Tuesday, January 31, 2012

Tippy-taps are truly terrific

Loaded into the white Landcruiser and bouncing along the sand roads I watch a blur of tiny antelopes, termite mounds shaped as 10 foot tall castles, sky blue birds and innumerable camels sashaying through the brush. A little boy with a stick tends to a hobbled camel that crosses the road with indignation. A nomad family with their well packed camels encouraged along their donkey that had a large white goat strapped to its back, legs splayed. I do not know if the goat was special or obstinate to earn a ride on a donkey.

We were passed by a van full of men and miraa (qat- a leaf and twig with amphetamine like effects) bouncing cartoonlike ahead of us. We had witnessed it running a checkpoint in a not so cartoonlike fashion a few minutes prior. They were friendly enough when we met up with them in Kokar and after a brief unintentional interaction had no further.

Pulling into Damajale, there are no tire tracks, just camel, donkey, goat, chicken and human tracks. Twig, mud and a few corrugated shacks are confined be stick and brush fences. All have a pile of branches for firewood outside.

Arriving at the community clinic we were disappointed to find the health workers absent. Only the watchman with the keys was present. Due to security reasons, we do not pre-announce our arrival. It would have been inappropriate to use someone else's clinic without them, so we observed a WASH training which was really amazing and acutely reinforced my opinions regarding preventitive services. The 'ounce of prevention is worth a pound of cure' idiom is so valid. Our partner organization is performing a KAP (knowledge, attitudes and practice) assessment on these communities and also offering the WASH training. I reviewed the surveys and it is eye opening to see the beliefs and practices regarding germ theory. Most people are not washing hands after going to the bathroom (nowhere to do it anyhow, but more on that later); fortunately this town now has a higher rate of pit latrines so most of the respondents were using these. Nobody knew how to make rehydration salts and many treated childhood diarrhea by reading from their holy book. The WASH training was so great, I was impressed to see how in a few hours germ theory was presented and hygiene not only taught, but understood. The teaching methods were effective, not pedantic, and the participants were fully engaged. Class was held on mats on the ground and followed by creamy tasty (camels milk?) chai. The host community was gracious and beautiful.

Part of the training is building tippy-taps, an ingenious hand washing station built from some strings, an old Jerry can and some sticks. Our host was very proud of his and demonstrated washing hands with more enthusiasm than I've seen in a while.

Sure, I can save an ill baby's life with aggressive medical intervention, but this program is preventing disease measured in the quantity of families and villages. I was very humbled to be reminded that string, leftover containers and a few hours of training can kick Western Medicine's butt when it comes to reducing sickness. Thats not to say medical teams don't make a difference (we do, but differently), just that prevention is the foundation of truly healthy communities.

Monday, January 30, 2012

Chai and mandazi welcome

From the air the red dusty plains turned to a creamy dusty color punctuated by shrubs, goats, camels and people. Webs of trails congealed into roadways then shanties. The plane lurches and bounces  then we are on the runway and the only strip of pavement I have seen for miles and miles. A three minute drive to our compound through Dadaab. Inside it is hot and dusty, but relatively peaceful. There is the sounds of goats, engines and an occasional voice. The diesel hum of the generator can be felt and heard. Frying meat fat and spices scent the courtyard near the kitchen. A skinny cat near the kitchen door is gnawing on an unidentified knuckle from what I assume is a sign of the cook's  generosity.

The wind only seems to make it hotter and dustier. I've claimed a bottom bunk in a room with five other beds (and people). We'll see who snores.

First thing on arrival was chai (tea) and mandazi (fried dough) and then I introduced myself to the toilet. Pit toilet- or squatty potty, if you prefer. I'll spare the details except to say that aim will be as important as strong thighs.

Orientation included tips on sleeping in the hot, still air. The advice is to soak your top sheet in water before bed. It's hot, dry and dusty. I wonder if I soak the sheet if I will wake up in mud with all the dust in the air.

Today we arrange our medicines for travel and tomorrow out for one of the clinics with the goal to consult on difficult patients for the local health providers and offer general clinical education. We will be primarily working in the border towns of Kokar, Damajale, Hamey and Dhobley. We also may be entering some other villages that don't have an healthcare services. I'll try and post a map once available.

Ready to depart

Up at 4:45 getting ready for flight to Daadab. Just time here for a quick note. I'm excited to get started. As some of you may know, we will not be working in the refugee camps but with displaced persons outside the camps and with host communities. Many of these communities have no current health care. We will also have the opportunity to train local health workers which I believe will ultimately be of the most service.

Call to prayer just finished, accompanied by a cacophony of birdsong. I need to to find breakfast before departure.

Saturday, January 28, 2012

Awaiting transfer flight to Daadab

Arrived in Nairobi a couple days ago and due to schedule changes for flights. Because of this we are staying in Nairobi a short time prior to transfer to the Somalian/Kenyan border. We finished our briefing and debriefing with the outgoing team and so we've been cramming enjoyment in between cups of tea. (tea is big here).

Nairobi is a busy town with some beautiful areas. The Kenyan people that I've met so far are friendly, curious, very welcoming and quite funny. Everyone speaks English so communication in Nairobi isn't a problem.

First day we met with the security director and went over operating protocol and the overall security situation. Our security team is excellent and I believe will be thorough and effective. We also met with the other organization we work with in the region. We spent the afternoon in traffic jams interspersed with supply shopping for final items.

Today we went to take a 'short hike' on Mount Longonot in the great rift valley (short per Bruce, an outgoing team member who is actually from Eugene). Bruce apparently understates since six hours later we had ascended the volcano, hiked around the crater and put in 18 miles in the equatorial sunshine. We did have enough water and enjoyed sharing a package of arrowroot and banana chips amongst the five of us. we just finished an excellent Ethiopian meal and I'm really tired. Tomorrow we are going to a baby animal orphanage and a short safari.

I realize his sounds more like a travelogue than a report on the medical work that I came to do. This is a highly abnormal situation because our in country flights changed after our international arrangements were made. It is frustrating not being able to immediately serve but since I can't change it, I might as well enjoy it. Monday we depart for Daadab.