The Last Mile, Northern Ethiopia: Mobile Community Health Outreach

When we think about seeking medical care or prenatal care, we think about “going” to the doctor or clinic. For many, if not most, mothers in the global north, that is exactly what happens. They go.

But for some, “going” to receive medical care or a wellness check-up is simply not an option. Take a place like Chifra, Northern Ethiopia, for example; “going” to the hospital is not an obvious option here. First, the communities here are pastoralists in nature, and second, the health systems are weak, and therefore, the health centres are, in most cases, miles away.

Meet Adawuka Mukna, who is pregnant with her sixth child.  

Well, pregnancy can be beautiful; it is the miracle of life, the wonder of making a new person and birt and the joy of welcoming a sentient being. But for many mothers like Adawuka, it is also dangerous and challenging on both emotional and health levels. They have little or no choice when it comes to maternal care or that of their babies, who are exposed when they are most vulnerable. This is in addition to other environmental and societal challenges like droughts and conflicts. 

Adawuka is eight months pregnant now. Her pregnancy has been problematic since her first trimester. She has been sick, she has bled a few times and is afraid of the outcome of this pregnancy. “In my current pregnancy, from the very beginning, in the first three months, when I reached three months, I started bleeding, but no miscarriage, the baby stayed.” She recalls.

Distance to healthcare

For Adawuka and many women in her village, going for the much-needed prenatal visit to the health centre is challenging because the nearest hospital is over 50 kilometres away. It’s too expensive for her and her family, and they therefore avoid the trips. Besides, she is already feeling uncomfortable from the pregnancy, and 50 kilometres would be quite a stretch.

She lives on the plains in Chifra, a district on the edge of the recently war-torn Tigray area. It’s one of the driest places in Ethiopia.  The people here are mostly pastoralists, keeping cattle and camels for their livelihood. The rains haven’t been here in a while, and Adauka is afraid her village mates might have to move to look for pasture for their animals. “Now, this is the worst drought. We moved our cattle to the areas that get rain. We were not displaced by the conflict, but the drought is forcing us to move.”

Adawuka lives in a round house made of clothes and reeds built on bare, sandy ground. Around it is a dry expanse of brown, surrounded by grey hues. Her, under the African sun, the land with the rising mirage rolls as it always has, as if it feels that time and the heat are one thing. 

The people living in her area are going through different health challenges. Some basic health conditions that would easily be treated become critical simply because of a lack of access to health care.  “My (pregnancy) problem is hurting me, and  currently, people in my community are not healthy.” She says. 

Adawauka is worried mother. “ I may not give birth at the time I was expecting due to the bleeding. I heard that women who face bleeding may not give birth at their expected time.” She explains.

Mobile Community Outreach

But every month, a mobile health team visits her village. Every month, a tent is set up. Every month, women, children, and the elderly gather outside the tent to seek medical services. Every month, Amref Health Africa, together with medical staff, supports the provision of health services in Adawuka’s village.

The mobile health outreach brings an ambulance, medical equipment, and healthcare workers to help treat community members who live in one of most marginzaled places in the country. “Now when I heard, the day before yesterday, about your visit, I thought it would be a relief for me not to have to travel far because transportation is a problem,” Adauka says. 

The monthly mobile health outreaches in the Afar region focus on providing preventative and primary care services, such as health screenings, vaccinations, physical exams, and education. By identifying health issues early, like Adawuka’s, and educating people about preventative care, the mobile health clinics help mothers maintain and potentially even improve their health.

Healthcare workers like Henok Sitatow join the outreaches to provide these treatments to communities in rural areas. “When you come and give support to women who were unable to get the services you give antenatal injections to newly pregnant mothers and be able to prevent a disease, there is some sort of joy that it gives you from solving something in your capacity. I get this kind of joy from my job. I am joyful when I do my job, in the way.”  Says Henok.

The outreaches also remove the transportation and financial barriers to accessing medical care and bring healthcare services where they are needed and to those who need them urgently. Adawuka, and many in the area, are already riddled with poverty, and with the little money they get, they make impossible choices between food and health services.

“ In pastoralist areas, as such, there should be a health centre within a fifteen-kilometre radius. But this place is 55 to 60 kilometres from the nearest health centre.”  Henok adds. 

Through the outreach, the clinical officer provides antenatal care and Adawuka a much-needed visit to find out about her pregnancy challenges. “We came to give those health services through the mobile outreach.  In this service, we will work on prenatal care for pregnant women. We will provide family planning service. If there are needs for postnatal services, we will also provide them, We are providing a general integrated outreach service.” Says Henok, who heads the community health outreach.

When Adawuka gets into the tent, Henok attends to her. He listens to her, feels her baby’s heartbeat, and takes her blood pressure. Outside the temporary tent, a long list of women awaits him. Today, Adawuka will get an injection. Henok fears she might be susceptible to infection and will take precautionary measures with the injection.

“The outreach has benefits for us. Last time, when I was sick, they came and gave me medication, and I got relief from that sickness. After I took that medication, my heartburn was relieved. My gum scars improved. The bad feeling I had at night has improved.” She says.

Adawuka’s hopes

As Adawuka walks home from the outreach under the midday sun, with her two children, one latched to her chest and the girl walking beside her, she is hopeful that she will have a safe delivery. 

It’s more likely that Adawuka will deliver her baby at home, helped by a traditional birth attendant. This is the case in almost all the homes in the area. 

But having received some medical attention, she is hopeful that her sixth child will ‘come’ home safely. “ At the beginning, I faced problems due to the pregnancy challenges, but I would prefer the healthiest method [of childbirth].” 

So, when we think about seeking medical or prenatal care, it’s not only about “going” to a doctor or health centre. In fact, sometimes it is the opposite; the health service and healthcare workers “ go” to those in most need and those on the margins of society.

Author: Kipng’enoh, Fundraising Content Manager