Medics from Gwent keeping Ethiopian mums and babies healthy
IT WAS 18-year-old Shemsia Sultan's first baby and things were not going well. She had been in labour for many hours with no sign of progress. It was late at night and the nearest aid was at a health centre 40km away.
Shemsia's family phoned them to ask for help. The centre had recently taken delivery of a motorbike ambulance from the Gwent-Southern Ethiopia Link and it was soon on its way to pick Shemsia up. Later that night, a midwife, trained by the Link, helped deliver a healthy six and a half pound baby girl.
In Ethiopia, one in 27 women die from pregnancy-related complications and 85% of people live in rural areas, far away from hospitals. This means it has one of the world's highest maternal death rates, but this Gwent charity is here to help fight this terrible toll on the country's women. I'm travelling into Ethiopia’s poor and rural south with the Link to see how they tackle this problem. My companions are Drs Biku Ghosh and Robyn Phillips of the Link and the Chief Medical Officer for Wales Dr Tony Jewell.
The Link helps in many ways. It gives training, it gives equipment, like the motorbikes. But Nevill-Hall based Dr Robyn Phillips is going to lead a workshop, complete with flipcharts and (electricity allowing) a PowerPoint presentation. She might even talk about stakeholders and ‘gap filling’.
One health centre manager tells me they have no midwives, no microscope and no reliable electricity. How can a workshop help him?
This is Dr Phillips’ fourth visit to Ethiopia and she's confident it does. “They help us identify needs and how they're using equipment. They can tell us if kit is not working. Good practice is shared and where there is need we can 'gap-fill' with equipment, influence or training."
This term 'gap-fill' is often used, mostly referring to skills and equipment. It's because in a poor country like Ethiopia there are a lot of gaps. Gaps between what should be provided and what actually is.
Some things are too expensive for the centres to buy themselves. We took five diesel generators with us, and each of the £1000 machines are given out and soon will be giving health centres reliable electricity. Biku tells me how important they are: "It's not just lighting. Microscopes and centrifuges need electricity, you can't do blood tests and make diagnoses without these".
One health centre manager tells me: "I'm so very happy to get this generator today. Now we can have light."
While Robyn wrestled with shortages at health centres, Biku, Tony and myself went to Dilla hospital. Our Landcruiser bounced up the rutted track outside, the hospital, housed in single-storey, barrack like blocks. Its gloomy interior contrasted with the bright, covered walkways leading to fragrant, unkempt, flowerbeds.
It was clear that all was not well here. Filthy corridors, often crowded with people, led onto equally dirty wards. In the corridor outside the operating theatre, the green line, beyond which is supposedly a sterile zone, was all but invisible.
This contrasted with the pathology lab. The link had donated some microscopes to the hospital and we were shown a clean and busy lab with them standing smartly in a row.
Other equipment we saw was an oxygen concentrator donated on a previous visit. These vital machines deliver concentrated oxygen to patients. Pure oxygen cylinders are expensive and must be brought from Addis Ababa. On this visit the link also imported 30 of these to be given to hospitals in the southern region serving 17 million people.
Following us was a little boy, about three years old. Everywhere we went, he went, eyeing us curiously and giving us a cheeky smile. I asked a doctor who he was. "He’s an orphan" said a doctor. "His mother will have died in the hospital and there's nowhere else for him to go."
The next day we headed further south to Chilelektu, a small town 62km from Dilla. Our guide is Elias Gutey - manager of a health centre in nearby Yirgacheffe. The steep, winding tracks we drove are the sort of roads that the motorbike ambulances could easily cross.
These visits highlight what works and what sometimes doesn't in the link's relationship with health centres.
The motorbike ambulances are clearly a success story. Chilelektu’s bike is in good repair and has a plaque marking its donation by the Gwent link. Education on cleanliness has paid off here. “The cleaning lady has managed to keep this centre clean without a reliable water supply and that's very difficult." says Biku. Other centres and Dilla hospital didn't manage this.
The closesness of the relationship between the centres and the Link is apparent. Biku discovered in one of his fortnightly calls to each health centre that the generator had failed earlier this year. He called Elias and the generator has been working since then. I met many people like Elias who Biku has worked with for over many years. "Continuity and trust are important" he says.
Often, despite earlier encouragement and promises, broken equipment is left unrepaired, pharmacies and store rooms are disorganised, wards are dirty. A recurring theme is getting basics right. "Cleanliness, organisation and leadership are so important" Biku states, “without them, their job becomes much harder."
Elias told me why some centres found this difficult. "Without a lot of water it's difficult to keep them clean."
Before we return to Hawassa, there’s time for Biku and Robyn to meet the mayor of Yirgacheffe and argue against plans to build a hospital 2km from the town centre. Biku explains it would be a bad idea. "The location is the most important factor - it must be accessible” he tells him.
I ask Biku if he ever feels daunted by the scale of the challenge: "Some people say 'this is Africa' as if to say nothing should be better here. I ask 'Why not?' There is always something you can do."
For twelve years they’ve kept doing; training, persuading, checking, building relationships, giving time and equipment. And those people from Gwent and Ethiopia, although separated by 9000km, are helping to bring two very different worlds closer together and fill those gaps to keep Ethiopian mothers and babies healthy and safe.