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Camels bearing healthcare deliver hope in Kenya – photo essay | Global development

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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.

Communities Health Africa Trust (Chat) travelling on camels to deliver health care

  • No roads, no problem. Communities Health Africa Trust (Chat) delivers health care to hard-to-reach areas of Kenya

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.”

Jacinta Peresia brings back water from the river

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.

Chat’s camels take a break.
Health visitors wade across a river.
Chat healthcare workers carrying supplies.
The camel caravan makes its way to hard-to-reach areas.

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.

Elizabeth with Susan and her youngest child, Rehema.

  • Elizabeth Kibatis (left) with Susan Oyan and her youngest child, Rehema. Kibatis works with Chat and has been teaching friends about family planning, creating ‘a ripple effect’, she says

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.”

The Chat mobile health clinic

  • Access to healthcare is expensive in such remote areas and, in an emergency, villagers are forced to walk for hours to the nearest health facility

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.

When the camels arrive, health workers set up tables and tents for a mobile clinic.

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?”

A woman and two children.
Women and girls attend the healthcare clinic.
Women and children at Chat's mobile clinic.
Chat also educates people on TB, HIV and Covid prevention.

  • Chat focuses on family planning but also educates people about TB, HIV and Covid prevention, across 14 counties

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.

  • Ami Vitale is a photographer and film-maker.

Jacinta Peresia with two of her children.

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Lives lost at Europe’s borders and Afghan MPs in exile: human rights this fortnight – in pictures

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A roundup of the struggle for human rights and freedoms, from Mexico to Manila

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Belgium tightens Covid rules as health system ‘is cracking’

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Belgium has introduced new measures to curb the surge of Covid-19 infections in the country, following the third emergency meeting of federal and regional governments in three weeks.

“The autumn wave is much heavier than was estimated,” Belgian prime minister Alexander De Croo said on Friday (3 December).

“The infection rates are among the highest in Europe and the pressure in healthcare has become unsustainable,” he also said, arguing that new measures are necessary because “the system is cracking”.

One item on the agenda that proved to be divisive was the closure of schools – a move supported by experts and the federal government but opposed by regional governments.

Belgium’s so-called concertation committee of federal and regional governments finally decided to keep schools open, but it impose a longer, three-week, Christmas holiday for primary and pre-primary education. The holiday will now run from 20 December to 10 January.

According to Flemish prime minister Jan Jambon, this extra week will be used to administer the booster shot to the teachers.

And until the school holiday, a class will go until quarantine after two cases of Covid-19 are detected (previously three cases). Additionally, all extracurricular activities will be barred.

Children from the age of six upwards will also have to wear a face mask at school and all other places where its use is compulsory. And parents have been advised to test their children regularly.

For this coming weekend, indoor events with more than 4,000 attendees will be cancelled. From Monday, this will apply to all with more than 200 attendees.

Events with fewer than 200 people inside will still be allowed under the current criteria – that everyone needs to have a corona pass, be seated and wear a face mask.

Museums and cinemas would remain open, but with a capacity limit of 200 people per room.

The committee also decided that restaurants and bars can continue to remain open until 11PM, as it is currently the case – although experts had asked to close them at 8PM.

This new package of measures has already been criticised by representatives of the cultural sector, who argued that the restrictions do not target the source of the problem.

“Instead of fighting the virus, we are fighting culture. Bars open, but culture [events] only 200 people. Who are we fooling?,” said Michael De Cock, director of the Koninklijke Vlaamse Schouwburg [Royal Flemish Theatre].

There is also no restrictions for private social life in the so-called “contact bubbles” – despite this also being recommended it by experts. Nevertheless, there is a recommendation to limit contacts as much as possible.

At work, there are no new measures, as the committee previously announced that teleworking is mandatory at least four days a week.

Intensive-care cases expected to peak next week

An average of 318 Covid-19 patients were hospitalised each day in Belgium this week – which represents an increase of four percent compared with the previous week.

There are currently 3,707 people hospitalised in the country, of which 821 are in intensive care.

“Although the number of infections is very high, the number of deaths in our country is lower than in comparable countries, and that is due to the high vaccination coverage,” said de Croo.

“Getting vaccinated is an act of solidarity,” he added.

More than 75 percent of the Belgian population is fully-vaccinated, and over a million people have received a booster shot.

For his part, Belgian virologist Steven Van Gucht said on Friday that the number of Covid-19 patients on the intensive care units of the country’s hospitals are expected to peak next week.

“It is unclear whether we can then expect a rapid fall or whether the figures will remain at that high level,” he also said, according to VRT news.

The highest number of new Covid-19 infections (25,574) during this fourth wave was recorded on Monday 22 November.

But new measures will make coronavirus figures fall more quickly, relieving the pressure on the health care sector, Van Gucht said.

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India’s ‘pencil village’ counts the cost of Covid school closures | Global development

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School closures in India during the pandemic have left their mark on more than the children who have seen delays to their learning. In one Kashmiri village the impact has been catastrophic on employment.

Pick up a pencil anywhere across India and it is likely to come from the poplar trees of Ukhoo.

This village, with an abundance of trees, about 10 miles south of Srinagar city in Kashmir’s Pulwama district, supplies more than 90% of the wood used by India’s pencil manufacturers, which export to more than 150 countries.

Before Covid, more than 2,500 people worked in the village’s 17 pencil factories and the industry supported about 250 families.

But, after nearly two years of school closures and a dramatic drop in demand for the village’s products, factory owners reduced their workforce by more than half.

Workers were dismissed without pay, while many of those who kept their jobs had migrated from other parts of India, and were cheaper to employ. Now the village and its workforce are waiting eagerly for the market to revive.

Rajesh Kumar, 26, from Bihar, has worked in Ukhoo for seven years. Like other migrant workers, he lives in a room on the factory premises and works 10- to 12-hour shifts. During lockdown last year, the factory owner provided food and accommodation when production shutdown for about three months. He is one of the luckier ones to be back working now.

“I hope the pencil demand increases and these factories are full of workers again, as many of our friends and people from our villages find work [here] and are able to make a living,” says Kumar.

Poplar logs outside a pencil slate factory, Ukhoo
Factory owners have had to lay off half of their workers during the pandemic. Photograph: Adil Abbas

Farooq Ahmed Wani, 27, from the city of Jammu, has worked as a machine operator in Ukhoo for the past five years.

“We are hoping that schools reopen throughout the country so that there is more demand for pencils in the market,” he says in an optimistic tone. “Then these factories can employ more young people and more migrants can also get some work here.”

Pencil wala Gaon, or “pencil village”, attracted the attention of India’s prime minister, Narendra Modi. In his monthly radio programme, Mann Ki Baat, last year he said the district was an example of how to reduce the country’s dependency on imports. “Once upon a time we used to import wood for pencils from abroad but now our Pulwama is making the country self-sufficient in the field of pencil making,” Modi said.

90% of the wood used in pencils manufactured in India comes from Ukhoo.
Ukhoo supplies 90% of the wood used in pencils manufactured in India. Photograph: Vincent Lecomte/Gamma-Rapho/Getty

A recent ministry of home affairs report said that the village would be developed as a “special zone” for manufacturing. “Now the whole country would be supplied finished pencils, manufactured completely in Pulwama,” the report noted. But the pandemic has shown how overreliance on one product in a region brings its own problems.

A migrant worker trims a plank of poplar wood at a pencil slate factory
A migrant worker trims timber at a pencil factory. The factories attract workers from several states. Photograph: Adil Abbas

Abrar Ahmed, a unit supervisor at one of Ukhoo’s factories, says everyone has suffered. “Even the sawdust from woodcutting machines is usually taken by the local villagers who then sell it to poultry farms and for other purposes in the village.”

Manzoor Ahmad Allaie owns one of the biggest factories in Ukhoo.

“We are only doing about 30% to 40% [of normal levels of] business now because of the Covid lockdown impact from last year, which means we produce about only 80 bags of pencil slats a day,” says Allaie. “Earlier we could produce about 300 pencil slat bags [a day] in the factory, which were transported out of Kashmir.”

He is eagerly looking forward to India’s schools fully reopening. It has been a hard two years for the pencil villagers, he says.

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