What precipitated the attack has not yet been determined. Khalwale worked in medicine prior to entering politics.
From 1980 to 1987, he studied medicine at the University of Nairobi and earned a Bachelor of Medicine and Bachelor of Surgery.
He was assigned as a medical officer to the Kakamega, Kisii, Machakos, Msambwebi, and Kirinyaga districts of Nairobi's Kenyatta National Hospital.
He said that between 1988 and 1990, in the then Kakamega District (now Kakamega County), he gained his first practical management experience.
He boasted of having made sure that all hospitals, health centers, and dispensaries were fully operating with enough staff and a steady supply of medication and vaccines.
Later, he entered private practice in the cities of Mombasa and Kakamega, where he advanced to entering politics.
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