26 October 2012

Health and Disease in Ethiopia

I had to get lots of needles before coming to Ethiopia. Inoculations against polio, hepatitis, yellow fever...I don't remember all of the lovely things injected into my arms at the university travel clinic. I felt like a pincushion, and this after opting out of some of the more expensive shots - meningitis and rabies vaccines. Once I arrived in Addis Ababa and met with other Westerners, I was regaled with stories of amoebic dysentery, worms, mysterious skin fungus, strange fevers, diarrhea, vomiting, malaria. I was told to just accept that this would happen to me too, every week or every two weeks. The veterans wanted me to grin and bear it, join the club and suffer in unity.

Instead, I have been uber-careful about what I eat, how often I wash my hands, what water I drink...but I have also been pretty lax about holding the hands of small sick children, drinking fresh juices, and eating in the homes of poor people or at the local hangouts of my Ethiopian contemporaries. I had been told by a linguist who had worked in Ethiopia for about 13 years to take probiotics. And I have, almost every day since coming here. Luckily, I haven't gotten sick too often. In fact, I didn't get sick for the first 2 months of living here.

Why do people get sick here? This is due, I think, to a combination of things. Unsafe water - so many places the water comes from rivers and streams that have untreated effluent running into them. If that water is used to clean your glass/plate and there is a bacterial residue left behind, you may suffer. Uncooked food. Raw meat is a popular dish here and I will not ever eat it, but lots of people do, both foreigners and Ethiopians, and then they pay the price. General lack of hygiene in Ethiopia. The simple act of handwashing is ubiquitous in Ethiopia before taking a meal, and usually also after a meal, because Ethiopian food is eaten with your hands. But for some reason - maybe lack of water - it goes out constantly in Addis, especially in the dry season - handwashing before preparing food is not as common. Also, handwashing here means hand rinsing really - there is not always soap available, but soap is necessary to remove unwanted bacteria from your skin. Using wastewater to irrigate crops - pathogens are known to travel on all the surfaces of fruits and vegetables, even in developed countries. People preparing food with untreated diseases themselves. I remember an outbreak of hepatitis at a local pizza joint in Connecticut, due to one of the pizza flippers being a carrier and not washing his hands properly before preparing food....There are things just as bad or worse than hepatitis floating around Ethiopia. One of my housemates was researching an article on hygiene and said some hundreds of thousands of Ethiopian children die every year due to diarrhea, caused by lack of access to clean water. Check out these links to read more. UNICEF has even established a national handwashing day to promote awareness and hygienic habits.

The other reasons are the water, the dust in the air, the mosquitoes, and the fleas. All of these things potentially carry disease. Washing in contaminated water can make you sick. Inhaling dust laden with giardia can make you sick. Getting bit by malaria infested mosquitoes can make you sick, even if you are taking the meds, which no one, except myself, takes here. Getting bit by fleas can make you sick. Contact with a handrail, bus seat, door knob...AHHHHH I WILL NOT LEAVE THE HOUSE!

So as I sit today with a fever and nausea, I consider all of the diseases I have seen or heard about since coming to Ethiopia - leprosy, HIV/AIDS, malaria, typhoid fever, typhus, schistosomiasis, giardia, malnutrition...and think that a little fever, headache, and stomach discomfort isn't too bad. My friend's husband was just treated for a double bout of Typhoid and Typhus. In Addis currently there is a type of 'flu' floating around. Ethiopia is reputedly one of the worst countries in the world when it comes to available health care. My one experience of needing a doctor here was quite positive, but paying $10 or $20 to see a doctor for me is a steal - for the average Ethiopian, this can be impossible. Also, simple accidents can alter an Ethiopian's life - especially if they go to a "country" doctor, who sometimes do things like tie off broken bones so tightly the limb turns gangrene, tear out tonsils with an unclean knife resulting in infection and death, setting the bones incorrectly, causing permanent crippling.

Morning musings of a sick girl in a sick country.