Access to Chronic disease care in Ethiopia is so poor that patients who present usually may be quite advanced with one or several complications that result in major disabilities. As a consequence of this Palliative care is becoming increasingly important in Chronic care. Training in Palliative care skills at hospitals in Addis Ababa in collaboration with Hospice Ethiopia is one of Dr Yoseph's contributions at the Ministry of Health, which is not expected to expand to hospitals outside Addis Ababa as well. We delivery training to physicians and nurses to be able to manage pain in patients with chronic disease.
A.F. is a 30 years old woman who was diagnosed with Kaposi sarcoma related to immune-compromising disease. She has developed severe neuropathic pain and was shouting day and night with severe pain. She was referred from the eastern major town of Harar. She travelled with a devoted husband who went to any lengths, even if traveling 500 km to the capital Addis Ababa. The couple had to travel with their 3 years old son, as there was no one to take care of him. After few days of focused pain management with round the clock administration of adjuvants pain was well controlled she went back home to follow up.
Developing nurse leaders in advocacy for NCD care, an Ethiopian experience
By Dr Yoseph Mamo | Project leader
The vision of empowered nurses, acting as leaders to realize the ideals of ‘access of care to the rural poor’, is a compelling one. We started to recruit appropriate nurses to lead this effort in three health centres: Shebe, Agaro and Asendabo, each of them located about 50 kilometres south, west and east of Jimma University Hospital respectively.
While recruiting, we also began advocating for THET to support a rotating fund, providing essential medicines and to address the universities mandate and lack of involvement in health care. We quoted the social accountability article of the universities vision and mission statements, that they aim to make to research an entry-point to further health care training and that providing quality service to patients (subjects) and the training of nurses (data collectors) are an ethical requirement of the institution.
Funding for training, coaching, mentoring, supervision and transportation were mobilised, yet again, by THET.
Epilepsy: Burns are one of the major causes of disabilities due to epilepsy. It is a sad fact that many epileptic patients face the danger of falling into open fire made for cooking or other reasons. Falling from on high while collecting twigs for firewood and drowning in the rainy season in the flooding rivers are some other causes of major disability and death. Here are three stories which describe the effects of such epileptic incidents.
A 30 year old lady from rural part of Jimma who developed hand deformity of the fingers and hand following fall into fire while cooking. She remained unmarried and shunned by her family as a burden.
A 21 year old shepherd who had made a bone-fire in the field to warm himself in the cold season while herding cattle had sudden attack of seizure. Fortunately only his hands fell into the fire while the rest of his body was safely away. It was too late when he was discovered and his left hands were burned beyond recovery and amputated while contracture couldn’t be prevented on his right hand. He is currently unable to use his hands.
A 16 years old school girl who fell into open cooking fire while helping her mother, who supports the family selling Injera. The mother was around to take her out of the fire but not soon enough to avoid severe burns to the face. After recovery with a very scarred face, the girl refused to go back to school for fear that her looks would frighten off younger students and also bring her stigma among her peers. Her chances of education and forming a family when coming to age all gone together. She continues to live with her mother
Such tragedies can be effectively prevented through early detection, control of seizures with anticonvulsant drugs and health education. After injury a quick and appropriate burn management and Rehabilitative measures for those who have developed serious disability would also be crucial. Decentralization of services through training of nurses in the primary care setting which are far more accessible to the victims in terms of distance would give the opportunity for early detection and control of seizures and when this has failed an early burn treatment and referral in severe cases will significantly reduce the burden of permanent disability to these patients.
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