Sunday, October 27, 2013

(Health care)? in Ethiopia

By Annabel Lemma

A month into my first semester at Brown, I caught a cold. It was a normal cold which was accompanied by somewhat frequent coughing. It was not much different from other colds I acquired at previous times, so I treated myself as I always had; I drank a lot of fluids and got a lot of sleep. But my friends kept telling me that I should go health services and get it checked out as it could be a more serious problem. Even though I knew that their advice was out of concern, my first reaction was that it was just a cold, people seek medical assistance when they are really sick and I was not. I had always made fun of those people that went to the hospital for the smallest things and I definitely did not want to be one of them. Thus, I decided against my friends’ advice to go to health services.

My attitude towards hospitals and my definition of sickness are influenced by the community that nurtured me. I was born and raised in the capital city of the very beautiful eastern African country Ethiopia. Living in a country where cases of HIV/AIDS, malaria, tuberculosis (TB) and other diseases are very common, I unconsciously accepted that common cold, flu, headache, stomach pains and similar ailments were really not sicknesses. The majority of the population in Ethiopia rarely seeks medical assistance unless it is an immediate life threatening illness. There is this mentality that is widely accepted that state hospitals are for extreme medical cases. Even in a family like mine, where both adults are well educated, going to clinics or hospitals is not a common phenomenon. I have never had a general medical check-up, and the only times I remember seeking medical assistance is when I needed vaccinations. My father had a problem on his ankle bone and he did not go to the doctor until he actually was not able to walk. His ankle was fixed and he was back to normal in a couple of days, but I cannot help but wonder, what if it was not fixable? What if he was just too late to get it looked at that he was not able to walk anymore?

This refusal of the community to seek early medical assistance has tremendous consequences in both small and large scales. Every day, numerous people in Ethiopia die from curable diseases like TB, malaria and influenza (three of the four leading causes of death in the country. The inability of individuals to seek medical assistance has a significant contribution in realizing this fact. The major cause of the problem, however, is the combined effect of the limited number of health institutions, inefficient distribution of medical supplies and disparity between rural and urban areas. A WHO study  in Ethiopia states that it is estimated that more than half of the population of the country lives more than 10 kilo meters away from the nearest health facility, usually in regions with poor transportation infrastructure. Then the situation changes from ‘I will not seek medical assistance’ to ‘I cannot seek medical assistance’. While the complete unavailability of medical assistance is a major problem in the rural areas of the country, the unavailability of medical supplies, the quality of medical care that is provided and affordability of health care pose as the major difficulties to people who live the urban areas.

A couple of years ago, one of my father’s close friends was diagnosed with End Stage Renal Disease (ESRD). Because he was diagnosed at the very last stage of chronic kidney failure, he only had two medical options that can be carried out in order for him to be able to survive. His first and more preferable option was to get a kidney transplant while his second option was to enroll in a regular kidney dialysis treatment. There are not any hospitals in the whole country that are well equipped to perform transplant surgeries, as thus no transplant surgeries are currently performed in Ethiopia. The cost of getting a transplant surgery in a foreign country together with the cost of travel for the organ donor and receiver is unimaginable to the average Ethiopian with a per capita income of US$370/year (World Bank) and consequently the option of transplant surgery was out of question. The only option he was left with was regular dialysis treatment. Three years ago there were two medical institutions that provided dialysis treatment; the main referral governmental hospital and a private hospital in the capital city. By the time my father’s friend was sick, all the 25 dialysis machines in the governmental hospital were out of order and no dialysis treatment was offered there anymore, and sadly it still remains that way after two years (I visited the hospital during summer 2013).

Without any other options left for him, the ESRD patient enrolled in a dialysis treatment that costs US$120 per session in the private hospital. There is no health insurance system in Ethiopia and we also don’t have a publicly-funded health care system. In our system, individuals pay for the service they are provided at the time of treatment. At the beginning, he attended three dialysis sessions per week, later it was reduced to two and at the end even one. Friends and family helped him morally and economically to their capacity, but there was only so much that they could do. I could not imagine the position he was in when his life suddenly transformed to the worse when he changed from a healthy capable man with a good standard of life to a being dependent on others. It must have had a lot of psychological impact on him. He sold his car and later his house just to see the light of another day. But inevitably the time came where there was nothing he could sell anymore and he was living off of other people. He stopped working because he was too weak to carry out the tasks that were assigned to him. It is so hard to live with just one dialysis per week. He then later passed away.

His case, for me, embodies everything that is wrong with the Ethiopian health care system. The first of all is his failure to get diagnosed earlier, which possibly could have resulted in a different outcome of the story. The second is the unavailability of medical supplies, medical practitioners and health services that resulted in the unavailability of transplant surgery and dialysis. The last one was the unaffordability of the little available medical care in the country which resulted in his economic downturn during his struggle to better his health condition. What makes this case more unbearable is the fact that there is so much that could have be done to better conditions. This is just one of the many cases in the country that are heart breaking, there is so much we can improve—so much we can fix. From small social changes like increasing the availability of clean water and sanitation, to providing education to the community about the early symptoms of widespread diseases and dispersing primary care throughout the country, there are definitely many things that we can carry out to bring change in the general health of the population.

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