When Moi retired from politics in 2002, our travels together on State business came to an end, bringing a long and enjoyable chapter in my life to a close.
There was a point when the international trips became routine. In late 2002 on a night flight returning to Kenya from Washington via London, I was in first class two rows from the President.
I was dozing when I was awakened by the familiar voice of former US President Bill Clinton. He and Moi were discussing opportunities for the Clinton Foundation and the Moi Foundation to work together following Moi’s imminent retirement.
I peeked out of a corner of my eyeshades to confirm it indeed was Clinton then rolled over and fell back to sleep once more. Presidents no longer excited me. I needed my sleep.
I can’t say I miss the official trips. Fun, enlightening and often exciting at first, over time they became physically exhausting as well as personally and professionally disruptive. It was a relief to finally remove them from my list of responsibilities.
When Moi was no longer president our relationship changed, especially as he entered his nineties. He and I became more informal and friendlier with each other. He regularly moved back and forth between Nairobi and his farm in Kabarak near Nakuru.
Dr Silverstein on how Moi handled rumours about his health
As soon as he was back in the capital, I would be called to see him early the next morning. He was no longer rushed so there was time to talk, usually about his favourite topics — religion, domestic and international politics.
As the years went by, he spent more and more time at his farm and I flew there at least every one to two weeks. There were more medical issues as he aged, mostly arthritis or problems with his teeth or his eyes.
When he was in Nairobi, Channa (Dr Silverstein’s wife) and I would regularly arrange dinners with Mzee and some of his closest friends. Each time I would change the venue.
Initially, the dinners were at our house, then we sometimes held them at the Serena Hotel, the Fairview or other restaurants. Latterly, our venue became Sally Kosgei’s house. Charles and Margaret Njonjo were a must for these get-togethers.
The late President Daniel Arap Moi.
Photo credit: File Photo
The other regulars were Jerry and Muringo Kiereini and Sally Kosgei. We had other guests on occasion, such as Richard Leakey, the Israeli ambassador, and Abraham and Mary Kiptanui.
At the end of one of these meals Charles pushed back his chair and stood up. ‘As the eldest of this group, I would like to make a speech.’
Moi pushed back his chair and stood up too. ‘You are wrong. I am the eldest. You have forgotten I was driving cattle on foot over long distances in 1936.’
If I miss anything from my two decades as the President’s personal physician, it was the small and unrequested privileges accorded me. Petty annoyances were quickly resolved.
Our phones and electricity in town and at the farm always worked. When they didn’t, the service was reconnected immediately. I never stood in bureaucratic queues. I was always taken care of by senior personnel.
Requests to intervene on someone’s behalf always made me uncomfortable, and I nearly always declined. There were occasional exceptions when I saw that a friend or colleague was being treated unjustly. In my opinion, this was not an abuse of power.
There is one example that stands out in my memory. One of my medical colleagues was arrested for the alleged manslaughter of a politician’s wife. She had died of a common complication from a difficult surgery that he had performed. He was remanded in jail under terrible conditions.
Former President Daniel arap Moi (seated) is taken through the voter registration exercise by Mr Stephen Ngeno of the Independent Electoral Boundaries Commission at his Kabarak home in Rongai constituency on November 19, 2012. Photo\SIMON SIELE
Photo credit: File | Nation Media Group
I was outraged by this and spoke to Attorney-General Amos Wako and President Moi. They agreed to help me transfer him immediately to Nairobi Hospital. I was able to keep him there for the next several days under the guise of medical management for a possible heart attack until his lawyer, Byron Georgiadis, got him released on bail. He was soon cleared of all charges. I believed that using my position to get justice was not an abuse of power.
Charles Njonjo was of a like mind. I once asked him what he missed most from his days in power. His answer surprised me. ‘I don’t miss the politics, Kijana (young man). I don’t miss the power. The only thing I miss is the ability to pick up the phone and change people’s lives, protect them from injustice and help them get what they deserve. I can’t do that anymore.’
In 2017 I noticed with concern that Moi was having increasing difficulty in walking. I brought in Dr Hadi Manji, a Kenyan-born neurologist at the National Hospital for Neurology and Neurosurgery in London.
He reviewed Moi’s extensive medical history and conducted tests. Nothing explained his muscle weakness. I was not the only one who was concerned.
On New Year’s Eve that year I received a call from Moi’s youngest son Gideon. He asked if we could meet. I assumed he meant after the holidays, but no, Gideon wanted to see me at once. He arrived at the farm the next morning in his helicopter. His father’s physical deterioration, Gideon told me, had him deeply distressed.
He said that he wanted everything possible done to arrive at a definitive diagnosis and treatment, no matter where in the world we needed to go to get it.
I explained to Gideon that pressing the case further might well be an exercise in futility, reminding him his father was in his nineties. He persisted and urged me to consider going outside of Kenya where more advanced medical technologies would be available.
His first suggestion was Germany because we had had a very good experience in Essen with Moi’s aortic aneurysm repair by Professor Christophe Broelsch. I agreed that Germany offered fine facilities and expert care but suggested we consider Israel, where his father could receive top-notch treatment and visit holy places. Mzee was always moved by his trips to Israel and had often mentioned how much he wanted to return for a religious visit.
Gideon was excited and asked me to proceed with it at once. ‘Israel is the land of miracles,’ he said. Dr Manji returned in mid-January and examined Moi once more, noting his significant decline in mobility in just a few months.
We conferred and decided to focus on Moi’s spine as the possible source of his spreading weakness, or perhaps the nerves that spread into the body from the spine or alternatively, their connections to muscle tissue. Our diagnostic tool would be an MRI.
Late the next evening we conducted an extensive series of scans requiring several hours to complete. Moi stoically endured the torture of lying on the hard table for hours, and then thanked us all for our trouble. Our hopes for a definitive diagnosis, however, remained unrealised.
Getting Moi to Israel was a nightmare. We selected one of the country’s very few private hospitals and forwarded all of the President’s medical records. I also recruited my well-connected friend Aryeh Glozer to help with arrangements. No luck.
The hospital informed us that in their view there was nothing more to be done for Moi than what we had already done. Taking a patient for whom they could do nothing further, they said, made no sense and would only hurt their reputation. Fortunately, Aryeh and I both knew a senior doctor at Tel Aviv’s Ichilov Medical Center.
It is Israel’s third-largest hospital and one of its finest, capable of performing the latest and most sophisticated nerve conduction studies. But first, we had to get Moi there.
We determined that transporting him the roughly 3,000 miles from Nairobi to Tel Aviv by private jet was our best choice. It certainly wasn’t the easiest.
The comptroller’s office neglected to send Shino Aviation, our air charter service, the required advance payment, jeopardising the whole trip. Only Gideon’s personal intervention with the government bureaucracy saved the operation.
I asked Channa to come with us. She is an experienced nurse practitioner, familiar with medical evacuations and very good at logistics. She was very fond of Moi as he was of her, especially having experienced her nursing skills when he underwent the abdominal aortic aneurysm surgery in Germany. Her expertise would be critical at several junctures of the expedition.
Departure was scheduled for early morning in the hope of avoiding press attention, particularly as Moi would be in a wheelchair. Unfortunately, several social media sites covertly covered the departure, which was complicated by equipment problems.
The apparatus meant to hoist Moi aboard was incompatible with the aircraft. The nursing team and security detail had to carry him up the stairs and into the plane. Similar difficulties awaited us in Tel Aviv, but with the assistance of Jon Chessoni, the acting Kenyan ambassador and son of my late friend Chief Justice Zach Chesoni.
How Dr Silverstein became Moi's doctor
We got Moi out of the airport and to his hotel near the medical center. The accommodation – the best available – was modest by presidential norms, but Mzee was exhausted from the trip and happy for a bed. He fell asleep almost at once.
The next day the medical centre admitted Moi into one of its very few single rooms while Hadi Manji, Gideon Moi and I met with the heads of the centre’s departments of neurology, orthopedic surgery and rehabilitation. An extensive set of advanced diagnostic tests was then performed. The results, once again, were inconclusive.
There was nothing more to do except a muscle biopsy, the results of which would not be known for several weeks. It was about this moment that the internet lit up with stories that Moi was dead or dying accompanied by photos taken at the airport as we struggled to get the President aboard the aircraft.
Newspapers were taking an interest in the story. It threatened to go viral unless we interceded. John Lokorio, the State House comptroller, asked Lee Njiru, Moi’s longtime head of the presidential press unit, to dispel the rumours. Lee assured his old contacts Moi was well.
Even though the biopsy was a relatively simple procedure, it became an administrative conundrum. My morning began at 6.45 am in the hospital shop where I encountered the President’s butler, Paul Kirui, buying fruit juice for Mzee’s room. When I asked Paul where he was at that moment, he replied Mzee was on the Minus One floor, one level below us.
‘Yes, you arranged it,’ Paul said.
‘Oh, yes, that’s the word.’ He smiled politely. ‘Sorry for my English.’
More confusion greeted me at Minus One where I encountered Mzee on a gurney. With him were Frederick Kibichii, his personal nurse, as well as his aide-de-camp and security personnel.
It transpired that the Israeli nurses spoke very little English and were having trouble communicating with Moi. As the head of the hospital had arranged the procedure informally the night before, Moi was not on the surgical schedule. The nurses did not know when or who was doing what. Nor had a surgical consent form been signed.
To add to their confusion, they were not accustomed to patients such as this tall African man of undeniable stature who was surrounded by an entourage of men who, in contrast to the informality of Israelis, were all wearing tailored suits. Fortunately, my Hebrew was good enough to overcome these obstacles, and the procedure went ahead without more issues cropping up.
The comptroller’s office back in State House again failed to send the required funds so Gideon’s wife, Zahra, covered the hospital costs with her personal credit card. We thus were able to spring him free from the hospital. The first stop was the InterContinental Hotel in Tel Aviv where we made Moi comfortable in the presidential suite on the top floor.
Former President Daniel arap Moi welcomes ODM leader Raila Odinga in his Kabarak home on April 12, 2018. PHOTO | COURTESY
Photo credit: File Photo
Its breathtaking view of the Mediterranean Sea immediately energised him. He became enthusiastic about everything Israeli, especially Israeli fresh fruit, dried figs, dates and breads. It is a cuisine not unlike that described in the Bible.
He loved the sparkling ‘Israeli water’, which was really Perrier but written in Hebrew, and said he wanted to continue drinking it. When he returned home I made sure he did.
Early the next morning after breakfast we set out for Jerusalem on the spiritual leg of his journey. As we pointed out various sights to Mzee, his voice changed and became charged with energy. He was becoming progressively more animated.
We all were excited as we entered the narrow, walled lanes of the Old City of Jerusalem.
How Moi doctor, Dr Silverstein, came to Kenya
Just before we reached our first stop, a young Israeli security officer joined us as anticipated and warmly greeted Mzee. Our guide for the Church of the Holy Sepulchre in the Old City of Jerusalem was Shmulik Avyatar, once the chief of the Mossad in Kenya. He was now in his late seventies and pursuing a second career as a tour guide. Like Moi, Avyatar was deeply religious.
The stone complex dates from the 4th century. Avyatar explained that it encompasses two of Christianity’s holiest places,
Golgotha where Jesus was crucified and His tomb. We climbed a slight rise to the site of the crucifixion. Then we moved to a large slab where Jesus’ body was prepared for being interred.
Moi said to me in Swahili, ‘Look Daktari! This is where Jesus was put after his death.’
Everyone wanted to touch the stone, and Mzee was no exception. I took several photos of him with the rock slab, his face lit with excitement. There was a long line of tourists waiting to see Jesus’ tomb.
Moi was shown to the head of the queue by two Greek Orthodox clerics wearing long black vestments. I thought it would be too taxing for him to negotiate the tunnel into the crypt, but I was wrong. He lingered for a long time. When he emerged, he was beaming.
Our second stop was the Wailing Wall. It is one of the very few structures that has survived from the Romans’ destruction of the second temple in 70 AD. Although Moi had visited the Wailing Wall before, it was still a special moment for him.
By now he was tiring. After a brief visit with Israeli diplomats, we returned to Tel Aviv. The trip had inspired him and he radiated happiness. He retired without dinner. The next morning after I had conducted my usual, brief physical exam he announced that we had to make the pilgrimage again and bring along Charles Njonjo. At that Channa suggested we call Njonjo. She got through to Kenya and put him on the phone with Moi.
‘Charles,’ he bellowed into the mouthpiece, ‘I’m in Israel, and I just saw where Jesus was buried. I touched the rock where He was placed before burial. You must come here on our next trip so you can enjoy this also.’
It was Saturday, Shabbat. We were scheduled to leave early on Sunday. A diplomatic team from the Kenyan embassy came by in small groups for short visits with the President, and to have their pictures taken with him.
Channa and I busied ourselves with organising everything for the flight. Mzee’s happiness was evident on the long flight home. As I identified points of interest along the way, he nodded and smiled with excitement as if he’d imbibed some elixir that had led him into a new realm of being.
After a few weeks, I received a letter from our colleagues at the Ichilov Medical Center. Having analysed the results of the biopsy report in minute detail, they said they were able to eliminate all of the ominous neurological diagnoses we had considered.
It appeared, simply enough, that Moi’s muscle loss was primarily due to disuse. He wasn’t getting enough exercise because he had fallen into the habit of accepting the assistance of the strong men around him. This is not unusual among the elderly.
It was great news. At least we could now act rather than wonder what to do. For this, I give credit to Gideon for his insistence that we take Mzee overseas for medical treatment. From then on with aggressive physiotherapy and the special equipment we had brought back from Israel we were able to help him recondition.
In the year following this trip his spirits remained high and his condition continued to improve. But even as a man of science, I’d think it hasty not to consider how in the Church of the Holy Sepulchre a man of such abiding faith might have experienced something wonderful and beyond explanation. Besides, Israel is the home of miracles.
Mzee continued to improve fairly dramatically with the help of a full-time physiotherapist. By this time I was flying in weekly to see him at Kabarak, occasionally bringing close friends such as Charles Njonjo and Sally Kosgei. He received visiting dignitaries too and always enjoyed his family coming to see him.
The mornings were best for him. In the afternoons when he tired he became somewhat confused. I continued to enjoy our conversations with his great insights and memories just as we had been doing for more than 40 years. His physical condition had improved, and he was able to walk between parallel bars.
In December 2018 I received a phone call from his nurse Fredrick that his oxygen saturation level had dropped lower than usual. Gideon decided to have him flown by helicopter from the farm to Nairobi.
After landing at his home at Kabarnet Gardens, he was brought to the hospital. Moi looked very tired and was far less communicative although he recognised everybody. I had the radiographer waiting in his room and a chest X-ray was taken immediately.
By this time his oxygen saturation had dropped to 65 per cent on room air. The normal level at Nairobi altitude is 93 per cent and above. The chest X-ray showed the entire left lung was opacified. A subsequent CT scan showed that there was a collection of fluid causing his lung to collapse. It also showed pneumonia in the left lung.
The pressure was relieved with the insertion of a chest tube to drain the fluid, and his breathing improved. My next concern became the cause. We took repeated samples of fluid as well as doing a bronchoscopy to rule out the most likely cause, which was cancer. None of the procedures showed any evidence of cancer.
Over the next several months, Mzee developed diabetes and we admitted him to the hospital repeatedly. He remained very brave, stoic and trusting despite his discomfort.
As I watched his gradual decline, I felt very conflicted. It was my policy to discuss advance directives for end-of-life care with patients while they were mentally competent to understand their prognosis and make their wishes known.
This entailed asking whether they would want to be kept alive by being put on artificial ventilation or be subjected to tube feeding, dialysis or painful investigations. Or would they like to be treated in a hospice fashion to make sure they were comfortable and didn’t suffer during their final journey.
To this day, I feel guilty that I did not have this conversation early. It was my responsibility to initiate a discussion, particularly as Mzee never brought it up himself.
For some reason, probably because he was who he was and because of the cultural differences, the conversation never happened. Autonomy — the right of competent adults to make their own decisions — is one of the first principles of medical ethics.
With the increasing fallibility of his cognitive functions, Moi reached the stage where decision-making passed on to the next of kin. I had the end-of-life conversation with Gideon on several occasions and later with all the sons. It was made clear to me that in their cultural setting the input of the daughters was not necessary.
The family wanted everything done to keep Mzee alive. Gideon, who was closest to their father, acted as the family spokesperson and his proxy.
Mzee’s oldest son Jonathan died from pancreatic cancer on April 20, 2019. After that Moi deteriorated rapidly. Jonathan had been much closer to his mother Lena and had a very difficult relationship with his father. Gideon had initially decided against telling Mzee about Jonathan’s rapidly growing cancer.
I suggested that he tell him as Jonathan’s condition was incurable and his death would come soon. I offered to go with him. He agreed that we do this when he returned from a trip out of the country. Unfortunately this never happened. Jonathan developed clots in his legs that went to his lungs. He died just three weeks after the cancer diagnosis had been made.
The morning after his death it was on social media. We were sure Mzee would hear about it either from the television or from one of his friends. It was agreed I would fly to Kabarak to join the whole family there. As Gideon was still overseas it fell to Raymond, who was now the oldest son, to break the news to Mzee.
While we waited for him to arrive, Mzee and I had tea together and chatted about this and that. Raymond and Mzee had their conversation in Kalenjin.
The old man was understandably very shocked. He kept on asking again and again if it was really true that Jonathan was dead. The difficult relationship that had endured for the past 30 years must have made the loss of his eldest son even harder to bear.
The funeral was attended by hundreds. Mzee was in no position to go, physically or emotionally. Charles Njonjo and I and other close friends sat with him and watched the service on television. He was then driven to the private burial.
After that Mzee’s deterioration became more rapid. He developed recurrent infections and required blood transfusions.
His lungs began accumulating fluid once more. Chest tubes had to be reinserted on several occasions. By October 2019 he was too sick to be at Kabarak. We kept him at his home in Kabarnet Gardens where I saw him daily.
He was admitted to hospital for a week mid-October then re-admitted for another 18 days the following week. He was at home for only three days before being admitted for the final time on November 9. After that he stayed in hospital until he died on February 4, 2020.
Mr Peter Kenneth (left) and Wiper party leader Kalonzo Musyoka (second left) with former President Daniel arap Moi (centre) at his Kabarak home on April 25, 2019 as then Baringo Senator Gideon Moi (right) looks on.
Photo credit: File | Nation Media Group
During this time Charles Njonjo regularly came to be with his old friend. He was one of the few visitors Moi really looked forward to seeing. When Moi deteriorated and became less communicative, Charles would sit by his side silently holding his hand. On leaving he would say a short prayer, intoning it so softly only Moi could hear him.
To ensure we were optimising treatment and not missing any possible diagnosis, Gideon asked that we bring in a chest specialist from San Francisco whom he knew from Kenyan contacts. He came in November and reviewed the entire situation. He had a few technical suggestions but was in agreement with the treatment Moi was receiving.
Gideon was spending most of his days and some of his nights in the hospital, obsessing about what new technology might improve Mzee’s physical condition and mental alertness. In his great effort to save his father, he researched all possible treatments including stem-cell therapy.
Although I did not think this would change the inevitable decline, I discussed this with Mzee’s London neurologist, Dr Manji. He too didn’t see any medical benefit in the treatment.
Gideon was introduced to Dr Hussayn Salem, a London-based molecular biologist with a special interest in gene and cell therapy.
His team included two professors from Europe. They agreed to fly out, but there was going to be a delay. Immediately before their expected arrival, Mzee had a cardiac arrest.
I was called at 9.30pm on November 21. The ICU team had started resuscitation measures including CPR (cardiopulmonary resuscitation). I jumped into the car with my driver James Muiruri and made it to the hospital in record time, calling an anaesthetist to assist as we drove.
Resuscitation was ongoing when I entered the room. Gideon, the aide-de-camp and the two security staff were standing with their arms around each other in prayer.
It took about 30 minutes to resuscitate Mzee and stabilise him sufficiently to move him to the ICU. He never regained complete consciousness. At this stage he required a tracheostomy and regular kidney dialysis. There were moments when he was lucid and communicated, but they were brief. He would sit in a chair and watch inspirational videos of Christian evangelists such as Billy Graham, who was a personal friend of his.
When Mzee seemed to be stable, Gideon called Dr Salem and asked whether his team could come. They arrived on January 18, 2020. They called their procedure regenerative therapy. It entailed removing blood, centrifuging it, and mixing it with beads of gold-quartz particles to activate various proteins to promote cell regeneration.
I didn’t think it would do any harm although I was sceptical it would do any good. Mzee didn’t get better, but he didn’t get worse either. Then on February 3 he suddenly deteriorated, undoubtedly due to an infection that spread into his blood (septicaemia). That night he was rushed to the ICU. He was in septic shock. He passed away the next morning.
President Moi’s exact age was not at all clear. His official birth date was September 2, 1924. However, from talking to his contemporaries, his students when he was a teacher, his family and those who knew him as a young man, my best estimate is that he was born between 1914 and 1918. He was well over 100 years old when he died.
When I look back at his final eight months of life from my own cultural perspective, I wish his final journey could have been shorter and more comfortable. It hurt me to see him in distress.
But there were some positive aspects. His presidential duties had left little time to be with his family. That family relationships were not stellar was no secret.
During Mzee’s prolonged deterioration the family seemed to pull together. This new closeness was evident at the funeral at Kabarak when Raymond handed over Mzee’s ivory rungu to Gideon. Raymond was the head of the family, but Gideon had assumed his father’s political mantle.
When Moi died, I was devastated by the loss of a close friend and someone I had looked up to as a patriarch for 40 years.
He had advised me wisely when I sought his counsel. I invariably heeded what he had to say. He never drew me into his political and business affairs.
Nor did he assume to interfere in my medical practice. There was not a single occasion when he sought a second opinion about his health unless I had already suggested it. I think I can fairly say our relationship was on a footing of mutual respect.
He was a devout Christian but also well versed in Judaism. We spent many hours discussing the Bible and had the habit of counselling each other by quoting biblical passages. I was honoured when Moi’s sons asked me to deliver an eulogy at their father’s funeral in Kabarak.
Daniel arap Moi provided a solid presence in my daily life. I ended the eulogy by putting on my prayer cap and reciting the Jewish memorial prayer for the departed, El Maleh Rachamim, in Hebrew and then in English. I miss him still.
