Four legs and queuing for a drink – Part III
Making the Link – Population, Health and Environment
As well as understanding the medical services and the need for them, I was also keen to understand what was happening to the environment, particularly the wild animals. Every morning we were woken by monkeys chattering happily in the trees over the campsite, but the vast majority of the animals that I saw were domesticated.
One morning, John took me for a drive up the dry river bed to see what wild life we could find. As we drove we seemed to pass small herds of domesticated animals every few minutes, mostly goats and camels, but occasionally sheep and cattle and almost all tended by children.
We stopped at one of the rare water holes where a man was bringing up buckets of water from about 2m below ground level into a trough for a herd of a hundred or so goats, tended by three undernourished children aged about 9–12. However, what truly amazed me was what I saw 100m away. Along the luggar bank and hiding from the sun under a big tree was another small herd of goats, looked after by a girl who looked no older than about 10, patiently waiting for their turn to be served at the water trough.
Four legs and queuing for a drink
An old man told us that some elephants had been seen that morning and pointed us in the direction they went. We duly found five and I got some wonderful photos – with one of the locals getting me in a good position for photos and another half dragging me back to the Land Rover for safety reasons. A great experience for me, but I couldn’t help thinking of the thousands of elephants that used to roam across the nearby plains.
The only other wild animal we saw that morning was a baboon – a situation not unlike the UK where we are used to seeing so many fields of cows and sheep and just the occasional fox. At least our herds are protected by fences and hedgerows instead of by undernourished child shepherds who have no school to go to. All this reminded me of the figures from the WWF Living Planet report, which showed that globally, wild life animal populations have fallen by more than 50% in the last 40 years. In contrast, United Nations reports show that in the same period, the human population on Earth has doubled. What are we doing to our world, whether it be Africa or Europe? Humans currently make up 32% of the global biomass of vertebrates with wild animals now less than 5%, the rest being livestock bred for human benefit.
For many Samburu men, having lots of children gives them high social status. Recently, a researcher from University College London (UCL) carried out a survey on the attitudes of Samburu men in rural areas within the communities reached with CHAT PHE services, with a particular focus on the relationship between environmental problems and family size. This programme involved focus group discussions and semi structured interviews and revealed support for environmentally–sensitised family planning promotion. These men highlighted their dependence on natural resources and challenges faced in providing for large families and maintaining livestock during droughts. They realised that these practices lead to natural resource exhaustion, environmental degradation and wildlife dispersal, undermining the key economic benefits of environmental and wild life conservation. The researcher concluded that relating family size to the environment is a compelling strategy to improve support for family planning among Samburu men.
The PHE approach is getting increasing attention in many developing countries and was highlighted at the recent Global Summit on Family Planning in London (FP2020). CHASE Africa, which started out in Kenya with tree planting, has taken this approach – matching the focus on the environment with a focus on family planning and women’s rights with support for programmes run by CHAT, Dandelion Africa, the Mount Kenya Trust and an expanding number of other centres in East Africa.
It is encouraging to hear that men are responding in this way as it is my experience to date that most women in rural Kenya want to hide their use of contraception from their husbands, as their husbands just want as many children as possible. The culture in many parts of sub-Saharan Africa is for the men to make the decisions on family size, and it is my understanding that discussion between partners on this sensitive subject is often limited. These research results suggest that a holistic approach bringing together family planning and environmental conservation is a good way of showing what can be achieved in terms of better nutrition and providing more opportunities for education, jobs and improving the general quality of life. It is a way of encouraging men and women to discuss related problems together. This approach has worked extremely well for the Blue Ventures programme in Madagascar which combines marine conservation with family planning in small, coastal communities.
I was only able to stay with the team for a few days, so arranged for a small aircraft to pick me up to fly back to Nanyuki. The airstrip was on a bare hill top with no more than a windsock, a “T” on the ground, one tree and a tiny, grass roofed shelter. As we flew away I was very conscious of how dry the area was, with any water at all in only one of the river beds I could see, and of the difficulties the local people had getting adequate supplies of water for themselves and their animals in the dry season.
It was sad to think of the disappearing wild animals with the likely loss of future jobs in ecotourism, the father who cried because he could not support even one of his 10 children through school, the women who were so anxious to stop having more babies, but felt unable to talk to their husbands about the problem and the many, many, often poorly nourished children: some just sitting around with nothing to do, slightly older ones tending their animals, with little prospect of school. I sincerely hope that the PHE (Population, Health and Environment) programmes undertaken by organisations like CHAT can give these communities the knowledge and support they need to help them develop sustainable and rewarding lives for themselves.
The work of CHAT in Samburu areas is effective and greatly appreciated by the local communities. Michael, one of the most experienced mobilisers, visits primary and secondary schools in the region every few months to give talks, show videos and lead discussions on key topics like HIV, family planning and the environment, helping the young people to understand what is going on and helping them to make their own decisions about what can be done. Nevertheless, getting the message to the many rural communities yet to be reached by such programmes of the benefits to themselves and their environment of conservation efforts and smaller families is a huge challenge.
Let us hope that these programmes can be expanded and many more comparable schemes can be developed throughout Kenya and indeed throughout the whole of Sub-Saharan Africa. As education and understanding of realities improves, so the barriers to the changes that can bring such benefits to the quality of life of so many people are slowly falling.
* Int. J. Environ. Res. Public Health 2017, 14(5), 528
CHAT work with grass roots mobilisers who reach out to their communities with information and advice about family planning options. As well as family planning they also talk about environmental issues and encourage communities to think about the links between family size, the environment and resource scarcity: “It will help communities make informed resource allocation and distribution decisions in relation to their family size, influencing communal decisions and realising that their high population growth rate impacts negatively on the entire community. Men were especially receptive to this form of ‘logic’ thus bringing men and boys into the family planning conversation and participation.”
Jane is one of CHAT’s mobilisers:
Since her own shamba [Swahili word for a small plot used for growing subsistence crops and fruit-bearing trees, often including the dwelling of the farmer] is small, Njeri and her husband have to work on other people’s farms, mainly picking tea to supplement their income. Njeri is a 38 years old mother of three and comes from Embu, a village near Mount Kenya forest. Njeri has been married for ten years. 
We’ve had news from Gabriel Musundi, founder and CEO of Community Health Volunteers – CHASE Africa’s partner based in Kakamega, western Kenya.
in Embu County, Rebecca, a 26 year old mother of three, was among the beneficiaries of the family planning programme.
Mary writes, “I have worked with MKT for 15 years as a member and a leader of one of the tree planting women’s groups. I was approached by an MKT official to join in and be trained as a Community Health Worker particularly focusing on family planning. I didn’t quite understand how family planning and conservation related. After training I got to fully understand the logic between sustainable families and conservation.
In layman’s term this is equivalent to giving more than forty thousand women one year of family planning. It’s an effective and unified way of showing how the various different contraceptives (from the daily pill to a five year implant) we offer through our mobile clinics are reaching and impacting the communities that we serve.
Community Health Africa Trust mainly operates in the remote northern areas of Isiolo, Laikipia, Baringo and Samburu counties where many people are semi-nomadic pastoralists who have poor access to healthcare. CHAT uses a variety of methods to reach their clients. Sometimes it’s a back pack nurse travelling on a motorbike, but when travelling further from base the trusted Land Rover is used. When the terrain becomes too challenging for wheels, a team of camels is the preferred form of transport.
As well as running the mobile clinic, Dandelion is well underway in building a clinic at Sarambei, which should be opening in July 2017. Once built, Dandelion will apply for an SC11 registration so that they have government recognition. The clinic will have a big impact on the community because women will have a safe place in which to discuss, learn about and access sexual and reproductive health services. Currently, the nearest hospital where women can have safe deliveries of babies is 20 kilometres away and the rates of HIV transmission between mother and child are high due to home deliveries. Giving birth in the new clinic will save the lives of many women and their babies.
The location of the proposed project is on the Imbirikani group of ranches where approximately 15,000 Maasai live. In this area FGM and polygamy are still common practice with very few women using family planning. The project is due to start in March 2017.
In November 2015 Stephen Rubunga, one of the co-founders of CTPH, spent time with Dandelion Africa to learn more about how to conduct mobile clinics. With the knowledge gained and funding from CHASE Africa, CTPH set about scaling up its family planning services with plans to conduct three mobile clinics around the Bwindi Impenetrable National Park in late 2016. In these remote areas most people do not have access to family planning. During our pilot mobile clinic nearly 100 people from Nyabaremura village in Rubuguri parish were provided with family planning counselling and commodities, as well as HIV testing.
MKT has been very successful in engaging the local community with their conservation projects and the community health project launched with CHASE in 2014 has changed the lives of thousands of families. 21,000 family planning treatments (equivalent to 30,000 women each receiving one year of contraceptive cover) have been provided free of charge, with many women opting for the three year implant. Giving women the chance to choose when they want their next child gives them an opportunity to earn an income and help themselves to escape poverty. The project has also helped over 13,000 people receive primary healthcare.
In 2016 CHASE funded the purchase of 2,000 avocado seedlings. Most of these have been given to pupils who have shown real interest in environmental matters at schools covered by our tree growing projects. They have taken them home and planted them there.
In 2012 world leaders gathered in London for a summit on Family Planning. Out of this summit FP2020 was born, which set the objective of offering 120 million additional women family planning options by 2020. FP2020 is hosted by the United Nations Foundation, which builds public-private partnerships to address the world’s most pressing problems. It is supported by philanthropic, corporate, government and individual donors.
Many women use Depo-Provera as their preferred method of contraception, but this means having to visit a clinic every three months to receive an injection. For those living in remote areas this can mean a long trip to the clinic. It would be so much easier if they could self-administer this form of contraception. A new product called Sayana Press does just this. Sayana Press is small, light, easy to use, and requires minimal training, making it especially suitable for community-based distribution—and for women to administer themselves through self-injection.
I have been a professor of medicine at a London teaching hospital for more than 25 years. Over these years I have become increasingly uncomfortable with the way the global environment is being destroyed and degraded by human activity. The climate is changing, forests are disappearing, desertification is overtaking previously fertile land and natural resources (particularly fresh water) are being consumed faster than they can replenish themselves.
I soon arranged a visit to Dandelion Africa, one of several health related charities in Kenya supported by CHASE Africa. It was an eye-opening experience! Dandelion was founded by Wendo Aszed, who gave up a position in banking to found Dandelion in 2009 with the core aim of raising the quality of as many aspects of life as possible for those in the local communities around her home district, especially the women. Her outreach clinics go to isolated rural communities who have previously had few or no health services. The clinics provide basic general medical services including vaccination and HIV screening, but the key focus is on family planning. So many women are anxious to limit their family size so they can afford to feed and educate their children. Many less educated men still want many children so during these clinics there is a constant focus on education through discussion groups and short dramas – not to tell individuals what to do, but to explain the consequences of large and small families and let individuals decide for themselves what is best. Clinic days are fun days out for the children, but for the older ones, it is also educational with talks on hygiene, coping with menstruation (so girls don’t miss school) and avoiding pregnancy.
As an ambassador for CHASE, I am doing all I can to support their activities with Dandelion and the other related charities in Kenya they support, particularly CHAT (Community Health Africa Trust) and the Mount Kenya Trust. I do this largely by giving personal talks to a wide range of groups in schools, universities, many adult organisations and to University of the Third Age meetings. My aim is always to present the facts on population growth, both in Kenya and around the globe and how the problems are, or are not, being addressed. The commonest reaction is to say “I never thought of things that way”. One recent comment was “very interesting, lots of questions, but all a bit scary!” How true that is!
The Mount Kenya National Park was established in 1949 to protect the Mount Kenya, its wildlife and environment. It covers 276 square miles, centred on Mount Kenya itself – Kenya’s highest mountain. It is the main water catchment area for two large rivers – the Tana, the largest river in Kenya, and the Ewaso Ng’iso North. Mount Kenya’s ecosystem provides water for over 2 million people. The whole area is some 90 miles north northeast of Nairobi.
In December 2016, Henry visited one of MKT’s day clinics. The visit started with a trip to the Timau Sub-County Hospital in Meru Country to pick up a doctor, nurse and supplies for the clinic. From the hospital the group travelled to a small church and setup the clinic. At the clinic they welcomed members of the local community who were seeking healthcare for themselves and their families. The clinic also offered family planning to those who wanted it – counselling and advice are offered to help women make the best decision for themselves and their families.
In the Kakamega Forest we work with Community Health Volunteers to bring mobile clinics to rural communities. CHV in Kakamega was founded in 2006 to “create awareness to the residents on HIV/AIDS, as well as on issues of sexual and reproductive health”. The team of volunteers who all live in the area they serve is headed up by Gabriel.