MOYALE, Kenya - As health workers approached a huge acacia tree that would provide shade for a makeshift clinic, more than 50 women and 30 children were already waiting for them.
Local enthusiasm for the monthly check-up made the habitual blasts on the car horn unnecessary in Yabalo Godha village, 40 minutes' drive from the market town of Moyale on Kenya's northern border with Ethiopia.
This semi-arid area in Marsabit County is home to herding communities whose animals roam the vast landscape – and its remoteness makes healthcare provision tough.
In a bid to improve services for nomadic women, about 50 solar-powered bracelets with Global Positioning System (GPS) trackers have been given to expectant mothers.
The furthest recipient is in Laqi, almost 100 km (62 miles) away from Moyale's central business district, where there is no hospital or school.
When the itinerant healthcare trial began in February last year, 168 expectant mothers were enrolled at 10 sites, mostly in pastoral communities selected by local leaders.
The health team informs a community volunteer or village head when a doctor, nurse and nutritionist will visit, bringing medicines.
Each trip has attracted about 150 mothers seeking healthcare, some furnished with GPS bracelets and some without, said Dahabo Adi Galgallo, an epidemiologist at Moyale Sub-County Hospital who started the project.
On the Yabalo visit in April, three of seven women in the area with GPS bracelets showed up.
Two others were nearby, the tracking system showed, while two had crossed the border into Ethiopia.
"Due to international laws, we can only monitor them and provide help when they come back," Galgallo said.
After a five-hour session taking blood and urine samples and screening for diseases including sexually transmitted infections, Galgallo's tests revealed 25 new pregnant mothers.
"The numbers get bigger with each visit," she said, showing no signs of fatigue.
Galgallo was born in Marsabit to nomadic parents who moved around so much she attended six primary schools. She grew up painfully aware of the health problems facing her community.
Home deliveries were the norm, with some mothers dying from bleeding during birth and even losing their babies to malnutrition.
Determined to act, Galgallo chose health as a career.
As a disease surveillance and lab coordinator in Moyale, she came up with evidence that more pastoralist women were dying during childbirth compared with the average for the area.
"That women were dying from pregnancies was known - what was not known was the extent of these deaths," she told the Thomson Reuters Foundation.
Over a year from mid-2014, Galgallo interviewed 60 pregnant women about antenatal care in local dialects Oromia and Borana.
As a follow up, she analysed data from 2015 to 2016, finding 40 percent of all baby deaths happened to mothers who received no antenatal care, with far lower shares for those who did
Galgallo's study revealed nearly half of expectant mothers could not afford 450 Kenyan shillings ($4.45) for antenatal checks. Some said they lived too far from the hospital, while others were not aware of the need.
"Ignorance here is rife, illiteracy levels are high. I have had some women coming to ask me how many months they have been pregnant," Galgallo said.
She then began to wonder if she could stop women dying who did not make it to health facilities.
The 2014 Kenya Demographic and Health Survey placed Marsabit County in the top four nationwide for maternal and infant mortality, said Moyale Sub-County Hospital CEO Kussu Abduba.
The hospital delivers 200 babies per month in a small maternity ward without an operating theatre.
As pastoralists move in search of water and grazing for their livestock, tracking and caring for mothers in the field seemed the best solution, said Abdi Fataha Bashiri, Moyale's head of reproductive health.
CHEAP AND SIMPLE
To do that, Galgallo came up with the idea of a bracelet containing a GPS system that could be worn by these women.
Being waterproof, small and culturally designed with bright orange beads made it acceptable for them to wear, she added.
In 2017, Galgallo won a $100,000 Grand Challenges Africa grant from the African Academy of Sciences, in partnership with the Bill and Melinda Gates Foundation, to put her concept into practice.
"I can tell you solar was the best option to power this GPS," said Denis Kalikidane, who handles technology for the programme.
The bracelets are automatically charged via a tiny fitted solar panel that absorbs light while on the wrist.
Few would have been able to afford the device if it had been designed to run on batteries, added Kalikidane.
He prints out a sheet with the location of each mother the morning before a visit, which helps the team work out where best to set up camp.
In locations where the GPS signal is patchy, they ask the community exactly where to find the women, he added.
Each month Galgallo and her team make 10 visits to different sites scattered across the county.
Health workers often choose a base near a water point, to which communities usually stay close so their goats, cattle, camels, donkeys and sheep can drink.
SERVICE AT RISK
Galgallo said her team had surpassed four antenatal visits for each mother, as recommended by the World Health Organization, and had helped nearly 270 pregnant women so far.
"For those with GPS, there have been zero deaths of both mothers and infants," she added, noting that those with bracelets can also receive home visits.
Health workers follow mothers who continue to wear their bracelets after giving birth, to immunise their babies in their first year, she added.
Despite its success, the GPS system needs refinement, Galgallo said. More bracelets are required that can cover longer ranges – and, ideally, they would operate as a two-way system in case of emergencies.
She is worried what will happen when the project funding runs out in September.
"Most people in remote villages trust that the service will keep coming," she said, adding she hoped to find new financial backing.
Moyale hospital CEO Abduba said the results would be assessed and "we will then see how we can expand it throughout Marsabit".