Country of choice: Kenya.
Indigenous people chosen: Turkana Tribe of Kenya
Numbering about 250,000, the Turkana tribe is a pastoral community that is found the semi desert region of Turkana District which is in the Kenyan section of the Rift Valley. The language spoken by the tribe is classified as Cushitic. The main economic activity (pastoralist) of the tribe is similar to that exhibited by the other Cushitic groups of Kenya i.e. the Maasai and Samburu (Economics, 1995) The Turkana tribe rears large herds of goats, cattle, sheep and camel which are their major source of both income and food.
The Turkana tribe moves from a place to another in look for water and fresh pastures for their animals thus making them a nomadic tribe. The tribe allows polygamy as long as the husband can afford ton pay the dowry to the woman. However, because the core source for upkeep of the Turkana tribe is cattle, a cattle rustling is a common phenomenon and therefore it’s common to see a herdsman herding his herd while armed with a gun. Unfortunately, in relation to this topic of Investigation of Healthcare Services available to indigenous people, the Turkana tribe is marginalized by the Kenyan government and so is scarcity of social amenities to the tribe.
Availability of Healthcare services to the Turkana
Before we can delve into the availability of medical services to the Turkana, we can reflect their nomadic pastoral lifestyle and relate it to the medical services. As stated earlier, the tribe occupies a remote area that is far flung in the northern part of Kenya. Made of family groups ranging 40-100, which are referred in the tribal language as Adakar, they migrate through established migratory routes through the vast semi desert land. Since the tribe migrates throughout the year, it only complicates the availability of healthcare services to the tribe.
There have been initiatives to improve the health of the Turkana such as the project initiated by AMREF,” Ng’Anadakarin Bamocha” which translates to “action on mother and child health”. The initiative has built health clinic on the established migratory routes. Also, the AMREF works together with the Turkana County Council, African Inland Church and the Catholic Diocese to cater for the medical needs of the Turkana.
Due to the opinion that particular political and economic s factors are the causative of ill-health, the provision of medicines (regarded as the Western medicine in the community) it gets a negative effect on the medical care of the Turkana’s nomadic pastoralists. The Western medicine doesn’t also blend in with the healthcare seeking habits of the Turkana which in turn complicates its effectiveness.
The AMREF initiative projects, the patients are given medical health for a small period (usually once for a duration of six months). That occurs when the AMREF personally visits the Adakar but when the AMREF goes away, the Turkana are left to resort to their cultural healthcare practices.
The types of illnesses in the Turkana tribe
The Turkana puts illnesses into two categories. The first grouping, the Turkana believe is caused by their God whom they refer to as Ngidekesiney ka Akuj. The second illnesses are categorized as being caused by witchcraft which they refer to as Ngidekesiney ka ekapilan. However, the Turkana has the perception that a large number of their illnesses are caused by the Ngidekesiney ka Akuj and that the illnesses define their every activities. These illnesses can be fatal in some cases but the tribe deems them as controllable. Therefore, the sick will be treated in their nuclear home, referred to as awi in their language. The remedies involve use of natural treatments such as ekitoi which comprises of concoctions of herbs. These treatments are meant to protect the body against the intrusion of any illness and are administered through an orifice. Due to the great effect of the Western medicine to quickly relative the Turkana of signs of diseases, it has been named the ekitoi.
The second type of illness which is believed to be caused by witchcraft, Ngidekesiney ka ekapilan, is seen as caused by anomalous people (defined as being jealous) and who can cause illnesses, dry weather spells and in some extreme cases, death. The Turkana have got the remedy for Ngidekesiney ka ekapilan which is divination. In what the Turkana tribal men term as “the throwing of sandals”, they will do it but if it bears no fruit, then they seek religious intervention called Emuron. These Emuron vary greatly from the healing depicted by the common doctors since they are religious leaders, conjurers and witchdoctors, rolled into one. However, the Ngimurok act outside the scope of the coverage of the Western science. The treatment method applied by the Ngimurok, which the Turkana view as for treating the “naturally occurring diseases”, differs greatly from the etiology applied by the Western countries.
Conversely, it cannot be denied that the Western medicine and the Turkana beliefs are somehow similar but the difference is that the medicine anthologies exaggerate the constituents of the medical systems as though they were “self-contained systems.” The Turkana tend to reclassify an illness if that specific illness will defy the treatment of a particular therapy.
For ages, the Turkana have always used their form of traditional medicine and always to them when they lose patience in the treatment (i.e. take too long to cure or treat) of Western medicines. The Turkana also turn ton their traditional herbal medicines to avoid the reliance of the Western medicines. But it is worth noting that the herbal remedies don’t function like the Western medicine but as McCormack in Janzen 1992 aptly describes “they work as a cultural and social appropriation of the therapeutic technology”.
The provision of Western Medical facilities
The application of the Western medical and health care facilities is hindered by several factors: One the pastoral community depicts low populations. Second, there is the language barrier because of the poor communications. Third and the major factor that hinders, is the tribe’s nomadic movements which cannot be predicted. The availability of medical services and facilities and also other social amenities can be attributed to the climate of the region and also the geographical location of the place. Therefore the remoteness of the place contributes to the neglect of the Turkana by the Kenyan government.
Even though there have been initiation and implementation of Health care projects and initiatives purposely for the nomadic pastoralists, there are only situated where there is a considerable number of the nomads so that the treatment expenditures for every treatment can be decreased (Chris at al, 2006). Healthcare in such places can only be effectively be implemented through mobile clinics. It can’t be disputed that mobile healthcare services reach out to more people than other types of District hospitals. For example, a research was carried out on the attendance of Maasai on hospitals and it was found out that the number who attended the mobile clinics were greater (12 400) whereas those who attended the district hospitals were only 1100. Therefore the implementation of mobile clinics in such places can be more effective.
Unfortunately though, the expenses of patients that can be treated at a mobile clinic per individual are estimated to be Ksh. 3 compared to Ksh. 2.50 for similar medical services at a district hospital. The extra cost comes as a result of the expenses of transport to those remote places. There are medical setbacks that are associated with the Turkana. First, the patients have a poor follow-up of medical services and second not coming back for subsequent medical doses. As per the medical studies carried out in Turkana in 1991, it revealed that the number of patients, who were new at the clinic, exceeded 83%.
The AMREF initiative medical projects
Even though the African Medical Research Foundation (AMREF) has been operational ever since 1957, it wasn’t until 1977 that it set up a laboratory in Turkana after there had been an outbreak of hydatid cysts that are affiliated with the Echinococcus tapeworms (George, 2001). In 1982, French and Nelson did a study and their survey revealed a yearly occurrence where there are 198 reports for every 100, 000 residents of Northern West part of Turkana. The study showed that their counterparts of Southern part of Turkana recorded cases that were 17% for every 100, 000 people. Some of the causes for this were attributed to the high ratio of man: dogs whereby the northwest was found to have 1:0.36 while the south was found to have 1: 0.12. Among other proposed cause were the scenes where the children’s vomit and faeces waste was consumed by the dogs.
Treating such diseases, have been met with varying levels of success. There have been challenges in treating, for example in such cases, the dogs and also the fact that the Turkana don’t take changes well. Also, it cannot be overlooked that the Turkana are greatly hit with high rates of morbidity and mortality due to the causes of the tropical diseases that wreak havoc to other third world countries among them malaria, measles, diarrhea and tetanus.
Proposed health reasons
Several factors have been proposed in explaining the huge rift between the health difference of Turkana and other people. The factors are: their nomadic life and dispersion capped by the intricacy of accessing and maintaining treatment; their intimate closeness to dogs and other animals; factors relating to socio-economic and their cultural differences that motivate some specific forms of complains; disorders associated with their dietary habit of rich in milk; and environmental factors found in the places that they occupy.
Some of the diseases were identified as: soaring levels of brucellosis and anthrax due to their closeness to animals; anemia disorders that were related to their diet; the eye infections and respiratory disorders due to the high levels of dust and lack of protective gear from those elements; and high cases of measles and whooping cough being attributed to mobility.
The Turkana mobile unit
The mobile unit held in the North West part of the Turkana runs for a period of 25 days and the first of those mobile unit safaris which number eight are arranged at the start of the year. The mobile units are divided into five sections namely: the diagnosing section, the immunizing section, antenatal care section, lab services and a dispensary. The Turkana value immunizations and so do their attendance is high. To discourage cases whereby the women severs their babies’ umbilical cord using unsterilized materials (such as spears and knives) upon giving birth, the antenatal gives pregnant women tetanus vaccinations. The mobile units also teach the Turkana health education lessons.
After the AMREF pitch their tents it doesn’t take not until afternoon that the Turkana starts trickling in. The mobile unit registers significant attendance numbers from the following day (Publishing, 1997). Even though the AMREF pegs the area that the Turkana are likely to be it becomes cumbersome in some cases since finding them takes long safaris and this can be attributed to their nomadic lifestyle and that others are unsure on using the facilities.
There is also complexity when prescribing the drugs because the patient may be describing the illnesses that got another person other than person that was witnessed at the awi therefore leading to the prescription of the wrong medicine; or may explain some kind of symptoms that they had in the past; or in some cases they could be using them for wrongful purposes such as for treating their animals or worse still selling to the Somalis who are found there.
The Mobile units initiate by the AMREF improves the healthcare of the Turkana without tampering with their nomadic lifestyle and has an access far much more than that of the district hospitals. The nature of the mobile units, mobile (which means that they are not limited to one place) makes it possible for the Turkana to access medical services since the services can be administered by pitching tents on the Turkana’s established migratory routes or moving with them. However, the effectiveness of the medical services is hindered by the fact that the medical attendants see the patients on rare occasions or the patient’s progress can’t be followed up. Even though the mobile units are effective in improving the health of the Turkana, the mobile units are a costly way of provision of health care services since there are not proceeds that are expected from the tribe for the maintenance of the facilities.
Chris, J. (2006). World Yearbook of Education: Health Education. Abingdon, Oxon: Taylor & Francis.
Economics, C. B. (1995). Rural development abstracts, Volume 18. Oxon: Commonwealth Agricultural Bureuax.
George, N. (2001). Health,state,and society in Kenya. New York: University Rochester Press.
Publishing, H. (1997). Africa Review. Phoenix, Arizona: World of Information.