The landscape around Tindouf town is bleak and desolate, a wasteland of stone and sand, and drifts of spent plastic bags and bottles, blown by the desert winds. In a corner of this desert, between 90,000 and 150,000 Sahrawi people are trying to build an independent nation, in preparation for their hoped-for return to Western Sahara. Security considerations do not permit UN and Aid workers to stay in the camps themselves, so we were based about 9 miles away, in Tindouf. Sitting in a bowl of flat-topped, low sandstone hills, Tindouf is a small Algerian town with the gritty feel of a frontier outpost. We remind ourselves that this place remains one of the world’s flashpoints and could erupt at any time.
Fiercely independent, the Sahrawis are a people for whom the high prevalence of diabetes, hypertension and cardiovascular disease reflect the change from a nomadic way of life to the settled inactivity of the refugee camps. Some of the traditions associated with this nomadic past persist, to the detriment of today’s blood pressure and blood glucose levels.
The most obvious of these is the drinking of tea which is brewed and stewed to undrinkable bitterness, then made palatable by the addition of huge quantities of sugar, and served in small glasses. This tea-flavoured syrup may once have been a useful source of immediate energy for people constantly on the move, but now it fuels an epidemic of obesity. We were told that 34kg of sugar had been bought to provide 2 cups of tea a day for the 30 participants in our 10 days of training courses, and by day 8 the cook had used it all and had to buy more! Even more striking is the practice of fattening up a bride before her wedding day. The traditional practice involved two weeks of pampering, forced inactivity and feeding with rich food; nowadays this is combined with the administration of high doses of steroids.
This combination of strong traditions and fierce independence meant that the trust and confidence we gained from the 60 doctors and nurses by the end of the programme was hard-won, especially as we had to overcome the additional barrier of language. Most of the doctors and nurses had been trained in Spanish (many in Cuba), but the local language is an Arabic dialect called Hassaniya. We were lucky to have the support of two wonderful interpreters during our three-week trip.
And how do we measure the success or impact of our training? This is hard to do, but if anecdotal evidence is anything to go by, we did our job well. The head of the catering services, who asked the Public Health Officer about the nature of the training, was heard commenting ‘Usually with training here, fewer and fewer people come every day, but this time they are all coming back’!
And in such a challenging environment the words of the Public Health Officer give us reason to believe that our pragmatic and flexible approach will lead to long-term impact on the health the Sahrawi population.
“This training was one of the most successful trainings we ever had in this operation. With your experience and expertise you succeeded to gain the confidence and friendship of refugee leaders/authorities, partners and health staff, and I believe that this confidence was the secret of a such success”.