Bridging the Primary Healthcare gaps of two IDP Camps in Togdheer Region

Introduction

  Taakulo Somaliland Community (TASCO) implemented an Integrated Emergency Response WASH, Nutrition, Health, Food Security and Education program for  drought affected communities through life-saving assistance, livelihood support and protection services in Jame’adka Ainanshe and Ali Awad villages in Oodweyne District funded by the Somali Humanitarian Fund (SHF).

 We’ve made possible and approached to work closely with the local communities, the beneficiaries and the administration of those designated areas for the proper utilization of the program, minimizing risk on human lives as a result of worsening droughts and to establish mutual understanding for the need of  immediate intervention to prevent further progress and deteriorated humanitarian situations in the ground. 

Dr. Mohamed Y. Dualeh, examining a child suffering from Measles in medical outreach in Jame'ada Ainaanshe

IDPs camps hosts the most vulnerable and poor communities whom cannot receive treatment by their own resources, that meant, they cannot able to buy medicines and travel long way the  nearest town to seek medical help, so despite of having many treatable conditions they are still forced by the circumstance to continue suffering from it, and sometimes complicating to a worsen medical illness as a result of missing healthcare facility in their villages, for that reason, TASCO attempted to fill the gaps in primary healthcare facilities in two desperate IDP camps and its surrounding villages by deploying two mobile health and nutrition teams and providing essential medical supply to reach most vulnerable comhmunities, pregnant and lactating women and children in all ages. Thanks to SHF for funding this project as we would not be able to reach these people without their support.

  We have trained and recruited two health and nutrition teams each deployed to specific location in those two villages, which are supposed to work 5 full days in the ground and return to their families in weekends, whom their primary duty is to help malnourished children and pregnant lactating mothers with nutritional supplies from both MoHD and UNICEF, and also immunize children from preventable diseases, and raise community awareness on realization to reach expected outcome or put into action from all anticipating results in executing this program. 

We are here going to list and share some impediments and lessons learnt during our launching event in which SHF considered to get their humanitarian efforts.

Training of Health and Nutrition Teams

  In an implementing and starting working on exercising of our ambition for efficient responding of humanitarian needs and better healthcare indices in those two remote villages; TASCO employed and trained 10 local healthcare workers which consist of 4 qualified nurses, 2 qualified midwifes and 4 Auxiliary Nurses which are supposed to work in two different mobile health and nutrition teams and each team is expected to work in certain area of the project scopes namely above. 

Mobile HNT trainees with some government officials, including the deputy Governor; the Mayor and other members

 The staff were firstly selected and delegated by the District Health Office in Oodweine and then  have been examined and approved by our Health and Nutrition department in support from one senior officer from the Central level of the Ministry of Health. After then, they have been trained with Integrated Management of Acute Malnutrition (IMAM) and Extended program on Immunization (EPI) teachings under the field experts from the Ministry of Health.

Some of Mobile Health teams receiving practical training in Oodweine MCH

 According to the pre and post test evaluations and field exposure teachings in Oodweine MCH, the participants made significant improvement and demonstrated excellence in understanding the concept of save health and nutrition practice and proper delivery of the supply to its right people.Some MHNT members with their facilitators in hand on training in Oodwine MCH    

Huge break in medical care settings

 TASCO implemented SHF funded project and discovered that the need to arrange and send teams of health and nutrition is not just enough to fulfill and complete the break of medical needs in those villages, and there should be a further intervention and strengthening of the involvement by creating high level of medical alerts, advocating for the communities and to occupy some basic medical needs from our administration resources.

 For example, we had met an old mother in her seventies complaining of shortness of breath, generalized edema, insomnia, polyarthralgia, dysuria and urinary incontinency, a complex array of symptoms with characteristic and transient early diastolic precordial murmur suggesting that she had serious heart and kidney disorder that could be preventable , so as a matter of emergency we had arranged her trip to go to Burao for further medical care, diagnosis and management and TASCO sponsored all of her traveling and treatment costs.

No Ambulance, Health Posts and MCH

 As we are working on fulfilling spaces on healthcare delivery to the remotest and in most needy areas by means of staffing skilled and trained health and nutrition teams.

With our three Land cruisers and other strong wind blowing loose sand and dirty from a dry surface by creating dust storms which is common in arid and semi-arid regions that sometimes forced drivers to stay far away each other to see the road, we eventually reached our destinations and begun distributing free medicines to sick people in all ages; still, it seems that this doesn’t help them anymore, as there is no health post, no MCH for pregnant mothers and children and no ambulance ready for them when it comes to lift severely malnourished children and complicated pregnant mothers to well equipped and advanced facilities which are far from their locations, so as a result we must use our vehicles to occupy this need and to be used for transportation for those in emergency medical attention. We are extending our gratitude to SHF who enabled us to do this live saving interventions.

Medical staffs in the outreach measuring MUAC from a child

  On the second day of our field work at Ali Awad IDP camp, a fortunate mother of her early twenties started symptoms of labour, complaining a painful contractions or tightenings that may be irregular in strength and frequency, and may stop and start. There was no either ultrasound machine, nor was any other means for proper diagnostic tool, but on abdominal palpation the fetal head found above the mother’s umbilicus as a hard, smooth, rounded mass, which gently felt on between your hands. This is very likely to be the baby’s head and is often seen when the fetus lies with its buttocks in the lower part of the birth canal, and its buttocks and/or the feet are the presenting parts during delivery, which is fraught with danger, but her relatives firstly refused to be taken to Odweine MCH, which was the nearest one. And after 4 hours of caring under our Mobile Health and Nutrition Teams, eventually they’ve agreed to take her, and next they had arrived to Oodweine by our vehicle followed with our qualified midwife and one nurse , she had gave birth a healthy boy with no complication in the following night.

Burden of Malnourished Children

  These IDP villages and the similar ones with the same living standard is considered to be unsafe when it comes with children, as a result of poor livelihood conditions, lack of nutritious foods from the animal sources and agricultural products; many children started severe wasting and growth failure featuring nutritional defects with high prevalence of infections among children.

A boy with Trachoma living in Jame'adka Ainaanshe 

•  Notably, cases with Trachoma which is known to be a public health problem in 41 developing countries, and is responsible for the blindness or visual impairment of about 1.9 million people in the world are found in these IDP camps. Similarly, we have seen 5 children affected with measles in Jame’adka Ainanshe ID camp and one measles case in Ali Awad village with the support of SHF 

A child receiving Vit. A supplement in the hands of our Mobile Health and Nutrition healthcare worker.

By: Dr. Mohamed Y. Dualeh, MD