Mobile Health and Nutrition Teams Providing Crucial Services for Pastoralist Mothers As They Cope with Drought

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Mutas does not look at his mother. He is not looking anywhere, rather he lays still, his unfocused pupils covered occasionally by heavy eyelids. While we talk, his mother, Bedra Dek, keeps her eyes entirely on him. Her one-year-old son is suffering from severe acute malnutrition (SAM) and despite the food and water shortage and her two other children, she explains that all her thoughts are focused on him improving.

“When your child is well, spiritually you feel happy. This is what I am waiting and hoping for. Nothing else is in my mind except this,” Bedra speaks softly, her eyes never wavering from her son.

About six months ago, Mutas became sick with a cold. Since then, he has fought that illness and intermittent diarrhoea while they lived in remote rural areas. Living in remote areas means even farther than where we are now, which is over 300 km from the regional capital and 63 km off the paved road through desert sand – no roads. Bedra walked yet another 15 km to the settlement just outside Al-Bahi kebele (sub-district) after hearing that there was a mobile health and nutrition team (MHNT) providing lifesaving services. She knew Mutas was not improving, and indeed, shortly after her arrival, he had become lethargic and largely unresponsive.

MHNT in Somali drought 2017
Bedra Dek, 21-years-old, looks at her one-year-old Mutas Abdulahi, who is ill from malnourishment. ©UNICEF/2017/Tesfaye

At 21-years-old, Bedra has 7- and 4-year-old daughters in addition to Mutas. They are a pastoralist family, living in a rural village and often traveling vast kilometres in search of water and grazing land for their livestock.

While the semi-arid Somali region is often dry, the drought brought on by the negative Indian Ocean Dipole (IOD) in the past few months is beyond anything Bedra has experienced. Her family’s herd of over 200 goats and sheep is now down to four, and their physical appearance is too poor to sell in the market.

Upon arriving in Al Bahi, she went to the MHNT, which has temporarily set up as a static clinic in the site to service the hundreds of families in the area. MHNTs were initially set up over a decade ago in this region as a unique and necessary component of the emergency health service delivery system to reach nomadic families such as Bedra’s. They respond to disease outbreaks, provide routine immunizations and basic healthcare including treatment of common illnesses, conduct screening and manage uncomplicated cases of malnutrition as well as refer to higher levels of care as necessary. Here, the team has encountered high levels of malnutrition and the majority of children have low immunization status. The team is both responding to emergency care needs as well as conducting mass immunization and other preventative measures to ensure that a temporary settlement like this does not create further disease and suffering.

Once a child is diagnosed with SAM, they are provided with ready-to-use-therapeutic-food (RUTF) and medications which should help them to quickly improve. To ensure progress, mothers are instructed to come weekly to have their children checked. We meet Bedra, as she waits with Mutas for his weekly check.

MHNT in Somali drought 2017
The homes of pastoralists gathered at the temporary Al Bahi site starting from December 2016, in Gashamo woreda, Somali region. ©UNICEF/2017/Tesfaye

UNICEF continues to support the GoE’s MHNTs through vehicle provision, transportation allowances, emergency supplies and technical guidance. UNICEF emergency health and monitoring consultant, Kassim Hussein, was present when Mutas was referred. When asked about his role, he explained how he roves around the region providing technical support. “During emergencies, things may be done in a haste, there may be staffing or technical knowledge gaps, or the situation may reach extreme levels and the team is too busy to report. I make rounds to all the teams, providing technical support and ensuring standards of care and supplies are available at adequate levels. I then report back to UNICEF and the regional health bureau,” explains Kassim.

Now Mutas is being seen by Mohammed Miyir, the team leader of the MHNT in Al-Bahi temporary settlement. Originally, he diagnosed Mutas with SAM; now his condition has developed medical complications, making him unable to receive fluids or medicine. This development signals the need for him to be sent to a stabilization centre (SC) at the Gashamo woreda (district) health centre, where he will receive in-patient advanced care until he reaches a minimal level of improvement in his responsiveness and weight.

Bedra is perplexed. Just minutes before they told her this news, she had said she wanted anything for him to improve. Now that it may happen, a new reality hit her. Her two daughters will need to be left behind – there is no room in the MHNT car. This is often an issue mothers out here face. With husbands caring for the grazing livestock, if they need to go to a SC for further treatment, who will take care of their other children? Some find neighbours to watch their kids, other mothers choose to stay and hope for the best, concerned about finding their children again as people are so mobile.

For Bedra, she has another 10 minutes to decide until the car will be ready for her.

Severe Water Shortage No More

 Project Taps into Existing Groundwater to Bring Sustainable Water to Community

By Ayuko Matsuhashi

SHINILE, SOMALI, 17 January 2017 – Munasib Omer, Chief of Bisle kebele (sub-district) in Shinile woreda (district), tells how excited the community is about the ongoing drilling work of a borehole in the kebele. “Thank you! Thank you to those who are providing the water to this kebele.”

Harshim Town Fafan Zone Somali region
Chief of Bisle kebele, Munasib Omer Maydhane, explains how Bisle has not had sustainable water while standing in front of an abandoned reservoir. ©UNICEF/2017/Tsegaye

He continues, “Since I was born, there has been no sustainable water supply in this community. We are entirely dependent on rainfall and travel 15 km one way to get water from a dried river bed. Here, we can use our hands to dig through the sand and find some water. But in the last 10 years, we have suffered from water shortage. NGOs and the government have been providing water through trucking but this is not enough and not predictable as the road condition is so difficult for trucks to access. Our primary problem has been always water.” He points to the road from which the UNICEF car arrived. “As you may have seen, there are many empty houses [along the way]. People left because of the water shortage.”

A mother of four children, 32-year-old Fadumo Ali talks about how difficult it is to raise children without a secure water source. “Sometimes there is no water to give to our children. We cannot wash them.”

UNICEF’s implementing partner, Hydro, began drilling a borehole in November 2016 at a location 1.5 km outside the Bisle community, which has a population of 11,000 people. This crucial drilling work is made possible by the DFID emergency fund. While it is difficult to find water by drilling in lowland areas due to the nature of the hydrogeological complexity in the Somali region, water was found at a depth of 210 meters and the drilling was completed at depth of 299 meters. According to a pump test, the borehole is providing more than 30 litres per second. The post-drilling construction is planned to be completed by March 2017. This news has brought hope for a better future to the Bisle community.

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People from Bisle kebele play with the water during a successful pump test of the borehole. ©UNICEF/2017/Godfrey

Fadumo is now looking forward to the day that she will no longer need to worry about water. She will have a few extra hours per day once the borehole is functional as she will not travel in search of water. “When I have regular water and more time, I want to do more about sanitation and hygiene for my children. I will clean my children more often.”

Through the generous contribution of donors, UNICEF will continue to support regional water bureaus across the Somali region to implement similar sustainable interventions that will support children and their families.

 

 

 

Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from ECHO. The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

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She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

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The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

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Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

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Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

 

Laying the foundation of future generation

A new pre-school programme is helping Ethiopian Children to get ready for school

By Demissew Bizuwerk

Mengi-Benishangul Gumuz- Ethiopia 28 September 2016 – In one of the classes at Mengi Elementary School, in the Benishangul-Gumuz region of Ethiopia, Edidal Abdulkerim, six, and her friends sing about the five senses with melodious tone along with a small tape recorder. Before the next song starts, their teacher Abdulaziz Ahmed asks questions to make sure that the children got the message right.

The children are learning with stories, plays and songs and the expression on their faces says it all. This is their first ever school experience at the age six and seven. Perhaps, just before their critical age of learning passed by.

“It feels great to sing, write and colour,” says Edidal cracking a beautiful smile. “I have many friends here and we play together.”

Benishangul Gumuz - Education
Edidal draws with her friends in her class room. She is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

Edidal, is one of the 30 students in Mengi Elementary School who are enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR). This new programme is designed to prepare rural children, who have not had the chance to attend any form of early childhood education, for primary education by helping them develop cognitive, behavioural as well as foundational ‘pre’ academic skills.

ASR offers 160-hours of pre-literacy and pre-numeracy learning and helps children to develop social skills.  It is an interim strategy which helps children aged between six and seven make a successful transition from home to school while formal pre-primary classes are gradually introduced across the country.

A daunting task of ensuring quality remains ahead despite Ethiopia’s significant achievement in expanding access to primary education. There are quite a number of children in early primary classes who do not acquire the minimum expected level of skills. And the numbers are alarming. The average mean score for reading skills in grade 4 for instance is found to be only 45 per cent, which is below the minimum passing mark of 50, set in the education policy[1]. And this statistics even goes lower in remote rural villages such as Mengi.

“There are many reasons which can explain this poor performance of children in rural Ethiopia,” says Maekelech Gidey, UNICEF Education Specialist “But the main one has to do with school readiness”. The country lacks adequate pre-school facilities where children can be supported and encouraged to better understand their environment and develop skills, which are vital for success in school and later in their lives.

It is only 48 per cent of Ethiopia’s 7.7 million children aged between three and six who have access to early learning[2], and many young children, especially rural girls like Edidal, were not part of this statistics.

Children who start their formal primary schooling on weak early childhood learning are more likely to fall behind their peers and consequently drop out of school too early.

It is this challenge that prompted the development of the ASR initiative.  In 2015 the programme was introduced and piloted in the Benishangul-Gumuz region after designing a well fitted curriculum and training of teachers.

Benishangul Gumuz - Education
Edidal shares a smile with her best friend Narmin in Mengi primary school. They are both enrolled in an eight week education programme – during a summer break- called Accelerated School Readiness (ASR) ©UNICEF Ethiopia/2016/Tadesse

How does ASR work?

First, teachers and community leaders identify the village children in the month of May each year.  If the nearby schools have O classes already, then the children will be enrolled for eight weeks in the month of July and August. Otherwise, they will undergo the same programme during the first two month of the academic year in Grade 1.

For the ASR to succeed, it needs a dedicated teacher like Abdulaziz and the children have to attend the programme regularly. Missing even a single day of class means missing a lot in the programme.

“Some children who live far away from school skip class when it rains or when their parents go to the market early,” says Abdulaziz. “So I visit their homes to tell their parents about the advantages of this education to their children and the importance of attending class regularly.”

Intizar Abdulkerim, a seven year old who loves to learn about the environment, says her mother is sometimes reluctant to send her to school when she needs help with the household chores. “I feel sad when I stay in the house during school day,” says Intizar “every time I skip class, I lag behind my friends.”

It looks like old habits do not go away easily. The perception of parents towards the education of their daughters still needs to be worked on. “Boys attend the programme more regularly than girls,” says Abdulaziz. “Yet my best performing students are girls,” he added pointing towards Edidal and Intizar.

Edidal and Intizar will be entering Grade 1 in the coming academic year with a solid base. The combination of play and learning activities of the ASR have inculcated the children with the necessary pre-school skills that they need to succeed further.

A preliminary assessment on the impact of the ASR has revealed that, the programme is effective in having children acquire pre-school skills in mathematics and literacy. This is a good news for experts from the region’s education bureau and UNICEF who have been working on the programme since its inception.

The ASR experience in the Benishangul-Gumuz region is also extended to Oromia region based on its cost effectiveness and impact.

While Edidal wants to become a teacher, Intizar’s dream is to be a doctor. There is still a long way to go until the young girls’ dreams are a reality. Yet, for now, the foundation of their future is laid on fertile grounds. 

[1] Ethiopian Fifth National Learning Assessment (NLA), MoE 2016

[2] MOE, Education Statistics Annual Abstract 2008/ 2015-16

Government of Ethiopia and Humanitarian Partners Release 2017 Humanitarian Response Planning Document

ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.

While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.

In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.

The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.

Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.

Providing gynaecological services to Ethiopian women scarred by FGM/C

By Endale Engida

AYSSAITA, AFAR REGION, 24 November 2016 – Asiya’s marriage was meant to be a joyful occasion, but on her wedding night, this 18-year-old found only pain.

Like nearly all young girls in Ethiopia’s Afar Region, she had undergone Female Genital Mutilation/Cutting (FGM/C) at a very young age and trying to consummate the marriage with her husband brought only pain and bleeding.

In the Afar region, a particularly severe form of FGM/C known as Type III or infibulation is practiced whereby the vaginal opening is partially sewn shut, condemning generations of women to pain.

Asiya’s husband, Burhan Helen, was determined to help his wife and he asked around and discovered that the hospital in their woreda (district) had recently set up a gynaecological unit specialized in opening up women who had been subjected to infibulation.

Female Genital Mutilation in Afar
“FGM should stop, I have seen the problem myself, I always struggle when I am on my period, my period doesn’t flow normally so it was very painful. I won’t cut my future daughter. I am very happy to have gone through surgery and I am thankful for the organization working on this.” – Asiya Ali, 18, undergone FGM and currently following up at Ayssaita primary hospital, Afar region, after her surgery. ©UNICEF Ethiopia/2016/Tadesse

FGM/C has long been outlawed in Ethiopia, but is still widespread in the country with an estimated 65 per cent of women between the ages of 15 and 49 (EDHS 2016) having been cut – down from 74 per cent in 2005 EDHA

However, those numbers mask regional variations. In regions like Afar and the Somali it can reach up to 90 per cent while other areas have a much lower prevalence due to different cultural norms in the diverse nation of Ethiopia.

In regions where it is practiced across eastern Africa and up into Egypt, it is believed FGM/C is necessary to ensure a woman stays a virgin before marriage, and many men say they would not marry a woman who hasn’t been cut.

In 2014, the Government of Ethiopia committed to ending the practice by 2025 and has been working on discouraging it through public information campaigns. Penalties for carrying it out range from three to ten years in prison.

For those like Asiya who have already undergone the procedure, the new gynaecological unit established in May 2016 at the Ayssaita Woreda hospital is a life saver.

Female Genital Mutilation in Afar
Dr. Hatse Abrha is a gynaecologist at Ayssaita primary hospital, Afar region. Dr. Hatse Abrha has been assisting girls and women with health complications due to FGM, a project under UNICEF Ethiopia. ©UNICEF Ethiopia/2016/Tadesse

Thanks to the funds from Foundation Espoir through the Luxembourg Committee for UNICEF, the hospital now employs Dr. Hatse Abreha, the only gynaecologist in the hospital.

The hospital, which serves a mostly pastoral population of 90,000, can now treat gynaecological and obstetric cases, including FGM/C reconstructions. By October 2016, the hospital was treating 200 FGM/C cases a month. In many cases, patients can be discharged the same day after the surgery.

Dr. Abreha diagnosed Asiya’s condition and also noted that in addition to pain during intercourse, she suffered discomfort and slow flow during menstruation. She and her husband were counselled about the procedure and then she received the deinfibulation surgery.

“I want to see these innocent girls and women no longer be victims of FGM/C, though these kind of interventions are only part of the solution and will not solve the root cause of the problem,” he said.

After a careful period of outpatient monitoring, Asiya was pronounced cured.

“We have special gratitude to Dr. Hatse Abreha for his friendly care and follow up,” she said during a follow up visit. “We are here to teach our community not to practice FGM/C on their girls and our own children will not be victims of FGM/C.”

 

Giving a village in the Amhara region its own water supply transforms lives

By Ayuko Matsuhashi

WOIRU DIKALA, Amhara region, 7 August 2016 – The women of Woiru Dikala kebele (sub-district) used to spend much of their day searching for water, a mission that grew even more difficult as drought ravaged Ethiopia’s Amhara Region over the past year.

Women and children often walked for more than six hours to get the water their community needed, searching for scarce rivers and ponds among the dry, rugged gorges of Raya Kobo woreda (district).

Local women at Raya Kobo woreda, Woiru Dikala Kebele -Amhara National Regional State enjoys the newly inaugurated water supply.
Women in Woiru Dikala kebele spend much of their time looking for water.   Now they can easily access clean water thanks to the multi-village water supply system built with UNICEF’s support.  ©UNICEF Ethiopia/2016/Mersha

This area, near the borders of Tigray and Afar regions, is full of migrants from these parts of the country also searching for water for their family and herds and fleeing the recurrent droughts.

So it was with great rejoicing that the people of Woiru Dikala welcomed a joint UNICEF and DFID project introducing a multi-village water supply system drawn from a deep well with a total of eight water points around the village – including one for the primary school.

Comments we received from community members included “We can avoid the risks of abuse of women and children as they travel to collect water from the gorges including at night time,” and “Our children and even adults have been frequently affected by diarrheal diseases and intestinal parasites. We feel happy that our life will be changed.”

The new water system will help 5,000 people over the next 20 years, including the 2,100 living in Woiru Dikala kebele.

The El Niño-driven drought has hit much of the country over the past year, but eastern Amhara has been especially hard hit, with over 1.5 million people suffering from a critical shortage of water.

The shortage also has severe health implications. The kebele has seen an outbreak of the itching menace of scabies because the lack of water means poor sanitation and personal hygiene.

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Boys and girls in Woiru Dikala kebele can grow healthily as they have unrestrained access to clean water. They can also attend school more regularly without worrying about fetching water. ©UNICEF Ethiopia/2016/Mersha

The condition breeds in cramped, dirty conditions and can move quickly through a population causing a great deal of distress among children, who make up half the population of the kebele.

Poor water quality also led to an outbreak of Acute Watery Diarrhoea, which can be fatal for the young and infirm.

Regular access to clean water is key to combatting these diseases. There is no health facility in the kebele.

The inauguration of the new water supply for the area was attended by several regional officials as well as representatives of UNICEF.

“This water supply system provided from a deep well should support local resilience in times of climatic uncertainty,” said Jane Bevan, UNICEF’s manager for rural Water, Sanitation and Hygiene.

Ms. Gillian Mellsop, UNICEF Representative to Ethiopia visits and inaugurates the UNICEF/DIFID supported community emergency water supply scheme at Woiru Dikala Kebele, Raya Kobo woreda, Amhara region.
Attending the inauguration of the new water system were Ato Woldetnsae Mekonnen, head of the Water, Irrigation and Energy Department for North Wollo Zone, Jane Bevan, UNICEF’s Rural WASH Manager, Ato Ayenew Belay, head of Amhara’s Bureau of Finance, Ato Kedir Mustefa, administrator of Raya Kobo woreda, Gillian Mellsop, UNICEF representative to Ethiopia, Ato Yimer Habie, deputy head of Amhara’s Bureau of Water, Irrigation, and the Bureau of Energy. ©UNICEF Ethiopia/2016/Mersha