Supporting Rural Health Centres in Ethiopia

A 16 year-old boy had been brought to Jimma University Hospital by his father, with the problem of weight loss and extreme thirst and hunger. He was subsequently diagnosed with Insulin-Dependent Diabetes (Type one) and after receiving in-patient training on how to inject insulin, he was sent back home with sufficient insulin supply for two months. He continued his follow up every two months.

Two years later I saw the boy drinking the forbidden Coca-Cola before his visit for his blood sugar check-up and insulin refill. After several hours of individual and group health education on diets harmful to a diabetic, I was very disappointed to see him drinking that. When he arrived to see me in the clinic, he was apparently unaware that I have observed him practice the ‘taboo’. I asked him about his drinks after few minutes of chat and physical check-up. He was taken aback and after few minutes of hesitation confessed to me the following story…

After making six trips from his home in the Shebe area (60 km from Jimma by vehicle and four hours of walking) to the hospital, his father was unable to support him further. After a painful discussion the decision was made that the boy should stay in Jimma, working at manual labour and going to the hospital every month for his insulin. The boy had very serious difficulties with completing manual labour, finding a safe place to stay and finding enough food to eat. One day he heard a fellow patient, how he drinks Coca-Cola before each check up to acquire more insulin vials. He then sells his extra insulin to buy food and pay for rent. After hearing that, the boy decided to follow in his footsteps and acquire more insulin than he actually needed, to sell and earn a living.

This was a shocking story, but also an eye opener. My job isn’t simply medical, it is hugely impacted on by economic poverty. From that day on I started work to organize patients in to an association and establish some kind of self-help funding, so that patients can be economically empowered as well receiving health education and information. I know that this will continue to be a challenge. 

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.

Links:

• Ethiopia programme