When Ali’s cough persisted beyond the fifth day, his mother Alasey Derow became deeply worried.
“I knew it was time to take him to the hospital because it could develop into something worse,” she said.
Ms Derow had heard about the outreach clinic that would be held at Murga Harun, which is about 40 kilometres from the public hospital in Tula Tula, Wajir West.
At the outreach clinic that is held every two weeks, the clinical officer saw her son and prescribed medication.
His weight was also checked for signs of malnutrition using a test called mid-upper arm circumference, which involves the measurement at the midpoint between the tip of the shoulder and the tip of the elbow. It is used to assess one’s nutritional status, with low scores indicating that he or she suffers from malnutrition.
“The boy is okay nutrition-wise. We have given him something for the cough and are confident he will soon be okay,” said clinical officer Lack Onami, who has spent seven years at the “bush” clinics.
For children with malnutrition and stunting, Mr Onami will prescribe rations of Corn Soya Bean, or Ready to Use Therapeutic Food also known as plumply nuts, a type of fortified peanut butter paste rich in vitamins and energy contained in a package. These food and medical supplies are provided free of charge by the government.
Children are also vaccinated against mumps, measles and rubella, polio as well as pneumonia.
For 60-year-old Osman Gele, the news about the forthcoming clinic was a sign that it was time to travel.
“I sat in the bus for a six-hour drive from Shandarua to Merti, Isiolo, where my family had migrated to,” says Mr Gele, a clan elder and community health volunteer.
His mission was crucial: to ensure his daughter and the other families in Merti attend the outreach and get their medical problems attended to.
Mr Gele’s daughter is pregnant and he did not want to take chances with her delicate condition.
“My daughter is expectant with her first child. I could not afford to let her miss out on the essential appointment with the doctors,” said Mr Gele.
His daughter Deka Ibrahim, 17, is eight months pregnant. Since she got pregnant, the family has migrated from the village to escape the worst effects of a two-year drought that has ravaged Wajir County.
She is a little hesitant when we ask her about her experience but with gentle coaxing from her father, she opens up and speaks confidently.
“It is my first antenatal clinic visit. I have been away all this time because of the drought,” says Ms Ibrahim.
She had left the area known as Shandarua, a Somali word for malaria nets, with other family members in search of pasture and water for their livestock after the October-December 2018 rains failed.
They settled in Merti, which is in the neighbouring county of Isiolo.
At this visit, health workers gave her the anti-tetanus vaccine, folic acid supplements and paracetamol for back pain that is common to women at her stage of pregnancy.
Had she followed the antenatal care rules, this should have been her fourth visit.
She is one of the 64 percent of women in the county who attended at least once in the course of their pregnancy as opposed to the 33 per cent who attended all the four required sessions.
However, due to the drought, she could only get the opportunity to visit the clinic when the outreach clinic came to her village.
The young mother is not going back to Merti. Instead, she will stay in the area until her baby is born.
“I am too tired to travel now,” she says.
Mr Gele uses his smartphone, which has social media app WhatsApp to reach members of the community when he gets confirmation on the outreach clinic dates.
Once the nurses or clinical officers tell us when the clinic will be held, we inform the 200 families in my area through WhatsApp and phone calls so that no one is left out, he says.
In cases of difficulties, the community health volunteers call the hospitals in Griftu, Tula Tula or Hadado for the county ambulances to rescue the mothers in distress.
According to the Kenya Demographic and Health Survey (KDHS) of 2014, Wajir has a maternal mortality ratio of 1,683 deaths per every 100,000 live births, which is almost four times the national average of 362.
The KDHS and the United Nations Population Fund estimates that the county’s neonatal or infant death rate is 362 per every 100,000 live births a worrying nine times higher than the national average, which is estimated at 39.
For Alasey Derow, the nearest health centre for her family is the outreach clinic in Murga Harun that the Ministry of Health, the Wajir County government and Save the Children, a child survival NGO, jointly sponsor.
Save the Children is carrying out a humanitarian aid effort in the county, which includes fuelling vehicles involved in water supply, sponsoring mobile outreach centres to ensure that residents access vital services like antenatal clinics for expectant mothers and immunisation for children under five years of age.
“We are interested in ensuring that the children’s chances of survival are maximised through interventions in the health, nutrition and logistics required to bring services nearer to communities in the area,” said Programme Manager Abdullahi Aden.
At the Murga Harun outreach centre, a hive of activities marks the proceedings as mothers and their children queue for the essential weighing and examination before medication is prescribed.
“So far, we had three cases of malnutrition in the 40 children we have seen since morning,” says Joyce Koros, a nurse at Tula Tula Hospital that also works in the outreach effort.
Malnutrition affects both physical and brain or cognitive development of a child that can last for the rest of his or her life in crucial areas including schooling, health and livelihood.
Pregnant and breastfeeding women, as well as children, are among the most vulnerable during emergencies, including droughts and flash floods.
Malnutrition rates among these mothers also increase during emergencies, leading to poor health outcomes for their infants, including poor growth and development, increased morbidity and mortality.
According to the Save the Children report, Wajir is one of the regions that have global acute malnutrition (GAM) rates of between 15 and 29 per cent.
“Turkana Central, Turkana West, Mandera, Wajir, Garissa and Tana River have critical acute malnutrition with GAM rates of 15 to 29 per cent,” notes the report.
A Unicef report on the food security in the county listed its main food groups like cereals, oils, fats, sugar, milk and milk products, with very minimal intake of protein-based foods such as meat and eggs as well as fruits, which are a source of vitamins.
“At the household level, 18 per cent or almost one in five of the households consumed less than three food groups while 52 per cent or slightly more than half consumed three to five food groups. This means that even children did not meet their minimum dietary needs,” said Save the Children nutrition monitoring officer Adikadir Adan.
He said the food insecurity in the county had resulted in a humanitarian crisis.
“Malnutrition rates in the county are reported at 16.4 per cent, which counts as a crisis requiring urgent humanitarian action,” said Mr Adan.
He said much of the children’s disease burden in the county could be attributed to acute malnutrition.
“Among the general population, morbidity or sickness rate remains high at 20 per cent, with the main disease affecting children including acute respiratory infection (56 per cent), fever with chills (30 per cent), watery diarrhoea (42 per cent),” said Mr Adan.
He said research had shown that more than three quarters or 77 per cent of the county’s women did not meet the minimum dietary requirements.
Mr Adan said the bleak situation had resulted in 20 per cent of households being classified as food insecure in terms of their ability to cope with prolonged drought and accompanying food and water shortages.
“A food-insecure household is classified as one that lacks the money or resources to obtain food supplies. As far as coping ability is concerned, 20 per cent of the households were classified as food insecure as they did not have the money to buy food supplies,” he said.
The Unicef report also sounded the alarm on stunting levels, reported at nine percent of the children in the region.
Food consumption was also indicated as “poor” for 17 per cent of households, meaning they did not consume vegetables or staple foods normally eaten in the community.
Ms Derow’s son Ali was suffering from watery diarrhoea and also had a cough. When the Business Daily met her, she had just picked medicines for her son at the outreach clinic.
“From this place, the nearest government facility is Tula Tula Hospital, and that is more than 25 kilometres away. It is extremely long for me, especially when I am with my children,” she said.
Before the outreach clinic was brought to Murga Harun, she used to go to the facilities in Merti or Tula Tula.
As the drought continued to bite, it became harder for families to access health facilities due to migration further into the bush to get pasture for their livestock.
“We had migrated to Merti in Isiolo and when we heard about the outreach clinic we decided to come back for services because it is close to our home,” the 37-year-old mother of six said.
“Hearing about this week’s outreach was such a big relief for me. Those other health facilities are so far away.”
DEATH IN THE BUSH
Ms Derow is not as lucky as Ms Ibrahim as far as being monitored while pregnant or giving birth at a government health facility is concerned.
All her nine pregnancies and subsequent deliveries were handled at home under the watchful but sometimes ineffective hand of the traditional birth attendants in the community.
Three of her children died before reaching the age of five, including one at childbirth.
She particularly recalls the death of her son in the bush as she struggled to bring him into the world.
“I lost my fourth son after 48 hours of protracted labour, marooned in the bush without a car, camel or donkey cart in sight. The birth attendants tried their best to save him but it was a fruitless effort. Back then, I did not want to go to the hospital. But I know better now,” she says.
Another daughter died at one year, with another breathing his last aged three.
Her last-born will take the medication, and soon be back to playing and fetching water with other children, something she is thankful for.
The three women’s cases are just an example of how extreme weather conditions attributed to climate change are driving a spike in malnutrition and maternal mortality cases in Wajir.
The region is now in the grip of a heavy rainy season that has arrived with flash floods in some areas, after a severe drought that has lasted two years.
Just three weeks ago, humanitarian aid agencies were seeking urgent aid for the most affected people in the county that is home to 661,941 people in a vast region covering an area of 55,840.6 square kilometres.
With the October rains having arrived with flash floods in some areas, the situation for affected families has rapidly shifted from that of lacking water to suffering the effects of flooding.