Dust everywhere

I’ve spent the last several days traveling and tromping throughout the vast (56,501km2) district of Wajir in Northeastern Province – or NEP aka “nothing except problems” or “nothing except pleasure” depending on your point of view according to my security guards (UN requirement for phase III areas – I had two military style police escorts) and the district disease surveillance coordinator (Abdikadir) with whom I’m visitng various health facilities. The first day was the easiest since we just visited facilities in and around the town, so no need even for a security detail. Our primary objective is furthering public health through assessing surveillance for acute flaccid paralysis, measles, and neonatal tetanus; assessing immunization activities; teaching (or as it’s known in the field, sensitizing) health care workers about basic concepts of surveillance, immunization, and diseases; and increasing awareness (or social mobilization) regarding the upcoming 2nd round polio immunization campaign. However, on occasion, given that I’m a doctor, I’m asked to help assess a patient or two. For instance, a local private health care worker reported a potential measles outbreak in one of the Somali villages around town, so Abdikadir and I went to investigate. The presentation of the supposed cases overall weren’t consistent with measles (i.e., rash history and presentation not consistent, etc.) – I hate to admit it, but I was a little disappointed. It would have been really interesting to see real measles – it’s unfortunate that pathology or ill patients make for more “fun” intellectually for infectious disease docs. Anyway, I suspect some other viral or possibly bacterial infection was making the rounds in this village…

Following the first day around town, the next several days were real safaris out to the bush. Long, hot days and very bumpy, crazy drives over very, very bad, unpaved roads, sometimes rocky, sometimes packed dirt with unexpected little ditches or potholes of all sizes, and most times plenty of sand or very fine, loose red dirt. Sometimes, I wondered if parts of the road were even passable, but somehow we always managed to either get through or find a detour or “diversion,” as they say here. By the end of our series of sojourns, we were all covered head to toe in fine red dust, as was the car, inside and out, and everything else that was exposed during our drives. I even taste dust and blow out red dust. Blegh. But despite that and having to get used to constantly feeling hot, dehydrated, and intermittently wet from sweat and/or sticky, the last several days were really great. We started early every morning, which meant that often we’d see plenty of the wild animals that were up and taking advantage of the cooler morning temps to feed. Lots of dikdik, giraffes, gerenuks, and even a few jackals and servals. Unfortunately, they’re all much too fast for my camera, but I have the memory of them in my mind. Pretty cool. Although most of the time, we barely ran into anyone or anything out there between bulas, or villages, we occasionally ran into a bit of a traffic jam – camels, donkeys, and/or goats with their herders. We certainly saw plenty of them at various watering holes, too. Funny thing just to mention, according to Abdikadir and my security detail, the people here don’t ride the camels. They use them as beasts of burden like the donkeys they also have, or for milk and meat, but they would never think to try to ride them. In their minds, that would be abuse – don’t ask me about that logic.

We’ve traveled in every direction from Wajir town, which is somewhat central in the district: east almost to the Somali border, south as well to the border, west to the neighboring Kenya district, and finally north, just a kilometer from the Kenya-Ethiopian border. The last was quite the experience. Up until then, we were making long days so that we could always return to Wajir to sleep with the longest trip being a 500km circuit around the South. However, the North circuit required traveling at least 600km. Given the poor condition of the roads and harsh climate as well as the number of facilities we needed to visit, it would have been crazy to try to do all of that in one day. So, we had no choice but to overnight in Moyale, a town just a kilometer from the Ethiopian border and just in the neighboring Eastern province. That was an experience I wouldn’t care to repeat. I think I would rather have gone camping. One guesthouse we looked at had showers and Western style toilets, but you wouldn’t want to use them given their condition and odor – definitely disgusting. The guesthouse we ended up in had no running water (they have a bore-hole well and you take basin-type baths), and yep, the “toilet” was pit latrine style. Well, it was only for one night. I was glad that Abdikadir, my driver, and the two security guys were all going to stay there, too, in rooms around mine because there were no other females staying there, and security seemed a little questionable. Given that there were no other females and limited privacy, I opted to forego a “bath” and instead used copious handwipes to clean up – almost like camping. Plenty of insects abounding around the place and even in bed with me despite my using my bed net. I woke up twice to feel something crawling on me (definitely good size, not some small bug or mosquito), reflexively wiped or swiped them off, and heard them smack the wall and fall to the ground – I don’t want to think about what they could have been. Oh well, things could be much worse, and at least dinner at one of the nearby hotels (did I mention how “hotels” here don’t usually mean lodging; they mean restaurants or food stops) was decent (and hygienic, I hope) – plenty of goat meat, which is pretty tasty, and spaghetti with kale. I’m laughing at myself now for thinking that the lodging at Mwingi had been bad. Still, despite the minimal lodging accomodations, it’s been a really interesting and rewarding experience overall to work with health care and public health workers here in Northeastern province.