Shaping Healthier Futures Through Storybooks

Non-communicable (chronic) disease among Ethiopia’s rural poor during the Covid-19 pandemic  

The Tropical Health Education Trust. 

We have been working in Ethiopia since 1997 to address the needs of the rural poor with non-communicable (chronic) diseases - NCDs. In partnership with two Ethiopian Universities (Jimma and Gondar University Hospitals) we have been delivering decentralised care from health centres in the vast rural areas around the hospitals so that patients with NCDs – particularly chronic respiratory diseases, hypertension, diabetes and epilepsy – have access to quality services. An unfortunate effect of the Covid-19 pandemic has been the disruption of the regular care required by patients. An additional problem is that many people with NCDs appear to be more vulnerable to becoming severely ill or even dying from the virus. 

To address this, we have in cooperation with the Federal Ministry of Health and the Universities of Jimma and Gondar launched the “Covid-19 preparedness and response project.”  Health workers are being given training on emergency preparedness with a special focus on managing the disease in NCD patents. Part of the project is to enable remote consultations for NCD patients using mobile phones.  This will help patients who live far away from health centres or hospitals and find it difficult to access health care and treatment.  

Read the story of Dr. B 

My name is B., I am 26 years old and I am a General Practitioner working at a Health Center in Addis Ababa. 

I grew up in Addis Ababa. My mother was a mathematics teacher and my father worked at an international NGO.  Growing up, I had all the help I needed to succeed at school. My parents were very supportive so I would say I had a good upbringing.  

On a typical day I get to work at 7:30 am and usually start work immediately. I work at one of the outpatient clinics. However, as the only medical doctor at the health center I receive frequent consultation requests at the other outpatient clinics, emergency room and labor ward. I stay at work till 5 pm and go back home.   

The main health problems in my community, I would say, are Non Communicable Diseases. Especially Hypertension and Diabetes with their associated complications. Previously these conditions used to be Predominant in the elderly population but recently we are seeing more and more cases at younger age.   

I believe the main reason that people have poor health in my community is lack of awareness. Many Non Communicable Diseases could remain asymptomatic until their end-stages and the damage is already done. I think this is one of the reasons which make NCDs get less attention by the community. 

One of the hardest situation I had to deal with happened in relation to the COVID 19 pandemic. I was called to ER to help on a case of a 75 years old female known hypertensive patient who came to the ER complaining of a severe headache. Her blood pressure was 200/120mmHg and told me that she had discontinued her medication due to the Easter fasting. Our health center doesn’t have the necessary monitoring devices nor the essential laboratory investigation to properly investigate and manage this woman. So I had to refer her to a hospital, but she resisted and refused to go because she was afraid that she would contract the Covid-19 in the crowded hospital and that she would die alone with no one to bury her. And her financial situation wouldn’t allow sending her to a private lab for the investigations. She was crying and begging me to just give her some pills and let her go home. I was helpless and couldn’t do anything except to manage her high blood pressure for the time being. 

Once I was on a night shift and was called to the labor and delivery ward where a 23 years old lady came in labor and within few minutes delivered a baby boy who was preterm. But her abdomen was still term sized so I asked how far along she was but she didn’t know because she never had antenatal visits. So I immediately checked for a second baby and, as I suspected, there was one. When I delivered the second twin he was blue and floppy and not crying and I was very nervous. Me and the midwives immediately started to resuscitate him. In the end we were able to return pulse and spontaneous breathing.  the twins were sent to neonatal ICU. Both turned out healthy in the end 

Since the Covid-19 pandemic, there has been a lot of misinformation about the nature, transmission and treatment of the virus. Some people in my community have fallen victim to this and believe the different myth regarding COVID 19 and we (the heath care workers) are facing challenges on addressing these misguided beliefs. So, I will continue working on awareness creation especially preventive measures.  

Yeshihoseg is 30 and has had insulin-dependent diabetes since she was 21 years old. Life is hard as she is divorced, supporting two teenage children. For a living she sells the local beer, Talla. Managing her diabetes is an additional burden and although it is made easier by being able to attend the health centre, she finds it difficult to control and as a result her blood sugar levels are often very high. Most recently, she attended the clinic because she had frequent headaches and some swelling of her legs and face and was found to have raised blood pressure. She also said that she had been taking traditional (usually herbal) medicine which is common in Ethiopia but difficult for the clinic staff as the active ingredients of these medicines are frequently not known.