Wednesday, November 25, 2009

Measles and...Elections?

Just a quick update on our ongoing Measles outbreak: we now have 528 cases of Measles reported. Eek. The number continues to rise, and the demographic has shifted slightly. Currently our most affected age groups range from 0-10 years, and we also have a high number of cases in the 30-45 year range. Of course at this point all age groups are affected, but those are our two largest clusters.

In other news, National elections begin in Namibia this Friday (11/27). There have been a couple isolated incidences of violence in a few areas in the North of Namibia, but by and large things seem peaceful. Peace Corps is taking every precaution, and I am confident that everything will be fine. The last two elections Namibia has held have both been peaceful, so hopefully this time around will follow suit.

Keande nawa, and I will update when I can...

Gobble, gobble, gobble

Tomorrow is Thanksgiving! What the heck? Things I am missing out on this year: turkey, stuffing, cranberry sauce, stuffing, gravy, stuffing, mashed potatoes, rolls, and stuffing. Ohhh and pie. Did I mention stuffing? Aside from all of the food, I really miss my family. I hope everyone is well, and I cant wait for the next time we will all be together again.

I leave you all with a picture taken during our Turkey day celebration in Opuwo. You know I always keep it classy!

Cheers! :)



Monday, November 23, 2009

Okuti onguza

"I cant tell you not to go, but please don't go."

Not the most reassuring words in the English language. Particularly when uttered by the commanding officer of the Police just before we set out on a whirlwind adventure. His next words soothed us though, "If we don't hear from you by Saturday, we will send out a search party." Thats good to know.

With newfound confidence in our task, my three colleagues and I set out into the vast wilderness characteristic of this region. The characters: Barbra, the Chief Health Inspector for Opuwo District, Michael, our Health Informations Systems Specialist/nurse, David, our IT-savy driver, and myself. Our task: to travel to a village in the far North-West of Namibia where 10 people had reportedly died from Measles. Armed with a photocopied map of Northern Kunene region, three leaking plastic jerry cans of water, a mountain of mosquito nets, countless satchels of water-maker, a massive coolbox full of vaccines, and three mostly-intact fuel cans, we were ready for anything. Our route was clearly defined; the red ink from a ball point pen our trusty, albeit vague, guide. Very few people had ever successfully completed this journey and the only directions we were able to lock down were, "Follow this road until you think you reach a place called Orupembe. From there keep driving and you will reach a red drum, then a blue drum, followed by an Orange drum. Take the pathway to your right and continue until you can't go any further."

In this instance, the word "road" was used quite loosely. We had about five minutes of tar road, then about 10 minutes of decent gravel road conditions, and by the time we were 50km outside of town I was puking in a plastic grocery bag in the back of our enclosed bakki. The copious vomiting was largely due to the rough, bumpy, winding road on which we were travelling, although in hindsight I'm confident that the petrol fumes seeping out of one of our leaky fuel cans didn't help matters.

Road sickness aside, the route was incredible. As we headed North, the landscape gradually changed from the dense Mopane forests, to deep sandy riverbeds and steep rocky mountain crossings. After a particularly difficult, rocky pass, we emerged on an open savannah punctuated by tall, graceful ostriches. The open grasslands stretched for countless miles, only ending at the base of the tall mountains surrounding us on all sides. The only sign of human life was the narrow road down which we were travelling.

The first day we passed only one other vehicle. As nightfall approached, we finally reached a "town," the extent of which was a small shabeen (bar) and a police station. Hooray for civilization! The officer on duty suggested that we continue to a nearby camp, where we could rest for the night so that we would be nice and refreshed for the second leg of our journey. Since there is no telephone service in that part of the country, let alone cell signal, he promised to radio the Opuwo police and inform them that we had made it that far.

It was dusk when we finally reached our destination. The "camp" was an abandoned rest area peppered with a few broken down bungalows long since condemned; its only amenity an open air brick latrine with squat toilets. It was situated in the heart of an old blasting zone (what they were blasting for is anyones guess). We set up our makeshift camp in the dark of night, and fell asleep fast, too exhausted to even eat dinner.

The next morning we rose before dawn, packed up our tents, and set out just as the sun was rising over the mountains. The most difficult part of our journey lie ahead; our first obstacle was a steep mountain crossing hugged tightly by sharp rock outcroppings and drastic canyon drops on both sides. Bouncing along the road, I was struck by a sense of awe and wonder at the beauty of the scenery. It was a new side of Namibia, and the fact that I was one of few people to ever see this part of the country was not lost on me. At times it was necessary to stop the vehicle and survey the route, but by some miracle we made it successfully through. Little did we know that the real challenges were still awaiting us. After clearing the mountain pass and traversing a few uneventful kilometers, we reached our greatest challenge: SAND. We had entered the no-mans-land of the far North-West.

We reached the sand trap in the heat of the day. The intense winds coming from the coast blew long sections of sand across the sparse earth. The valley surrounding us was arguably one of the most barren landscapes on the planet. We found ourselves stubbornly pushing our bakki out of the sand in the Namib Desert in the heat of the day. After a few minutes David was able to get enough momentum to keep the vehicle moving forward and he carried on for a ways without us. Micheal, Barbra, and I began slowly trudging through the sand, alternately complaining and rejoicing over the insane situation in which we found ourselves.

In time, we caught up with the vehicle. David had made it a few kilometers before getting stuck in the sand again. At this point we saw the only other vehicle we would pass on our journey: a large 10-seater Land Cruiser. It was on its way from the lodge where we were headed to some invisible airport deep in the desert. There were 8 smiling white faces on board, and they seemed sympathetic to our plight and yet excited to be leaving on their chartered flight. The chap driving suggested we air down the tires, and told us that if we were still there when he returned he would help tow us in.

The airing-down worked, and with a little more heave-ho we were soon on our way. As we moved further North toward the boarder of Angola, the landscape became even more desolate. The sparse grass was replace by large sand dunes, and towering mountains surrounded us on all sides. The grass that could survive was so sparse and small that it was difficult to imagine that the springbok we occasionally passed could be sustained by it.

In time we reached a Himba village on the top of a large outcropping. We stopped and greeted them, ascertained our bearings, and proceeded to distribute mosquito nets, water maker, and jerry cans to the people staying there. We also gave some health education about Measles, and promised to return to vaccinate the children. It was at this time we were met by a man on a quad bike; he had been radioed at the lodge and informed that we were stuck in the sand. Finding us free, he proceeded to lead the way to the camp. We started up a steep hill, the road largely lost in a deep sand dune. He knew the way, and carefully led us through a series of passes, which culminated in an intense final descent. We were perched on the edge of a monstrous sand dune and the only place to go was down.

The sand rushing past my window was falling at an equal rate with the vehicle, which may of may not have been cause for concern. The stark panoramic views were incredible; wide barren valleys intersected vast mountain ranges and for as far as the eye could see there was nothing but desert. By some divine grace, we made it down the pass, and from there it was only a short distance to the lodge.

As we turned the last bend, life burst forth. The Kunene River, rich and abundant with flora, was a startling contrast to the vast emptiness around it. The quadbike led us to the staff area of the lodge, where we were greeted by a nice gentleman holding a tray of cold towels, and a lady offering us ice cold beverages. We were filthy and sweaty, and yet the staff treated us like we were their esteemed guests. They served us lunch on a patio overlooking the Kunene River, during which time the manager informed us of the situation in their area.

This particular lodge is part of a larger system of game lodges stretching all across Southern Africa. Nestled in the junction where the Skeleton Coast wilderness meets the Kunene River, it boast being the most geographically isolated, and therefore one of the most exclusive lodges in the world. Visitors to this lodge reach their destination exclusively through chartered planes, and the going rate to stay is around 1000 USD per person per night. In exchange for the exorbitant fee, guests are treated to exclusive river tours, quadbike excursions to the Skeleton Coast and the surrounding dunes, beautiful wilderness drives in their stately Land Cruisers, excellent food, and panoramic views in all directions. However, because the lodge is built on communal land, they also have a responsibility to care for the local indigenous people in the surrounding area. One of their responsibilities is to provide transport to the migrant Himba people who frequently move back and forth along the river. The manager was alerted when people crossing the river began expressing great fear; reports were circulating that 10 people in one village on the Angola side had passed away due to Measles. A slow panic began to spread among the locals, and the manager quickly alerted the medical headquarters, who put him in touch with the Director of the Ministry of Health and Social Services, Kunene Region (aka my boss).

So there we were, dispatched to assess the situation, and treat/immunize when necessary. The manager wasted no time. He refused to let us camp and provided us an incredible room, which was far beyond anything we could have ever expected. After settling in, we headed out to visit four villages in the area. Because the villages were in hard-to-reach places, the manager took us and all of our supplies out with the Land Cruiser.

The first village where we stopped was tucked between a sand dune and a mountainside. Small scrub-grass managed to grow here in isolated patches, but it seems to be the only thing capable of eeking out an existence. Yet somehow the Himba were thriving. The villagers were so welcoming; we sat in the shade and they gathered around, listening as we explained why we had come, and sharing with us their fears and concerns. There were many children present, and we immunized them one by one. Some were stoic and some screamed with tremendous force, but in the end they were all covered. We did the same in three other villages, and passed out many mosquito nets and water-maker along the way. Luckily, we did not find any people with symptoms of Measles, and hopefully the villagers will stay that way.

It was a once-in-a-lifetime experience, and I am so grateful I was a part of it. Seeing how the Himba have been able to survive and thrive in one of the most unforgiving environments in the world really put my own life into perspective. Here are a people who seem to have "nothing" and yet they find enough to be satisfied in life. Their huts survive an average of three months before the environment destroys them, so they simply move and build different ones. When we asked the villagers what their cows were subsisting on, they could not answer; they don't understand how their cows could live in such sparse grass, yet somehow they do. They find joy in their children, and from the land itself.

Later that evening, as I drifted off to sleep in my exceptionally comfortable, thousand-dollar-a-night bed, I contemplated all that I have to be thankful for. I couldn't even begin to list them all here, but suffice it to say that I am grateful. It is an incredible adventure I am living, and it would not be possible without the love and support of my family and friends.

Our task completed, we loaded up our gear and headed back into the wilderness early the following morning. On the way back, we continued to distribute mosquito nets and other goodies, and we provided plenty of health education. We also collected 5 people intensely affected by Measles in a distant village and took them back with us to Opuwo State Hospital. All in all it was a very successful journey, and despite the many chips stacked against us and everyone who said we couldn't, we made it back in one piece. And in the vast emptiness (okuti onguza), we found a wealth of life and hope, scratching out an existence somehow...



Words to live by...

From A Rolling Stone
To pitch my tent with no prosy plan,
To range and to change at will;
To mock at the mastership of man,
To see Adventure's thrill.
Carefree to be, as a bird that sings;
To go my own sweet way;
To reck not at all what may befall,
But to live and to love each day.
To scorn all strife, and to view all life
With the curious eyes of a child;
From the plangent sea of the prairie,
From the slum to the heart of the Wild.
From the red-rimmed star to the speck of sand,
From the vast to the greatly small;
For I know that the whole for good is planned,
And I want to see it all.
-Robert Service

Wednesday, November 11, 2009

Adventures...

I am heading out to the field tomorrow morning with a small team of health workers. We are going to investigate some suspected cases of Measles, and possibly to immunize some children. I will do my best to take some pictures! Updates coming soon......

:)

Monday, November 9, 2009

Measles Update:

As of this morning, we have 362 cases of Measles reported in Opuwo District....and the number continues to rise. Our Measles Treatment Center is now fully operational, which is great for the 29 patients we currently have on admission at Opuwo Hospital. We are still struggling to acquire supplies and balance our staff, but at least the patients are now in relative isolation. Also, the health outreach teams returned from the field last week, and they were able to cover 872 children who had never been previously immunized. With any luck, we will have another round of outreach teams in the field next week so hopefully more children will be protected!


Friday, November 6, 2009

Omeva...

Water. Beautiful water.

Over the last nine months, I have become painfully aware of water. In my life before Africa, I understood water in simple terms: It comes out of the tap when you turn the handle, you can buy it in nice little bottles, the faucet has an endless supply, and you shouldn't let it run while you brush your teeth. Turns out that my understanding of water was very limited.

When I turn the handle in my bathroom, more often than not nothing comes out. Sometimes we go many days at a time without any water whatsoever; in the past seven days we have had about 6 hours of water service at the hospital. I repeat AT THE HOSPITAL. We deliver babies here and perform surgery. It boggles the mind that there is no water in a place where patients come to be treated for TB, HIV, Measles, and a variety of other illnesses. But it is a reality, and its now my reality.

The Director of the health facility has been very active of late trying to solve this ongoing water crisis at the hospital. Numerous meetings and discussions have been held with key officials in our area regarding the struggle we are facing in the absence of water. As often happens when a crisis breaks out in Namibia, a committee was assembled to address the issue. A couple months ago, representatives from various water agencies came out to the hospital and took a long look at why water is not being supplied effectively. They discovered that one of the main reasons why water is not being supplied to the hospital stems from an engineering oddity. The intake area in the reservoir from which the hospital should be pulling its water supply is quite high, and as such the reservoir must be over 60% full in order for the hospital to receive any water.

Now here is where the first problem arises. As long as NamWater is suppling all of Opuwo town and surrounding settlements with water, the reservoir level will remain too low for the hospital to receive water. Upon making this discovery, the decision was made among some officials to stop providing water altogether to two local villages, so that the water level could be raised. The water returned at the hospital, but when the Director discovered that it was at the expense of countless people in our local community, she again took up the issue.

It turns out that things are even more complicated; it just so happens that the vast majority of water contracts in my area are held by the Town Council, an organization of traditional authorities from the surrounding territories. NamWater pumps the water up from the earth, and the Town Council buys the water and in turn supplies it to the town. It seems that the Town Council has some past due contracts which are outstanding, and currently they do not have the money to square their debt. Thus, NamWater has refused to continue to supply water until some agreement is reached. So, for the time being Opuwo has water only when the Town Council can pay.

Now, unfortunately for us, the hospital is one of major contracts held by the Town Council. So we are subject to the same "water outages" as the rest of the town while Nam Water and the Town Council sort out their problems. This political problem, coupled with the engineering problems at the reservoir, have left us both literally and figuratively high and dry.

We have now begun the process of getting a direct water supply, where the hospital would have a direct line from Nam Water complete with private meter and a pressure boosting pump, thereby eliminating the Town Council as the middleman. The process is long, but if it works out Opuwo Hospital may have water once again. Of course the Town Council is not pleased to be losing such a large contract, but all of these things will have to sort themselves out in time.

So to add to my previous water understanding: water is scarce. water is political.

Thursday, November 5, 2009

Otjinguenjenje


Otjinguenjenje is the Otjiherero word for Measles. The entire Northern area of Kunene Region is being heavily affected by Measles at the moment. The outbreak started about a month ago, and so far Opuwo District has had 292 cases reported. Currently we have 36 patients on admission (15 adults, 21 children) and to date we have admitted 120 patients at Opuwo Hospital. Thus far two people have died: one a woman of 42, the other a two year-old child.


Measles is a virus which is highly contagious, and also highly preventable. Symptoms include rash, coughing, fever, conjunctivitis, and spots in the mouth (Koplik spots). In the Western world, people are routinely immunized for Measles as children, and outbreaks are virtually unheard of. However the vast majority of people in my area are not protected, and as a result Measles is spreading like wildfire. In schools children often stay in "hostels," where they sleep in close quarters, and the home situation is very much the same; the traditional style of living here keeps families very close together. As such, when one person is exposed, they then spread the virus to many other people.


This crisis has stretched us to the limit. Our wards are overflowing with people, and after three patients who were here for treatment for other diseases contracted measles, along with two hospital staff members, we reached out for assistance from other organizations in Namibia. Thanks to the Namibian Defense Force, we have now had five tents donated to our health facility so that Measles patients can be kept in relative isolation. Some nurses have also joined us from other regions of Namibia, and they are helping to ease the heavy burden on our staff.


So its been a very busy time here, to say the least. As one of the coordinators for the social mobilization/targeted immunization campaign, I have been working to help ensure that we protect as many children as possible from this disease. Last week we had 8 teams in the field, and over the course of 3 days they were collectively able to immunize 581 children who had not been previously immunized. It was a great start, and hopefully this week will prove to be an even greater success. Despite the fact that we are facing a transport crisis, as well as a water crisis, progress is being made!


There is still a lot of work to be done...wish us luck!