Todoloi a’ edewa camps saving the lives of mothers and children in nomadic communities in times of COVID–19

Todoloi in ng’aturkana loosely translates to ‘reach us.’ The Turkana community uses this term to express devastating circumstances such as droughts, hunger, wars, sickness or any other difficult situation to call for help. From the beginning of 2020, Turkana County has experienced multiple natural calamities that did not only disrupt health service access but also impacted routine social-economic activities. The locust invasion on their sparse herding fields, followed by floods that made roads impassable and then the COVID-19 response measures announced by the government had a devastating effect on their livelihoods and health outcomes.

In as much as Turkana County has reported seventy-two COVID-19 cases and zero deaths as of August 29, 2020, the COVID-19 pandemic and the response to it are affecting both the provision and utilisation of reproductive, maternal, newborn, and child health (RMNCH) services. There has been a decline in both utilisation of maternal health services (antenatal care, skilled birth attendance and postnatal care) and child health services like immunisation. Family planning uptake also declined as cases of sexual and gender-based violence surged. Movement restrictions, curfew hours and stay at home orders have made the pastoralists who travel long distances to access health services shy away from visiting health facilities for fear of being arrested and the costs associated with being quarantined.

Additionally, myths and misconceptions about the COVID-19 pandemic have been a barrier to accessing health services due to low literacy levels and limited communication infrastructure like the radio that does not reach some sub-counties. These areas rely mostly on traditional leadership structures, the provincial administration or community health volunteers to get any important messages. Similar to other rural areas in Kenya, Turkana communities also regard COVID-19 as a disease of urban people.

Leaving no one behind

To reinforce access to health services for the far-flung communities, the USAID funded Afya Timiza project in collaboration with the Turkana County Department of Health answered the todoloi call through medical camps. The todoloi a’ edewa camps provide integrated health services including, family planning, antenatal care, postnatal care, immunisation, deworming, Vitamin A supplementation, adolescent and youth sexual reproductive health, treatment of minor illnesses and referrals.

The tree of men and equity

To ensure women, children, adolescents and youth are protected and empowered, medical camps are held under the ekalale (a local fruit tree similar to the baobab tree). Such trees, usually found along riverbeds are a magnet for traditional gatherings, kangaroo courts and watering livestock. They remain

a symbol of community information sharing and planning for community events, especially by men. According to Ekale Loowa a community health extension worker in Turkana South, the ekalale encourages men to participate in health education sessions during the camp.

“The health education sessions during the todoloi a edawa help us understand why it is important for women to wait at least two years after every delivery before getting pregnant again. We have also learnt how each household can facilitate better health by improving the environment through the construction of toilets and handwashing,” explains Peter Lobanyale, a kraal leader.

“Most of my male peers believe that circumcision protects them from contracting sexually transmitted diseases, including HIV. Todoloi a edawa provides a platform for me to enlighten them about safe sexual reproductive health practices” says Rose Akitale, a peer educator.

Since the inception of the todoloi a edawa in August 2020, over 2,410 children have been reached with Vitamin A supplementation, 220 children have been fully immunised, and 480 women have been provided with antenatal and postnatal care services.

Loito Nangeri is expecting her fifth child, and the todoloi camps have enabled her access to antenatal care services. She lost her previous pregnancy and is grateful for the access to maternal health services.