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One-stop health shop for Kenyan pastoralists

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By CHRISTABEL LIGAMI
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Under the scorching morning sun of northern Kenya, women and their children wait patiently under a tree for their turn with the outreach team.

Around them are water containers and goats. Close by are the men whose livestock is being attended to by veterinary officers working alongside the health officers.

This is Natole village in Kibish region of Turkana County at the border confluence of Kenya, Ethiopia and South Sudan. It lies within the Elemi triangle, a historically disputed land among the communities from these three countries.

People here are pastoralists, who are always on the move, seeking not only for pasture and water for their livestock, but also to elude cattle rustlers.

Without roads, access to the community is a challenge. Only heavy duty vehicles can traverse this hot, dusty region and during the rainy season, movement becomes hampered by floods.

Healthcare in this region remains a challenge not only due to widespread environmental degradation, food insecurity and malnutrition but also because a large percentage of these populations is not insured.

They have to trek long distances to reach health facilities that are either understaffed or have no qualified medical staff.

Llipsini Ekuwam, 28, is at the health outreach organised by Afya Timiza in partnership with the Ministry of Health and the Turkana County.

Known as Kimormor (a Turkana word meaning “all together”), this is an innovative is funded by USAID to connect nomadic communities with basic health services.

Llipsin arrived at the centre at 9am with her two-year-old son just before the health officers got started.

“I walked for about three hours to get here,” she said.

The mother of three says she has never delivered at a formal health facility and never attended an antenatal clinic.

Her children have never been immunised or been to a hospital for medical check-ups.

Seeing how her children are spaced, one would think that this is a result of family planning. But that would be untrue considering Llipsini has suffered three miscarriages.

“Every two years, I conceive and at some stage I get a miscarriage but then the next pregnancy makes it to term. I think this is OK because the miscarriages clean up my womb and prepare it for the next baby. That is why the pregnancy that follows is always a success,” said Llipsini, adding that all her children are healthy and have no complications so she sees no need to worry.

She has never used any family planning device or method and believes that how a woman gives birth is up to God, something that cannot be controlled.

“All you are supposed to do is wait until God gives you another baby,” Llipsini added.

Even the idea of taking her children to a clinic is news to her. “I have never heard of it nor have I seen other women doing that,” she said.

Llipsin’s son is among other children who were dewormed, weighed and their height taken to ascertain their health status and whether they are malnourished. Her baby’s weight and height are fine for his age.

“I came here because the health volunteers talked to my husband about it and he asked me to come with this baby. The other two children are at home taking care of the goats,” said Llipsin.

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“If family planning is as good as the community health volunteers say then continue talking to us about it and we will change. We have started bringing our children for check-ups and are now aware of the importance of attending antenatal clinics and making safe deliveries at the health facility.

Eventually, when we experience the benefits of family planning and our husbands agree to it then we will take it up too,” Llipsin adds.

After discussing the topic with the health workers at the outreach centre, she promises that the next time she is at Kimormor outreach she will consider trying out the family planning services.

The campaign is done quarterly as a follow up to the monthly facility-based outreaches that offer human healthcare services only.

The various service departments meet at the county headquarters in Lodwar where department heads of the targeted services are located.

To initiate the outreach, the Afya Timiza team delegates community health assistants, community health volunteers and the area chiefs encourage the Emuron and Kraal leaders to mobilise their communities along every mapped migratory route.

Water points a provide a strategic location for setting up the outreach. As the community’s stop to water their animals and replenish their water supply they also receive the services.

“We get the information on the migratory routes to follow from the Ministry of Water office. This saves time spent on trying to reach the people,” said Gilbert Wangalwa, chief of party of Afya Timiza.

At the service delivery point, each department is tasked with its core mandate.

For example, the Ministry of Health provides human health services including antenatal care, postnatal care, immunisation, screening for malnutrition and providing the nutritional supplements as well as HIV/Aids testing and counselling.

The Ministry of Livestock, Agriculture and Pastoral Economy deworms and treats animals and also sensitises communities on the importance of growing locally available foods.

At the outreach centre, men accompany their families as they bring along their livestock for veterinary services.

“Most of the time we use the men to pass along the message and so as they come for the veterinary services, they come along with their families,” he said adding that the strategy has worked well because in Turkana the men are the overall decision makers.

On this day John Lomulen has brought his animals for deworming and vaccination. Lomulen has three wives. His first wife has accompanied him for family planning services.

Although he is happy that his cows have been vaccinated, he is not sure that it is a good idea for his wives to use contraceptives.

“What if the bandits come and kill our children? I still think we need to have as many children so that if some are killed we have some left,” said the 40-year-old.

He said that if they had better arms to protect themselves from the cattle rustlers, they would take family planning seriously.

Lomulen first heard of the Kimormor outreach from Faustino Muya, a community health officer, who was going around educating people about health.

Mr Muya and his colleagues use digital devices known as Digisomo to sensitise the community.

The Digisomo is a simple battery-operated computer audio device that is not dependent on the Internet or electricity.

It is loaded with standardised messages translated into the Turkana and Samburu languages on the five thematic areas of family planning, reproductive, maternal, newborn, child and adolescent health as well as nutrition and WASH (an acronym that stands for “Water, Sanitation and Hygiene”).

Universal, affordable and sustainable access to WASH is a key public health issue within international development and is the focus of Sustainable Development Goal 6.

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Public officers above 58 years and with pre-existing conditions told to work from home: The Standard

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Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.

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However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.

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Uhuru convenes summit to review rising Covid-19 cases: The Standard

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President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow

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Drastic life changes affecting mental health

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Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.

KBC Radio_KICD Timetable

Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.

Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.

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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.

In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020.  It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.

A study by Dr. Habil Otanga,  a Lecturer at the University of Nairobi, Department of Psychology says  that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.

The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.

KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.

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Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.

As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.

“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”

Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.

“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.

Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.

“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”

Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.

“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.

Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.

Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.

She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.

Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.

“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added

Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.

“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and  also engage in   reading that would  help expand their knowledge.

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