GARISSA, 18 December 2009 (IRIN) -

GARISSA, 18 December 2009 (IRIN) - In remote northeastern Kenya, poor healthcare, a harsh climate and an ever-growing influx of refugees conspire to make preventable and treatable diseases more deadly than elsewhere in the country.

"You must either prepare to mourn or celebrate when your wife gets pregnant," Mohamed Geley, a truck driver in Isiolo, told IRIN.

Geley's wife died in October as he was taking her to a hospital in Isiolo Town in the east, from the area of Modogashe (about 200km away) for a caesarean.

An under-developed health system characterizes the northeastern and upper-eastern region. "These are areas which do not attract [health] staff as they are hardship places. There is a chronic shortage of staff," Argata Guracha, of the World Health Organization's (WHO) Emergency Humanitarian Action (EHA) programme, told IRIN.

The poor infrastructure does not help. "Facilities that can do a basic C-[Caesarean] section are just available at the district level. Yet getting there is a problem.

"There are few options [available] so you have to depend on a health facility, which is often very far [away]," said Guracha.

Nomadic lifestyles in the predominantly pastoralist region, as well as female illiteracy, are factors limiting access to antenatal care. “As the mother’s educational level rises, so does the likelihood that she will see a health professional for care during pregnancy,” noted the 2008-2009 Kenya Demographic and Health Survey (KDHS) – Preliminary Report.

KDHS results showed that 72 percent of women with no education received antenatal care compared with 91 percent of those with incomplete primary education.

More mobile clinics and maternal shelters would help, said Guracha as "most interventions that work well in a static community do not work well here". Maternal shelters, located close to the hospitals, which accommodate expectant women so they can access full health services, are being piloted in the northern region.

Northeastern has the lowest percentage of women who deliver in a health facility nationally at 17.3, according to the KDHS. In Nairobi Province, the percentage is 89.4, and 44.2 in Nyanza Province. Northeastern also has the lowest percentage of women who receive antenatal care from a health professional (doctor, nurse or midwife).

Challenges

Poverty, persistent conflict, and culture - for example, the insistence on obtaining a husband's consent before a woman can give birth in a clinic - are also barriers to health service delivery and access.


Photo: Ann Weru/IRIN
Children play at a shallow well: Most of the wells are uncovered exposing residents to the risk of using contaminated water
Guracha said: "A poor system of referring those with complications to health centres is also a challenge.”

Poor roads make transporting medical supplies difficult. "You may have so much in Nairobi but there are cost implications," he said.

Most of the roads are poor and often get cut off during the rains due to the largely flat terrain, rendering some parts inaccessible. Even in dry times, roads remain tortuous. The area is characterized by cyclical drought and flooding.

Cholera risk

According to an October alert by the UN Office for the Coordination of Humanitarian Affairs (OCHA), "Diarrhoeal diseases are a permanent feature in Africa’s Horn mainly due to recurrent natural disasters such as floods and droughts, which reduce the availability of safe water."

The absence or deterioration of social service delivery in health, water and sanitation sectors only serves to exacerbate recurrent diarrhoeal-related outbreaks, it added.

Several districts in the northeast and upper eastern region were also affected in a cholera outbreak, including the upper eastern town of Moyale, bordering Ethiopia.

"Those affected were using contaminated water as there was a drought," Rashid Osman, the assistant chief of the Odda Location of Moyale, told IRIN.

First reported on the Ethiopian side, population movement along the porous border was said to have fuelled the spread.

"When there’s no water, sanitation issues follow," noted Mutuku Kimeu, Isiolo District drought management officer (DMO). The Kipsing area, north of Isiolo, was also affected by cholera early this year.

Cholera resurgence has been reported in Turkana District, in the northwest, according to OCHA, adding that the Kakuma refugee camp in the district had recorded about 144 cases.

Already, more than 500 water wells have been contaminated, according to OCHA, after latrines were submerged in El Wak, in the northeastern Mandera area, which borders Ethiopia and Somalia.

Refugees at risk

According to OCHA, poor sanitation and overcrowding in refugee camps are additional causes of epidemics.

''You must either prepare to mourn or celebrate when your wife gets pregnant''
For example, the Northeastern Province capital of Garissa borders Africa's largest refugee camp, Dadaab, which as of 13 November was housing 267,525 refugees – more than three times its capacity.

Arriving at an overwhelming rate of 6,400 a month, the mainly Somali refugees are adding more pressure to the already overstretched facilities and resources in Dadaab, according to the UN Refugee Agency (UNHCR).

But the effects of the influx are far-reaching, with the lack of a general medical screening centre for new refugees increasing the risk of disease spread.

In October, the International Rescue Committee (IRC) reported that 21 H1N1/A cases had been confirmed in two Dadaab camps. Measles and polio have also been reported.

Cross-border disease importation remains a threat. For example, a recent polio outbreak in Turkana originated in neighbouring Southern Sudan, according to the public health and sanitation ministry. Kenya had been polio free for about 20 years.

This calls for strengthened cross-border surveillance, Guracha added.

Despite both polio and measles being preventable, immunization coverage remains low at only 48 percent compared with almost 86 percent in Central and 85 percent for Rift Valley Province, according to the KDHS, due to infrastructural and livelihood challenges.

"Because of low immunization coverage, a poor health system and porous borders with a flow of a homogenous population, there are bound to be major disease outbreaks," he said.

Threat of kala-azar

The northern region also sporadically reports cases of neglected tropical diseases, such as visceral leishmaniasis, also known as kala-azar or black fever. Kala-azar is endemic in northern Kenya and outbreaks are common during drought.

According to Guracha, such diseases are neglected as "in routine budgets, much is not allocated to them as they are not among the top causes of mortality".


Photo: Allan Gichigi/IRIN
Young girls go in search of water in Dadaab refugee camp, Kenya (file photo)
He said there had been a resurgence of kala-azar in the larger Wajir District and in Isiolo. The areas reported a kala-azar outbreak in 2008, which mainly affected malnourished children.

The Kenya Red Cross Society (KRCS) is implementing an integrated health outreach programme in the region to improve healthcare access, KRCS Eastern Regional Coordinator, Liban Mohamed, told IRIN.

Mohamed said KRCS-recruited scouts were helping to mobilize communities in areas such as Isiolo and Marsabit to seek preventive health services.

"Immunization coverage in Garbatulla [140km from Isiolo], has increased from 65 percent to almost 100 [percent]," he said.

Meanwhile, many families are still struggling to access medical services in the region.

"I know of a family who sold all their livestock in Marsabit to take their daughter to hospital in Meru [about 300km away] last month, but she died; it was a double tragedy," Cosmas Adow, of the local Pastoralists Information and Research Organisation, told IRIN.

Communities that are far from health centres sometimes end up using traditional herbs when sick, which may be risky, said Ibrahim Kosi of the Sericho Development Initiative.

According to a recent report by the International Federation of the Red Cross and Red Crescent societies, infectious diseases and weak national health systems in developing nations are among the two greatest international health challenges.

Hasil (Bahasa Indonesia) 1:

GARISSA, 18 Desember 2009 IRIN) - Di Kenya Timur Laut terpencil, kesehatan miskin, dengan iklim yang keras dan berkembangnya masuknya pengungsi berkonspirasi untuk membuat penyakit yang dapat dicegah dan diobati lebih mematikan daripada di tempat lain di negara ini."Anda harus baik mempersiapkan untuk berkabung atau Rayakan ketika istri Anda hamil," Mohamed Geley, seorang sopir truk di Isiolo, kata IRIN.Geley's istri meninggal di bulan Oktober ketika ia mengambil dia ke rumah sakit di kota Isiolo di Timur, dari daerah Modogashe (sekitar 200km jauhnya) untuk bedah.Sistem kesehatan memberatkan mencirikan wilayah timur laut dan atas-Timur. "Ini adalah area yang tidak menarik [kesehatan] staf karena mereka tempat kesulitan. Ada kekurangan kronis staf,"Argata Guracha, dari organisasi kesehatan dunia (WHO) program darurat kemanusiaan tindakan (EHA), kata IRIN.Miskin infrastruktur tidak membantu. "Fasilitas yang dapat melakukan dasar C-[Caesar] Bagian tersedia hanya di tingkat kabupaten. Belum mendapatkan di sana adalah masalah."Ada beberapa pilihan [] sehingga Anda harus bergantung pada fasilitas kesehatan, yang sering sangat jauh [kaki]," kata Guracha.Gaya hidup nomaden di didominasi pastoralist daerah, serta perempuan buta huruf, adalah faktor yang membatasi akses ke perawatan kehamilan. "Sebagai ibu pendidikan tingkat naik, begitu pula kemungkinan bahwa dia akan melihat profesional kesehatan untuk perawatan selama kehamilan," mencatat 2008-2009 Kenya demografi dan kesehatan Survey (KDHS) – laporan pendahuluan.KDHS hasil menunjukkan bahwa 72 persen wanita dengan pendidikan tidak menerima perawatan kehamilan dibandingkan dengan 91 persen dari mereka dengan pendidikan dasar yang tidak lengkap.Klinik lebih mobile dan tempat penampungan ibu akan membantu, kata Guracha sebagai "kebanyakan intervensi yang bekerja dengan baik dalam komunitas statis tidak bekerja baik di sini". Ibu Shelter, terletak dekat dengan rumah sakit, yang menampung hamil sehingga mereka dapat mengakses layanan kesehatan yang lengkap, dipiloti di wilayah utara.Northeastern memiliki persentase terendah wanita yang memberikan fasilitas kesehatan nasional di 17,3, menurut KDHS. Di Provinsi Nairobi, persentase adalah 89,4, dan 44,2 di Provinsi Nyanza. Northeastern juga memiliki persentase terendah perempuan yang menerima perawatan kehamilan dari profesional kesehatan (dokter, perawat atau bidan).TantanganKemiskinan, konflik yang terus-menerus dan budaya - misalnya, atas desakan pada memperoleh persetujuan suami sebelum seorang wanita bisa melahirkan di klinik - juga hambatan untuk penyampaian layanan kesehatan dan akses.Foto: Ann Weru/IRINAnak-anak bermain di sebuah sumur dangkal: sebagian besar sumur terungkap mengekspos penduduk risiko menggunakan air yang tercemarGuracha berkata: "sistem miskin merujuk orang-orang dengan komplikasi ke pusat-pusat kesehatan juga merupakan tantangan."Jalan miskin membuat pasokan medis pengangkut sulit. "Anda mungkin memiliki begitu banyak di Nairobi tapi adalah biaya implikasi," katanya.Sebagian besar jalan miskin dan sering mendapatkan memotong selama hujan karena Medan sebagian besar datar, render beberapa bagian tidak dapat diakses. Bahkan di jaman kering, jalan tetap berliku-liku. Daerah ini ditandai dengan siklus kekeringan dan banjir.Kolera risikoMenurut lansiran Oktober oleh kantor PBB untuk koordinasi Urusan Kemanusiaan (OCHA), "Diarrhoeal penyakit yang merupakan fitur permanen di Tanduk Afrika terutama karena berulang bencana alam seperti banjir dan kekeringan, yang mengurangi ketersediaan air aman."Ketiadaan atau kerusakan sosial pelayanan di sektor kesehatan, air dan sanitasi hanya berfungsi untuk memperburuk berulang diarrhoeal-terkait wabah, tambahnya.Beberapa daerah di wilayah Timur Timur laut dan atas mereka juga terpengaruh dalam Wabah kolera, termasuk atas timur kota dari Moyale, berbatasan dengan Ethiopia."Mereka yang terkena dampak yang menggunakan air yang tercemar karena ada kekeringan," Rashid Osman, Asisten kepala lokasi Odda Moyale, kata IRIN.Pertama kali dilaporkan pada sisi Ethiopia, populasi gerakan sepanjang perbatasan dikatakan telah dipicu penyebaran."Ketika tidak ada air, sanitasi masalah mengikuti," mencatat Mutuku Kimeu, Distrik Isiolo kekeringan manajemen petugas (DMO). Daerah Kipsing, di utara Isiolo, juga dipengaruhi oleh kolera awal tahun ini.Kolera kebangkitan telah dilaporkan di Turkana District, di barat laut, menurut OCHA, menambahkan bahwa kamp pengungsi Kakuma di distrik telah mencatat kasus sekitar 144.Sudah, lebih dari 500 sumur air telah telah terkontaminasi, menurut OCHA, setelah kakus tenggelam dalam Wak El, di daerah Timur Laut Mandera, yang berbatasan di Ethiopia dan Somalia.Pengungsi di risikoOCHA, sanitasi dan kepadatan penduduk di pengungsi kamp-kamp adalah tambahan penyebab epidemi.'' Anda baik harus mempersiapkan untuk berkabung atau Rayakan ketika istri Anda hamil ''Sebagai contoh, ibukota Provinsi Northeastern Garissa berbatasan kamp pengungsi terbesar Afrika, Dadaab, yang pada 13 November adalah perumahan 267,525 pengungsi-lebih dari tiga kali kapasitas. Mendarat di tingkat yang luar biasa dari 6,400 per bulan, terutama Somalia pengungsi menambahkan lebih banyak tekanan sudah buruknya fasilitas dan sumber daya di Dadaab, menurut badan Pengungsi PBB (UNHCR). Tetapi efek dari masuknya luas, dengan kurangnya pusat pemeriksaan medis umum untuk pengungsi baru yang meningkatkan risiko penyakit menyebar.Pada bulan Oktober, Komite penyelamatan internasional (IRC) melaporkan bahwa 21 H1N1 A kasus yang telah dikonfirmasi di dua kamp-kamp Dadaab. Campak dan polio juga telah dilaporkan.Lintas-perbatasan penyakit impor tetap ancaman. Sebagai contoh, polio wabah baru di Turkana berasal dari tetangga Sudan Selatan, menurut Kementerian sanitasi dan kesehatan masyarakat. Kenya telah polio gratis selama 20 tahun.Ini panggilan untuk memperkuat pengawasan lintas-perbatasan, Guracha ditambahkan.Meskipun kedua polio dan campak yang dapat dicegah, cakupan imunisasi tetap rendah pada hanya 48 persen dibandingkan dengan hampir 86 persen di Central dan 85 persen untuk provinsi lembah Rift, menurut KDHS, karena infrastruktur dan mata pencaharian tantangan. "Karena cakupan imunisasi rendah, sistem kesehatan yang buruk dan berpori perbatasan dengan aliran populasi homogen, ada pasti harus wabah penyakit utama," katanya.Ancaman kala-azarWilayah utara juga sporadis melaporkan kasus penyakit tropis terabaikan, seperti viseral leishmaniasis, juga dikenal sebagai kala-azar atau demam hitam. Kala-Azar endemik di utara Kenya dan wabah umum selama kekeringan.Menurut Guracha, seperti penyakit diabaikan sebagai "dalam anggaran rutin, banyak tidak dialokasikan kepada mereka karena mereka tidak di antara top penyebab kematian".Foto: Allan Gichigi/IRINGadis-gadis muda pergi mencari air di kamp pengungsi Dadaab, Kenya (file foto)Dia mengatakan ada bangkitnya kala-azar di distrik Wajir yang lebih besar dan dalam Isiolo. Daerah melaporkan sebuah kala-azar wabah pada tahun 2008, yang terutama mempengaruhi anak-anak kekurangan gizi.Kenya Palang Merah masyarakat (KRCS) yang mengimplementasikan program penjangkauan kesehatan terpadu di wilayah ini untuk meningkatkan akses kesehatan Koordinator Regional Timur KRCS, Mohamed Liban, kata IRIN.Mohamed kata Pramuka direkrut KRCS yang membantu untuk memobilisasi masyarakat di daerah seperti Isiolo dan Marsabit untuk mencari pelayanan kesehatan preventif."Cakupan imunisasi di Garbatulla [140km dari Isiolo], meningkat dari 65 persen hingga hampir 100 [persen]," katanya.Sementara itu, banyak keluarga yang masih berjuang untuk mengakses layanan medis di wilayah itu."Aku tahu dari sebuah keluarga yang dijual semua ternak mereka di Marsabit untuk membawa putri mereka ke rumah sakit di Meru [sekitar 300km jauhnya] bulan lalu, tapi dia meninggal; itu adalah tragedi yang berulang,"Cosmas Adow, penggembala informasi lokal dan organisasi penelitian, kata IRIN.Masyarakat yang jauh dari pusat-Pusat Kesehatan kadang-kadang berakhir menggunakan herbal tradisional ketika sakit, yang mungkin beresiko, kata Ibrahim Kosi Sericho pengembangan inisiatif. Menurut beberapa laporan oleh Federasi Internasional Palang Merah dan bulan sabit merah masyarakat, infeksi penyakit dan lemah sistem kesehatan nasional di negara berkembang adalah di antara dua tantangan kesehatan internasional terbesar.