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‘Culture is hard to break’: Kenya’s medical schools face a shortage of cadavers | Global health

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Scalpel in hand, Carl Mwangi, a first-year medical student at the University of Nairobi, slices through the brain tissue. “To figure out where the vessels are, you have to dig in deeper,” he says, excited to be dissecting a human brain for the first time. But if he wants to do more dissections, the aspiring neurosurgeon will have to secure one of only 10 places on the anatomy programme here.

Only postgraduate students and those specialising in anatomy are able to get hands-on dissection experience as Kenya’s oldest medical school grapples with a shortage of cadavers. Until recently, medical students would spend at least 250 hours on dissection in their first year. However, most students now learn through prosection – examining bodies that have already been cut open. Up to 12 students have to learn using one cadaver in anatomy class.

“Undergraduates’ exposure [to dissections] has reduced drastically,” says Musa Misiani, an anatomy tutor at the university, who is concerned how this will affect future teaching.

Carl Mwangi studies with textbooks and a laptop.
Carl Mwangi hopes to become a neurosurgeon. Photograph: Patrick Meinhardt/The Guardian

More medical schools – Kenya now has 12 – and higher enrolment rates have increased demand for cadavers. These are mainly sourced from morgues, which can hand over bodies if they have not been claimed after 21 days and efforts have been made to contact relatives.

Nairobi university has a body donation programme but has only received two to three annually over the last five years. Awareness of the programme is low, even among medical students.

“Accessing the bodies through traditional means is becoming more of a challenge,” says Prof Moses Obimbo, head of the human anatomy department. “We need to inform our people of the importance of body donation. We try to be innovative but if we run out of these resources to train, and one of the key resources is cadavers, I foresee a fall in standards of medical school training.”

Friends and relatives pull a coffin out of a hearse, Nairobi, Kenya.
Family members have been known to contest body donation bequests, preferring to bury the body. Photograph: Patrick Meinhardt/The Guardian

It’s not a new challenge for the school. When it first opened in 1967, founder Joseph Mungai had to source corpses from a medical school in neighbouring Uganda. But the situation is now serious, and speaks to a wider issue about attitudes in Kenya towards donating bodies and organs to science .

A 2016 study of students at the university showed that while surgical trainees and medical students would recommend people donate their bodies to science, nearly 50% are not inclined to do so themselves, citing cultural and religious reasons. Some feared their bodies would be excessively mutilated or mishandled.

View of a coffin at Lee Funeral Home in Nairobi, Kenya, on January 19, 2023.
Last year the University of Nairobi held its first memorial service for body donors. Photograph: Patrick Meinhardt/The Guardian

A wider study that included other Kenyan medical schools found that even among those willing to donate follow-through can vary. Potential donors don’t always sign a donation card or include the bequest in their will. Family members have contested bequests to the University of Nairobi. “We live in a cultural context, and people in Kenya want to bury their dead,” says Misiani. “That’s one of the biggest barriers.”

To encourage more donations while taking on board people’s sensitivities, the university has started conducting burials for cadavers after they’ve been used. Last year, it held its first memorial service for body donors.

Morticians say medical schools could do more to source bodies. A more formal arrangement could be made between mortuaries and medical schools. About 100 unclaimed bodies from Mbagathi hospital in Nairobi were buried last year but could have been used for research.

Former humanitarian worker Philip Ogola
Former humanitarian worker Philip Ogola, 46, has decided to donate his body after death. His family say they are not sure whether they will honour his wishes. Photograph: Patrick Meinhardt/The Guardian

After having a front row seat on health emergencies, Philip Ogola, 46, a former humanitarian worker from Nairobi, wants to donate his body or his organs to science. “You see people appealing for blood, bone marrow, eyes,” he says, but even though the need is dire, there’s often no response to public appeals, except for those made by prominent people. “It made me wonder: why do people only donate when there’s a disaster? As a country, we don’t have a donation culture.”

Medics say the country is also in urgent need of organ donors with a significant number of patients dying each year because they can’t find a match.

Ogola’s family are not pleased with his decision to donate. “Why does he want to do that when he knows our traditions?” asks his mother, Angelina Awinom, his next of kin. “I’ve had so many thoughts since I found out about it. Where would his body be taken and what would be done with it? It has caused me a lot of grief.”

The decision, she said, would be an unwelcome surprise to relatives and friends in their village in Siaya, western Kenya, where burial traditions hold particular importance, and a number of rites call for an intact body. Awinom, a practising Christian, is unsure if she will respect her son’s wishes if the time comes. “Even if I do it, it will not be with a willing heart,” she says.

A hand holding a pot containing a cornea.
A donated cornea ready for transplant at Lions SightFirst Eye Hospital in Loresho, Nairobi. Photograph: Patrick Meinhardt/The Guardian

Ogola is due to have a cornea transplant at Lions SightFirst Eye hospital, a private facility in the city. About 1,000 people are on the waiting list. The hospital receives an average of 15 cornea donations a month, and now mostly relies on local donations.

Christopher Mwangala, the hospital’s eye bank coordinator, would like Kenya to make organ donation the legal default at death – unless a person opts out – to increase donor numbers and save, or improve, many lives. Similar policies have been adopted in countries across the world, despite some debate on the efficacy of the opt-out system.

“That’s the only way we can get donations,” says Mwangala. “Culture is hard to break.”

Late last year, Kenya launched the Tissue and Transplant Authority – replacing the health ministry’s previous department – to encourage donations through regulations that protect organ donors and recipients. It also aims to make organ transplants – still largely a preserve of the privileged – more accessible.

Three medical students study
Carl Mwangi, right, studies with some of his classmates inside their dorm at Nairobi University Residences. Photograph: Patrick Meinhardt/The Guardian

Poor regulation has allowed room for an illicit trade in organs , which the authority hopes to curb. Officials admit they are “playing catch-up” and have much work to do. “We are coming into an environment where we are regulating what’s already being practised,” says Alfred Obengo, chair of the authority.

Medical students say they are not learning enough about organ donations and transplants. Only about 3% of students felt confident in their knowledge on the subject, and less than 10% were familiar with the country’s transplant laws.

Ogola does not plan to change his mind about donation. “We need to normalise these conversations,” he says. “It’s the only way to end the stigma.”

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Uganda condemned for ‘shameful’ decision to close UN human rights office | Global development

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Rights activists and campaigners have condemned the Ugandan government’s decision to shut down the country’s UN human rights office, describing it as “shameful”.

In a letter to the Office of the UN high commissioner for human rights (OHCHR) in Uganda dated 3 February, the foreign affairs ministry said it will not renew the host country agreement it signed with the OHCHR, which established its initial mandate in the country in 2005. The current mandate, signed on 9 February 2020, expires in August.

“The government of Uganda will now continue its cooperation with the OHCHR Headquarters either directly or through its Permanent Mission in Geneva,” reads the letter.

The development comes less than three months after the UN’s committee against torture adopted the concluding observations on Uganda, which raised concerns that torture and ill-treatment continued to be frequently practised, and called for investigation and prosecution of security officials accused of excessive use of force, violence and arbitrary detention.

“The closure of the @UNHumanRightsUG office proves that [the] government has lost all sense of shame. It no longer wants any close international scrutiny of its human rights record,” tweeted Adrian Jjuuko, executive director of the Human Rights Awareness and Promotion Forum.

“If the protectors are sent away, what then happens to those they were protecting? We are headed for tough times,” he added.

Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure.
Adrian Jjuuko, (speaking, centre left) executive director of the Human Rights Awareness and Promotion Forum, has condemned the OHCHR closure. Photograph: Alice McCool

Bobi Wine, the reggae singer turned Ugandan opposition leader, whose supporters remain in unauthorised places of detention or “safe houses”, said it was no surprise that Uganda’s president, Yoweri Museveni, who has been in power since 1986, has closed the OHCHR. He tweeted: “In the face of growing international condemnation and isolation, tyrant Museveni has responded by shutting down NGOs, Facebook, DGF [Democratic Governance Facility] & declaring several internationals Persona Non-Grata or deporting them! Now he shuts down @UNHumanRightsUG.”

Wine added: “You’ll recall in the aftermath of the 2021 election and the hundreds killed or abducted by the Museveni regime, we petitioned the UN Human Rights Office & the military brutalised journalists right there. This UN Office condemned these actions. Not surprising it’s being closed.”

Human right activists and advocacy groups have called the decision a “mockery” and accused the government of running from international scrutiny on abuse and protection of human rights.

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“This is unbelievable, and the reasons given by the government are a mockery of the real state of human rights in the country,” said Jjuuko. “To claim that Uganda no longer needs the office [OHCHR] because of its strong stand for human rights is ironic to say the least.

“A strong stand for human rights would imply opening up to the UN and other actors.”

David Livingstone Sewanyana, founder of the Foundation for Human Rights Initiative in the capital, Kampala, told the Guardian, “The decision not to renew the mandate deprives Uganda of a critical player in the field of human rights promotion and protection.”

At least 38 local and international staff at the head office in Kampala and two field offices in Gulu and Moroto stand to lose their jobs.

Jjuuko said: “Following closely on the closure of the DGF, this is a scary move which indicates that the government is no longer willing to have its human rights record scrutinised by international actors.

“This leaves local organisations at much more risk of being further silenced and their work curtailed without the government fearing close international security. It is a sad day indeed for the human rights movement in Uganda.”



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2023 State of the Union address, live | Biden will call for collaboration with Republicans | USA

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On the List: Biden’s guests at the State of the Union address

In the highly theatrical ritual of the State of the Union address, delivered each year by the President of the United States to a joint audience of congressmen and senators on Capitol Hill, the most eagerly awaited list in the hours leading up to the address is that of those invited by the President himself to attend his speech on the floor of the House of Representatives. They are carefully chosen to underscore with their presence the points the president wants to emphasize. This year they range from rock stars (Bono) to anonymous citizens unwittingly placed at the center of a whirlwind of tragedy and media attention, such as the parents of Memphis teen Tyre Nichols, the latest name to enter the history of police brutality infamy in the country.
 
What follows is a list of some of those illustrious guests at tonight’s speech in Washington: 

Bono. Singer of the Irish band U2 and activist for the most varied causes, for whose fight he deploys his worldwide fame.

Oksana Markarova, the Ukrainian ambassador to the United States. She was already invited last year, when Biden’s first speech came six days after the Russian invasion of Ukraine. Nearly a year later, the end of the war seems far off, but the U.S. commitment to Kiev’s cause remains unwavering.

Row Vaughn and Rodney Wells, mother and stepfather of Tyre Nichols. Five police officers beat him to death last month in Memphis. His case, and the poise of his parents, have reopened the debate about police brutality in the United States, an issue that seemed on the mend after the chokehold death of African-American George Floyd at the hands of a white Minneapolis police officer on May 25, 2020. 

Brandon Tsay, another anonymous man at the center of American political power. Tsay disarmed the killer of 11 people in one of the latest mass shootings to horrify the country. It happened in Monterey Park, California, and the tragedy ripped the Asian American community in half. 

Deanna Branch. Lead was found in her son’s blood because of water coming out of the home’s plumbing. The Biden Administration has set a goal of replacing all lead pipes in the country within the next decade.

Mitzi Colin Lopez. Immigrant rights activist, specializing in advocacy for dreamers.  

Doug Griffin of Newton, New Hampshire. Lost a daughter to a fentanyl overdose. Biden plans to stress the importance of the fight against opioids. The drugs have taken the lives of 100,000 Americans by 2022.

Amanda Zurawski, Texas neighbor. She almost died because of restrictive anti-abortion laws that came out of the Supreme Court ruling that eliminated a woman’s federal right to choose.

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High-profile lawsuit against Meta can be heard in Kenya, Nairobi court rules | Global development

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A Kenyan court has ruled that a case brought against Facebook by a former content moderator can go ahead.

Daniel Motaung, who was hired as a Facebook content moderator by the tech firm’s subcontractor Sama in 2019, filed a suit against the two companies last year, alleging that he had been exposed to graphic and traumatic content at work, without adequate prior knowledge or proper psychosocial support – which he says left him with post-traumatic stress disorder.

He also claimed he was unfairly dismissed after trying to unionise his co-workers to fight for better conditions.

Facebook’s parent company, Meta, contested its involvement in the case, saying that Sama was Motaung’s employer, and Meta could not be subjected to a hearing in Kenyan courts because it was not registered, and did not operate, in the country.

However, on Monday the judge found that the tech giant was a “proper party” to the case.

The Kenya employment and labour relations court is yet to release its full ruling on Motaung’s case, but the decision – the first of its kind in Africa – is already being hailed as a win for the accountability of big tech on the continent, and in the global south.

“If the attempt by [Meta] to avoid Kenyan justice had succeeded, it would have undermined the fundamental tenets of access to justice and equality under the law in favour of foreign privilege,” said Irũngũ Houghton, executive director of Amnesty International Kenya.

“We finally have an avenue for accountability,” said Odanga Madung, senior researcher for platform integrity at Mozilla. “It calls for tech giants to make serious changes within their companies that take into consideration their workers and users outside the US and Europe.”

Cori Crider, director of Foxglove, a UK tech justice non-profit, which supported the Motaung case, said social media platforms should not outsource critical online safety functions like content moderation. “It is the core function of the business. Without the work of these moderators, social media is unusable. When they are not able to do their jobs safely or well, social media’s safety brutally falters.”

Meta is facing a second court case in Kenya, which was due to be heard this week but has been postponed. It was filed by two Ethiopian petitioners and a Kenyan rights advocacy group, Katiba Institute, who claim that the company failed to take online safety measures to manage hate speech on the platform during northern Ethiopia’s civil war – which they say fanned the conflict, with serious offline consequences.

Mercy Mutemi, a lawyer for the plaintiffs in a second case against Meta due to be heard in Kenya, outside a Nairobi court in December.
Mercy Mutemi, a lawyer for the plaintiffs in a second case against Meta due to be heard in Kenya, outside a Nairobi court in December. Photograph: Anadolu Agency/Getty Images

The father of one of the petitioners was killed after a violent Facebook post that was reported, but not acted on in time. The petitioners claim that Facebook also failed to recruit enough moderation staff to its regional hub in Nairobi.

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“There are problems with Facebook’s woeful failure to value or to staff content moderation outside of the English-speaking United States,” said Crider, adding that Monday’s ruling could have global and regional implications on how tech firms think about and manage content moderation.

Leah Kimathi, a convenor for the Council for Responsible Social Media, agrees. “Big tech should not just look at Kenyans as a market, but should be accountable and alive to the nuances, needs and peculiarities of Kenya, especially when it comes to content moderation.”

Facebook has more than 13 million users in Kenya. It and Meta’s WhatsApp are the most commonly used social media platforms in the country.

A nationwide poll conducted in 2022 by the Council for Responsible Social Media showed that 68% of Kenyans who have internet access get their news from social media, and that a majority of these feel that social media platforms could do more to remove harmful content.

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