Risking life in order to survive

Medhin Selamu

22 April 2020

Ethiopia is one of the biggest sub-Saharan countries, with a population more than 110,000,000. Sub-Saharan Africa (SSA) countries are known to have weak health systems and shortages of healthcare workers (1, 2). After the COVID-19 outbreak the Ethiopian government has taken several measures to prevent and control the spread of the disease, ranging from advising to wash hands to declaring a state of emergency.

However, community members seem not to take precautions seriously. After the detection of the first case, for the first couple of days most people were washing hands seriously. As the time passed, in many places either the soap or the water containers were empty when you checked to wash your hands. Like many other African countries, implementing the social distancing is not easy for most people in Ethiopia.  I feel that we Ethiopians have a very tactile culture where we shake hands and talk to people with soft voice and get closer among each other when we communicate. I wonder how we could manage to adhere to social/ physical distancing.

I am living in one of the outskirts of Addis Ababa. The area is filled with many daily labourers. In my neighbourhood there is a very small coffee shop that provides service for about 70 to 100 people every day. Food and coffee is served in the street because there is no space in the shop. This place is chosen by many people because of its low cost and good taste of the food. Most of the customers are bajaj (tricycle) drivers and daily labourers. Around the first week of April there were 44 confirmed COVID 19 and on the 6^th of April the ministry of health has announced the death of 2 cases.  Then the response to movement restriction by the coffee showed owner and customers was very swift. I felt they had started staying at home to protect themselves.

It was reopened on the fourth day. I asked the owner and she said “if we stay at home we will die starving, if we go out we will die by corona ... so I chose working and feed my family”.  When you see this coffee shop the service is provided in the same pattern as it was before COVID-19 - people eat together, three to four people are sharing a plate and having coffee together. The only thing that has changed is the shop has put soap next to the hand washing bowl. With our weak health system and with this lack of strict adherence to World Health Organisation recommendations such as hand washing and physical distancing, I wonder what is going to come when the disease begins spreading in the community.  Poverty, living as a daily labourer or working in an informal sector have complicated the effort to contain COVID-19. Some people have to work in the morning so that they can buy lunch and work in the afternoon to buy dinner. The effort being made by the government and stakeholders to tackle COVID-19 should give more attention on how people working in the informal sector may subsist in such times. 

Views and opinions expressed are entirely my own.

References

1. Chen L, Evans T, Anand S, Boufford J, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet 2004;364:1984-90.
2. Belita A, Mbindyo P., English M. Absenteeism amongst health workers – developing a typology to support empiric work in low-income countries and characterizing reported associations. BMC Human Resources for Health 2013;11.

Medhin Selamu is a nurse, social worker and mental health professional.  She was working on integration of mental healthcare in rural primary care in Ethiopia for the past eight years. Her research interest are healthcare workers wellbeing, job related stress and burnout. Currently she is working in ASSET Ethiopia as project coordinator (Maternity cover).