in Somalia

Part 2: Treating TB Successfully in a War Zone

Q. About the wars in the South and Central parts of Somalia, how do they affect your work on TB treatment?

The problem it might bring along is lack of access to these health facilities, and incidentally that is why we have many facilities- about two-thirds are in the South and Central parts of the country. The major worry is that we may not be able to supervise and monitor routinely, we may have a problems of stocks running out, but because we have been anticipating these kinds of problems, we supply drugs and lab needs worth of 3 months, in addition we give a buffer supply just in case we cannot access, the centers will have some supplies for a couple of months until things are okay.

We may get reports late, then the supplies naturally will go late also, but we have been trying to minimize this by having the supervisors proactively going to these centers and trying to get reports in good time.

Q. Could you maybe describe a health worker’s daily experience in the South and Central part of Somalia? How are they able to reach so many patients?

From one facility to the other, the roads are ruined, it takes long hours to reach from one place to the other, and some places are only reachable only by air, and of course there is limitation of air services, so we rely on the flight ‘ECHO’ which is by the European Union, and then there is also United Nations provided aircraft which we have to pay and its quite expensive, most of the time we don’t prefer this because of costs. There are so many road blocks also with Militias manning along the roads so sometimes it is difficult and also for international staff it is not possible to reach everywhere

The other thing we have been fighting is to keep the patients on the treatment throughout the 6 or 8-month period. In Somalia there has been a system that we call ‘Dameen’ (Guarantor)…Dameen is derived from Arabic. Before a patient starts, a guardian, parent, relative or a responsible person has to sign a sort of agreement that they will ensure that the patient will continue the medicine until the course is finished. When this patient is not seen, the health workers go and trace the person who guaranteed the patient, and this person who guaranteed is supposed to trace the person to bring them back.