Thirteen camels amble their way across the dusty, drought-stricken landscape, accompanied by seven men in bright yellow T-shirts and three nurses. The camels are loaded with trunks full of medicines, bandages and family planning products. It’s a mobile health clinic on hooves. When the camels arrive at their destination, men, women and children form a line as they wait for the handlers to unload the boxes and set up tables and tents.
Among those waiting is Jacinta Peresia, who first encountered the health visitors six years ago after she nearly died giving birth to her 11th child, a daughter called Emali.
Peresia’s husband had been hesitant to allow her any reproductive healthcare but the near-death experience prompted him to encourage her to speak to the nurses, and she was given contraception.
“Growing up, I didn’t know it was an option to plan my family and have the number of children that I could comfortably look after. Poverty and my continued weak health have forced us to make this choice. Money went a long way in the past. Now we tell the girls not to get tricked into early marriage.”
Peresia lives in Lekiji, a remote village set between the Ewaso and Nanyuki rivers in thorny scrubland in central Kenya, about 50 miles from the nearest town, Nanyuki. It is a place of natural beauty and a rich prehistoric heritage dating back millions of years, but the area’s natural resources are diminishing. It is not uncommon for people to come into contact with elephants as they compete for water and pasture. More and more people are looking for dwindling resources such as firewood, water and grazing for their animals. Lack of economic opportunities is putting more pressure on people and the fragile ecosystem. There is no secondary school, which means that most children end their formal education at primary school level and teenage marriage is common, particularly for girls.
Access to healthcare is expensive and, in an emergency, villagers are forced to walk for hours to the nearest health facility. For women, the lack of facilities, combined with patriarchal attitudes, means they have had no control over their reproductive health. But Communities Health Africa Trust (Chat) organises mobile healthcare outreach to poorly served communities such as Lekiji. Chat identifies vulnerable communities with limited access to health facilities and significant family planning needs, and brings health provision and education to their door.
Lack of roads is no barrier to their work. If they cannot reach the communities by car, they switch to an older form of transport: camel. In the past three years Chat has reached more than 100,000 people with behaviour-changing messages that focus on family planning but include TB, HIV and Covid prevention services across 14 counties in Kenya. About 37,000 women have chosen longer-term family planning methods.
Susan Oyan, 23, is a mother of three children under six. Her best friend is 19-year-old Elizabeth Kibatis. Kibatis is trusted in the community, especially among her peers. She meets friends to teach them about the options they have to plan their family. “In the beginning, people did not want to have conversations about family planning. I started with three friends, including Susan, and it created this ripple effect. The realities of life – not enough food, firewood, water and people [forced] to take menial jobs to make money – are making people think differently about the choices they can make for their families.”
The main reason women do not explore family planning is generally because of men, she says. “If a husband finds out, they do bad things to the women. That’s why we try to get men involved, make them understand that reproductive health services benefit everyone, and improve their wives’ wellbeing. Rampant misinformation has not made it easy. They say that birth control makes you sick.”
Despite the misleading claims, Kibatis has become a role model for the other young women in Lekiji. She works with Chat providing information, dispelling myths around family planning and then convincing other women and girls of the benefits of having control over their own bodies and being able to afford to take care of their children. Everyone is included in these conversations so that men and boys can’t brush off family planning as “women’s business”. She has been taking birth control and is planning to have children in four years, after completing her catering studies in Nanyuki. She has clearly had an impact. When schools shut down due to Covid only one schoolgirl from Lekiji got pregnant, bucking a national trend: over a period of three months in lockdown, 150,000 teenage girls in Kenya became pregnant, a 40% increase in the country’s monthly average.
Kibatis is among the women waiting patiently for a three-year birth control implant from the mobile clinic.
At the centre of Chat’s approach is linking people’s health needs to nature, raising awareness of how poor natural resources can worsen health, and how poverty can have a negative impact on the environment.
Peresia has noticed that people are sick more often than they used to be. Children are getting stomach problems, which she believes is from the muddy water they are forced to drink from hand-dug wells in dry riverbeds. Stress levels are high because there is no more pasture for the livestock.
“The environment has been destroyed. We have fewer trees [because of the need for cooking fuel], minimal grass, and sometimes the river dries up. We often have to try to dig for water in the dry riverbeds, but the water is dirty. I now know why it’s getting worse. It’s because of climate change. During the day, it feels like the sun has come lower in the sky and is closer to us. The trees are starting to die. If trees disappear, what else is left?”
Today, Peresia encourages her children to only have the family they can support. Her eldest son recently got married and his wife is about to have their first child. She says: “I tell all of my children, particularly the boys, ‘Two is enough!’” She thinks it’s not environmentally sustainable for the planet to have more than two children. She has learned to recognise the interconnection between people, their health and the natural resources on which they depend.
“As the world changes, we need to change too,” Peresia says, and proudly shows off 11 trees she has planted to help with reforestation efforts in her community.
Wanjiku Kinuthia is a conservationist with Maliasili.
Through the dim forest, a slow procession of hundreds of people largely dressed in white, some in a trance, others singing fervently, heads towards the Osun River. As they have every August for 700 years, Yoruba people gather here at the Osun-Osogbo sacred grove, a Unesco world heritage site in south-west Nigeria, for an ancient festival celebrating their traditional spirituality.
Yoruba religious practitioners, adorned with cowrie shells, some with crosses or Islamic beads, pray for protection and offer sacrifices. In a region where Christianity and Islam are dominant, Yoruba traditions have often been cast as demonic – a legacy of colonial violence against Indigenous faiths – but are practised by a devout minority and hold a wide significance for people of varying faiths.
Recent years have seen a growing appreciation of Yoruba spirituality among the younger generation, with more young people becoming practitioners and Ifá priests.
The two-week Osun festival attracts visitors from across the Yoruba-dominated south-west, along with diasporas from South America and the Caribbean, as well as tourists. Osun, the goddess of the river, is said to have appeared to an ancient warrior, instructing him to bring Yoruba people out of famine, into safety in Osogbo city. In return, they would offer a yearly festival.
Osunnike Ogundele, 53, wears a shimmering green and gold lace dress, her hair braided with cowrie shells. “I’ve been here all my life,” she says, explaining her mother’s influence, and her own guidance for her children.
“My fondest memories of the grove are our mothers before us who passed on the knowledge we have now. There was so much to learn from just observing them and we are trying our best to pass this on to our daughters too,” she says. “Osun answers all prayers, no one cries to her without leaving with a smile.”
Osunniti Sikiru, 32, a Muslim and Osun priestess, is one of a number of custodians of the grove. She describes how, for Yoruba people, cultural heritage should be understood as predating the advent of Abrahamic religion in the region.
“Most of our forefathers weren’t Christians or Muslims,” she says. “There’s a big misconception that as a Muslim one can’t combine it with Osun worship. Water is very symbolic in Islam and Osun worship, both emphasise purity. I am still a practising Muslim, I still pray five times a day, my son is named Ibrahim, but Osun worship precedes most religions in Yoruba land.”
Princess Adeola Iya Osun, 47, another priestess, chimes in. “One of my daughters is a pastor and my son actively goes to the church, but what I try to preach is a symbiotic relationship between faiths.”
There have been concerns that the Osun River, seen as having healing powers, has been contaminated, sparking fears for the health of the worshippers who wash and drink here. Local media investigations allegedly found dangerous levels of lead, lithium, aluminium and iron, caused by the activities of artisanal miners and large companies.
Last year, pictures of the polluted river caused uproar and demands for government action. A warning by the state authorities not to drink from the river came on the penultimate day of this year’s festival, sparking further anger. Some chose to drink anyway, knowing the river was contaminated, believing they would be protected from ill-health.
Pollution is a serious worry for those attempting to maintain the integrity of the grove and its surroundings.
A committee of custodians leads these efforts, clearing the litter, while preserving the architecture and stone carvings.
On the final day of the festival, visitors crowd the banks of the river to meet priests and priestesses for consultation and prayers. Baskets are laid out full of kola nuts, fruits and vegetables.
In a trance, a priestess bellows praises to the goddess, then shares messages and warnings. As devotees arrive for prayers, testimonies are shared by people who have attended for several years.
Iya Osun’s parents had challenges having children, she says. “My mother came to pray to Osun for a child. I’m a result of that answered prayer.”
As the festival ends, the crowds leave the grove and the dense forest, their prayers made, hoping to return next year with testimonies of their own.
Earlier, the head of the Donetsk People’s Republic (DPR), Denis Pushilin, said the republic is negotiating with Pyongyang on the arrival of builders from North Korea. In July, North Korea recognized the independence of the DPR and Lugansk People’s Republic (LPR).He said Russia will not force Donbas and North Korea to avoid cooperation.
MOSCOW (Sputnik) – The UN Security Council sanctions against North Korea do not apply to the Donbas republics, Director of the Department of International Organizations at the Russian Foreign Ministry Pyotr Ilyichev said in an interview with Sputnik.
Earlier, the head of the Donetsk People’s Republic (DPR), Denis Pushilin, said the republic is negotiating with Pyongyang on the arrival of builders from North Korea. In July, North Korea recognized the independence of the DPR and Lugansk People’s Republic (LPR).
“The recruitment of labor from North Korea is subject to international restrictions established by UN Security Council resolutions. However, it must be taken into account that they apply to the member states of the world organization, which the people’s republics of Donbas are not,” Ilyichev said.
He said Russia will not force Donbas and North Korea to avoid cooperation.
The poliovirus is circulating again in the West. A virus that was on the way to global eradication has been detected in recent months in the wastewater of New York and London. This is not unusual, since it can appear in the fecal remains of vaccinated people with the attenuated pathogen. What’s different now is that the poliovirus – which causes the infectious disease polio – has been recorded in an adult in the United States, something that has not happened for a decade, and that samples from the United Kingdom suggest there is local transmission of the disease.
How did the virus get there? To answer this question, it is first necessary to understand the two types of vaccines that are used against polio. In countries where transmission is eradicated, an intramuscular vaccine is used. This contains the inactive virus, which is enough to prevent it from spreading in an environment where the pathogen is no longer circulating in the wild and most of the population is vaccinated. The second type of vaccine is made up of oral drops with a live attenuated virus, which is used in countries where polio continues to circulate. It produces antibodies in the blood, as well as the oral and intestinal mucosa. “With this vaccine, the immunized person would not develop the disease nor would they be able to infect others if they become infected with the wild virus,” explain researchers José Jiménez and Ana María Ortega-Prieto, from King’s College London, in an article in The Conversation.
The only two countries where polio remains endemic are Pakistan and Afghanistan, with 12 cases and one so far this year, respectively. Normally, when polio is detected in fecal remains in the wastewater, it comes from the excretion of people from these countries, which is not a major problem. What has happened now is that the virus is not just being detected in wastewater, it’s infecting people.
It’s still not fully confirmed that there is local circulation in London, but the European Center for Disease Control (ECDC) has warned: “The poliovirus levels and the genetic diversity among the isolates suggests some level of virus transmission both in the areas where positive samples were found and in adjacent ones.”
Local circulation has been confirmed in New York, where one adult has been paralyzed due to the virus. According to the US Centers for Disease Control and Prevention (CDC), this case, is just “the tip of the iceberg.” “There are a number of individuals in the community that have been infected with poliovirus,” Dr. José Romero, from the CDC, told news network CNN. “The spread is always a possibility because the spread is going to be silent.”
As was seen during the Covid-19 pandemic, when a case is detected and its origin is unknown, it is normally a sign of uncontrolled transmission. “For every one case of paralytic polio identified, hundreds more may be undetected,” said State Health Commissioner Dr. Mary T. Bassett in a statement. This is partly due to the fact that most people who contract the poliovirus are asymptomatic. Only in about 1% of cases does the virus cause problems: if it enters the central nervous system, it can cause paralysis and muscle atrophy.
What are the consequences of these outbreaks? In both London and New York, vaccination rates are lower than in the rest of their respective countries, meaning there is an elevated risk for children, who mainly affected by this disease. In London, authorities have already launched a vaccination campaign to offer booster doses to one million children between the ages of one and nine.
The road to polio eradication
The spread of polio is limited, at least in countries with high vaccination coverage. But these recent cases show that the virus still presents a risk and completely eradicating it is a complicated task, even if it seemed within reach.
The Global Polio Eradication Initiative (GPEI) was launched in 1988 with the aim of eradicating polio just as smallpox has been eradicated. In general terms, the program has been a success: the number of polio cases worldwide have dropped 99% since its creation.
Only Pakistan and Afghanistan, where Islamic fundamentalism makes vaccination campaigns difficult, report a few cases each year. And Nigeria, the other country where there is wild poliovirus (i.e. not the virus is transmitted by the attenuated vaccines), has not reported a single case since 2016.
The secret to this achievement is mass vaccination: first with the oral vaccine and then, when the country is already free of the disease, with the vaccine given by injection. Keeping vaccination levels high is key to curbing the virus.
According to UNICEF data, global vaccination levels dropped between 2019 and 2021 by 5%. In other words, 25 million children stopped receiving their doses. Vaccination rates are the lowest they have been in the last 30 years: 81% for diphtheria, tetanus and whooping cough, which are considered a good indicator for other conditions. This means it is likely that polio coverage is at similarly low levels.