Ethiopia - Eye Opener

The day starts well. The breakfast menu at the local café is probably the best I’ve found in Africa; there’s no boiled cows foot soup, dry bread with salty butter, anaemic omelettes, papaya... In fact it’s so good I seize the moment and order two things. Breakfast banquet over we rush off to meet the outreach team. We wait while they finish packing the vehicle with medical equipment and then prepare to head out to the field. It’s another false start - the outreach team need to have breakfast first. We loiter and potter for an hour. We then head off to the outreach location together. My child-like excitement at seeing the programme first hand has not yet subsided. We bounce along the winding roads as we head yet further up into the highlands. Settlements become more sparse, poverty more obvious. But it’s what I’ve come to call ‘picturesque poverty’ – thatched huts, lush green surroundings and full of life, not the scenes of desolation and despair that covered our TV screens two decades ago. We reach the government health post where the outreach will be based today to provide some of the family planning services the Health Workers are unable to. I step out of the car and immediately regret not having had the foresight to bring a hat and gloves; the wind is howling over the mountainside and its freezing. Everyone is walking around wrapped in blankets, only their heads and feet showing.

The health post is typical of local buildings – it comprises three small rooms constructed with a frame of tree branches, walls of mud, straw and dung, and a roof of aluminium; there are windows but no glass. The outreach team are tasked with turning this into a sterile but welcoming environment in which to conduct consultations, medical procedures and recovery. In less than an hour the team are set up and ready for the first client.

While the first client is having a tubal ligation I cower out of the wind behind several huge stacks of dried animal fodder and corn. An Ethiopian colleague translates for me as I start a conversation with a woman who is huddled outside the health post wrapped in her blanket. She was there to provide moral support to the first client who’d come for a tubal ligation on her recommendation. A year ago she too had come to Marie Stopes on the recommendation of a Government Health Worker. A widow with three children, she decided her child bearing days were over and that a tubal ligation would simplify her life. It was a success story; she’d only felt discomfort for a couple of days, and hadn’t felt healthier or happier since. When I asked if there was anything we could do to improve the service she said only “I did not know about Marie Stopes until someone told me. Most people don’t know. You need to go out and tell more people about it”.

The second client was happy for me to sit in on the procedure so I sat in the corner of the cramped makeshift operating room while the three staff went about their business. Central to the organisation’s approach is a pain management technique which seeks to reduce reliance on pain relieving drugs in short procedures. As someone who is queasy and has a pathetically low pain threshold, this isn’t a concept I warmed too. But I sat there and watched a woman lie in silence as her abdomen was cut open, her fallopian tubes pulled out and tied together, and her abdomen stitched back together, with nothing more than local anaesthetic, distracting conversation, and a comforting and encouraging team. If I hadn’t seen it first hand, I would have struggled to believe it.

Disappointingly that marked the end of the services today. Clearly we really do need to go out and tell more people about the services. We packed up the vehicles, agreed we’d conduct a debriefing back at the clinic out of the cold, and headed back. We arrived ahead of the outreach team and waited. We were reassured they were “on their way”, “nearly here”, “not far”. An hour later they arrived. They’d stopped for lunch. I think the Ethiopian language must have a lot of ambiguity within it if a group of Ethiopians can’t reach a shared understanding of what’s been agreed. There’s also an intriguing habit of randomly inhaling sharply at the end of sentences, almost in a Gordon Brown style.

We lunch at 4pm, return to the clinic to look at the records and stock for a couple of hours, and then head off for what I’m told will be a “cultural experience”. We wander through a non-descript entrance into a dark bar strewn with cow hides and the skins of more exotic animals. In the corner of the bar are a musical trio – two typically beautiful Ethiopian girls and a half drunk young man. They take turns to sing, play a guitar like instrument, and drum. The girls excel at singing traditional songs with sporadic high pitch whooping noises, dancing with their shoulders and necks in a style oddly enough akin to the 1980s hit ‘Dancing like an Egyptian’ and Shakira. They have the men entranced and they respond by tucking notes into their tops. The half-drunk young man excels in working his way around the bar, spontaneously making up amusing lyrics about each individual. He has everyone in hysterics and they respond by tucking notes into his top too, if only to encourage him to move onto the next victim. It’s a great and unexpected end to a long day.

Over breakfast the following morning, as we complemented the waitress on smiling through our numerous requests for bespoke breakfasts, I learn that there’s a world record for laughing and it’s held by an Ethiopian.