Cradled by Humanity

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Turkana, Northern Kenya … “This is Africa!”

Not sure if it stems from the residual joy of the recent election of our 44th President or the exotic, challenging allure of Mount Kilimanjaro, but going to Kenya has always been very high on my travel wish list.

And now, this wish has come true! As part of my induction at Merlin ("Medical Emergency Relief InterNational"), the NGO that I have recently begun working for, I am spending the next two weeks in Eastern Africa to get a visual appreciation and a general sense of some of our programs on the field - not a bad way to integrate into a new job if you ask me! So, after a short week spent at Merlins headquarters in London, I was off again, crossing the Equator on my way South to this dynamic continent. I would spend roughly a week in Kenya, checking out our nutritional assistance program in the Northern part of the country, followed by a week in South Sudan, visiting Merlins secondary structure at the Nimule hospital, right by the Ugandan border - a packed schedule!

The flight down was effortless - I made sure to get a copious dose of western media in, topped off with some fine British Airways culinary delights. I landed in Nairobi around 9 pm, seamlessly went through the customs line, bought my visa, grabbed my bag and stepped outside to take in my first breath of Sub-Saharan African air... I was punctually greeted by a Merlin driver who took me straight to the guest house, where I met a couple of other Merlin staff who kindly showed me to my room - lights out!

I spent the next two days working out of the Nairobi office -- the regional headquarters for our East African programs(which currently include Kenya, Somalia and South Sudan). The office is set up in a very quaint house with a beautiful garden, which gives it a welcomed "tropical feel" - a nice change from the concrete high rises of downtown Los Angeles and London. It is split up into two parts -- front and back for the Kenya and Somalia teams respectively.

Those two days were spent speaking with members of each team, going over the updated health and security briefs for both regions as well as discussing the latest assessments of our programs in each country. By the end of the second day, I was itching to get out of the city and onto my first field visit... There is nothing wrong with Nairobi at all - in fact, I would love to see more of the city, but I came here for a different reason this time around. Not to mention, the day after my arrival, I was forwarded the following MSF ("Doctors Without Borders") warning about the city often referred to as "Nai-robbery":

"The security situation has deteriorated considerably in the recent weeks. In Nairobi we are witnessing an increase in carjackings, robberies and kidnaps targeting the expat community. Bar, restaurants and shopping malls appear to be new operating zones for crime perpetrators. Contributing factors to this situation is the sharp decline in the socioeconomic conditions of the population coupled with the restructuring of the Police Force... Small weapons availability and competition for scarce resources like water are contributing to the insecurity in the northern part of the country (Turkana - ) The risk of terrorist attacks remains high as a consequence of the instability in neighbouring Somalia. IT IS COMPULSORY TO FOLLOW STRICTLY THE LAST APPROVED SECURITY GUIDELINES
FOR KENYA."

Okay - fair enough. Needless to say, I would had to curtail my night "outings," which was perfectly fine, given how tired I was... I did manage to squeeze in a post-work Tusker (the national beer), with Dominik, the Program Coordinator for Boma (South Sudan), who was also transitioning through Nairobi. I had done my homework, learned the basic Swahili ("Jambo" - hello, "asante" - thank you, "kwaheri" - goodbye) and familiarized myself with the latest security and health concerns. I felt, by and large, ready (as ready as I would be). SIDE NOTE: Just as I was typing this last sentence, I saw what surely appeared to be a scorpion crawling right next to my feet on my bed -- no joke! Hmmmmm... Should I go look for it? Nah, probably gone anyway! Right about now, Leonardo DiCaprios infamous words, from "Blood Diamonds" are echoing loudly in my head: "This is Africa!"

So I packed my malaria pills, mosquito net, a couple books, some repellent, snacks, a torch and of course, my camera. The next day, I was off to Lodwar the capital of Turkana on a small propeller plane.

Turkana is the northwestern-most district in Kenya. The region shares international borders with three countries: Sudan in the North, Uganda in the West and Ethiopia in the East, as well as the majestic Lake Turkana (formerly called Lake Rudolf). With a population of about 300,000, the Nilotic-speaking Turkana are the third-largest tribe in Kenya, as well as its second-largest group of pastoralists, after the renowned Maasai tribe.

Yet, despite the sheer grandeur and beauty of the lake, this is not - by any means - a promising place for life! According to the Kenya Food Security Steering Group (KFSSG), the worst-affected areas of the current drought in the country are the pastoral livelihood districts, of which Turkana is at the top of the list.

In fact, the 2009 KFSSG food security assessment, published in late May and July 2009 identified pastoral areas as the areas most at risk of falling into humanitarian emergency and under Acute Food and Livelihood Crisis (AFLC) - one of the reasons why Merlin has been operating in the region for a few years and continues its efforts to raise more funds for our projects there.

Moreover, the prolonged drought has forced as many as 50,000 pastoralist families to move their animals and change their migration patterns in search of water and pasture. To put things into perspective, people from these affected communities often have to walk over 20 miles to search for water.

These food shortages are causing a number of health-related issues, mostly focusing around chronic food insecurity, which has subsequently led to high levels of malnutrition and high levels of diseases - as if the drought itself was not enough! Just last week, the World Health Organization announced that at least 29 people have died of cholera and hundreds more are being treated for cholera-related symptoms such as acute watery diarrhoea in the Turkana District. In addition, Turkana suffers badly from the usual suspects (HIV, TB, polio, malaria, etc.) and though its population (well, some of them) do have access to basic medicine, the fact that they are so malnourished makes it almost impossible to keep any of it down. To put it bluntly, how can a child dying of AIDS take down a horse pill while not having had anything to eat in days?

You see, it is a viscious, seemingly endless cycle - malnutrition leads to chronic diseases and chronic diseases lead to malnutrition.

Sorry - I wish this entry could be more joyful.

As part of its presence in Turkana, Merlin has been conducting nutrition programs for children under the age of five, pregnant and lactating women as well as training community volunteers in detecting cases of malnutrition and supporting the Ministry of Health in the training of village volunteers and health facility staff in emergency preparedness and response. I was especially interested to learn more about the involvement of village volunteers and their help in disseminating appropriately-targeted messages to improve health and hygiene in the region.

A visit to the region quickly makes it abundantly clear that the population most in need of emergency humanitrian assitance are children. In fact, according to the latest UNICEF study (June 2009), 2.2 million children die every year form malnurtrition. In Kenya, infant (children under five) mortality is a staggering 115/1,000, most of whom suffer from malnutrition.

By now, you are most likely thinking: "enough with the statistics, Alex!" Ok, one last one: After speaking to several local health workers, I discovered that though there are a number of contributing factors and complications, the source of this madness is the food crisis and insecurity. The World Health Organization considers anything above a 14% malnutrition rate to be an emergency. Currently, in Turkana, the average hovers around 21%!

Simply put, these communities need more food and this message could not have been made more apparent to me. It does not matter how many brochures you see, how many photos of starving children you stare at, or how many alarming statistics you read - to see a crying child in the flesh in front of you dying of hunger is the most viscerally awful (and powerful at the same time) sight you can lay your eyes on.

One of my favorite travel authors, AA Gill, summed it up well when he wrote:
"Nothing prepares you for mass starvation, for the promise of famine. Or rather, everything prepares you for it, years of photographs and terse news reels, skimmed journalism, accusing posters and award-winning photographs. They all prepare you for it, but none of them protects you from the truth of it. The terrible, terrible, pitiful shock of it. It is not staring at the face of starvation that thuds like a blow to your heart, it is having starvation state back at you... All our lives, weve examined these people and swallowed the lump, turned the page, been quietly moved, but protected by the one-way mirror of news. We have averted our eyes to the grinning photos of our own plump children framed on the mantel, and felt the shaming relief of the uninvolved. Nothing protects you from the quiet scrutiny of a thousand fly-blown, bloodshot, liver-yellow, starving eyes, and nothing protects you from the smile of welcome." What do these children have to smile about? And yet they do, and theirs are most powerful smiles I have ever witnessed.

Quite fitting that I should be writing this on World Food Day

So I spent the first day going to an Outpatient Therapeutic Feeding Program (OTP) for severely-malnourished children. This was, quite simply, incredible. Merlin has set up these remote sites where health workers (in this case, two) are accompanied by community volunteers, whom are trained locally by Merlin Staff to bring children to these locations where they are tested for malnutrition - height, weight and MUAC - ("Middle Upper Arm Circumference") tests and subsequently fed "plump nuts," a nutritional paste made primarily out of peanuts and sugar. Some of the children, deemed "severely malnourished," sometimes (provided the resources are there) get admitted into the stabilization center at the pediatric ward located in the Lodwar hospital where they are fed and monitored closely.

Let me be clear here. These volunteers are unpaid, and often times walk up to 10 miles a day to bring take these children to these sites. They do so 5 days out of the week, up to 10 hours a day, going to different sites each day, depending on where the greatest need lies. It is the most selfless act of humanity I have ever seen. I spent a good deal of my time speaking to these volunteers to get a sense of what drives them to do this each day, while they could be doing something much easier and getting paid for it. Their answer, quite simply: "Because we make a difference." AND BOY DO THEY EVER!

As with most jobs (especially in this region of the world), a few things outside the "job description" often times need to get done. In this case, though these outpatient sites are essentially "feeding facilities," many malnourished children come there with other "complications" and their mothers have nowhere else to take them. So the health workers and volunteers, who are already grossly understaffed and swamped, often have to also test for other diseases and take the necessary steps to heal them. While I was there, a crying, severely malnourished child was displaying the classic symptoms for malaria - high fever, lethargy and vomiting. As if he needed to go through more pain, the team drew some blood from his finger to test for it. An agonizing, five minutes later, the results were in... Much to our fearful expectations, he had tested positive for malaria.

I tried not to think about this particular incident too much and assured myself that this child would be given the adequate medicine and with a few more helpings of plump nuts, he would be healthy in no time... Easy for me to say - as I casually pass by with a stock prescription of Malarone in my backpack - the most expensive form of anti-malarial medication ... "This is Africa."

I spent the rest of the morning playing around with the kids, laughing and letting them take photos with my camera - something they seem to really enjoy (especially seeing the pictures afterwards!) It was, it seemed, the only form of added value I could contribute. Again...those smiles!

The second half of the day did not involve many smiles, sadly. We headed to the Lodwar Hospital, where Merlin, in conjunction with the Ministry of Health, is heading the Pediatric Ward. This is the place where children (mostly severely-malnourished) who have developed grave complications are admitted. I would like to think that my upbringing and my life experiences have given me a good sense of preparation for a number of situations, some more difficult and unexpected than others, but I can safely say that seeing these kids and their mothers curled up in the hospitals barren, dilapidated facilities was by far the hardest thing I have ever seen. As with the feeding sites though, the difficulty was somewhat alleviated by the commitment of the local health workers. In this case, it was Peter who attended the ward by himself and not only knew each child by his or her name but gave each one a great deal of care and attention.

It was a long, difficult day, none of which will ever be forgotten. Needless to say, I did not have much of an appetite that night nor did I sleep very well.

It seemed like I had dozed off for barely half a hour when my alarm clock went off the next day around 6 am. Assam, the Nutritional Health Officer, and self-proclaimed "free-lancer" (when describing his current romantic involvement), was picking me up at 6:45. With Simon, our reliable driver, we would go on a "road trip" throughout Turkana to visit other Merlin OTP sites and stabilization centers. So off we went in our Merlin-outfitted 4WD Landcruiser, with the perennial NGO "no guns" sticker on either side of the vehicle. I soon forgot all about the residual lethargy as soon as we got out of town, hit the dirt roads, and were all of a sudden surrounded by pristine natural beauty with no other cars in sight for hundreds of miles. This put to shame any of the National Geographic photos I had seen and dreamed about! Bright red clay, and stupendous acacia trees seemed to provide the perfect backdrop for camels and goats to graze freely (God knows what other animals roamed around!). We passed by a number of villages where local pastoralists were headed out to retrieve some wood and other resources for their families. Despite often carrying a full load in their hands (and on top of their heads!), each "passerby" would make it a point to smile and wave to us... Oh that smile!

Our first stop was Kaeri, about two and half hours outside of Lodwar, where we visited another Merlin feeding site. This time, there were not nearly as many children (a good sign, I was hoping), which made it easier to speak with the health workers and interact with the children. I sat down with Mary for an informal interview in the dispensary room, where I was able to get her perspective on what it was like to be a health worker in Turkana. We discussed, among other things, the rewards and challenges of her job and, like others from the day before, her dedication to these children was incredibly uplifting. She has been working in this field for 15 years (3 years with Merlin). When I asked what makes her proud of what she does, her answer was simple, yet the rewards anything but - "To take care of the sick." Enough said.

The kids were amazing! Where did all this energy come from? Certainly not from a steady nutritional diet! They were so lively and entertaining - both captivating and captivated, it seemed. One particular kid, Nawash, was incredible. He was deaf and mute, yet ever so vibrant! We spent a good deal of time together, walking around, laughing, and he even sat next to me during the interview with Mary. It did not matter that he could not hear a thing... He just wanted to be part of the action. I will never forget Nawash!

Truth is, I will never forget any of this day - spent bouncing around the dusty roads going from one Merlin site to the other, interacting with the communities, some healthy, some sick, yet all so dignified, so respectful, and so, so friendly. We made it all the way to Lake Turkana by late afternoon, which is actually massive (150 km long!) There seemed to be balance of warmth between the air, the water, both of which seemed to be hovering at a sweltering 30 degrees C. (close to 90 degrees F.). After a total of about 400 km (8 hours of solid driving - thanks Simon!), we made it back safely to the Merlin compound where we had a quick debrief and went on with our evening activities, which, at the Merlin guest house revolves primary around watching Big Brother Africa and terrible American TV shows, including The Hills and Dr. 90210. I had to convince my fellow colleagues, my friends, that contrary to popular beliefs, this was not what life in LA was like! I really hope they believed me.

A truly amazing day.

My time in Turkana has come to an end - flying back to Nairobi tomorrow for a short day, after which I will be heading to South Sudan for chapter 2 of my trip.


Parting thoughts: Kenya is often referred to as "The Cradle of Humanity." I did not really understand the meaning of this expression until I came to Turkana. I think I get it now - at least my interpretation of it. You see, after spending a few days there, I feel that those smiles and, more generally speaking, the radiating sense of courage and resilience will stay with me forever. The funny thing is, I came presumptuously hoping to be able to offer a few of my western thoughts and meager ideas, but in the end, I did no such thing. In fact, the one who has learned (and who has yet to learn so much more) is me. This resulting appreciation will not, EVER allow me to cope with seeing starving children or dying mothers, but the unyielding level of compassion - this very humanity - is what gets me through. So in the end, really, I can grateful say that I have been "cradled by humanity."

Unfortunately, I have nothing more than a few words, particularly "asante," a few cookies and a passing smile to show my gratitude and admiration - clearly not even scratching the surface of my true appreciation.

It always baffles me how some of the poorest countries lacking any and all basic resouces are often times home to the most generous people, who go out of their way, despite the blatant hardships, to help others in need. In this case, it is the health workers and the village volunteers of Turkana who have formed the threads that, along with many other selfless people all across the country, make up the "cradle of humanity."

"kwaheri"

*Notes:
1) Additional photos
2) You can find out more about the Merlin programs in Kenya here

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