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Making A Difference: Responding to the Horn of Africa Famine with PSI and CARE in Ethiopia

Grandma with kid 2I’m eager to get into the field this morning.  I’m a bit groggy after being woken up early for the call to prayer in this predominately Muslim part of Ethiopia.  But what has really tired me out is the 3 days of grueling travel to get to this border of Ethiopia and Kenya near the border of the Somalia region of Ethiopia.

Tokuls 2I’m in the heart of the area that is being devastated by the East African famine.  Several years of drought turned this area into the top humanitarian crisis of the past year.  P&G and our partners made a commitment at the 2011 Clinton Global Initiative (CGI) to reach 2 million people by providing 300 million liters of clean drinking water with the P&G water purification packets.  It will be our largest single response ever.

Pond 2As hour after hour passed over the last several days in the car, I marveled at the supply chain necessary to bring the P&G water purification packets from our production site in Pakistan all the way to this remote area.  I’m traveling with Wondwosen Keremenz of PSI Ethiopia who leads the safe drinking water program.  He’s traveled several times to this region to train our partners on the correct procedures for demonstrating how to use the packets.


Wondwosen before & after 2I started my trip in Addis Ababa and met Staci Leuschner, the PSI Ethiopia country representative, and we discussed progress over the last year and plans for the coming year.  PSI Ethiopia has long been one of our strongest programs.  And  largely because of the massive response to the famine, 2011 was the biggest impact to date.  PSI Ethiopia delivered more than 150 million liters of clean drinking water using the P&G water packets last year.  They not only respond to disasters but also provide the product to a broader audience using social marketing.  They created a short film about one of the villages that has become a model area for the use of the packets including a shop owner who makes large batches of purified water to provide to his clients (LINK to video).

Camels 2While a bit mind-numbing to spend so much time in the car, it’s interesting to see the change in landscape every hundred miles or so.  We eventually end up in an arid landscape with camels, cactus, and Acacia trees.  There seems to be a town about every 100 kilometers so we stop to take a break from the bumpy roads at several of them and fortify ourselves with some of the delicious Ethiopian coffee.

Carrying 2As we enter the more rural areas, we see women walking beside the road carrying everything that might be needed for a household - from food to water to long poles for building their homes.  Another respite from the drudgery of the long travel is check for birds and we’re treated by seeing some hornbills, hawks, eagles, and the Spectacular Starling. 

Termite landscape 2But most impressive to me are the huge termite mounds that appear like obelisks decorating the landscape.  They’re the color of the deeper soil and so there are clay red ones and limestone white ones that seem like ghosts walking across the land.  Some are gigantic.

Termite hill 2

 

Wondwosen tells me that today we don’t have far to travel.  I think to myself that’s because we’re already at the end of the earth and there’s nowhere else to go!  We meet some of the CARE Ethiopia team and quickly head to the field.

CARE started their famine response here in the Borena District of Oromia along the Kenya and Ethiopia border with funding from P&G and the European Union.  They began in July of last year when humanitarian groups first started mounting responses to the famine.  It’s one of many districts where PSI has provided the P&G water purification packets and training to respond to the famine. 

Women and cow 2The strategy behind CARE Ethiopia’s approach goes back to work they pioneered in 2003 when they were the first humanitarian group to provide nutrition therapy along with the P&G packets.  CARE found that clean water was very helpful in addressing malnutrition in these areas where people have unclean water.  It makes sense that if you eliminate diarrhea with clean water then malnourished children can retain more of the nutrition from food and regain weight to recover faster.

Bezuayehu Belechew with packets 2CARE works through the local community health workers to provide the P&G water purifier packets.  Bezuaychu Belochew is a 24 year old single woman who has been a community health worker for 4 years.  She loves helping the community and plans to hold off on getting married and starting a family while she pursues this career for several more years. 

Women with kids 2

 

 

As she shows some of the local women who have gathered how to use the packets, she explains that the most important things she teaches the community is how to prevent disease. She specifically teaches hygiene such as hand washing, sanitation such as building latrines, and treating their drinking water. 

Handwashing station 2

 

 

 

Bezuaychu tells me that showing people how to use the water purifier packets takes a little more effort than teaching people how to wash their hands. Once people understand they’re more likely to use the packets than wash their hands at the correct times.  While both habits are extremely important for a healthy family, she believes that having a way to treat the highly contaminated water is the most important health prevention habit for the families.

Weighing baby 2We watch as one of the malnourished children, Habiba Bela, is weighed and various health measurements are taken by Bezuaychu’s colleague.  She measures the mid upper arm circumference of Habiba with a cloth measuring tape as a quick indicator of nutritional status.  The cloth is colored red in the short distance indicating a severely malnourished child, yellow indicates moderately malnourished, and green indicates they’re okay.  The mothers of the severely and moderately malnourished children are immediately given the P&G water packets to treat their family’s water and nutritional supplements for the children.  The severely malnourishced children are also given the more expensive and quicker acting Plumpy Nut and families of the moderately malnourished children are given fortified flour and vegetable oil.

Green 2Habiba was given water treated with the P&G packets and Plumpy Nut 6 weeks ago when she was deteremined to be severely malnourished.  But, today is a great day because the measuring tape and other health assessments show that she’s quickly regained weight and has now graduated to outside the risk of malnutrition.  It’s fantastic to see that our effort is really making an impact.  Habiba was at great risk of dying without this intervention.

Bezuayehu water 2I ask to visit one of the households so we can see how the people live and how they use the P&G packets in their homes.  Amale Guyo is a 30 year old mother of six children.  She runs a small shop out of one corner of her house, while they cook, eat, and sleep in the rest of the house. 

 

 

 

 

Boy at water 2Amale gathers her drinking water from a large pond.  It’s extremely dirty water that they share with their cattle and goats.  She received the water purification packets from the community health workers when they found that her youngest child was moderately malnourished.  Their home has mud floors and cow dung walls. 

Amale guyo stirring 2

 

 

 

 

Amale keeps the floors as clean as she can, but the cow dung leads to an enormous number of flies.  Amale bring in some smoking embers to keep the flies from flying in our faces but now it’s hard to breath and doesn’t seem to have of an impact on the flies.

Flies 2

 

 

 

 

While Amale shows us how she uses the packets, I ask her if she’d tell me about the impact of the drought on her family.  She gets very serious and says that it’s the worst drought she can remember.  Sometimes it’s easy to graze their cattle in this area and they thrive.  These people are pastoralists whose life depends on their livestock.  Amale and her family had done very well during the good years and built up a herd of 30 cattle.  But during this extended drought, the ponds dried up and the cattle started dying.  Amale and her family only survived because some of the humanitarian groups trucked in water.  Her herd was reduced from 30 cattle to only two.  And she tells me that some of her neighbors have been left without even a single cow.

Amale guyo filtering 2I ask Amale to explain to me why this loss of cows has such a negative impact on her family.  She looks at me quizzically at first as if to ask how I can be so ignorant as to not understand the importance of cattle to your family.  But she’s patient with the foreigner and explains that the primary nutrition that the youngest children receive is milk from the cows.  And, they sell the milk in town in order to buy other food and occasionally slaughter a cow for meat.  So, losing the cattle can bring down the whole family.

Amale guyo with CSDW 2

 

I thank her for her patience and in order to lighten the mood from the gloom of thinking about the drought, we joke while enjoying the purified water.  I tell her that I don’t have any cows and wonder if she’d consider trading a cow for one of my strong daughters.  She says that since I only have two daughters that maybe I need some more children.  She has six children so maybe I’d prefer one of her children instead of one of her two remaining cows.  We have a good laugh and I secretly hope that my daughters don’t hear that I tried to trade them for a cow in Ethiopia – and couldn’t get even one cow for them!

Woman with cup 2Before we leave, Amale makes a special point to thank us for providing the P&G water purification packets.  She tells us that they feared everyone would get very sick when the rains came and they started gathering water from the ponds.  They knew that it was highly contaminated because the running water brings feces into the pond.  But, thanks to the P&G packets, the rainy season did not bring the expected wave of disease outbreak.  The grandfather also shows up to thank us profusely.

Old man 2Amale tells me that they expect they’ll be much better off in about a year if the rains come in March and again in October.  This will allow the cows to calf and they’ll have milk again.  She’s glad to hear that the CARE program will continue to provide the P&G packets for the next year.

Gun 2

 

 

 

As we travel to the next site, the CARE Ethiopia team explains that they’re caring for thousands of malnourished children in this area.  And, it’s just one of many areas in the drought areas of Ethiopia and Kenya where we’re reaching.  I ask about the impact of losing so many cattle and the CARE staff explains that because it’s the primary asset some of the local tribes have had armed conflict against each other in order to steal cows.  Based on this, I’m not too surprised when I see a man with an automatic rifle.

Alemnesh Bayesa 2At the next clinic, we meet Alemnesh Bayesa, another community health worker.  A local NGO is having a program to pay the locals to help rehabilitate one of the ponds that was damaged during the recent rains.  Alemnesh and the local nurse are using this opportunity to screen all the young children that have come to the clinic with their mothers. 

Woman 1 2

 

 

They’re quite a gathering of women at the clinic and so it’s an efficient plan to screen children.  Of the 20 children that they’ve screened today, they’ve identified 3 that are moderately malnourished and one that is severely malnourished. 

Malnourished 2

 

 

 

 

I ask to see the severely malnourished child.  It’s frightening to see the measuring tape show that he’s well into the red zone as I know this means he’s in bad shape.  When we examine him, his eyes will not focus.  When I check his skin it’s clear that he’s dehydrated because when I lightly pinch the skin on his arm, it doesn’t spring back.  The nurse agrees the child is severely dehydrated as well as severely malnourished and they’ll immediately get him to a clinic that has more advanced care while starting to rehydrate him.

Women gathered 1 2Alemnesh has worked in this area for four years.  She tells us that people were familiar with the P&G packets prior to the drought because a local NGO was providing them for several years.  The only water source is the pond water and people really value the clean and purified water. 

Kula Roba stirring 2

 

 

 

 

 

Kula Roba is a 45 year old mother of 10 children.  She tells us that she uses 2 packets of the P&G packets every day.  She’s one of the families who received the packets prior to the drought for many years.  In fact, she’s been a fairly regular user for about 3 years.  They haven’t been supplied continuously but now that she knows the importance of clean water, she boils her water when she does not have access to the packets. 

 

Kula Roba sitting 2Kula describes an impact of the drought that is similar to what we heard from Amale.  When they lost 5 of their 8 cows and all of their goats, they didn’t have enough food for the children.  The children became so weak that they stayed at home and didn’t want to walk to school and didn’t have enough energy to study. 


Canteens 2

 

 

Kula says the CARE program has made a big difference for her family.  The children now are back in school and while they wait to rebuild their heard, they’re selling charcoal.  Kula shows me that one of their cows is producing milk again.  I tell her that the canteens that she’s made to store the milk are quite attractive and would make nice souvenirs to sell to tourists. 

Kula Roba and Lelo 2We enjoy some clean water after the end our chat and Kula’s youngest, Lelo, drinks a lot of the pure water. 

Lelo 2

 

 

 

 

 

 

 

It’s been well worth the days of travel to see first-hand that our efforts are really making a difference.  The supply chain and training provided by PSI combined with the local expertise and work with the community health workers provided by CARE are leading to a significant health impact that is saving lives.  I’ve never seen an area with any greater need for the P&G water purification packets and I’m grateful that we’re able to help.

 

 

 

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