Championing for Cultural and Structural Change for the Better: 5th January Event Recap

In January 2016, AWiB’s monthly networking platform focused on health care system matters, with a speaker who exuded optimism, possibilities, warmth and professionalism.

Dr. Senait Fisseha is Director of International Programs of the Buffet Foundation, a lawyer and a physician, specialist in maternal health, with a specific focus on infertility and reproductive health issues.  Her sub-specialty training is in High Risk Obstetrics/Maternal Fetal Medicine, Urogynecology, Family Planning and Infertility, and soon to start Gynecologic Oncology.

She has been serving as a full professor and chief of the division in University of Michigan. Her works oversees reproductive health programming and strategy in Latin America, Africa and Southeast Asia. In Ethiopia, she is known for having been instrumental in fulfilling the Ministry of Health’s plan to create a center of excellence in maternal health at St. Paul’s Hospital in Addis Ababa. As a medical student, she became a founding member of the Ethiopian North American Health Professional Association.

Here are Dr. Senait’s quotable quotes:

‘It appears that the status of many public hospitals in Ethiopia is of concern, with limited utilization of health services, very weak community involvement and poor hygiene and sanitation. What to do about this?’

‘Are patients empowered to ask questions to take advantage of alternative health care?’

Women carry half the sky. And yet, in our society, we value boys more.’

‘There seems to be a generational gap, and delayed gratification a thing of the past. It looks like nowadays, things are expected to be immediate. Many young people may not want to go through the sacrifices required in this [health] profession. With the right kind of mentoring and commitment, passion can rekindled, nurtured, and young people can be helped to decipher temporary challenges.’

‘Be comfortable of the chaos and the struggles when working and raising children, and take it as a challenge.’

‘Our society gives a background message of what our role should be, and that one should always take care of others. And yet, it’s important to take care of oneself. When you feel good, you are a best mother.’

‘Mentorship for women is important, as well as nurturing relationships. Reaching out to people and maintaining relationships requires effort, but we need to sustain others the way others sustained us.’

Leveraging Networks

What has shaped Dr. Senait’s worldview? Dr. Senait knew she wanted to do medicine from a young age (especially primary health care). She was also concerned about the plight of women in Ethiopia, having seen how many of them were ill-treated, and this shaped how she worked for them in the future, especially around ensuring their reproductive rights are respected. She also believed that the sense of community was very important to her.

As a primary health care professional, educated and living abroad, Dr. Senait was drawn to return to Ethiopia as often as possible, serving as coordinator and book-keeper in many projects. Realizing how the health system in the country seemed to be losing momentum and passion, she proactively resolved to become part of the solution. Senait thus resolved to reach out to healthcare providers and mentor, and armed with a vision, she resolved to develop relationships of trust to make things happen.

When later appointed by the Buffet Foundation, she led activities around reproductive health matters in Ethiopia. Leveraging her networking skills, Senait’s work has also forged relationships with organizations and individuals, including the Packard Foundation and individuals such as Dr. Ephrem Tekle, Director of Maternal Health and Child Care at the Ministry of Health. 

Primary Health Care Matters in Ethiopia

During her talk, Dr. Senait ran us through facts and statistics regarding advances of primary health care in Ethiopia. Acknowledging the visionary leadership of Dr. Tedros Adhanon, the former Minister of Health, who had inherited a country with very high maternal mortality, high HIV AIDS prevalence, a high need of skilled birth attendance, and poor infrastructure for people living in the rural areas (with 84% of people living in such rural areas).

Senait applauded the bold advances in health care made in the country, including the presence of 166 primary hospitals, expansion of medical and midwifery schools, the training of health extension workers, and the construction of new health posts and health centres. It is reported that Ethiopia has made one of the boldest interventions to tackle Millennium Development Goal (MDG) 5 by reducing maternal mortality by 50%, and reducing child mortality from 1400 in 1990, to 350 in 2015.

Dr. Senait also reminded us of the tremendous assets Ethiopia has, included its committed, bright people holding great work ethics.

And yet, there are ‘spectacular progress, and spectacular inequities’ – Dr. Bill Foege, CDC, in Ethiopia exacerbated by many inequalities.

Dr. Senait then passionately invited all to consider focusing on women in one’s development endeavours. Why so? ‘Because women carry half the sky,’ she asserted. ‘In our society,’ she added, ‘we value boys more.’

Statistics spoke to that:

  • Nearly 70% of the world’s poorest are women;
  • Two thirds of people who don’t read and write are women;
  • Every woman in 110 experiences pregnancy-related complications, 1 woman dies, and 40 of these women will have unsafe abortions;
  • Only half the number of women receives the recommended healthcare.

Dr. Senait gravely added: ‘A pregnant woman has one foot in the grave. We are so silent to the death of such women. Health is one thing, but we have prejudices against women.’ Senait also solemnly added that there are many manifestations of misogyny [dislike, prejudice] against women, shown in child marriage, domestic violence rape (conjugal/date/gang) and abduction. She concluded: ‘Access of women to health is just one aspect. We need to educate women and our community.’ 

What does the Health Sector need?

Dr. Senait posed a few questions pertaining health care provision in Africa/ Ethiopia, that she and her colleagues have been entertaining:

  1. How do we set up healthcare priorities? Justice and fair allocation of resources, in her view, are priorities,
  2. How to include marginalized people? Cost effectiveness and equity are key,
  3. Regarding physician density, Ethiopia in 2006 had 1 doctor per 30,000 patients (WHO). Africa carries 40% of burden of disease, and the lowest number of physician distribution because of many leaving the country. Studies show that physicians leave mainly because they want to work in a healthy environment, and opportunities to improve. What can be done regarding this?
  4. Ethiopia’s health policy framework has promoted private sector and NGO involvement. As a result of this, private practice boomed. There has been a tenfold increase in private sector growth. What are the quality issues? Are patients empowered to ask questions to take advantage of this alternative care?
  5. It appears that the status of many public hospitals in Ethiopia is of concern, with limited utilization of health services, very weak community involvement and poor hygiene and sanitation. What to do about this?
  6. As citizens, what is our responsibility to help this work? How can we become informed patients, decipher what is real or a myth, and how can we ask the right question? 

Generating Transformation in the Health Sector

Given the above ongoing issues and questions, through the University of Michigan, Dr. Senait Fisseha and her team resolved to generate change in one of these structures, St. Paul’s Hospital in Addis Ababa. This would involve creating a medical school that would challenge the status quo.

The strategy of Health Sector Transformation Plan within St. Paul’s hospital, entailed:

  1. Strengthening primary care, and develop health professionals: high school graduates are being trained, for a year, in maternal health and sanitation. They are then deployed within the community, creating linkages,
  2. Human Resources for Health through improving specialty training,
  3. Faculty development: in the training, integrate the elements of ethics and empathy. The postgraduate training programme started in 2012.

Cultural Change

As a result of the above, Dr. Senait reported that for the first time in the history of St. Paul’s hospital, physicians, the best of the best, left employment within NGOs and came to St. Paul’s. Many also seemed to be attracted to the possibilities of having advance training. In addition, there is a significant decline of patients leaving the structure, to receive service elsewhere. Finally, more female patients seem to come to request for healthcare, stating that they were getting respectful and compassionate care. In addition, in the hospital facility, it was noticed that doctors would stay longer and practice after hours.

In the above endeavor, Dr. Senait also mentioned the work of:

  1. The Center for International Reproductive Health Training (CIRHT), a new center to train and  build physician skills, in partnership with the Ministry of Health,
  2. The Ethiopian American Doctors Group, having the membership of 250 physicians of Ethiopian origin, having the purpose of building an economically sustainable center of excellence. The mission of this organization is to provide  high quality medical care through education and research. The planned services are neurology/ stroke, oncology, trauma services, cardiothoracic, orthopedics and burn treatment. 

Q & A Time

Several questions were asked in plenary. Below are some, coupled with Dr. Senait’s answers:

Q: Wouldn’t it be better to give training to community health care workers, rather than professionals?

A: As discovered through CIRHT, it is expensive to give training. Due to past practices, there is a culture that does not value training, and participants are expected to be paid to attend. The system is broken.

To this point Dr. Ephrem also answered that there are still inadequate skills and supervisors for health professionals.

Q: When it comes to a couple having infertility issues, much more pressure is placed on women, and this is painful: how does your initiative pay attention to raising awareness in society?

A: This issue is the same as in the West. There are consequences to not being able to have children. We are defined by our ability to have children. In reality, the causes are 40% attributed to the males, 40% to the females, and 20% is unknown. In the West the people in question are counseled; such options are not available in Ethiopia. Infertility can be preventable, at times caused by tubal diseases, sexually transmitted diseases, gonorrhea, unsafe abortions, and scarring of the uterus.

A course on this topic will be launched. We are donor-driven. Instead, we should give women comprehensive care. The biggest service would be on awareness: what can one do to prevent tubal infections? And we need to stop shaming the woman. 

Q: Ethiopia has achieved substantial progress in health care. Where is the health burden?

A: For me, Dr. Tedros and Dr. Kesete (former and present Ministers of Health) are unsung heroes, including NGOs, Civil Society Organizations and academic institutions. Between 1994 and 2006 they integrated work of health extension workers. It is the leadership that made this happen, creating an environment to support innovative, bright and bold young people.

To the above, Dr. Ephrem added that there has been a concern about how much has been invested on training, since many trainees leave the institutions. The plan for the next 5 years is to work on training quality before students graduate, through more skills labs. He added that the agenda for the next five years is centred around equity and quality (since cost-effectiveness and equity don’t go together). The other focus will be to develop regional states such as Benshangul and Afar. 

Q. For the younger generation wanting to pursue a career in the medical profession, there is a need for too much time commitment. Females too are expected to work out of Addis. How do you see this?

A. There seems to be a generational gap, and delayed gratification a thing of the past. It looks like nowadays, things are expected to be immediate. Many young people may not want to go through the sacrifices required in this profession. With the right kind of mentoring and commitment, passion can be rekindled, nurtured, and young people can be helped to decipher temporary challenges. At the same time, times are changing, and young females in this profession giving birth early are accommodated. 

Q. How can nurse practitioners be part of this scheme to increase impact?

A. Ethiopia does not have a nurse practitioner programme. We have a tri-phase programme in OBG. The Ministry of Health has halted the work of many nurses’ schools because quality had become an issue. At present, the Ethiopian Midwives Association is teaching nurses and midwives. 

On Dr. Senait’s Being

Dr. Senait shared how she feels she has been shared by hardship, which have taught her endurance. During the turmoil of the Derg Era, Senait lost a brilliant and courageous brother who studied in the States, but came back to join the movement against the regime: he was imprisoned, tortured and killed. She also lost both parents, and had three siblings left in prison, one being as young as ten. She reflects that perhaps, this is where she developed her ‘can-do’ attitude.

As a mother and a professional who travels a lot, how does she do it all? Dr. Senait invites us to be comfortable of the chaos and the struggles when working and raising children, and take it as a challenge. She mentions she is grateful that she has a wonderful husband, who is a feminist, committed to seeing her succeed, and comfortable in being in the background.

She advises other mothers not to feel guilty about the decisions they make. ‘Our society,’ she says, ‘gives a background message of what our role should be, and that one should always take care of others. And yet, it’s important to take care of oneself.’ She adds: ‘When you feel good, you are a best mother.’ Message is to take care of others, not the self. She remembers how, ten years ago, she was at the height of feeling the pressure of it all, and she stopped her car, and decided to give herself ‘me’ time. She now has some intentional practices to look after herself, and make time to be with friends.

She is very grateful of all the relationships that have sustained her, and how others have invested on her, provided her with scholarships, and mentored her.

Senait concluded the evening by saying: ‘I wish that I had had the opportunity to be part of AWiB in the past. AWiB provides a supportive environment that enables women to connect with others who have similar challenges.’

‘Mentorship for women is also important,’ she added, ‘as well as nurturing relationships. Reaching out to people and maintaining relationships requires effort, but we need to sustain others the way others sustained us.’

At AWiB, we are grateful for having had this eloquent, passionate woman, who values human relations, and who is contributing to the transformation of organizations for the health benefit of so many in this country and beyond.

AWiB invites all those interested to be part of this platform. AWiB strives to be a catalyst for Ethiopian women leaders to connect, learn and grow together by meeting on a monthly basis and networking, through Round Table Discussions and annual events such as Women of Excellence.

Upcoming events for members include:

  • Being Health Smart: on Cervical Cancer’, on 23rd January, 2016.

Members are invited to visit the AWiB Resource Center, where there is also free Wifi available.

Events open for all include:

  • ‘Know how to find your Dream Job!’, on 4th February, 2016.
  • The May Forum of 26th May, centred around the theme of Transformation.

In addition, the call for nominations for Women of Excellence 2016 is out, and nominations are accepted till 31st March, 2016.

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