Report of visit – 21st May to 27th May

The object of our short visit was to revisit the two Government Health Centers to ascertain the improvements and suitability of the Health Centers to receive our BSc Midwives graduating in July.

Brian and I were very happy to be accompanied by Dr. Lil from Berlin University Hospital who had previously volunteered to work at our clinic at Keyit and was here as our medical advisor.

On arrival in Gondar we had an appointment with Atto Destau, the deputy Zonal health officer.  We discussed our objectives and he confirmed that he had been working to improve the 2 health centers after our last visit.  Destau also agreed to send Ambacho, one of his staff with us which was gratefully appreciated as it would put out a very firm messaged that we were all very serious to improve the standards of midwifery services in the Simiens.

Brian, Hawlt, Wendy and Lil drove to Debark driven by our new driver, Kadir, who is a delightful, bright young man and proved to be an excellent 4×4 driver. We delivered some donated medical supplies to Debark hospital and met our 3rd year Midwifery students who were there on rotation getting practical experience.  Merkuria, the head of the Hospital, in the absence of Dr. Shegaw, agreed to accompany us to the Simiens.

The next day we drove seven hours into the Simiens to visit the first Health Center, Dlibza in Beyeda Woreda where, unlike our first visit, we were warmly welcomed by all the staff and health center chief. Ambacho and Merkuria commenced to complete the Gap assessment then we all completed the inspection.

Wendy and Merkuria concentrated on the cleanliness and infection control, Dr. Lil the medical aspects and documentation, Ambacho the assessment and Brian the placenta pit, water supplies and furnace etc. Following our inspection, we enjoyed a traditional coffee ceremony.  Overall, the midwifery department was greatly improved.  The staff had obviously worked very hard to improve everything which was unrecognizable from our last visit. The only outstanding issues were the water supply to the clinic and the need for further infection controls.

We spent the night in a local hotel and then travelled to Chiro Leba in Janamora Woreda the next morning which was also greatly improved. The midwifery department was transformed from our last visit and obviously a lot of effort had been put in by the staff. The midwives said that they were taking responsibility for the cleanliness of their areas if the cleaner was not available.  Again, connecting the water to the clinic and infection control needed some attention.

After lunch, everyone visited our clinic at Keyit. We were very pleased to hear that it is seen as an example of a good clinic in the area. We dropped off supplies, met Addis our nurse/midwife, and had a coffee ceremony. En-route we met a water well expert to discuss boring a well in Tellempt where the local population relies on river water – consequently there is a high rate of gastrointestinal problems.

The following day we delivered a Mule Aid saddle to the park for use by elderly or disabled people wishing to explore the Simiens. We also donated another first aid kit and discussed the possibility of running another first aid course.

If the standards are maintained and progress made to rectify the deficiencies we will deploy BSc midwives to both health centers and another to Adi Arkay so that the 3 health centers would have 3 diploma and 3 BSc midwives to enable them to work 3 shifts of 8 hours instead of 12 hours as now.  One of our midwives from Adi Arkay who will now have 1 years’ experience working in an excellent Health Center will be transferred to Chiro Leba.  The remaining midwife from the Hamlin will go to Adi Arkay with another from Gondar.

The idea of our newly graduated midwives not only working at Debark Hospital for a month but rotating through the Adi Arkay health center as an example of an excellent health center was discussed before deploying them to their work places.

We also discussed the proposed competition among the Health Centers; Ambacho and Merkuria would work on a plan together with Mitiku.  There are about 36+ health centers in the project area, some of them taking 2 days to reach so it was suggested that all the Woreda health officers nominate one of their health centers and these would then be visited by 2/3 members of the team over a six month period.

Before leaving for the airport Wendy and Lil went to the market together with the Beyeda health officer to buy both health centers 5 water containers with taps and soap to enable the staff to wash their hands between patients until the water was connected

In conclusion, the staff in both health centers had obviously worked very hard to improve the cleanliness of the midwifery departments which were greatly improved and the staff seemed much happier.  Apparently the patients had commented on the improvement and there was a rise in the number of women attending.  The two remaining problem areas in both health centers was the lack of connected water and poor infection control.

Hopefully we can keep our team together to inspect the health centers nominated by the zone for our next 7 BSc midwives graduating in 2018.-

We will next visit in September/October.
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SMMMS Trip Report January/February 2017

The main objective of this trip to Ethiopia was to choose with our stakeholders suitable Government Health Centers to deploy our five midwives who will graduate in June 2017.

Addis – On arrival in Addis we were met by Ahmed and taken to MSD’s office for a general discussion on the project and an update on our 4×4. Things are progressing well with the vehicle, with an advertisement for a driver will be posted shortly.

Ahmed had presented our SMMMS project to a meeting of The Consortium of Christian Relief and Development Association www.ccrdaeth.org consisting of 500+ Ethiopian NGO’s and we were voted among the top 20 NGO’s. SMMMS will now go forward with the other 19 to be whittled down to the top 10. If successful the judges will visit the project and finally arrive at a winning NGO. Fingers crossed.

Gondar – Meeting with Getachew from the Department of Finance and Economic Development.

                      • A general discussion surrounding our project and procedural arrangements.
                      • Our 5 year agreement with the Government expires at the end of 2017. Getachew will organize an appraisal of our project prior to renewal which we fully support.
                      • Graduation of our 2 BSc midwives from the Hamlin, which are now in the Adi Arkay Health Centre and plans for the graduation and deployment of our other midwives.

Gondar University – Department of Midwifery

                    • Visited the Gondar University and the Midwifery Department and met with the Dean of the Department. We discussed the progress of our students and our plans for after they graduate.

 

Debark – Travelled to Debark with Ahmed and Melkamu

                      • Visited Debark Hospital to give the medical equipment we had bought for them. Discussed the deployment of our midwives and a general agreement on the possible health centers for them to be deployed. Dr. Shegaw kindly agreed to join us to inspect the health centers.
                      • Drove into the mountains to re-inspect the Health Centre at Chiro Leba with Dr. Shegaw which was in poor condition during our last visit. The present head of the health center seemed more engaged but due to the upheaval a lot of staff had left including the cleaners so he was having to clean among his other duties and was in need of a pharmacist, laboratory technician and cleaners. Despite this the health center was cleaner and the midwives now just doing midwifery duties. We decided that we should support the health officer and the health center to improve the facilities.
                      • Visited Beyeda health center as a possibility for our midwives. Beyeda had a good reputation so we were surprised to find a health centre not very clean and rather disorganized. Apparently, the head of the health center had changed recently.
                      • Visited our 2 midwives in Adi-Arkay (picture of delivery room below). What a difference – clean and well run and had a tour of the midwifery department by Aden and Malefia. We were invited to a wonderful coffee ceremony attended by all the staff. We left some sets of baby clothes for newborn babies.IMG_0065
                    • Back in Debark we visited the Park HQ and renewed our acquaintance with the Head of the park and tourist officer. Discussed Peter’s ideas for the introduction and local production of the SaddleAid saddles.

Debark and the Simiens

                      • Wendy returned to Debark (after Brian flew home) and to the Simiens to inspect another health center and a new hospital at Dilibza plus our clinic at Keyit with Hawlt and Melkamu.
                      • We finally arrived at Dilibza after 8 hours of bumpy roads and having a tire cut up by sharp rocks! We went to see the Woreda Chairman and Woreda health officer to discuss the deployment of our midwives. Despite a general push by some of our other stake holders for our new midwives to be deployed at the new hospital they confirmed that they already have sufficient midwives at the hospital but instead were in need of midwives in their health center. We visited and inspected the midwifery department and again found it was in need of cleaning and painting. The Woreda Health officer agreed the need of general improvements and would consider painting and a general clean.
                      • Visited our clinic at Keyit which was clean and our midwife Addis was in the middle of an ante-natal and family planning clinic which seemed to be well organized. The ladies confirmed that they liked the care given and this reflects in the increased number of ante-natal, deliveries and post-natal care.
                      • Distributed the lovely children’s hats that Marcus’s grandmother and her friends knitted which were well received. Walking back to the village we were invited to a wedding celebration and generally thanked for our good work and support of the community and blessed by a local mobile priest!

IMG_0096 - Copy

Conclusions

A good visit overall and with the help of our partners, MSD, our vision for the project is finally reaching fruition and is very exciting. We now have our nurses, health extension workers and the Government Health Centers all working together to give good medical care to the people of the Simiens. The Health centers provide our nurses with delivery packs, vaccines, family planning items, HIV and Malarial testing kits. On our side our mobile nurses work closely with the health officers for direction and supervision and use the same reporting procedures as the Government nurses.

Our nurse in Tellempt, a very remote area on the fringes of The Simiens which is very rocky, arid and in areas affected by the drought and malaria is working closely with Concern International, a leading International NGO working in nutrition to identify malnourished children and setting up feeding centers. In the last quarter nearly 1000 children were identified and in treatment.

We have already deployed our first 2 midwives successfully to Adi Arkay health center. We have another 5 graduating in June 2017 with 7 in 2018 which will be deployed around the 5 Woreda’s on The Simien Mountains.

It has been a long time coming but finally the Government is seeing the full benefits of our programme and is actively supporting us by improving the Health Centers in the mountains and facilitating the exchange of supplies and information.

Lastly our mobile nurses need a big thank you for all their hard work in very difficult terrain. They sleep in schools, churches, tents and health posts while on their rounds and are held in great esteem by their patients and are making a measureable difference to the health of the population.

Next visit – We will go back May/June time frame to re- inspect the health centers and make a final decision on deployment of the midwives in July 2017 together with our stake holders. We will also visit other Health Centers for our 7 Midwives graduating in 2018.

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August 2016

It’s been a busy year so far…we made a decision to change our in-country partners and have now signed a contract with Mahibere Hiwot for Social Development to take care of our in-country interests (http://mahiberehiwot.org/). This is proving to have been a good decision and we are working well together to implement our programme.

We now have a full complement of five mobile nursing teams covering some very remote areas of the National Park. With the increased scale of the project and bigger distances to cover to re-supply each of our nurses we have invested in a second hand Toyota Land Cruiser which is ready to ship duty-free to Ethiopia. In the rugged, off-road terrain in the mountains this should make re-supplying our clinic and our nurses much easier.

Our first two BSc Midwives will graduate in October and will be assigned to the local Adi Arkie clinic to work after we signed a memorandum of understanding with the Gondar Ethiopian Health Minister governing their deployment.

We have conducted another successful course on “Safe and Clean Deliveries” for Health Extension Workers working in the mountains.

Our clinic is attracting more and more patients including ante-natal and post-natal checks and lots of deliveries—even if we have to encourage the ladies to attend the clinics with baby clothes and small gifts!

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December 2015

At the end of December Wendy, Brian and Hugh travelled to Ethiopia to review project progress. During this time they were accompanied by Hawlt, the SMMMS in-country medical coordinator

Upon arrival in Debark they went to the Hospital to view the first aid course being organised to train Park scouts and local guides. We were pleased to see that the Red Cross instructors had co-opted our SMMMS nurses into the programme to help teach the course.

Upon completion of the course participants received a Red Cross certificate in First Aid.  Congratulations to all.

During the next phase SMMMS nurses will attend a Red Cross Trainers of Trainers course, which will allow them to teach Red Cross courses upon qualification.

During this time we also met with met Dr Shegaw, the head of Obstetrics and Gynaecology dept at Debark hospital.  Together with Dr Zumichael, the Director of the hospital Dr Shegaw was delighted to receive additional medical books that Dr Marcus had sent along with thermometers and Doppler, a gift from SMMMS.

A key goal of this trip was to expand SMMMS’ operation into Tellempt – the most remote Woreda in the National Park. After one and a half days of tough 4X4 driving the team made it to the village of Tara where they met with local administration officials.

There are about 94,000 people in the Woreda with no road connection.  There are 22 Kabela’s with 5 Health Centres.

We explained our project and they discussed their main health problems and priorities which are maternal, neonatal care and malnutrition.

The Woreda officials quickly agreed to the deployment of an SMMMS mobile/community nurse in the southern area of Tellempt. The new SMMMS nurse will arrive in January based out of the village of Betal which is an extremely remote area that lacked medical coverage. This would work out very well for us as the area borders the area covered by our Beyeda nurse.

During the trip SMMMS also met with UNDP to discuss the set up of solar panels at our clinic in Keyit.

National Park officials expressed their support for SMMMS’ efforts. We presented Simien Park Director with first aid kits, paid for by Exodus travel company which he was very happy with and requested a further 5 large first aid boxes for the camps in the mountains. The Ethiopian Red Cross has since donated 3 of the boxes to Sankabar, Gitch and Chennek.

We are also looking to tap into the Parks communications for emergency evacuation of patients from the clinic.

Finally, after much effort (and the help of a few local men) we were able to transport a water cistern with all the necessary plumbing up to our clinic in Keyit.

The hospital engineer will arrive to install the tank so that the nurses can have water out of the tap.
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November 2014

SMMMS’ medical advisor Dr Marcus Stevens visited Gondar, Debark and Keyit during the month. During the trip he met with Carole Ashurst, who has dedicated most of her life to helping those in need. Together they visited Gonder hospital where they met Dr Solomon and Dr Shataye. Both doctors were very excited to hear about the SMMMS project in more detail and offered their ongoing support.

SMMMS discussed plans for first aid training in the mountains, including the importance of training those that can train others so the investment is sustainable in the long term. In addition we pledged to supply park scouts with small first aid kits.

Dr Marcus also visited Debark hospital where he met with Dr Mhretab, Dr Shegaw, and hospital CEO Zemicheal Gebreal. They had a very productive afternoon discussing various areas for collaboration between the hospital and SMMMS. They are fully committed to furthering the service the hospital can provide and clearly hope to develop a close link with SMMMS. In their words, “let us work to make this hospital like your home. Bring your friends and colleagues and we can work together. You are always welcome here.”

Dr Marcus discussed organising a training session at the hospital for the SMMMS nurses covering basic surgical skills and a variety of other topics, to be chosen by the nurses themselves and taught under the supervision of Dr Shegaw. This would be a fantastic resource for the nurses, allowing them to keep their skills and knowledge up to date. Dr Shegaw is very keen to supervise the clinic and provide regular advice and education, essentially an in-country medical adviser.

Given that Debark hospital has a desperate lack of textbooks with their ‘library’ only containing ten books Dr Marcus donated several medical textbook along with a few stethoscopes.

The dental equipment has finally arrived safely at Debark Hospital from Addis. Debark hospital is very thankful for the dental equipment recently donated and are hopeful it should be in use soon, they are organising a biomedical engineer to set it up and have applied to the health ministry to transfer a dentist to the hospital. Once functioning it will be the first ever dental service in the area.

A big thank you again to the Belgian dentist who donated his entire surgery, Ethiopian airlines and Dentaid.

A big thank you to Exodus travel and adventure holidays for their generous donation of first aid kits for all the Simien Mountains National Park Guides and Scouts following their successful completion of a first aid course. This will not only benefit trekkers in general but give a first capability to the villages.

We are exploring possible cooperation with SaddleAid, an organisation that designs and produces inflatable donkey saddles to transport injured or disabled people. This donkey friendly technology could have a very important use in the mountains when casualties need to be evacuated to Debark. The saddles would be positioned at the clinic and with a number of mule handlers in nearby villages who could be contacted in case of emergency in order to get casualties to the closest access road where they can be picked up by vehicle.

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October 2014

A big thanks to a retiring dentist for donating his entire dental surgery to us, and, also to Ethiopian airlines for agreeing to transport the equipment to Ethiopia at a greatly discounted price. Thanks also to Dentaid, a U.K NGO for their help and advise. The dental surgery will go to the local hospital in Debark where it will benefit all the population of Debark and The Simiens.

Twelve students primarily from the area of Beyeda took part in an examination process to select 6 students for the SMMMS Midwifery Scholarships. The successful candidates will go forward to Gondar University to start their 4 year BSc course. Congratulations and good luck to the successful candidates.

Thank you toe Gane and Marshall for sponsoring a midwifery student, for their 4 year BSc degree at Gondar University. More information on their Ethiopian travel agency can be found here.

September 2014

Our Vice-President Hugh Lovatt raised €800 euros for SMMMS after taking part in this year’s Peak District Challenge during which he completed a 90km run through the UK’s rugged Peak District in under 18hours – including a large part of night time navigation and one river crossing!

A huge thanks to everyone who gave, and if you still want to donate to SMMMS you can visit the following page.

July 2014

Between 11-20 July our treasurer Brian Lovatt travelled to Ethiopia to conduct an in-country project review with the new GRRDA Deputy General Manager/SMMMS Project Manager, Kassahun Demissie, and Hawlt, the SMMMS Medical Coordinator.  Brian met with all of the SMMMS nurses to review their activities, discuss their needs, and issue medical equipment and supplies.  He met with most of our project stakeholders to review, assess, and coordinate project activities.

The SMMMS clinic in Keyit is heavily subscribed with patients from neighbouring villages.  Its popularity is due to the fact that it is considered to be the community’s own clinic and the fact that it is free.  When Brian visited there in the mid-afternoon there were at least 20 people waiting to be seen – 2 were critical, and there was another patient in treatment with an IV for dehydration. The clinic has also been performing deliveries.  Patient demand is so great that we have agreed to add a second nurse, which should also be a midwife.

The SMMMS project remains highly regarded by the Simien Mountains National Park (SMNP). The level of cooperation has continued to improve and collaboration in a range of areas remains very good.  They continue to provide unrestricted access to the Park, use of their facilities, and cooperation with transport.  We have agreed to provide medical/health related training to address their needs.

This would involve training 68 guides and scouts in first aid. The training will be to the standards of the Ethiopian Red Cross, certified by them and result in “Red Cross” certificate of completion.  Training will be performance oriented and participants must demonstrate the ability to recognise the problem and administer the appropriate first aid. Courses will be based on 12 students per instructor.

Brian outlined plans to deploy our graduating midwives to the Government Health Centre at Chiro Leba in 2016 and the need to bring the facility up to standard for a fully capable Maternal Care and Delivery Centre. He discussed specifically the need to:

                                    1. Establish arrangements for cooperation and collaboration with the Debark Hospital, the Janamora Health Officer, the Head of the Chiro Leba Health Centre.

                                    1. Develop requirements for equipping a maternal care/delivery ward, constructing residential accommodation for expectant mothers at the Health Centre, providing ambulance services for patient transfer/emergency evacuation to the Debark Hospital, emergency communications, etc.

                                    1. Developing an agreed action plan for implementing the required capabilities NLT the summer of 2016.

He also meet with senior medical staff at Debark Hospital to discuss how to further develop the “clean and safe birthing” initiative thoughout the region and the integration of our graduating midwives into the Government clinics.
As a consequence of the initial discussions we agreed to a Memorandum of understanding to combine our resources to reduce mother and baby deaths which are currently well above the national average. The hospital is the main source of maternal care for The Simien Mountains, providing cover for about 250,000 people

June 2013

we have been busy pushing ahead with our 5 year plan.  Hawlt is now our area supervisor  and has been doing great work co-ordinating with health officials and the people of the Simien mountains and making them stake holders in the project.  Hawlt now has an office at the park head quarters in Debark.

Two more nurses have been recruited and have started work.  One has taken over the clinic at Keyit from Hawlt and the other has headed up a new mobile team operating out of Ambaras.

Our 3 midwifery student at The Hamlin continue to do well and are at the top of their classes.  We have obtained up to another 6 midwifery scholarships at Gondar University for a 4 year BSc degree, starting in September.

Our container packed with supplies for the clinic at Keyit has left New York thanks tothe AFYA foundation.

January 2013

Brian, our secretary, flew to Ethiopia to witness the signing of our 5 year plan by The Health Minister at Gondar.  This has allowed us to move forward and opens a lot of doors for us in Ethiopia.

Community Projects Africa has asked us to take over the running of the clinic at Keyit which they had built.  We are working with The AFYA foundation, an amazing charity that recycles medical supplies.  Hopefully a 20 ton container will soon be on its way from the U.S packed with supplies for the clinic.  Also, a generator will be purchased together with a water pump  and a fence enclosing the clinic to increase security.

Hawlt, our present clinic nurse is to be promoted to our area supervisor.  Getu, our present mobile/community nurse will take over the clinic and a new nurse recruited together with a new mobile team to operate from Ambaras.

Our 3 Hamlin sudents have settled in well and one even voted by her peers and staff as Miss Hamlin 2012!  It is hoped to offer up to 6 Bsc midwifery scholarships at Gondar University Midwifery College in the new academic year.

     The new clinic at Keyit

November 2012 

We have 3 students at The Hamlin Midwifery College in Addis who started their 4 year Bsc midwifery course.

We are still negotiating with the Government on our 5 year programme but are ready to fly to Gondar to finalize everything in the near future.

Nurse Geru’s clinics appear to be working well and are attracting more and more patients.

The new clinic and nurses accomodation are finally finished.

Visit to Ethiopia January 2012

SMMMS is currently providing community nursing services in the Janamora Woreda of the North Gonder Administrative Zone through the Gonder Relief, Rehabilitation and Development Association (GRRDA) and under agreements with the Amhara Region, North Gonder Zone and the Janamora Woreda. Nursing services are provided by a community nurse operating from the GRRDA Non-Governmental Health Post (NGHP) in Kiet to seven kebeles with a population of around 35,000.

SMMMS would like to expand its services in Janamora by introducing specialised maternal and child health care and then to extend these services into the other woredas in the Simien Mountains, beginning in eastern Debark in 2012 and eventually covering Adi Arkay, Tellemt and Beyeda.

On this basis, SMMMS officers conducted a field assessment of SMMMS operations in northern Janamora, 19-22 January 2012, followed by a field survey of eastern Debark, 23-27 January, including meetings with community leaders and health officials, visits to health facilities and a sample survey of community health issues and needs.

It is proposed that :

a mobile/community team will be introduced in Eastern DebarkWoreda.

Traditional birthing attendants (TBA’s) will be given a months training in  basic, safe, clean obstetric care.

Health Extention Workers will be given 15 days basic obstetric training.

We would offer 6 midwifery scolarships to local girls graduating from high school. Hopefully commencing in October.

December 2011

Our young, fit and enthusiastic nurse has been busy introducing himself to the elders and villages in his catchment area and generally getting organised to carry out his work.

We will be going out to Ethiopia in January to work with him for a few days and to make sure that he is prepared for the rainy season.

Our agenda will also include  preparing the ground for the deployment of our 2nd mobile medical team in the Debark Worda.  Talking to Government officials, meeting elders and villages and producing a detailed programme with the help of the community

We will also be discussing the introduction of midwives with local Government officials and midwifery colleges, as we think, due to the shortage of midwives in Ethiopia, it will probably be necessary to train local girls as midwives who will  go back to the mountains to to work after qualifying..

August 2011

The mountains are proving to be not only testing for the people living there but for our nurses also as our 2nd nurse quit due to the tough conditions.  Hopefully our third nurse will last longer especially as the weather should be improving.

We are also an officially registered Belgium charity, or asbl,  number 0838-437-019. 

2 – 18 March 2011

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.

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General scenes in the Simien Mountains