Diary of an appendage

Earlier in October it was “World Mental Health Day”, a fact I was unaware of until I heard it on the World Service one morning. So I thought I would take the opportunity to say a little about what I (John) have been doing while Barbara shares her skills in Education here in Mekelle.

In VSO terms, I am an AP – an Accompanying Partner (or less flatteringly, appendage person). If our intake (the class of 2011) is anything to go by, accompanying partners don’t stay appendages for long. Of the 4 who came in September 2011 (two women and two men), one has set up her own educational charity, one quickly found a full-time working role in her town, one became an official VSO volunteer in management… And then there’s me. My position was slightly different, as I have my portable work as a translator, which I have continued to do, and in many ways that aspect of my life is not much different here in Ethiopia than it was in England. In fact, not all my translation clients even know that the work they send me is going to Africa. I was worried before we came here that the Internet would not be fast or reliable enough for me to keep working, but it has not been a problem. Of course, we don’t have wi-fi, just a pay-as-you-go “dongle”, a flash drive modem you stick in a USB port. At the beginning of each month, you top it up with  scratchcards available in most shops, from 300 birr (approximately £10.00) for 1 GB to the maximum 700 birr (a month’s wage for an unskilled worker) for 4 GB. The top-up at the beginning of each month can be rather frustrating, as you often hear the heart-sinking message, “sorry, you made a mistake”, delivered by a pre-recorded female voice with a Chinese accent (the provider is the Chinese multinational, ZTE). Particularly irritating, since it is rarely you who have “made a mistake”, just an overload on the system.

There are, of course, other differences. The electricity supply here isn’t always predictable, so it’s not uncommon for the lights to go out unexpectedly (we have blown up a couple of surge protectors, but fortunately not before they did what it said on the tin – protecting our computers), but I have a head torch and bought a long-life laptop battery before I came, so the work can go on.

One unanticipated quirk of Ethiopian life is the interference of the Almighty in my work. In February we moved from our small flat to a house with a garden, which has been a huge pleasure. The only downside of this, which we were unaware of when we moved, is that we are some 100 m from one of the city’s big churches. Ethiopian Orthodox Christian priests like to chant, in fact, along with preaching, praying, collecting money and drinking the local homebrew, that’s pretty much all they do. They chant in a language called Ge’ez, last spoken 2000 years ago and incomprehensible to the average “Gebre” (Joe Bloggs). They often start chanting at 2 or 4 am and go on for six or seven hours. Sometimes, they will stop midmorning, and then restart at noon, just as we sit down to lunch in the garden… Now I’ve nothing against chanting in the privacy of one’s own church. Granted, we’re not talking Handel’s Messiah, more what sounds to the untutored ear like the early rushes of “Ethiopia’s Got Talent”. However, though in most respects mediaeval, the Ethiopian Orthodox Church has entered the modern world with a vengeance when it comes to public address systems. Every church in Mekelle has one, each attached to a microphone, and each microphone manifestly attached to a priest. What has this got to do with my work? Well, I translate using a dictation system, and the cacophony from the nearby church is sufficient to scramble not only my brain, but also the highly sophisticated directional microphone I use to translate with. Anyway, there is much more to be said about the 1700-year-old Ethiopian Orthodox Church, but that’s a subject for another day…

To get back to what I do here, though I couldn’t afford to give up my translation business, I didn’t want to accompany Barbara here simply to carry on as if I was in Pangbourne (without the river!). Once we had settled in, I began to look around for ways in which I could make myself useful. There is no shortage of NGOs in Mekelle, but what I was looking for was some way of using my second skill as a counsellor. In March this year, I came across a small local NGO dedicated to serving people with mental illness in Mekelle. A few facts about mental illness in Ethiopia:

  • Until recently, standard treatment for mental illness was holy water and chains, the former for treatment, the latter for protection – both are still widespread
  • It is not uncommon for households to keep family members with a mental illness chained up at home, again partly for protection, but also partly because of the stigma
  • There are also significant numbers of people with severe mental illness on the streets, who have been expelled by their families.

If you’re interested in the subject of mental health in Ethiopia, here’s a link: http://www.diretube.com/articles/read-throwing-off-the-chains-of-mental-illness-in-ethiopia_2026.html.

For the six months before I met them, the small team of volunteers had been going door-to-door to every house in the city to identify people with mental health needs.

Mental illness in Mekelle:

  • some 500 people were identified as being in serious need of mental health care
  • Mekelle has been the epicentre of two famines and two wars in the last 30 years, so these 500 probably don’t include people suffering from less “florid” conditions such as post traumatic stress disorder, depression, etc.
  • Mekelle is unusual and fortunate in Ethiopia in having 3 psychiatrists in its health services.

When I got involved, the newer of the two local hospitals had provided a 10-patient, secure mixed ward (with 4 rooms so that men and women are separate), where it had begun treating some of the patients. However, the team at that time was becoming demoralised because of lack of resources and support. Although the hospital provided free accommodation, basic nutrition, diagnosis and, until recently, pharmacological treatment, the volunteers were responsible for providing 24-hour nursing care, additional food, clothes, etc. out of their own pockets – and few people here have much to spare – with no prospect of future improvement. So the timing of my arrival was serendipitous, as I was able to provide help in keeping the work going. The association now has 27 volunteers, working shifts in the hospital psychiatric ward, monitoring released patients, educating families about mental illness, bringing in new patients, taking patients to follow-up appointments, tracking medication, etc.

Of course, I am completely out of my depth. As a counsellor, my training is with people whose mental balance is sufficiently strong to sit in a room and talk fairly coherently for 50 minutes. Here, many of the patients we work with have psychotic conditions. One has killed three people, others roam the steets naked or yell at passers by. I know enough about mental illness to know that definitive “cures” are not always possible. However, even with limited resources and just three psychiatrists (they are talented and dedicated people, but mental illness is very much a cinderella field of medicine in Ethiopia), the Association is achieving much in improving the lives of a greatly neglected population. One example is D, a fortyish former teacher of the deaf who had a nervous breakdown a few years ago, and was frequently to be seen shouting threats and insults, particularly at ferenjis – Barbara found herself on the wrong end of one of her tirades early on in our time here, and became a frequent object of her attention in the streets of the city. D was “rescued” by the wonderful Azmara (also the association’s treasurer), treated at the hospital and is now living independently in a small room we have provided. She has two daughters she has not seen since she became ill, five years ago, and hopes to be reconciled with them soon.

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However, one of the intractable problems is the lack of follow-up to hospital treatment here. Often, families are unprepared to take people back, even when they are “stable”, so they end up on the street. In other cases, people are taken off the streets for treatment and inevitably relapse when they return. It is heartbreaking to meet patients at the hospital when they are brought in, see them improve, and then meet them again on the street, back where they started. So our next project is to build a “therapeutic community”, a halfway house where patients can go after treatment for a period of convalescence and reintegration. This will be a residential community that provides shelter, support and therapy; it will also be self-sustaining, with a number of cottage industries, including biofuel production from waste vegetation and paper (to replace charcoal, which is scarce, expensive and environmentally damaging), poultry breeding, and perhaps dairy production and ox fattening. The aim is that these activities should both generate income and provide productive and therapeutic work. We have applied for land from the city, which is very supportive, though there are, of course, procedures to go through. If everything goes to plan, we hope to begin construction at the beginning of 2013. I am in the process of approaching various potential funding agencies (USAID, DFID, …) to assist with this. There is also good reason to hope that the Ethiopian authorities will be ready to support us once they have “proof of concept”.

From my point of view, one of the great rewards of being involved in this project is the people I have met, both the individuals who are the backbone of the Association, and the patients. It has brought us an insight into a different aspect of local life and friendship, and a great deal of the generous hospitality for which Ethiopians are so famous. We know from experience that as a foreigner in any country, one tends to skim across the surface of the culture. The only way to go deeper and to learn more is to work with local people, which is why VSO exists, and it’s part of the reward that Barbara gains from her role here. My position is somewhat different, but it brings me close to what I had hoped to experience in our time in Ethiopia.


Leave a comment


  1. Mary SImmonds

     /  05/11/2012

    Hi John, I’m very impressed by what you are doing here – it looks like an extremely worthwhile project. The pictures and reports of mentally ill people in chains are horrendous.

  2. Nicola Cother

     /  18/11/2012

    Again, I thoroughly enjoy reading the monthly ‘newsletter’ from Mekelle and, on this occasion, it certainly makes me thankful for what I and my family have here. You are doing wonderful work. I will add the ‘halfway house project’ to my ‘If I win the lottery, charities who I will give to’ list. Fingers crossed 🙂

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