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Travelling clinics to help children in Somalia’s remotest areas stay healthy

UNICEF/ Pflanz
© UNICEF Somalia/ 2011/ Pflanz
Hodo Kayse, a nurse with the Somali Red Crescent Society, follows-up with a malnourished child who responded well to treatment at a mobile clinic in Dalow village in a remote area of Somaliland.

By Mike Pflanz

DALOW, Northwest Somalia “Somaliland”, 20 September 2011 – Sofiya Abdullahi watched anxiously as her three-year-old son Abdirahman stepped onto the electronic scales.

For weeks, he has struggled to beat a bout of chronic diarrhoea. Growing sicker, he had refused food and lost energy.

Sofiya’s family are nomadic herders, walking the bush finding pasture for their goats, sheep and camels in a remote and mountainous corner of northwest Somalia far from any major towns.

They survive on their animals’ milk. In times of drought, like recently, that dries up and children are vulnerable to malnutrition and the illnesses which cause it.

“There was no health care available for people like us,” she said. “When my son fell sick, I tried some traditional medicines which did not help.”

But then she heard about a team of nurses travelling from village to village across the region, holding regular clinics checking and treating sick children.

A fortnight ago, she walked down off the mountains with her son and his 12-month-old brother, Nasir, to the village of Dalow, where she knew the team would be visiting.

“Both of the boys were malnourished, but it was not too late,” said Hodo Kayse, a midwife and nurse with the Somali Red Crescent Society, which runs these mobile clinics.

“We started them on treatment and you can see that both are recovering well.”

Sofiya smiled as the scales showed that Abdirahman’s weight had increased from 10.1kg when Hodo first checked him two weeks ago to 10.8kg today.

The clinic is part of the Outpatient Therapeutic Programme (OTP), supported by UNICEF with funding from the European Commission Humanitarian Aid Department, which treats children before they become so sick that they need hospitalisation.

Before the mobile OTP team began touring these villages, there were few options for sick children.

“We had to take them to Berbera or Hargeisa, the nearest towns,” said Ubdi Ibrahim, 30, whose two-year-old son Abdikhadar was declared fully recovered after a month of admission in the malnutrition management programme. 

“That is far and expensive, and the only transport is trucks coming to buy camel milk. All of us know someone whose child died in the past because this place is far from health services.” 

UNICEF/ Pflanz
© UNICEF Somalia/ 2011/ Pflanz
A young girl is weighed and her height is measured, to help calculate her nutrition status, at a mobile clinic in Dalow village in Somaliland.

Now, those health services come to them. One recent morning, 40 mothers waited patiently as the three-person Red Crescent team methodically checked children’s height, weight and upper-arm circumference.

These measurements help nurses calculate if a child needs special feeding to fight malnutrition, usually with Ready-to-use therapeutic food, a pre-packaged high-nutritional value peanut paste formulated to treat severe acute malnutrition.

Those with underlying conditions – pneumonia, for example – receive the necessary medicines. At the same time, nurses talk to mothers about how best to feed their children, how to wash their hands and boil drinking water, and other steps to keep their families healthy.

In a corner, another of the SRSC team is giving babies immunisation shots. All of the children seen today will return in two weeks when the clinic next passes through, for follow-up consultations.

For those who fail to respond to treatment, or come when they are already very sick, nurses refer them to the nearest hospital with an inpatient Stabilisation Centre.

This is a special ward where severely malnourished children can be treated and monitored around the clock. There are 21 Stabilisation Centres and more than 800 Outpatient Programme facilities across Somalia which UNICEF supports.

Down on the coast, a two-hour bumpy drive from Dalow, Zamzam Abdi’s daughter Asma is growing stronger after almost four weeks in Berbera Hospital.

She is 20 months old, but looks barely bigger than her three-month-old brother, Ahmed, lying next to her.

In Zamzam’s village, there are private pharmacies, and a health post, but “none of
them could help”, Zamzam said.

“It was my last resort to come to the hospital, but she was so sick she was lying down not moving, like a person in a coma,” she said. “There were children who were sick in my village, and they died. That scared me very much, and that’s why I came here.”

It was a difficult choice. Her three eldest children are now scattered among relatives, and for the month that Asma has been in hospital, Zamzam has been unable to earn any money for the family.

“It is very much easier to treat a child before they become very sick, and it means there is not so much bad impact on the family,” said Layla Hassan, an SRCS health officer, who helps manage the mobile OTP team.

“All we need is to be able to continue, and even to add more teams, to reach more people.”



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