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Nicolette Jackson in Ethiopia
Our programmes are operating in some of the most remote areas of the country – in the town of Humera and the village of Abdurafi. Humera is in the very far north-western corner of Ethiopia, approximately 20kms from the Sudanese border and right on the Eritrean border. When we stand on the roof of our office we can see Eritrea on the other side of the river. We flew into a city called Gonder which is in the highlands and then drove for seven hours to reach our project site. The landscape is extraordinary – volcanic, pointy, ranges and very green and lush bush (now that the rainy season has begun). Every time we drove past people they would start waving. The kids would scream ‘farengi’ (foreigner); their exuberance and openness is very contagious. I spent a week in Abdurafi and a week in Humera. In both places we’re running HIV, Kala Azar and malaria programmes. In addition to providing treatment for the three diseases, we conduct outreach visits to farms and resettlement sites where we provide health education, testing for Kala Azar and malaria and nutritional assessments. At this time of the year tens of thousands of men come to these areas to work on farms where sesame and cotton are grown commercially. At the peak time in October – 100,000 workers will travel to the region. Their work is tough and involves clearing large areas of bush, cutting down trees, removing stumps, ploughing the land and then harvesting the crop. These men sleep out in fields without nets which mean they’re particularly vulnerable to becoming infected with Kala Azar and malaria. They’re also at risk of exposure to HIV through unprotected sex with commercial sex workers. And since they’re not residents, they have no right to access free health care. Prior to MSF’s arrival, they were reportedly left to die in the streets because they had no money and no family to care for them. When I was in Abdurafi I spent two days on outreach with our local Ethiopian team comprising a nurse, a health educator, a driver and an English nurse. We travelled by tractor which is bone-jarring and painfully slow. In the settlement sites we visited people who’d come from overcrowded highland areas. They have chosen to relocate to the lowland to land given to them by the government. In these areas there is more space and the black soil is more fertile. The people are literally dropped in the middle of nowhere in a site that has been identified, and they have to start clearing the land and to build their village from scratch. They often have to make a three-hour walk from the settlement site to reach their plot of land. For the first year the government gives them a small food distribution: sorghum and oil once a month and two dollars to buy spices. A few pumps have been built but water is still insufficient. The settlement residents report spending between three and eight hours a day to collect the water they need. It’s a very basic, precarious existence In these communities we visited, which sometimes have up to 5,000 inhabitants, the health service that is provided by the government has serious limitations. They only have a junior nurse and a so called 'frontline health worker' who's had a couple of months of training. Together they must deal with all the health problems of an undernourished community, living in malaria and Kala Azar endemic areas, with inadequate water supplies. The objective of an MSF outreach visit is to look for Kala Azar, malaria and malnutrition. Children under-five will be weighed and measured to ascertain whether or not they’re malnourished. We ended up bringing back five severely malnourished children with us. The most disturbing was a four-year-old boy who had to be carried by his mother – his whole back had been reduced to a 'rib-cage'. Now the ‘hunger gap’ has begun – this is the period
which occurs every year prior to the harvesting of the new crop, when
stocks are running very low – and our teams are going to be finding
more and more children who’ll need therapeutic feeding.
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