Well it’s time for me to leave Ethiopia soon and make my way back to the UK. I’m going to take some time to pick up my life in the UK and get things organised as well as catching up with friends and family on my return. Overall I have enjoyed the last 10 ½ months. There have been a lot of challenges along the way with patience and resilience needed but I have also had so many amazing experiences, been welcomed by the people here and made friends with some lovely people.
Here are some of the things I will miss about Ethiopia in no particular order:
1. Looking up into the sky and seeing so many stars in the sky. With almost no light pollution the number of stars and planets that can be seen is staggering and awe inspiring.
2. Almost every child that we come across on the daily walk to work wants to say hello and also to shake our hands. Apparently it’s good luck to shake a ferengi’s hand. I think that bizarrely I will miss the attention and friendliness when I leave.
3. I’ve had over 10 months of daily sunshine here and even though it’s the rainy season now we still get some sun during the morning. It’s been lovely to have the sun daily and soak up it’s warmth.
4. The work/life balance here is definitely more in favour of life! The two hour lunch breaks where you are expected to leave the hospital and go home to eat your lunch were hard to get used to at first but now very much enjoyed.
5. Every time you see someone rather than just abruptly asking for what you need first you need to exchange greetings with each other. This involves handshaking and sometimes kissing each other’s cheeks. There are many ways to say hello and how are you. Every one of these, as well as the proper responses, are normally used before you continue on with the conversation.
6. Having never really been a coffee drinker before coming to Ethiopia I have become a convert! The coffee here served as part of the coffee ceremony is a bitter brew made palatable by a few teaspoons of sugar. Some local coffee will definitely be in my luggage coming back.
7. Ethiopian food is lovely with a great range of spices used. One of my favourite dishes is tegamino, a thick chickpea flour and spice paste, served with injera, a thick pancake made from tef (the local stable grain).
8. Being able to buy cheap, in season vegetables has been lovely. This has meant lots of meals from scratch without any of the processed cheats normally used. I’m sure I’ll be using some of those cheats when I get home but I hope to do more cooking with fresh ingredients.
9. Over the year I have made many great friends in people at work, people living in Axum (Ethiopian and ex-pats from the States) as well as my fellow volunteers. I will miss seeing these people every week and hope to keep in contact after I return to the UK.
10. One thing I have learnt to respect over the last months is the power of the purple stamp! In Ethiopia everyone has a purple stamp – the hospital, local businesses, VSO. If you want anything to happen first a form or letter has to be produced but unless you have the purple stamp the letter is worth nothing ☺
Here are some of the things (in no particular order) that I’m looking forward to when back in the UK:
1. Being able to speak the same language as patients and nurses so that I can be sure that what I am saying has been understood. This enables me to be sure that patients and parents understand what is happening and why I am doing things. It means that the nurses follow instructions that I give and understand why they are important as well as to come and tell me if the patients are deteriorating.
2. Surprisingly one of the things I’ve missed most is a variety of fresh fruit. I’m looking forward to apples, pears, grapes, melon, pineapple and strawberries.
3. A decent bottle of red wine – no further explanation needed.
4. A wide variety of lovely cheeses (especially soft cheese like brie and camembert). Outside of Addis and cheese brought back to the UK it’s not possible to find cheese in Ethiopia.
5. Seeing family and friends again after the time away and catching up on everyone’s news as well as just spending time with people.
6. Having daily access to hot and powerful showers. Although I’ve been lucky and have had hot water where I am living the water pressure is never great which can make it difficult at times.
7. The insects in Ethiopia seem to love me. Not having to worry about getting bitten all the time and having to keep applying insect repellent will be much appreciated.
8. Working in Ethiopia has made me appreciate the NHS even more. Healthcare, which is free at the point of care, where you can give the patients the treatment they need without needing to worry if they can afford it is unimaginable to people in Ethiopia. People use holy water or traditional remedies as they don’t trust the medical system here leading to delays in presentation and poorer outcomes for patients.
9. Less bureaucracy or at least bureaucracy that I understand and know!
10. I’m looking forward to seeing the changing seasons and all the differences they bring. One thing that made me feel homesick last year was all the pictures of autumn as the leaves changed colour.
And finally thank you to everyone who has helped and supported me over the last year. It has been wonderful to read all of the messages that people have left on the blog.
Coffee is such an essential part of life here that after 8 ½ months I really couldn’t go any longer without writing about it. Coffee is found in many different forms – unroasted beans, roasted beans, ground coffee, flavoured chewing gum, and incense sticks to name a few! The majority of coffee or ‘bunna’ is drunk black from small cups after being prepared in the traditional way.
It is claimed that the origin of coffee is in Ethiopia with legend saying a goat herder from Kaffa (where coffee grows wild) discovered the berries after his goats became excited following eating it. He then took the berries to the monks who threw the beans on the fire calling them the devil’s work. Following smelling the aroma of the roasting beans though they crushed the beans and distilled them in boiling water thus creating coffee. This gave them renewed energy for their holy devotions and the tradition continued.
The coffee ceremony is a routine part of daily life as well as part of all celebrations. It is a way to entertain friends and family, welcome people and celebrate. Only women know how to perform the coffee ceremony. The men don’t have the skill and are often found getting their coffee fix at pop up coffee stalls by the side of the road. You need to make sure that you leave some time free for the full ceremony though as it can take an hour or more to complete.
For the complete ceremony the ceremonial apparatus is arranged on a bed of long scented grasses. First the green coffee beans are roasted over a charcoal fire.
Once they have obtained the colour needed the pan is brought round for everyone to take some of the coffee scented smoke. The beans are placed into a pestle then and pounded by hand into the ground powder (the nurses on the paediatric ward use the modern technology of a food blender for this part!).
The water is placed on the stove to start heating in the traditional coffee pot (jebena) on top of the charcoal. Once it has started to warm the coffee is added. The coffee pots all have a similar design but there are differences in the style in different regions in Ethiopia.
The coffee is allowed to boil over a few times and then returned to the pot before the first cup (awel) is severed. (You need to be quick to say if you want it without sugar as this is added as a standard – sometimes up to 3 spoons into the very small cup.) More water is added to the pot again and it is put onto boil while everyone drinks. The second cup served is called the ‘tona’. Following more boiling the final cup (bereka) is served. This is the mildest cup and least bitter. Chatting, dancing and popcorn or bread accompanies the coffee. Frankincense is also burnt on the charcoal to add to the atmosphere. Once the third cup is completed it is time to go back to the tasks of the day.
And yes, for all those I know at home, I do drink a lot of coffee here in Ethiopia! It’s impossible to refuse and I’m getting to like the taste (although that may be due to the sugar ;))
I saw an article recently in the British press about the high under five child mortality rate of the UK (www.theguardian.com/society/2014/may/02/uk-child-death-rate-western-europe-health). It caused me to reflect on the differences between child death in the UK and Ethiopia. The UK under five child mortality rate in 2012 was 4.8 per 1000 (30th in the world). This is high compared to other western European countries (Norway’s rate is 2.8 per 1000) and I agree needs to be improved. However for other countries, like Ethiopia, this rate is something to aim for. In 2012 the under five mortality rate in Ethiopia was 68.3 per 1000 (156th in the world). The rate in Ethiopia has fallen dramatically from 204 per 1000 in 1990. A child mortality rate of less than 5 per 1000 is just a dream currently for health professionals working in Ethiopia and other countries round the world.
It is a tragedy when any child dies anywhere in the world. The aim should always be to reduce the number of children dying and examine the causes of deaths so action can be taken. The lower the child mortality rate gets though the more difficult it is to affect it. Ethiopia has taken significant action to try to reduce the under five mortality rate and meet the Millennium Development Goal to reduce the under five mortality by two thirds. It was announced in September last year, not long after I arrived in the country, that the MDG for under five mortality had been achieved. This is fantastic as it makes Ethiopia one of only a handful of countries currently to achieve this MDG.
Behind the headline figures is another story though. Ethiopia is a federation of 9 regions and 2 city administrations. The rate of child mortality varies considerably between each region with some still having an under five mortality rate as high as 169 per 1000 in 2011, while others have a rate as low as 53 per 1000. You also have to look at the age under five of the child when the death occurs. The rate of neonatal deaths is still high. Although child mortality decreased rapidly, neonatal mortality (death in the first month after birth) has not decreased as rapidly. The neonatal mortality rate was 3 per 1000 in the UK in 2012 (34th in the world) compared to 29 per 1000 in Ethiopia (168th in the world). In comparison to the under five mortality rate as a whole the neonatal mortality rate in Ethiopia has decreased by less than half from 54.2 per 1000 in 1990.
Death is more common here but there is always sadness when a child dies. Families mourn their children no matter how old the child is (newborn or older). Just because families often have many children doesn’t meant that life is seen as cheap or not as important because they are only children. It is particularly hard for me when a child dies who I feel that if they had been in the UK I could have done more to save the child’s life.
Events around a death in hospital follow a different pattern here. In the UK resuscitation attempts are prolonged with the family present and kept informed throughout. I found when I arrived that resuscitation was not always attempted for babies and children, although this has improved since my arrival with nurses now attempting resuscitation even if there is no doctor present. The family is often in a different part of the ward and do not always want to be present with the child. After the child dies they are wrapped in white clothes and given to the family for burial. Usually the male relatives will leave the ward with the child and the shovel and pick axe that are kept on the ward. After the child has been buried they return the tools and the family will leave to mourn in private.
There is still plenty to do in Ethiopia that will affect the child mortality rate. Reducing the neonatal mortality rate is a major part of the challenge and one of the reasons that I am working here in Ethiopia is with the aim of establishing a neonatal unit here at Axum St Mary Hospital. The neonatal deaths here occur mainly due to infection or prematurity and low birth weight. Basic care can help a lot of the babies who currently die. Keeping preterm babies warm, making sure they get the right amount of feed to gain weight and supporting their breathing can save a lot of babies who otherwise wouldn’t survive. For infection it is about recognizing a child is sick and starting antibiotics early. Stopping some traditional practices (uvulectomies and use of traditional medicine) that often lead to infection would also help. Education of mothers and families is essential.
Through improving nursing care, giving guidelines for neonatal care, training staff in newborn resuscitation and care, creating a neonatal unit with the equipment needed we hope to help to reduce the neonatal mortality rate here in this small corner of Ethiopia.