Four legs and queuing for a drink – Part I

From Nanyuki to Loikumkum

Nearly three quarters of Kenyans still live in rural areas, where the infrastructure is often very limited, especially with regard to health services and travel. CHAT (Communities Health Africa Trust) is a community based organisation based in central Laikipia, close to the foot of Mount Kenya. They provide integrated mobile Population, Health and Environment (PHE) services, with a focus on innovative family planning and a strong component of environmental awareness. CHAT targets slums as well as other urban, rural and remote areas. I was fortunate enough to spend a few days with the CHAT team in the West Ndotos in Samburu in northern Kenya – an opportunity to see for myself what life is like in an area so far from any major city or town, understand the needs of those who live there and see what is happening to the environment, particularly in relation to the still rapidly increasing population.

With three of the team, led by Shanni Wreford-Smith (CHAT’s director), we set out from the office in Laikipia at 5.00 am. The pre-dawn drive along barely discernible rough tracks was enhanced by glimpses of a range of animals, particularly the striking silhouette of a giraffe surveying us with interest as dawn approached. With sunrise, the beauty of the open countryside was revealed, with little sign of civilisation for the next four hours. Crossing a river was a novelty. One of our team had to remove his shoes and wade across to assess both the depth of water and to exclude the presence of any large stones that might strand our Land Rover. He did a good job – we drove across the river with ease and I didn’t even get my feet wet. In due course, we reached Maralal, a small town which is the capital of Samburu county, to meet up with the other half of the team. Maralal has about 500m of tarmac road – the only surfaced road I saw in Samburu territory. I moved to the Land Rover of John Wreford-Smith, (age 86), who had been the government custodian of the forests in northern Kenya over half a century ago.

The challenging drive continued, this time with a heavy trailer loaded with fuel and supplies for the team for three weeks, bumping along a steep, rugged track. The mountain peaks in that area go up to 2500m, but there was good agricultural land at the mid-levels with flourishing crops of maize, wheat and beans – much greener than at the lower levels, which were very dry. Then we descended through a forested area to the plain where we were close to the border between the Samburu and Turkana tribes, an area with a notoriously insecure history. In 2012, Turkana tribesmen had rustled cattle from a Samburu area, but when police chased them into Turkana territory, 40 police had been massacred. John told me that when he first lived in the area, there were thousands of elephants on the plain. On that day, all we saw was one ostrich. The vegetation was mostly sage brush, but at least that is good camel food.

Eventually we reached our campsite on the banks of a broad but dried up sand river – the Loikumkum luggar – flat, spacious and plenty of shade for our comfortable tents. I had a small but modern and luxurious tent on my own. They told me that on a previous visit there, some people were woken up in the middle of the night by an odd rustling noise, only to discover elephants scratching their backs against the trees! A little spontaneous night running was required. We did not have the privilege of such a visit, but elephant droppings were certainly there. They also told me that on another visit, flood waters in the night rose to within a few inches of the level of the camp and they nearly had to pack in a hurry and move up to the local village, Loikumkum, a 10 minute walk away on higher ground.

Our cooks were outstanding. Vegetables were purchased en route and on one occasion, the goat for dinner was purchased by negotiation with one of the young shepherds tending their flocks along the river bed. One of the cooks would do the rounds to gather everyone together from their tents at meal times. A touch reminiscent of UK traditions was a small boy coming down from the village each morning with a churn of fresh milk. Established ablution facilities were distinctly limited, but making do was not a problem.

In Loikumkum, there were a few solid huts, but most people lived in grass huts spread out over the gently sloping ground. I was introduced to James at his home. He was 17. He was one of 10 children. Two of his older sisters were married, but the other eight and their parents lived in a grass hut about four metres in diameter. He was the only one at school and he wanted to be a journalist. He was at home as teachers were on strike at the time. To get to school, he had to walk for a day and a half, to Baragoi. He said his father was in tears because he was not able to support even one child at school. The dowry from the wedding of one of his sisters was helping to pay his school fees. He did get some support from the school and other sponsors. I do hope James gets the chance to realise his ambition. I was delighted to hear recently that he has now graduated from High School and has been offered a place at University. The younger children worked on tasks like looking after the domesticated animals. James himself was very conscious of the problems of looking after large families and felt that families should only have the number of children that they can support. I suggested he might help with the medical team, which he did with enthusiasm for the rest of the time I was there.

The clinic was held on the river bank. It consisted of a table and chairs for consultations and treatment, a small tent for privacy, when required for examination, and another table for the “pharmacy”. A reasonable selection of common drugs was available. There was only one nurse, Pauline, in uniform, assisted by several mobilisers. Mobilisers, known locally as community own resources persons (CORPs), who act as the link between CHAT and the local communities, have some basic health and environmental awareness training. They usually go door-to-door before a clinic to tell those in local villages when the CHAT team is coming and what services will be available, particularly providing information on family planning options. Most women prefer long acting, reversible contraceptives (LARC), either an implant inserted under the skin in the upper arm, which can last for 3 years or an injection, which lasts for 3 months. A few like the contraceptive pill, which is less convenient as it has to be taken every day, or for their partner to use a condom. Very few favour sterilisation or vasectomy. Pauline acted as a family doctor as other medical services were rarely seen in these areas. Rose, CHAT’s project officer, sat with an enormous book, recording all the procedures – a legal requirement. All those over 18 had to be tested for HIV and patients were also asked about any symptoms suspicious of tuberculosis (TB). If they did have symptoms they were referred to the nearest hospital for further tests. I understand that up to a third of such referrals are confirmed to have TB. Follow up of these patients is undertaken by mobilisers, in partnership with the government run Comprehensive Care Clinic.

The Team

The Campsite

Our morning milk

All you need…

James and Steve

The Clinic in Operation