is not human. I think that is why I denied it. It denied other people the ability to help me. They did the moment I allowed it,” she said.
Ms Mukuria was fortunate to recognise that she had a problem and sought help. Other military personnel have not been that fortunate.
Dr Susan Gitau has been counselling Kenya Defence Forces soldiers since 2012, when she was asked to debrief 248 troops who had returned from Somalia.
One of the soldiers she handled, a captain, was her neighbour in Thika.
He had served in Somalia twice but came back a broken man. He eventually killed himself.
“Before Somalia, Kenyan soldiers had not been involved in a major war and there was no alarm about PTSD. Things are now different. There is a big number of soldiers, who are returning home broken. Not even their families or the society know how to handle them,” Dr Gitau said.
“Society idolises soldiers and this makes the already bad situation worse.”
PTSD manifests itself in the form of flashbacks. It returns the person to the state he or she was in when the traumatic event happened.
Some can react dangerously and even hurt or kill people.
Dr Gitau said that if PTSD is not treated, it only takes a slight trigger for the patient to experience battlefield flashbacks.
If the flashbacks keep recurring, the soldier develops acute PTSD. When the condition becomes chronic, some begin abusing drugs.
“The war flashbacks often occur when the soldier sees something he experienced in the battlefield like blood or an image of a suicide bomber. The image become a trigger,” she added.
The problem is usually passed on to close family members. They are often confronted by a changed husband and father.
“The war is also fought by wives, who know nothing about dealing with someone who wakes up at night and begins strangling them,” Ms Mukuria said.
“The context is that all this time, they live with the threat of being ambushed and attacked. One goes home one day and is supposed to get into bed with his wife, something he has not done for months. At night, the person lying next to you moves and you react.”
Dr Gitau said PTSD makes a person who was once calm and collected — like many soldiers are — highly irritable.
They also tend to become hyper vigilant. They jerk, wake up at night and pace around the room and develop panic attacks that become part of their lives.
The worst bit comes when hopelessness sets in.
“They take drug overdoses and develop substance disorder,” she said.
People with PTSD experience recurrent negative thoughts and emotions. Typically, someone who always had a smile on their face and loved being around becomes disinterested in people, family and work.
“This happens because the victim has not been treated and has reached a level of hopelessness. If they are tested for depression, the results show a very high level of PTSD. At such a moment, you are not sure if the person will be alive next time you see him or her,” Dr Gitau explained.
She added that most soldiers she has handled do not want to talk about their battlefield experiences and often become defensive when the topic is introduced. The soldiers also blame their leaders for sending them to battle.
Ms Jessica Kiplagat’s husband, Sammy Morell, was a changed man when he returned from Somalia for the first time.
“My husband looked confused and often talked alone. He also became quarrelsome, picking up fights over very minor issues,” she said.
The helicopter pilot became a smoker and a heavy drinker. He also kept to himself most of the time.
“No one, not even the military, cared. He did not get any help,” Mrs Kiplagat recalled.
Soldiers who survive deadly attacks often suffer from “survivor’s guilt”.
According to Dr Gitau, they are affected by the fact that they survived while the people they trained, lived, travelled and then eventually came under attack with, died.
With funerals, families and the events that follow, the survivor’s guilt grows.
Even as other people celebrate the fact that the soldier did not die, he plunges towards depression.
“You live with these people who are happy because you are alive. But you are like ‘what does it mean?’. That can weigh on somebody, depending on their level of emotional intelligence and social support,” Ms Mukuria said.
Top military officers also suffer from the “commander’s guilt”. This happens when the soldiers they sent out to fight end up dead or missing in action.
“Unfortunately, we live in a society where men and emotions are synonymous. The truth is, the things that drive men to be strong, to man up, are actually anxiety and fear,” said Ms Mukuria.
When they cannot bear being in dangerous situations anymore, some soldiers leave without permission, finding their way home and into hiding.
They become deserters, a serious offence in the military. Such soldiers are hunted down and court-martialed. They are eventually thrown into prison along with rapists, robbers, murderers and other offenders.
Paul, not his real name, is a man on the run. He sits near the exit whenever he goes to social places and is constantly on the lookout.
Paul fled from his unit’s camp in Somalia where he had been deployed for the second time. He had made it clear that he did not want to go back.
His childhood dream of being a soldier has ended. Paul feels he became a liability to the army, his wife and child.
Paul said that whenever he closes his eyes at times, he sees himself in the battlefield, stumbling over the bodies of his colleagues and villagers.
“In the quiet moments of the day, when I am seated around people, I see the faces of wives, children, husbands, mothers and fathers whose lives I destroyed,” he added.
He has not sought professional help and believes the nightmares will somehow go away. Paul’s greatest fear is what will happen to him and his family when the military finally finds him.
For retired Corporal Abdi Awi, the voices in his head started when he came back from Somalia. He was among the first members of the transport division, based at Kahawa Barracks, Nairobi, to cross the border in October 2011.
“The thing used to make me quarrel my wife and beat her,” Mr Awi said.
He met Ms Mukuria for counselling when both were serving. That did not work out and he was dismissed in October 2015 after being found with rolls of bhang. He is now homeless.
Ms Mukuria bumped into Mr Awi in Lang’ata, Nairobi, this year. Horrified at his drastically changed life, she took a video that was later posted on Facebook.
“I had just taken lunch and was heading home when I saw this street man,” Ms Mukuria said.
She added that his skin was black with accumulated dirt, his clothes in tatters and his legs were skinny.
Mr Awi had a hood that partially covered his face.
“I looked at the face and knew who he was. Our eyes locked and we knew each other,” she said.
When he called her “Madam”, the respectful salutation that her juniors in the army used, she was embarrassed and angry.
Ms Mukuria said that while she had not done enough to convince her professional colleagues that the military was not taking enough care of its people, she had also not done enough to support her former colleagues.
“I was like, ‘may be, all the talk is the problem. Maybe if they heard from somebody who is the manifestation of what this talk is about, it will awaken understanding in some people, some compassion and empathy and people will be moved not by anger, but by compassion’,” she said.
Despite the prevalence of the problem within its ranks, the KDF has not done much to institutionalise the treatment and care of soldiers with PTSD.
Experts say that a soldier who goes to war should be psychologically screened before and after the mission. Unfortunately, that never happens.
PTSD requires discipline from the patient, said Dr Gitau, adding that most of the soldiers she has handled do not go through all the therapy sessions.
She said the biggest problem with the KDF is that those affected are only sent to seek help when PTSD becomes acute.
While the natural temptation is to question the military and its methods, such as tracking down deserters or dismissing them when they show signs of PTSD, Ms Mukuria advised against criticising the KDF.
“People want to embarrass the Armed Forces. The military doesn’t have a face. It is not a person. It’s a system and it will crush you. It is there for its own image and survival,” she said.
For Dr Gitau, it goes beyond the military.
“This is a societal problem. It is high time the private sector, the society and the government joined forces to provide help to our veterans. They need to be appreciated and recognised for keeping our borders safe,” Dr Gitau said.
When Ms Mukuria took the decision to leave the army, she wrote a two-week treatment programme for soldiers with PTSD and set up the NGO True North.
Her aim was to address the emotional and cognitive aspects contributing to the drug use, violence, suicide and the wandering off that she had observed.
She used her lump sum pension payment to fund the first phase. Ms Mukuria also approached institutions and individuals to support her cause. She knew she was onto something when those she approached agreed to help. Her treatment also involves getting to the soldiers’ families.
“If you really want to support this person up to recovery, you have to help them and their immediate family. And not just the immediate family, but also the other people this person relates with. It could mean a friend, cousin or someone from the extended family,” she said.
Counselling worked for Ms Kiplagat when her husband died in a copter crash in Lamu in 2015.
She suffered for a while, ravaged by the stress that came with knowing how her husband died and fighting with her in-laws. Her young son also constantly asked for his father.
Ms Kiplagat was later introduced to Dr Gitau, who counselled her and treated her for PTSD.
“Dr Gitau was of great help. She explained to us the reality of widowhood and how to deal with it. And all this was free of charge. Counselling in this country is pretty expensive and beyond most women whose husbands have died in combat,” she said.
“For one, they are mostly young, without steady sources of income. That means they cannot afford it.”
She added that counselling made her a better person.
“I’m now able to go out and meet my friends and have a drink with them, unlike the past when I remained indoors. I also share my experiences,” Ms Kiplagat said.
Ms Mukuria advised against confronting someone with PTSD or in the case of the military, reaching out to a commander or colleague.
“When you notice something is out of place, the first thing should not be ‘You need help’. It should be ‘I am concerned because I have noticed. Might you want to share with me and if not me, might I be able to help you to actually get linkages to people who can help you? I am here for you.’ That’s what we can do,” she said.
Ms Mukuria compared recovery from PTSD to what alcoholics go through: Working to avoid exposure to triggers and fighting the temptations that may come about.
For soldiers, the work they do has to support their recovery and they cannot be in an environment that triggers anxiety.
Dr Gitau said people with PTSD need care and compassion because when they re-experience the battlefield trauma, they become violent, turn to the bottle and become highly paranoid.
When she realised the extent of the problem, Dr Gitau established a counselling centre at Thika Barracks, where she offers her services to veterans for free.
She also trains soldiers as peer counsellors. They go on to help others, especially in combat zones.
“The soldiers are armed with mechanisms that help them deal with PTSD and they cope better. Healing is a process. It is a collaborative affair between the therapist and the soldier,” she said.
If the symptoms are beyond the counsellor’s intervention, soldiers are referred to the soldier clinical psychologists who administer drugs. If they are beyond the clinical psychologists, they are put in a safe place where they are closely monitored until they recover.
Dr Gitau said preventive counselling is the best PTSD treatment.
“We offer psychological First Aid where soldiers are trained and are able to tell the signs of PTSD,” she said.
The debriefings are basically therapy sessions, where soldiers are trained in psychological First Aid before they are deployed. This makes them keep one another safe, track each other’s psychological wellness and being able to tell PTSD symptoms. The debriefings also help to establish a referral system.
Kenya has very few trauma specialists and the best solution is to equip military counsellors, volunteers and peer counsellors with intervention skills.
Despite its apparent shortcomings, Ms Mukuria still loves the military and has dedicated her life to serving veterans through her NGO.
However, she advised against thinking that PTSD is a problem for the military. “There is no ‘military people’,” she said, “There is a Kenyan society.”
Reported by Dave Opiyo, Joan Njaro, James Okong’o, Rose Ng’ang’a and John Ngirachu. The five are students at the Aga Khan University’s Graduate School of Media and Communications and this story is part of a Solutions Journalism project
Public officers above 58 years and with pre-existing conditions told to work from home: The Standard
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
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Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
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Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.
Uhuru convenes summit to review rising Covid-19 cases: The Standard
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
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Drastic life changes affecting mental health
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