TURKANA COUNTY, Kenya (December 5, 2011) — Akal Longor has brought her son Ekalale on one of their regular visits to the Kakwanyang Dispensary and health outreach center. Ekalale is about a year old and small for his age, but he smiles and even takes a few steps when his mother sets him down on the floor. He is recovering from severe acute malnutrition.
Akal, 20, is too shy to speak, so her older sister Agnes tells their story. The sisters live with their extended family in tiny Lokitoeliwo village, about two kilometers away, she explains. Formerly nomadic pastoralists, they've become sedentary after losing most of their livestock amidst prolonged drought here in north-western Kenya.
By July of this year, Agnes says, the few goats that remained were no longer producing milk. Nor was the household earning enough income to buy food. Ekalale grew weak, ill and dehydrated. In August, his mother and aunt brought him to the outreach centre.
On their first visit, nurse-in-charge Lawrence Kisagan checked Ekalale's weight-to-height ratio and mid-upper arm circumference. These two key indicators of nutritional status confirmed that the baby was severely malnourished. He was immediately placed in the center's outpatient therapeutic-feeding program.
Kakwanyang Dispensary is a half-hour drive north-east of Lodwar, the nearest town, along the rutted dirt roads of sparsely populated Turkana County. It brings health services within reach of children and families who would otherwise have to walk four hours to the district hospital in Lodwar for care.
The Kenyan Government set up the spare, two-room outreach centre with help from UNICEF and other partners in July. Like similar facilities scattered around Turkana, this one was established in response to health risks — including outbreaks of cholera — that are exacerbated by drought and poor access to safe water. Another concern was the need for improved routine immunization coverage here.
Critically, however, the centers are also meant to reduce the rate of severe malnutrition among Turkana children under five, which has spiked as high as 37% in some areas. Hence the integration of health, immunization and nutrition services at Kakwanyang Dispensary.
Ekalale is one of six severely malnourished children who are receiving outpatient treatment at the dispensary — treatment that comes in the form of Plumpy’nut, a highly nutritious peanut-based paste provided by UNICEF.
For children like him who arrive at the outreach centre severely malnourished but without serious medical complications, the ready-to-eat therapeutic food can be used at home. Families then bring their children to the dispensary for weekly appointments to have them weighed and assessed, and to replenish their Plumpy’nut supplies.
"We have honoured all of our appointments," says Ekalale's aunt Agnes, and his condition reflects that commitment. "At first he was not responding, but slowly he has improved," she adds.
When severely malnourished children have reached the target weight for their age and height on two consecutive weekly visits, they are discharged from the outpatient program. In August, Ekalale weighed 5 kilograms. Now he is closing in on his target weight of 6 kilograms and has almost fully recovered.
Once Ekalale is discharged from therapeutic feeding, however, the help that he receives from Kakwanyang Dispensary will not end. Instead, he'll continue to benefit from a UNICEF-supported supplemental feeding program there.
To prevent moderately malnourished children from slipping into — or back into — severe malnutrition, the dispensary distributes Unimix corn-soya blend to almost 90 children under five. More than 100 pregnant and lactating women, including Ekalale's mother, also get supplemental feeding at the outreach center.
Nurse Kisagan suggests that efforts to prevent severe acute malnutrition are paying off, because admissions for therapeutic feeding were much higher when he arrived a few months ago. "There is a great improvement," he says. "At the beginning, it was terrible."
UNICEF Representative in Kenya Olivia Yambi notes that the interventions mounted intensively since July built on existing programmes in Turkana. She says they have made a difference by working in the communities where at-risk children live. Still, Yambi cautions that long-term prospects for children like Ekalale and their pastoralist families remain uncertain. Amidst recurring drought, rising food prices and conflict over livestock, water and other scarce resources in Turkana, their timeless way of life hangs in the balance.
In some cases, the Turkana pastoralists are moving away from total dependence on animals by planting sorghum or other crops when possible. Many women, including Ekalale’s mother and aunt, also weave and sell baskets and brooms to generate some income. Despite such efforts, about a third of all households in the county depend on food aid to survive.
"We have to build on this," says Yambi, "for more sustainable solutions."