How Health Workers Are Reaching a Nomadic Tribe in Sub-Saharan Africa
The Ateker tribe often slips through the cracks of health systems due to their nomadic lifestyle.
Access to health care is essential, and a priority to United Nations member states who committed to achieving universal health coverage by 2030 — but for a nomadic tribe that moves between countries, it's easy to be forgotten.
The Ateker tribe, also known in Uganda as the Karamojong, located in the northeast sub-region of the country, are a nomadic and pastoralist group who roam between Uganda, Kenya, South Sudan, and Ethiopia in search of food.
Their migratory nature puts them at risk of falling between the cracks of formal health systems, so a special effort must be made to locate Ateker people and provide them with health services.
In Uganda, trachoma, an infectious eye disease which can lead to blindness, has been eliminated as a health problem in 46 out of 50 districts, according to Sightsavers Uganda. However, the disease is still prevalent amongst the Ateker population.
To treat these communities who are typically very remote, health teams often need to travel across treacherous terrain — on roads that are rough and that sometimes cross flooded rivers. In some cases, where vehicles are unable to travel, health workers climb hills and rocks on foot to reach communities to provide eye screenings, health advice, medication, and even perform surgeries.
While in Kampala, Global Citizen met with Dr. Johnson Ngorok, country director of Sightsavers Uganda and a member of the Ateker tribe, to discuss the group’s lifestyle and how health organizations are reaching this remote population.
This interview has been lightly edited for clarity.
Tell me about your childhood growing up in the Ateker tribe.
I’m from the Napak district in northern Uganda. I was fortunate that my father had six years of education, which was enough for him to write and get a job as a policeman. He took his children to school, although everyone else, as per tradition, would move around. In my time, if you had the opportunity to go to school, that was great. I went to schools in the Karamoja area.
What is the Karamoja area like?
The area is semi-arid so there are issues with a lack of water. Cattle rearing and farming, which these communities are involved in, is an adaptation to the harsh climate. Most of Uganda is very green but this area in the northeast is very dry and crop farming doesn’t do very well. The nomadic life is one in search of water and pasture. When you finish the water and grass in one area, you move on. People move together in groups of about 20 to 100 people.
What issues do these communities face?
Hygiene is a big issue, especially latrine coverage. People settle in homesteads — which we call manyatta — and there are lots of huts in the manyatta. These are permanent structures which people keep coming back to as they return from various areas.
There is less than 5% latrine coverage in manyattas, so most people go to the bush — which attracts flies. Also, the cow dung from people’s cows is also a source of breeding flies, which is a hygiene problem.
Water is not easily available and people walk a long distance to get it, so when they get, they need to prioritize how they will use it. Will it be for washing your face or will it be used for cooking? They will definitely choose cooking.
How do the government and health organizations reach these groups?
The roads are so poor during the rainy seasons, and you need a vehicle to cross rivers and go through the rough terrain to reach these communities. There are also a lot of mountains in the Karamoja area and communities that live in the mountains. Reaching them is terrible and difficult — we have actually not [yet] reached them. All four districts we have not eliminated trachoma in are in Karamoja. It’s a challenge. How do you reach people in the mountain?
Because they have a low level of education, they may not see the importance of the service you are providing, so they want food, not eye treatment.
However, when a person like me speaks their language, they say, “What? You are Karamojong?” and I say, “Yes, I am.” When I explain it in their language, I tell them that if they don’t take this treatment, they will go blind. Traditionally, they believe that if you perform a surgery, you are going to remove their eye, but we try to explain to them that we cut on top and push the skin up so the eyelashes no longer touch your eye. I think when a person like me explains it, they are more accepting because I am one of them.
How do you locate the communities in order to provide them services?
We work with local leaders amongst them, who are a little bit educated, in order to find out where the group has migrated. They don’t have basic Nokia phones, you have to track them down. Sometimes they have routines like going to certain areas during certain seasons.
There are old people who stay back in the manyatta. It’s the young people who are nomadic and move around with the cows. The young people occasionally come back with meat and milk for the elderly who remain. So we get to know the whereabouts of the nomadic people by asking around.
Tell me about providing eye care in these areas.
These surgeries are performed anywhere. The idea with trachoma procedures is just to pull back the eyelashes. It’s a simple operation, but very useful and because it doesn’t require going internally into the body, it can be done anywhere. We try to maintain hygiene, so we will try to do it in a church or school if we can find one. When we find a building, we create an operating room and fumigate it for hygiene. We also carry tents, so when we can’t find a suitable place, we put up a tent.
When we are in deep remote villages, these surgeries are not done by doctors, they are done by clinical officers who are like medical assistants. They are trained to perform these surgeries; it takes one year of training to become an ophthalmic clinical officer, which is like an opthamologist assistant, and you can perform these simple eye procedures.
What unique challenges are there when providing a service to people who regularly travel across borders?
When we do mass drug administrations or surgeries, we [sometimes] go to a place only to find that our target group has moved to another country and we can’t provide that service.
To work around this, there are cross-border meetings, for example between Kenya and Uganda, and we share information so that when the group moves to another country, they get the service from there, and when they come here, they get the treatment here. Otherwise, there will be cross-border infections and these diseases won’t be eliminated.
I think we have established a strong connection with health services in Kenya. South Sudan, on the other hand, is very difficult because they don’t have health programs on their side, so when these groups travel there, they cannot receive care.