A few weeks ago I got a rare opportunity to go on a field trip with an international humanitarian assistance organization working in Buhera, Murambinda. This is one place that has hit the headlines because of a measles outbreak wreaking havoc in that area. A few kilometers off the main road, health centres are accessible only by travelling along uneven dust paths that field vehicles have, over time carved out. Travelling like this in the back of a 4X4 Landcruiser is a lot like being in an army squad-car – an experience so jarringly bumpy that by the time you reach your destination, your insides feel like they have haphazardly re-arranged themselves along your internal torso. But this is nothing compared to the kilometers that women and children in Buhera have to walk barefoot in the parched plains under the baking sun to reach the nearest health facility. The fields are pitifully without any maize; a few sorghum stalks litter most of the space. Day two on an active measles case finding mission, we took to the dust road on our way to Muzokomba – one of the villages where several outbreaks had been reported. We passed an extraordinary figure of an old woman who at a distance looked like a scarecrow perched precariously on a tree. As we drew closer, I noticed that the old woman was dressed mostly in rags. She had made a makeshift shaded seat – something akin to a hammock, only not as comfortable. The makeshift shelter is called rindiro or watchtower. Her thin frame was sitting alertly upright, and cross-legged, her eyes blankly staring into the distance. Pathetic pieces of crockery lay underneath her seat, and a small pot was cooking something foul smelling a few meters away. She was watching over her meager sorghum crop, protecting it from baboons. You could literally count the number of stalks littering her small field. The field workers explained that this was common practice; villagers just have to do this or else starve. And I thought I had problems. Apart from watermelons, sorghum is about the only crop that thrives in the harsh Buhera climate. As we drove further, two small boys sat in their own rindiro, at a time when they should be in school. I wondered if they stood a real chance at intimidating an adult baboon…
At the end of this tour I came to the conclusion that if for any reason organizations like MSF, Goal and Red Cross offering various forms of humanitarian assistance in Buhera decided to cease operations in Murambinda today, they would be responsible for thousands of deaths in that area. I also found the devotion and hardwork of the field personnel touchingly dedicated. Active case findings mean following the grapevine for leads on where the disease is resident. It is about coaxing the largely indifferent women at the clinics for more information and leads. It is about driving for many kilometers following the leads supplied and when you find sick children, you seek permission from their guardians after which if granted, means bundling mothers and children in the back of the truck and taking them back to the nearest measles clinic.
Certain sects of the Vapostori religion are the most uncooperative. As soon as they spotted the measles medical team vehicles approaching their homesteads, women literally scurried for the hills to hide their children therein. Field workers have recently been forced to carry out physical inspections of huts and under beds as religious parents go out of their way to avoid ‘sinning’. They have to use a variety of tactics ranging from coercion and intimidation to literally begging in order to obtain the cooperation of guardians to get sick children treated for measles. The team I travelled with had a directive they moved around with – which had been written by one of the chiefs, demanding that all villagers get their children immunized and treated for measles and that those refusing to do so will be committing a crime prosecutable under the law as a criminal offence. The directive also highlighted that any parent who denies a child treatment, resulting in that child’s death would be charged for murder and incarcerated. On average, seeking permission to treat measles patients takes anything between 30minutes to an hour per household – of first making small talk, coaxing and sometimes begging. This is the kind of work that is the preserve for really patient fieldworkers. I kept thinking to myself, damn stupid people – this disease is claiming the lives of their children in droves, and yet someone has to drive all the way just make that realization apparent to them and convince them to seek treatment for their children. The dynamics of religious hegemony are something we will never understand. At one homestead, the head was adamant that no child of his would be immunized or receive ‘Western’ medical treatment. In such cases, field workers have no choice but to leave medication behind and hope against hope that the parents would administer it to their sick children. A lot of the times, teams have returned days later to check on the children and found funerals in progress. That is just the way it has been.
I managed to speak informally to some of the mothers detained at a clinic in Muzokomba, and they intimated that sometimes, they really want to seek treatment for their kids but their husbands just won’t have it. One or two were clearly not happy to be at the clinic because it went against the grain and spirit of their religion, which believes strongly that if God created people, only he should then be responsible for treating the sick among humankind. Moreover, the insurmountable distances villagers have to travel on foot to reach the nearest clinic greatly contributes to the disinclination to seek medical attention.