Ethiopia: Providing Care in the Somali Region

© MSF

MSF is the only organization working to provide people with free, good quality healthcare in the area. To get the treatment they need, people come from villages nearly 60 km (37 miles) away.

In August 2009, Doctors Without Borders/Médecins Sans Frontières (MSF) started working in Imey, in the Somali region of Ethiopia. For nearly a year now, together with personnel from the Regional Bureau of Health, MSF staff have been running a primary health care center in East Imey and supporting another in West Imey.

Separated by a river that staff and patients must cross on a small boat, the two sites provide regular outpatient consultations to more than 2,000 patients per month. Services include antenatal and postnatal care consultations for pregnant mothers and those who have recently delivered. Women with complicated deliveries are referred to the maternity department in East Imey. Both centers now feature a vaccination component and a nutrition program to treat malnourished children as well. Below, outgoing field coordinator Christian Sorensen talks about the project:

What are the most pressing needs of the community?

Chronic poverty and irregular rainfall make the hard life of Imey’s pastoralist and nomadic population even more difficult. Basic health services hardly exist, and the community has a lot of different needs. Especially in East Imey, the humanitarian situation is a real challenge because of insecurity and an undeveloped infrastructure.

We take care of 70 patients a month in East Imey’s 15-bed inpatient department (IPD). Children come to the center with respiratory infections like pneumonia or severe malnutrition. Sometimes people arrive with animal bites or gunshot wounds. And due to the poor quality of the water that is available, waterborne diseases like eye infections, skin disease and diarrhea are quite common among the population.
Tuberculosis (TB) is also a major health problem for the people of East and West Imey, so we are planning to start diagnosing and treating patients with TB in the near future.

In order to improve the access to health services for people who cannot even reach the center, we started running weekly mobile clinics in new locations. There are no other functioning health facilities in the district or any other organizations providing health services here. It’s true that our activities target primary health care, so we can only address some of the needs. Without a doubt, there is still a lot of work to be done in order to provide more people with free, good quality basic health care in these areas.

MSF refers people in need to the closest hospital, which is six to eight hours away by road. Practically speaking, what does that mean for the patients?

It means that most people do not have access to hospital services, and they also cannot afford to transport themselves there. Our health clinic is the closest place to go. I know that the community really appreciate that we refer people to Gindir; they know that if we can’t do something in our own structures to help them, then we will transport the patients to the hospital for necessary operations or complicated deliveries.

However, considering the drive is six to eight hours, we really do our best to treat the patients in the clinic. If you are sick or injured, eight hours on a bumpy road is a nightmare. But in Imey there are no other [hospital] options.

One night, we received a woman who had been in labor for several days. Our nurse and the midwife from West Imey had crossed the river at the middle of the night to bring the pregnant woman to the IPD in the East Imey center. We don’t have the surgical capacity in the clinic to deal with delivery complications, so when the woman’s condition was stable, we drove her to Gindir hospital for referral. Fortunately, both the mother and her new baby survived.

How do the people of East Imey see the activities of MSF?

As the only foreigners in the area, part of our responsibility is to talk regularly to the community that is hosting us, to explain why we are there, what we are doing, and that the services are free and for everybody.

We’ve visited villages near and far, and we found out that people know about the health center. Still, one of the main challenges is to get people to come to us earlier, before they get too sick to treat.

It’s easy to talk to the community. The Somali culture is a culture of meetings, discussion, and exchange. In fact, the midwife working in the clinic has made a lot of efforts towards meeting traditional birth attendants (TBAs) in the district in order to raise awareness about the kinds of problems they face and to discuss how to cope with the challenges like high risk pregnancies. These meetings are fruitful for the TBAs and the MSF midwife, but in the end, the winners are the patients.

What are the next steps for the Imey project?

We have to continue to target the most vulnerable people within the population, meaning those who most likely cannot even make it to our health center. Through opening mobile clinics in more locations, we can give people who can’t access the existing health structures an alternative.

The districts we are working in are big; some areas are more than 60 kilometers [36 miles] away from the clinics. And if you are sick, you can imagine that walking 60 kilometers under the burning sun is not what you want to do. If we could reach people, rather than them having walk for two days to come to us, that would make a difference to their health.

Starting a TB component in the project is also crucial. We have a lot of experience in working in TB in other areas of Ethiopia, and it’s much needed here.

What do you think is the impact of MSF’s work in Imey?

It’s clear that there are not many alternatives for people, if any, when it comes to health services in the two districts where we are working [and] also in neighboring areas.

We receive patients from villages far away and other districts. A few weeks ago, I met a mother who was walking for three days to bring her ill son to the center. Her child was diagnosed with Kala Azar, a tropical disease transmitted by the sandfly, which can be a deadly disease if left untreated.

We have a role to play in saving lives, giving treatment, and taking people’s health needs and worries seriously, because they have no other option. Also, by running these health centers we are involved in training health personnel in Somali region. In the long run, they will be the ones carrying on and continuing this work.