Our hospital serves an area of 2.5 million people. Located in southwest Ethiopia, we care for diverse populations from farming villages and tribal areas, to refugees from South Sudan. Health-care activities here are below standard by any measure and we face what sometimes feel like insurmountable challenges to curb these problems. But the single biggest challenge of all is water.
In our hospital, because we only have clean tap water available approximately twice per week when it is brought in by truck, we must supplement with river water, which we know is unclean. This may sound unthinkable, but a hospital needs water daily and for many purposes: not only drinking but also meal preparation, delivery rooms, operation theaters, patient wards, sterilization of medical equipment, toilet utilities, laundry, gardening, personal hygiene and so on. The lack of water/sanitation/hygiene (WASH) services deeply compromises our ability to prevent and control infections and puts our staff — our doctors, nurses and midwives, pharmacists, administrators and cleaners — at risk.
We have tried to harvest rain and have talked to city administration to direct the town’s total water to the hospital for one hour to pump it into a holding tank. It’s not enough.
Our hospital is not unique. Recent global assessments of the extent to which health-care facilities are able to provide essential water, sanitation and hygiene for their staff and patients, are dismal. In short, facilities overwhelmingly lack soap, water and toilets. This widespread problem poses global risk when many of these facilities are the frontline defense against infectious diseases that can turn into pandemics.
Large disparities exist among different facilities within the same country. That’s certainly something we see here. For example, according to the Ethiopian Ministry of Water and Energy 99 percent of health-care facilities in Ethiopia’s capital city of Addis Ababa have access to water while only 23 percent of health-care facilities in the region near our hospital have water (2012).
Services that should be basic and routine, such as a safe and clean delivery, put mothers and fragile newborns in particular risk. Here’s a typical scenario we see in our hospital: A laboring mother comes where she will be triaged by a health professional without gloves as often they are not available. After that, a physician examines her with unwashed or inadequately washed hands. She will then be admitted to the delivery ward where she will sleep with no bed sheets on an inadequately disinfected mattress. The floor is splashed with amniotic fluid and blood. All because there is not adequate water.
When she is ready to give birth, she will be transferred to a delivery table, which is partially cleaned with two jugs of water and detergent. If everything goes well, she will be blessed with a child. When things go the other way, she might have to go to the operating room for delivery. The OR has no adequate supply of tap water, which increases risk of post-operative infections that are rampant in our institution.
Once the procedure is over, both the mother and the child will have to stay in a crowded post-operative ward for three to four days where 12 beds are packed into a small room without adequate, safe water for personal cleanliness. To make things worse, the mother could acquire water borne infections from a meal prepared using unsafe water or the baby may develop easily prevented infections like sepsis. Subsequently, the baby might be required to be taken to the NICU for further treatment, which is an additional economic burden for the family, as are additional medical, food and bottled water costs incurred during the stay.
We know the Ethiopian Ministry of Health is working to improve this dire problem. It has created a national policy and strategic plan to radically improve the provision of safe water and sanitation throughout the country and bring significant benefits to millions of people. The ministry is also trying to link WASH with infection prevention through its flagship project, Clean and Safe Health Facility (CASH).
Still, disparities are so big among different locations and conditions remain very bad in our hospital.
With all our problems, our hospital is still doing its best to address the needs of the region and local community. Last year we performed 303 caesarian sections, 1522 major surgical procedures and 1500 minor procedures — all of which should be unthinkable without water. The most important cause for morbidity was infections and related sepsis, all due to inadequate and low-quality water. We do the best we can.
We need leaders, governments and donors to come together on this most fundamental health-care need. We deeply appreciate the U.N. secretary general calling for all health-care facilities to have adequate facilities by 2030. Now it is time for coordination and action. This worthy goal will be accomplished only when health, development, water and finance sectors work together to achieve access to real health care. As professionals serving on the front lines, it is with deep gratitude and urgency that we make this most fundamental request.
Teklemariam Ergat Yarinbab is the chief executive director of the Mizan Tepi University Teaching Hospital. Tewodros W. Liyew, M.D., is chief clinical director at the hospital. Ephrem Alemayehu Kirub, M.D., is the hospital’s clinical governance and quality improvement unit head, and Biruk Ambaw Teshome, M.D., is the unit’s vice head.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.