Taming malnutrition, disease and death one song at a time

It is hard to imagine that anything can germinate in the parched barren land in Murombus Village in West Pokot. And in these circumstances, one in two children under the age of five are undernourished (the highest rate of undernourishment in Kenya).

About two hours away, is Kitale Town, part of Kenya’s food basket. The road to Murombus Village, from the nearest health facility – Chepararia Sub-County Hospital – winds through a hill, and for a moment, one catches their breath twice at the unadulterated beauty, then the horrific story of the Kamatira blackspot, where a van plunged and killed all aboard in 2017.

The contradictions! They lead us to the unique relationship between Samuel Ngolenyang’ and 37-year-old Silvia Mesunja. Samuel, a community health volunteer, is in charge of 41 women who make up the Murombus Mother to Mother Support Group.

Their story is not the usual “community health volunteers encourage us to go to the hospital”, but we’ll get to that.

As you approach the homestead where they meet every Tuesday, songs in their native Pokot rent the air.

Samuel, the only man present, is the lead singer. They made up the song specially to welcome Schola, a programme officer at the non-governmental organisation Action Against Hunger, which helped form the group.

The song, like others, are just not a symbol of hospitality; they save lives. They helped save Silvia’s eighth pregnancy.

After the usual pleasantries, the singing continues. Elaborate and culturally defiant. Since 2014, Samuel has been composing songs for the group to share basic, but crucial public health messages that span handwashing to curb killer diseases, family planning and other reproductive health issues.

After prayer, they start with Kenama, the first song.

“Let us breastfeed continuously for six months and start planning for the next pregnancy after that.”

Another goes: “When you conceive, even if you just think you have conceived, go to the clinic to see the doctor. After delivery go the clinic. Even if you are a housewife, go to the clinic. Even if you are working go to the clinic.”

Another comes with admonition: “We should wash our hands, wash your hands before eating. Wash your hands after going to the toilet. Do not be lazy. Lazy people are stupid.”

LOVE TO SING

The soloist holds an improvised water can, cut out at the bottom so that water flows when it is hang outside the toilet.

They have songs to encourage use of bed nets to prevent malaria, and songs on the the use of toilets instead of practising open defecation and songs for other public health hazards.

Samuel chose to use songs because the Pokot love to sing.

“This is a good way to get them to internalise what (the public health messages) they are singing about.”

It was this singing that attracted a heartbroken Silvia to the group.

Married to a teacher, Silvia had had two older children and she desired another child. Her husband was teaching far away in Ortum and she was left to navigate pregnancies with traditional birth attendants as was the custom.

The first miscarriage was in 2003. It was a good day. She had eaten, done all her chores and then lay down for a nap. Sharp pain woke her up and the whimpering set in.

Without transport to get her to hospital, she endured the agony the whole night. The following morning, her husband got a vehicle from a neighbour, but by the time they got to hospital, the baby was gone.

ALMOST GAVE UP

Between sobs, Silvia narrates how she lost a second baby while unconscious, then a third, fourth, fifth and a sixth.

Trying to cope with the pain of loss with no counselling, the seventh baby turned her into a philosopher.

“I thought, ‘Maybe God is trying to teach me a lesson’ but when I lost the seventh baby, I gave up on being a mother. I didn’t want to try again,” she told Healthy Nation, adding that she kept trying to replace the emptiness brought about by the death of her babies by getting pregnant soon thereafter.

Having lost seven pregnancies (miscarriages or immediately after birth), Silvia was just about to give up hope.

Then one day in 2013, she heard a bell ring and suddenly, a throng of women passed her home on the way to their Tuesday mother-to-mother support group meeting. Some were her friends and they tagged her along. That’s when she met Samuel.

“I learnt things that nobody had taught us – sleeping under nets and the need to use pit latrines instead of the bushes.”

“I heard the man (Samuel) talk about the need to space children, why we should wait before getting pregnant and the importance of taking folic and iron supplements to keep us from giving birth to deformed babies,” she recalls.

Lack of sufficient iron is associated with anaemia, low birth weight, cognitive defects and poor pregnancy outcomes.

According to the World Health Organisation, iron deficiencies contribute to one in five maternal deaths globally. To improve maternal health, the Ministry of Health drafted the iron folic acid supplementation (IFAS) policy in 2013 to address iron deficiencies among pregnant women.

All pregnant women should take a combined tablet of IFAS daily from conception to delivery. The lack of iron is part of a larger nutritional problem called hidden hunger, where the body lacks iron and other micronutrients such as vitamins A, D, E, zinc and iodine.

PREMATURE BIRTHS

Mothers who lack these micronutrients, give birth prematurely or to babies who are too small (low birth weight) and cannot fight the simplest diseases.

In Kenya, 22 out of 1,000 babies die in the first month following birth. In December 2018, the uptake of IFAS among pregnant women in Kenya stood at 71 per cent, while in some instances, only eight per cent of women reported taking iron supplements for 90 days or more during their last pregnancy. West Pokot IFAS coverage is relatively good at 80 per cent.

Despite these measures, there is often a missing link between women like Silvia and health services. Many well intentioned health projects have failed to yield fruits as the communities they seek to help fail to embrace them.

On the week of this interview, West Pokot County was being declared open defecation free. After many years of spending money on behaviour change campaigns that teach the public about the need to use toilets and making minimal progress in certain fronts, the county’s Director for Health Dr Nobert Ajuoga was elated.

“Being declared open-defecation free may look like a very small thing to others, but I am extremely happy because only I can understand the lives, the money and human resources that I will save now,” he said.

On the maternal and child health front, simple songs, rather than elaborate behaviour change campaigns, are bearing fruit. From listening to the songs at the support group, Silvia made some resolutions.

“He said I should wait for six months before trying to get pregnant again. I decided to wait for a year. When I got pregnant in 2014, I went to hospital immediately and attended all the four antenatal clinics where I was given the iron and folic acid supplements. The baby was being monitored and the nurses would tell me it is okay”

Faith Chepchumba was born in Chepararia Sub-County Hospital, during Silvia’s eighth and final attempt at motherhood.

***

Kitchen garden in dry land saves the day

Health problems in rural settings like Murombus take place in many forms and are worsened by poverty that leads to lack of diversity in diet and food insecurity.

With the help of Action Against Hunger, Murombus Mother to Mother Support Group started a kitchen garden in which they all learn to plant traditional vegetables such as kunde and terere, as well as beetroot and tomatoes.

An agriculture extension officer came for their support group meeting, set up a demonstration garden at the home they meet in, and through song, each member was sent to replicate the kitchen garden in their homes.

“Tea is not food, you know! You have to eat real food,” one of the women chimes as she tends to vegetables in the garden.

Mary Kepkama, a government employed and paid community health worker, told Healthy Nation that cows, goats and sheep – the main source of protein in the region – are often considered men’s property and are riddled with conflict.

ENERGY-SAVING STOVE CLAYS

“Women cannot slaughter livestock for food, so they kept chicken for eggs and meat for subsistence and for sale,” says Kepkama.

But this part of West Pokot is very cold, which resulted in deaths of chicks. To get around this, the group made an energy-saving clay traditional stove that doubles as a heater for the chicks.

The stove has three compartments. One side has an opening for firewood, the middle compartment is used to store the cooked food, and the last compartment houses the chicks, and has an opening to the outside, allowing them to walk out into a space enclosed with wire mesh to protect them from hawks.

The group also has a saving scheme, through which they collect Sh1,000 per member every month.

The money goes into two accounts – one account is used to bail each other out when they need money for feeds and other bills, while the other is used to provide loans at 10 per cent interest.

The Saturday savings scheme meetings are so sacred, that whoever comes in late, even by a minute, is penalised Sh100.

To boost their income, the group also makes traditional bead jewellery in sets of a headband, bangle, anklet and necklace, which they sell for Sh3,500 a set. They save the larger portion, and use the rest for household needs.

So well-fed has Murombus Village become, that the county nutrition department and Unicef no longer consider it as one of the West Pokot villages where children’s weight and height must be measured, for admission into feeding programmes to fight malnutrition. -