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Inside a health post in Maianbessa, a rural village about 25 kilometers outside Mekelle, Ethiopia, on September 4, 2009.
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Editor's note: Hanna Ingber Win, the Huffington Post's World Editor, was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world's worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying.
This is the fourth of a five-part series on what she learned on her trip.
MAIANBESSA, Ethiopia -- I get into a UN Land Cruiser with the UN Population Fund (UNFPA) staff coordinating my visit to Ethiopia and an official from the ministry of health to visit a rural health post. We leave the northern Ethiopian city of Mekelle, and its Obama Cafe and Obama Pool House, and drive about 25 kilometers along winding roads into the countryside. We pass donkeys with packages strapped to their backs and young boys using foot-long sticks to herd their families' cattle. Other young boys jump and down when they see our vehicle, hoping to sell us a live sheep to buy and then slaughter for the upcoming Ethiopian New Year.
The Land Cruiser zigzags around the uneven terrain, trying hard not to get stuck in the deep pockets of mud. We must also avoid hitting the donkeys and sheep standing in the middle of the roads. According to a common saying, if you hit an animal, you must pay its owner the value of that animal plus the value of seven generations.
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Inside a health post in Maianbessa, a rural village about 25 kilometers outside Mekelle, Ethiopia, on September 4, 2009.
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Eventually the road becomes too narrow for a vehicle, and our crew gets out to walk the next couple of kilometers.
Yellow stone homes shaped in small rectangles dot the lush green fields. Women sit on the grass sifting legumes to later boil and eat with injera, the traditional Ethiopian bread that looks like a flat circular sponge. Guard dogs stand on the rooftops, which stand only six or seven feet high. A farmer walks by holding a live chicken with its legs bound. Young boys and girls spot the group of foreigners and run towards us in their ripped up T-shirts and beaded necklaces, shouting hello. Some see my Caucasian skin and immediately shout, "Money! Money!"
We arrive at the Maianbessa Health Post and find a group of women lined up on the porch outside carrying their babies in sacks on their backs.
Ethiopia, a country of 77 million people, has 2,085 physicians, according to the health ministry. Of those, there are about 200 gynecologists, according to Dr. Ashebir Gaym, the president of the Ethiopian Society of Obstetricians and Gynecologists. During my time in the country, doctors, students, journalists and non-governmental workers all repeated the same line to me: there are probably more Ethiopian doctors in Chicago than in Ethiopia. The statistic comes from the International Organization for Migration, which estimates that some 20,000 professionals migrate out of Africa each year.
The Maianbessa Health Post serves a community of 5,000 people and typically sees about 10 patients a day, says Malefia Gebretensaye, the post's health extension worker. Malefia is one of 30,000 health extension workers who have been installed in rural health posts across the country as an attempt by the Ethiopian government to address the dire shortage of medical professionals in the country.
"Health extension workers are expected to provide clean delivery services at home and in health posts, along with identifying complicated labors and high-risk pregnancies, and referring them to nearby higher facility," Dr. Kebede Worku, state minister of health in the Ethiopian federal ministry of health, writes to the Huffington Post in an email.
Health extension workers are a quick -- but only slightly effective fix -- to a massive problem. They receive one year of training and can provide basic primary care such as information on family planning and access to contraceptives, immunizations for children and malaria medicine.
It is immunization day at the Malanbessa Health Post. Inside, a mother holds her infant on her lap as a health assistant prepares an immunization. The assistant grasps the baby's arm and begins to inject the immunization. The baby gives the assistant a look of angry horror and lets out a loud scream as the mother squeezes her eyes closed and turns her head away from the needle.
At a table nearby, Malefia fills out a chart with information on what immunizations the baby has received and when the baby must return.
Like 94 percent of Ethiopian mothers, most of the women in the community give birth at home with the help of a relative or neighbor. If they have a retained placenta, they come to the health post to have it removed.
For all other complications, the health extension worker must refer the women to a health center about eight to 10 kilometers away. About 15 percent of all pregnancies involve complications. For those mothers, UNFPA says they need access to a midwife who can help with minor complications, a district hospital where they can have surgery if necessary and a working transportation system that can get the women quickly from the midwife to the hospital.
The villagers in Maianbessa, like most Ethiopians, do not have access to transportation, and if a mother needs to go to the health center, she must be carried there by stretcher, Malefia says. Four men must hoist the stretcher carrying the mother -- who at this point would be in labor -- onto their shoulders and walk the 8 to 10 kilometers.
Once they arrive at the health center, the mother is still unlikely to have access to a medical professional who has the skills and equipment necessary to perform surgeries like cesarean sections.
At one such center in Serbo outside of Jimma in western Ethiopia, the health officer told us they cannot handle any birth complications due to lack of human resources and equipment. If a mother has a prolonged labor and her uterus ruptures, she must leave and go to a hospital.
In Ethiopia, where 85 percent of the country lives in rural areas and donkeys seem to have the right of way, getting to a hospital can take days. And for many women, that travel time becomes the difference between life and death.
Maternal health serves as a good measure of a nation's health care system because the entire system -- infrastructure, referral services and financial processes and more -- need to function properly to improve women's health, according to Dr. Muna Abdullah, a reproductive health officer with UNFPA.
"Maternal health is a litmus test for a country's health system," says Dr. Michael Tekie, another reproductive health officer with UNFPA.
Maternal deaths are also preventable. The three ways to drastically reduce maternal mortality are providing information on family planning to reduce the number of unwanted pregnancies, access to skilled birth attendants and access to emergency obstetric care, according to Dr. Michael.
In Ethiopia, the maternal health statistics suggest that the nation's health care system needs an overhaul. Less than six percent of women have access to a health professional while giving birth, according to Ethiopia's 2005 Demographic and Health Survey. The maternal mortality rate is one of the worst in the world. For every 100,000 live births, 673 women die giving birth, according to the survey.
Progress has been made to reduce global child mortality rates, yet maternal mortality rates have remained stagnant in many countries. Child mortality rates in Ethiopia are still too high -- UNICEF reports that an Ethiopian child is 30 times more likely to die by his or her fifth birthday than a child in Western Europe -- but since 1990, Ethiopia has seen a 40 percent drop in child mortality.
Maternal mortality has not seen similar progress. Furthermore, for every maternal death, 30 other mothers develop debilitating maternal injuries like fistulas and ruptured uteri, according to UNFPA. Additional related casualties include stillborn babies and the hundreds of thousands of children orphaned because their mother did not have access to proper health care.
"Maternal death is the tip of the iceberg of women's health misery," says Dr. Francois Farah, UNFPA's Ethiopia Country Representative. "That's what we see -- a woman dies. What we don't see are the injuries."
Tomorrow: Training Ethiopia's medical professionals
Read the first installment on one woman's journey to find a doctor in rural Ethiopia, the second about girls fleeing child marriage and the third on debilitating pregnancy complications.
Follow Hanna Ingber Win on Twitter: www.twitter.com/Hanna_India
Hanna Ingber Win: Mothers of Ethiopia Part III: Battling Pregnancy Complications
Hanna Ingber Win: Mothers Of Ethiopia Part II: Escaping Child Marriage
Hanna Ingber Win: Mothers Of Ethiopia Part I: Zemzem's Journey
Yet western writters seem to not understand the apartheid policies based on ethnicity. In Tigray, the home of the Racist regime you will find Health Care centers at least in every little towns and village.
Just recall the story of the woman from Jimma. She has to travel 48 hours in while in labour. That is from the place where 60% of the racist regime's foreign export earning comes--- Oromo Coffee.
The Oromo people must fight this racist regime in every way possible. Western journalists who get a chance to report on the situation must always look in to the underlying problems of this problem.
Remember, in Jimma Oromo patients are treated through interpretors in their own country. Oromo Doctors are in prison in Tigre Concentration camps.
Meles Zenawi is the most evil man walked on the face of the earth since Hitler.
Down with Tigre Apartheid Regime of Meles Zenawi.
Read more at: http://www.huffingtonpost.com/hanna-ingber-win/mothers-of-ethiopia-part_b_306954.html
http://www.unicef.org/infobycountry/ethiopia_34881.html
Women have to be cut open before the baby is born..and I am not talking about a cesarian.
The scaring and fistulas from the butchering that happened to them as lil girls causes problems.
Without FGM there would be a lot more uncomplicated deliveries.
Fight Female Genital Mutiliation - it is a KILLER
Thanks.
The number of health care workers in Ethiopia is much lower than on the report here. Similarly, the estimated number of Ethiopian physicians in Chicago is incorrect. There can not be more than 2or 3 dozens Ethiopian physicians in Chicago area. Therefore, the figures in your article are misleading.
The main cause of Ethiopia's problems is tyranny, dictatorship, greed, impunity, ethnocentrism and political exclusion . No project including health care can become successful if we let people to suffer under tyrant rulers and gangsters. Often, our governments enable tyrants who are the main cause of the health care problems in countries like Ethiopia.
The figure reported about the reduction in the child infant mortality rate (i.e 40%) on your article is very much implausible because the current problems in Ethiopia does not allow progress in health care parameters. 20 % Ethiopians, 14 million, require food aid because of starvation.
Corruption under the ruling tyrants has become endemic.
Any figure that comes from Ethiopia or produced by the ruling gangsters need to be scrutinized before being posted as the gangsters are best known in making figures to fool the West.
Any ways, next time, please try to get independent figures than those that may have been created in the rulers offices or at Sheraton.
Thanks
Do I really need to answer myself?
This type of reality makes me want to toss my cookies (throw up) If this is some kind of diversion from our own health care problems then I think it illustrates if we don't get off of our duffs we'll be in the same situation and I don't think the fat cats from Wall Str. will help us out.
I read somewhere the Iraq and Afghan War were costing the US 12.5 million dollars an hour. You could probably provide a lot of pre natal care for that and hire the doctors by pre paid phone.
Additionally, prenatal vitamins and monitoring of blood pressures and urine samples could be done by some woman within the village, who would be trained to do that, and would receive a small salary to do so. They could also be instructed and then able to speak about hygiene and other things relating to pregnancy.
The best thing that the country could do would to be to ban marriage in women before the age of 18, to permit them to mature and to become better prepared for childbirth, and to have classes for the men of the country so they would understand the need for this as well as barrier birth control to permit women to go three years between pregnancies.
We need better morals.
You have a great point. There are more Ethiopian doctors in US than Ethiopia. The problem is not because Ethiopia could not able to produce a good doctors, the problem is they rather to go abroad and work. The saddest part is western country is happy to get them, instead of encourage them to go back to their country and help the poor who gave a free education.