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!
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.
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.
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.
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.
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:
- Establish arrangements for cooperation and collaboration with the Debark Hospital, the Janamora Health Officer, the Head of the Chiro Leba Health Centre.
- 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.
- 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
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.
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
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.
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..
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.
General scenes in the Simien Mountains