How to give sanitation sex appeal??

It’s hardly surprising that the building of pit latrines in the poorest countries is one of the least funded and most overlooked areas of health development. A vast amount more sex appeal will be found in other highly worthy public healthcare needs- malaria bed nights, for instance, undoubtedly save thousands of babies lives and are easy to distribute... in addition to lending themselves to great marketing opportunities to photo peaceful sleeping babies.  Yet 2.6 billion people  do not have access to a safe  latrine and this includes half of people in sub Saharan Africa. 

4,000 children die daily from preventable water related diseases- more than die from malaria, HIV and measles combined. Diarrhoea is the second biggest killer of children under 5.

Improved sanitation could prevent 1.5 million deaths from diarrhoeal diseases per year. The environmental rewards would also be enormous as currently 200 million tonnes of human waste go uncollected and untreated each year. It is estimated that every dollar spent on sanitation would save nine dollars in days lost from work plus the cost to the local health services. As much as  5% of African GDP is lost to illness and deaths caused by dirty water and lack of basic sanitation.

One of the Millenium development Goals is to halve the proportion of people without access to basic sanitation by 2015. Currently sub Saharan Africa will be at least fifty years late with this MDG unless the health agenda rapidly decided to focus money and effort here.

The added improvement to quality of life is probably larger than any other public health intervention. Whilst a good immunisation campaign will save millions of lives...it does nothing to improve the daily life of its recipients. Yet it doesn’t take much imagination to see that if you offer an adolescent girl an opportunity to use a safe,  private latrine  you have improved her life beyond measure. Certainly give girls access to education and books... but how many campaigns focus on giving her access to a childhood and adolescence where she can enjoy the basic human  right to personal privacy.

Of all the public health interventions we have undertaken this is the most universally popular one with the community.  Whilst it is very hard to evaluate whether families using pit latrines are accessing health care less, it is at least  easy to assess how much they are used : in every case the take up in use of the latrine amongst school age children and adults is virtually universal: if a latrine is there it is used by all but the youngest children and a few of the very old and infirm. In addition we have not yet come across a manyatta across the group ranches who have turned down the opportunity to have a latrine. 

But it is an expensive intervention. After we complete this year’s agreed building programme we will be working  with the micro finance project to see if they can help us with low interest development loans for pit latrines and looking to ways of cost sharing with families. But still it will remain expensive ..... and of course it is the poorest families who probably need the latrines most as their family numbers are generally higher and their health education is generally lowest. It is good to see some NGOs also focusing on latrines in Isiolo district- but here the problems remain the same; most NGOs will fund only basic materials, building and adding materials has to be added by families and consequently  they are out of the reach of the poorer families. In addition, not unnaturally it is the village ‘centres’ and schools which are generally targeted , where the need is highest, but again the poorest of the poor will miss out.

And Public Private Partnerships in Water Development - (Swimming Pools and Power Showers??)

We have now sunk and capped the new community bore hole in Kimanjo.  Finding water was a great day. Still waiting for the hydrology report which will tell us the recharge rate along with the water quality. 

Despite the usual Kenyan hiccups in the process: transport dilemmas and break downs for the drilling rig as the November rains had washed out  roads; a broken rod down the borehole which meant many days of arduous work for the guys operating the machine etc. etc ;  this has been a project  enormously assisted at every stage by the District Water Officer who has unfailingly given practical assistance to mitigate hold ups and given sound professional advice throughout. His ability to overcome obstacles in the cause of getting water to a remote area shows how successful  the much vilified government agencies (how often are those two terms African government agency  and corruption used synonymously?)  can be when they have committed, honest, active  and knowledgeable personnel on the ground.  A good news story from an African government agency? Without doubt.

In the next phase of development we very much look forward to continuing this partnership with the  District Water Office to equip the bore hole with a solar pump, put in two pipe lines-  to the Primary and new secondary school, and a second to the upcoming Health Centre with  a new holding tank at the top of the village. In addition the extreme cooperation and assistance of the Kimanjo Water Users Association, and their highly active Chairman, have meant that achieving the necessary licenses and permits and the cooperation of the community has been made easy. Whilst in future wars will undoubtedly  be fought over water (and the lack of it)  in Africa, it must also be remembered that water is capable of uniting communities for the common good.Two good news Africa stories here then. On all those occasions when we are feeling cynical in the field of African development how important it is to remember the good days and so, so many  good people .

Does this mean everyone in Kimanjo will now be able to use water ad lib? Far from it. Even should the recharge rate be better than anticipated , families are unlikely to be collecting much more than 20- 40  litres of water a day. That is whole families.  Compare this to the US average  of 700 litres per day per person.... with 153 litres  per person merely for washing and drinking. The rural African average water consumption is around 30-40 litres a day, but far less in these semi arid and arid lands. One eight litre flush of the toilet in Europe will use more water than adults here would use in a day... with considerably less used during drought periods.

So.... no swimming pools or power showers just yet.... but, if our partnership with the Water Office continues as successfully as it has been for the past few months it should not be too long before life is a good deal easier for many women and children.. with the added advantage that our Health Centre build can now ramp up momentum.  And this will be down to a great Community effort.

Elephant Poaching- Stop the Ivory Market!!

It was a very sad day last week when a lone young male elephant was killed by poachers nearby.

The market price of ivory is at an all time high of over $700 per pound in China and Vietnam, the demand being fueled by the newly rich middle classes desiring ivory carvings. Kenya’s elephant population is estimated at between 32,000 and 35,000, but estimates for Africa remain vague  - between 400,000- 650,000. The International Fund for Animal Welfare (IFAW) considers that as many as 100 elephants a day are being slaughtered across Africa - even if this number is exaggerated the problem is still massive.

Kenya banned hunting in 1977 and banned the selling of ivory, symbolically burning all its old ivory stock in 1989 and again last year, but the problem of poaching in neighbouring Tanzania where ‘controlled’ hunting is still legal is far greater, and it is from Tanzania and Zambia that most of the illegal ivory is shipped.

Until all ivory trading, legal and illegal, is stopped, there will continue to be an incentive for the poorest Africans to risk their lives shooting elephants to fuel  demand.  Priority now is to convince the older Chinese that they no longer want to buy ivory. Engaging constructively with Chinese people, who currently number over a million resident in Africa, with numbers fast rising, is clearly key.

Back to the dead elephant. The tracker dogs (bloodhounds) did a first class job of tracking the Samburu poachers to a distant village, but from here they are able to melt away. Even when this investigation is concluded and if they are apprehended, so long as there is a market and an order, there will be other poverty stricken Maasai and Samburu warriors ready to take their chances for the few dollars they can receive for two tusks. This time our Rangers were able to drive off the poachers and recover the tusks. These were passed to the Kenya Wildlife Service with a good deal of formal paper-work. They are then indelibly tattooed - taking them forever out of the market place.

So the radio network gets busy as security is increased across the whole area and the location of all herds and lone individual elephants is monitored ever more closely.

Meanwhile we treated this as a learning opportunity for all the local schools: environmental clubs and teachers from Ngabolo and Kimanjo Primary plus all the Kimanjo secondary students came to look at the now putrid carcass.  Vultures, tawny eagles, martial eagles and ravens are fast assisting the hyenas and jackals to dismember the carcass carcass. These Maasai kids have all been brought up to live alongside elephants. Despite their daily life being made hazardous by elephants they all value them as part of their landscape and heritage and they know that shooting elephants is not only illegal and dangerous but morally very out of kilter with their culture. They are taken back to school to consider how they can help to ensure the survival of elephants for their own children. 

Secondary Students on Safari

Only by stopping the market will these tusks be totally saved

Fmeale genital mutilation-Towards an end to the Cloak and Dagger ?

The Female Genital Mutilation (FGM) education campaign progressed remarkably smoothly in Laikipia North this year, now in its third year the 28 established NHP Health Workers and their support team , led by NHP Nurse Rose, are now proving to be a self motivated and highly efficient team –Rose’s smile and calmness have maintained a positive effect on the whole community, deflecting the fiery exchanges seen in our first year.

The new Bill outlawing FGM, passed on September 7th, has helped this campaign dramatically. The Bill, proposed by Mt Elgon MP Fred Kapondi back in 2010, provides that a person convicted of carrying out FGM will face seven years in jail or a half million shilling fine; causing death via FGM can result in life imprisonment. Aiding and abetting FGM also carries heavy penalties. Three years ago it was difficult to get local politicians to support the campaign to, at the least, delay female circumcision, since they were not sure on which side votes lay; but the new law has made things clear for all. We have been fortunate that the local Chiefs have taken a very positive and forward thinking stand, ensuring that progress over the last three years has been fast. Traditionally, as soon as a girl has been circumcised she is pronounced ‘ready’ for marriage, leading to the end of her education. But in many cases the Chiefs have actively insisted that girls not be taken out of Primary school and have also assisted them in registering themselves in school, where local teachers have identified girls being kept at home.

Our campaign in Isiolo is in its first year, with a brand new team of highly enthusiastic Health Workers. Here many lessons have to be learned concerning logistics- particularly as we are currently drowning under a sea of mud, wiping out roads on a daily basis.And never underestimate the infinite time required for Kenyan politics ! No one can focus on education until the all important decisions of how many ‘lunch’ goats to be assigned to each village has been settled. Perhaps such precise allocation decisions have more priority in the Samburu community than in the Masai community where NHP was formerly based. We still have the biggest Baraza (meeting) tomorrow, and rains permitting, we will meet our last year total of over 2,000 attendees.

The team are promoting an alternative public ‘Blessing’ for the girls as their Coming of Age ceremony- rather than the Cloak and Dagger (..literally) ceremony that has been taking place behind closed doors for so many years. Since the average age for circumcision is puberty this has meant few girls accessing secondary education.

The health problems begin with the infections and heavy bleeding caused by the non-sterile and unprofessional operation, proceed via the hazards of early pregnancies, for girls who often have several more years of growing and are already poorly nourished ; through to large areas of scar tissue causing horrific and often life threatening tears and haemorrhaging during birth. In addition mothers will starve themselves during pregnancy, even when food is plentiful, in order to limit the size of their baby to limit the danger and pain of a healthy birth weight baby.

I cannot say that I am taken in by the argument given against the cut by many men and women, at every baraza that the lack of sexual satisfaction obtained by the women causes more female 'promiscuity' or as generally translated from the Maasai 'prostitution', but I guess I am not one to be able judge this question.

Whilst meetings can be highly charged, and to some it is still seen as a controversial and emotive topic; if each year another cohort of young girls is given the choice to delay the cut until after secondary schooling that has got be a good thing for Kenyan development.. and Kenyan politics.

Girl's Education.. Family Planning Choices.. and Fertility Rates...

On Tuesday,leaders from around the world meet in Senegal for the International Conference on Family Planning. As the population in Kenya has soared in the past 30 years by two and a half times, with an average growth of 3 percent per annum, this topic needs to be top of kenya’s development agenda.

The current Kenyan population level is 41 million, up from 21 million in 1989. There is no greater challenge to development, as over-population tends to nullify economic progress. With the advent of Free Primary Schooling in 2003, kenya did a great job of getting Bottoms On Seats. Access to education has improved enormously, but as population levels rise the GOK and donor governments have been unable to meet the required funding, particularly in the poorest rural areas where fertility rates remain highest. In schools we work with, if we removed our teaching support, class sizes would rise in some cases to 120 pupils to one teacher. Education for sure: but based on Quantity not Quality.

There is a clear correlation between levels of female education and female fertility rates. Education leads to delay of marriage, to increased knowledge about contraceptive choices, to greater economic choices for women, to increased autonomy in women’s decision making and to greater communication within marriage: all of these assisting in access to Family Planning and increased exercise of choice. As effective FP choices increase so greater education is required. With the advent of three year Implants, choices increase in both number and complexity.

It is inevitably the economic cost of education, versus its perceived benefits that will be the prime determinants of parents sending kids to school in the poorer rural areas. When the drought of 2009 in the Ol Lentille Community killed over three quarters of domestic livestock, not only did the schools see a large increase in enrollment of younger children, but also many Morans, who would formally have been out herding, entered primary school for the first time.

Seven or more years in school cuts fertility rates in half; but it is years in Secondary Education which has the greatest reduction in fertility rate for girls and the greatest delay in marriage. Educating mothers decreases child mortality and leads to healthier infants.Access to Family Planning is a basic Human Right which cannot be seen in isolation from those other basic Human Right- Female Education and the Right to Health Care.

Pictured are the Nabakisho Health Care nurses in action at a mobile clinic at Rumate where FP choices are discussed... levels of understanding of their full range of FP choices will remain hazy for many of these women who have no education.