Southern Ethiopia - Gwent Health Link

Summary

The link visit in March 2009, more than ever, demonstrated growing sense of ownership and partnership amongst the link partners in Ethiopia.

Following request from Hawassa during the visit in March 2009 the link helped to set up the microbiology services for the Hawassa Referral Hospital for the very first time and donated several items such as pleural biopsy needles, bone marrow biopsy set, pulse oximeters etc. not available in the country.

During the visit to Yirgacheffe HC the link donated several essential items, evaluated the impact of link so far and had constructive discussion with the local community regarding progress of the community link. The link donated 3 microscopes to the Yirgacheffe High school laboratory as well as handed over money donated from the Abergavenny community to the schools and churches in Yirgacheffe.

In Alaba HC the link donated several essential items, evaluated the impact of link and had constructive discussion with the local community about future plans.

In both these places the motorbike ambulances are being used regularly, a total of 115 times in the last 5 months. In Alaba pregnant mothers with difficulty in labour have been brought to the health centre from up to 40km distance and in Yirgacheffe from up to 15km. 

In Wondogenet HC the link donated a motorbike ambulance as well as other essential items in a formal ceremony attended by the regional, zonal and woreda health office, local community including mother’s group.

In Wondogenet the link also arranged joint meeting with the representatives from all three exemplar health centres where frank discussion highlighted strengths and weaknesses of all three health centres and learning points for others. It was agreed that this joint meeting will continue every three months taking place on a rotation basis in each health centre.

''Thanks for your unreserved effort and contribution to our Regional maternal and child mortality reduction strategies at large you are doing so far. I recognize the effort of  our partners not in terms of money or large geographic area coverage but the life of individual that get saved or values added to the client improving the health status of the people or individual person. So keep up by doing your good things what ever you could afford to do so in your life time. Let us keep our partnership at highest and I hope we can make a difference'' - Kare Chawicha, Head, Regional Health Bureau, SNNPR Region, Ethiopia

Introduction

Links are about partnership, friendship, commitment as well as responding to local needs. The link visit in March 2009, more than ever, demonstrated growing sense of ownership and friendship amongst the link partners in Ethiopia, with the community and staff in the health centres, with the regional health department and in Hawassa Hospital.

Objectives

The main objectives of this visit were to assess and evaluate the impact of link support in the three exemplar health centres; monitor progress in relation to the exemplar health centre standards already agreed; donate a motorbike ambulance to Wondogenet Health Centre; provide on the job skills training to the health centre staff; meet up with the local community especially in Yirgacheffe to try to strengthen the fledgling community link; to help set up for the very first time a microbiology service for the Hawassa Referral Hospital; to discuss with the Regional Health department about coordinating link activities with current government policies; to discuss with the Hawassa University about support for the new MSc course for the Health Officers and other training programmes.

Visit

Five members from Gwent visited including David Williams, Iestyn Harrigan (both Microbiologists), Melrose East, Robyn Phillips and myself. Iestyn was on his first visit to Ethiopia but the rest of us have visited several times. David has been unwell for few days before the travel and on the journey from Abergavenny to Heathrow he was definitely feeling worse and we agreed that he should not make this long journey. But by the time we reached Heathrow he started feeling slightly better and decided, as has been typical of commitment from David over the years, that he must go so that the setting up of microbiology in Hawassa Hospital is not left solely with Iestyn, who was a new comer.

Local arrangements including travel and accommodation etc were efficiently arranged as before by our Assistant link Coordinator Misganaw with Dr Aberra.

Yirgacheffe health Centre:

During our two days in Yirgacheffe health centre (HC) we were impressed to find out that the improvements noted at the health centre during our previous visit 5months back have not only been maintained but in many areas the HC staff have taken further steps to meet the agreed exemplar standards.  The link donated emergency surgical/ obstetrics and laboratory materials including suture materials, cleaning material, protective gowns and gloves, adult and paediatric masks, laboratory reagents to the HC. We were delighted to find out that the motorbike ambulance donated by the link at the end of October 2008 has been used already for nearly fifty times at times bringing seriously ill pregnant mothers from over 15km away. We understood that there were problems regarding finding funds for the fuel supply for the motorbike ambulance and payment for the drivers for the motorbike ambulance. This has been already resolved by Dr Aberra’s intervention few weeks back when he visited the HC. Health centre in Charge Ato Elias has also taken the lead by driving the motorbike ambulance himself to ease the problem.

We treated the HC staff for a lunch with us at the Lesion hotel where we were staying and all of us had a great time. We went through all parts of the health centre with Ato Elias HC in charge and Ato Debrewok our evaluation coordinator at the HC and discussed areas of improvement that could be considered. One of the main problems was finding a suitable examination couch in the minor injuries treatment room. We promised to support with this as soon as possible. Melrose continued with her on the job midwifery skills training for the nurses/midwives in the HC.

We were sad to see that at the time of our visit both the admission wards of the HC were being used as part of emergency feeding centre for malnourished children. We were all impressed by the leadership shown by Ato Elias and diligence of all the HC staff especially Ato Debrewok.

Yiragacheffe Community: Although the Abergavenny-Yirgacheffe link was established in 2007 and a visit took place from Abergavenny in 2007, there have been concerns on both sides about slow progress of this link. I was approached by members of the Abergavenny community link school group and church group before my visit to try to improve the communication. I was requested to bring with me letters and some money (over £1000-00) raised by the schools in Abergavenny for the schools in Yirgacheffe  and money raised by local churches (over £1000-00) for developing a primary school by one of the churches in Yirgacheffe.  I requested Ato Befekadu., ex Mayor of Yirgacheffe and the founder of the community link to accompany us to Yirgacheffe. In Yirgacheffe we had an open meeting in the Mayors office with heads of local school, churches and many other members from the community present. We donated the money from Abergavenny community link to respective groups in Yirgacheffe. Next day I visited Yirgacheffe high school. The single microscope our health link donated during our last visit was the only microscope in the biology laboratory of this school with over 3000 students.  During this visit we donated another 3 microscopes to the high school. I also visited four primary schools and the local church where a new primary school is being built. The local community showed its sincere appreciation and great eagerness to continue with this link.

Alaba Health Centre

On our arrival to Alaba HC we were pleasantly surprised to be welcome by Enguday on her first day back after having her first baby only less than 3 months earlier. During our two days in Alaba HC we were again impressed to find out that the improvements noted at the health centre during our previous visit have not only been maintained but in many areas the HC staff have taken further steps to meet the agreed exemplar standards.  We were delighted to see that this busy HC with its huge workload (around 100 new malaria cases diagnosed every day!) has now got more staff for all areas. The link donated emergency surgical/ obstetrics and laboratory materials including suture materials, cleaning material, protective gowns and gloves, adult and paediatric masks, laboratory reagents to the HC. We were again delighted to find here that the motorbike ambulance donated by the link at the end of October 2008 has been used already for nearly sixty times at times bringing seriously ill pregnant mothers from over 40km away. Melrose trained nurse/midwives and students on the job midwifery skills and I taught the student nurses in emergency surgical problems.

We went through all parts of the health centre with Ato Bekele HC in charge and discussed areas of improvement that could be considered. One of the main problems was finding a suitable examination couch in the minor injuries treatment room as well as in one of the out patient clinics. We promised to support with this as soon as possible. We treated the HC staff for a lunch with us at the local hotel and all of us had a great time. Next day we were invited to Enguday’s house to see her baby Ruth and to a lunch (spicy porridge with butter, as is traditional when you first visit to see a new baby).

We were sad to see that here also the admission ward of the HC was being used as part of emergency feeding centre for malnourished children.

Wondogenet Health Centre

We arrived in Wondogenet in early evening to find that most of the HC staff was at the football match between the HC staff against the local school. When we met the staff after the football match we were surprised to find that they have named the sports club for us. One cannot fail to be impressed by the camaraderie and team spirit that currently exists amongst the Wondogenet staff. We invited the HC staff to a barbeque next evening and had a great time singing and dancing around the fire late into the night.

We went through all parts of the health centre with HC in charge Metasabia and were suitably impressed by the high standard maintained in all areas. There were few minor areas of improvement that could be considered were addressed immediately. We have no doubt that Wondogenet HC is currently one of the best health centre in the southern Ethiopia.

A formal ceremony was held in the presence of Ato Bassamo, Head of training, SNNPR RHB, Ato Mesaye, Head of Sidama Zonal Health Dept., members of the health centre development committee, community leaders, women’s group, and members from local villages and the HC staff and representatives from Yirgacheffe and Alaba. The link donated a motorbike ambulance for the health centre as well as emergency surgical/ obstetrics and laboratory materials including suture materials, cleaning material, protective gowns and gloves, adult and paediatric masks, laboratory reagents to the HC.

Joint meeting with representatives from all three exemplar health centres

During this visit we arranged a joint meeting of representatives from all three HCs, Dr Aberra and ourselves at Wondogenet. This included HC in charge from all three HCs. Frank discussion highlighted strengths and weaknesses of all three HCs and learning points for others. It was agreed that this joint meeting will continue every three months taking place on a rotation basis in each health centre.

Hawassa Hospital

During our previous discussions at Hawassa Hospital need for a microbiology service for the hospital were highlighted. Dr Yifru, Head of Hawassa College of health Sciences emailed us again in the beginning of the year requesting help to set up microbiology service there similar to as our link had already done in setting up histopathology service there in 2008. Following further discussions with microbiology colleagues by our link laboratory lead David Williams we managed to find enough support to help Hawassa start a functional microbiology department for the very first time ( for details please see David William’s report in our website).

Dr Yifru had also sent an urgent email and requested during our telephone conversation help with some urgent material for the hospital. Pleural biopsy needle and bone marrow biopsy sets were apparently not available anywhere in the country and were urgently needed for the hospital serving wider population than before and offering more services. We managed bring a supply of these items along with essential sutures and anaesthetic accessories. They were received like gold dust by the hospital. We also brought with us two pulse oximeters and happy to donate them to the hospital operating theatres which had none at that time although it was operating a large number of seriously patients day and night.

During this visit I also had frank discussion with Dr Yifru and all department heads to discuss the new MSc course for the health officers and how our link or other outside organization can provide support. Skills teaching, teaching with basic science particularly anatomy was agreed by all to be most urgently needed. The college has been asked to take a large number of in take of medical students in the coming year and is in desperate need for support with teaching as numbers of experienced teachers are extremely low. I agreed to find help in UK if possible.

SNNPR Regional Heath Bureau

From the very beginning the link has always worked closely with the SNNPR regional health bureau. However during the last two visits this relationship has become even stronger. Ato Bassamo, Head of training has been of immense help over the years and he also found time to come to Wondogenet for the motorbike ambulance presentation ceremony as well as taking active part in the Joint meeting with the HC representatives from all three exemplar health centres. We also had a very constructive discussion with Ato Kare, Head of the Regional Health bureau and summarized activities and future plan in line with the Ethiopian Government Health care policy. Ato Kare is highly appreciative of the important contribution our link is making in SNNPR towards reaching MDGs.

Conclusion

All the activities planned with our partners in Ethiopia went smoothly. In this visit more than before the visitors from Wales were made to feel as part of the large family in SNNPR, in Hawassa as well as in Yirgacheffe, Alaba and Wondogenet. There is no doubt now that the link has been able to establish true partnership in Ethiopia in the areas it works.