Tales from the Sand River
Another patient was a girl aged about 15. She had been married at the age of 12 and had one child aged 10 months. She came with her husband (a refreshing sight) and chose to have a three month contraceptive injection. Another lady, aged about 27 (she wasn’t sure of her age) had four children and wanted a LARC to prevent further pregnancies. However, she was very anxious that her husband should not find out as if he did, she was sure he would beat her. A sobering thought, but a United Nations survey of women in Sub-Saharan Africa showed that just over 50% of women living in rural areas (and just under 40% of men) consider that it is acceptable for a man to beat his wife for at least one reason.
Jane is a young woman who came down from her manyatta because she wanted to help with the clinic. We all thought she was single, but it later turned out that she had three children, the youngest one being only a couple of weeks old, so she had to nip back to her home at frequent intervals to breast feed the baby. Later, Michael took me to visit her manyatta, which consisted of three grass huts. Her husband has two wives and the first wife had a hut for her and her six children, Jane had a hut with her three children. The third hut was the village shop, run by her husband. Despite being in a grass hut, it looked well stocked, neat and organised. It was the only communal building I saw in the village. Despite her domestic commitments, Jane joined the clinic team with enthusiasm and I was later pleased to sponsor her basic training as a mobiliser. I’ve recently heard that Jane now works as a Family Planning CORP, with CHAT supporting her ‘back pack’ door to door PHE mobilisation work.
Some villagers came down to the clinic just out of curiosity or to be sociable. One elderly lady kindly agreed to have her photo taken with me. She took one look at the photo and said I looked as old as her (cheeky, but she was probably about right)!
The next morning, we drove along the luggar to set up another mobile clinic for different manyattas. The striking image on arrival was seeing eight children squatting under a tree. The oldest can’t have been more than about nine, and two who looked no more than six or seven, were holding even littler ones. They were just sitting there, nothing to do, no adults in sight, so were delighted when Pauline and Rose joined them for a few minutes. Adults did, of course, come to the clinic. The most memorable was a local policeman, who brought his wife, who had four children. He thought that was enough and that she should have a LARC, which she did. Then he mentioned that he had also brought his second wife, who had two children and asked for her to have an implant. At the end, he casually mentioned his third wife. She only had one child, so he saw no urgency for her to have an implant and did not bring her to the clinic. This was a relatively small family (many have more than 10 children) and it was even more unusual that the husband should bring his wives to the clinic. I never understood how some men could have so many wives, without leaving other men with none! This may be partly explained by the Samburu custom that Morans (young men in the age group 18-30 who have gone through their initiation to manhood, which includes circumcision) often leave their village for lengthy periods to look after the animals and do not marry until they return from this period of their lives.
Sitting around the camp fire, I heard interesting tales. One story concerned a lady with four children who wanted no more, so had an implant, without telling her husband. Two years later he was concerned that she had not got pregnant again, so took her to the local witch doctor. His advice was that to get pregnant again, she should be smeared with the droppings of a black goat. She sighed and complied, then slipped along to the hospital to have her implant removed. She duly got pregnant again, so hubby was happy, but nipped back to the hospital soon after delivery to have the implant reinserted. Another woman wanted an implant, but her husband, who was with her, was reluctant. First she had to provide a urine specimen to be sure she wasn’t already pregnant. She went out to the bushes to produce a specimen, but when she came back in she said she had lost her purse. She asked her husband to go and look for it – plenty of time to insert a LARC before he got back. Tales of illegal abortion were often disturbing. One rough, physical method, described in gory detail and involving strategic kicks and abdominal pummelling, has been associated with rupturing of the womb and other internal abdominal injuries. It’s not surprising that such actions can lead to fatalities, but the demand for illegal terminations is so high, especially for young, unmarried girls, as the local custom is that they cannot marry if they have had a child and there are no safe, legal abortion options available to them.
The CHAT team is typically on the road (or should one say struggling across wild country) for about three weeks at a time. In some areas, not even Land Rover access is possible, so the team travels by camel train, but inevitably, this dramatically increases journey times, so the area covered is smaller. Clinics are held almost every day and on some days, up to 80 LARCs may be inserted. I have enormous admiration for all the team. Everything is done in a wonderful, cheerful manner under very basic conditions and their services are so greatly appreciated by the local people. There is a catholic mission quite close to Loikumkum, but the priest is usually away when clinics are held in the area.