“There are things which much cause you to lose your reason, or you have none to lose”
I recently visited the pediatric casualty ward of Black Lion Hospital. The images I encountered there will remain with me forever.
Despite being one of the largest hospitals in the country, conditions are absolutely horrifying; the peeling white and yellow paint provides little contrast from the grey and dirty concrete floors and corridors marked by puddles of urine, vomit and other unidentifiable fluids. There are no fans in sight, and the foul stench of body odor, urine and disease is staggering. Though there seemed a minimum of 14 to a room, I saw no curtains or masks to divide those with malaria, HIV or dysentry from those with acute respiratory infections or other contagious diseases.
Where there are cribs they are, for the most part, in varying stages of unacceptable disrepair—the matresses are stained and torn and the rusted rails most often no longer close. The rest of the infants and young children are forced to lie wherever there is room (most without blankets) on dirty wooden benches or on the floor on makeshift cardboard mats. I saw three infants lying perilously on a surface resembling the stainless steel trays used in the West for holding the sterile equipment of surgeons. Family members who are unable to afford accomadation within the city have no choice but to sleep on the floor beneath or beside their dying young. The presence of doctors, nurses and interns are scarce—one anxious father reported that he had not seen his child’s doctor in over seven days. A mother begged me for water to give to her dying child, as another struggled desperately to give her newborn child medicine from a glass, due to the apparent absence of baby bottles or eye droppers in the ward. I saw a ‘cast’ made of duct tape, cardboard and a plastic bag worn by a tiny patient who lay wimpering on the floor with an IV attached to his head. I was told that in this hospital, infants suffering from a specific liver condition are placed directly underneath 100-watt bulbs, apparently for some kind of improvised treatment—an incredibly painful and dangerous procedure which on its own can cause blindness and severe burns.
Before leaving, I spoke briefly with a foreign intern who explained with a defeated sigh that every day they were forced to carry out medical procedures for which they were unqualified, because "there is simply nowhere to turn for help”.
Hope seemed, for the most part, absent from this ward; I was told most children would not live to see e following week.
(Annual Federal Health Expenditure: 4.9%)
25 comments:
Reading this pains me, it seems we keep going further and further into the abyss. I was so shocked by the Hospital Services and filth in the late 80's on a visit. I was told that it was the outcome of Socialism. But reading your article shows me we are even worse off under
"Revolutionaty Democracy" I at least thought with all the fancy hospials such as Gabeirl etc and the poliferation of Clinics that charge ridiculous amounts for the so called haves that the Ministry of Health would have the decency of at least managing One Hospital decently. But as
usual the greed culety, callousness of this regime contunies at all levels.
It is really painful for me too. We are in the process of extinction.
Revolutionary democracy is a dirty path to the unknown. It is in fact a left over of Albanian communism a reckless "ideology" written by a reckless person without regard to possible dangers or consequences. It is anti-development. We have tp pray to God!!!
I wish I could feign shock. About a year ago - I took my brother from a nasty car accident to the "ER" of Black Lion - and was then shocked:
1) to move him myself in the rain on a cold metal stretcher
2) wait in a long line to register while he had a head injury and internal bleeding
3) Find out to my brothers benefit - that doing things via the back-channell gets you immediate treatment
I'm ashamed of the implications ... that money determines who lives and dies - more so than in the West.
Ironically, I myself was taken ill just a few weeks later and learning from the past entered a private hospitat called Hayat. Not only did they over-charge but the staff were so unprofessional it is beyond description.
This private establishment was simply a store - no more no less. They took the care out of health and merely sold "health" (your not even sure that's what your getting either)like a damn commodity.
I guess to put it in context it might be worth reading the recent edition of Foreign Affairs on "Global Health."
The point is that:
A. state expenditure has been cut as part of the (US-IMF-WB) neo-liberal global theology over the past 20 odd years leading to a public health collapse
B. Ethiopia is merely a specific example of the general trend, i.e. not recognizing this will simply lead to a simplistic conclusion that the Woyane regime is to blame -
I wish that was the case the medicine would be soo much easier.
To the anon, above: You must be from Sachs and Zenawi school of "celebrodictators" school of thought. What is a "neo-liberal theology", anyways? Is this some kind of seminary?.
I thought you commies are all dead. It is the neo-liberal economic policy that ultimately won, not the communist Russias command economic policy. Second, thanks to the "neo-cons", you commies are exploiting the monitory institutions that you labelled as "neo-liberal".
ryu,
First, I suggest practicing the point of this forum - civility and concern for our fellow citizens - right?
Secondly, your labeling my post as emblematic of "Sachs and Zenawi school" meaning 'communist' is wrong since Sachs is THE neo-liberal "shock therapy" don and Zenawi is a dictator who practices crony capitalism while ruling with the iron fist and discipline of communist cadre structures.
Third, I was trying to make a contribution to the debate that the public health ill in Ethiopia - raised by the insightful post on Black Lion - transcends the TPLF regime's policy.
Any alternative political force, hopefully democratic, will have to face certain political and economic realities that impact Ethiopia but are located "outside" of Ethiopia.
The (undemocratic) international financial institutions and the networks promoting poverty ENHANCING neo-liberal policies. As such, Ethiopia's salvation can not be merely about having new tenants in Menelik's Gibi.
"Inside" of Ethiopia - not only is the economy dominated by a single 'investor' and the TPLF holding companies but the rights of 'investors' (in the name of creating a few jobs) to do anything for a profit including trampling the rights of citizens health and well-being is unacceptable. The capitalist Russia of Sachs and company - is one where public health collapsed and for the first time in recorded history a developed nation’s life-expectancy was reduced by HALF (from around 72 to 49). Wealth is not “trickling” down to the poor but like in all countries that have adopted policies that allow for “investor” freedom and state welfare for “investors” with limited social support for citizen’s, people are working hard, productivity is up, profits are at some of their highest and wealth is going UP to the richest while the poorest get even poorer.
Anyway, there is a need to move beyond the communist vs. capitalist frame and speak frankly of social well-being. It is not ok to have Ethiopians starving and having no access to medical care because some ideology, capitalist or otherwise, says we need a few more Al-AMoudi's so wealth can one-day “tickle” down to the poor.
Fourth, the FACT is that no country has EVER had sustained economic growth by following "free-market ideology". Thus, to keep prescribing neo-liberal policies in the face of historical facts (Holland, Britain, France, Germany, Canada, Japan and US)and contemporary examples (HK, Singapore, Taiwan, South Korea and of course "communist" China)is sort of fundamentalist. It is no longer 'science' but akin to a religious faith not based on the observable but on the invisible sometimes needing miracles (such as East Asia 'miracle') and new prophets (such as Sachs and Stiglitz) to renew faith.
Lastly, you have to forgive my skepticism of overly nationalistic rhetoric since some of the most despicable acts of violence and theft – from Iraq to our own Ethiopia - is based on being subservient to the nation and national ‘elected’ or ‘dictatorial’ personalities not to principles such as social justice. In focusing on the holders of power and certain personalities we miss out on the system and networks that are necessary for a dictatorial regime such as the TPLF to maintain power longer than the Derge and for Ethiopia (much like the rest of the Third World) to becoming increasingly impoverished.
Selam,
I apologize for the breadth of the post.
Yesterday I had lunch with an Ethiopian taxi-driver (in the west) who was a medical doctor working in one of the hospitals in Addis- possibly the same hospital visited by Megenagna. Ironic?
This state of health sercices in Addis Ababa and the rest of Ethiopia should be put in some sort of context.
What is the state of health sercices in Tigray at the moment (it was non-existent before the Woyane)?
This heart-breaking reality witnessed at the Black Lion hospital, I believe, is the "price" the rest of Ethiopia has to pay so that the current "master race" of Ethiopia- Tigrayans- provide a similar if not better health or educational services to their own people (in Tigray).
Don't ethnic Tigrayns call themselves the "golden people" these days....cring!. Ones loss/tragedy others' gain/blessing....
And another thing:
It just confirms what many in rural Ethiopia and Africa have always suspected: Africans were better off and HEALTHIER before the advent of modern medicine!!
Badly managed modern health services is doing more damage to Africans' health than good. Its best outcome is the spreading of more diseases that were previously confined to certain areas (like the insalubrious ghetoes of Addis Ababa).
Thanks, Megenagnya.
Liban
and to back my claim...
Observe the priorities of the Woyane regime in building yet another International Airport in Tigray...Aren't the already built ones enough?...guud ekko now!
"Ethiopia: Int'l Standard Airport Under Construction
The Ethiopian Herald (Addis Ababa)
February 6, 2007
Posted to the web February 6, 2007
ENA
Humera
Work on the construction of an international airport was well in progress in Qafta Humera Woreda of Tigray State with over 122 million birr, the project manager said.
Aynalem Fekadu told ENA that the airport will have a runway of 4-km length and 2-kms width.
The earth work for the runway has already been finalized, he added.
He said the Ethiopian Airports Enterprise and Sur Construction have signed an agreement to finalize the construction in 2000 (E.C.). The construction was launched in 1997 (E.C.).
Work on the construction of the airport in being carried out with a budget allocated by the Federal Government."
Liban
Anon: No need to be so sensitive, besides, you earned the label because you used a pejorative term "neo-liberal" that was conined by lefties.
Sachs is a "neo-liberal"? This is a "shock therapy" (mock!). Is that why he is on a mission to save Capitalism from the approaching catastrophe? And Is that why he thinks the only ones who don't see this coming calamity are "blind doctrinaire neoliberals and their neoconservative allies"?. And is that why we recently read the "paradigm shift" shtick by his dictator-protege?
Don't try to absolved TPLF just like that and blame it on IMF, WB or on Dergue. They have been sitting on their fattened ass far too long doing nothing.
ryu,
I'm not sensitive per say as I am passionate. If your saying that "leftist's" deserve to be ridiculed then you my friend need to take an anti-Salafi pill. No one has a lock on the truth of politics - is'nt that a core characteristic of the TPLF?
As for your points about the TPLF they are well directed - the TPLF has not only been sitting on their ass but have very carefully aligned themselves with key economic players to dominate the ethiopian economy and power to their benefit. We agree that is a simple truth - BUT - my point was not to say the obvious - as it was to raise the larger issue which is what forces are arrayed against the democratic movement in Ethiopia?
If the answer is simply the TPLF then as has been the case with other recent examples, Bolivia or Eastern Europe, we will be in for a rude shock.
Mind you we are speaking about economic policies - as such - the difference between Sach's "aid+humanitarianism" and the IMF/WB adminstered "poverty alleviation" approaches are base on the same assumptions. In fact, MDG is works in conjunction with the PRS of the IMF/WB. They aim to construct an Ethiopian economy that produces low-value "flowers" for export (the same IMF/WB says to bad for Kenya) while the stench of raw sewage is left to air Ethiopian cities since social spending must be cut for loans to be handed out.
With respect to health care systems - please see the comparison b/n "free-market" US with over 40 million!! uninsured and Scandinavian and Candian "social democratic capitalist" health systems that cover all.
Thus, in the Ethiopian case we have 2 problems: that of a corrupt ruling regime, hence cutting funding for public health care, and a "neo-liberal" ideology that constructs a health system that is profit driven and excludes those who can not pay (majority of Ethiopians) to die.
To dumpy the TPLF but retain a profit driven system that polarizes society into a few rich and thousands of poor is immoral and once again not going to happen this time around. Both the TPLF AND the "neo-liberal" impoverishing agenda will be buried in the ashes of a democratic Ethiopia.
Selam,
As we all know, this has nothing to do with ethnicity as purposefully metioned above and continues to be instigated by the Meles camp. The point is that all ethiopians as you will find in Black Lion are dying under this government. The progress some westerners like Sacs talk about in relation to Ethiopian economy relates to Mele's bank account. Places like the black lion are big secrets that keep missing in progress reports year after year.
So, Mr. sublimity, what is Moral?
And what do you suggest this nonprofit economic policy you're pining for should be running on?
And what is "anti-selafi pill"? Is that why you sounded like an overstrung dopehead between trips.
In case you forgot, the remark about the those well edowed booties was supposed to be about the lamentable health care record of the dictators, not about the positioning of their *** in certain way.
I am just nanoseconds away from being a little more than derisive.
But I will keep it that way for a while. You don't seem to get it, but I suggest you read the "shift", you know, of the "paradaigm" type. And see if you have got company.
Actually I am familiar with the scandinavian and Canadian type of healthe care. Well, I will tell you this: If you are fine with waiting 2 years fo MRI or 12 hours for emergency or attended by overloaded health system, good luck.
ryu,
Don't be too sensitive - the point is to practice what you preach. It is hypocritical to denounce Stalinist politics and economics while demanding allegiance to the same except in a neo-liberal market fundamentalist garb.
Your obsession with the TPLF and its policies leaves us with only half the picture. It is like the Eritrean myth of, single handedly, beating the largest African army - out of context it seems to have some traction but once you fill in the blanks it is empty and hollow. The shock of seeing their army devastated in the 1998-2000 war by the same Ethiopians has shattered the EPLF dominated state-building process. A rude awakening indeed!
So, your saying that had Kinijit mounted the Ethiopian throne the PRSP and such national development "plans" (can you say Command Economy)would be shelved since Ethiopia's new leadership would assert her sovereignty to design its own plans, ignore the pressure of the debt, and have some mechanism of raising credit from world credit markets? As the recent case of Argentina, Brazil and other Latin American countries testifies - it is not merely about electing out rotten politicians but also what comes after (the question of Ethiopia/Brazil/Argentiana's relation to the world economy).
Even feudalism and slavery had profits - I'm not arguing against "profit" but about the type of system that is built. Would you be ok with slavery in Ethiopia - if it will bring "development"? Why should Ethiopia be made into a slave to the IFI's and the neo-liberal market regime? Mind you it is not all Ethiopians who are losing out in this type of global integration lead by the TPLF - certainly the thousands of rich domestic and foreign business groups are laughing all the way to the bank.
As for the type of health system that Ethiopian's would prefer - just like - electing TPLF out of power - Ethiopian's must be given the power to debate and select the type of society they want, including health systems. Then we will see the merits of our otherwise limited argument. Regime change without a democratic debate and action on a pro-majority/pro-poor economic and social program is an invitation to another round of misery, albeit with elections, an invitation that any sensible person on the losing end of the game would decline.
Selam,
P.S. Don't worry the struggle for democracy is not the monopoly of market fundamentalists.
"Democratic Bangladesh" and "Democratic India" classic examples of regimes where the poor remains poor and the rich gets richer. On the flip side, communist and dictatorial China is lifting the great majority of its people out of poverty, arguably, faster than any other nation in history. Of course, Ethiopia has tried, feudal, capitalist (under the pre-Derg emepors Menelik II and Haile Selassie I), socialist (Derg), capitalist (Woyane) ways to development and failed miserably.
Worse, there is no sign that it would succeed in neo-liberal or other recipes handed-down to its current and/or would be rulers.
What we want- I am refering to ethnic groups in Ethiopia that haven't had a go at controlling the reins of political power- is a TURN at returning the favour....serious!. That way we too could get to enslave the former rulers (and their constituencies) and benefit from the process. Fair? Who cares what is fair. Frenjis don't...Asians don't...Arabs don't....Africans don't....and the Amhara and Tigre people don't.
Liban
Liban,
I agree about the TURN. Yet, must it be a TURN to another round of domination? ET can be built on democratic foundations to allow for a viable and robust political community.
The participation of representatives of 'ethnic groups' i.e. such as the OLF must be recognized but above this step in creating a dynamic Ethiopian identity is the question of social and economic program.
Do not be quick to forget that the poorest and marginalized regions of ET during the so-called ‘amhara’ dominated period were ... Menze.
This is not to say that Menelik and H.I.M did not siphon the riches of ET, they did in collaboration with a multi-ethnic "coalition-of-the-willing", but ALL Ethiopians suffered although in varying degrees.
Let us not go back to the Eritrean game of crying "I have been more F**ed than you have and so I'm a VIP victim."
We need to add greater depth to our political sophistication - away from the simple formula:
"You look like me so I'll push the button that has your pictures on it."
If anything - Kinijit - has shown that after 16 plus years of ethnic, push the button, experimentation - that substance matters more to the ET peoples than your Afro.
Nevertheless, your initial suggestion that Ethiopia's political space must be OPENED up in content and not simply in form is on point.
And that this TURN must be in ways much more dramatic than Kinijit's program is, I think, going to remain THE central point of contention in contemporary Ethiopian politics.
Selam,
Since the initial topic raised by the condition of Black Lion Hospital centered on the ET health system some might find this article of interest.
Soc Sci Med. 1998 Feb-Mar;46(4-5):505-22
Kloos H.
"Primary health care in Ethiopia under three political systems: community participation in a war-torn society"
"Let us not go back to the Eritrean game of crying "I have been more F**ed than you have and so I'm a VIP victim.""
Nicely put! Not just the Eritreans, their cousins from Tigray- that barren and godforsaken province in northern Ethiopia- too suffer from this VIP VICTIM MENTALITY.
Just why the heck the rest of Ethiopia or the world have to FEED these never happy, miserable and alaways whining people???
If the gods are not genourous with them, then that shouldn't be our fault. Should it?
Trust me. There would be no peace in Ethiopia as long as we are forced to live with the Tigrewoch. We must divorce them for a change.
Long Live Ethiopia -minus Tigrewoch!
Liban
It is beyond comprehension, a government whose people are in such poverty, spends millions of dollars to launch an attack on its small neighboring country, instead of using the money to improve the condition of its people.
Thank you for your Informations.
What i think again and again(since the Somalia invation by Meles)"ARE WE GOING TO INVADE ALSO ERITREA NEXT?"
My instinct and assumtion is "yes,the life and money of poor ethiopians is going to be spended in ERITREA"
What do you think about this?
Victory for ethiopian people!
what is wrong with we ethiopians? the world is moving towards space, excelling technology and make life easier and are you still talking about war with eritrea? u know what I am tired of this and you better think positive. Eritreans, if we talk about them, they feel they are important so why not ignore these roches and forget about them. currently I don't even have enough money to invade them. let us invade freedom, deemmmoccrracy and let us make more and more money so that we can beat mr bill gate who focus on money and suceed forgeting small things such as Air tra.
call now for freedom. dont delay.
I heard that their are more Ethiopian doctors practicing in the city of Chicago than in the entire country of Ethiopia. Does anyone know if this is true?
And if so, what can be done to encourage Ethiopian doctors working in USA to return for a few months at a time and serve their home county brothers and sisters?
Yes, that's true. I challenge all the physicians in Chicago to leave the US and come to Ethiopia and rural areas as well, and live and save lives. Or donate 90% of their income to public health facilities. I lived abroad till I was 22 years old as a diplomat's son, but am commited to work here as a pediatrician and change many lives after I have seen the suffering.
But you are missing the point.
The letter describing the casualty ward of Black Lion Hospital.
I worked there and will work in the future as long as it takes. Frankly I love that place. We should appreciate what we have and improve instead of painting drama over it and discussing nonsense politics. I am sorry but nothing is far from the truth. In that place we are saving so many children and visiting for an hour does not qualify one to make a comment on the environment. If one is that much concerned please reconstruct the place to your standards or an ER standard with pediatric appeal. That's the least you can do instead of travelling abroad and working where you are not that much needed. You are like an Engineer in a country with skyscrapers. Life is so short and I have no respect for physicians who leave our country to become interns or medical students and matter to noone. They are like microdrops in the ocean they cross.
So I challenge as well the doctors who graduate and immediately think of jumping the country at the first opportunity. That's just no character. You can be a subspecialist, a fellow abroad in US and mean nothing, but you can be a GP here and save a life every three days or so. This is your choice. You don't need to get respect or approval of others. As long as you are saving lives, that's what matters.
Dr. Kassegn Zemene
I hate to disappoint the post author, but most of the world's "healthcare" facilities look more like the Black Lion Hospital, rather than the Mayo Clinic. And it's a safe bet that things will not improve for decades to come. So I have nothing but respect and admiration for the medical professionals who choose to stay and work under those conditions. The focus should be on how many they manage to save despite a lack of basic medical supplies.
Andy
Most of the Comments are so exaggerated, when i say this the whole story and it's facts are not true. The hospital as a federal Hospital with many critical cases, i would say it is working fine. If this kind of hospital with many patients in any world would have collapsed long time ago. Here we are talking about 40 years health care services without single maintenance. Change is a process, it doesn't come in one sunset; countries that we call developed were like this couple of decades ago. The problem is not only one the hospital and it's management, system. However, most patients come from he remote area of the country and not educated at all. So those people do not know how to keep clean the area inside the hospital, their room, bed and other clothing they use during their stay at the hospital. The Hospital is providing service above its capacity instead shutting it down and give hope for the hopeless. You still can do something about it instead of talking. As I said change is a process.
By the way,that light bulb thing is called phototherapy for neonatal hyperbilirubinemia, changes unconjugated bilirubin by intramolecular cyclization to lumirubin, in addition to photo-oxidation and configurational isomerization. This is a standard practice in this 21st century across the globe with few contraindications such as porphyria (congenital erythropoietic p.). Of course, the eyes and private parts should be covered and baby kept well hydrated. This avoids us from doing exchange transfusıon by goıng ın belly button (umbilicus) & changing baby's blood with fresh one, twice over. Just writing this note to have the facts right. I HAVE THİS NOTE AS WELL.
A DOCTOR'S FAULT İS COVERED BY EARTH.
Was advised to stay anonymous, so I'll let you guess who am I:)
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