Nomad Health Hike

And this week’s PCV Project of the Week:
Nomad Health Education
Volunteer participants: 4 PCVs: Hanna Kirlin, Cory VanSteenwyk, Melissa VanSteenwyk, and Emory Nelkie. 8 First Year Medical Students from Loyola Medical School in Chicago, one pharmacist from Kelaat M’gouna, a nurse from Kelaat M’gouna, and two representatives of a Spanish travel agency, Mugámara, who’ve led the expedition for the last 2 years.
Beneficiaries: The nomadic people of the Oulilimt region and surrounding areas.
Where: Oulilimt, which is a small town/region located about 8 hours (by foot) over the Atlas Mountains from Ait Bougamez. This isolated area is where nomads often pass the summers to graze their flocks.
When: June 14-21, 2010
Goals and Objectives:
Medical Student’s Goals: To observe/collect data on demographics and prevalent medical problems nomadic people face, and to understand and eventually help prevent some of these illness; to hand out “hygiene kits” (toothbrush & paste, disinfectant soap, floss and lotion) and provide proper education on why each item of the kit is important and how to use them properly; to hold “focus groups” for women (young and old) to gain understanding on their current birthing practices and how best to improve these practices, thus decreasing infant mortality rates; to give women, of childbearing age, birthing kits (razor, clean towel, sanitary drop pad, floss, gloves, alcohol swabs, soap, and education handouts with pictures) and to administer education and discussions on proper usage of the kits (all with the help of the nurse).
Mugámara Travel Agency: Their goal was to provide the nomadic people of the Oulilimt area with an opportunity to receive medical assistance (by bringing in the pharmacist and nurse), as well as setting up an educational center for the nomadic children to attend during the summer months. They also planed and arranged all the logistics for the event. An additional goal of the agency is to learn and study the lives of these nomadic people to better understand the people they are helping (and possibly make a financial profit while doing so).
Peace Corps Volunteers Goals: To assist in any way possible in the previously stated goals with a main objective being to help increase the other foreigners’ cultural understanding and sensitivity of Morocco and Berber people, conduct translations, assist with education, and do what we do best as health/environmental volunteers by making the trip a success for the medical students and travel agency!!
• The plan was to set up two tents in two different locations about one and a half hours apart from each other (Oulilimt and Talmount). The tents would be utilized in the goals of both the medical students and travel agency doing assessments, health education and medical screenings. After this, the tents were to become temporary schools for the nomadic children to study for the remainder of the summer. The opportunity of going to school gives the youth a chance to improve their futures since the majority of nomads (men, women and children) haven’t had any formal education and many are literate and don’t speak Arabic. Secondary tents were also to be assembled to serve as housing for the teacher in each of the two sites. Two teachers, from lower in the valley, volunteer their time during the summer months teaching the students and are responsible for these tents. In addition the plan was to construct a basic pit toilet bathroom for the children and teacher’s use during these summer months.

• With the presence of a pharmacist, nurse and medical students, the tents in Oulilimt (where we camped) were to be transformed into a small clinic for two days. The idea was to have the nomads come and visit the pharmacist so they could be evaluated (and treated if possible) for their medical issues and the medical students and PCVs were to assess the area and needs of the nomads, perform health education and give out basic supplies. This is important because the majority of nomadic people that we planned to reach are at least a 2 hour walk plus an additional 6 hour transit ride from the nearest reliable medical clinic in Kelaat M’gouna. Needless to say many do not receive medical treatment as often as they should if at all. The plan for treatment was to include the cleaning wounds, diagnosing illness and the distribution of pharmaceutical medications, and verbal instructions to encourage prevention and treatment of common illnesses and ailments. Once the health work is completed in Oulilimt the plan was to travel to Talmount, a nearby village where another tribe of nomads currently spend their summers and set up an additional school (as well as collect more demographic/medical data, without the presence of the pharmacist and clinic).
What Happened:
Day 1:
• PCVs met in Ait Merrow (Emory’s site) in the afternoon. We prepared for hike, made sure all supplies were ready, and started off about 3 hours on the trail.
• We spent the night next to the river.
Day 2:
• PCVs continued on the path/river another 8 hours until sunset
• Camp was set up near river (near Irgizga and Tamzirt).
Day 3:
• Morning- found several small Hanuts with basic supplies for the next few days.
• We hiked about a total of 5 hours.
• Set up camp (near Ighrim Izdar and Ozirimt).

Day 4:
• After hiking a few hours we spotted the Medical team/Group leader/Nurse on the trail. We accompanied them a few more hours until arriving at our final destination, Oulilimt.
• The night of we collaborated (discussed goals) a bit with the others and planned out the activities of the following days.
Day 5:
• Sent a small group (1 PCV, 2 Med students and 1 Moroccan guide) to the nearest nomad homes in the surrounding regions to inform them about the Medical staff’s presence and purpose, and encouraged them to come to Oulilimt during the next 2 days
• The rest of the group cleared a large area of rocks, set up two tents (one tent for clinic/school, and the other for house of teacher) and prepared for the arrival of the nomads the following day.
• The pharmacist arrived
Day 6:
• At the clinic, visits and treatment lasted from about 11-4pm, PCVs and medical students assisted. Treatment included distribution of pharmaceutical medication (provided by the pharmacist), cleaning and disinfection of wounds, and advice about home remedies or referral to the nearest clinic if needed.
• Children were weighed using a make shift scale constructed out of tent poles and rocks. Results were used to determine if children were at normal maturing rates based on their ages.
• “Focus groups” to learn about birthing practices; led by the female nurse, female PCVs and female medical students; birthing kits where explained and given to those who were of age and expecting more pregnancies.
• Environmental lessons which included drawings and discussions were conducted by PCVs and medical students with the kids after visiting the clinic.
• Small Health Lessons were conducted by PVCs and medical students before giving each family their “hygiene kits”, these lessons included tooth brushing, hand washing, and skin care lessons.
• Medical students and Spanish travel agent constructed the bathroom for children and teacher.
• Meeting at the end of the day to discuss what went well and what needed to be changed for the next day.
Day 7:
• Same activities as the previous day, with a few changes to improve organization
o Instead of having the people wander around after they had seen the pharmacist we set up specific stations they had to visit, one at a time. They had to carry a sheet of paper that kept their demographical data organized and whether or not they received birthing kits or attended the birthing education/demonstration. They carried the sheet with them to each station where it was updated with different categories of information. At the last station, they were only given their “hygiene kit” with education if they had gone to each of the prior stations. This allowed us to know whom we had given the kits to and whom we hadn’t, and to make sure families weren’t receiving duplicate supplies. The demographical data included basic questions to allow the medical students to better understand what life is like for a typical nomad and what problems they face. The sheet also recorded who was seen and what treatment, if any, they were given.
• All hygiene kits were given away, with a few birthing kits remaining.
• Meeting at the end of the day: collaboration with PCVs and medical students to discuss successes and data collected over the last two days.
• Cancellation/postponement of building the second school/tent in the next town due to some changes in teacher’s schedule. It will be set up by the locals in July.
Day 8: Goodbyes and hiking out to Ait Bougamez.
Results:
• Total number of people (men, women and children) who visited the clinic (“doctor” visits, environmental education for kids, women’s focus groups, small health lessons) = 97
• Number of birthing kits given away = 23
• Number of women educated on the proper method of birthing (as well as a demonstration of how to use the birthing kits) = 30
• Number of children (under 16) educated on good Environmental behaviors = 20
• Number people educated on proper tooth care, hand washing, skincare (most received toothbrush/paste, floss and lotion) = 97 (everyone!!)

Things that went well:
• The supplies that the medical students brought, such as the “hygiene kits”, “birthing kits”, and school supplies (paper, scissors, markers and crayons) for the kids were really nice and the nomads definitely benefited from these items.
• The turnout of nomads this year was greater than the previous year with more women and children in attendance—even though they were a little skeptical because last year the doctor from Spain did not give out medication, only advice (this year medication was available).
• The med students were great to work with and although only one had prior experience in Morocco they brought a lot of good ideas to the table for this event and events to come and were very motivated to help anyway they could.
• We were able to involve several Moroccans (mainly the cooks, pharmacist and nurse) in leading and translating the health education (capacity building).
• The medical student’s language ability: 3 spoke Spanish fluently, two spoke French fluently, and one spoke Arabic at an intermediate level. All of these languages were spoken while on the trip and having more people with language ability helped make the trip successful because it increased the level communication with more people.
Things to improve on/vision for the future:
• Many of the challenges we faced stemmed from a lack of communication prior to the trip’s commencement. Although the goals of the travel agency, medical students and PCVs were similar they were not lined up as well as they should have been for the trip to be a success for all involved. Each came into the event wanting to accomplish their particular agenda. From our perspective, the travel agency saw the medical students as a way to achieve its goals and ensure funding for future projects and the medical students saw the travel agency as an entity they employed to run the trip, and thus, those organizing it should be more flexible to their desires on how the trip should run. This caused problems that permeated into all areas of our work, from scheduling the nomadic events to meals and how much people should pay to eat. In the future it would be best to have better communication prior to the event, so that everyone is on the same page, with a clear understanding and acceptance of each other’s goals.
• A lot of medicine was given out by the pharmacist, much of it was needed, but it’s possible that by doing this, we are encouraging the nomadic people to depend on outside help to come to them, rather than them taking the initiative of taking care of themselves (making trips to Moroccan clinics when necessary, where they can receive the same if not better help and medications).
• Another idea for the future is to bring in the group of medical students, pharmacist/doctor/nurse and PCVs to the same location when the school is already in session (after the tents and equipment have been set up by the travel agency). This way we would partner with the teacher and incorporate the health lessons into the curriculum giving the students a stronger foundation for the health education that would be given at the clinic. Also, we’d spend our time more effectively because it wouldn’t be spent setting up the tents and we could focus our time on checkups/health education. And, it’s always good to have a HCN, like the teacher, to help with the education and be a community liaison. We believe this would be more sustainable, the education would be more effective, attendance would be higher, and we could monitor and evaluate our work better.
• By dividing up (medical students/PCVs and travel agency), all parts involved can accomplish their specific goals without the other interfering.
• We were under the assumption that the pharmacist was actually a doctor, which is how we introduced him to the nomads. He did a great job, but in the future it would be nice to have a real doctor come and run the clinic.
• Because this was the first time this group of medical students came to help with the clinic, they didn’t know what to expect and therefore, organization lacked the first day of the event. Records were kept, but poorly organized and it was very difficult to know how many people came, were educated, or received hygiene kits. There was no organization in giving out the hygiene kits the first day; if we hadn’t recognized some of the people and their families, then multiple family members would have received kits while other families would have gotten nothing. And, the kits were randomly given out, without asking how many people were in each family so it’s possible not everyone in the family received toothbrushes.
• This was not a PCV planned event, we came to help and evaluate the event to see if this would be a good endeavor for Peace Corps in the future. Based on our prior experience planning health education and working with Moroccans, many of the organizational problems faced could have been avoided if we had planned the event.