It’s time for Africa!
Selam!! (Peace in Amharic)
Without wanting to sound overly dramatic this is a fairly overwhelming blog to write so to do it justice but so you don’t fall asleep, I’ll write it in instalments.
It has been a busy schedule for the last couple of weeks… My first trip to Africa, and it did not disappoint! Ethiopia is definitely an assault on the senses but a thrilling one all the same so I hope that comes across here!
Firstly a huge amasegnalhu (thank you) so much to the Save the Children team in the country office for hosting me, making me feel so welcome and at home when for me it was such a stark contrast to the now familiar London offices.
I have to say the first challenge was appearing to feel calm on the ride from the airport to the guesthouse- Ethiopian roads are notoriously hectic and dangerous, with the surprise crater popping up to throw the van off course every now and again (security warned us there was a 10% death rate from all road accidents and to avoid ground transport where possible!). It did give me a chance to speak to a colleague working as a consultant for StC and as it turns out in a similar area- the more people I speak to the more it becomes apparent the interdependencies of the groups and opportunities for collaboration.
After settling in, (and the 3/5/7am wake up calls to prayer from the local mosque ), trying my first Ethiopian food- injera, I met the nutrition team the next day. It was great to finally meet the people I had been emailing for the last 3 months. I realise it’s not always possible, but having the initial discussions with the team to frame objectives for the trip and my project, and discuss their concerns really highlighted the importance of face to face interactions to build relationships and actually how much more efficient it can be than battling connection/time difference and hectic schedules via skype (the Ethiopian internet services are a massive challenge, which I hadn’t fully understood until it took me 25 minutes to load 3 emails!- a frustration shared by my Ethiopian colleagues trying to promote and support online monitoring tools).
The dynamic of the country is fascinating and was also really important to understand to put the nutrition programs in context. A lot of the acute malnutrition programs (SAM/MAM) are in response to emergency, currently the aftermath of Ethiopia’s worst drought in 50 years!
Each region has it’s own identity, resources, livelihoods, clans and languages which is a huge challenge when trying to implement programming -reaffirming that one size just doesn’t fit all and the environmental context is invaluable to predicting, reacting to, and designing the most beneficial programming and support for beneficiaries.
Dire Dawa region ( North east of the capital and bordering Somalia and Djibouti) is fairly complex with a mixture of pasturalists (who tend to be nomadic- moving to wherever they can pasture their herds of camels, goats or cows mainly) and agriculturalists growing crops, mainly cereals. The nomadic clans are the biggest challenge as they are hard to track and trace in the clinics and have a particularly high rate of defaulting (not being able to attend follow up clinics for additional treatments).
Visiting the clinics it struck me how resourceful people can be- you would not believe how remote some of the health extension posts are (some 100s of km from the nearest town- we drove for well over an hour through essentially desert land to reach Shinile and Erer health posts) but the clinics are able to triage cases and offer much needed treatments within the community or facilitate in patient referral for communities that would otherwise not have the chance to access healthcare at all. The clinics offer nutrition treatment and counselling, services for pregnant and lactating women, Water, Sanitation and Hygeine information services (WASH), vaccinations and under 5 healthcare generally. I had the opportunity to look at patient records and really understand the challenges of data collection and monitoring in such remote locations-and also pick up some of the local language (Amharic) . It’s not uncommon for families to have to travel 10km+ to attend these clinics, many of them on foot and it’s a testament to the dedication of the volunteers who go searching communities screening for new cases for the clinic.
We passed by settlements that accumulate around water sources- understandably people use the water for drinking and washing- themselves, animals, vehicles and as a toilet-with massive health implications as you can imagine which is where the WASH education comes into play. Being around farming communities there were also an alarming amount of rifles being carried- never in a threatening way but still not what I’m used to!
We also experienced the delivery of aid trucks to Shinile district- distributing grains, and a real sense of the desperate situation that these communities find themselves in- women with babies arguing over rations- really hard to see, making me feel pretty helpless and guilty 1. for not having anything to offer and 2. for how wasteful we can sometimes be.
It was the full field trip experience – with tyre blow outs, car breakdowns in the desert, camels, tuk tuks, monkeys on the runway, a real baptism of fire, but more than I could have hoped for!
The insight from the field offices was invaluable in being able to put the challenges in context- balancing government, donor and internal monitoring and reporting, whilst ensuring quality of the delivery of programs. From my perspective also understanding what is realistic to be able to implement in such remote communities given the resources and how further development of CMAM report could be prioritised and supported.
Next stop…. Hawassa in the south (via Addis)….