From Dadaab to Nairobi

Today is World's AIDS Day. Let us not forget the sufferers of HIV/AIDS especially those in the developing world.

Last night there was a whole lot of planning for WC to go to many places including Dhobley which was back on the schedule for next Friday, there was no talk about security or road condition. I am not sure whether the fighting in Dhobley has ceased or what happened to the Kenyan military sweep of the border. Security in the person of Omar did not offer any insights.

WC was able to ascertain from their visit to Kokar the lack of sanitation facilities and inadequate water supply but the sole MTI representative who went there did not ask whether there would be a physical place for medical care or how security could be ensured for future MTI team, questions that are crucial for the provision of medical relief there. Then it was announced that the next two MTI teams have been canceled and there will not be any medical relief for the month of December. The reasons again are not entirely clear to me but one was offered by a WC staff that there would be no one in the compound from December 22 to January 2 because of the holiday break but it still does not account for the first few weeks of December. I am sure the team that was due to arrive two days from now must have been sorely disappointed. The villagers who have looked to us to provide medical care will not understand why we stop coming. Each time when we went there they seemed to welcome us and were extremely happy to see us. I do hope that the only MTI Kenyan rep will continue to go to the various villagers in December to do clinic.

Sucri the day doorman promised to take care of Yanburi, the cat with the blue eyes whom I found sleeping soundly by the huge water drum. I crept up and touched him on the back which sent him flying off in a fright.



This morning we went to the Dadaab Airport to board the MAF plane to Nairobi. It was completely full and one of the passengers sat in the co-pilot seat. I had to leave a day early because there is no guarantee of a seat on the ECHO flight tomorrow. As we went down the runway and up in the air, the plane made a sharp turn in the opposite direction of our usual helicopter flight heading towards Nairobi.



My sick teammate left yesterday for home having recovered quickly from her brief illness but Jim, our leader who accompanied her remained in Nairobi to meet the next team to brief them. Having heard that they will not be coming he plans to change his flight to leave as well. I will remain in Nairobi for a couple of days before flying home.





As I took walks around the neighborhood I saw signs offered by "doctors" to solve various life troubles. If these doctors had such powers they would have been very rich by now and would not have to advertise to attract fresh clients!

The Last Helicopter Ride

Kokar was to be my last destination as it was determined last night but this morning when the Chief came with his councilor the fourth seat which was supposed to be for me on the helicopter was quickly relinquished to the councilor. We were hoping to do a clinic there while the Chief met with the villagers and WC staff. The reason for my not going there as was explained by Andrew was that they did not feel safe for a “white person “ to do her clinic and they could not provide or promise security. I have heard many strange excuses before so I was not surprised.

So my last day of doing clinic was scratched and I went with Krista, Tracy and Samuel to Damajale to inspect the water situation and to see Krista do her sanitation demonstartion to the women there. It was very sweet of Krista to invite me so I was not stranded in the compound. Again the clinic in Damajale was closed tightly. The Community Healthcare worker ran hurriedly to open the consultation room thinking that we came to do clinic there.





Krista is an enthusiastic teacher and her translator, Fadum, a tall Kenyan Somali gathered eleven registered women and many other ladies under a tree sitting on a mat going over pictures of sanitation. The main concept was hand washing to prevent the spread of diseases. The women took a tea or lunch break after washing their hands. At the end of the session they were each given a wash basin.





Samuel took us to a borehole where water was pumped to the village. There is plenty of water now since it has been raining. Before then animals were dying and Samuel said there was an NGO whose sole purpose was the removal of the carcasses, he said the stench was unbearable. In the days of the drought, it was not unusual for people to walk for up to six hours to the next village to get water if the water pump in their own village did not work. We also learned that camel owners had to pay seven shillings a camel for water and the camels came once every 4 days to drink.



In the town square, there are drinking troughs for the animals. I saw a woman selling khat while caring for her baby and a few stalls away, a group of men were sitting and lying chewing khat, some of them were probably high on it.





Since it was my last helicopter ride, I asked the pilot whether he could perform some maneuvers for us and performed he did. We swooped up and then nose-dived close to the main road and followed the road closely for a while. He did some sharp banking and swooped closed to some acacia tree tops scaring some camels. It was one of our very best rides yet. We circled around Dadaab to get an aerial view of the town and looked for the UN and our compounds.





I learned a lot about the doings of World Concern having heard of this organization for the first time. They seem to concentrate their efforts in the delivery of food in the form of vouchers for many families affected by the famine, the delivery of non-food items such as mosquito nets, plastic sheeting, pots, etc., the delivery of water in the form of borehole, truck delivery of water, in the availability of latrines and sanitation education for the communities. I like their philosophy of educating the communities that they own their problems and that they have to come up with solutions for the problems even if jointly with WC and eventually when all NGOs leave if they ever, the communities will know how to sustain the solutions.

The health bit is a collaboration of Medical Teams International with WC which at this point is not as well coordinated perhaps because it is just a medical relief now. I hope that with time the medication available will be more in line with the needs of the communities and that something can be offered for the nutritional status of the children.

I am sad to leave this medical relief having the feeling that I really did not accomplish all that I came here to do. Having said that, we did provide crucial medical needs of the communities that we visited; some like Hamey has good hardworking healthcare persons to care for them but others such as Damajale, despite the presence of a facility receives only sporadic care and Kokar enjoys none of the above. However security situation is such that we have been prevented from crossing the border to Somalia. The upside was the helicopter saved us many hours of difficult road traveling. I guess God has his own way of arranging things for us. Perhaps someday for me helping out in Somalia may still come true.

Back to Hamey

We are now down to two people and two possible places to go for medical relief with the third possible place being Kokar. Because at the end of our disorganized one-hour clinic there last week, someone threw stones and dust at Jim, WC wanted to discuss with the elders to mend fences and to make sure such incident does not recur. It turned out that it was a woman who threw the stones and something would be done only if it was a man who committed the act. Apparently the elders came to the compound today and promised that things would be different and to give the pilots time to determine the whereabouts of Kokar, we will head towards Kokar tomorrow but back to Hamey we went this morning.

Since we have been flying almost daily, I joked to the pilot that we should be upgraded to the premier class. To which he replied that in a little while the steward would be by to serve us drinks but that we had to excuse him for not shaving this morning.





By the time we arrived, the Community healthcare workers had seen a total of 40 patients. The day was rather hot but they have now learned to open the flaps of the tent allowing an occasional breeze to come through. Aden was again my translator. He is the oldest of nine children,father and mother in their forties. I saw close to 50 patients but towards the end many of the people who were seen this morning by the community healthcare workers came again.





The sickest patient wearing a belt with the name "Obama" embroidered on it came on a donkey cart. He lay prostrated on a UNHCR blanket brought by the family. He had a high fever and was dehydrated. Rumors had it that he had been treated with 5 days of penicillin and gentamicin and still felt unwell. For the last two days he began to have bloody diarrhea. We decided that he might have typhoid fever and gave him an injection of antipyretics, ceftriaxone and oral rehydration fluids which he was able to take about 250 ml. At the end of clinic, his fever came down and he was able to walk home. We were not able to find the box of ciprofloxacin or azithromycin and he will have to return for more injection of ceftriaxone.

There were other patients, children who had fever and were moderately dehydrated.  It was hot and the confounding head scarf got in the way of my stethoscope and so eventually I let it slip down my head.  I did not think the villagers cared.

With the rainy season the frogs have been honking all night and I presume they have been doing so since the rain started, it just that the loudness of the generator obscures their noises. When I get up in the middle of the night to see the stars I hear them very clearly. By then the generator has long since been silenced. I also notice that there are two calls to prayer, one at 4 am and the other at 5 am. Sleep is not easy then and the donkeys seem to hee-haw desperately during the early morning hours.

On Sundays some of us went to church at the Dadaab International Worship Center, not a very attractive name. The church is a small long concrete hall and around a hundred people were present. They are a very rowdy English-speaking group, the Swahili service follows suit. Unlike the Muslims their attire is more modern, no long skirts, long sleeves or head scarves. In fact they walk into the town of Dadaab dressed as they are for church. World Concern chooses the more conservative attire in order to win the people (Somalis from Kenya and Somalia who tend to be conservative in dressing) that they are helping over to their side.





There is a large pool of water just right outside the compound which I was told some local children had used as a swimming pool. There are two hotels on each side of the compound, one of them is called the New Alzazeera Hotel. Dadaab town is rather small and we took a walk down its main street. With all the hype concerning dressings I personally feel quite conspicuous and uncomfortable.

Liboi

Previous volunteers used to stay in Liboi where World Concern has a compound right in the center of town. From there it is about twenty minutes by car to the Somalia border. Because it is close to the police station and a military base, security apparently is alright. From there Damajale and Hamey are more easily accessible. However because of the recent military sweep and the rain that makes the road to Liboi impassable we have stayed in Dadaab.

Dhobley is still a no-go because of the security situation and we will not be visiting it at all since we will be leaving for Nairobi even earlier than planned because of the current flight situation out of Dadaab. One of our team members got ill and was flown to Nairobi this morning accompanied by another member leaving the MTI coordinator and me in Dadaab to finish up the rest of our trip.

Because we have recently provided clinics at Damajale and Hamey we decided to go to Liboi to see if there may be future collaboration with the Ministry of Health or Medecins Sans Frontieres. As we approached Liboi the roads to Liboi are just rivers, it is difficult to imagine how one could reach it by land vehicles. The helicopter landed in the muddy field close to the military base and we immediately were met by four military officers after we walked through muddy paths, at one point I had to hang onto a fence slowly inching my way along the mud in order not to slip. The military officers wanted to know our mission which I thought logistics/security would have communicated with them earlier and they wanted to know why the helicopter did not stop its engine but just dropped us off and took off immediately. They were friendly enough.







After walking through the police ground, the WC vehicle came to meet us, only to be stuck in the mud a few hundred meters down the village. So we decided to get off and walked. The rest of the WC staff that took the first helicopter trip had been busy checking the food vouchers at the compound.





We walked to the Liboi Healthcare Center to see the two tents provided by MSF for treatment of cholera. In October, Somalians were sent across the border to be treated here but since the Kenyan incursion, there have been no patients. The inpatient wards were completely empty, the sole patient that they had had just been discharged. The outpatient clinic was closed for lunch. We met briefly with two MSF staff who were not opposed to having other healthcare volunteers to come to Liboi. Andrew told them that we would comeback after lunch to visit the MSF center but that did not take place because then he informed us that the helicopter was coming to pick us up at 3 instead of 4 pm. We went to what he called Liboi Hilton Hotel for a lunch of Ugali, cabbage and goat meat.



Back at the compound I tried to befriend a cat with beautiful blue eyes. I named him Yanburu or Parka, it means cat in Somali or Swahili respectively. He must have some Siamese genes. I have been feeding him goat meat which is quite difficult to chew. The other day the watchman heard persistent loud banging on the gate and when he hurried to open it he only found three goats waiting to be let in. He shooed them away angrily. It was rather funny.

The Illusive Dhobley of Somalia and the Old Man who walked with his Camels

Dhobley is one of the communities that World Concern is involved in the distribution of food vouchers for about 1800 families twice a week and the distribution of non-food items (mosquito nets, sheeting, pots, etc) for about 800 families in addition to sanitation, water projects , etc. Medical Teams International is also involved in providing medical care there. It is in Somalia and about 25 Km from the Kenyan border.

Dhobley has been on our schedule at least three times but we have been unable to go there for a variety of reasons. Once it was the rainy weather that made the roads too muddy to use and two days ago the reason given to us was that the personnel accompanying us were not familiar with Somalia or Dhobley. However the latest we heard was that the Kenyan military is going for a sweep of the Kenyan/Somalian border for the next two to three days. Yesterday we heard that there have been attacks on the military in Garissa and somewhere else that I have not heard of resulting in several casualties that have to be flown to Nairobi. The latest is that there is now fighting in Dhobley itself. AFREC (Africa Emergency Committee), a partner of WC in Somalia deems it unsafe to travel in Somalia. They were intending to travel from Dhobley to Liboi to meet the WC people to receive the food vouchers for distribution but canceled the trip. It means that we will not be going to Dhobley any time soon. Perhaps in our short stay here, Dhobley will not be secure enough for us to visit at all.

This morning we took the helicopter again, the pilots said that perhaps we could go to some place nice being that we are such frequent flyers. We hinted that we would not mind them doing some sharp turns or banking. Just as soon as we took off the pilots did just that, It was quite fun. Before we reached Damajale, they flew the chopper really low and asked whether we enjoyed our safari, I commented that we did not see any animals. They said it was only for the premier class not for business. But we did see the camels gazing up at us while eating from the top of the acacia trees. We landed sharply again and close to our clinic in Damajale.



The health care worker again had not opened the clinic, he only ran quickly to unlock the doors as soon as he heard the chopper. As we got ready, I looked at his record book and saw that he did not open the clinic from November 11 to 23 and then the clinic was not opened again except for the days we came to Damajale.

I was quite busy today, personally saw about 54 patients, in Hamey yesterday I saw 48 patients. I again tested a few children and a woman for malaria but none of them had it. Many elderly men and women had poor vision with cataracts which I could not do anything. Almost all the women, young and old complained of chest, low back pain (which they said its kidney pain) and knee pain, mostly from walking a long way and carrying water. I jokingly asked if their husbands helped them with the water, their reply was they don't carry heavy things.





Close to the end of my clinic, an 84 year-old man, blind in one eye, walked in slowly with a walking stick fashioned from a tree branch, complained of joint pain when he moved around. By right he should. He told me he loved to walk with his camels and wished to continue to do so.  I gave him some ibuprofen and told him to take it with food 30 minutes before his activity. He was happy with that.







The pilots were an hour late because the fuel station in Garissa made them wait for an hour. In any case they made some nice maneuvers. As we approached Dadaab, I asked them whether the tents in the distance indicated the Dadaab Refugee Camps. They asked if we would like to fly over the camps. And so we had a look from the air the enormous Dadaab camp, some of the camp grounds seemed to be flooded. Each camp holds about 80,000 refugees and the oldest of them is about twenty years old and the tents have been replaced with more permanent structures. Officially there are three camps in Dadaab but unofficially there are about six camps which translate to over half a million refugees in North Kenya. This is an amazing and unfathomable number of people displaced from their homes.









It took us on the jeep about three and half hours to get to Damajale and then perhaps a couple of more hours to reach the border of Somalia. The refugees who fled the drought or conflict in Somalia had to travel by foot with children and some worldly belongings in the intense heat without security of food and water to reach the Dadaab Refugee Camp, probably many weeks of traveling with children and animals dying on the way. We who live in parts of the world free of conflict have a lot to be thankful for.

We wished one another a good weekend as the pilots will have a day off on Sunday.

The Human GPS

Yesterday we were supposed to go to Hamey but ended up in Damajale, apparently the coordinates given to the pilot by logistics were incorrect or were put into their GPS system incorrectly, I am actually quite confused. We have had meetings practically every day but for some reasons no one could truly explain the security situation or why we ended in Damajale. When asked to show us the different locations of our clinics, security or logistics were either not able to produce it or not willing to. When you are in Africa, things get quite fluid like the security situation here and no one can be pinned down. Someone said,"This is Africa (TIA)."

So it was decided that we would go to Hamey but to ensure we got there a human GPS, that is, Samuel the water engineer who has the coordinates for the water tank in Hamey would accompany us. However early this morning I saw him leaving with Sakuda, our program person for Garissa. Fortunately the road to Garissa was blocked by water and he was turned back in time to go with us in the helicopter. As we left Dadaab, I could see the three groups of refugee camps of Dadaab.







We found Hamey alright; I could even see the tent under the acacia tree. Unlike Damajale, Hamey is a very small village. We landed right next to the tent. Again unlike Damajale clinic which seemed to always be closed, the tent clinic was open even on a Friday and the healthcare workers were seeing patients.



We took some time to organize some space for ourselves and also to cordon off the area for the purpose of crowd control, the police officers came and that helped.
It turned out to be a very busy clinic. Again the children were the sickest with malnutrition, worm infestation, anemia, pica, diarrhea, fever and dehydration. The very sick child who came to see Jim the other day turned out today all better, smiling and walking on her own two feet. I tested a few children for malaria and they did not have it. The mosquitoes have returned, it will be a matter of time when malaria is back. I saw a woman with elephantiasis for three years.







We then heard from the pilots that they would be coming to get us a little early because of an impending thunder storm. Even before we were to pack up we finished seeing everyone that needed to be seen. The healthcare personnel invited me to their lunch of rice and meat which they shared while squatting behind the tent. This was given to them by one of the villagers in appreciation for their work. It wasn't much, a lot of rice and a few pieces of goat meat on bones but it was very generous and sweet of them to share with me.



On our way back to Dadaab, the rain came, not heavy. Far away towards the direction of Somalia we sighted a rainbow.

The Blessed Helicopter on Thanksgiving Day in Dadaab

Happy Thanksgiving from Dadaab.

Today we were to board the helicopter to go to Hamey, a village that took us about three and half hours to get to. The helicopter was delayed but we were happy to load our gear and ourselves. It was a four passenger chopper in addition to the two pilots and it took off from the Dadaab Airport. The helicopter is provided by a German NGO and would serve World Concern for two weeks before heading to some other humanitarian mission. It could not have come at a better time as the road traveling was difficult and long.






From the helicopter, we could still see areas of brown earth not covered with vegetation. It took us about twenty minutes to arrive at a village which according to the coordinates was supposed to be Hamey but in fact it was Damajale. Droves of villagers, young and old came running to see the big bird. The pilot asked Andrew to go and ask for directions to Hamey but for some reasons he wasn’t able to because he did not speak Somali. We flew around looking for Hamey as we headed towards Liboi. In the end we decided to land at Damajale and run our clinic there. The government clinic again was closed as we arrived. The two community health workers do not seem to open the clinic consistently.

The store and the consultation room that I used last Saturday were filthy. I decided to talk to the community health worker about taking responsibility to clean the room. He gave the excuse that the cleaner was away yesterday but I argued that we were there last Saturday, he should have ample time to clean up. Thereupon he asked me whether we would pay to clean the place. I told him that his community was lucky to have a clinic while Hamey had a tent and Kokar had none. I made it clear to him that neither World Concern nor Medical Teams International was going to pay for the clean-up. This was his space and he should take great pride in keeping it clean for the community. We were told by the staff of WC that previous MTI teams cleaned up the place before starting clinic and soon after they left it reverted to the current condition.

I wiped the table and chairs with alcohol and set up a clean area for my patient, translator and myself as best I could before starting to see the patients. For crowd control, the police stood at either end and we cordoned off the corridor with duct tape only allowing some patients to wait on the benches.

I saw a number of malnourished children, anemia, pica, worm infestation and fungal skin infections seemed quite rampant. I drained a foot abscess of a youngster who fell off a tree and poked his foot with a thorn, cleaned a panga (machete) wound on a hand. A cute baby had a bad case of impetigo but was still smiling despite all that uncomfortable sores. Women young and old complained of chest pain, low back pain, knee pain and poor appetite, many were anemic. I am not sure whether the joint pain has anything to do with the long distances they had to walk to fetch water. By age 20, many of the women already have at least four babies and many looked older than their stated age. The amount of clothes they had on made me feel hot and uncomfortable.



We had a date with the chopper and had to finish clinic on time. Later we learned that the chopper had to travel to Garrisa to refuel and would be delayed. So we waited for an hour and a half with our armed guards and flew home in 15 minutes. What a treat. For the days that we have been running clinic we have had no lunch but snacked on peanuts and an egg that we saved from breakfast, these we had to consume surreptitiously. It would be unseemly to eat in front of hungry children.

And so we spent our Thanksgiving in the bush of Africa thankful that we do not suffer from famine and hunger and we have the good fortune of the arrival of the helicopter to take us quickly to these rural villages at least for the rest of the time we are going to be here.