Report of planning visit to Ethiopia

November 2012

Anna Cannon, Ethiopian Co-ordinator
Sarah Norris, Secretary

Friday 23 November 2012

Three of the trustees from midwives@ethopia, Anna, Jane and Sarah left Heathrow on a planning visit to Ethiopia.

Saturday 24 November 2012

Arrived at Addis Ababa 75 minutes early because of the strong winds and after a short wait and an Ethiopian coffee we were picked up and taken to our hotel.

During the afternoon we were able to visit the National Museum in Addis Ababa to see Lucy, the oldest skeleton ever discovered.    We then visited Debrewerk Getachew in the Mueshulakia Health centre in Addis Ababa to discuss and agree plans for future training and support from the charity.  Debrewerk is a fantastic role model and leader who has achieved so much in the health centre since he has taken over.  We have worked with Debrewerk for a number of years, he initially attended one of the training sessions run by Southern Ethiopia Gwent Health Link (SEGHL) and after further training he is now the health officer in the Health Centre.    We had a very productive visit including a tour of the facilities and were able to agree training programmes that we will help deliver during our May 2013 visit; the training will also include midwives from the surrounding health centres to ensure a wider audience and good use of time.

In relation to our partnership working both parties signed the Memorandum of Understanding (MOU), we provided Debrewerk with some training materials as well as our business cards, bookmarks and an m@eposter.  Prior to our visit we had obtained a number of training DVD’s from Medical Aid Films (MAF) and Debrewerk kindly agreed to use them with his staff and provide feedback; we will send this feedback to MAF as agreed.

We agreed that this partnership will be very positive both in Ethiopia and for anyone associated with midwives@ethiopiacurrently and in the future.

Sunday 25 November 2012

We were collected by our driver, Hamid and began our journey to Hawassa after visiting a house that we may be able to rent for future visits rather than staying in hotels; it could be cheaper and offer a more relaxing stay in Addis Ababa.    We settled our bill for the hire of the 4×4 (£200 + 700 bire) and filled up the car with petrol on the journey; 800 bire.  Sarah agreed to take responsibility for recording the expenses, important for our records but also to ensure we have accurate costs to use in future bids.

There was much discussion in the car about the various bids we were planning to submit and what should be included as well as some musings about the future of midwives@ethiopia– blue sky thinking at its very best!!  Thoughts included:

  • Administrative support – agreed to build up to 1 WTE and cost at A4C Band 4 to ensure the person has the right skills.  The role to include assisting with the completion of funding  bids, travel arrangements, marketing, fundraising, an annual celebration event and a  conference in Addis Ababa.
  • Midwife based in Ethiopia to help support the work of midwives@ethiopia i.e. arranging training, working, supporting partners in Ethiopia and in the future supporting student midwives and midwives who visit Ethiopia with the charity.
  • Base in Ethiopia – ?rent a small space in the Mueshulakia Health Centre.
  • Transport – consider the purchase of a Land Cruiser and ship over from Dubai.
  • Annual event in the UK to market the charity and also to thank supporters.
  • Consider opportunities for student midwives and midwives to support midwives@ethiopia and visit Ethiopia in the future.
  • Purchase of flower pots/metal containers for Mueshulakia Health Centre to increase the numbers already there, support the gardener so the health centre has a positive environment.
  • Purchase of training materials for Mueshulakia Health Centre – need to consider storage and maintenance.
  • Buy a birthing stool for Mueshulakia health centre.
  • Build a guest house for m@e to stay and rent out to generate income.

Sarah and Jane had an Amharic lesson from Anna and Hamid during the journey, it was suggested that we should be tested to ensure we are learning and committed!   One way to focus one’s mind and learn.

The journey provided many opportunities to talk and plan as well as seeing wildlife; Baboons on the road as well as a number of dead animals; hyenas, donkeys and dogs.  On our drive into Hawassa we spotted Hippopotami in the lake so took the opportunity to take some photographs much to amusement of the local residents.

We booked into Kifle Selam Hotel in Hawassa, a hotel suggested by Metisabia as it was central and very nice.  Metisabia is a nurse lecturer who is keen to work with the charity by providing support during our visits i.e. arranging meetings, hotels and possibly teaching midwives and Health Extension Workers.  After checking into the hotel we walked to the lake to stretch our legs after the long journey even though it was nearly dusk, it was very busy with walkers, young couples and a wedding party.  We heard the hippos roaring in the lake; saw a snake and lots of lovely birds.  Metisabia joined us briefly in the evening to discuss our visit and also invited us to her house on Wednesday evening for dinner with her parents.  Anna telephoned Dr Aberra, a Consultant Surgeon who was a partner with SEGHL, who we hoped to meet during our stay in Hawassa as he is very supportive of the work we will be doing in Ethiopia; he will be a great help during our visits and will be able to put us in touch with new contacts.

Monday 26 November 2012

We visited the Regional Health Bureau (RHB) to meet Ato Kare Chawicha, Head of the RHB and Ato Habtamu Beyene to discuss the work of midwives@ethiopia and our plans for the future.  We presented the relevant papers pertaining to midwives@ethiopia; the strategy and constitution as well bookmarks and business cards.  Ato Kare was very positive about our charity and the teaching we are planning with our partners in Hawassa College of Health Sciences (HCHS) and Yirgacheffe Health Centre.   He suggested we should ensure we meet with him each time we visit Ethiopia to keep him up to date with our progress and to ensure we receive the necessary help and support.    Our reception here was very positive and so encouraging for the future plans of m@eas without this support it would be impossible to work effectively with our partners. We look forward to a strong relationship with Ato Kare and Ato Habtamu and their team.

After our meetings in the RHB we went to Hawassa College of Health Sciences to meet with the Ato Sintyahu, Head of Midwifery and the team of Midwifery Lecturers to introduce them to midwives@ethiopiaand to ask their views on how we can work in partnership to deliver training to the lecturers, midwives and possibly student midwives in the future.  Unfortunately Ato Sintyahu was not available as he is studying for a Masters and was at University; however we had a very productive meeting with Wro Rubka, Wro Kidest and other midwifery lecturers who gave us some great ideas and are very supportive and excited by our proposals.   We provided them with the paperwork including the strategy, constitution and MOU but they explained that they could not sign the MOU and suggested we meet with the Dean, the responsible person; a meeting was arranged by   Kidest for us to meet the Dean later that day.

During the afternoon we met with the Dean, Wosenyeleh Semeon Bagaljo and had a helpful meeting where he was able to offer us some advice about how we could work with the College.  He also suggested who we should communicate with when planning training and visits to Ethiopia and we were able to provide reassurance about our work to date and that we had that morning had a very positive meeting with Ato Kare.   The Dean suggested he required time to read the MOU and consider any implications for the College and we agreed to meet with him again on our return to Hawassa later in the week.

Tuesday 27 November 2012

We left Hawassa on the next leg of our journey; south to Yirgacheffe via Dilla.    While in Dilla we had a problem with the car and needed to have a puncture fixed in a local tyre company; we were reassured that the tyre was safe and would not cause any further problems.  We left Dilla to complete our journey to Yirgacheffe.

On arrival in Yirgacheffe we booked into the local pension, a new place to stay.  It was lovely and clean and there was hot running water; what a luxury!

During the afternoon we visited the Health Centre and the staff working in the maternity unit.  The major change since our last visit was the amount of building work; the health centre will become a community hospital which is fantastic news and a positive addition for the community of Yirgacheffe.   We met with Zenash; the Head of the Heath Centre to discuss the charity and clarify if she felt there was a need for on-going training of midwives and HEW’s.  Unfortunately, it was her first day in her job so we tried very hard not to overwhelm her with information; we were pleased that she felt we could work together and that the midwives did require support and training.  We spent time meeting the staff and were able to provide them with some baby clothes to give to newborn babies and ascertained that they would like more training as well as some equipment to help them care for women in labour.  Equipment required included mattresses for the beds, delivery packs for the HEW’s and Kiwi suction pumps.  We also discussed the use of Misoprostol for the treatment and prevention of postpartum haemorrhage and this was felt to be an important contribution by m@eand would make an enormous difference in the care of women and reduce the numbers of women dying.

Sarah and Anna spent time talking to one of the midwives about her midwifery role in the Health Centre.  The plan is to write an article and hope that it will be published in a professional midwifery journal in the UK.

The weather in Yirgacheffe is often very wet with tropical storms and true to form as we were leaving the Health Centre there was a thunder and lightning storm.  Luckily since our last visit a couple of women had set up a small café outside the gates of the Health Centre and we were able to shelter under the tarpaulin while sitting having a coffee.  We were a local attraction for a while as many of the children crammed into the small café area; I think they thought we were very funny but they all loved having their photographs taken.  The owner was very patient and we promised to return to see her in May 2013.

Ahammed was able to come and collect us and on arrival back at the pension Anna spoke to Ato Nenko who advised that we should meet with Elias, Head of Rural Health Office; we immediately made our way to his office.  We had met Elias during our previous visits as his last role had been the Head of the Health Centre and he had made some very positive changes during his tenure.  Given that he was aware of the work of the midwives from SEGHL he was very positive about the continuation of the training and was able to offer advice and support for our future visits.

Wednesday 28 November 2012

We left Yirgacheffe to make our way back to Hawassa but with plans to meet with senior members of staff at the Gedeo Health Zone Department in Dilla.   We met with Ato Nenko Sorsa and Ato Bizuneh and were able to provide information about midwives@ethiopia and our plans to work in partnership with staff in the Health Centre at Yirgacheffe, the Rural Health Office and the Health Sciences College in Hawassa to delivery training programmes to lecturers, midwives and Health Extension Workers (HEW).  We had an interesting discussion about Traditional Birth Attendants and future training; we were informed that the Government’s plan is to ensure all pregnant women are cared for by trained midwives or HEW’s and we should concentrate the training on these groups of staff.  We were pleased that they were happy to support the charity and facilitate opportunities for us to work in partnership with the staff in Gedeo Zone.   We both signed the MOU and planned to meet again in May 2013.

After arriving in Hawassa we met with the Dean of HCHS and were pleased that we were able to sign the MOU together and both agreed it will be positive to work together in the future.

In the afternoon we made the decision to visit the Adare Hospital in Hawassa to try and arrange to meet with the individual in charge of the maternity unit.  We were able to meet Dr Eyasu Elias, Obstetrician to discuss the skills and knowledge of the midwives and whether there was a need for them to attend further training.  Dr Elias was in agreement that the midwives would benefit from training in obstetric emergencies and will be released to attend the training planned for May 2013.

In the evening we went for dinner with Metisabia and her family which was lovely and we were treated to excellent Ethiopian food, hospitality and a coffee ceremony.

Thursday 29 November 2012

Up very early to get back to Addis Ababa, we had wanted to get back by lunchtime but unfortunately we experienced a ‘blow out’ in the tyre that had been fixed in Dilla.  Luckily we were driving through a town and Ahammed was helped to change the tyre by some of the local men; good job he wasn’t relying on us 3 to help, delivering a baby is one thing, changing a tyre is another!!!

One of the memories of the week occurred on our way back to Addis.  As we were travelling along the main road there was what seemed to be a dust storm but it was actually about 200 camels being herded down the road by men from the Affar tribe.    Apparently they do not like having their photographs taken, we did not find this out until after we had taken a picture.  An interesting scenario followed but we do have an amazing photo.

We had a quiet afternoon getting our thoughts together after a busy week.  We had planned to write the report, an article for publication etc. but somehow this did not quite happen.

Friday 01 December 2012

During the morning Sarah and I visited the Ethiopian Midwives Association and met with Hiwot Wubshet, Executive Director and Ato Mengistu, Head of Administration to talk to them about midwives@ethiopiaand discuss the possibility of working together in the future.   We were very pleased that Debrewerk could join us for the meeting as he was able to provide evidence of the training and to support our work in Ethiopia.

Hiwot gave us an overview of the EMA and the midwifery situation in Ethiopia.  The EMA are meeting with the 43 teaching institutions across Ethiopia to identify gaps and are advocating that lecturers have 2 years midwifery experience before going into teaching.   Associate lecturers are being developed and these individuals will be a positive conduit between academic institutions and health facilities.  In terms of training they are linking with BEMOC in association with the Ministry of Health and currently have 16 trainers who provide training in 4 sites; to date they have trained over 1000 midwives.   The EMA are lobbying to have a midwife based in every Regional Health Bureau to support their plan to improve the status of midwives.  Hiwot explained this is a challenge but believes it is better than previously and is positive for the future because the government are keen to promote midwifery.

We were able to provide information about midwives@ethiopia, explained our aims and objectives and our desire to work and link with the EMA in a way that will support midwifery in Ethiopia.  We discussed our desire to hold an annual conference and Hiwot felt it may be more beneficial to concentrate on one geographical area rather than hold a conference in Addis Ababa.  However, she explained that the EMA are planning to hold a conference next year and it was agreed that as our next visit will coincide with the dates of the conference we would give a lecture at the conference.

It was agreed that it will be very positive to work together and one element of support we could provide was relevant strategic and professional documents i.e. NMC Code of practice as the EMA are producing standards for all midwives practicing in Ethiopia.   2 midwives who have previously attended training in Hawassa with SEGHL are now working in the EMA and will provide great opportunities for communication and collaboration.  We plan to meet with representatives of the EMA each time we visit Ethiopia.

During the afternoon we visited one of the markets in Addis Ababa to buy the contents of a delivery pack for every HEW who attends the training provided by midwives@ethiopia.  We had discussed this with the staff in the Health Centres and they felt this would be a very positive contribution which will provide the HEW’s with the necessary equipment to conduct a clean delivery.  The idea will be to post a photograph of the pack/bowl on our website to provide information for potential supporters who wish to donate.  The bowl/pack will be purchased locally at a cost of £1.50 and we hope this will make a difference to the women and babies giving birth in the community.

We left Addis Ababa at 01.15 hours for the overnight flight home arriving late at Heathrow because of the dreadful weather conditions.  As always at the end of such a busy and emotional trip it is lovely to be home but sad to be saying goodbye to friends, we agreed the trip had been very successful and provided us with many opportunities for the development of the charity.

Written by Anna Cannon and Sarah Norris

Trip Report Week 2