August 25, 2018
After a long wait for the rains to stop, the roads to clear and the political turmoils to settle we finally were able to schedule our health center visits. On the 25th of August, a memorable day for me, I joined the FLAME data collection team on my first ever health center visit to Chenchoq Health Center. Our mission was to collect Maternal and child health data and conduct a meeting with the intervention group- the priests and health development army for our study.
The health system in Ethiopia follows a hierarchy with Federal Ministry of Health on the top followed by Regional Health Bureaus, which is further made up of Zonal Health Departments, Ward Health Offices and then finally the Health Centers. The health centers are the first point of entry or primary care centers for patients into the health system.
Chenchoq Health Center falls under Chilqa Ward Health office, North Gondar Zonal Health Department, Amhara Regional Health Bureau and finally the Ministry of Health.
Our ride of 2 hours began at 7:30 am when the university vehicle driven by Shikur Amman with our FLAME colleague Getayeneh Antehungena and Atalay Gosha came to collect us ( me and Rebekah- another FLAME fellow from Seattle) at the University guest house. We then headed to the University condominium in Agego, where Adino and Alemmeh joined us.
Chenchoq health center, in Chenchoq Kebele, is immediately below a circular Saint Michael Church. This center is also important for us because it was one of our pre-implementation survey site during our planning p
hases. This visit was indeed a very good learning/inspiring moment for me. I was already impressed enough by what the FLAME intervention and SCOPE program as a whole, has been doing in empowering and brining positive changes women and newborn’s health. This visit made it more possible for me to understand the real essence of the program.
I had two specific responsibilities that day. One, to help our data collectors in collecting the data, monitor their process and assure quality data collection. Second, to interact with the health professionals, get their views and understand the situation of the facility and their perceptions towards the intervention.
The head of the center was in Gondar for a training of two weeks, so I was briefed by Mr. Aschalew Dissie, clinical nurse who was working in Tangura health center for a year before when he was stationed at Chenchoq last 2 months.
Human Resource at Chenchoq Health Center:
|Health Center Head||
|He was in Gondar for training.|
|Health Information Technician||
As per Mr. Dissie, the center receives 20-30 patients rest of the week except on Thursday and Saturday when it gets crowded with about 100 patients, due to the adjoining farmers market. Three explanations come to my mind- people awaiting the markets day are not really ill, their ailments can wait, or they are a long distant from the center. This adds on to how people in developing nations still regard their health as secondary, they wait for the market day to pay a visit to the clinic.
Chenchoq health center conducts around 10-15 deliveries per month. The deliveries are conducted by the midwives and nurses. In any case requiring referral, their nearest referral center is Ikeli hospital 30 minutes drive away. The center or the ward does not have any ambulance so the patient’s family/relatives have to arrange for public/private vehicle in case of referrals. For those who cant afford or are unlucky enough not to find a ride, traditional homemade stretchers and piggy back riding on shoulders are also not rare.
Few interesting things that I noted:
- Digitalization of patients records was going on rapid pace. Two local teenage girls were hired for this purpose of uploading data of all old and new patiens in a nationwide uniform HMIS software.
- Separate Out patient room for Young patients, aged 10-24 years of age. There was no patient or clinician in the room that day, but the walls were full of educational messages about HIV/AIDS and Voluntary Counseling and Testing (VCT). This depicts the disease burden of HIV in Ethiopia and Africa in general plus the efforts to combat and the focus on this particular age group.
- The powerof the whole village had been disrupted since last three days due to road constructions. The center had a generator setup by the government. It was operated 5 hours daily. The power sockets of the entire facility could be seen crammed up by cell phones and electrical devices belonging to the hospital staffs and nearby villagers.
The Intervention team meeting:
The intervention team meeting, with Priests and Health Development Army (HDA) and moderated by Adino and Rebekah, started at 10:35 am with a blessing prayer by the oldest priest in the group.
It was a full attendance meeting with 9 priests, 9 HDAs and 3 health workers from the center who also attended the meeting. The participants updated each other with the progress of the program, their activities and difficulties. Concerns were expressed about the challenges raised by traditional birth attendants in the villages who were opposing our intervention.
Strikingly, unlike other group meetings I have seen, the participants here were very patient, well behaved, attentive. They took turns to speak, no one got ever interrupted nor looked bored to listening. This meeting ended at 12:20 PM with the blessing for every one.
I have worked in resource limited settings all my career. I can therefore, relate to the situation of these health centers and the surrounding villages. Though there is obviously a lot, yet to be done, the medical team of the health centers, non-medicos of the intervention group, the religious faith leaders and our health development army, living and working in these meagre conditions, are real life warriors.They deserve a respect that they rarely get. Though I cant recall the words of the priests prayers, blessed be all- Amen!