Where camels are used to deliver health services to locals
On a chilly Sunday morning at about 4:00 am, we are woken up by sounds of camels. It is early 4:00am and a group of seven camel handlers wake up 12 camels, ready for the day. The previous night, all camels were properly settled, ready for the task ahead. In what looks like a well-coordinated exercise, the camels are settled using some sound signals from the herders and the camel handlers. The animals’ fore legs are tied as well. Koimai Lewarges, a camel handler and herder says this exercise prevents the camels from moving away at night. “By the time we go to sleep, we must ensure that all the animals are present for the exercise,” he says. Lewarges then checks all the camels for any injuries. He identifies a neck bruise on one of the youngest camels in the group and quickly fixes it. “We just spray this medicine and we are good to go. This is to keep away flies,” he explains.
It is their 14th day of the quarterly camel mobile outreach; an initiative funded by the USAID through Afya Timiza project. The project implemented by Amref Health Africa in Kenya seeks to deliver health services in hard to reach areas of Samburu and Turkana counties. To this team of seven, among other health workers, work starts early every day of the camel outreach cycle. This cycle started in Samburu East and will cover Samburu central and parts of Isiolo County in 30 days.
Gilbert Wangalwa, Chief of Party Afya Timiza Project says the camel outreach initiative is being implemented in Samburu East, Samburu Central, Kibish, Loima and Turkana South Sub counties. The choice of these areas, Wangalwa says, was due to the low coverage of family planning, reproductive, maternal, newborn, child and adolescent health services. “There is a high unmet need for reproductive health in these counties. For Samburu county, a bigger portion of it is covered by conservancies and poor road network. This is a challenge for the locals when accessing health services,” he said.
Using 12 camels, the handlers, together with a team of healthcare workers pitch tent in manyattas. It is a sparsely populated area and the nearest health facility is miles away. A few members of the pastoral community have been staying here for some time. The camel outreach involves clinic sessions, counseling and health education. For every community the team meets, they set base there for about four days.
As time progresses to 5am, the camel handlers get busier. The middle-aged men are packing for the day. They are preparing for a seven to eight-hour journey ahead of them and order is key. The precision in their packing skills is evident from the speed, order and coordination within the team.
Their job description seems well defined for each camel handler. Lewarges and other camel handlers oversee loading and offloading the camels as well as treating the animals. They also set up the camping facilities.
The camel outreach comprises a temporary doctor’s room in a tent; complete with medicines, family planning commodities and immunization drugs among others. In the team is also a nurse, two community health workers, seven camel handlers, a clinical officer and a community owned resource person who serves as a community mobilizer. At 7pm, the team closes the exercise and immediately begins preparations for the next day. The seven to eight-hour journey the next day starts at 6am.
It is a tough terrain and the sun is hot. “We have to ensure that all drugs are well packaged to prevent them from excess heat. In addition, the weight of all the food items and drugs must be well distributed in order to ensure balance,” he says. According to Lewarges, a camel can carry up to 40 kilogrammes of luggage.
To residents of Resim Location in Samburu East, the camel outreach is a much-needed solution to the limited number of health facilities, poor road network, inadequate health facilities and shortage of healthcare workers in the area. In such places, locals walk tens of kilometres in search for healthcare. With a population of 58,122, Samburu East Constituency is served by 28 health facilities, according to the ministry of health. This means that one health facility serves at least 2,000 people in the constituency.
Misawa Learat, a resident of Resim village in Samburu East threats from wild animals, difficult terrain and long distances are some of the challenges she faces in search for health services. The mother of seven recalls the long days to the hospital when her children were younger. “Three years ago, I walked over 40 kilometres to access maternal and neonatal health, family planning services and treatment for general ailments in Wamba health centre,” says Learat. With the bad terrain and lack of transport to the nearest health facility, she opted to stay home most of the times. When she managed to go to a health facility, it was a whole-day affair. “I would walk about four hours one way and by the time I got treatment, it was already late in the evening. This meant that I had to walk back with my children who were already tired. This is perhaps the story of many mothers in the county.
For Learat and other residents here, the dry season signifies a migration to the next available pasture for their livestock and food for their children. “Health services would find us moving,” she jokes. But in September this year, just like every year, residents of Samburu County and its environs received free health services at their manyattas. On this day, Learat arrived at Resim village by 1pm to receive health services through the camel outreach initiative. The project launched in 2016 seeks to increase access and use of family planning commodities, maternal, newborn, child and adolescent health services in the hard to reach communities of Samburu County.
Learat is the first client on this day of the camel outreach. The 30-year-old mother of seven has come for family planning services and routine medical checkup. She benefitted from the services in 2016. “I always look forward to these outreaches. They have saved me a lot of time and resources.”
According to Sylvester Sang Murei, the clinician attending to patients at the outreach, about 70 patients from Resim area sought medical services on the first day, including treatment, immunization and referrals. “This a free service. Since the health services are brought near the people’s homesteads, we believe the numbers will be higher,” said Murei. “According to him, the session that takes up to 10 minutes per patient includes pre counseling, treatment and post counseling session. In this some parts of the county, there is stigma that comes with walking into a hospital building. But in this case, since we come to their homesteads, the patients are more at ease while seeking medication,” he added.
In these outreaches, Murei says, there are more women and children coming for healthcare services as the men are often in the fields with their livestock.