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Blue Nile Children's Organization is run by a small staff and volunteers, both in Seattle and in Addis Ababa, Ethiopia. Many of our projects can be benefited by additional volunteers or interns. If you are interested in working for BNCO or would like to comment or ask questions please contact us!

The following is a summary of information about patient attitudes on health and health care gleaned from academic sources. Some studies were conducted among Ethiopian immigrants in the U.S., or in rural regions of Ethiopia. This may not represent the perspectives of the patients we will see at ROMC, but is a reasonable starting point for a provider unfamiliar with Ethiopian culture to get acquainted. This summary will be augmented by talks with Ethiopian immigrants and physicians during the months leading up to the November mission.

 

The majority of the peer-reviewed literature on health beliefs and practices in Ethiopia focuses on common infectious diseases such as malaria, tuberculosis and HIV/AIDS. However, objective information about the frequency of use of various levels of care and barriers to health-seeking behavior likely generalize to the treatment of chronic disease as well. For instance, a number of research studies attempt to determine the factors that prevent patients from seeking care in a timely manner.

 

Delays in Seeking Care

 

Several studies confirm a delay in seeking health care consultation for TB, often exceeding 30 days after symptom onset, which is greater for those living in rural or pastoral areas. Mesfin et al (2009) reported that patients receive treatment from sources including the Orthodox Church (i.e., treatment with holy water), private practitioners, rural drug vendors and traditional healers prior to presenting at a public health facility.

 

Distance from home to treatment center and the use of public transport to get to a treatment center have been found to be independently associated with incomplete TB treatment (Shargie 2007). The most apparent barrier to patient utilization of emergency care also seems to be distance, as evidenced the results of a recent survey in Tigray (Presser 2007). Sixty-three percent of respondents reported having to travel >10km from the nearest emergency center and many lacked motorized transport.

 

Along the same lines, a median treatment delay of 38 weeks was reported in a study of patients with mental health disorders, with greater delays being associated with the following factors: having no formal education, joblessness, having a diagnosis of epilepsy and having a physical impairment (Bekele 2009).

 

Knowledge of Malaria

 

Multiple studies confirm that the majority of both urban and rural Ethiopians are well-informed about the transmission and symptoms of malaria. It also has been shown that those seeking health care for malaria utilize a variety of systems including public health facilities, private clinics and community health workers. However, one study suggests people prefer to use private health care providers for malaria treatment due to a perception that they represent a higher quality of care (Deressa 2008). The use of traditional plants and the application of smoke to repel mosquitos are cited as preventative strategies employed by poorer families (Karunamoorthi et al 2009).

 

Sexual and Reproductive Health

 

Literature on health and sexuality reveals that obstetric fistula commonly results in social stigma in such forms as divorce, not being allowed to eat with family members, and not being able to join community associations (Muleta 2008). Virginity is viewed by some as a way to secure marriage, especially in rural regions where boys are 3-4 times more likely to desire to marry a virgin (Molla 2008). Use of antenatal care has been associated with literacy status, income, gravidity, religion and occupation (Fekede 2007). Higher attendance of antenatal visits also have been documented among younger women (age 15-24).

 

Implementing a Care Plan

 

A substantial amount of research has been conducted in the area of adherence to antiretroviral therapy (ART). Amberbir et al. (2008) found that children whose parents did not pay a fee for treatment or who had received nutritional support from the clinic (presumably suggesting they had poorer nutritional status) were less likely to adhere to ART. A cross-sectional survey of three ART centers in Addis Ababa found that the major reasons for non-adherence were being too busy, simply forgetting and being away from home . Correlates of adherence included having regular follow-up, not being depressed, having no side effects, a regimen that fitted the daily routine, and satisfaction with the relationship with doctors.

 

Cultural and Religious Beliefs

 

The EthnoMed website is a website about cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants to Seattle or the US. A portion of this is relevant to Ethiopians. The topics of attitudes toward death and dying and child birth practices and postpartum care are summarized at the site and worth visiting.

 

According to EthnoMed, antibiotics commonly are used and expected in Ethiopia, where individuals who consult doctors usually receive a medication for every illness. Many Ethiopians are not accustomed to the practice of withholding treatment until diagnostic work is done and are dissatisfied if no medication is given, even for a minor illness. Ethiopian doctors generally utilize an interpersonal approach to care unlike the more businesslike approach of Western doctors. The site states, “… an Ethiopian doctor will never inform a patient of a terminal diagnosis. Instead the doctor will tell a close relative. This protects the patient from being discouraged; encouragement from relatives gives the patient hope and protects him or her from despair.” When using an interpreter, be aware that patients may prefer interpreters of the same gender or political/ethnic background. More information on helpful tips for working with interpreter services will be provided.

 

Those who practice traditional medicine alone or in conjunction with biomedical approaches may consider illness a punishment from God for a person's sins or as the anger of spirits. Spiritual healing, such as prayer, is often the preferred treatment for many diseases, particularly among rural Ethiopians. Mental illnesses can be seen as the result of evil spirits and be treated with prayer. For an interesting although somewhat dated summary of traditional health beliefs in Ethiopia, refer to: Hodes RM. Cross-cultural medicine and diverse health beliefs-Ethiopians abroad. West J Med 1997; 166:29-36

 

Also be aware that over half of the population is estimated to adhere to Ethiopian Orthodox Christian religious practices, including fasting. The Great Lent Fast or Abiy Tsom is a 56-day fast during the Lenten period preceding Easter. It applies to all individuals over 13 and includes total abstention from meat, dairy and eggs and a single daily meal taken after 2:45pm. This will not coincide with the annual November mission, but for those providing care in late winter or early spring it may be an issue. Dr. Tesfai Gabre-Kidan, MD, of Seattle, WA suggests that if a patient is considered to be medically unsuitable for fasting practices, the patient can be referred to the Head Priest for counseling as there are exemptions stipulated by the church.

 

(References for this page can be found on PubMed)