Throwing off the chains of mental illness in Ethiopia

By Julia Belluz - Thursday, October 25, 2012 at 6:00 AM - 0 Comments

Stefano De Luigi/VII Network/Corbis

On a recent visit to Debre Libanos, a 13th-century monastery outside Addis Ababa, one of Ethiopia’s few psychiatrists found 17 people in chains. Suffering from serious mental health issues ranging from schizophrenia to bipolar disorder, they’d somehow ended up at the monastery with other sick Ethiopians, seeking blessings from the Christian priests.

But the chains were not meant as a deliberately cruel measure, explains psychiatrist Dawit Wondimagegn; the monks were attempting to ensure the mentally ill didn’t “end up on the street,” where they would be in danger, a harm to themselves and others. The chains are a desperate, stop-gap effort to keep patients safe, says Yonas Baheretibeb, a professor at Addis Ababa University. In a way, they are emblematic of the state of psychiatry in Ethiopia today—there are only 44 psychiatrists in the mostly rural Horn of Africa country, where the population tops 85 million. Due to the shortage of health workers, and a centuries-old belief that possession by evil spirits or supernatural forces are to blame for afflictions of the mind, priests often end up on the front lines of mental health, treating the sick with prayers and holy water.

Yonas and Dawit know there is another model of mental health-care delivery. They’d both studied psychiatry with a team of Canadian physicians thanks to the Toronto Addis Ababa Academic Collaboration (TACC), a nine-year-old partnership between the University of Toronto and Addis Ababa University. They recognized that the patients simply needed antipsychotic medication.

After months of back-and-forth meetings with the priests, where the doctors gently suggested that psychiatry could supplement—but not replace—religious healing, Dawit and Yonas talked the priests into a pilot project; priests still provide spiritual guidance, but medical staff are now allowed to visit the monastery every two weeks, where they administer medications and practise psychotherapy.

“Now no patient is chained,” says Dawit. Indeed, they now help with the day-to-day running of the monastery—“fetching water, doing gardening.”

The Addis Ababa-based doctors are working to extend this model throughout the Ethiopian capital, where a network of thousands of religious healers now treat the mentally ill. Eventually, the program could be expanded elsewhere in Africa, where mental health care is rudimentary or non-existent. Last week Grand Challenges Canada, a government-funded non-profit, provided a $1-million grant to assist TACC, part of a $20-million investment in 15 mental health projects in the developing world. The reason for the push? According to the World Health Organization, more than 75 per cent of the world’s mentally ill live in developing countries—and fewer than one-fifth of the sickest patients receive any care at all. “It’s better to go where patients are and try to help them,” says Dawit. Even if that’s in the church.

Ethiopia says farewell to a ruthless hero

By Julia Belluz - Monday, September 10, 2012 at 5:50 AM - 0 Comments

Carl De Souza/AFP/Getty Images

In Addis Ababa last week, it was impossible to miss Meles Zenawi’s grip on the popular imagination. On Aug. 20, the government announced that Ethiopia’s first and only prime minister had died in Brussels of an unknown illness, after 21 years in power—and weeks of speculation following his disappearance from public view. Zenawi’s image soon appeared in the signage over fruit markets and banks, on hats, in the windows of cars and buses, even in the playing cards children sell for change in the streets. One restaurant had an unusual memorial: Zenawi’s face painted in cocoa powder and butter on an Ethiopia-shaped pizza. At night, the city’s bars and clubs were silent, and no one danced because a state of national mourning had been declared. Instead, TVs broadcasted tributes to his excellency on loop, with news that the former deputy, Hailemariam Desalegn, would take power until elections in 2015.

“Addis is very sad right now,” a taxi driver says en route to the national palace, where the late PM lay in state in advance of Sunday’s funeral. Asked why people love Meles, as he is known, he gestured with his hands: “Jobs. He bring us work,” he said. Women like him too, he said; Meles advocated for equal rights. Others expressed their adoration: because he was brilliant and had a strong vision for the country; because he liberated them from a military dictatorship, brought back Ethiopian pride and increased investment in education and health care. (His health minister is lauded around the world for enacting progressive, evidence-based policies.) Zenawi was also a key mediator between Sudan and South Sudan, and an ally in the U.S.’s war on terrorism in the Horn of Africa.

But human-rights observers say the advancements came at a cost: jailed journalists, political prisoners, contested election results and a concentration of power that only expanded during his tenure. He was known to hold meetings without any aides present; his was the final word. Ethiopian journalists told me there’s little hope for a free press and for voicing dissenting opinions, so the people don’t have enough information to even begin to critique Zenawi’s administration.

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After Zenawi: Mourning Ethiopians wonder what comes next

By Julia Belluz - Sunday, September 2, 2012 at 7:40 AM - 0 Comments

Sudan's President Omar al-Bashir walks past a portrait of late Ethiopian Prime Minister Meles Zenawi, a gift from another delegation, when he arrived to pay his respects to Zenawi's body lying in state at the national palace in Addis Ababa, Ethiopia, on Saturday. (Rebecca Blackwell/AP Photo)

Ethiopians remembered late prime minister Meles Zenawi on Sunday morning at a state funeral in Addis Ababa. Macleans.ca contributor Julia Belluz was in the country earlier this week and filed this report on a country in mourning:

In a psychiatric ward in Addis Ababa, the hold Ethiopia’s recently deceased leader had on his people became clear. On my way through the crumbling, labyrinthine building, a patient drew me back into her room, and gestured at a large photo of Meles Zenawi, this country’s first and only prime minister, hanging over her bed. Visibly distressed and with a furrowed brow, she told me in Amharic that Zenawi had died.

That I already knew. I landed in Ethiopia last week, four days after the government announced His Excellency was dead after 21 years in power and weeks of speculation about his health and disappearance from public view. It was impossible to miss the cult of personality and Zenawi’s grip on the popular imagination.

During breakfast on my first day in the capital, I spotted a tribute to the former medical-school dropout. It was Zenawi’s face on an Ethiopia-shaped pizza. One of the waiters saw me examining the curious display. “That is our prime minister who has died,” he said. “Please take ze picture. Take ze picture.” So I did, and he explained that the hotel chef was inspired to paint the former prime minister in cocoa powder and butter on dough.

This love was displayed in the streets, where Zenawi’s image appeared in the signage over fruit markets and banks, on hats, in the windows of cars and buses, even in the cards children were selling for change. The bars and clubs were silent and no one danced in Ethiopia because a state of national mourning had been declared. TVs all over Addis Ababa played tributes to Zenawi on loop, and in the morning papers—which are largely controlled by the state—page after page was filled with photos and stories about the leader, as well as speculation about the question on everybody’s mind: what comes next?

Later on, I went to see Zenawi’s body lying in state at his official residence.

“Addis is very sad right now,” the taxi driver told me as we snaked through the crumbling and congested roads to the top of a hill where never-ending iron and brick gates protected the national palace. When I asked him about the issues that concerned the Ethiopian people, he said they were thinking about one thing: Zenawi. When I asked why people love Zenawi, he gestured with his hands to show that the poor have been elevated from “down here.” “Jobs, he bring us work,” he said, flicking at the past decade of economic growth in Ethiopia. Women love him too, the driver added, since Zenawi advocated for equal rights.

Other Ethiopians also expressed their adoration for Meles: because he was brilliant and had a strong vision for the country, because he liberated them from a military dictatorship, brought back Ethiopian pride, and increased investment in education and health care. (His health minister is lauded around the world for enacting progressive, evidence-based policies.) Zenawi was also a key mediator between Sudan and South Sudan, and an ally of the U.S. in its war on terrorism in the Horn of Africa.

But human rights observers argue that the advancements Zenawi made in Ethiopia came with a heavy price tag: jailed journalists, political prisoners,  contested elections results, and a concentration of power that only expanded during his tenure. A reporter I met from Kampala said she wouldn’t file anything about the death of Meles because she feared she may never be allowed back into the country. Ethiopian journalists told me there’s little hope for a free press and voicing dissenting opinions, so the people don’t have enough information to even begin to critique Zenawi’s administration.

As well, some raised questions about the actual progress made under His Excellency’s leadership. As one Ethiopian father of two explained, while the late prime minister is known for growing the economy, “I personally just don’t see it. I have a job but things cost more money.” In fact, Ethiopia is still a place where people die of hunger, and the per capita income is about $3 per day. Labour is cheap, and that’s apparent everywhere in Addis, with its over-staffed hotels and restaurants. On a drive through the capital one day, a local pointed out, “See all the young people on the road? That’s because people die early here.” The median age is 18.

Back outside the presidential palace, the taxicab guided my colleague and I as we joined the throngs of Africans who  dedicated their day to mourning Zenawi. Most were wearing their Sunday best, many were in black, and women’s heads were covered for modesty. From outside the compound, with the high iron and brick gates, long roads to entry, and the dozens of military and policemen, it felt like we were about to enter an African Versailles.

The crowd was split up by gender, and we were slowly herded closer to a security check-point. After a vigorous pat down by a female officer, we were shepherded into a spare and cold marble hall, with high ceilings and drawn curtains. At the front of the room, tributes played on TV. I couldn’t understand what the words and music meant, but we all sat solemn faced, waiting to pay respect.

Suddenly, we were instructed to stand up and get moving, closer to the prime minister. We were herded along a verdant flower- and tree-lined path that led to the coffin. As we approached the top of the winding road, one wailing woman was restrained and shuffled away for what seemed like unruly grieving. The line narrowed to a single file, and we were suddenly in front of the closed coffin, draped in a red, green, and gold flag, at the top of red-carpeted stairs.

That’s right: No embalmed body, and questions about the circumstances of Zenawi’s death remain unanswered. Around the coffin, there were photos of Zenawi and bouquets of flowers. Women wearing black jerked their limbs and cried out, an Ethiopian mourning ritual. It was difficult to take it all in; we tried to pause but were asked to move along. We were not the only ones who wanted to see Zenawi. There must have been 10,000 Ethiopians flowing through the presidential compound.

Back outside the palace gates, I noticed that the prime minister’s residence faces a shantytown, the kind of contrast that’s available all over the city. The taxi driver easily spotted my colleague and I, the only white faces in the crowd.

Amid the black fumes from passing cars, the air heavy with pollution, we stopped to admire T-shirts for sale. They all carried images of His Excellency. The driver bought one, and when we stopped at a roadside market, he got out of the car to immediately change into his new T-shirt. While the world grapples with the legacy of this polarizing figure, this Ethiopian wanted to show his people that he is filled with sorrow.

When it comes to bogus health reporting and policy, it really is a small world

By Julia Belluz - Friday, August 31, 2012 at 3:31 PM - 0 Comments

Getty Images

The morning started late at the United Nations conference centre in Addis Ababa, Ethiopia. On the gated compound—surrounded by muddy roads, and a mash-up of steel huts, unfinished buildings and Western-style hotels—it was day one of a World Health Organization forum about how to get better evidence into health policy-making.

Science-ish had travelled to the Horn of Africa to talk about the role media can play in divulging information about health research and holding policymakers to account when they ignore or misuse it.

The room suddenly filled with some 50 delegates from all over Africa and the world—Zambia, Nigeria, Malawi, the U.S., Great Britain, the Sudan. Most of them have been working for the better part of the last decade on tools and methods to ensure that high-quality research gets out of the ivory tower and makes its way into policy and the realm of public knowledge.

After the translators readied themselves to connect us through our many languages, the meeting began. Unsurprisingly, perhaps, it quickly became clear that reporters and researchers working on getting the evidence message across in this region face a number of unique challenges. One journalist from Ethiopia asked about how to start a national professional group for reporters because none exists here and the state controls the media. A researcher from South Africa said reporters in her country routinely botch health stories because there are few dedicated journalists who understand the beat. A Sudanese health columnist told Science-ish that everything she writes has to be vetted by government officials before it goes to print; words they don’t like get cut. “I will still write it anyway,” she said defiantly, adding that the government of Omar al-Bashir recently sanctioned a colleague for speaking out. “Now he sits in the corner of the newsroom, silent.”

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Freedom for a political martyr

By Kate Lunau - Thursday, October 21, 2010 at 3:40 PM - 0 Comments

Samson Haileyesus/AP

Last week, Meles Zenawi was sworn in as prime minister of Ethiopia for his fourth term since taking power in the East African country in a 1991 coup. Days later, Birtukan Mideksa, a 36-year-old former judge and single mother—and the country’s most famous political prisoner—was released after requesting a pardon. Accused of inciting riots after the 2005 elections, Mideksa, who leads the biggest opposition party, had been serving a life sentence; Amnesty International has described her as a “prisoner of conscience,” and she’s drawn comparisons to Burma’s Aung San Suu Kyi.

While Ethiopia remains a Western ally, its human rights record has come under heavy criticism. Human Rights Watch called Mideksa’s release “just a first step,” adding that an unknown number of political prisoners have been jailed. The U.S. State Department has noted “unlawful killings, torture, beating, abuse and mistreatment of detainees and opposition supporters by security forces.” Upon her release, Mideksa declared herself thankful to be back with her family, including her five-year-old daughter. When asked to comment on whether she’d be returning to politics, she replied: “Oh, this is not the time.”

What’s the new global source for fresh, shiny produce?

By Nancy Macdonald - Thursday, August 19, 2010 at 12:40 PM - 0 Comments

Nancy MacDonald/ REUTERS/Stringer

Visit a supermarket in Abu Dhabi and you’ll be greeted by row after row of picture-perfect produce, most of it imported. The Indian subcontinent has long supplied food to the wealthy desert capital. These days, though, it’s likely those rows of shiny vegetables and fruit came from an improbable source: Ethiopia, a country practically synonymous with famine. Yes, Africa, where one in three people is malnourished, is now growing tomatoes and butter lettuce for export.

Ethiopia’s biggest greenhouse farming operation is kept hidden from curious, or hungry, eyes; even in Awassa, the southern city where it’s housed, few know it exists. Two kilometres down a dusty private road, past a checkpoint guarded with AK47s, hundreds of pristine, white greenhouses suddenly appear, alien to the setting. Farming in Ethiopia is still done by sickle and ox-driven plough. But inside Awassa’s cool, humidity-controlled greenhouses, vines are fed by a computerized irrigation system, the latest Dutch agricultural technology.

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Beloved, and behind bars

By Nancy Macdonald - Thursday, June 3, 2010 at 1:40 PM - 22 Comments

Photography Chris Flaherty

Two months ago, Halle Mideksa celebrated her fifth birthday. For the fourth time, the bubbly little girl—dressed, to meet Maclean’s, in pink and purple, hopping on one foot, a yellow sucker gripped between her teeth—had to celebrate without her mom, Birtukan Mideksa. The 36-year-old former judge is Ethiopia’s most famous opposition politician. But she was forced to miss Ethiopia’s state elections on May 23—along with the party for her only child. Mideksa, the only female leader of a main opposition party in Africa, is being held in a two-by-two-metre cell she shares with two other prisoners. She’s been at Kaliti jail for 18 months—her second stay in the hot, crowded maze of sheet-metal shacks at the southern edge of Addis Ababa, the capital. She is accused of violating the terms of a pardon under which she was released in 2007.

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