Ethiopia is an ancient country with a rich diversity of peoples and cultures, but it has remained underdeveloped in socio-economic and political terms, and in technological advances, largely due to lack of resources.
In recent times the country has experienced severe calamities and political upheavals which have caused untold suffering to its people. Ethiopia's geographical position and climatic vulnerability mean that it is never free from the shadow of recurrent drought and starvation which brought it to the forefront of international media attention during the 1980s and early 1990s.
One of the world's poorer countries, many of Ethiopia's health facilities are in a state of dilapidation, especially in rural areas. Water and electricity supplies to hospitals and health centres, where they exist at all, are often sporadic and sometimes dangerous; leaking roofs and uneven floors further contribute to damage and decline to the extent that the provision of health services steadily disintegrates.
Conventional health parameters such as infant and maternal mortality, morbidity and mortality from communicable diseases, malnutrition and average life expectancy, place Ethiopia among the least privileged nations in the world. Nearly 90% of Ethiopians live in rural areas. Scattered villages populate remote valleys far from the nearest government health services which tend to be sited along the accessible main roads. Devastated by war, many health institutions are structurally damaged, some are beyond repair and will need to be rebuilt entirely. The population too are devastated by recurrent drought, both in the past and now.
At one time, Ethiopia's infrastructure and government services were excellent but, since the communist regime of the mid-1970s, health, education and welfare provision have deteriorated for want of essential resources. Historically, the level of academic training for health professionals has been relatively high and health workers at all levels achieved an enviable standard which was maintained with regular input from external trainers. However no significant infrastructure improvements or new equipment has been provided for over thirty years in many cases. Existing equipment lacks maintenance and spare parts, and much of that used in Ethiopia would be considered obsolete in any industrialised country.
There are few roads in rural Ethiopia and 85% of Ethiopians rely on subsistence farming. Here, patients tend to seek medical attention only in extreme cases, especially during times of planting or harvesting, and often need to be carried for three or four days to reach a basic health centre. On arrival there is likely to be no equipment for tests, to help with diagnosis or for treatment. Even beds tend to be in a poor state of repair, if they are in evidence at all, and patients often must lie on the floor. Having travelled long distances, patients cannot always get the treatment they need.
Regional and district hospitals are in a similar condition and suffer the same shortages. Orthopaedic patients and amputees can spend as long as four months in hospital waiting for crutches, such is the shortage of supply.
Conversely, in developed countries such as Great Britain, health facilities are regularly upgraded, superseded or replaced as a matter of policy in order to maintain the highest standards. Until the time of replacement, medical equipment is kept serviceable and in operation in all our hospitals.
New technology and the need for reliability force the replacement of a great deal of perfectly good equipment, which then goes to waste. Much of this redundant equipment still operates as designed and would be a great improvement on the dilapidated equipment presently in use in most of the health institutions throughout Ethiopia. The potential for rehabilitating health centres in Ethiopia by recycling basic but reliable equipment from Britain is enormous.
There is only around one doctor for every 30,000 people in Ethiopia but many of these are based in Addis Abeba and the ratio in rural areas can be as high as 1:140,000. Initially, we are working in the Amhara Region of northern Ethiopia where there is currently only one qualified surgeon among the region's population of 17 million.
Frustration among health professionals, stemming from an inability to carry out the work for which they were trained, results in low morale and, ultimately, disillusionment. This leads to a deskilling of the workforce and a further weakening in health services. Re-equipping rural health facilities will allow staff to carry out the work for which they were trained. It also helps stem the exodus of qualified health professionals from rural areas where they tend to migrate to the private sector or emigrate in search of satisfaction and reward.