June 2024 news from Ethiopia

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Hospice Ethiopia UK’s Chair Sue Mumford has monthly online calls with Director of Hospice Ethiopia UK, Ephrem Abathun. Here is some of the latest news from Ethiopia:

  • Ephrem has been in discussions with the Ethiopian Ministry of Health about revising and publishing a new strategic plan for Palliative Care in Ethiopia. Crucially the provision of morphine is included for the first time in the revised plan.
  • The Minister of Health has now issued the necessary documents for the Black Lion Hospital to import morphine powder to produce oral morphine liquid. The American Cancer Society has purchased the morphine powder so we are optimistic that oral morphine solution will soon be available to relieve the pain for the dying in Ethiopia. Initially this medicine will be available for patients at Black Lion Hospital before being expanded to other hospitals in Addis Adaba and then to regional hospitals across the country.
Ephrem teaching a family to administer oral morphine solution to a patient. Photo taken in 2016, when oral morphine was still available in Ethiopia.
  • Training: Ephrem and his staff laid on a workshop for Chaplains and representatives from the Christian Orthodox, Protestant and Muslim communities. Following this a draft training manual is being produced for training religious leaders in supporting terminally ill patients. As part of this work some of Hospice Ethiopia’s patients were questioned about what spiritual care they felt is needed when approaching the end of life. All this will help deliver the individualised care that people approaching the end of life deserve.
  • Following a joint application between Hospice Ethiopia and Hospice Ethiopia UK, True Colours Trust (a UK charity that supports palliative care providers across Africa) is providing funding for a 4 day palliative care training course at Hiwot Fana Hospital in Harar later this month. Harar is a holy Islamic city in eastern Ethiopia and is known for its maze-like alleys and traditional houses decorated inside with flat baskets.
  • Hospice Ethiopia UK and Hospice Ethiopia has recently been approached by Dr Yates from Soddo Christian Hospital (situated in the Oromia part of Southern Ethiopia) to provide palliative care training for their staff. The hospital serves a population of over 20 million people. Planning is in the early stages for this training to be delivered in the autumn when some of HEUK’s trustees will be visiting Ethiopia.

Doctor receives palliative care training funded by HE UK

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Money raised by Hospice Ethiopia UK has been used to fund training for a doctor based in Southern Ethiopia, Dr Juhliad. His interest in palliative care started in 2019 when he received a three day introduction to palliative care at The Black Lion Hospital in Addis Ababa, delivered by Hospice Ethiopia’s Director, Ephrem. Dr Juhliad now works at Yabelo Hospital which is a town in the Oromia region, 580km south of Addis Ababa. Here he sees patients who desperately need symptom management and end-of-life care. With our help this year he has completed the foundation course in palliative medicine at Trivandrum Institute of Palliative Sciences and is now attending a Master Class course that will go on until December 2024. He will go to India for ‘hands-on’ clinical training in November 2024 as part of the course. This is what he told us:

“The hospital where I am based now doesn’t have a specific place dedicated to patients needing palliative care. And it seems difficult to persuade the hospital administrators to integrate palliative care services for now. But I am trying to integrate palliative care practice into my daily routine for patients who might be candidates for such services at a chronic disease medical outpatient department. Moreover, I am intending to launch a free telehealth service for patients needing palliative care through my social media platforms…I am also interested in providing webinars on palliative care for frontline healthcare workers.”

A day in the life of Ephrem Abathun

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When the trustees visited Hospice Ethiopia last month, we took the opportunity to ask Hospice Ethiopia’s Director, Ephrem Abathun what a typical working day looked like for him. We thought you might be interested to hear what he said.

His day usually starts about 6am but may be earlier if he has international guests visiting. He aims to leave home around 6.30am after eating some kinche (cracked wheat) or eggs with bread and has an hour’s drive (25km) to the HE premises. Ethiopian coffee (and occasionally tea) is drunk with breakfast, in the morning, after lunch and mid-afternoon. Gullilat Korbu (Finance Officer), Wengi Yared  (Programme Manager), and the nurses arrive shortly after him, between 7.30-8am.

Ephrem’s working day begins with reviewing operational activities so that he knows what he has to prioritise and on certain days of the week there are regular weekly meetings for example on Monday mornings he has meetings with the staff and the management team (Wengi Yared and  Gullilat Korbu). Lunch is around midday and is always a working lunch. He either brings lunch from home – “spaghetti pasta” or he meets international guests for a working lunch. On Monday afternoons he holds a clinical meeting with the nurses when difficult and distressing cases are discussed. He tries hard to make sure this meeting is not cancelled as it is a good opportunity to share his experience and build good working relationships with his clinical staff.

There a number of things that have to be fitted in around meetings and appointments for example, working on project applications with Wengi, speaking to local partners on the phone for example the Addis Adaba Health Bureau, attending face to face and virtual meetings with donors and partners, and writing reports.

During the last 2 years he has rarely had time to visit patients himself who are registered on the Home Based Care programme but now that doctorate is finished he hopes to have more time to support the nurses carrying out these visits. Certainly Hospice Ethiopia’s patients benefit hugely from his wealth of experience.

Ephrem usually leaves the office around 6-7pm and then has an hour’s drive home, receiving phone calls from staff, partners and others on his way. He tries to eat supper with his wife and 2 girls (aged 9 and 12) when he arrives home, which might be pasta, injera, barley bread and vegetables. Meat (beef) is eaten once or twice a week. (Beef is the cheapest meat in Ethiopia and is cheaper than goat, chicken, lamb and is produced across Ethiopia.) Once his daughters are in bed there is often more work to catch up with.

Ephrem works 5 days a week in theory but at weekends he works at least a further ½ day’s work. He tries hard not to work at all on Sundays so that he can spend time with his family.

This typical day looks pretty straight forward but from our experience working in Ethiopia is challenging. Long traffic jams, intermittent internet, massive paperwork demands by regulatory authorities, lack of internet banking and certainly no internet shopping all demand the patience of a saint. Fortunately Hospice Ethiopia’s Executive Director is one of these!

Patient Story: Abigia

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Abigia, a female aged 29, was diagnosed with rectal cancer 2 years ago when she was referred to the Black Lion Hospital (BLH) with abdominal pain and a bloody perineal discharge.

She was treated with surgery (a colostomy was formed after attempted tumour resection failed) followed by radiotherapy and 6 cycles of chemotherapy. When treatments proved unsuccessful for her cancer which had spread from the primary site, she was referred to Hospice Ethiopia for palliative care.

Her social history is tragic and her physical problems are complex. She is of protestant faith and was previously living with a Muslim husband and a son, aged 12. However, her husband left her without support and moved, with her son, to Harar (a city in eastern Ethiopia). Her parents live in Addis Ababa but there is no contact with them (they do not answer her telephone calls), likewise, her 12-year-old son has declined visiting her.

She has no neighbours to care for her and is too weak to cook for herself, so she is emaciated and weak, and confined to her bed in her single room (approximately 3m X 4m) house. She is under threat of eviction as she is destitute and her landlord is fearful of her dying in his property.

Until the visit, she had reduced her food intake as she had no stoma appliances and thus hoped to minimise her bowel actions via the colostomy. She had significant local pelvic pain and an open perineal wound with odorous discharge. She was taking tramadol 100mg twice daily and amitriptyline 12.5mg at night for the pain but these gave little respite. The BLH had prescribed injectable morphine 5mg which should be administered 4 hourly to work effectively. However, an injection required a visit to the health centre (volunteer drivers had taken her 600m to the health centre on an ad hoc basis) so injections were infrequent but had helped the pain for a few hours.

The care plan from Hospice Ethiopia’s nurses included ongoing financial support from the Tewolde Medhane fund, provision of medicines and stoma bags, counselling from nurse Kalkidan (who also donated her lunch) and a follow up visit later in the week. She declined being photographed and not surprisingly was tearful during the visit.

The Big Give 2023 ends soon!

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We are really delighted with the response so far to our Big Give project 2023 – the donation window is ending soon at midday on Tuesday 5th December. If you haven’t had a chance to donate yet, don’t worry – there are still match funds available so every pound you donate will mean £2 for Hospice Ethiopia. We have raised a fantastic £7,710 so far; please help us reach our target of £11,760 to enable the hard-working staff in Ethiopia to get a pay rise.

Please visit the Big Give website here to donate.

Your donation will enable people like Mariam (not her real name; see photo) to have ongoing visits from Hospice Ethiopia’s nurses to help her cope with her depression and anxiety. She is aged 35 and was diagnosed with bowel cancer in the United Arab Emirates (UAE) where she was a migrant worker. She paid for surgery to remove the cancer and a colostomy was formed. The UAE government does not provide free health care to migrant workers so she returned to Addis Ababa and has had 10 cycles of chemotherapy at the Tikur Anbessa hospital. Mariam had to buy these drugs from the hospital pharmacy and if they were out of stock she had to go outside the hospital to a pharmacy to try and buy the necessary drugs.

The chemotherapy has caused ongoing diarrhoea which has been extremely problematic to manage especially when she did not have any stoma bags. Fortunately, a new supply of stoma bags was brought to Hospice Ethiopia by the HEUK trustees.

Mariam is effectively destitute and therefore lives with her mother (who also has terminal cancer) in a one-room house along with her infant niece. She is unable to work due to her illness and relies on a monthly grant from the HE Tewolde Medhane Fund (formerly the Comfort Fund) to buy food, medicines and other essential items.

Successful event at Stody Lodge, Norfolk

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We were delighted to be invited by Kate MacNicol to provide the teas at their Open Garden at the end of May. Alongside 200 varieties of rhododendrons and azaleas, this open garden in North Norfolk also has some wonderful magnolias, camellias, expansive lawns, woodland walkways and vast carpets of spring bulbs. Its 4-acre Azalea Water Gardens holds 2,000 Azalea mollis plants which is believed to be the largest single planting in the UK. 

We are extremely grateful to all of the many volunteers who helped with baking cakes, serving teas, setting up, clearing up, parking and more. Thanks also to the Blakemore foundation who donated some cakes.

We were extremely lucky with the weather, the sun shone down and it was a glorious spring afternoon. Overall we made a fantastic £684 for Hospice Ethiopia!

British doctor volunteering at Hospice Ethiopia

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A British doctor, Fredrika Collins, is currently living in Ethiopia and volunteering at the Hospice in her free time. She’s written an article for us about her time there:

I am Fredrika, a doctor from the UK, working in Addis Ababa, Ethiopia, hoping to specialise in Palliative Care.

I have been living in Addis Ababa for 7 months. I arrived just before the Meskel celebration in September 2022, an important date in the Christian Orthodox calendar which commemorates the finding of the True Cross. This impressive spectacle sees thousands of worshippers congregate in Meskel Square, Addis Ababa’s main square, dressed in traditional white robes and holding lit candles, as they sing together in front of a gigantic bonfire. It was an early introduction into Ethiopian culture, where the main religion is Orthodox Christianity. Tradition and faith run strongly through communities.

I’m working as an internist at a busy international hospital among a majority Ethiopian team. I have found the work challenging but incredibly stimulating. During my days off I’ve had the great privilege of volunteering with Hospice Ethiopia, where the vast inequality between their patients and those at the private hospital where I work has become apparent.

During my time with Hospice Ethiopia I have joined Nurse Filagot on several of her home visits and I have been blown away by her skill, dedication and compassion. The main issues I saw confronting patients were poverty, social isolation and uncontrolled pain, the latter largely arising from a chronic shortage of oral morphine in Ethiopia. Unwell patients who can no longer work often can’t afford basic necessities, let alone hospital care or expensive medical supplies such as stoma bags. Sometimes they become cut off from their community or family which is particularly sad to see.

It has been inspiring to watch Nurse Filagot navigate these many problems with only limited resources. Depending on the patients’ needs she provided medicines, economic or food support packages, referrals to health facilities and always a listening ear. She often acted as an intermediary between the patient and their family to help resolve conflict or misunderstanding.

Patients who are socially isolated and able to travel to the main Hospice Ethiopia site have the opportunity to join the weekly day centre, where they can enjoy coffee, lunch, music, talking and of course – never an opportunity to be missed – traditional Ethiopian dancing, known as eskista. Joining this session, led by Wengi, the brilliant project director, was extremely heart warming and I could see how happy and animated the group became.

Last month I also had the chance to travel to Kampala, Uganda, to visit the main Hospice Africa site and meet the legendary Dr Anne Merriman. An article about the team’s work recently appeared here in The Guardian. I toured their morphine production unit, a series of stainless steel containers in a small room that supplies all of Uganda’s oral morphine. Before this production unit came into action, Uganda’s population faced the same restricted supply of oral morphine as Ethiopia does today. The hope is that a similar system can be set up in Addis Ababa, which would be truly transformational for the many terminally ill patients living in extreme uncontrolled pain throughout Ethiopia.

I am grateful to Hospice Ethiopia for welcoming me into their team and look forward to the next year working with them.