Off the “Medical Grid” -or- Goat Sacrifices as Health Insurance

When David and I traveled to western Kenya, we assumed that we would be going “off the grid.” Indeed, we had no electricity, internet, or cell phone service for the week, but we didn’t realize just how far away from all medical services and health infrastructure we would be.

Although I have traveled to some fairly remote parts of Uganda through my work at the Infectious Diseases Institute (IDI), even the remotest places seemed to be an hour’s drive at most from a health center, clinic, or hospital. Not so, in the nomadic lands of Western Kenya. The Pokot District Hospital in Kapenguria was a six hour drive from the village Alale. Medicines Sans Frontiers (Doctors Without Borders) has a clinic in the lowlands with at least one ambulance that ferries people to Kapenguria, but most villagers would have to walk for days to reach the hospital.

Making the dearth of medical services even more tragic, the harsh semi-arid climate of the lowlands is not an easy place for human survival. The traditional diet of the Pokot is the meat, milk, and blood (drawn from the necks of live animals) of cows, camels, and goats. Currently the Pokot are attempting to diversify their diets by planting maize. (In our modern concept of nutrition, it’s a wonder that anyone survives on a mostly liquid diet of entirely animal products, but they’ve done it for hundreds if not thousands of years.)

David and I biting through very tough dik-dik (wild antelope) meat for breakfast. Wild meat is another staple in the Pokot diet.

It was the rainy season when we visited and the lowlands were looking lush and green, but many of the Pokot still did not have enough food. We saw several food distribution sites where USAID and other funders were passing out huge bags of corn to Pokot women.

Pokot women returning home with food aid, maize.

It is little wonder then, that every animal is consumed, even if it dies of illness. David and I came upon a group of people skinning and carving a cow who had died the night before of an unknown illness.

Children watching a sick cow be butchered.

Insect-borne disease also compounds the health problems. The lowland Pokot live in homesteads surrounded by a fence made of thorn bushes. Families are polygamous with each wife having a mud and stick hut, and livestock live within the compound and intermingle with humans. This means that the homesteads are basically saturated by animal dung and accompanying flies which gather around the mouths and eyes of children. Such an area is easily a breeding ground insect-borne diseases like malaria and kala azar. Kala azar is spread by the sandfly and is fatal if left untreated. It clusters around areas of drought, famine, and high population density. In Africa, this largely means Sudan, Kenya, and Somalia. Both malaria and kala azar can be prevented by sleeping under nets, wearing long clothing, and using insecticides. Both can be diagnosed through rapid testing and cured with a fairly basic drug regimen. (See here for MSF’s work on kala azar.)

David with one man’s wives and children in their homestead.

Everywhere we went in Pokot we encountered the sick. One particularly depressing homestead had two feverish men lying on the ground. On our last day, the entire community gathered at our compound to discuss the sick. (It was assumed that all of them had malaria, which they might have since it was the rainy season and the sick felt feverish, but no one was tested.)  One sick boy was brought to the compound and laid in front of David and me. We watched flies crawl in and out of his mouth as he slept fitfully.

The Pokot believe that sickness is brought on by someone having wronged the gods or another human, so the elders brought a goat with them to be sacrificed to absolve any wrongdoing. After a long discussion, Michael convinced the elders not to sacrifice the goat until they listened to the Community Health Worker (CHW) and tried his tablets. We sent our vehicle to pick up Amos, the CHW, from the nearby trading center.

Amos speaking to the group as Michael translates. Notice the sick boy in red lying on the ground in front of David and me.

A pastor checking children for malnutrition.

Amos talked to the group about making sure all children were vaccinated, especially from polio. He motioned to his slightly crippled legs and told them that was from polio as a child. He encouraged the group to always bring sick people to him as soon as they became ill (especially children). If they wanted to sacrifice goats that was fine, but that should only be done after the sick person received medication. Then he passed out malaria tablets, Oral Rehydration Solutions, and basic pain killers. A pastor from a local church, measured the small children’s arms for malnutrition, recording the circumference. Thankfully, out of the forty or so children only one was near a dangerously low weight.

Though East Africa is plagued with insufficient clinics and hospitals lacking staff and medicine, the medical plight of the nomads is especially precarious. They are truly off the “medical grid,” lacking access to even the most basic healthcare. In order to improve the quality and length of the life of the nomads, some serious infrastructure needs to be built. Until then, let us support people like Michael and Amos who continue to fight for health equity in the middle of the desert bush, far off the grid.

To learn more about how you can support Michael’s work with the nomads through Daylight Center and School,  click here.

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