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PLOS BLOGS Speaking of Medicine and Health

Far from the reach of global health programs

Gavin Yamey, the Senior Magazine Editor of PLoS Medicine, is currently on sabbatical from the journal after being awarded a “mini-fellowship” from the Kaiser Family Foundation to undertake a project as a reporter in East Africa and Sudan.

In this, his latest blog, Gavin writes from the Kenyan Coast, detailing the difficulties truly rural communities face in obtaining medical care.

Far from the reach of global health programs

I’m on the Kenyan coast, the last leg of my fellowship in global health reporting.  One of the many privileges of my trip is that I’ve experienced the opportunities and massive challenges in delivering health tools to those known as the “hard to reach.”

Isolated rural communities, with no roads to or from them.  Lakeside villages that can only be reached by epic boat journeys.  None have electricity, running water, or sanitary means for disposing of excrement.  I’ve traveled with researchers and NGOs and seen the kinds of obstacles that global health programs are up against.  Countless times I’ve heard public health professionals here in Africa say to me, off the record, that they wish the folks in Geneva or Washington DC, those spearheading the global campaigns, would come and see what “hard to reach” looks like.

I’ve learned a new expression: “tarmac tourism.”  It refers to Western health experts visiting the poor world, but sticking only to the well developed places with tarmac roads.

There’s virtually no tarmac in southern Sudan (which was the first leg of my journey), just one or two patches of it in a few towns such as Juba, the capital.

If you leave the tarmac, and drive for several hours in a Toyota Land Cruiser, the pot holes will crush your bones.  Along the way, you’ll see the most fragile houses of mud and straw; there’s nothing permanent, nothing solid, a legacy of a 22-year civil war.  If you go and visit a community health center, you’ll see that it is just an empty hut, with no medicines or equipment, nothing to offer.

In one “hard to reach” village in the state of Northern Bahr El Gazal, where only 1% of children go to school, I spoke with the community leaders.  Two women had just bled to death in childbirth.  There was no transportation to get the women to the nearest hospital.  There’s a car in the village, but there was no money to pay the driver.

I kept hearing, throughout my trip, that southern Sudan has the world’s highest maternal mortality rate, but it was only away from the tarmac that the reality hit home.

Gavin Yamey


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