International
Development Organization
03-2006
carried out in Sololo area, Moyale district
A child recovering from severe malnourishment in
Sololo mission hospital
1.0 INTRODUCTION
3
1.1 Background
information
.
.
.3
1.2 Methodology
.
4
2.0 THE FINDINGS
..4
2.1 Factors
leading to Current drought situation
..4
2.2 Consequences
of the drought
..4
2.3 Who is
affected by the drought
...5
2.4 Malnutrition
..6
2.5 General
health conditions
7
2.6 Mortality
rates and Major causes of Mortality
.7
2.7 Livestock
Situation
...8
2.8
Water situation
.8
2.9 Water use
.8
2.10 Interventions
in place
..9
2.11 Other
Organizations in the area
...10
3.0 CONCLUSION
AND RECOMMENDATIONS
.10
3.1 Conclusions
.....10
3.2 Recommendations
..11
1.0 INTRODUCTION
Following
persistent drought, in the North and Eastern Parts of Kenya, CCM felt the urge
to intervene on humanitarian grounds in support of the people of
- Food Situation
- Malnutrition levels for special
interventions
- Interventions in place
1.1
BACKGROUND INFORMATION
Sololo is a small town in the west of Moyale district, 90km from Moyale town. The town is inhabited mainly by the Borana speaking community. Sololo town serves basically Obbu and Uran divisions of Moyale district. The town lies near Ethiopian border and therefore serves the neighbouring Ethiopian people. The total population of the area is 22, 472 people.
Table 1:Population Distribution By Location
|
LOCATION |
NO.OF VILLAGES |
NO.OF HOUSEHOLDS |
TOTAL POPULATION |
|
Sololo town |
19 |
1200 |
7,200 |
|
Anona |
8 |
296 |
1,494 |
|
Golole |
11 |
516 |
4,000 |
|
Uran |
9 |
500 |
3,700 |
|
Walda |
9 |
250 |
1,200 |
|
Dambala Fachana |
13 |
185 |
1,700 |
|
Sololo Makutano |
10 |
300 |
1,600 |
|
Rawana |
5 |
187 |
1078 |
|
Amballo |
3 |
72 |
500 |
|
Total |
87 |
3506 |
22,472 |
* The data presented above cover only the area served
by CCM
The Borana people are herdsmen and nomadic by culture. However, following changes in land ownership and use systems, some of the Boranas have embraced sedentary life while nearly half the community still move from place to place in search of water and pasture. However, even those who have more permanent settlements still have their animals migrating from one place to another. Division of labour on gender lines among the Borana is quite evident with the woman bearing the burden of home maker, while at the same time getting more involved in cattle keeping due to the increased enrolment of children in schools. The male gender is entrusted much more with outdoor activities; mainly, moving with animals in search of greener pastures and water. The men also have a crucial role to protect the community from raiders and any other invaders. Due to constant insecurity in the area, it is common to see home guards with AK47 guns usually licensed by the government for self defence and community security.
1.2 METHODOLOGY
The survey was conducted using semi structured interviews guided by a checklist. The key target of the interviews was government administrators mainly the chiefs and assistant chiefs as well. Other interviewees were community health workers and health officials at various hospitals and dispensaries. A few community members randomly selected were interviewed as well, to get a feeling of perceptions and impact of drought.
2.1 Factors
leading to Current drought situation
The current drought being experienced North Eastern and Eastern Parts of the country is as a result of persistent lack of rains over the past three years. Consequently, the entire Northern frontier has gone without a single harvest for the past three years while the East, which was receiving rains far below average has had to content with very low yields. Part of the problem that has aggravated the famine situation has been the communitys failure to use drought resistant crops such as millet which does better in areas with less rainfall. In addition, the community does lack the technical know-how to maintain and service water boreholes and equipment installed by CCM. This has forced CCM to engage a paid person to repair and fix any malfunctioning pump.
2.2 Consequences
of the drought
The drought has had far reaching effects on the local population. The Sololo survey revealed that the drought had led to the following:
- Caused at least seven deaths, 4 in Uran and 3 in Sololo Makutano over the past one year according to the area chiefs.
- Led to poor health as a result of poor feeding most affected being children, women (pregnant and lactating mothers) and the elderly.
- Displaced certain communities from their permanent settlements
- Led to withdrawal of children from schools to search for water or assist in other pressing family needs.
- Accelerated school drop out rates due to inability to raise school fees.
- Crumbled the peoples purchasing power and brought the economy of the area down on its knees
As a result, there have been cases of population pressure on certain areas and desertions on other areas. Walda alone has seen and increment of 184 households into the area. That is about 1,104 people moving into Walda due to its reliable water source. In Dambala Fachana, a whole sub location of about 700 people had moved out of their homes to live within Dambala Fachana centre where there was water though not very reliable. A replica situation was also reported at Rawana where the entire Banale sublocation moved into Uran location
2.3 Who is
affected by the drought?
Generally, the population in its entirety is badly affected by the drought. However, all those interviewed pointed out that women were most affected. This was because of their role in the family. The interviewees allocated 72 hours a week to be the minimum time women spend searching for at least 20 litres of water while she spent 36 other hours searching for grass for weak animals every week.
A malnourished woman without a meal for the day lays
on a traditional bed inside her manyatta.
At least eight women were reported to have been injured after falling down from the steep slopes of sorrounding hills as they sought for grass. Three of them sustained broken limbs and one was fatally wounded by a falling boulder after slipping off the hill. Two of these women were admitted in the Sololo mission hospital while five others were treated and discharged. One woman sought traditional medicine to nurse her injuries.
Children, especially those breastfeeding, had to do without even the breast milk as their mothers attended to other time-taking chores. Generally, all children had to go without milk. Children below five years of age are the most affected
Previously, the government officials in the area identified 50% of the local population to be in need of food intervention. However, as time advanced, numbers of people without food or any reliable source of income increased up to over 90 %. Only a few countable individuals in stable employment are able to put a plate of food on the table. The chiefs reported that these individuals were now under pressure because culturally they can not eat while their relatives are starving. Therefore, even though in employment, they had to sacrifice and support others hence got their resources depleted. This was the reason why food aid was given to 100% of the population though at nominal quantities.
2.4 Malnutrition
It was established that malnutrition was not considered as a medical problem among the local community. To them, lack of food was a condition that could lead to death and whose medicine was food. This meant that severe cases of malnutrition did not get medical attention.
From Sololo mission hospital, data showed that 80% of the patients admitted were suffering from chronic malnutrition. According to the hospital doctor, chronic malnutrition is a condition resulting from persistent underfeeding coupled by poor dietary intake. This phenomenon made the body weak and worked against the body immunity exposing the person to other diseases. Thus, people with chronic malnutrition were more susceptible to other diseases than those with healthy feeding habits. The doctor observed that chronic malnutrition was a condition common within the area and as reported earlier one that the community did not take so serious. Those who were admitted in hospital went to hospital to seek attention for other medical problems and not because of malnutrition
Data obtained in
the last one year (Feb 2005 feb 2006) indicated only two diagnosed cases of
malnutrition in all the clinics in the area. This was a clear indicator of
misdiagnosis and prompted the CCM staff to seek definition of malnutrition and
signs associated to malnutrition from the health workers found in the health
centres surveyed. Three of the community health workers were not able to give a
case definition of malnutrition but were able to associate Kwashiorkor and
Maramus to malnutrition. Despite Kwashiorkor being a common disease in the
area, data obtained from the dispensaries did not indicate its presence nor
that of Maramus. Community health workers, however, acknowledged that there
were cases of children who had visible signs of the two disease seen in their
dispensaries. It emerged that the community relied heavily on camel fat
extracts and traditional herbs to treat Kwashiorkor. In all the dispensaries,
there were no government nurses found on site during the time of the survey.
Sololo mission hospital had in the past two months received 5 cases of severe malnutrition, 4 of them being children under five years and the fifth case was a lactating mother. By the time of this survey, there were two children admitted in the hospital receiving intravenous medication due to malnutrition. Other than the food aspect, one of the children had contracted Tuberculosis and was in bad health condition.
The doctor noted that patients whose immunity had been affected by poor feeding recover quicker in the hospital due to the improved diet and frequent feeding offered within the hospital. However, after leaving the hospital, the condition became worse and patients could easily develop other complications.
On nutrition, it emerged that the community relied heavily on light starchy meals and milk. The hospital doctor felt that the eating habits of the surrounding community had a lot to do with the high rate of malnutrition. This is because, according to him, milk for adults was not enough to build the body and provide the essential protein intake. It also came out that the community did not eat chicken meat or eggs.
2.5 General
health conditions
The Sololo hospital doctor reported increase in TB infections in the recent past. He also noted that what made the situation worse was the fact that the community sought traditional healing methods instead of taking the patients to hospital early. This increased the infection rates. Other than TB common diseases recorded in the hospitals and dispensaries include diarrhoeal diseases and respiratory infections. Diarrhoeal diseases had increased in the past one year, a phenomenon attributed to contamination of domestic water.
Respiratory
diseases were said to be common among elderly people and children below five
years.
Among women of
child bearing age, it was established that there were many cases Vesicle Vaginal Fistulae (communication
between the vagina and the urinal or anal organs of the woman leading to
inability to control secretion functions)
a problem that could also be attributed to female genital mutilation.
Skin infections
were more common among children. Also it was established that many of the
children and homes were infested by lice, something they blamed on water
scarcity.
There were poor records of mortality at the local administration level. As a matter of fact, the chiefs never kept any record at all of the same. Usually, the area chief took the name, age and suspected cause of death to the district level where deaths are recorded. It was reported that death certificates in the area were not so popular and therefore people did not follow so much the official process of reporting deaths. In such a scenario, it was hard to establish the authenticity of deaths purportedly caused by starvation as indicated earlier in this report.
The dispensaries did not keep such record as they never handled critical cases. In case a person was brought to them in the verge of death, the dispensaries referred such persons to the Sololo hospital.
Sololo Mission hospital had proper death records. It emerged that on average, the hospital recorded at least one death per week.
Malnutrition did not emerge as a cause of death within the hospital. The Major cause of death among women of child bearing age was reported to be complications arising from prolonged labour pains, in most cases resulting to death of the foetus within the womb due to asphyxia.
The month of
July and august recorded the highest number of deaths especially among elderly
men and women. This was attributed to respiratory problems complicated by the
cold weather. Among children Malaria was highest killer disease
It was noted that these deaths could be averted if only health care attendants at the village level took patients to hospital early.
2.7 Livestock
Situation
The situation of Livestock in the area was pathetic. At the time of this survey, there was a night of very heavy down pour which the residents said that was likely to result to more livestock deaths because of the sudden cold. The rains were, however, received with renewed hope that they will yield to greener pastures if only it (rains) will be more sustainable.
On average, the Sololo community has lost 70% of their livestock. The loss has not been uniform. In some homes all livestock and in particular cows, goats and sheep succumbed to death due to lack of water while some homesteads lost as few as six animals. Those who moved their livestock to Ethiopian side earlier last year are said to have escaped the wrath of the drought. Even though, all livestock farmers have had their share of the loss though at varying scale.
2.9
Water situation
Access to water in the area was limited to five boreholes serving a population of over 22,000 people. CCM staff in conjunction with Government water engineers were in Ramolle 1 fixing a new generator that had been donated by CCM project. This was thought to ease the congestion at water points. The average time spent queuing for water is 24 hours per person. More often it is the woman who fetches water as prescribed by culture. Some villages walk as far as 30 kilometres to get to the nearest water point. When it rains, the villagers collect water from the roads and other places holding ground water for domestic use. This clearly indicated the desperation the community go through to have water.
Uran dispensary, situated 3km away from the nearest borehole had its patients bring 5 litres of water as a rule before they could be treated. Only then could patients be given medical assistance while the water supplied would be utilised for both medication where needed and clean the dispensary.
During the time of the survey, no trucks were distributing water to the local community.
2.9 Water use
An assessment of water use revealed that the scarcity of the precious commodity had restricted its use to basic needs only. Available water was used for drinking and cooking only. Washing clothes and body hygiene were no longer essential. Adults showered only once a week while children were sponge bathed only when necessary. Though sounding bizarre, one woman acknowledged not washing her childrens clothes for more than six months; I cant remember when I was washed my childrens clothes last may be six months ago or more, some clothes have never been washed since they were boughtsaid the woman. One of the chiefs interviewed reported that in his house, only his clothes were washed because his job required him to appear clean.
Water collected by the road side is used for consumption
2.10 Interventions
in place
Food situation had been deteriorating in Sololo area in the past three few weeks to critical conditions. Though the government had declared a national disaster and appealed for help, it took Moyale district a little longer to feel the intervention. By the time of this survey, the was relief food distribution all over the area of survey with Dambala Fachana receiving a minimum of 40 kilograms of maize rations per household while Anona recieved the least, i.e. 18 kg per household.
Apart from maize all households across the board received 6 kgs of beans and 3 kilograms of rice. A quarter litre to a full litre of oil was given out to households in the various households.
In Damballa Fachana, the population was divided into three categories as indicated below:
- The very needy (the very Poor) 60kgs of maize
- Moderately needy - 50kgs of maize
- Those with large herds of livestock/alternative income 40kgs of maize
There were huge disparities in the proportions of relief food given to the various locations in the district. This was because the distribution followed 1999 population census that were allegedly taken during a migratory season. Thus, those areas where population was high at that time received the highest rations while areas that had been deserted received very little rations. Damballa Fachana enjoyed an advantage while Anona and Rawana were highly disadvantaged
Further information revealed that there has not been any further relief food distribution other that that stated in this report. It has also been confirmed that World Vision (WVi) took over as the official lead agency in charge of relief distribution.
It was reported that displaced populations were not given any food rations from the location they occupied at the time of distribution. They were, however, entitled to ration at the locations where they were registered residents. In many cases the displaced communities were registered as far as Amballo and Torbi. The distance involved did not allow them to go for the food rations and hence went without any intervention.
There were also cases of Ethiopian immigrants and casual beggars who crossed the border in search for food. In Sololo town, at least 104 Ethiopians were present on the day of distribution trying their luck to get food. Damballa Fachana also received over 200 Ethiopians. It was also established that the Kenyans also went to seek for food assistance from their Ethiopian counterparts during relief distribution on the other side of the border. The Kenyans boasted of having government and Non governmental organizations more responsive to local needs as compared to their Ethiopian neighbours.
2.11 Other organizations in the area
It was
established that only Food for the Hungry International (FHI) was in the area
but was not responding to the emergency. By the time of the survey, officials
of FHI were found in one of the locations (Uran) conducting a capacity building
seminar. No other organizations were working in Sololo area, and in food relief
inventions, no organization other than CCM and the government were intervening.
3.1 Conclusions
Generally, the Sololo community need food, water and health care. Food interventions so far are quite unreliable and even when distributed the can only last but a very short period. It has been established that the World Vision (WVi) has taken over the food distribution exercise as the lead agency in Moyale. However, the agency was only to reach out to a 30% of the population and this will mean that a good percentage of people who have been depending on the relief support will be cut off from any assistance.
Food insecurity is expected to persist. World Food Programme has already announced that all they have will not last beyond April and as a result appealed for help from international donors. The Kenya Meteorological Station predicted rainfall below average and especially in the famine stricken area. All these gloomy findings point to one thing more starvation cases, acute shortage of water and deaths of livestock.
3.2 Recommendations
Based on the above picture, action must be taken to save loss of lives and possibly find lasting solution to recurrent drought in Eastern and North Eastern Kenya. It is therefore strongly recommended that:
- Due to the fact that malnutrition rates have not reached alarming levels, support can be given through the existing hospital to handle the few emerging cases as the situation is monitored over time.
- There is need for food aid in the area, more specifically targeting displaced populations as well as balanced diet food supplements as the governments is only distributing hard cereals .
- There is need for a door to door nutritional survey in order to establish the levels of malnutrition in the area.
- Water interventions through water trucking services and repair of existing boreholes for the short-term.
- Drilling of boreholes in villages far from water points as a long term measure of ensuring access to water
- Community to be sensitised about health needs and importance of seeking medical attention on time
- There is need for organizing community health education covering more specifically nutritional education, body hygiene and water handling at domestic levels. This would go way into improving the health of the Sololo people
- The office should organise workshops to build further the capacity of the community health workers assisting in dispensaries. It should be realised that the community health workers have had to play the role of nurses in the dispensaries. Any effort that can be done to motivate the nurses to take up full responsibility of the duty they are called to serve should be done.