Bringing healthcare to the San community of Namibia

6 April 2018

The San Bushmen of Namibia are considered to be one of the oldest cultures in the world, having lived in southern Africa for more than 20,000 years. Traditionally hunter-gatherers, with no concept of ownership of land or cattle, they have been forced off their original lands, which are increasingly being used for agriculture and grazing - leaving them unable to survive in their traditional lifestyle. 

Since the 1980s the number of San living traditionally is statistically negligible, and they are often now reliant on paid work as labourers or domestic staff. Many cannot find work at all.

The San’s per capita income is the lowest of all language groups in Namibia, and many live in extreme poverty - surviving on US$0.60 per day.

A lack of education amongst adults means skilled employment is nearly impossible to achieve, and ingrained historical prejudices mean many San are turned away from even unskilled jobs. Many families cannot afford to send their children to school, and some schools refuse to enrol San children. The combination of discrimination and marginalisation exacerbates the lack of opportunities for the next generation to gain skills to elevate themselves out of poverty.

The health status of the San is intrinsically linked to their low socio-economic status, and San life expectancy is 22% lower than the national average, at just 48 years.

50% of children die before age 15 and 20% die within their first year.

Only 10% live longer than 60 years. Common health problems include malnutrition, lack of wound care, gastrointestinal disease, respiratory diseases, malaria and TB. Many health problems are easily treated, but there is a huge lack of access to healthcare. The San usually live in remote areas, health staff do not speak their languages and they lack a say in the running of local services.

Tuberculosis is widespread, and the San have one of the highest rates of multi-drug resistant TB in the country.

Bringing healthcare to the community

Our clinic programme in eastern Namibia provides free healthcare to more than 3,500 patients a year: 40% are babies or children and 80% are San bushmen. TB and HIV are prevalent in the community, as is alcoholism. Common diseases amongst the children include fungal infections, intestinal worms, diarrhoea, dehydration, malnutrition and mouth infections. By themselves, these illnesses are not usually severe, but left untreated they will get worse and can lead to serious infection and even death.

In addition to treating and examining patients at the clinic, the programme provides a number of further services to improve the San’s access to basic healthcare:

  • Outreach clinics to remote areas to reach those unable to travel to the clinic (staff regularly travel more than 5,000km a month for outreach clinics)
  • Transportation of those in need of urgent medical attention to the nearest hospital (120km from the clinic)
  • Re-feeding programmes for malnourished babies and children including the provision of formula for orphaned babies
  • Deworming at remote schools
  • Health education at mother and baby clinics
  • Training of Community Health Workers in first aid skills and healthcare techniques, to impart to their communities
  • Provision of videos in local languages covering public health issues such as wound care, pregnancy, sick children, TB and HIV

The clinic has two permanent doctors, one nurse, one receptionist and four translators. Volunteers support the resident Doctor and Nurses at the clinic and contribute to outreach clinics in rural schools and villages. The clinic and its work is entirely funded by voluntary donations and support from volunteers.

TB clinical and research programme

The clinic currently employs a UK-trained respiratory consultant who runs a TB clinical and research programme. Pilot research showed that San Bushmen have a prevalence of TB of 39%.

The objectives of the TB programme are:

  • To identify the incidence and prevalence of TB in the San community
  • Develop a screening programme
  • Develop a treatment programme which reduces interruption and defaulting from treatment
  • Help the San to access healthcare and receive appropriate treatment

Some TB patients are managed by the clinic, and they have recently successfully complete relapse TB treatment in a 4 year old boy, who came to the clinic every day for 8 weeks of injections followed by 6 months of tablets.

Other functions of the clinic

  • Provide training for the San people and their neighbours in health rights, which enables them to demand their right to health
  • Strengthening local organisations and community groups to carry out health awareness-raising on HIV, TB and malaria
  • Strengthening the capacity of local health services to provide quality health care
  • Working with the San people to establish small-scale agriculture projects to provide nutritious food to people living with TB and HIV

The role of medical and humanitarian volunteers

Volunteers provide hands-on support at the clinic and dispensary and learn about the San way of life, the diseases affecting them and give care to people living in extreme poverty. While this project is great for those with some medical experience or students, if you are interested in working for a humanitarian cause, no medical knowledge is required and your help will still be very valuable.

Volunteers support the resident Doctors and Nurse at the clinic and contribute to outreach clinics in local schools and villages. Volunteers may also get involved with training Community Health Workers to learn new first aid skills and healthcare techniques for them to impart to their communities.

Depending on your experience, interests and background, volunteers can expect to undertake basic clinical work (checking blood pressure, haemoglobin levels and mid-arm upper circumference), history taking and patient examinations, as well as obstetrics, family planning and counselling, all with the support of local translators.

Those with no medical experience can support healthcare workers within communities, work in the dispensary and on reception, and perform basic medical procedures such as temperature taking.

Programme highlights:

  • Qualified volunteers will run consultations and assist with outreach work in the remote villages around the clinic
  • Assist staff with daily duties such as primary healthcare, observations, tending to wounds and in the pharmacy
  • Help in the community with family planning and substance abuse counselling
  • Work with the nurse in the local community carrying out basic procedures
  • Help with community feeding programmes
  • Work on your own initiative and help individuals outside of your clinical skills
  • Support community development projects such as the Bushman Co-operative 

For more details about the clinic programme, please visit the project web page.

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