A Carmelite in Turkana, Kenya

Fr R.L. McCabe, O.Carm. is a member of the Irish Province and has spent almost all of his priesthood serving in Africa, first in Zimbabwe and now in Turkana, Kenya. As well as being a priest he is also a medical doctor who specialises in tropical medicine. As both priest and doctor he ministers to the needs of the desert nomads in Kenya. The following text is from Fr McCabe.

Desert Nomads

Introduction

The scattered people of desert and semi desert areas have scanty medical care and their health and disease have been little studied. Except for hydatid cyst disease, the same position holds for Turkana. This semi-arid land comprises an area of some 23,000 square miles in North Western Kenya. Various opinions are given about Turkana, some expressing almost horror at a “horizonless frying pan of desolation.” One might expect “vast plains of dehydrated thorn scrub, siteless deserts and scorched black mountains.” Nevertheless, the scenery, at least in the Lokitaung area, is beautiful and diverse. There are several mountains and hills covered with bush. The most astonishing feature is Lake Turkana, (formerly called Lake Rudolph), one hundred and 50 miles long and about thirty miles wide, set in the midst of the desert.

The vast majority of the population/belong to the Turkana tribe, very tall, fine looking, dark coloured people, over 300,000 in number. Most of them lead nomadic lives. However, in recent times, some people have become more settled, living in towns such as Lodwar. Besides those of the Turkana tribe there are people who have come from “down country”, i.e. other parts of Kenya. They hold positions in the government services or engage in other occupations. There are also people of Somali ethnic origin, Asians and a small number of Europeans.

I first came to Africa in 1961. I engaged in medical work in Southern Rhodesia, now called Zimbabwe. I wrote a thesis on “The Pattern of Health & Disease in a Remote District close to the Mozambique Border.” The pattern of disease there reveals most interesting comparisons and contrasts to that of Turkana. I left there in 1977 and came to the Lokitaung area, N. Turkana. I went for several years to the village settlement of Loarengak about a mile from the sandy shore of Lake Turkana. I returned to Lokitaung, seeing patients in the hospital where I established a laboratory.: I also practice in Kaling, 30 Kms from Lokitaung, where I have a clinic with a laboratory. Lokitaung is a small town six hundred milcs north of Nairobi, near to the borders of Sudan and Ethiopia and about seventeen miles from Lake Turkana. I operate a mobile medical service. With a team of two African medical assistants we travel to distant watering places. The nomadic Turkana people bring their animals to these wells. Any patient who needs attention comes to our clinic situated under the shade of a tree or in a manyatta, i.e. a small hut build by local people consisting of interlacing branches of trees with leaves. I am much impressed by the general good health of the nomadic people. Except for Hydatid Cyst Disease, the common respiratory illnesses and musculo-skeletal aches and pains, they are remarkably fit and well. This contrasts with the more settled areas where sexually transmitted diseases and alcoholic disorders occur.

Some years ago, I was under the incorrect opinion that HIV/AIDS was not a problem among the Turkana people. However, it is now a serious situation and likely to get worse. This is particularly noticeable in towns such as Lodwar and Kakuma with its vast number of refugees. Expectant mothers on testing in 1999 were found to be 12% and 19% HIV positive respectively. Lodwar District Hospital has a regular monthly intake of patients suffering from AIDS. In Lokitaung Hospital we have no facilities for HIV testing, yet I have seen a small number of patients, clinically very suggestive of AIDS. Sexually Transmitted Disease [STD] show a high incidence in the towns.

There are a number of factors involved in the transmission of these diseases. In the past, Lodwar could only be reached by a dirt road, dangerous in places such as the Marich pass, through the mountains to the desert. There were no public service vehicles. However, a new tarred road was built and there was a marked increase in traffic with small taxis [called ‘matatus’] and huge lorries carrying supplies through Lodwar to Kakuma refugee camp and then further to Lokitchogitro with supplies for the Southern Sudan. Truck drivers use these towns as resting centres for their very long drives from Nairobi, even Mombasa. Another factor in the increase in these diseases, one which is only too common among the people of developing countries is poverty. Poor young women, seeking some money, can offer themselves as prostitutes. A breakdown in the strict cultural practices of the past is another factor.

This study is primarily concerned with the pattern of health and disease of the people living in the Lokitaung area. Blood, urine and stool specimens have been taken in an attempt to gain accurate data. However, general information is given about the rest of Turkana in order to discuss comparisons and contrasts. For example Hydatid Cyst Disease is far more common in North Turkana than South Turkana. Considerable epidemiological information on health conditions in Kenya have been compiled. This study should hopefully produce useful fresh information on conditions in Turkaxa. Modern scientific medicine is only a comparatively recent edition to such a remote area. Traditional medicine practised since times immemorial is still a prominent feature. I, being conscious of the better aspects of these ancient skills, have tried to blend both systems into one acceptable to the local population. However, this still remains a challenge. It is hoped that this study will give health workers a picture of the medical conditions they may encounter in Turkana. It should provide evidence for an association between ecological, cultural and other factors for the presence of certain diseases such as Hydatid Cyst Disease. Perhaps even more important are the factors which account for the virtual absence of diseases which effect vast numbers in other parts of Africa namely hookworm, roundworm and schistosomiasis. Conditions such as hypertension and coronary artery disease are not seen among the nomadic people. Attention to these factors will help to decide priorities for health services, not only in Turkana but in other places. It should stimulate further research into ecological conditions which at first sight seem so harsh and damaging to health. Paradoxically, the desert can lead to a spartan degree of wholeness and fitness. This is seen in the lives of the Turkana nomads who have successfully adapted themselves to an arid environment.

Geography

The Turkana desert is an area of approximately 70,000 square kilometres of desert and semi desert territory in Northwest Kenya, East Africa. Geographically it is a homogeneous unit of vast arid plain situated on the floor of the Eastern Rift valley and extending from 2-5 degrees north of the Equator. A relatively low average elevation is interrupted by isolated mountains, hills, and larva cones as well as by innumerable sand rivers. These flow for some hours or days each year depending on the unpredictable rainfall. It has an annual rainfall of 300mm or less in some places. Temperatures are high, e.g. 37 degrees C varying somewhat in the relatively cooler months of June and July. High winds are a distinctive feature, especially the in Lokituang area. The Turkana desert is bounded on the North by Sudan, on the West by Uganda, on the East by Lake Turkana (formerly Lake Rudolph) and separated from the remainder of Kenya by the high mountains of West Pokot. When I arrived in 1977 the roads were made of murren or ‘dirt’ roads with most difficult corrugations and potholes. In recent years, a good quality tarred road has been made from Kitale to Lodwar, with an extension to Lokichoggio on the Sudan border and to Kalakol on Lake Turkana. This road has now seriously deteriorated. Many roads may be impassable during heavy rains, due to lack of bridges over flooded rivers.

Historical

The only tribe in the Turkana Desert apart from the Somalis and a very small number of government officials, teachers and Europeans, are pastoral people of Nilohamitic origin who probably lived originally on the Eastern highlands of Uganda. They have close links, as part of the ethnic Karamajong cluster with the tribes presently occupying that territory. Possibly four centuries ago the Turkana were forced off these lands into the more arid land of the desert which now bears their name. Under British rule the district was virtually cut off from outside contact, the government’s policy being one of non involvement and non interference with the Turkana people. Following a devastating drought and later floods in the years 1960 and 1961 a limited number of foreigners were allowed into Turkana in order to aid and administer famine relief programmes.

Social & Cultural

The geographical and historical factors already mentioned tend to dominate the life of the Turkana people. They tend to cling to their traditional pastoral role even though it provides them with only a marginal level of sustenance which often approaches malnutrition and famine. The tribe is a closely knit one and the geographical isolation of the territory ensures little contact with other people and even with the rest of the national territory of Kenya. There is a single tribal language Turkana, common to the whole tribe and it is used universally, though the men know a little Swahili, and school children who generally know Swahili and some English. It can be safe to forecast with the advance of education the use of the Swahili language and English will become more widespread. In the meantime, the Turkana language remains a strong cultural bond which makes the Turkana very aware of his own distinctness from all outsiders. Religious rights and customs are universal among the Turkanas. They pray to God, whose name in Turkana is Akuj, similar to the name for the sky or heavens above. Considering the beauty of the deep blue sky during the day time and the wonderful expanse of stars, which seen so near, at night time, this name is surely appropriate. They ask Akuj for rain, so that their animals and themselves will be healthy. Morality and marriage matters are based on polygamy which in turn is based on economic factors to be explained in the next section. The begetting of children and the increase in herds, goats, sheep, cattle, camels are the driving forces in Turkana life.

Economic

The vast majority of Turkana people are pastoral, looking to animals as the criteria of wealth and status. Because of the nature of the Turkana desert the flocks must find pasture where ever it is available and this means that during the dry season the manyattas or homesteads must be moved to the hills. It has been estimated that as a result of this a full family reunion may not take place more often than every two or three years. Tribal marriage takes place only when the husband can pay the bride price to the bride’s father. The brides price is usually so high as to be beyond the ability of the young Turkana man to pay. One result of this system is that the wealthy man will have many wives while the poor man will remain for many years tribally unmarried, unable to collect the bride price.

A small percentage of the Turkana people have become fishermen on Lake Turkana in recent years and have a somewhat better standard of living than the rest of the tribe. In all classes there are still traces of the famine camp mentality whereby the Turkanas feel that they have a right to material support from foreigners without having to work for it. It will take a long time for the Turkana people to become independent and self reliant and the danger of further famine will never be far away. In social and economic development, in the fields of education, public health and medicine generally as well as in literacy, they are still very much an underdeveloped people.

Famine

Famine occurs at regular intervals, e.g. 1960-6 1, again in 1970. An extremely serious famine occurred in 1980-81.The effects are still being felt in Turkana. No reliable statistics are available for those who died of hunger and disease. Famine came back again in 1992, but not quite as severe as 1980-81. This was perhaps due to better management.

Civil Data

The total population of Turkana is approximately 200,000 people. A census was done in September 1999. No precise figure is available because of the nomadic character of about 80% of the tribe. They generally believe that in spite of a high infant mortality rate, an increase in the total population is taking place every year.

Distribution according to race and language

The whole territory is occupied by the Turkana tribe with its own distinctive tribal language. The only non Turkana people in the territory are a small number of:

·     Somali traders who generally profess the Islamic faith.

·     Government officials and police located mainly in the two centres of Lodwar and Lokitaung.

·     Europeans, mainly catholic and protestant missionaries, volunteer workers and technicians.

There has been no recent migrations, apart from the migration of some Turkana people, mainly products of the famine camps to the southern areas of Kenya. It is now known that about 40,000 Turkana people live outside of Turkana. Many of these are living in conditions of dire poverty, in around Kitale, just over the southern border of Turkana. Others work as shepherds and watchmen, even as far as Nairobi.

Refugee Camp

In 1994 a large refugee camp was established in Kakuma under the direction of UNHCR with the Lutheran World Federation being the managers of the camp site. Approximately 70,000 people, mainly refugees from Southern Sudan, are in the camp. It is very close to Kakuma Mission Hospital where severely iii patients are transferred.

Civil Administration

The Republic of Kenya is divided for the purpose of civil administration in the provinces, each administered by a provincial commissioner and each provinte is divided into a number of districts, each being administered by its district commissioner. Turkana is one such district and its District Commissioner is in Lodwar The Turkana district is itself subdivided into divisions, each With its own district officer. Each division has a number of locations, each administered by a chief and each location has a number of sub-locations each administered by a sub-chief

Medical Activity

Medical activity is of the most professional type but is hampered by a number of major difficulties of which the following are but a few:

a)    Their low level of nutrition makes the people very prone to a number of serious diseases and when they get a disease they have very little resistance to it.

b)    They tend to seek medical assistance only when the illness has progressed to a late stage.

c)    They tend to abscond during the course of the treatment if they think it is not curing them.

d)    They have no understanding of the necessity of taking medicine at the prescribed time and in the prescribed quantities.

e)    They have recourse to medicine or witchcraft before coming for medical treatment.

Outstanding Problems

Here I shall merely summarise them briefly:

*     A recurrent famine situation of the people resulting in poverty, hunger and malnutrition on a wide scale.

*     The nomadic character of the people and the prevalence of polygamy.

*     The close knit nature of Turkana society makes it difficult for expatriates to penetrate.

*     Geographical difficulties of the territory which makes travelling and therefore the provision of supplies very difficult and costly.

Because the vast majority of the Turkana people are engaged in a pastoral way of life, children find themselves caring for goats and camels almost as soon as they can walk. It is common to see children who are about four years and upwards tending large herds, leading them to whatever pasturage may be found and later guiding them to water holes which are usually found deep down in the bed of dried up sand rivers. Both boys and girls are engaged in this work. The boy until he grows big enough to inherit some of his father’s flock and the girl until she reaches maturity and can be married off to increase her father’s wealth by a substantial bride price. It is a well known fact that many under developed people, when education is made available to them, avidly desire it for their children, if not for themselves. The Turkana are only now beginning to show such ambition and many still prefer that their children continue in their traditional way of life. They know so little of the outside world that they are aware of no alternative to their pastoral nomad struggle for existence. They have no concept of improving their income, other than through an increase in the number of their flocks. This is very detrimental to them. If they keep on increasing their flocks, then when the time of drought comes, many animals become very weak, numbers die, so that the Turkana people lose out. If they had sold their animals when they were still in relatively good condition they would have got a good price for them. Some try to eat meat from dead animals and get very ill as a result of it. People bring in large numbers of hides, that is skins of dead animals, to traders yet they get very little for them because the animals are so poorly nourished that the hides are of poor quality. They have no concept of improving their income, other than through increase in the number of their flocks. They do not see the need to protect themselves against the ever present threat of famine.

Education

The difficulties which arise in relation to the education of boys are multiplied in the case of the education of girls. Since Turkana society is polygamous and since a substantial bride price is payable to the father of the bride on the occasion of marriage every father ambitions a wealthy marriage for his daughters. He will usually be glad to give them in marriage to a wealthy man, irrespective of his age, as soon as they are physically mature for marriage. In addition a Turkana girl may see no role in life for herself apart from child bearing. To pursue a long course of education, while her contemporaries are having children is difficult for her.

On June 3, 2010, Fr MacCabe was honoured by the Royal College of Surgeons in Ireland who conferred on him the Degree of Doctor of Medicine, honoris causa. The text of the citation can be read here:  RCSI MacCabe Citation 2010