CASE STUDY: ILLERET ZONE TT SWEEPING, NORTH HORR SUB COUNTY MARSABIT COUNTY
Illeret is a village in Marsabit County, Kenya. It is located in Northern Kenya, on the eastern shore of Lake Turkana, north of Sibiloi National Park and near the Ethiopian border. Administratively, Ileret is a part of a ward of the same name, which is part of North Horr Constituency.
The ward is predominantly occupied by Dasanach community who lives both in Kenya and Ethiopia. The village is 17 KM from the border but from settlement no distinct boundary that separate the Kenyan population and Ethiopian population. The community is purely pastoral-nomadic and also do fishing in Lake Turkana.
Illeret lies 550 Km from Marsabit town via Sibiloi National Park and shortest route 470 Km through Darade administration police post and road is impassable during raining season.
The journey was a rough ride for surgery team who’s this was their first trip to Illeret. The two days journey from Marsabit with first stop over to sleep over night in North horr, the stay in North horr was meant for the team to get security updates and road conditions from North horr catholic Mission priest in charge.
Planning for TT sweeping
This involved all surgical team that comprise of OCO, ON, OA, driver and Caritas Marsabit health manager, coordinated by implementing partner Caritas Marsabit (Catholic Diocese of Marsabit), the sweeping had been postponed twice due to insecurity. The planning was detailed in that the following were highlighted slightly different from other zones initially swept;
- Security analysis was done to dispatch surgery. This was triggered by frequent fighting along the route by Dasanach and Gabbra tribe over pasture and Darade water point.
- Enough commodities both consumable and non-consumable
- Logistics, fuel, conditional spare tyre, well equipped tools box
- Accommodation for the surgery team, there is not a single lodge and the few rooms of Illeret Catholic parish was being used by Malteser international team who are based in Illeret to support livelihood, WASH and education programs. So we had to organize with nurse on the ground to arrange for accommodation.
- Enough snacks to last at least five days working in the community.
- Translator- the local nurse to be used.
The terrain was really tough; we had the first tyre puncture about 30 km from North horr town in a small village of Ell-beso in the middle of vast Chalbi desert. We had to fix the spare tyre and had no option of Puncture repair.
About 35 km from North Horr, the team encountered with another challenge of being out of network and here some members were trying to make the last call for the day to their family members before being suddenly disconnected. The driver who is familiar with the route alerted the team in advance to make the calls.
The ward has 1527 households with population of 9790 (male 5255, female 4535) according to 2009 census.
The area had never benefited from trachoma trichiasis surgical outreach since inception of the programme due to its remote location and insecurity which is a major factor that scares away development actors .Nevertheless Catholic Diocese of Marsabit has persevered the challenges and have been there for this hard to reach community over the years.
Therefore the surgery team were eager to harvest TT cases but to our surprise we found that the population had been treated by Ethiopian authority for both surgery and partially along the border, mass drug administration was done few weeks to our visit, thus the surgery team managed 17 females patients and one major observation was that the elderly were few in the community and this might be attributed to poor life style, early marriages for both gender.
The case finders were trained after identification with help of nurse in-charge of the Illeret health centre. The case finders’ selection was done putting into consideration literacy level at least those who can document properly and fill the household screening register. The active case findings were done after clustering the villages into three clusters of four villages each for ease of supervision of the case finders and verification by ophalthamic nurse.
Unlike normal sweeping where the case finding training is followed by five days of active case findings, this zone was unique in its way, the active finding was done concurrently with verification of suspected cases and operation after counselling of the patient. The combination of sweeping steps was determined by the distance of the zone from the operation area and logistics involved. Therefore, to have value for money the exercise was done in an one off exercise instead of traveling back to marsabit after training of the case finders.
The zone is served by dispensary manned by three nurses and among the three nurses one is Dasanach the one and only Dasanach health worker in the entire Marsabit County and probably Kenya who was sponsored by Catholic Mission to serve the local community.
The population get the specialized care from the Ethiopian health facility along the shores of river Omo, the level 4 facility is located 74 kilometres from Illeret which is easily accessible compared to Marsabit county referral hospital 550 km away.
The eye care services from county government department or even before devolution did not exist. The congenital, secondary trauma and retinoblastoma in children is left unattended not unless they were lucky to access the neighbouring Ethiopian dispensary which is less than a kilometre from the border.
Case study prepared by Peter Arero
Caritas Marsabit (Catholic Diocese of Marsabit) health Manager