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Eritrea’s Health Care System

Eritrea’s current healthcare system foundation developed during the years of the armed struggle, which took place from 1961 to 1991. The achievements of the Eritrean People’s Liberation Front (EPLF) in healthcare during the armed struggle were notable. In the early 1970s, the liberation front had only a single mobile clinic, and the vast majority of the country had no access to modern Healthcare. During this time, most people in rural areas relied solely on traditional healers. However, by late 1978, the front had developed a comprehensive health service that treated 1.6 million patients per year and epitomized the World Health Organization (WHO) guidelines for primary Healthcare. For the 2021 Eritrean Festival, the southern region was assigned the past, present, and future Eritrean healthcare system. We interviewed four medical professionals, Dr. Andemariam Gebremichael, Ogbit Kidane, Hadas Hailom, and Menges Zerazhion, who shared their experiences in Eritrea’s healthcare system from the armed struggle for independence until now.

Dr. Andemariam Gebremichael is a professor of immunology who received his first degree in Ethiopia, then attended Boston University, and then Harvard, where he received his postgraduate degree. After that, he became a professor at Harvard University. In 2004, he moved to Eritrea when Orotta School of Medicine and Dentistry was established and has been living and working there ever since. He discussed how the Orotta Medical School is a significant achievement for Eritrea because it provides quality medical education and produces excellent doctors.

Orotta also has a 7- year Dental school program with graduates serving every corner of the country. He emphasized that Orotta Medical School provides students with more than just a medical education and education on Eritrean culture, societal values, and issues that go parallel with providing quality medical care. For example, one of the sayings of the school is, “first we build a person, then a doctor.” In other words, a patient cannot be healed by medicine alone; a patient also needs a doctor with shared values, discipline, and knowledge. Dr. Andemariam reiterated the school’s success in producing high-quality physicians who have been able to solve many of the health challenges faced by the country, and he expects things to continue to improve.

Hadas Hailom, a registered nurse in Dallas, Texas, was a fighter during the armed struggle starting in 1977. She said she decided to become a nurse because it gives her great personal satisfaction to treat sick and needy people. As a nurse during the war, Hadas’ assignment was to work behind the trenches, treating freedom fighters wounded in battle; her primary duty was to stop bleeding and rescuing wounded fighters off the battlefield. As a member of the armed struggle, Hadas was trained as a nurse and as a soldier.

Hadas recounts the struggles she faced as a field nurse during the war, and she stated that there were many challenges during that time, including supply shortages, weather, and camouflaging from enemy warplanes. In addition, she talked about how the challenges faced by medical workers in the field were complex. However, EPLF’s dedication and ingenuity to alleviate the challenges were rewarding.

Ogbit Kidane graduated from Asmara Nursing School in 1991 and worked as a nurse in charge in the medical surgical unit from 1981 to 1996. From 1996 to 2001, he worked as an instructor at Asmara Nursing School. From 2001 till present, he has been working as a registered nurse (RN) in Dallas, Texas, specializing in dialysis and pediatrics. Ogbit stated that he wanted to become a nurse because he was interested in and wanted to help save lives. He talked about being a nurse in Eritrea before independence and how he worked at Haz Haz hospital, where he mainly treated civilians but encountered some very injured EPLF fighters whom he says were treated with quality care.

Ogbit treated patients with many infectious diseases such as meningitis, typhoid fever, tetanus, and rabies. He also talked about how almost two-third of the general population was affected by malaria. He said that even though chloroquine was available to help treat the illness, at the time, a shortage of nurses, medical assistants, and clinics meant that many people were not getting the proper treatments, and this led to many deaths. Ogbit emphasized that education is an essential factor in preventing malaria. With the shortage of medical personnel, the fragmented health system of the time was an obstacle to prevention and treatment. However, this changed after independence when more medical professionals were trained, new clinics were built, transportation improved, and a better-organized healthcare system. These changes significantly improved the treatment of malaria and helped minimize the disease to the minimum. Overall, Ogbit reiterated the significant improvements in the Eritrean healthcare system today, such as clinics in rural areas, transportation from remote villages to larger hospitals, and more trained medical professionals. He is very proud of the people and government of Eritrea for working hard to make this happen.

Menges Zerazhion is another revolutionary fighter who joined the Eritrean People’s Liberation Front (EPLF) in September 1975. Menges served as both a fighter on the field and in the medical units treating wounded fighters and civilians in the surrounding areas. He recalled the early years of the war, when supplies were minimal and very few medicines were at his disposal. During those times, fighters carried everything they had in their backpacks. He stated that all of his medical supplies were kept in these bags. Due to the nature of the war, Menges and his medical unit always had to move their makeshift clinics to new locations to evade enemy assaults; this was an added challenge to the treatment of patients and was the reason for keeping supplies in backpacks.

In addition to lack of resources, Menges also mentioned a shortage of skilled medical staff, but in 1973 a doctor joined the medical unit, and things began to improve. In addition to the doctor, other medical professionals such as pharmacists and nurses began to join the front. When it came to training, Menges said those with more experience trained fighters,  and in times of relative peace, fighters went to school to learn different subjects. The foot medics played an essential role in providing Healthcare during the struggle as they were doing much work in the field, in the trenches, and the hospitals. In 1975 EPLF created mobile healthcare teams.

Menges was a part of one of the first teams tasked with obtaining medical supplies from enemy-occupied areas (with military protection) and then went to the villages to treat patients. These mobile health teams would then take the supplies and treat civilians in surrounding villages. Another notable development Menges shared was that the EPLF also began training people who lived in the villages to serve as community health workers for their local community. EPLF provided these community health workers with continuous training and supplies to help address the health needs of the village dwellers who didn’t have easy access to healthcare at the time.

Menges said he was amazed when he would treat wounded fighters; how they would always point out things he may have overlooked during treatment. At times they would even form queues outside of Menges’s or other healthcare providers’ tents so they could be the first ones to get treated in the morning to return to battle immediately. EPLF soldiers were always eager to get back to the front even after suffering life threatening injuries because they were so dedicated to the cause of Eritrean independence. Some would even get in groups and escape the medical clinics when no one was around and return to the frontlines to fight.

In conclusion, the Eritrean healthcare system has made significant progress since independence in 1991 by building upon the values and efforts made by medical workers during the armed struggle. The government motto is to leave no one behind, and today, Healthcare in Eritrea has been free since independence and is still free at the point of care. Furthermore, healthcare services in Eritrea are tailored to rural and remote populations, focusing on prevention rather than treatment.

The Ministry of Health (MOH) has aimed to eradicate contagious diseases, promote public health, and take a scientific approach to traditional medicine. At the time of independence, there was only one referral hospital in the capital city of Asmara. This time however, there are several referral hospitals with at least one in each region and clinics in most villages. In addition, the government has taken on significant initiatives to solve and expand the health of its people by starting medical schools and expanding the existing medical education institutions. Finally, we would like to thank our veterans for their service and sacrifices to our country and share their experiences with us. May their legacies live on forever!

NCEA: Public Diplomacy Group Magazine, Volume 1, #3

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