Samburu is a classic example of “untampered nature”, God’s creation that many a tourist pay colossal amounts of money to go view: villages demarcated only by hills; gazelles staring curiously at vehicles passing by.
I spent five days among the community, in the places they fetched water, slept, and sought for food.
From a point of privilege — driving from one village to another, and spending a day or a few hours in a homestead before moving to the next — I wondered how breathtakingly exciting it would be to be this one to nature; to stand a few metres and say, “Oh look, that is a herd of elephants walking to the river with their new calf.”
To wonder whether the zebras within sight are the normal ones or the nearly extinct Grevy’s type; to cringe at the thought that a hyena could be lurking in the background because I can see antelopes and dik-diks; their food.
However, on the third day, this beauty was the source of their death and pain. It was a testimony of the steps they had to take to catch up with the rest of Kenya.
A TREK FOR JABS
Watching Norparaku, in her 30s, in Marmarai in Samburu County strap her baby evokes emotions of gentleness. The baby smiles and chuckles at her as it is placed in the shawl, unaware of the long journey its mother is about to take to sustain it.
She is about to walk for an hour in an unforgiving terrain back home after bringing the baby for immunisation in an outreach camp that a non-governmental organisation, Action Against Hunger, has organised with the county health department.
She tells the Sunday Nation that she does not mind the one-hour walk from her village in Lekea.
“Under normal circumstances, I would have walked the whole day to Suari or another eight hours to Ngilai to look for a health centre, spend the night there and wake up the next day to come home,” she says.
Throughout this time, she and the baby she is carrying would rely on the only food she carried until she came back home.
At six months, her baby has not received a single shot of a vaccine. By this time, according to the World Health Organisation’s recommendations, a baby should have been vaccinated against tuberculosis with the BCG vaccine, and received some polio vaccine.
Here at Marmarai Health Centre in East Samburu, the nearest health facility is Wamba Health Centre, nearly 74 kilometres away.
She would generally not visit Wamba because of safety issues: there is a seasonal river called Lengusaka that has “carried” people with it when it rains briefly.
Then there are more elephants on the route. Yes, elephants.
She, just like the 56 per cent of women in this county, as recorded in the 2014 Kenya Demographic Health Survey, cannot read or write. But even with her attenuated knowledge of health issues, she knows her child needs those jabs.
Today, she has to take advantage of the opportunity now that the nurses are here.
“I have also come for anything else they can offer me until the next time,” she told Lifestyle.
TREATMENT BY ALL MEANS
Norparaku and other women have learnt to place their trust in herbs. Sometimes, I learnt, a bad headache will be eased by cutting the head to drain blood. Sometimes it works but sometimes, in most cases, the children die.
During this exercise, nurse Teobalda Michael and a volunteer nutritionist do what they can and refer, maybe even carry with them, the cases that need more than what the makeshift “hospital” at the back of a van can offer. Teobalda is anxious; she is almost running out of antibiotics for respiratory tract infections that affect two out of three people (58 per cent), according to data from the National Health Information System. She can draw a straight line from the pneumonias to the small houses that are poorly ventilated where the Samburu live in, and the dust.
“I am happy today I have not met severe cases of pneumonia, or advanced cases of tuberculosis where the lungs are on the verge of collapse,” she says.
The women and men are seated and listening to her as she talks to them about basic but crucial life-saving health tips such as the need to drink water, use the toilet, the need to be immunised, and how to feed their babies.
She will also offer family planning services, iron supplementation and food for expectant and lactating mothers. The community’s trust on nurses like Teobalda is so deep that whenever she is around, they call her to deliver mothers who are lucky to be in labour then.
Malnutrition is the challenge on which all other health problems in this county rest, where bodies are so deprived they might not fight a simple disease. This was a pattern in nearly all the households Sunday Nation visited in four villages spread apart.
According to a SMART Survey, annual study on health indicators in arid and semi-arid counties, the global acute malnutrition in Samburu is 18 per cent, nearly four times the acceptable 5 per cent.
One in 10 children (10 per cent) are severely stunted. That is just a number until volunteer nutritionist Mourine Njeri says that food is needed for 1,000 days of a child — for, among many other things, the brain to develop and to grow the child’s immunity to fight diseases.
“After 1,000 days, you cannot correct the damage,” she says.
It does not take a medical degree to tell most of the children seated at the camp are malnourished. They are too small for their ages — short, the skin is flaky, and they are not jovial. Food is hard to come by, given the drought that has become commonplace in the county.
The mother was probably hungry throughout the pregnancy and when the child was born, she could not breastfeed, and the baby did not have food.
Mothers do what they can, including diluting the milk with water to feed their children. When they come to outreach camps, they find nutritional supplements, whose benefits are reversed when the children drink dirty water and are plagued by the attendant stomach complications.
But amid all the gloom and dread, one-year-old baby Barunye sticks out like a sore thumb. He is — strangely — overweight. His mother, barely 16, credits this to her older co-wives who have helped bring up the boy with camel milk.
EFFORTS TO SAVE THE SAMBURU CHILD
Community health volunteers such as Simaloi Leteren are an integral part of the health system in this county, but even with their well-meaning care, they cannot substitute the skill needed to yank the baby out of the jaws of death caused by hunger.
At Wamba Health Centre, Mourine receives severely malnourished children referred by Teobalda from the outreach exercises who are starving. They have to be hospitalised as emergency cases. Like Asha’s child — whose system was so starved she was first put on F75, a nutritional prescription meant to strengthen the body to support blood circulation, breath and even respond to medicine.
At six months, the baby weighs only two kilograms. Mourine would monitor the baby like some project, even weigh and record the time, before moving it to F100 and PlumpyNut, another nutritional supplement, after the baby is stabilised. There are pictures of Leinaisho’s twins of remarkable improvement from ghastly looking babies to happy toddlers.
This is additional work, apart from the pregnant and lactating mothers who need to be monitored for iron supplements, diabetic, HIV; hypertensive patients that she has to see. The county only has 13 employed nutritionists.
Bernadette Lorunguiya, the nurse in charge of Wamba Level 3 Health Centre and who organises outreaches such as the one that Norparaku has come to, was tired of receiving “walking dead” children and mothers who have a beating heart but would not survive even if she and her colleagues gave them all to save them.
She told the Sunday Nation: “Referral here is someone walking for those many hours to the hospital and asking for the ambulance, then we drive to the patient, and if they are not dead by the time we get there, they die of being driven in the hilly rough roads when they are critically ill.”
Even with the beastly four-wheel drive, Bernadette takes about five hours to reach areas such as Ndonyonasipa, Gilati, Serolipi and Pareu.
MORE TROUBLE FOR RESIDENTS
Apart from the distance, there is no network coverage in the area. Stories are told of healthcare staff working hours in the aforementioned areas sending a message then paying as much as Sh1,500 to a motorbike driver towards no particular direction, “walking” with the message until they “collide” with the network.
Then they would call their family members before paying the same money to go back. This is the same way they make medical referrals. Obviously, the outcomes are not pleasing.
When they are not walking for health facilities, women like 29-year-old Mercy Lesan from Nkoteyia is looking for water. Laborious does not even begin to describe the journey from her village Legama to Lisiang’a, where they fetch water. The journey begins at 5am and takes three to four hours.
There is extra tact and finesse to navigate the terrain as one approaches the river. The road is steep, winding in shrubs and sharp stones. Climbing down needs keenness not to slide; climbing up needs strength to fight the gravity. Unfortunately, the animals are often at the river before them.
In the scotching sun and baked ground, the elephants, monkeys, cattle, zebras and gazelles did more than drinking: they bathed, peed and defecated in the water. This, according to Mercy and her friends, is better than the water in the next water source (Wigama) which has turned green and smelly; even the animals would not drink it.
With no other alternative, they fetch the water, knowing too well it would harm them. That there is a borehole closer that broke down and has not been repaired shows how poor counties such as Samburu are struggling with the social side of managing development, which should dictate what interventions should be prioritised over others, whether money allocation should consider the challenges that the county has.
After many children show up at the medical outreach with cholera, bloody diarrhoea (indicating dysentery), Action Against Hunger repaired the borehole in Nkoteyia, reducing the walking time to a manageable one hour.
Nkaeria Lekimariri’s speech on the borehole bleeds of feelings of more than the health needs she sorted. She is grateful for the fact that she and her children would not be visiting the hospital. Now she has a choice of how she would spend her time.
“I like white, and I would never wear white before because the clothes would be tarnished, or bathe as frequently as I would have wanted,” she told Lifestyle.