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Be the change you wish to see – Ghandi

I am in Mumbai for the Global Forum on Sanitation and Hygiene organized by the Water Supply and Sanitation Collaborative Council (WSSCC).

I have to give credit to the organizers that they brought me all the way from Ethiopia covering all my costs and, I have to say, it is a learning experience I will pay every penny I have for. I met some great people, saw a different culture and picked up some interesting lessons for the job that I do.

But I have also to say that the biggest lesson came from the worst of my Mumbai-Forum experience. I woke up on the second day of the Forum, went online and emailed my girlfriend back home that I loved the hotel and service before going out for breakfast. And, ironically enough, as I walked out of the elevator on my way to where breakfast was served, I met one of the organizers who has been corresponding with me all along. I said hi and she hi-ed back. And, then, as an afterthought she said, “oh by the way, we have been informed by the hotel that there has been overbooking here and that we are gonna have to move you to another hotel.” And she said this with so much politeness that I totally understood her situation. I could see how difficult it was for her to tell me that I had to move out of my hotel and she was giving me such a short notice. In fact, I was just going to pack, check-out and would stay in the conference facility the whole day. The transfer was all arranged so well that I barely have anything to complain about in terms of organization/arrangements. However, the very thing that I was told out of my hotel to make room for someone coming later on would’ve caused me to respond somehow differently had I paid for my travels and my accommodation. But I was here on a bursary and didn’t have the bargaining power to confront that good lady like: “Come on, I know there can be overbooking, I organized a few international conferences myself. But the late comer should go and get the rooms in the other hotel. First come first served, isn’t it?” But as I said, I was on bursary and it was so a natural step for her to pick me out. I told my friends what happened and as I was returning to the elevator to pack my things, I met this guy with luggage coming back from the registration desk with name tag hanging from his neck. The two words I saw read…United States – that is where he is from. So we started this little discussion and I asked, “So are you arriving just now?” And he went, “No, I arrived late last night but they didn’t have room for me. It seems they are trying to get me one…” They were looking for a room for him and others who came later on. Little did he know that I was kicked out so he gets a room.

It would be simply natural for the organizers to ask me and not him to go to the other hotel. I would have done the same and given how good the lady has been in the process it would be stupid for me to assume that I was less cared for because of any other reason than the way my travel and accommodations were financed - I was on a bursary fund and the guy (or his organization) paid his bills. It was merely a class difference. So I have no grudge at all with the wonderful lady. In fact it wasn’t personal. It was an institutional decision.

But that made me think about my ‘class’, and how I can change that. I thought, being in the country of the great Mahatma, I must ‘be the change I wish to see’ in my future. And when does change begin? TODAY. So I made the first change. Instead of going out and visiting Mumbai’s slums I opted to attend Dr. Everold Husein’s training on Communication for Behavioral Impact which will affect my career positively. I realized that I would get the treatment I want not by visiting someone else’s poverty but by overcoming my own. That’s how I ended up in Dr. Husein’s session. But that happened to be the best session of all and I hope to follow that on with the “measuring behavior change using outcome mapping” training that will take place on Friday. I decided to make the change happen in my career, be self-sponsored next time and not get ‘kicked out’ of my hotel room to make room for someone else.

I want whoever reads this to remember and focus on ‘the moral lesson’ part and not the hotel-room-change thing. In fact, I eventually managed to stay at Renaissance moving with an extra bed to my good friend’s room and that happened because the organizers including the lady I mentioned above kindly helped me to.

Last but not least, if you wonder what Dr. Hosein’s session has done to me, I give you the following before-and-after thing. Imagine that I am a communication expert for Dr. Hosein and my job is to help get people in my situation to his sesion over other competing sessions at the same time. Before, I would have said, “Come to this training and you will have a lot of knowledge about COMBI”, now that I know COMBI cares more about and taps into  what people ‘want, need or desire’, I would say “Come to this training, be self-sponsored next time, and avoid getting kicked out.”

“Every African woman has walked through the grave at least once” – Ambassador Dr. Brookman-Amissah

Behailu Shiferaw

I just came back from Accra, Ghana, where I attended a regional conference Keeping Our Promises: Addressing Unsafe Abortion in Africa.

When I got the invitation to attend and cover the conference, I was not sure if it was not just another conference discussing a ‘western agenda’. Seemingly, understanding that prevalent mentality, the media coordinator, Kirsten, prepared a pre-conference press briefing to help us explore our values about the issue. Then, there was Ambassador Dr. Eunice Brookman-Amissah, Ipas Vice President in Africa, who eloquently addressed how close the problem was to our heart. She quoted someone as saying, “Every African woman has walked through the grave at least once.” And I said to myself, “Really!? Every African? Well, my mom didn’t. My sister didn’t.”

And then, suddenly, I was reminded of what my mom once said to me when I beat my younger sibling. She said, “Boy, don’t you ever touch my little son again. I have breastfed you for three years that he will never be able to stand up to you.” I was not sure as to how long a baby should be breastfed under normal circumstances. I was, however, eager to know why I was breastfed longer than my brother. She told me that she had a miscarriage of an almost fully-developed fetus while I was still very young. And since her breast was already filled with milk, I was given a second round on it. As young as I was, I did neither know nor care about the miscarriage at all.

 

As I remembered that, while still in the press briefing room, I realized how rampant birth related complications really were. But then a series of questions surfaced: “If it is as prevalent as they say it is, why is the issue not accorded with the attention it deserved? Why is it never on top of the agenda? Why is it never as important an issue as it is in the West where it significantly shapes voter behavior?” May be it is a Western problem. May be it didn’t affect us, Africans, as much as it affected the developed world. May be safe abortion procedures are more expensive than treating post-unsafe abortion complications. May be…the list of the logical assumptions accounting for the issue’s lack of attention was endless. But they were all wrong.

First and foremost, unsafe abortion is definitely an African problem, too. Africa has been hit the hardest by the preventable pandemic. Ipas Africa handed out a flyer that summarized the state of abortion in Africa. Credit be to them.

Every year, the flyer shows, there are more than 5.5 million unsafe abortions in Africa. Half of the 67,000 global deaths from unsafe abortion occur in this continent and the risk of death from this practice is greater in Africa than anywhere else in the world. According to the World Health Organization, the number of deaths from unsafe abortion is rising in Africa – even as it decreases in other parts of the world. And the number of abortion cases is also increasing in Africa while it is decreasing in other parts of the world. In fact, unsafe abortion accounts for more than 13 percent of maternal deaths in Africa.

For African women who experience unsafe abortion and survive, short – and long-term injuries and disabilities, such as uterine perforation, chronic pelvic pain and secondary infertility, are all too frequent.

Are African governments not aware of that? It is difficult to think so. They have been to such conferences so many times. They have read such reports many, many times. And more than anything, they are Africans, too. Their parents, sisters or at least neighbors, as much as mine, have “walked through the grave at least once”. So what is all the silence about?

So in search of the “why?”, I set out, only to find that the blaming finger points to no one but me and my fellow African men who enact (or at least failed to liberalize), interpret and execute the restrictive laws; to men who constitute the majority in parliaments; to men who hold the seats at the ministries of health in our countries; to men who head most of our nations; to men who share all the excitement that is there in having sex but who externalize the pain and guilt attached to being with unintended fetus to women; to men who have headed our community and who have, thus, authored all the gender imbalances.

There is so much money flowing to causes such as AIDS, TB, malaria, climate change … yes, those are the problems of the men, too.

Dr. Haile Gebresillassie is an Ethiopian researcher with extensive experience in the reproductive health area in Africa. He recalls one recurring question which policy makers in Africa often ask whenever experts recommend intervention in the reproductive health sector: “Don’t you think we should first study the extent of the problem to determine whether it’s worth intervening?” And as a public health expert, he was never challenged with this question when dealing with other issues but reproductive health – ‘the women’s issue.’

This neglect is equally, if not more, reflected in our laws governing abortion. Indeed, the laws and policies governing access to safe abortion in Africa vary, ranging from very restrictive, such as in Kenya, where abortion is permitted only to save the life of the woman, to liberal, such as in South Africa, where abortion is permitted up to the 12th week of pregnancy or later, in certain circumstances. Ethiopia’s law is one of the most progressive as well. In Ethiopia, women can terminate pregnancies in cases of rape, incest, danger to the health or life of the pregnant woman and in case the pregnant woman is a minor – all without having to produce any proof to any of the claims. Hats off for South Africa, Tunisia, Ethiopia, Ghana and others who worked hard to save lives of their women.

We are talking about a continent with a huge burden of unmet needs for contraceptives. In Ethiopia, for example, over 30 percent of women in their reproductive age cannot still access contraceptives – a critical element in the ‘continuum of care’ for women and children. State of World Population 2010, annual report published by the United Nations Population Fund (UNFPA), states that when women and girls have the power to decide for themselves when and if they will become pregnant, they are more likely to have healthy pregnancies and to seek antenatal (before birth) care. Their children are more likely to survive infancy and early childhood. Likewise, girls whose mothers survive are more likely to continue their education and, in turn, are less likely to marry and have children before reaching their 20s. This, in turn, lowers their risk of dying from causes related to pregnancy and childbirth. Imagine the reverse scenario in resource limited settings like most African countries where the contraceptives are not yet adequately available. It is irrational and irresponsible not to provide contraceptives and then to fail to provide safe abortion options. It’s not moral to ask people (at least those in unions) not to have sex until the government is done away with other priorities and is able to provide them with contraceptives. In developing countries alone, State of World Population 2009 states, there are an estimated 106 million married women who have an unmet need for family planning even if they do not want to become pregnant now or within the next two years—the definition of “unmet need.” One participant at the Accra conference addressed the issue saying, “where there are men and women [with no family planning options], there is pregnancy; and where there is unintended pregnancy, there is abortion.” So the choice is a matter of making it safe or not.

In summary, abortion, yes, is a problem in Africa more than it is anywhere else. And women are dying from it needlessly. But, fortunately, unsafe abortion is preventable and so are the thousands of deaths from it. Making the choice economically viable, safe abortion procedures are much cheaper than treatments needed for treating complications arising from unsafe abortion. In Nigeria, for example, research presented by Dr. Ejike Oji, representative to Ipas Nigeria shows, providing safe abortion services costs health facilities 71 percent less than what treating post-abortion complications would have cost them.

Just take a moment and imagine this scenario. You and your lovely spouse have already had enough children. But who says sex is just a reproductive act. Sadly, you neither have family planning options nor safe abortion rights at your service (note that I am not recommending abortion as family planning option but as a last resort). Now, what would you do? Would you stop having sex in fear of becoming pregnant? Would you continue to bear children whom you will not be able to cater for?  Or would you resort to unsafe abortion every time you are pregnant, which could probably mean every year? This is not a-scenario-of-the-improbable. There are millions of Africans who are living in such situations, and to your utter shock, yes – today.

No single generation does it all

Behailu Shiferaw

Thank you Halelujah for letting me be part of something I would, after years, look back to and be proud of. At this age, you know, God has been generous enough to help me do things that would make me smile through my grey hairs; if, God Willing, I ever live to see that.

As a journalist, while we were doing the tree-planting, I couldn’t help drawing analogies between what we were doing by the river and what it is to be doing our share in this country’s development.

Perhaps, it would be rewarding for me to start off by talking about those people who helped hugely in making this happen. When we, after a short drive from Romina, got off at Kebena, there were a few people waiting for us; full of grateful smiles. One of them was on a crutch. The other guy had a self-admitted neurological issue that compelled him to lose control over his vocabulary. It was encouraging to find such people with so much integrity left in their veins. After all these are people whom we tease for something they didn’t bring upon themselves. Also credit be to those who were with them in the process. Adding to my surprise was the personality of the coordinator from the Rotract’s side. He was a gentle man who chose to listen to others talking about what he actually did. If you brought someone new like myself, who was not involved the process, the chance of him/her picking those people as the heroes behind the event would be next to zero. How blinded we are by our stereotypes.

This, I thought, is a simple manifestation of two things. The first is the paradoxical fact that heroic deeds usually come from ‘unlikely’ sources. The second and what is more irking is how such heroes go unnoticed. Bravo Hale for finally persuading them to the ‘stage’ and bringing to light their heroic deeds. It is what leadership is all about, crediting right-doers so that no-so-right-doers would follow suit. Please note that there are people who have done so much for this nation but whose names we do not even know, leave alone praise them.

The second rather interesting analogy came to form between the ants and the government bureaucracy that has always stood on our way to doing our share to the development of our country. I was fascinated to note that our reactions to the ants were as diverse as are our reactions to the bureaucracy. Some kept distance; some walked in but were complaining about the ants; while others didn’t even believe the ants were worth their attention. Our engagement in the development process of this country has obviously never been bed of roses. It has been marred by ants whose magnitude and unconstructive role is as varied in scale as is the level of bureaucracy that discourages Ethiopians from contributing their share to the development of their motherland.

I and a newly-made-friend, Selam, were discussing/rather complaining about the bites when a guy whose name, I later learned, is Sami, chipped in a very good theory of why these ants bite. He said, “Don’t tamper with these ants. Just don’t mind them even if they trek under clothes. They don’t harm you if you don’t trouble them. Otherwise, they become defensive and keep bothering you.” Isn’t it what we witness everyday with our politics? I am not arguing that we should keep our distance from politics, I am just suggesting that there is so much more to helping one’s motherland than being immersed in the politics. We can do important things (such as tree planting) without having to anger the short-tempered ants. Don’t get me wrong, by ants I mean ants. Hope you understand.

The other interesting analogy formed between the plastic bottles and bags that lay scattered all over the place and the various problems that have always haunted our nation.  With Hale’s pragmatic leadership, we did some picking up of the litters after the planting. But we didn’t clean it all. When we left the area, there were still some litters that were left here and there. It was not because we didn’t know the area was not clean enough; it was just that we didn’t have enough energy to do more. The litters, for me, are nothing but a metaphoric representation of our problems as a nation; and we represent the generations who come and go through time. Therefore, the fact that we didn’t clean the area sufficiently, was a manifestation of one truth. No single generation does it all. When people say that “Rome was not built in a day”, they mean that it takes generations to build what we envision our country to be. There is no one generation that did everything to bring about what we see today; but there is always a generation that inspires the next; and our job is to be ones; to inspire the next.

I am, thus, not disheartened with the fact that we left some litters unpicked. I hope that others will do the rest. It is how nations change. It is like a relay race; you take the baton as far as you can and then you hand it over to the next who takes it forward. Probably it is not a good comparison in a sense that the race has an end while a country doesn’t. Same holds true with this piece of writing, I have documented a part of what I observed; let you add yours to make it whole enough to be passed onto the generations to come.

PS> Credit to Keroggie for facilitating the tree planting event. It could not have been better timed than now- when, probably for the first time in our history, we are having to wear gloves.

God Bless Ethiopia and Its People(s)!

FIVE MINUTES with Ms. Simonen

Behailu Shiferaw, Editor-in-chief, Lambadina

Note: Ms. Mari Simonen is UN Assistant Secretary General and Deputy Executive Director of the UNFPA. I met her at the ICPD+15 that was held in Addis Ababa, Economic commission for Africa hall.

Q: What is your general impression about the over all proceeding of the ICPD/15?

A: I am very impressed by the commitment of everybody who is here. They really worked very hard to do a very substantive review by each country of what they have been working on over the past fifteen years to implement the ICPD Program of Action. And they have come together and had several days of a very engaging discussions and were able to agree to forward looking and very clear program of commitments for the next four years. So clearly [there are] a lot of commitments and dedication to continue to work on these issues.

Q:But we have had several commitments signed before. For example, eight years after the Abuja Declaration of 2001 where African leaders agreed to commit more than 15 percent of their annual budget to health sector, only Botswana seems to have achieved that. So what’s African peoples’ assurance that the commitments made at ICPD + 15 are not just another list of commitments from African leaders?

A: We need to continue to be vigilant. That is why these kinds of review conferences are important so that we can take stock [and] we can see what has been done and what has not been done. I think one essential part is to monitor carefully every year if the changes actually do take place and help each country to try to achieve; help each country to find smaller steps that they can take even if they cannot do all of it.

Q: As a UNFPA deputy secretary general, do you think Africa is truly on track to achieve the MDGs and the ICDP?

A: Africa is making a big effort. Every country is making big efforts. So what is important to focus on is to build on the positive changes and use that as an encouragement to do even more. There are big challenges. Not all the goals will be achieved in the time frame. But that should not limit us from continuing to try and making changes in a number of areas. Some [countries] were lagging behind others but we continue. The main thing is to persevere with patience taking a careful look at what works and what doesn’t work so that we invest more on those things that actually work.

Q: In 27 years, Ethiopia is going to be a country of over 150 million people if things go on at the same rate. Do you think Ethiopia with only six percent of its mothers giving birth with professional birth attendant and Africa [hosting more than 48 percent of the global maternal deaths and high rate of youth unemployment,] afford to welcome more and more population with the limited resources we have?

A:The important thing is to make sure that little by little you expand the coverage of [reproductive health] services. So let’s focus on making progress on having these services accessible to a larger number of women little by little but with a clear idea of where we are going and how we can get there. We should not be discouraged by the fact that we are so far from the goals. Even making small steps is better than making no steps at all. I think that is the basic message of the conference. There is progress. It is not enough but that is not to discourage us. It is [important] to look at those things that work and to continue to build on them so that we can bring to scale the very good smaller initiatives that exist in many communities and make sure that gradually and eventually they will reach every person who wants to use the services. If [we] extend the availability of family planning, maternal health care and all the other reproductive health care components to every person in every corner of our countries that will in itself make sure that there will be a more balanced population growth which is in synch with the available resources that the country has.

Q: What is the role of the media in realizing the commitments as a stakeholder? And how much ready is UNFPA to work with the media?

A: The role of the media is absolutely critical in helping to communicate and to convey correct information among different groups of people. Media has big responsibility to look for the facts, evidence and to share that in a balanced way. You can combat the misconceptions and lack of information that exists on these kinds of issues. And of course, UNFPA continues to work with media. It is a very important partnership and we hope that your [media] network [on population and development] will do the same.

More Midwives, Less Maternal Deaths

Behailu Shiferaw, Editor-in-Chief, Lambadina Institute

Yengene Lope is not only ‘rich’ with children. She is also the pride of her husband and her family. No man except her husband has ever had sight of her private parts even during giving birth. A Mezjenger in Yeki district of Southern Nations Nationalities and Peoples’ Region, Yengene lived in a society where women deliver inside the jungle so that no one would steal a look between their legs.

“When I felt the labor coming, I hid out inside the jungle. And when the babies came thrusting forward, I did everything on my own. I pushed the baby out, cut off the umbilical cord using small knife or the sharp edge of sugar cane.”

That happened two decades or so ago. And technologically speaking, the world has gone very very far away from where it was twenty years ago. But the situation of mothers in Ethiopia has not traveled with such a speed. Still, only six percent of Ethiopian women give birth assisted by trained birth attendant.

Infants are dying a threatening deal. Women are dying giving life. And sadly they are all dying from avoidable complications.

In a country with a population size of more than 75 million, 673 in every 100,000 pregnant women die from pregnancy related complications and many many more acquire disability. Yengene was just a piece of luck away from having the same fate.

In fact, the problem is not exclusively Ethiopian. Various documents show that over 99 percent of maternal deaths occur in less developed countries, particularly in Asia and Africa. High-quality and accessible health care has made maternal death a rare event in the developed world.

Seemingly drawing on this staggering figure, Dr. Kesetebirhan Admasu, representative of the Ministry of Health (MoH) of Ethiopia stated, in a panel discussion organised by UNFPA, WHO and International Confederation of Midwives, that reducing maternal mortality was a ‘daunting task.’

However experts such as Mrs. Dorothy Lazaro, Midwives specialist with UNFPA responded on the same occasion that countries with limited resources at their disposal such as Seychelles, Zimbabwe and Sri Lanka had managed to curb their maternal mortality rates very much. She said that these countries registered remarkable success by training their midwives instead of depending heavily on physicians and specialized obstetricians. Seychelles, according to 2007 Unicef Report, for example, has one of the lowest maternal mortality ratios in Africa of 57 per 100,000 live births. Mrs. Lazarro said, ‘Seychelles has managed to do so with only three obstetricians.”

Ethiopia trained its first group of midwives in 1953. However, the growth has been so slow that the country has been graduating an average 13 midwives each year. Only 1,275 midwives are currently functioning in the second most populous country in the continent. This in turn translates to 1 midwife for 57,960 people which is way way below the WHO standard of 1 midwife per 5,000 people.

With all this grim facts, however, there is good news as well. Sophisticated hospitals and specialized doctors are not a must. Well-trained nurses, midwives, nurse-midwives and midwife assistants can perform most functions at Basic Emergency Obstetric care (EmOC) Facilities and increase birth attendance coverage by up to 40% by 2015.

By scaling up the service sector, Ethiopia can reduce maternal mortality. But for this to happen, the nation must act now.

UNFPA Executive Director, Thoraya Obaid, said, “Putting in place the health workforce for scaling up reproductive, maternal, newborn and child health services is an urgent task, and we believe that the support of health professional organizations will be crucial.”

WHO Report of 2006 indicates that the world needs 300,000 midwives in order to achieve MDG 5. Likewise, Ethiopia needs more than 15,000 midwives right now. Doesn’t Ethiopia need more midwives now more than ever?

Deliver and Move On

• Abuja-the way to ICPD, MDGs

Behailu Shiferaw, Editor-in-chief, Lambadina Institute

“We pledge to set a target of allocating at least 15 percent of our annual budget to the improvement of the health sector.” 27 April 2001, Abuja, Nigeria.

It was a statement taken from the commitment African leaders made over eight years ago; just one of the many commitments leaders have agreed to over the years.

Having travelled around and seen how people live in the less developed world, Mrs, Melinda Gates once noted:

“… I am especially moved by the mothers I meet. They invite me into their homes, and we sit on the floor, often on opposite sides of a small mat, talking. I have young children myself, and I try to put myself in their position. What would I do if I were on the other side of the mat? What would I want for my children?… on my side of the mat, when my kids are sick, they get antibiotics. On the other side of the mat, when their children get sick, they may be receiving a death sentence. Those of us in wealthy countries must try to put ourselves on the other side of the mat…we must remember that these mothers love their children just as much as we do.”

The priority for women ‘on the other side of the mat’ was health; their health and the health of their children; the health of their children who will one day become legislators of African governments or even leaders. Mrs. Gates changed roles with women on the other side of the mat; something even African parliamentarians, who lived African lives with similar African mothers, did not dare do.

Explaining why the Abuja Declaration of 2001 was not fulfilled in his country, the State Minister of Finance and Planning of Uganda, Mr. Jachan Omachi, listed energy adn railway networking among other priorities his country needed to address.

It is true that no nation affords to focus solely on one issue and not another. But once it is agreed that people should come first, it is equally plain that health is should come first. The most redundant statement on the ministerial meeting was: “population isn’t about figures but about people”.

Legislators can use their role of appropriating budgets to improve reproductive health. But that takes commitment. That takes the discomfort of sitting on the other side of the mat for a while. It is good to recognize, however, that countries like Botswana and Seychelles have achieved 15 percent and 14 percent, respectively.

Likewise, it is equally important to remind other countries who are not doing so well. At a time when Mauritius, Nigeria, Uganda, Zambia, Seychelles, and Botswana with 8 -15 percent of their annual budget allocated to health, work towards more investment on the sector, there are countries like  Guinea Bissau and Sudan which, according to UNICEF’s The State of the World Children 2008, have invested less than two percent of their annual budget on health.

Parliamentarians are important stakeholders who can facilitate better budget allocation for health and hence ensure well-being of their voters.

So parliamentarians of Africa, it is never too late. As Ms. Mari Simonen, UN Assistant Secretary General, Deputy Executive Director of the UNFPA, underlined, “We should not be discouraged by the fact that we are so far from the goals. Even making small steps is better than making no steps at all.”

But sooner is better than later. So act now. Live up to the previous commitments; invest on health, achieve ICPD and MDGs. Only that will make the commitments of ICPD/15 a credible one.