Monitoring health in African dams : the Kamburu dam (Kenya) as a test case

Dams are among the obvious efforts to improve the economic situation in a developing country. They aim at using locally available natural resources. At present they are among the most popular means for promoting socio-economic development. A significant number of these programmes have been undertaken in Africa during the past two decades, and it is to be expected that many more will follow in due course. Dams are anything but natural. They do not fit into the old balance which nature established between climate and environment. Man responded to this ecological situation by creating systems of food production, by rigidly adhering to their routine, by constructing shelter fitting the needs of his household, and by developing customs and rules to guide his daily life. These conditions of human living, also called subsistence economy, still prevail in many parts of Africa, and we usuallY consider them as belonging to a traditional life-style. But technological progress tends increasingly to disrupt the old ways of life by promising a different and· brighter future. Obstructing the natural flow of rivers on a previously unprecedented scale, and subjugating them to the strivings of man is just one of them. For growing food where this was formerly scarce, and for multiplying power which formerly depended on man's muscles only, this procedure is very efficient. As, however, only the sun rises for nothing. such gigantic efforts have to be paid somehow in gigantic currency. A dam creates a crisis situation in a given ecological setting. It does more than throwing up another physical gradient. It creates a new environment not only for flora and fauna, but also for man. Especially the history of the great seas-connecting canals is full of calamities following such interventions. Of the more recent history of numerous larger and smaller dams it can be confidently stated that every one was followed by undesirable or unforeseen effects. In recent years the attention for those effects has rapidly grown, and is still expressing itself in relevant documentation. Water and development in Africa are items very different from those in temperate climates. They have much more to do with health and wellbeing of the people involved. Those people are far less prepared for the implications than in economically advanced societies. That means that much more attention and efforts should be spent on planning, monitoring and evaluating the health effects at the introduction of dams and irrigation. The author himself was confronted with the consequences of dam construction on two different occasions. First, at Yelwa (Northern Nigeria) when he was a local doctor near the newly created lake behind Kainji Dam. Second, as a lecturer in Community Health at the University of Nairobi (Kenya). At that time the Kamburu Dam was already well underway in construction. The necessity to look into future health problems of the people concerned came as an afterthought, for which provisions had not been made. Only "modest" means were made available to Professor Odingo, who was in charge of the project. This lead to a pluridisciplinary ecological survey in 1974, followed by a repetition in 1977. Later on, in discussions with experts of WHO, FAO, UNDP and the World Bank the absence of more comprehensive documentation was often deplored. Many incidental reports and documents existed but they were hardly accessible, and reliable guidelines were not established

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