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.

In Ethiopia, Nationwide Polio Vaccination Campaign Reaches 13 Million Children

Sahro Ahmed vaccinates a child
Sahro Ahmed vaccinates a child in Warder, Somali region, Ethiopia. © UNICEF Ethiopia/2013/Sewunet

Somali Region, Ethiopia, 12 May, 2014 – Ethiopia kicked off a polio vaccination campaign on 3 October 2013, targeting 13 million children across the country following an emergency response that began in the Dollo Ado refugee camps in June 2013. In July 2013, Ethiopia Reports First Wild Poliovirus Case since 2008.

Ayan Yasin, a four-year-old girl, was one of the first confirmed polio cases in Ethiopia. Ayan lives with her father and mother, a typical pastoralist family, in their house, made of tin, wood and woven bed sheets in a remote secluded area three kilometres from Geladi Woreda in Ethiopia’s Somali Region. Living next to the Somalia border means that the family move frequently between Ethiopia and Somalia – making routine immunisation practices difficult.

When Ayan fell sick, her father took her to the nearest hospital in Somalia where he was told there was very little hope. After many visits to various health posts, Hergeisa Hospital finally confirmed she had Polio. “We call this illness the disease of the wind. We know that there is no cure for it, and that it can paralyse and even cause death. My daughter hasn’t died but it has disabled her forever,” says her father.

Close to 50,000 health workers and volunteers and 16,000 social mobilisers have been deployed all over the country as part of a campaign that includes remote and hard to access areas. With the support of the Crown Prince Court, Abu Dhabi, UAE, UNICEF has procured vaccines to support immunisation efforts particularly for children and the refugee population being hosted in the Somali Region. In total, 135,000 vials or 2.7 million doses of bivalent Oral Polio Vaccine (bOPV) were procured to immunise 2.43 million children with a polio vaccine – a critical input to immunisation activities in the Somali Region and Polio high-risk areas. The support from the Crown Prince Court has also helped to airlift the Polio vaccine to hard-to-reach zones of Afder, Gode and Dollo in the Somali Region.

Synchronised cross-border polio outbreak preparedness and response

Parents of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case in Degafur rural village
Parents of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case, lives in a border close to Somalia, in Degafur rural village, Somali region of Ethiopia. ©UNICEF Ethiopia/2013/Sewunet

Supplementary Immunisation Activities (SIAs) were conducted in Ethiopia, Somalia, Kenya, and Djibouti to accelerate progress towards ending Polio in the Horn of Africa. The synchronised SIAs were an outcome of the Horn of Africa Countries Cross-Border Polio Outbreak Preparedness and Response Meeting in Jigjiga, from 21 to 23 May 2014, where Ethiopia, Somalia, Kenya and Djibouti agreed to strengthen cross-border collaboration to eradicate polio from the Horn of Africa.

To reinforce support and strengthen Polio eradication efforts in the Somali Region, a high-level delegation consisting of Dr Kebede Worku, State Minister of Health, Mr Abdufatah Mohammed Hassen, Vice President of Ethiopia’s Somali Regional State and Head of the Somali Regional Health Bureau, Dr Pierre M’Pele-Kilebou, WHO Representative to Ethiopia, and Dr Willis Ogutu, Head of UNICEF programme in Somali Region, visited Warder in Dollo Zone, the epicentre of the wild polio virus outbreak in Ethiopia, on 14 June 2014. The delegation, together with the Warder Zonal Administration, launched the ninth round of Supplementary Immunisation Activities (SIAs) in the outbreak zone and formally inaugurated the Zonal Polio Outbreak Command Post, which had been established in April 2014 to improve coordination of response activities.

Sustained interventions to ensure long-term success

While the campaigns to vaccinate children against Polio in the Somali Region have been going well, ensuring long-term success in eliminating the disease will require sustained interventions.

Abdufatah Mohammud Hassen believes the best solution is to immunise every child and ramp up routine immunisation activities in the region. “The campaigns are just to stop the emergency but the main thing that we are doing is to reach every child by strengthening the routine EPI and ensuring that the health facilities have the capacity to respond to the demands of the public”

With the help of developing partners like the Crown Prince Court, Abu Dhabi, UAE, Rotary International European Commission of Humanitarian Department (ECHO) and Bill and Melinda Gates Foundation, UNICEF together with the Ministry of Health is continuing its efforts so that young children like Ayan Yasin living in the region are protected from the disabling symptoms of the Polio disease.

In Ethiopia, Nationwide Polio Vaccination Campaign Reaches 13 Million Children

Somali Region, Ethiopia, 12 May, 2014 – Ethiopia kicked off a polio vaccination campaign on 3 October 2013, targeting 13 million children across the country following an emergency response that began in the Dollo Ado refugee camps in June 2013.

In July 2013, Ethiopia Reports First Wild Poliovirus Case Since 2008.

Ayan Yasin, a four-year-old girl, was one of the first confirmed polio cases in Ethiopia. Ayan lives with her father and mother, a typical pastoralist family, in their house, made of tin, wood and woven bed sheets in a remote secluded area three kilometers from Geladi Woreda in Ethiopia’s Somali Region. Living next to the Somalia border means that the family move frequently between Ethiopia and Somalia – making routine immunisation practices difficult.

When Ayan fell sick, her father took her to the nearest hospital in Somalia where he was told there was very little hope. After many visits to various health posts, Hergeisa Hospital finally confirmed she had Polio. “We call this illness the disease of the wind. We know that there is no cure for it, and that it can paralyse and even cause death. My daughter hasn’t died but it has disabled her forever,” says her father.

Polio vaccines arrive in Warder
Bukhari Shiekh Aden of UNICEF helps in moving polio vaccines of an airplane which just arrived in Warder district, Somali region of Ethiopia for a campaign as a response of a recent polio outbreak in the Horn of Africa. ©UNICEF Ethiopia/2013/Sewunet

Close to 50,000 health workers and volunteers and 16,000 social mobilisers have been deployed all over the country as part of a campaign that includes remote and hard to access areas. With the support of the European Commission- Humanitarian Aid and Civil Protection Department (ECHO), UNICEF has procured vaccines to support immunisation efforts particularly for children and the refugee population being hosted in the Somali Region. In total, 135,000 vials or 2.7 million doses of bivalent Oral Polio Vaccine (bOPV) were procured to immunise 2.43 million children with a polio vaccine – a critical input to immunisation activities in the Somali Region and Polio high-risk areas. The support from ECHO has also helped to airlift the Polio vaccine to hard-to-reach zones of Afder, Gode and Dollo in the Somali Region.

Synchronised cross-border polio outbreak preparedness and response

Supplementary Immunisation Activities (SIAs) were conducted in Ethiopia, Somalia, Kenya, and Djibouti to accelerate progress towards ending Polio in the Horn of Africa. The synchronised SIAs were an outcome of the Horn of Africa Countries Cross-Border Polio Outbreak Preparedness and Response Meeting in Jigjiga, from 21 to 23 May 2014, where Ethiopia, Somalia, Kenya and Djibouti agreed to strengthen cross-border collaboration to eradicate polio from the Horn of Africa.

To reinforce support and strengthen Polio eradication efforts in the Somali Region, a high-level delegation consisting of Dr Kebede Worku, State Minister of Health, Mr Abdufatah Mohammed Hassen, Vice President of Ethiopia’s Somali Regional State and Head of the Somali Regional Health Bureau, Dr Pierre M’Pele-Kilebou, WHO Representative to Ethiopia, and Dr Willis Ogutu, Head of UNICEF programme in Somali Region, visited Warder in Dollo Zone, the epicentre of the wild polio virus outbreak in Ethiopia, on 14 June 2014. The delegation, together with the Warder Zonal Administration, launched the ninth round of Supplementary Immunisation Activities (SIAs) in the outbreak zone and formally inaugurated the Zonal Polio Outbreak Command Post, which had been established in April 2014 to improve coordination of response activities.

Polio vaccination in the Somali region of Ethiopia, as a response of a recent polio outbreak in the Horn of Africa
Polio vaccination in the Somali region of Ethiopia, as a response of a recent polio outbreak in the Horn of Africa ©UNICEF Ethiopia/2014/Sewunet

Sustained interventions to ensure long-term success

While the campaigns to vaccinate children against Polio in the Somali Region have been going well, ensuring long-term success in eliminating the disease will require sustained interventions.

Abdufatah Mohammud Hassen believes the best solution is to immunise every child and ramp up routine immunisation activities in the region. “The campaigns are just to stop the emergency but the main thing that we are doing is to reach every child by strengthening the routine EPI and ensuring that the health facilities have the capacity to respond to the demands of the public”

With the help of developing partners like ECHO, Bill and Melinda Gates Foundation, the Rotary International and the Crown Prince of Dubai, UNICEF together with the Ministry of Health is continuing its efforts so that young children like Ayan Yasin living in the region are protected from the disabling symptoms of the Polio disease.