Report on Visit to Ethiopia

Our original idea for visiting Ethiopia was to work with the mobile nurse and assess exactly how the programme was working. Unfortunately, the week before we flew, we were informed that the mobile nurse had quit due to ill health. Nevertheless we decided to continue to Ethiopia to look at the situation on the ground and discuss the project with Mr. Ayaneh from the Gondor Region Reconstruction and Development Association (GRRDA), including the conduct of a health survey of the people in the catchment area of the mobile nurse.

We met with Mr Ayaneh on 19 March together with Mr Abebaw from the Gondor Office of GRRDA who luckily for us was visiting Addis. We had a very productive meeting discussing all aspects of the project. There were two pressing points, the first to determine the exact area to be covered by the mobile nurse and second, to develop a detailed programme for the delivery of medical services. We also wanted to identify the second catchment area in the event that we were in a position to deploy a second nurse.

The 4th of March saw us back in the new Arkwasiye or Keyit as it is now known. It was wonderful to renew our acquaintance with the CPA nurse, Hawlte Abey, who was as dedicated and inspirational as always.

On the 5th of March Hawlte had organised for us to visit Lori where there was going to be a meeting of 100s of villagers from the surrounding area. During the proceedings, the head man addressed the assembled people, followed by Hawlte, to explain the proposed mobile nurse project. There were several questions and comments. One man spoke passionately at length to dispel any thoughts that this would not be a negative reflection on Hawlte. Another important comment was that too often the government clinics were without medicine. Finally, the villagers voted overwhelmingly to support the work of the mobile nurse and if possible to add a midwife or someone trained to care for pregnant women.

Following the vote, several teams of English speakers volunteered to conduct the health questionnaires with 50 families from 8 different Kebeles (communities) and Gots (villages). It was interesting to note that all the local school teachers helped in this and were very supportive of getting involved with health education in the schools as well as helping with further health questionnaires to complete a 10 percent sampling of the population. Although we had tried to keep the questionnaire simple it was obvious that we would have to make it even easier to complete.

The 50 questionnaires are now being tallied and we will give you the results when finished. There are already some interesting points coming out.

Family size typically 5-7

Instances of death among infants and children were common.

Awareness of basic health, sanitation and first aid very limited

Vaccinations virtually 0

No routine health checkups or child development checks

Respiratory and gastro-intestinal illnesses very common

No women’s health care or natal care

No access to medical treatment in most villages

Following our meeting at Lori we conducted an initial review of the Lori health surveys followed by a series of planning and coordination meetings with CPA-GRRDA Nurse Hawlte, local guides, scouts and elders to develop a detailed programme for the mobile nurse.

First was to locate the Kebeles and Gots in the Janamora region and marked them on a map There were 7 Kebeles, 26 Gots and 30,000inhabitants spread over 300km2. Keyit is in the north of the Janamora region and the Kebeles lie 10-15 km southeast of Keyit with the travel time being 3 – 5 hours to the different Kebeles. The Geographical centre of the Janamora region is actually the Got of Atgeba, further to the south.

Our ad hoc planning committee studied 5 different options for delivering medical support and selected the best options based on agreed criteria. From this we then developed a coordinated draft programme directive and terms of reference for Janamora Mobile Nurse.

The options considered were to visit

1 All 26 Gots

2 Only the 7 Kebeles, 13 Gots

3 6 Kebeles, 11 Gots but not the furthest kebele of Kilil

4 5 Kebeles, 10 Gots not Kilil or Meja

5 7 Kebeles and 10 Gots lying more than 2hrs from Keyit. The Gots under 2hrs would be covered by Hawlte at the Keyit clinic. (option adopted)

Despite Keyit not being the geographical centre of the Janamora region it was decided that it was essential that the mobile nurse should be collocated with the CPA-GRRDA clinic to capture the good will and expertise of Hawlte but could be relocated later if necessary.

Taking out the mandatory 2 rest days a week the MMT would be available for 22 days per month.

The MMT must return to keyit for resupply every 4-6 days. It was also decided that the cycle must be fixed and repeated every 30 days. It was deemed essential that all the Gots needed to know where the nurse would be at any given time.

On return to Addis we had another good meeting with Mr Ayaneh and offered our observations and programme for the MMT together with the relevant documents.

Looking at the programme it became very obvious that a young fit, enthusiastic nurse was required and that he would have to be self sufficient with essential medical equipment, a tent and camping gear.

It was agreed that it was imperative that the mobile nurse not run out of medicines or antibiotics. He would also require a lockable cupboard at Keyit to store his stock while out on his rounds. A robust box would be needed to carry his medical supplies on the mule, plus an insulated box for the antibiotics.

At the moment Hawlte has to go to Gondor to pick up his medical supplies every 3 months. This is a 5 day round journey. It was agreed that GRRDA would look into delivering the medicines to Keyit or at least to the nearest road point for pick up by the mule. It was agreed that someone from GRRDA should visit the Mobile nurse at 6 monthly intervals for support and coordination of the program.

Midwifery care was obviously a big point of concern for the villages which Mr Ayaneh had already had discussions with CPA.

GRDDA would be responsible for providing further medical questionnaire to the MMT to be completed by the villages.

Looking at the map with the Kebeles of the Janamora region marked it is fairly obvious that in the event of the deployment of a 2nd MMT it would make sense to cover the Kebeles of the Debark region.

We all agreed that despite the complexity of deploying the MMT it is a programme well worth the hard work involved and should make a big difference to the people of the Janamora region and hopefully, eventually, the rest of the Simien Mountains.