Where Kenya Begins & Ends

Kenya's Border Post 1 is on the outskirts of Mandera Town only one kilometre from Ethiopia and one kilometre from Somalia. Here the Daua River provides a natural border with Ethiopia to the North before it turns south to the Somali coast and the Indian Ocean. The river creates a narrow strip of fertile ground along its banks and gives Mandera Town its water supply. In Mandera the official border is a demarcation of nation states, official languages and trade barriers. At the same time it is an irrelevant, artificial line that is noted and overcome. On all sides of the border, the indigenous people are Somalis. If you live in Kenya, you shop in Somalia where goods are cheaper. If you live in Somalia or Ethiopia and you can afford it you will send your children to school in Kenya and visit the health facilities.

The Daua River is fuelled by the Highlands of Ethiopia. Miles up stream, heavy rains will regularly cause havoc down stream. When the Daua River floods in the Mandera district, crops and homes are destroyed.  In the aftermath another, greater risk threatens. As the waters retreat, the area is ripe for mosquitoes to breed. As people recover their losses, potential malaria outbreaks cast a shadow over the villages and towns along the river. Villages know that every night will bring the inevitable bites from mosquitoes. Being bitten every night for a month is not only an intolerable nuisance but a deadly threat.

In remote and difficult environments the State infrastructure struggles to provide essential services. Resources are limited and when an emergency occurs the staff struggle to respond. Working in partnership with the Ministry of Health (MoH) MENTOR's support during an emergency ensures the prevention and control of a malaria epidemic. One simple solution is the insecticide treated net. It saves lives; providing protection at night from mosquito bites as they sleep. MENTOR directly distributes UNICEF donated nets to all local health facilities in Mandera for distribution.

The most vulnerable are prioritized: children and pregnant women. The nets are a valuable commodity and too expensive for many families to purchase. They are a secondary need when families struggle to feed themselves. In harsh and difficult environments it is easy to allow everyday needs for survival to disrupt the vital visits to the health centre, which may be some distance from home. The nets are handed out at the end of the series of antenatal examinations and child vaccinations. They serve as useful incentive to encourage women to return to complete the full course of immunization and attend all the four scheduled antenatal visits.

Two hours drive from Mandera Town; MENTOR is supporting Rhamu District Hospital to address Malaria. The Ministry of Health's Public Health Officer, thankful for the delivery of nets, was keen to discuss MENTOR's plans for expanding its Internal Residual Spraying (IRS) programme. IRS is recognized by health authorities as the most effective way of preventing Malaria epidemics. The Public Health Officer declared ‘that IRS was like providing a bednet for the whole house'.

The most vulnerable villages immediately adjacent to the river had been targeted earlier in the year. At Border Post One, village elder Hussein Ali reported that the mosquitoes had gone after the homes had been sprayed. At Neboi village situated at the other side of Mandera town, Maow Ali, a MENTOR sprayer gave similar positive accounts. Families in both locations continue to use the nets now as a matter of habit. Life expectancy is low and infant mortality high; mothers are rightfully precious of their children's lives. These initial targeted sprayings laid the foundations for MENTOR's forthcoming and biggest IRS operation in Kenya.

23,000 Homes Protected from Malaria in 23 Days

IRS is a public health logistics operation and MENTOR is the expert. In Mandera, MENTOR is about to start their biggest campaign yet in Kenya, the "big push": 23,000 homes protected from malaria in 23 days. MENTOR can only make this possible through collaboration with the MoH public health officials and their local partner organisation, Concern for Pastoralist Development (COPAD).

With the support of the partner and community leaders, teams are recruited from the communities who will be benefit from the spraying. Local ownership and organisation are key to the success of the IRS campaign. The young and old, men and women are enthusiastic recruits. Being an IRS community sprayer is an important job but it also means employment, even if only short term. Work is hard to find and often temporary.

Deka Issack had worked for NGOs before but she was currently unemployed. Rashid Aden was an occasional private teacher and was working for an NGO for the first time. They were both grateful to be working for the first time in many months and happy to be helping stop malaria. They also welcomed the two-day practical training provided by MENTOR. The training ensures that the spraying will be undertaken systematically and rigorously. The participants take the training seriously, there is a lot to take in and get right. If they don't pay attention they would be undermining the impact of the spraying.

The town has been divided into two areas: Mandera East and Mandera West. The MENTOR Initiative and COPAD supervisors' job is to ensure that the 120 sprayers in the two locations, are all trained, equipped with the right protective clothing and resources and organised.

IRS is a team effort in the best sense of the term. Every part of the IRS process has its specialist staff with specific responsibilities, whether community mobilisers, spraying supervisors, mechanics and drivers. Zeinab Ali Noor, the Prevention Logistician, has overall responsibility for the spraying. Zeinab has worked for MENTOR before and moved to Mandera to implement this response. She has to be strong and focused to organise the teams, keep them supplied and overcome the inevitable daily challenges. And once the days' spraying is over, the equipment must be maintained, cleaned and stored.  Staff often work late and at weekends to ensure everything is ready.

Before the MENTOR sprayers arrive in the village, the community mobilisers have done their job.  In particular, village schools were visited because as one community mobiliser declared, "children are the best educators of parents." On the day, village elders use megaphones to ensure no one has forgotten and every home is ready for spraying.

The first day of this campaign begins in Mandera East. In Shaf Shafay, it is quite an event, the children know something exciting is happening today and mingle expectantly. The cries and commands of the mobilisers punctuate the early morning routine.  Soon three 4x4 vehicles arrive, depositing boxes and machinery. Men and women in bright white boiler suits, boots, green gloves and visors appear slightly alien and out of place in this pastoral setting, their faces serious and focused. They disperse rapidly in all directions shouldering silver canisters and clip boards. The bleep and gurgle of the supervisors hand held radios signals the operation has started. The inevitable beads of sweat on the brows of the sprayers as they emerge from the hut they have just sprayed is testimony to their hard work in the mid morning heat. A piece of yellow wool is tide to the outside of the home. It indicates that for now at least, one more home is protected from the omnipresent mosquito and the potential of malaria.

On the first day of spraying in Mandera West, Elizabeth Opondo, a MENTOR Prevention Supervisor, waits in the office compound for her team. She remarked with a smile that she had a team of boys, young footballers. They were the first to arrive at 6.00am, proudly marching in to get their gear and the first ready to leave for the days' work.

The spraying will continue for 22 more days. After that the team moves to Rhamu.

Planning is already underway.  The community based organization, Maslah Sanitation and Malaria Control, has already begun the preparation following agreement with MENTOR. Accurately mapping potential locations is necessary to calculate how many homes must be sprayed; how many teams and resources are needed.

For the District Officer in Rhamu, controlling malaria is an official priority. He is confident of success because the community feels ownership of the project. But he also sees the bigger picture. He emphasized that the government spends a lot of money on malaria drugs. MENTOR's IRS programme would mean less sick people and therefore save limited District resources.

Long Term Impact

Dr. Joseph Ndegwa and his colleague Asha Mohammad have a real challenge on their hands. As the Malaria Medical Coordinator and Clinical Supervisor their job is to change attitudes and medical practice regarding Malaria treatment in 30 facilities across the district. After being bitten every night for a month patients are often convinced they have malaria and demonstrate many of its symptoms. However Malaria is easily misdiagnosed; MENTOR provides rapid diagnostic test kits and drugs alongside training and supervision to support the implementation of the new MoH malaria treatment protocols. In doing so MENTOR helps to improve overall clinical practice and patient care in some of the remotest community health facilities in Kenya.

With the support of international donors such as DFID MENTOR is able it to share its technical expertise and wealth of experience. Its operations help the most vulnerable communities in Kenya and around the world. It is the strength and commitment of the national staff teams and partner organisations that ensures the success and impact of the programme in their own communities.