Essential Healthcare Amid Dust and Desolation in Southeast Ethiopia
MSF doctor Anna Greenham describes work and life in the Somali region of Ethiopia
“Life in the Somali region of Ethiopia is tough. The rains have failed, food is running out and even the camels are dying of thirst. Add to this a complex armed conflict and you have a recipe for disaster. Nomadic people can’t find water or grazing for their livestock and are forced to travel huge distances to survive. Many have lost everything. Without a livelihood they move to the edge of towns where they live in squalid conditions in very basic shelters, unable to access clean water or food. It is in one of these small rural towns, Wardher, that MSF provides the only reliable health care for a dispersed population of about 40,000 people.
Wardher town is a dusty, bleak place. Most people live in tin roofed shacks or mud huts. There are only dirt roads, no running water and electricity only works for a few hours a day. There is a market but hardly any fresh food is available.
You would probably be shocked if I gave you a tour of our clinic. Things are very basic. Crowds of anxious patients wait outside on benches for consultations. Some have walked for days to reach us. Many have tried traditional therapies first and only access the clinic when they are critically sick. The sickest patients are referred to our inpatient department where two large tents with mats on the floor function as wards. It may look chaotic but it is amazing what we can achieve with so little. As well as primary and secondary health care we support a TB program, feed around 100 malnourished children, provide routine antenatal care, vaccinations and even mobile clinics to isolated villages. By training local staff we hope to leave something behind when MSF eventually leaves the area.
Most of the children are dying from simple illnesses- diarrhea, chest infections, preventable childhood illnesses such as measles and malnutrition. We use IV fluids, antibiotics and nutritional support to nurse these children back to health. Amazingly, most of our patients do recover, despite the limitations of what we have to offer. Some are not so lucky. It is so sad watching a baby die from pneumonia, when in a more advanced setting they would easily survive. The nearest proper hospital is 2 days drive away so this is rarely an option.
When I am not volunteering as a medical doctor for MSF I work as a General Practitioner in the NE of England. Next time anyone complains about the National Health Service there I suggest they put themselves in the shoes of a typical nomad like Fatima*, who walked for 4 days with no food or water to reach the clinic with her 4 month old baby. She was so exhausted that her breast milk had dried up. Her baby weighed only 2.5kg and was close to death. We were able to admit them both to our inpatient ward and the child is slowly improving with intensive nutritional support. She is one of the lucky ones. Many others are not strong enough to make the journey.
Work can be very frustrating. I am so busy during the day that I never have time to finish anything properly! I juggle ward rounds, reviewing complicated cases in our out patient department, admitting emergency cases, doing minor surgery in our small dressing room and assisting difficult deliveries. Add to this training local staff, sorting out human resource problems and trying to chase goats out of my ward, I hardly know whether I am coming or going. It can also be stressful living and working in an area of armed conflict, with severe restrictions on any form of social life.
Despite all the difficulties and challenges, I do love my work. It is so satisfying seeing critically sick children recover, when without the efforts of the MSF team they would certainly perish. MSF is not only providing health care, our presence in Wardher also gives hope to what is a very neglected population”.
MSF has delivered vital healthcare to communities in the Somali region of Ethiopia, on and off as necessary and where possible, since the 1990’s; where the population struggle to survive amid numerous challenges, not least an ongoing conflict between governmental and rebel forces.
*False name to protect anonymity