Guinea Worm Eradication Programme Field Report

Report
from UNDP Emergencies Unit for Ethiopia
Published on 12 Nov 1996
Introduction
A six day trip was made to Kuraz wereda in South Omo zone of the Southern Nations Nationalities Peoples Resional State, flying to the Swedish Philadelphia Church Mission (SPCM) Kibbish Well Mission on the Kenyan border. Most of the trip was spent participating with activities related to the Guinea Worm Eradication Programme of UNICEF who had organised the trip. Advice and training in the use of GPS to map water points and settlements was given, and an appraisal was made of the operation of the Guinea Worm data monitoring system developed by the UNDP-EUE for UNICEF.

Background

The area of South Omo zone to the west of the Omo river's descent into Lake Turkana is one of Ethiopia's most remote and sparsely populated areas. After the Omo descends from the Ethiopian highlands it forms the eastern boundary of the large grass plains of Omo national park. Further south it meanders through the arid scrub plains of Kuraz (Geleb) wereda, forming the eastern boundary of the semi-nomadic Nangyatum (Bume in Amharic) people's territory. and Sudan. (map).

Ethiopia's border remains unchanged, following the eastern bank of the seasonal Kibbish river. However, the area to the west known as the "Itame triangle" was annexed by the Kenyans from the Sudanese in the late 1980s, partly due to potential mineral rights. Since then the Kenyans have attempted to control this area by the construction of a small town known as "Kenya Kibbish" opposite to the Ethiopian border police post of Bume town, and by encouraging the movement of Turkana people north from their traditional territory around Lake Turkana.

Present Situation

The movement of the Turkana into the area to the west of the Kibbish river has led to increased tension with the Nangyatum, and cross border raids and cattle thefts are commonplace. Earlier this month several people on the Kenyan side were killed in retaliatory attacks and people fear to keep cattle close to the Kibbish river.

These disputes have led to a change in the routes taken by the Nangyatum in search of good water and grazing for their cattle in the dry season (approximately November to February, but with large yearly fluctuations). This, coupled with poor health awareness of a primitive society, has led to the persistent presence of Guinea Worm (Dracunculiasis) infection amongst the Nangyatum.

Guinea Worm Eradication

The major drive of aid organisations in this area is the elimination of Guinea Worm, a parasite that is caught by drinking pond water that people who already have an emerging worm have come into contact with. The worms cause crippling pain and disfigurement; as the worm emerges from a patient's body large ulcers also form. Under the global eradication campaign backed by the Carter Foundation's Global 2000 and UNICEF fund activities of the Ethiopia Dracunculiasis Eradication Programme (EDEP) in Kuraz wereda , activities are locally based at the SPCM Kibbish Well Mission.

The only other endemic area for Guinea Worm in Ethiopia is in the Gambella region; work by the EDEP there over last four years has seen a dramatic decline in cases. In Kuraz, however, only slow progress has been made despite intervention techniques similar to those in Gambella, involving village level health education, case containment and monitoring, filter distribution and safe water supply construction.

A workshop to plan activities for the EDEP South Omo 1997 programme was held during the visit at the Kibbish mission, with the participation of SPCM, UNICEF, Global 2000 and government health and water officials from national, regional, zonal and wereda levels. (For more detailed information on this and other aspects of the EDEP please contact the Dracunculiasis Project Officer, UNICEF, Addis Ababa.)

Reasons identified for the lack of a dramatic decline in the number of Guinea Worm cases in Kuraz include:

low levels of the Nangyatum's awareness of the Guinea Worm transmission method;

lack of will amongst the Nangyatum's to participate in community development initiatives such as water point protection;

poor transport links that hinder monitoring and water construction work;

the unpredictable movement of the local people that make the provision of a constant safe water supply extremely difficult; and, imported cross border cases from Sudan.

Factors examining the last points are considered in more detail below.

Nangyatum Migration Patterns

At present most settlements consist of clusters of small huts situated a few kilometers from the east bank of the Kibbish or the west bank of the Omo river (see migration map). After the rains, sorghum is raised on flood plains close to the two rivers, necessitating those more dependent on crops to reside in these areas. In the wet season (April - July) the central plains between the rivers are used for grazing and Guinea Worm transmission rates are high as people drink from unprotected seasonal ponds.

Cattle tend to be kept away from the close vicinity of both rivers: the Omo due to tsetse fly and 'strange' water, and the Kibbish because despite 'better' waters, is too close to the Turkana people settled across the unprotected border. To find good grazing land and water in the dry season herds formerly moved west of the Kibbish river to the raised lands in the Itame triangle known as the "Loronoton hills". This area is now in Kenya and occupied by the Turkana herds, and so alternative places are used. The Kuraz mountain area south of Bume town is sometimes used, but the current preferred locations include the Birga Hills in the south of Omo National Park and the Naita mountain region, 100 kilometres to the northwest of Kibbish. The latter area is reached by following the Kibbish river in the wet season until it veers north into Ethiopia, then continuing west to the area bordered by Sudan, where other Nangyatum live.

Transmission of Guinea Worm is thought to occur from people returning from the Naita area - this is close to areas of southern Sudan where tens of thousands of cases are seen annually and eradication work is hindered by the civil war. Some Nangyatum men may also travel into Sudan to train with the Sudan Peoples Liberation Army (SPLA), often only to acquire guns and ammunition; virtually all Nangyatum men carry a semi-automatic weapon or rifles of some description. Inevitably, some will also return infected with Guinea worm, a process likely to continue until solutions to the border disputes and Sudanese civil war are found.

Omo National Park

The Omo national park is at present extremely difficult to access due to lack of transport links across the Omo river. The vehicle ferry at Omo Mursi was washed away downstream by this year's floods, and the main Omo Rate ferry to the south of the park is also currently not operational. These events contribute to the depressing statistic that no tourists visited the park in the first nine months of 1996.

Wildlife stocks are not affected by the Nangyatum grazing of cattle in the southern areas of the park. Rather, it is poaching for meat and trophies by the Nangyatum and the Surma people to the north that has led to the giraffe, zebra and elephants populations being decimated; today they are counted in tens, not thousands. Men armed with modern, more accurate weapons, often acquired from Sudan, range the park with impunity from the poorly trained and equipped park staff. Even a road project to the north was suspended earlier this year due to the Surma shooting over the heads of construction workers for intimidation.