In 1983, Moi’s personal physician Dr Antonia Bagshawe emigrated to Australia to enter private practice in Perth.
Soon after that Jerry Kiereini, head of the civil service, sent me a letter announcing my appointment to replace her. I was surprised and flattered by the honour.
I was to receive a monthly honorarium of Sh4,000 (about $350 at the time).
I had been seeing Moi intermittently over the past five years whenever he had a cardiac concern. Antonia had already approached me to ask if I would take over her role.
Naturally, I would have to be extremely discreet, she warned me. As I was to learn later from Moi himself, my big draw was being a foreigner and, by implication, apolitical.
This was something that I came to appreciate sooner than expected when political events threatened to split Kenya apart.
How Dr Silverstein became Moi's doctor
I thought the appointment would be an interim one as Africanisation was in full flow and several of my colleagues were very interested in having the job. Moi would have first call on my time and attention. This included accompanying him on all international travel.
Although these duties and responsibilities would at times take me away from my patients, the experience seemed more than sufficient compensation for any professional and financial drawbacks.
Contrary to the opinion of those pundits who believed that African leaders like Moi made a public display of their faith for political reasons, I soon discovered that the President maintained a strict schedule, rising at 5am each day to read the Bible, working ten to twelve hours and retiring early.
I saw him regularly once a week, usually on Tuesday mornings between 6am and 7am. I kept my visits brief — 15 to 20 minutes — out of respect for his busy schedule. Unless he had a specific complaint, these sessions routinely consisted of pulse and blood pressure readings and a few questions to help me gauge how he was doing.
Then we would enjoy a cup of chai masala together but not before he had said a silent prayer. During these few minutes we chatted about our favourite subjects. The latest medical developments, the application of the Old Testament in today’s world, international politics and Israel.
He was remarkably fit for his age but, like most people, he had a few medical idiosyncrasies. One was a condition called an arcus, a white circle around the irises of his eyes.
It gave him a strong penetrating gaze, which he put to good use at cabinet meetings and when addressing large crowds. Moi also had a space between his bottom teeth like many Kalenjin adults. When he was a child two bottom teeth had been removed to allow fluids to be administered should he suffer lockjaw from tetanus. Hundreds of thousands of babies used to die from it each year.
It was only during his presidency that massive tetanus vaccination campaigns significantly reduced the incidence of lockjaw. Later in life when Moi needed advanced dental work, he insisted that the space between his teeth be left as it was. He did not want to be seen as indulging in the vanity of cosmetic dentistry.
When my team worked with him, he thanked each staff member after every test and check-up with warmth and sincerity.
Dr Silverstein on how Moi handled rumours about his health
He would often end his session at the Nairobi Hospital by having coffee and biscuits with the radiologists Dr Bowry and Dr Talwar and their staff as he could now break his fast. He chatted easily with them and was never at a loss for conversation.
Every Christmas he gave me a sum of money to buy gifts for my staff to show his personal appreciation for their work and dedication.
He was an exemplary patient, always following my advice on medicine, diet and lifestyle. However, should politics intervene, he took his own counsel. Although a public figure, Moi was strictly private about his health. He made it clear I was not to release any information without his authorisation. In 1991, Moi got an Achilles tendonitis, and an orthopaedic colleague put on a plaster cast to allow it to heal.
In those days the national media covered Moi’s schedule on a daily basis. When he failed to attend church that Sunday, rumours and speculation began to circulate. He was ill. He was in hospital. He had died.
I got calls from politicians and friends from all over the world asking if they should rush back to Nairobi. I suggested to Moi he give a press conference so people could see he was well. He was having none of it.
“David, I didn’t start these rumours. It’s not my responsibility to end them.”
The minute the cast was removed at State House, Moi underwent a Clark Kent transformation into Superman. Gone was the passive patient. Back was the assertive Head of State. He jumped into his car and headed for Parliament. On the way the motorcade came to a sudden halt outside the Kenya Army Headquarters. Moi stepped out of the car and chatted to a group of people waiting at a bus stop.
There was another unscheduled stop downtown when he bought some food from a roadside stand. It attracted a small crowd as he stood there eating and talking to passing pedestrians. All this was well covered in the press. It was Moi’s way of sending out the message. The father of the nation was strong, healthy and in command. Once when we were in England for medical tests Moi found out that the sister of a Kenyan medical professor was a patient in the same hospital.
She was being treated for cancer. After his endoscopy, he passed by her room even though he should have first rested. In the middle of the visit, he felt ill and excused himself. He went to the washroom, vomited, washed and returned to continue the conversation.
When we returned to Kenya, he invited her to State House and handed her an envelope as she left: “You’ve been through financial hardship. This will help.”
Moi never summoned me for anything trivial, and I was always put through to him promptly when I called. He valued my time as he did his own. Occasionally at his request I would attend to his family, his friends and associates. In each case he insisted on promptly paying my regular fee.
There was only one issue on which I could not sway him. He worked too many hours. I even resorted to quoting Exodus where Jethro advised his son-in-law Moses, “…the things you are doing are not right. You will surely wear yourself out. Make it easier for yourself and let them share the burden.”
This did not dent his work ethic. Nor does it influence mine, much to Channa’s chagrin.
Whenever the president required medical treatment, I would try to coincide it with an official overseas meeting to dampen speculation about his state of health. Usually he only needed routine check-ups, but in June 2000 I diagnosed Moi with an entrapment syndrome.
Simply put, it is pressure on a nerve that can result in a range of outcomes from numbness to pain to muscle wasting. A common example of this is carpal tunnel syndrome, usually due to repetitive motion, where the median nerve is impeded as it passes through the wrist’s carpal tunnel on its way to the hand. Moi was suffering muscle atrophy in both his hands due to entrapment syndrome in his elbows. His ulnar nerves in both arms were being crowded by adjacent tissue. It can be fixed with a straightforward surgical procedure. An operation was duly scheduled to be performed in London.
On our way there we were to make a brief stop in Crans Montana, a Swiss mountain resort, where Moi had been invited to address an international economic forum.
I enjoyed dinner with Sally Kosgei at the hotel on our first night. Her position as the permanent secretary in the foreign affairs ministry meant she invariably came on these trips. We were by then seasoned veterans of countless trips and enjoyed sharing stories.
Sally was amusing and told a good tale. A favourite topic was the changing faces of the delegations as government officials came and went. We also used to trade stories on how presidential travel had impacted our lives, for better or worse.
I mentioned how my family and friends thought of the trips as a paid holiday, unaware of how stressful and tiring they could be. In my practice, for example, it meant that I was kept up at ungodly hours in distant time zones, monitoring the progress of my critical patients back in Nairobi.
Of course, neither of us would have ever wanted to give up our front-row seats to Kenyan history in the making.
The next day we toured the resort’s alpine museum and cheese cellar. Moi was a farmer at heart and so took an interest in the Swiss dairy cows. We also visited the Cave St-Michele vineyards for wine tasting. Moi politely sipped the crisp white wines though his palate preferred the sweet ceremonial kosher wines from Israel that he and Charles Njonjo discovered and enjoyed at my house. During the wine tasting I noticed the president was short of breath.
I wasn’t surprised. He was hypertensive and had been nursing a cold. We were 9600 feet above sea level, and it was cold.
The next morning I listened to his heart and detected rapid atrial fibrillation, an irregular and fast heart rhythm. I confirmed the diagnosis with my portable ECG machine. My immediate concern was the possibility of blood clots developing in his heart’s left atrium. They could break off and go to his brain causing a stroke.
President Daniel arap Moi greets supporters after he was sworn in for his final five-year term.
Photo credit: File | Nation Media Group
I went into town in search of blood thinners. Several pharmacists, not understanding my mixture of English and broken German, mistakenly believed I wanted narcotics and refused to help me. Finally I secured heparin, a blood thinner.
I administered it to Moi, who said he felt fine. He was nearly seventy-seven and robust for his age. Even so I was more than mildly concerned by the turn of events. I phoned Dr Steve Jenkins in London. He was a friend and an excellent cardiologist. I told him I wanted to enlist his help the moment we landed in England. Twenty years earlier, Steve had done me the favour of taking on my patient load, locum tenens, when I was called away from Nairobi.
I also contacted Dr Maurice Slapak, the brother of my dear friend Charles Szlapak. He was a retired transplant surgeon who also lived in London. I asked for his assistance too. Maurice knew the London medical community well.
He said he would be happy to make the necessary arrangements for Moi’s expected treatment of electric shock (cardioversion) to restore his normal heartbeat. We checked into the Mayfair Intercontinental.
Moi went to his room, and I called a meeting in mine. After discussing the issues and options with Jenkins and Slapak, I went to Moi and explained the situation to him in private. To make sure I wasn’t putting him through an unnecessary procedure, I took a second ECG. It confirmed my finding. There was no question he needed the treatment. Moi wasn’t upset by what I told him. He said I should do whatever I needed to do.
Jenkins told Moi to eat nothing after midnight and instructed me to have the president at London’s Cromwell Hospital first thing in the morning. Everything went according to plan. Moi was put under total anaesthesia. This differed from my Nairobi practice where I use pain medication if needed and conscious sedation so that the patient has complete airway control and can follow commands but has no memory of the event.
Dr Jenkins administered two jolts of electricity to shock Moi’s heart back into a normal sinus rhythm. He was then put on a course of oral anticoagulants. I breathed a great sigh of relief when we returned to Kenya.
The trip certainly hadn’t been the paid vacation my friends talked about. The responsibility of keeping the president in good health could be extremely stressful. That was certainly the case on this trip. I was happy to be home and return to my clinic. All had ended well. Moi never required shocking again for this cardiac arrhythmia. His entrapment syndrome was repaired on a subsequent visit to London.
