Working for better health in rural Ethiopia

Originally published in The Guardian May 21, 2015


Photo: Louise Gubb/Corbis


As a community health worker in rural Ethiopia, I diagnose and treat illnesses such as malaria and pneumonia, and provide ante- and postnatal care and family planning services. My kebele – or neighborhood – is 95km from Addis Ababa and home to more than 5,000 people. Most of the community here are dependent on agriculture, cultivating grains such as teff and maize.


The main challenges for the community include diarrheal disease, pneumonia, malaria and occasionally measles. Those illnesses cost the community in many ways, for instance in losing work, needing care from other members of the community, transport costs to health facilities and sometimes for treatment.


Two days a week, I work at the ‘health post’ and three days doing home visits in the community. The health post is made up of two buildings, with three rooms in each. The first was built by the government to be used for treatment, storage and pregnancy deliveries, while the other was built by the community to house health workers from the post.


Most working days I wake up at 6am and prepare my breakfast and lunch, before leaving the house and heading out to make home visits around the community. It gets too hot for that in the afternoon, so I tend to finish around 4pm, though we sometimes work until later in the day if we are assisting with special initiatives such as national campaigns against polio or measles.


Here, there is a lot of malaria. Between July 2014 to April 2015, I treated 329 malaria cases after undertaking rapid diagnostic tests. The majority of them were children under the age of 15; I thank God none of those I treated has died. Almost all cases of malaria are treated by health workers like me and my colleagues. But if a child is very small - weighing less than 4kg – we usually refer them to the health centre; the same goes for pregnant mothers in their first trimester.


Sleeping under insecticide-treated nets (ITN) is the main way to prevent malaria. ITNs were distributed to the whole community three years ago and some of them are now torn and out of use. There is also anti-mosquito spraying of areas where there is stagnant water and indoor residual spraying of community buildings. None of my family has been infected with malaria because we regularly use bed nets.


It was in 2008, when I was 18, that I decided to join this health worker program. I wanted to become a health extension worker (HEW) because our community has a lot respect for health professionals. My first role was as a level three HEW, which meant one year’s training after high school. But the training had problems: there were not enough teaching materials and we did not spend enough time learning in the lab.


There was not enough time for professional practice in the community either. I learned few skills and was not confident enough to provide the required services for my community.


But now our training has been upgraded due to the support of NGOs like Amref Health Africa. They provided learning modules and financial support during our field practice. I am now a level-four HEW. I have lots of laboratory skills, which I had to practice at the evening and weekends. We were attached to different health centers for maternal and child health, and community-based field practices like home health education and health promotion. This helped us to gain confidence. I am very happy to have had this improved training. I have many plans to use it to improve the health of the people living here.


Many of our community’s problems like diarrhea are due to poor environmental and personal hygiene. Hand washing practice is very poor in our kebele although it is the easiest way of preventing diarrheal diseases. So one of the things I want to do is ensure that in my kebele there is 100% coverage of standard latrines with hand washing facilities.


As for myself, I am 26 and have a three-year-old child who has been living with my family for the past year. Thanks to the district health office, I was able to take three months maternity leave together with my one-month annual leave. After that, I was able to work only at the health post until my son reached six months while my other colleagues covered the home visits. Now, at weekends, I walk 16km to visit my child. I find not being with him very hard, especially if he is sick. But my husband lives near my parents so he sees our son at least once a day.