Does Ethiopia Need an Electronic Medical Record?

Last week I visited a hospital in Addis Ababa. It was set-up much like all hospitals across the world, with an Outpatient and Inpatient departments, a laboratory, pharmacy and drugstore. However, the buildings were old and dirty and the corridors were filled to overflowing with patients many who looked in desperate need of care. Doctors and nurses say they understaffed and overworked.

I am here to evaluate an electronic medical pilot, which the government intend to rollout across 3,000 hospitals and health centres by 2015. This is in a country in which many areas do not have electricity and those that do are prone to power cuts (even here in Addis I have been without power for more than 24 hours), few people have computer skills and the existing paper based medical record keeping system is poor.

Whilst there are many potential benefits from electronic medical records, few developed countries have realised many of them and the effort required to do this is immense. This raises the question for me of whether Ethiopia really needs electronic medical records at this time. Maybe the money could be spent better? But then who is driving the implementation of electronic medical records? There are many donor organisations who have an interest and involvement in this.

Out and About in Addis Ababa

 

Kidus Raguel Rock Hewn-Chuch

There are hardly any tourists in Addis. Occasionally one might spot an air-conditioned bus with a few Fenegis in it but generally I am the only one around. But then there is not a lot of sight seeing to be done in Addis and a day would probably suffice to see the main attractions. 

Meskel Square is a good starting point for a tour. Next to it, the Red Terror Museum provides a graphic account of the reign of the Derg. During my visit, I was given a personal account of someone's incarceration and torture which makes my visit hauntingly memorable.

Entoto Maryam Church

A few kilometres uphill from Meskel Square, there is the National Museum of Ethiopia. It hosts a replica of the skull of Lucy, estimated to be around 3.5 million years old. The discovery of Lucy proved our ancestors were walking 2.5 million years earlier than was previously thought.

Traditional Dancing

A couple of hours hike out of the city there is a 13th-century hock-hewn church called Kidus Raguel. The church was partially destoyed during the Italian occupation but is still an amazing sight. Visitors are few but the guard is friendly and gives a knowledgeable tour. Also in the Entoto hills is the Entoto Maryam Church where Menelik was crowned in 1882. 

To round off a day of sightseeing, one can go to eat traditional food and watch some energetic and colourful dancers. 

The Cost of Living

The development challenge facing Ethiopia is immense. Its people are among the poorest in the world, the economy is growing too slowly and population growth is rapid.

The median wage in Ethiopia is estimated to be around 300 Ethiopian Birr a month (about £8). A healthcare assistant earns around 500 Birr a month, a GP or consultant around 5,000 Birr and a government official many times more. An IT student told me he hopes to earn several thousand Birr a month when he graduates. But only half of the population participate in work. Most working people in cities are self-employed (around 40%). Government employees make up about 18% and private employees around 16%. In urban areas agriculture is the main work activity.

Whilst the price of food in the market sounds cheap in UK terms (onions, potatoes, bananas and oranges are 10-15 Birr per kilo), a wage of 300 Birr will not go far, given the average number of children women in Ethiopia have is over five (the number is lower in Addis). 

 

The gap between those who earn the lowest or nothing at all and those at the top of the wage hierarchy is growing. Walking around Addis this gap is strikingly apparent. In amongst the shiny new tower blocks and upmarket shops and cafés are makeshift huts, street sellers and beggars. Everywhere you turn there is someone asking for food or money. Like many of my volunteer colleagues, my coping strategy is to simply give away all the coins I accumulate each day to the first beggar I see.

As VSO volunteers, we receive a small monthly allowance commensurate with local wages. This is intended to cover our food, electricity, water bills and transport to and from work. Our accommodation is provided by VSO. By shopping at the local market it is possible to live happily on this allowance. For those volunteers who are placed in rural areas there is nothing much for them to spend their money on anyway. In Addis there are several Ferengi supermarkets where we can spurge 400 Birr on a bottle of imported wine or a tiny bit of rubbery cheese. There are also several luxury hotels where we can eat Ferengi food at Western prices. One of my favourite affordable treats is a mixed fruit drink called Sprice which includes mango, banana and advacado (about 12 Birr).