Ethiopia: Outreach to pastoralist Somali communities over sweet tea

Serving sweet black tea with camel milk is at the centre of any Somali social gathering. This is why MSF has recently established so-called ‘tea teams’, usually one or two health education supervisors and a Public Health Officer. They regularly talk over the phone and meet for a chat over a glass of tea with influential community members in order to assess their health needs. In three months, they have developed an extensive network of 50 local contacts in 16 remote sites. 

The two MSF health education supervisors, Mubarak and Ridwan are both from Wardher. They are joined by Rwandan Nurse Olivier, and are headed out to meet community leaders in Kurtunle, a village about two hours drive from Wardher base. They have brought together 15 community elders, who are seated in a circle under a tree, while a young boy serves glasses of tea with camel milk. It is the end of March, a time for the monthly meeting with village elders to discuss the current health and water situation, and other pressing concerns in the community, and to collect data and information for our early emergency detection programme.

Pastoralist life in Doolo Zone, Somali Region, means moving from place to place, searching for water and pasture to feed the livestock, mostly camels and goats. The seasonal rains collect in pondscalled ‘berkat’, providing water for both humans and their animals. The rains also bring pasture to feed the livestock, who in return provide milk and meat, the staple food in the region. 

Community engagement to detect potential emergencies

“Our contacts are community leaders, traditional healers or birth attendants, camel brokers, teashop owners and barbers. They are knowledgeable and respected in their community,” says Mubarak. “It helps a lot that we speak the same language and are from here. We know each other. We share the same way of life and face the same challenges at home. We have all lost livestock and family members in previous droughts. It is all about decreasing the risk of diseases and improving all our lives. That is why the communities quickly accepted our outreach activities.”

Community elders in Kurtunle appreciate the sessions. “We have known MSF for many years. We trust and accept their assistance, especially during emergencies,” explains Bashir, a community leader. “The only thing we see otherwise is so-called humanitarian aid. Organisations came and left something visible and physical, a building or a structure. There is a health centre that should have eight medical staff. It only has five. They are health extension workers and not nurses. They are not qualified and trained.” 

“The centre should have water and sanitation equipment and drugs, but it does not. Not even dressings and solutions for skin infections,” Bashir continues. “When my daughter got sick, the staff were not able to administer an intravenous line. Even intravenous cannulas are not available. The centre is there to treat more than 20,000 people. You can say it is almost there, but you cannot say it is functioning. That is why I call it a so-called service.”

Decrease risks of disease outbreaks in nomadic communities

One lesson MSF learned from past emergencies, was to establish a more dynamic community-based surveillance and response system to reach the most vulnerable and hard to access pastoralist communities, providing them with a safety net in times of emergency. The tea team meetings, focus group discussions and health promotion sessions help enhance our knowledge of the populations’ health needs, health seeking behaviour, and pastoralist movement patterns. It enables us to adapt mobile clinic sites and to respond timely and rapidly to any potential epidemic, even in the most remote places.

“With the water shortage, skin infections, and diarrhoea are common these days. Whenever we see a rise in cases of disease, we organise focus group discussions for affected groups, like mothers with little children,” Mubarak says. “We respect their understanding and knowledge and integrate it in our health messages. We also distribute chlorine sachets and demonstrate how they disinfect and clean the water. Most of our communities have suffered from infections and poor water quality in previous years. Dirty water can cause diseases that can even cause death of our children.”

After their meeting, 60-year-old Sanweyne, a community leader in Kurtunle, guides the tea team to the berkits around the village. Three are completely dry and empty, and the fourth has only some puddles of muddy water left. 

“More than ten times in the past years, we were promised that a water borehole is drilled and fixed,” Sanweyne says. “We don’t know what crime our community committed that has made us so neglected here. Why are our needs ignored?” 

In the absence of a reliable water source unaffected by the arid climate,every aspect of life in Kurtunle, like in most communities in Doolo Zone, continues to depend on the main seasonal rains which are usually expected in April. 

“We are all hoping for good rains now. If it rains, the entire dry environment quickly turns lush and green, dust roads become muddy and the berkits fill up,” concludes Mubarak on their walk.

MSF has worked in the Somali Region of Ethiopia since the 1980s, supporting various government health facilities. 

In Doolo Zone, MSF was working in Wardher hospital and health centres in Danod and Lehel-Yucub since 2007. MSF handed over activities in these facilities to local partners in 2018. Since then, activities focus on comprehensive primary healthcare through mobile clinics, community engagement, surveillance and health promotion activities to an extensive area and to remote populations, in addition to emergency preparedness and disease outbreak response management. MSF runs 17 mobile clinics, which offer outpatient medical services and runs 30+ surveillance locations in remote areas for early disease outbreak detection, and a timely response to emergencies.