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August in Africa- Blog IV  (3 comments)

Posted by: Michael Leavitt
Friday, August 22nd, 2008

Written August 12, 2008

Today I will write about a remarkable young woman I met in a remote area of Africa. However, I will first describe the context of our meeting.

I asked my friend Tewodrose Adhanom Ghebreyesus, Minister of Health for Ethiopia, to show me the system of Health Extension Workers (HEWs). Our government, through our HIV/AIDS, Malaria and USAID funds, has helped build the system. We need to ensure our money is building capacity for ultimate sustainability and not just creating an endless dependency.

To understand the design of this effort, one must first remember the starting place. This is a nation estimated to have 80 million people. Statistics don’t do the level of poverty justice, but the average annual income is $700, although the majority of people earn less than $100 a year. The entire gross domestic product of the nation is about 80% of the non-entitlement budget of HHS. Vast numbers of the people live in villages where the word remote is inadequate. The average life expectancy of a male is less than 46 years old.

The Prime Minister and Minister Twedorose properly concluded that improved health was a pre-requisite to improved economic vitality. They also concluded that with the resources they had available to them, improving health through normal methods was impossible. They had to build something unique, and they had to start basic. They concluded the first objective was to build a primary health system that was within the reach of every Ethiopian citizen. They created a construct that calls for training 30,000 public health workers known as health extension workers.

HEWs are almost all woman and typically young, generally 18 to 25 years old. The Ethiopian government sought to identify high school educated woman from every area of the country and set up a training course that lasted one year, during which the women were taught to provide a surprising and impressive array of services, and a limited number of medical treatments.

By design, HEWs live in their communities, work in pairs, and cover 1,000 households. Their job is to know the people in their community on a personal enough basis that they are able to teach, persuade and enable the adoption of improved personal health practices in a way that will attack the problem of poor health at the root.

The Ethiopian government has undertaken (again with help from HIV/AIDS money from the United States) to build a series of health centers; one for every 250,000 people. These health centers have the capacity to provide basic curative service and have around 15 beds capable of managing a patient for up to 48 hours. These are typically managed by the equivalent of what we know as physician assistants. When needs go beyond what the health center can manage, they aspire to get patients into a system of larger hospitals.

The Ethiopian government reports considerable progress on fulfilling this vision. They will have recruited and trained 24,000 of the needed 30,000 health workers, for example. They admit to being a little behind on opening new health centers, but the reality is all systems like this have weak spots and break downs, and the goals of starting with prevention and focusing on the basics seem logical and admirable.

The Minister accompanied my delegation, which included Dr. Julie Gerberding and Tim Ziemer, the Coordinator of the President’s Malaria Initiative, to Axum, Ethiopia, a small city on the northern border. Our purpose was to accompany a HEW into homes and watch her work.

In that setting, I met Abrehet Tarekegne, an attractive and smart 20-year-old woman, who has been working since she was 18 years old as a HEW. Together, we visited a family that lived in a dwelling that appeared to be typical to the area. It was made of a collection of materials including mud, stone and straw. The family had seven children ranging in age from late teens to three years old (my estimate). They cultivated the land around them with some corn and wheat. They had some chickens and three cows, which they yoke and use to plow and cultivate their fields. They told me proudly about bees they raise. It is the one crop they have that generates cash. They get the equivalent of $50 per hive. Last year they generated eight hives.

Abrehet told me privately about the conditions in which the family was living when she first visited them two years earlier. There was no separation between themselves and their animals. They had no latrine system, no malaria nets and little idea of personal hygiene. My visit revealed they had rearranged their living quarters to separate the animals, though not as completely as she hoped. The living quarters were small, maybe 14 feet by 14 feet. There were two beds, both with bed nets. They had a latrine system built so that the waste was kept away from the house. She insisted I go inside the latrine to show me the way it worked. It was slightly more information than I wanted, but it demonstrated to me how committed these health workers are. She had a list of over 250 homes she was working with.

I asked how many visits she is able to make. She told me her goal is to spend considerable time with 10 families a week. She said, “I like to spend enough time with each one so that I can make real progress. Sometimes I have to help them do things.”

3 Responses to “August in Africa- Blog IV”

1. Marion Pattillo says:

   August 22, 2008 at 4:24 pm

   My brother-in-law recently gave me a copy of a book about how the Chlorine Dioxide Ion has been tested with patients in Africa to kill malaria, but that the discoverer of the simple and affordable treatment has been unable to get it further tested with safety and efficacy studies. The ion is apparently released when Stabilized Oxygen is combined with vinegar for three minutes and taken with water…

   I am a former hospital administrator from county teaching hospital in Fort Worth. I also worked with a major drug company to train their research associates…I can see why there would be little interest from drug companies for so simple a treatment…but I would think other humanitarian groups would at least investigate it…given the enormous need the Secretary is seeing on his trips in the area.

   After reading the book, I contracted the flu and decided I felt so bad…why not try the drops sent to me with the book..The next morning I was completely recovered. We keep it on hand now for just such occasions and have had the same results–whether respiratory or gastro-intestinal flu! Stronger doses are reported to have caused recovery from patients in Malawi who tested positive for malaria and then their blood tested negative for malaria after the simple treatment within days.

   Has anyone ever checked the treatment out?
2. Rose Araya says:

   September 22, 2008 at 1:55 pm

   Back in 1967 I was a PCV in Ethiopia and stayed at a health clinic for a few days on my way to visit Lalibela. Then the special project was against malaria – that was before HIV/AIDS. At that time the HEWs were young men (I suppose now the men are in the military). It is very sad to see how the Ethiopian government has squandered its funds on war and international bickering with Eritrea, instead of building up the country. There is a movie called “Black Gold” about coffee growers in southern Ethiopia – whose children are malnourished because they grow cash crops instead of food crops. I have seen on the news that famine is returning to Ethiopia.

   In reading the comments above, I was surprised to see all the entries on your proposal to limit women’s health options (and not on Ethiopian Health Workers!). The comments mostly support the rights of medical personal to refuse women the care they need. How about all the women who will be injured by such lack of care. If these people really wanted to reduce the number of abortions, they should be more than glad to have more women’s health options.

   I agree with the person who commented:
   “I am truly dismayed by the proposed regulation from the U.S. Department of Health and Human Services (HHS) that would permit health providers to refuse to provide health care based on religious or moral objection even though they are receiving federal funds. This is a clear violation of the separation of church and state, as well as a threat to anyone”woman or man”seeking reproductive health care. As a tax payer, I will not tolerate this.”
3. ArabBible says:

   September 22, 2008 at 2:14 pm

   I enjoyed reading about your trip to Africa…….the people in the United States should be very thankful that they have such high quality health care