Meskrem 8 2004

In country training

I have now been in Ethiopia for a week and finally we have been allowed out of the Red Cross compound. On Saturday we went to the VSO office in Addis for the first time where we had a cooking class and learnt how to make the local shiroj which is chickpea powder which gets fried with oil, spices and onions to make a curry type thing. We also had a demonstration of how to use the supplies provided by VSO including water filter, kerosene stove and mosquito net. Then we went shopping in small groups with some existing volunteers, to the market to buy pots and pans, bed sheets and anything else we may need on arrival in placement, and to the posh ferengi supermarket for olive oil, baking powder etc all of which are apparently hard to come by outside of the capital. Ferengi is the Amharic word for foreigner. There are actually loads of us in Addis as there are so many NGO’s all trying to do their bit so you don’t get too much attention, but out with the city ferengi, ferengi is apparently a common cry from the local kids (often followed by money, money)

When not shopping we have been having intensive Amharic lessons – I can now order food,  get directions, tell the time, get a taxi,  talk about members of the family etc. We’ve also had some really interesting talks from a variety of people about the politics of Ethiopia and the state of the health care system and their plans for development which fill you with a mix of hope and trepidation due to the massive size of the task ahead. To give you some idea of the figures (2005data):

Population 82 million growing at 2.6% per annum = about 1.6 million extra people/year

Maternal mortality rate: 871 per 100000 live births = 25000 pregnancy and childbirth related maternal deaths/year

Under 5 mortality rate 101 /1000 ie 10% of children die before their 5^th Birthday

Infant mortality 77/1000 ie most children die in the first year of life

Life expectancy is 54 years. 46% of the population is 15 years old or less.

These figures are now 5 years out of date and the 2010 results, due for publication in the next few weeks are meant to show significant improvement. However in Ethiopia it only became a legal requirement to register a birth 4 years ago and it is still not a legal requirement to register deaths. Add to this the fact that 85% of the population remains rural, and I have no idea how accurate any of this can be.

Ethiopia operates a three tier health system. Small rural health posts staffed by health extension workers do health promotion and basic health work. They feed into a health centre. Each health centre supervises around 5 health posts. The health centres provide primary health care similar to a large UK GP practise, but without doctors. The health centres refer on to district general hospitals and tertiary speciality hospitals. In the last 5 years there has been a massive expansion of the health sector in order to try and reach the millennium development goals. 76 health posts have become 14000, 150 health centres have become 2200, and 87 hospitals have become 197. Unsurprisingly, this has resulted in a real shortage of trained staff and people are therefore being rushed through training. In Ethiopia you don’t chose what you want to do after school, the government looks at your grades and directs you to medicine, nursing, midwifery etc. Most of the midwives currently in training are male. The result is a huge number of people doing courses they are not really interested in, and although they work hard, their goal is to get a higher degree so they can apply for work at an NGO or leave the country. It’s sad but not hard to understand and I’m not sure what the future will hold.