MSF anthropologist: “If they don’t understand what MSF does, they will never come to our health centres.”

1 Oct 2017
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Anthropologist Roberto Wright is working in Ethiopia’s Somali region to help MSF reach and be accepted by local communities.

It’s 8 am in Galorgube, a small town in Doolo zone in the Somali region of Ethiopia. The sun’s warmth is already strong. Until late 2016, this area was greener than it is today and also less populated. But with a series of failed rainy seasons, the ground turned orange and became dotted with hundreds of tents: improvised structures that mix colours, fabrics and materials. They belong to the nomadic pastoralist people who were forced to settle here after the animals on which they depend were killed by the drought.

In a dark tent, a tall, bearded man in an MSF T-shirt and his patient translator have spent an hour talking quietly with a group of about 40 men, mostly elders. They are the representatives of this community. The tall man is Roberto Wright, from Brazil, MSF’s anthropologist in the emergency team. He has been working in the Somali region since the end of June.

“We found a compromise that respect their perspective and at the same time uphold our medical objectives. They said yes, so it was worth it,”
says Roberto when he finally leaves the tent, a big smile on his face.

The community leaders have just agreed that a severely malnourished child is transported to be treated in the inpatient treatment feed center (ITFC) Yukub, just 6 km from Galorgube. Previously they had refused, because, like their ancestors, they trusted only their traditional healers.

“Part of my work is to understand their approach regarding traditional medicine and to explain MSF care to them so that they can combine both”
says Roberto.
“If they don’t understand what MSF does, they will never seek our services or come to our health centres.”

To achieve that goal, Roberto trains and works with an army of hundreds hardworking health workers, most of them either locals or displaced pastoralists. Every morning, they divide into pairs and spend the day talking with the displaced people, in particular the women, most of whom have between three and 8 children.

The health workers ask questions to discover if any of their children have severe acute malnutrition or other complications which need medical treatment. With the shortage of food in this area, the teams have been sending an average of 10 children per week to MSF’s health facilities for treatment.

“We need to adjust the way we work to their perspective, in order to fit in with their community practices,” says Roberto. “Our community engagement strategy looks for mutual.”

These are Roberto’s main goals in the Somali region: to help MSF reach these communities and to increase their acceptance of MSF. He has already done this in Iraq, Sierra Leone, Central African Republic and Turkey, but here, in Ethiopia, it requires spending much more time in the car. Distances in the Somali region are huge, and the various communities are far from each other. In two months, Roberto has spent 60 days non-stop on the road and covered more than 6,000 km.

Today he drives from Yukub back to Galorgube to transport another patient, a one-year-old baby, to MSF’s health facility. The baby’s mother and the community elders have agreed that MSF should treat him. From Galorgube, he will be transferred to Wardher hospital, supported by MSF, at two hour’s drive.

The baby’s mother is 25 years old, has four older children and is two months’ pregnant.

“We were living in the bush with 200 animals,” she says, “but now we only have 10. They all died. This is my younger child and he has been sick three times already.”

Before going to Wardher, Roberto and the outreach team will drive in convoy for two more hours to Leheylo, a camp for displaced people in a remote and dry area. Today is a therapeutic food distribution day and Roberto needs to meet the MSF team and check how people in the camp are surviving.

“For me, the challenge in the Somali region, apart from the long distances, is to understand how these people are trying to adapt. They are used to crises, but in this one their livestock are dying so fast, which is something they’ve never seen before. They need a platform to exchange ideas to work out what to do next. We want to develop this at the community level but also inside the heath facility in a health promotion tent.”

After another 65 km, the car arrives at Wardher hospital, where the original two tents for malnourished children have now grown to six, plus two wards.

The sick baby and his mother are taken by nurses to the waiting area, while Roberto jumps out to see how the new ward is going. When that is done, he looks up at the tree in the hospital yard and recalls the night when an MSF doctor called him because a mother wanted to leave the hospital with an unconscious child and go the traditional healer.

“That evening I went to the hospital to talk to the mother, find out why she wanted to leave and try to find some common ground,”
says Roberto.
“When I asked why she wanted to leave the hospital, she said, ‘I want to give my child traditional treatment. She must be exorcized. I want a sheikh to read the Quran to my child.’ I replied, ‘That is something we can help with.’”

As part of his community engagement strategy, Roberto had already engaged with key religious leaders, so he called a sheikh to go there. The evening finished under the stars, with a soft voice reading the Quran and the baby being cared for in the hospital.

It may not be a classic MSF role, but Roberto’s job as an anthropologist is an important part of the chain. The part that listens to local people and tries to understand them. And this, in the Somali region, has proven to be key to MSF’s ability to provide medical care.