Ethiopia
autumn 2003

I was met at the very smart Bole International Airport in Addis Ababa at 11p.m. on Monday 20^th October by Keleme Kana, the chairman of the south-west zone of the Kale Heywet Church - an evangelical church that puts a lot of effort into community and economic development. He took me to the guest house of the Society of International Mission (SIM), a sort of protected European enclave in the centre of Addis Ababa. Protected because of the security guard and large fence, an enclave because all the guests each time I have been there were white, while the streets outside are thronged with milling crowds of black faces, and the pavements are littered with homeless people sleeping in the open or in small hovels of plastic sheeting or corrugated iron. Nonetheless it is a haven with good facilities, good food and good conversation.

Next midday we started the 500 kilometre journey south to Arba Minch in a Toyota land cruiser. When we stopped to eat, I declined the offer of raw meat, and accepted rather roast lamb, so tough it made my decrepid teeth sing, but very tasty. That night we stayed in a pleasant hotel at Awasha, and then we continued the journey, constantly having to slow down to avoid pot-holes in the road or herds of cows and/or goats and even donkeys. The landscape was predominantly agricultural, with frequent signs of severe soil erosion. It is estimated that, each year, Ethiopia loses 60 billion tonnes of top-soil to neighbouring countries.

In Arba Minch I was accommodated in the home of Ralph and Monika Wiegand and family, a very energetic German family who had arranged last year’s seminar but who this year are in Germany. A young lady was employed to provide me with “Firenzi” (i.e. white man’s) food. Ethiopian food has variety, is attractively served and is very spicy. Normally I can eat anything and everything but, somehow, much Ethiopian food gives me problems. 

For some reason, and I am not clear what, on Wednesday night I suffered my worst ever night of diarrhoea and vomiting – I was amazed about how much fluid it was possible to lose in one night. Fortunately the facilities were good, and the next day I treated myself with anamed’s own remedy of tea made from Euphorbia hirta (asthma weed), which was growing right outside the house, and Oral Rehydration Solution (ORS) made from water, sugar and salt. Still, it took 3 days for m to feel 100%, just in time for the seminar which began on Saturday.

The seminar was well-organised. All 30 people who had been invited showed up for the first session, and the food, accommodation and all logistics were well taken care of. Half the participants had taken part last year. Their reports of their activity since last year were very encouraging. One member, a teacher by profession, had treated over 500 patients. About two thirds he had treated with Artemisia annua, people who suffered from malaria, haemorrhoids (a chronic complaint in the region) or pneumonia.

Artemisia is the one plant we introduce – the plant that is the current hope of the World Health Organisation for treating malaria, now that there is widespread resistance to the usual, cheap drug chloroquine. But whereas the pharmaceutical industry grows the plant and make tablets from the extracted vital ingredient artemisinin, we take the seeds, show people how to sow them and cultivate the plants, and then how to harvest the leaves and use them to make a tea which treats malaria just as successfully. Thus artemisia has become almost a by-word in this region. It is grown extensively by farmers in nearby Chencha, who are given 5 Bir (half a Euro) for 40 grams by development workers of the Kale Heywet Church, who pass it on to patients without adding anything to the cost.

In the words of Theo Tesfaye,

“You take 5 grams of Artemisia leaves, you boil one litre of water and you make an infusion, you filter it and divide it into four lots of 250ml, which you drink at 6 hourly intervals. You just take that for 5 to 7 days and it clears your blood from malaria – incredible! And there are no side-effects.”

“People already use herbal medicine, but they do not have a good knowledge of it. We encourage people to grow artemisia, and we train them. We bring them to the project site, and then give them cuttings to plant.”

“I am living in a country where thousands and thousands of people have no access whatsoever to hospitals or any place where they can get medication. So I say to people ‘Try it, and see if it works’ – and it does work!”

Another participant, a nurse, had shown 560 women how to use the leaves of Moringa oleifera to make leaf powder which is added to the meals of malnourished children, pregnant women and breast-feeding mothers. These leaves contain minerals, vitamins and proteins, and, when included in the diet of these people, make such a rapid difference to their health, or the quality of breast milk, that the moringa is known as the “miracle tree”.

It was encouraging also to learn that one participant has almost completed the translation of our seminar handbook into the national language of Ethiopia, Amharic.

Six days working together from 8.30a.m. till 7p.m. flew past as participants shared plants and treatments they had brought with them, we studied the range of herbal remedies for malaria and how to use (mercury-free) clinical thermometers, reviewed the use of solar energy, discussed how to treat AIDS patients, made ointment for skin complaints with the leaves of the neem tree and discussed the importance of gardens of medicinal plants.

One innovation in this seminar followed my challenge at the start that a small group produce a drama to portray something about Natural Medicine. This resulted in two excellent sketches, one of which portrayed the “conversion” of a sceptic in the formal health sector to Natural Medicine after experiencing both the efficacy of the treatment and the caring way in which the NM practitioner explained in detail to the patient the treatment he was giving and the reason for the treatment. Hopefully such a presentation in drama will encourage such practise in reality.

We define “Natural Medicine” as combining the advantages of traditional medicine with the advantages of modern medicine – for example the use of locally available plants in treatments with clear, reproducible recipes and accurate dosages. Thus, on the one hand, traditional healers who have no formal education whatsoever, and, on the other, fully qualified nurses and doctors, can all become practitioners of Natural Medicine. In countries like Ethiopia, in which it is reported that 300,000 children die each year from diarrhoea, a disease that can be very easily treated using common, locally available plants simply made into a tea, Natural Medicine can clearly make an enormous contribution.

I have myself no formal qualifications in either medicine or botany, but I am convinced of the value of Natural Medicine and I have extensive experience of facilitating people and groups. Having trained myself in Natural Medicine for a limited time, even I can play a valuable role in such seminars, as I call upon participants of all backgrounds to share their specialist knowledge and experience with the group.

On Saturday 1^st November I should have flown back to Addis from the small local airport. Waiting for the 17-seater plane were a party of 16 German tourists and myself. I had all my seminar luggage plus a bag full of artemisia seedlings – which aroused so much interest from the airport staff that my host almost conducted another seminar there on the spot. After passing through all the security checks, it was announced that the plane was overweight, and the plane took off leaving me standing somewhat disconsolate on the tarmac.

That night, after enjoying what I thought was a healthy supper of papaya, lemon and avocado I suffered severe stomach pain, which I noticed moved slowly lower in my abdomen. I made as mental note to study more about the digestive system when back home.

The next morning I was taken to the bus station at daybreak, 6a.m., ready to make the 12 hour journey to Addis on a very fully-laden bus – not so smooth or efficient as a short plane journey, but certainly a much better way to experience Africa.

Again I needed a couple of days for my tummy to recover. Tuesday saw me flying to Gambella in the south-west with the National Director and Environmental Coordinator of ZOA Refugee Care, a Dutch NGO which works closely with the UNHCR in a number of refugee camps in Ethiopia. The 17,000 Sudanese refugees in Bonga Camp, 40 km from Gambella, have access to a Health Centre, but when they return to the Sudan, as they hope to do if the very promising peace negotiations taking place in Nairobi bear fruit, the majority will have no access to modern medicine. Further, although the older generation still have knowledge of healing plants, for the younger generation this is a closed book.

Wednesday morning therefore saw a gathering of 35 people, Sudanese refugees, members of the host Ethiopian community (with whom, understandably, there is sometimes friction), a number of local professionals including a doctor and nurse from Gambella Hospital and ZOA staff who attended with a view subsequently to train animators in the refugee camps, who would pass on the knowledge in the mother tongue of the refugees.

This seminar could only be four days long, but it was said that this seminar was the very first such seminar at which the professional workers had remained right to the end, and that was despite the fact that the professional people from Gambella were stranded in their vehicle for 6 hours one evening due to a break-down. I was served by an indefatigable interpreter, one of the refugees, who translated all my words into Arabic, and translated the contributions of the participants, who spoke in one of several mother tongues, into English. I often think that we European people do not give African people nearly enough credit for their amazing gift with language.

In this seminar the discussion about HIV/AIDS was of particular importance. During the civil war in war, and the flight into Ethiopia, many lives were lost, and a high birth rate is now explained in terms of the need to replenish the numbers in each ethnic group. Furthermore, in the camps traditional customs have broken down, and it is now common for young people to marry, and commence giving birth, in their early teens. Such early marriages are often short-lived, and thus profligate sexual activity and the attendant danger of HIV transmission is rife.

I am confident that, following this seminar, many training seminars for refugees will be held not only in Bonga Camp but also in the 100km distant Pugnido Camp, that the local Ministry of Health will train local Traditional Healers in Natural Medicine, and that Natural Medicne will be taught in Gambella High School, where a garden of medicinal plants will also be established.

Early on the Sunday morning following the seminar I was taken for a short trip into the mountains that lay behind Bonga Camp. It was a beautiful, but tragic sight. Beautiful because of the wonderful landscape, tragic because of the way local people and refugees have burnt the forest every year. I was told that, in the past, burning was carefully controlled locally by the chiefs and local committees, but that decision-making has been centralised and controls are now ineffective. What could have been a paradise of biodiversity appeared to be almost devoid of animal and bird life.

Later that same day we flew a little further north to Asossa, and were then driven to Sherkolle Refugee Camp, ready to start the last (5 day) seminar early the following morning. 35 people had been invited, but well over 40 people packed the hall on the first morning. Because the seminar includes demonstrations and practical sessions in which everyone takes part, those uninvited guests had to be reluctantly turned away.

Once again, the seminar had been excellently organised. I have often been told that Ethiopian people do not work hard, or that they “eat together but do not work together”. (The traditional dish, enjera, is like a large pancake but made from a grain called tef, which is placed on a large plate. Piles of meat and vegetables are placed on the enjera, which is then shared by 3 or 4 people.) I feel I must record that, in all these seminars, the Kale Heywet Church team in Arba Minch and the ZOA teams in the refugee camps all gave the lie to this statement. My impression was that of highly committed and motivated teams of people. Perhaps the greatest need in the positive development of Ethiopia is (merely!) more examples of leadership that inspires.

This seminar was as much about building bridges as it was to do with Natural Medicine, between Moslem and Christian, between several different Sudanese ethnic groups, between refugee groups and the host community, between traditional healers and professional health workers, between camp residents and the professionals that serve them, between the rural people in Sherkolle and townspeople from Asossa. Developing better health through Natural Medicine was the uniting theme.

One participant, a man with grey hair (like myself), and bad teeth (also like myself) who looked 75 (not like myself) said, in his words of appreciation, “Keith, you and I are old men!” It is not always easy to remember that, in Africa, to be called an “old man” is a compliment. Others said to me, “You are old, but you are strong.”

I have confidence that, following the successful germination of artemisia seed before the seminars were over, malaria will soon be effectively treated in the Gambella and Asossa regions, both by medical practitioners and by the now newly trained Natural Medicine practitioners. I am constantly amazed by the interest in Natural Medicine shown by well-trained medical personnel, but they know that, given their meagre resources of drugs and staff, they can never meet the need, and they know also that, if common complaints are treated in the community, then the health centres and hospitals can concentrate on the more serious cases. We learnt, for example, that the three most common medical complaints dealt with in Asossa Hospital are malaria, diarrhoea and problems relating to malnutrition.

At 6a.m. on Saturday morning, with three Ethiopian colleagues, I commenced a two day car drive back to Addis Ababa, 700 kilometres through the mountains on either a dirt road or a badly degraded tar road. The journey was spectacular – I regretted only that certain regions were not given over to the protection of wild life. Village streets thronged with people, traders, carts, horses, donkeys, sheep and cows. The mountainsides were covered in small fields growing a variety of crops. We bought coffee – of course, Ethiopia was the source of the first coffee plants, and still has a tradition of serving good coffee.

Late on Sunday night I fell asleep on the aeroplane, and soon after 6 the following morning I was travelling on a high speed train with early morning commuters in Germany. That felt to be the least real experience of my 4 weeks away from home.

Keith Lindsey

November 2003