A Sense of Hope in Ethiopia
By Mimi Pomerleau, Board of Directors, AWHONN
As an OB nurse working in Boston and president of the Board of Directors of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), I was given the opportunity to visit Ethiopia to experience firsthand how engagement at the community level and leveraging strategic partnerships can make an impact in improving health outcomes.
Ethiopia, like many developing countries, is faced with unbelievable obstacles to successful healthy outcomes. Poverty, lack of safe drinking water, inadequate sanitation and limited access to health care are the key factors which lead to poor outcomes. It is astonishing to learn that one out of eight Ethiopian children dies before their 5th birthday or that each year an estimated 26,000 women die from pregnancy-related complications. Forty-nine percent of women are married by age 16, and women who are married at an early age are more likely to become pregnant earlier, experience prolonged labor and pregnancy complications, and are more vulnerable to gender-based violence.
During our stop at the Bishoftu Hospital, it was nice to see the regionalization of care. Bishoftu is similar to a small community hospital in the United States. One mother we met was so proud that because of the nutritional counseling she received along with the access to antiretroviral medications for HIV, and her baby has so far tested negative for the virus. We also learned that the NICU warmers did not work and were only serving as cribs. I later discovered that this is often occurs in many developing countries: equipment often is donated but care and maintenance information is not provided.
We continued on our journey to the city of Hawassa. We met with health workers, who told us that they had been selected by their community to represent them and provide health care. The workers eagerly shared their training process with us and explained the assessment and treatment algorithm that they followed as part of their practice. What I found most amazing was their participation in the research process: collecting data by logging every visit, the reason for the visit and the outcome.
Our next stop was in the Shebedino District, where we visited the Ramada health post. We visited a home in this community where we met a woman eager to show us the changes she made to improve the health of her family, including the sleeping area with a mosquito net to prevent malaria and the separate cooking hut where meals were prepared since she learned that cooking smoke was a respiratory irritant. For many Ethiopians, running water does not exist and the link between living conditions and personal health is not well understood.
When I look back on the experience, even though it is so different than the U.S. health care system and availability of supplies, I am still left with a sense of hope. When I first heard of the frontline health worker training, I was a little cautious. Maybe I was being a bit of a snob. I wrongly assumed that it had to be a nurse providing care, but when I visited the rural villages, I witnessed firsthand how the health workers are recruited from their communities, understand the culture and customs and are able to make positive impacts. I doubt that any skilled stranger would be as successful.
By leveraging local communities of volunteers and engaging organizations, individuals and the U.S. government, it is this sense of hope that we can help disseminate health teaching and practices to areas in need of more positive outcomes.