August 2021: Our Cleft Programme in Oromia

During the month of August we had two mobilisation programmes for cleft lip and palate, resulting in a total of 90 infants and children being able to receive treatment.

Both of these programmes helped families from remote and rural areas of the Oromia Region access safe treatment for cleft lip and palate. The first programme involved people travelling from the East and West Haraghe Zones to the Ethio Tebib Hospital located in Ethiopia's capital, Addis Ababa - and the second programme involved people travelling from remote areas of the West Shewa Zone in Oromia, to Ambo General Hospital, which is located about 120 km outside Addis Ababa.

A Closer Look: East and West Haraghe Zones to Addis Ababa

15 patients were identified from different Woredas of East and West Hararghe zones. Most families from East Haraghe were able to be collected by a Project Harar Programme Officer at Harar town - (birthplace of Project Harar!) and those from West Haraghe were collected at Chiro town.

The roads from the patients family homes in the East Hararghe zone have an average distance of 50 km away from Harar town but the roads from the Woredas of the West Hararghe zone to its capital town Chiro, create a slightly more difficult journey. Chiro and surrounding areas have lots of ragged hills making it challenging for road vehicles, some families lived so far away from the collection area of Chiro or Harar and journey on foot was necessary for some of the way, this was very difficult as it is currently the rainy season. 

Before being taken to the Ethio Tebib Hospital in Addis Ababa, the patients and their guardians were taken to the Government health centre to receive tests for Covid-19. The families were provided with accommodation, as they had to wait for three days to receive the results - fortunately all were negative. After this, patients were taken to the Ethio Tebib Hospital and given further health checks to check that they met the right health requirements for cleft surgery, all patients were deemed healthy enough and received successful cleft surgery - 13 for cleft lip and 2 for cleft palate. This included a 17 year old boy, who's cleft case was more challenging than the rest of the infants and children who received treatment, he was referred on to Yekatit-12 Government Hospital and then transported home by Project Harar, just over a week later.

A Closer Look: Mass Media Awarness Raising and Nutrition

This programme incorporated mass awareness raising messaging, in partnership with the Oromia Regional Health Bureau and Oromia Broadcasting Network (OBN). The OBN reaches many areas of Ethiopia, the campaign message was spoken in Afan Oromo, which is the national language of the Oroima Region, this resulted in 75 patients being idenfied as needing cleft treatment from across the region, but particularly from western and southwestern parts of Oromia, with exceptional case from Afar Region.

The journeys from each families home village (kebelle) were very long and challenging - one family's journey took 4 days long and several people managed to travel from hot spot security areas such as  Kellem and West Wollega. After receiving treatment the families travelling from hot spot ones had to stay in Ambo due to road closures, as there were security problems in the Kellem and West Wollega Zones. Project Harar provided food, care and accommodation for these families until it was safe enough for them to return home. 

In total 64 infants and young children where able to receive surgery, 43 for cleft lip and 21 for cleft palate. 14 patients were unable to receive surgery as they were either presenting signs of malnutrition or low haemoglobin. These families received targeted nutrition supplementation from Project Harar. 

This included biscuits, milk powder and peanut butter - that would last for three months. Project Harar's acting Programme Manager, Galeta, demonstrated to the families the nutritional benefit of the supplies and how best to incorporate them into their diet.

We spoke to Project Harar's Executive Director and Country Head in Ethiopia - Amanuel Tafese, who told us more about the nutritional support integrated in the Ambo Programme: 

“It was really good to see mothers feeling happiness when having someone beside them, in solidarity to support, this type of support contributes to the comprehensiveness of the cleft programme to fulfil the holistic intervention including the rehabilitation components of the programme.”

— Amanuel Tafese

Back in 2017 Project Harar ran a review project on nutrition within it's cleft programme. This involved our programme team and a specialist dietician travelling round remote areas to identify specific barriers to nutrition in cleft children. Barriers that were identified were more specific to the physical difficulties infants and children with cleft encounter - and centred more around social attitude and environment. Learnings from this project included a greater understanding of food purchasing and consumption in rural areas, such as, although lots of families worked in agriculture, they often sold their produce instead of keeping it to themselves and also if mothers were unable to breast feed their child, milk powder was either too expensive for the family to purchase, or not available in their area. Following on to this Natasha, Project Harar's specialist dietitian (volunteer) worked with Project Harar's programme team to contract nutrition focussed workshops for health workers in rural areas. This training included pin pointing key foods that are available in rural areas that can encourage healthy weight gain, such as high fat produce like peanut flour and oil - and suggesting ways they can be incorporated into a traditional Ethiopian diet. 

We spoke to Amanuel again after the August programme to find out more about the new challenges people in rural areas are facing, in terms of nutrition:

“Due to many environmental factors we have started to notice a higher number of patients being referred to PHE who are malnourished or have low haemoglobin. In the past PHE would always refer clients who needed nutritional support to their local health authority, but we are now able to give clients and their families nutritional support directly, especially as many families in rural areas do not have the means to source and buy such specialists goods themselves . At this time the inflation rate is very high in Ethiopia and there is a price increase in all items including food. If clients are displaying extreme signs of malnutrition, they will be refered to the nearest partner hospital for clinical feeding/earlier intervention.”

— Amanuel Tafese