Gembe East Health And Development Project Newsletter

Dear friends,

I would like to thank you all for your support over the past year. The web-log I mentioned in my last correspondence failed to be updated this year due to technological constraints my team, Julian Xue and Ke Zhang, and I encountered while working in South Nyanza.

We arrived in Gembe East in the middle of May to find the local leaders eagerly awaiting the report I wrote based on the data collected last year. We spent several weeks travelling across the community, meeting with key political, religious, economic, health and social leaders in the community presenting them our findings and confirming the accuracy of the information that was gathered. The reception was overwhelmingly positive , many leaders grateful to see tangible results from their efforts. More importantly, it gave legitimacy to claims that certain sectors needed to be urgently addressed.

Advocacy

It was decided by the chief and assistant chiefs that the report should be immediately released to local government ministries and NGOs operating in the area for advocacy purposes. We pressed the local ministry of health to:

- Hire a laboratory technician in the local clinic so that members of the community did not have to travel hours in order to get tested for malaria and other parasites. Most residents in the community fail to travel to these faraway medical centres for financial reasons, rather choosing to take drugs based on oft-incorrect symptomatic diagnoses.

- Change their approach to maternal health. Infant and maternal mortality rates at childbirth are exceedingly high in Gembe East due to a lack of access to proper medical care. While the clinics are well staffed and trained, they are often too far for women to get proper care. To emphasize the lack of use, clinics deliver 3 children per month on average for a community of 15,000 people. Women overwhelmingly turn to traditional birthing attendants (TBAs), healers who have no access to sterile gloves or instruments and have sporadic knowledge of HIV/AIDS. When asked why they prefer these caregivers to government professionals, women cite cost, distance, but mostly trust in the TBAs as factors in their decision making.

Complications are always referred to hospitals over two hours away. One day, I invited a local research organization dealing with malaria prevention to meet with community leaders to encourage expansion of their programs into more isolated areas. While we were meeting with a committee of teachers and elders, a teacher approached us and asked if we might bring his wife to the hospital – she was having complications with childbirth. According to the teacher, she started having complications the TBA was not able to manage around 8:30 am, half an hour after the only boat of the day was leaving for town. We arrived at noon. The land rover we were travelling in took two hours to bring her to the nearest hospital, getting caught in the mud several times. The woman luckily survived. The child did not.

We used our report and this incident to try and pressure the ministry into working with TBAs, to train and equip them, so they might recognize signs of potential complications in expecting mothers. This way, these mother might reach the hospital before the expected due date or receive better care at home. The current policy was geared at introducing new health workers into the scene, many of them men. Our findings indicated that pregnant women were unlikely to trust them with maternal care. 

The ministry of health, who also received a copy of the report, responded positively to each of these recommendations and vowed to petition for the funds for the hiring of a new lab tech. While the local minister was less receptive to the new maternal health approach, many of his subordinates seemed excited by the idea and will continue to promote it.

Small-Business Promotion

Outside of advocacy, our efforts were also directed at more concrete, practical results that could be immediately beneficial to the community. One of our project members, Ke Zhang, who recently started work at a high-profile international management consulting firm, saw that her best contribution to GEHDP would be to offer entrepreneurship courses to local business owners (who are frequently women) and members of self-help organizations. She spent several weeks talking to members of the community, identifying business models that were employed locally in order to create an interactive seminar that would be relevant to local needs. Over a period of a week, she visited all four sub-locations, teaching day-long courses which taught how to write a business proposal, acquire funding, be competitive in a small market, calculate profits, etc…Over 130 community members attended the seminars and the assistant chiefs recently informed me that other community members are requesting to attend similar trainings in the future.

During the preparatory phase, we also noticed that one of the major obstacles to starting a successful business in the area was a lack of capital to invest in their ideas. We approached a microfinance organization working in Nyanza and told them about the seminar we were giving and the constraints of starting a business in our area of focus. This organization, Osienala, has established a strong reputation in the Lake Victoria region and also runs a popular radio station. Osienala sent one of their representatives to a seminar and met with the local chiefs. He also gave a short lecture on the acquisition of loans through their organization. A recent report from the community has informed me that Osienala is now doing the groundwork for the establishment of at least one microfinance bank branch in Gembe East.

We are currently developing a proposal which would link Osienala’s loans program to a local agricultural research centre, which make access to better farming technologies more affordable.

Sanitation Programme

Another project was to work with the Waondo Youth Polytechnic, a school which provide youths with practical technical training in carpentry, masonry, tailoring and metal work. The headmaster, Alloyze Kanyango, approached me during my research last year expressing an interest in developing a new low-cost sanitation technology which would be more appropriate to local needs.

Upon returning in May, we presented a group of the school’s teachers and students with several different models that had been used elsewhere by development organizations. Together, we studied these models to identify how we would create them with local materials, how much they would cost and if they were culturally appropriate to the area. We settled on a model called the Tree-Loo, which is based on a lightweight superstructure which can be moved from one shallow hole (which would fill in a year), to the next.

The team settled on a design that would require no timber due to its local scarcity and short durability in this tropical environment. When holes would be filled, a layer of earth would cover it to avoid contamination. In that layer, owners would be encouraged to plant trees – for fruit, timber, fuel or shade. As the tree would grow, its roots would penetrate the faecal matter below, which is rich in nutrients. Since this new take on the design came from the school, it was re-baptized Yien Choo, which is Tree-loo in the local Dholuo.

A local jua-kali (means hot-sun or clever in Kiswahili) artisan with knowledge of ferro-cement technology was hired to consult for the project as ferro-cement requires fewer materials, meaning a lower cost and a lighter weight, but is more durable. Over the past months, they have been developing a production line of these latrines and will soon make them available to the public.

Once their product can be sold, the system will be self-sustaining and will provide the school with extra income to invest in more teachers and teaching implements. We developed a marketing strategy with them and started making linkages to NGOs which might consider contracting them for sanitation projects. This was combined with a public awareness campaign by holding public meetings, called barrazas, to discuss sanitation issues with the community. 

The next step is to produce manuals constructing the model in order to distribute copies to all students graduating from the school so they may incorporate it into their businesses. There is also a need to develop a sanitation awareness campaign to make links between poor sanitation and unclean water clearer to community members. Several temporary no-cost sanitation initiatives can also be undertaken with proper planning and awareness.

Vision for the future

Our involvement in Gembe East is not a mere one-trip initiative. We and the leaders of the community are already beginning to plan for the next series of projects to be undertaken. I will be recruiting new volunteers this year to go work in Gembe East for a period of three months. In addition to the aforementioned development of a proposal which would link Osienala’s loans program to a local agricultural research centre, making of latrine manuals for students, a sanitation awareness campaign, we have been looking into developing solar stoves which would reduce household dependence on increasingly rare (and expensive) wood or charcoal-based fuel. We have also studied the Millennium Development Villages program designed by The End of Poverty’s Jeffery Sachs. Many of the land-improvement technologies for better agricultural yields and environmental preservation can be used in this area. We are studying composting for the creation of natural fertilizers, some based off of the local pest water hyacinth, which would transform an economic burden into something productive. We would like to promote research on local erosion which is threatening homes, fields and the precious fishing industry through increasing lake sedimentation.

All of this year’s work was possible due to your moral and financial support. I would be thrilled to have feedback from you and hear any suggestions you may have regarding the direction of the program or expertise to share in a field you believe is relevant. We have a great deal to learn from our partners in Gembe East, and we can learn equally from you. It is only through the sharing of our knowledge and experiences that we will be able to find solutions to the challenges we are working to address. We appreciate any comments or financial support you might be able to give. We look forward to working with you.

Regards,

Alexandre Corriveau-Bourque

Project Coordinator

Gembe East Health and Development Project