Taking affordable medical care where few dare to go

It is 7:30 am. The tide is low and the small town of Lamu is just waking up as we prepare to leave for Kiangwe Village.

“This is the best time to leave so that we can come back before the tide gets stronger,” nurse Harrison Kalu tells one of his team members as he carefully places a box containing a variety of drugs into the speedboat.

The four-member team takes their position in the boat and the coxswain starts the engine. Although the ocean is still calm, some water still splashes into the boat.

Today the Safari Doctors team is visiting Kiangwe Village, one of the six isolated villages near Boni Forest, which have been largely abandoned due to insecurity.

After a two-and-a-half hours, we reach Kiangwe, where the villagers are anxiously waiting for the team. The team heads straight to a building that was once a school but has been turned into a military camp to set up a clinic.

PALPABLE TENSION

The tension in the area is palpable. Surrounded by armed General Service Unit (GSU) officers patrolling the area, the team, led by Mr Kalu, gets down to work, treating the soldiers first.

Thereafter they start treating the villagers, and it is here that we meet Aisha Ahmed (not her real name).

It is now a week since Ms Ahmed’s husband left for the deep sea to fish, leaving her with their eight children. Ms Ahmed would like to know when he will return home but she dare not ask because culture forbids her from doing so. Yet to medics, this information — unimportant as it might appear — is a matter of life and death.

This is because Aisha is in the final trimester of her pregnancy and could go into labour any minute. It is her ninth, and  at the age of just 21, this pregnancy predisposes her to numerous health risks as she not only has severe anaemia, but nurse Mr Kalu suspects that she could also be having placenta previa, a condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery.

“She needs to get to hospital now!” Mr Kalu tells the Lamu County medical superintendent accompanying them.

But Ms Ahmed ignores the nurse and refuses to go to Lamu County Hospital, a two-and-a half ride by speedboat from Kiangwe Village.

Reason? She cannot go before her husband comes back.

“We will need to send a boat that way very soon,” Kalu adds.

In the same village, three-year-old Baishe Abdi and his father have been eagerly waiting for the team so that they can attend to his wound. He was scalded by hot water a week ago while playing with his brother, but despite the wound covering almost his whole chest, his father, Mr Abdi Abdala, did not take him to hospital because he cannot afford it. Getting to the nearest hospital would have set him back at least Sh1,000.

So for the seven days he resorted to traditional methods to clean and treat the wound as he waited for the monthly medical checkups run by the Safari Doctors.

“I have been using warm salty water, honey and coconut oil to treat the wound,” offers the father of five.

Ms Ahmed and Baishe are among the nearly 1,000 patients that Safari Doctors attend to via mobile health services every month.

FLED AFTER AL-SHABAAB ATTACK

Thankfully, Mr Kalu is familiar with this territory. After retiring from the navy, he trained as a nurse and was posted to Mangani Village in Lamu County. Like the other health workers, he fled the village in 2014 after Al-Shabaab raided Mpeketoni Town and its surroundings and burnt the government motorbikes he was using to traverse the villages offering medical services.

“I was lucky I was not around when the terrorists struck because I had gone to Lamu Town to see my family,” he recalls.

Once a highly valued tourist destination, Lamu County, and especially the six villages — Kiangwe, Mangai, Basuba, Mararani, Kiwayu and Mtangawanda — is today almost a no-go zone as people are warned to keep off due to threats by Al-Shabaab.

Lamu is the only county in Kenya with less than one kilometre of paved road. But this very feature that makes it beautiful and pristine is the same on that predisposes it to major health care challenges

Due to insecurity and poor accessibility, schools and health facilities in the area have been abandoned, with most now serving as camps for the Kenya Defence Forces (KDF).

Most government workers fled the area after the Mpeketoni attack.

“Before we come to any of these villages, we have to alert the officers in charge of the KDF soldiers on the ground so that they can provide security and also advise us whether it is safe to go there,”Mr  Kalu explains.

But there is also a curfew imposed by nature: “We have to leave by 2pm before the tide starts rising, otherwise it is difficult to chart the waters,” says Mr Kalu.

Due to fear of attacks, aid groups, and even government workers, stopped working. As a result, the infrastructure is crumbling. Access to healthcare and education, considered basic needs in most places, are luxuries in these  villages.

“A passenger boat going to Lamu town passes here once a month. The only alternative means of transport is using the farmers’ boat, which charges between Sh1,500 and Sh3,000,” says Bakari Afande, a community health worker in Kiangwe.

But despite the insecurity and inaccessibility of these villages, Ms Umra Omar, the founder of Safari Doctors, and her team keep going back.

At about 2pm the tide starts rising. Mr Kalu and the team wrap up their equipment, carefully storing the samples from patients suspected to be suffering from TB. The dust trails of children running to the shore to help return the box of medicines marks the end of a day’s clinic.

And as Lamu beckons in the horizon, Mr Kalu cannot help but hope that Aisha’s husband returns home soon…if

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INTERNATIONAL RECOGNITION

Ms Umra Omar’s work has seen her receive international recognition, after being nominated one of last year’s Top 10 CNN Heroes finalists.

She says one of her colleagues submitted the nomination that has now “materialised into something I never imagined!”

Each CNN Hero received a $10,000 (Sh1,020,000 million) prize with the CNN Hero of the Year, Jeison Aristizábal of Columbia, receiving an additional $100,000 for the cause he supports.

In a brief speech after receiving her award, Ms Omar called for team work. “If you want to go fast, go alone. To go far, we must go together despite colour, gender, beliefs or social status.

“May this award be a constant reminder that marinating in comfort is not an option. Fear is not an option. With a leap of faith, we can all be the change that our world screams for,” said Ms Omar in a video posted on Twitter by CNN.

Through the rough ride, she has had her high and low moments.

“The absolute best moment was when a young woman walked up to me with her bundle of joy called Yusuf. After two miscarriages and complications, we were able to facilitate her checkups with her last pregnancy, which saw her deliver a healthy baby,” Umra recalls.

“Then there is the usual excitement of hearing the sail flapping as we head back to Lamu.  From the trip, I draw a sense of relief, satisfaction and hope knowing that we have made a difference,” she says.

Meanwhile her lowest moment was in December 2015 when funds ran out, with no funding in sight, threatening the project with closure.

“We could not renew the nurse’s contract and all sorts of doubts started creeping in. All the whys and hows of sustaining the initiative crept in. The fear of disappointing the communities that we serve also haunted me,” she recalls.

The mother of two has adopted a fighting spirit and adopted a mantra that keeps her going: “’Swim, swim...just keep swimming!  The most profound ability of the human spirit is persistence, the simplest yet hardest thing to do in the face of adversity!”

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SAFARI DOCTORS: AN INITIATIVE FOR CHANGE 

Safari Doctors was founded two years ago by Ms Umar Omar to provide free basic medical services, including immunisation, maternal and child healthcare and treatment of diseases like malaria and tuberculosis.

After completing her studies, the US-trained psychologist returned home to start the organisation, which has since saved a number of lives.

“The underlying theme in my studies was perhaps critical thinking and the importance of applying that to being an agent of change in one’s community, with primary emphasis on amplifying marginalised voices. But I am by no means a doctor,” says the 33-year-old mother of two.

Her decision to return to her home town was prompted by a visit to her childhood community in the islands, after learning about the closure of a medical aid project because of security concerns.

“We had come home for a vacation with our newborn and with a little research on the reality and the challenges and with support from the closed down project, I decided to start Safari Doctors,” she says.

It began with basic service delivery; a nurse was hired to conduct monthly outreaches on motorbike, serving about 100 patients.

Today, Safari Doctors travel by boat and offer outreach services by road using motorbikes to these marginalised areas targeted by terrorists, reaching an estimated 1,000 monthly.

The project entails mobilising a crew of medical professionals who travel around the Lamu archipelago delivering health services to the isolated Aweer and Bajuni communities.

Despite the risk, Ms Omar makes bi-monthly trips as often as she can to help the desperate villagers.

INNOVATIVELY NAVIGATES CHALLENGES

Safari Doctors innovatively navigates the challenges of remoteness, lack of infrastructure and insecurity using a dhow.

“Our emphasis is on primary health care. We all agree that prevention is better than cure. So our package includes reducing the prevalence of HIV/Aids, reducing environmental health-related diseases, and taking care of mothers and children, among others,” Ms Umar offers.

The cost of an outreach varies, ranging between Sh9,000 a month for the motorbike clinic, to as much as Sh400,000 for a full circuit around the islands, reaching some  10,000 villagers.

She works with a team of three core staff: an office administrator, a nurse and herself as a volunteers.

“The rest of the team, which includes a medical team of two to three staff from the county and the boat crew, brings us to about a dozen people per outreach,” she explains.

So who pays them?

“A stipend that is determined by the funds raised for a particular clinic is given to the team that participates in the outreach,” she says.

SPORADIC FUNDING

However, funding has been sporadic. Having started off with financial support from a local businessman, today Safari Doctors’ source of funding has become “pretty much like a giant puzzle” of well-wishers who, through crowd-sourcing, and in-kind contributions have seen the organisation carry out its activities.

Ms Omar says although they get the essential drugs from Mission for Essential Drugs & Supplies, the county government has supported them by providing a medical officer and nurses, as well as vaccines.

“We are not trying to be the government’s substitute but simply to supplement the need for affordable and accessible healthcare, and that means working closely to deliver that mandate,”Ms Omar says.

Working in this insecure region has earned Mr Omar some critics. “They ask questions such as, ‘Why are you going there when you are not supposed to?’” says Ms Omar. “And as a woman running around pushing this project many ask, ‘Why do that? Why not just sit at home and be taken care of.’”

Planning the clinics and making sure everything falls into place (the medical team, sailing crew, medicines, meals) is also intense, she says.

“But that is a necessary uphill battle that we are still in the process of mastering,” she adds.