3rd October 2002
The overall infant mortality rate in Ethiopia is 97 per 1,000. In some remote rural areas such as Affar in the north of the country it is 129. Included in these figures is the number of children who die between birth and their 1st birthday. I do not know what the incidence of still births is. Under five, mortality was 166 per 1,000 and about 230 in some rural areas. So a rural child had as near as makes no difference a one in four chance of dying before the age of five.
The reason for this was explained to me as follows: after the mother gives birth she returns to work in the fields with the baby on her back. She feeds the "back baby" whenever it needs to be fed. However, when she becomes pregnant again and gives birth, the new baby becomes the "back baby" and the older one, who may be only a year old, is left at home with little food and little care. Women, I was told frequently, want to extend the gap between pregnancies so that the "back baby" can get a better start in life. As can be seen from the figures I have given, about 100 children per 1,000 die between their first and fifth birthdays and it is to these children that a longer gap between pregnancies would be a help.
The Government has set up family planning clinics and so have some NGOs. I was very glad to see an infertility clinic in one of the NGO establishments I visited because this is of great importance to the couple involved even if other couples have many children. Many women in rural areas asked for Depo Provera or other injectable contraceptives because they frequently had to travel very long distances to the clinics. Since Ethiopian women are thin and active and I didn't see one of them smoking it seemed they had made a good choice. Indeed, their thinness was another problem, 30% of mothers have a BMI of less than 18.5, rising to 48% in the desert near Somalia. One could weep to think that young mothers could be like this while there are so many of us in the world who are overweight!
The long drawn out war with Eritrea and conflicts with their other neighbours have caused many problems for the people of Ethiopia including the need to spend a large part of their budget on defence. The salt in much of Ethiopia is deficient in iodine but there is plenty of iodine in the salt mines of the north. This has been mined but its transport around the country has been delayed by the war and lack of roads. Only one third of children are reckoned to live in households where adequately iodised salt is used. One can see the adverse effects. I saw two little girls, not of the same family, aged about three and four who were suffering from cretinism. I saw several people with huge goitres, too.
Probably the most memorable visit we made was to the Fistula Hospital in Addis. Due to the high incidence of obstructed labour, mainly in teenagers, many girls develop vesico-vaginal fistulae and/or rectal-vaginal fistulae. They are thrown out by their husbands and frequently rejected by their parents, too, because of their smell. Some also develop contractures of their legs due to damage to the nerves in their legs during the prolonged labour.
The Fistula hospital was set up over forty years ago by two saints, doctors, he, Hamlin, now dead, from New Zealand and she, Catherine, from Australia, who is still running the hospital. Thousands and thousands of young women have had their fistula repaired - they have a 93% success rate - and more recently have physiotherapy to help deal with their contractures. The hospital is a haven of peace, the nurses and nurse attendants, cooks and bottle washers are all former patients and a small village is being built for those girls who, though healed, cannot return home.
In the operating theatre there are four tables. Augmentin is the only antibiotic given and they have no problem with drug resistance Ruth Kennedy, the co-ordinator, told me. The girls are all given new clothes before they are discharged home. Some are in hospital quite some time because the repairs required vary in complexity.
I asked Dr. Hamlin if symphisiotomies were ever done in girls with obstructed labour. She said if they were got to hospital, and doing that was the real problem, Caesarian sections were carried out because in her opinion symphisiotomies, unless very carefully carried out, frequently lead to urinary incontinence and an unstable pelvis.
The Medical Missionaries of Mary have an outreach programme for those with AIDS. Dr. Carol Breslin of Chicago, but with Irish ancestors, is in charge. Dr. Anne Merriman, who has been so successful in setting up Hospice movements for such patients in east Africa and who I met in Kampala some years ago, had recently visited and they hoped to make hospice care available in Addis, too.
The UNFPA is particularly concerned about the incidence of illegal abortion in Ethiopia, Addis especially, where it contributes significantly to the high maternal mortality. These young women are usually moribund by the time they reach hospital. I met members of the Ethiopian Women Doctors' Association and they expressed similar concerns.
Some of my colleagues visited the Goal night shelter of homeless children on our last night but by then I was nearly moribund myself, or definitely a stretcher case. Their praise for the Goal workers made them sound like another group of saints.
The Irish taxpayer should be proud of the support we give UNFPA and Ireland Aid. Both are making a huge impact on the lives of people in Ethiopia as are the Irish and International NGOs. Let us hope they flourish and that it rains so that crops flourish, too.
Senator Mary Henry, MD
