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Opinion: Africans Shouldn't Have To Pull Strings To Get COVID Treatment

Maji Hailemariam Debena in Addis Ababa, Ethiopia.
Maji Hailemariam Debena in Addis Ababa, Ethiopia.

In February, I decided to leave my town of Flint, Mich., and travel to my home country of Ethiopia to work on a potential mental health research partnership for a few months — and visit my family, whom I hadn't seen since before the start of the pandemic. Cases seemed very stable both in Michigan and in Addis Ababa. Considering I take public health measures seriously and do not have much job-related exposure, I figured I would have a safe trip.

So, imagine my surprise when I found out that, just a few weeks after I arrived in Addis, I started experiencing COVID symptoms. Days later, my diabetic father — who I was staying with — started showing symptoms, too.

As I navigated the intricate landscape of testing, treatment and eventually, a vaccine for my father in Ethiopia, I realized just how much work the country needs to do to provide adequate COVID care to its citizens.

It was virtually impossible to get tested at a government health facility in my hometown of Hawassa, a town about 181 miles away from the capital. A visit to a private practice confirmed my worst fear. Then a few days later, my diabetic father also tested positive. He's in his early 60s, so his age and pre-existing health conditions increased his vulnerability to fight the infection. I was immensely relieved that my father's symptoms were not that serious.

The experience of getting COVID in Ethiopia made me wonder: how do people from poorer households, non-literate, rural or disabled manage to navigate the country's poorly equipped, underfunded, overwhelmed healthcare systems?

Education and networking were the tools I used to sidestep overcrowded health centers. I called my medical doctor friends in Addis Ababa and the U.S. for advice on how to monitor my dad's kidneys, diabetes and hypertension while he fought COVID. My friends suggested laboratory tests to check his creatinine, hemoglobin and oxygen levels. That required trips to three different private clinics in the city — which I drove dad to while struggling with my own COVID symptoms. All of them flatly refused to let him into their facility when they learned of his positive COVID diagnosis. Eventually, we were sent to a government-run COVID isolation center which we couldn't enter, because at the time, it was beyond its full capacity. I had to use my personal connections to get the tests done elsewhere.

My attempts to secure these tests for my father, while battling the virus myself, made me brutally aware of my own privileges in a country where a vulnerable citizen can be turned away from critical care.

And it doesn't seem like there is much hope on the horizon. Only 2% of the 1.3 billion vaccines administered globally have gone to Africa. With mass vaccinations yet to start in some African countries, Africa has the slowest and lowest vaccine rollout in the world. The vast majority of the unvaccinated in Africa have no idea when they will get access, even as Western nations daily disclose vaccine surpluses or problems with millions of contaminated doses that must be destroyed.

Meanwhile, I have witnessed the entire COVID response system in Ethiopia crumble around me, as thousands of people like my father are turned away from care or receive confusing referrals for inpatient care or any outpatient consultation with a doctor. I've also heard of Ethiopian families being asked for exorbitant deposits — up to 200,000 birr ($4,800) — to be admitted into private health facilities for COVID-related complications. This is a significant cost in a country that has an annual per capita income of $850.

In Ethiopia, it has become very common to see healthcare professionals on the COVID frontlines share their frustrations over lack of oxygen. There are also rumors about some rich people in the city purchasing oxygen cylinders for personal use. Meanwhile, countless others are put on waitlists or sent home.

Also, as we're learning from the experiences in Brazil, the U.K., India and South Africa, new strains of the virus are making the pandemic response complicated even in the world's wealthiest nations. Many African countries have extremely limited testing capacity, and what exists may not identify new strains of the virus. Ethiopia has averaged 7,000 tests per day over the past few months, with no known reports on the variants.

I don't need a published study to know that the COVID challenges I witnessed in Ethiopia are happening all across the African continent, and it has to stop. Constant neglect of healthcare delivery systems and fragile infrastructure means that vulnerable populations in African countries could die during the long wait for testing, treatment or a scant vaccine.

I've recovered from COVID and am feeling much better these days. My father, however, is still fatigued and suffers from poor appetite. We were finally able to get him vaccinated when the Ministry of Health expanded eligibility to people over 55 with underlying health problems in March. As of May 5, more than 1.3 million Ethiopians have received their first shots. There are no fully vaccinated people yet. But many of my aunts and uncles in rural parts of the country do not have access to the vaccine, due to short supply and logistics. I do not know when they will be protected, and it's scary to think of what would happen if the current outbreaks in the cities expand to the rural areas.

Meanwhile, I'll keep fighting — for myself and for the rest of the African continent who continue to wait for the Western goodwill to yield resources. I will continue speaking up and writing about vaccine inequity in my native Ethiopia and globally. I will write to local and international newspapers and academic journals, calling for government accountability.

If we are truly going to achieve the promise and the pride of the "Africa rising" narrative, African countries must develop policies that support health services and health systems research that will actually result in quality healthcare for citizens.

Maji Hailemariam is a research assistant professor at Michigan State University, College of Human Medicine, and a 2021 Aspen New Voices Fellow.

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