Go Global to Ityop'iya---Ethiopia!

Blain Mamo, MPH and Blen Shoakena

Minnesota Department of Health

Volunteers, Ethiopian Community in Minnesota Health Board

February 25, 2009

Around Ethiopia in 60 minutes…

• … a quick overview of its land, diverse people, centuries of history and culture.

• This is just a perspective of two Ethiopians

Geography

• Capital City: Addis Ababa (population approx. 3 million)

• Location: East Africa, landlocked

• Area: 435,071 square miles (1,127,127 km²) almost twice the size of Texas (or Britain and France combined)

• Terrain: desert in the east, tropical forests in the south, Highlands in the North and SW. Highest point 15,157 ft, lowest 410 ft

• Climate: Rainy season June to Sept. ; showers in February to March, dry the rest of the year.

Around Addis Ababa

Around Addis Ababa

Addis Ababa University, Est. 1950First postal office in Piassa neighborhood

Around Addis Ababa

http://www.flickr.com/photos/17405338@N07/1847606941/

Early…early history• There was Lucy or

“Dinkinesh”• One of the oldest

country in the world-human settlement in prehistoric time (human ancestors dating ~4 million discovered in Ethiopia… “Lucy” is the most famous recognized hominid fossil

Early History

• Traces its history back at least 3000 years

•“Era of Princes”16 different rulers-rife with conflicts for power and control

•Decentralized

1855-1868

•King Tewodros II (1855-1868) united and controlled all Ethiopia

•Beginning of Modern Ethiopia

King Lalibela(1141-1181)builds 12 rock-hewn churches

•Center of International trade

•Conversion to Christianity under Emperor Ezana (325 A.D)

•Islam introduced in 615 A.D. (refugees from Mecca settled in Negash)

•Evolution of Ge’ez

5,000-2,000 BC

•Obelisks in Axum Region

•Evidence of semiticlanguages (proto-Ge’ez)

Solomonic Dynasty 1268-1974Zagwe

Dynasty 1137-1268

Axumite Empire

400 B.C- 960 A.D.

D’mt Empire

700 B.C- 650 B.C.

1730-1855

1529-1542

Imam Ahmed Invaded Ethiopia

1635-1855

Gondar-capital of Ethiopia under Emperor Fasilides

D’mt Empire ( 700 B.C.-650 B.C.) Yeha ruins

Sabean tablet (read L-R-L & with no vowels)

Axumite Empire 400 B.C- 960 A.D.

Zagwe Dynasty (1137-1268)Churches at Lalibela

Bete Emmanuel

Bete Gabriel

Gondar Capital city (1635-1855)

Modern History & Current Politics• “Battle of Adwa” :defeated Italy in 1896 during “Scramble for Africa”; one of two

African countries never colonized (Italian occupation 1935-1941)

King Menelik II(1889-1913(d))

H.I.M. Haile Selassie I(1930- 1974)

Com. Col. Mengistu HaileMariam(1974-1991)

P.M Meles Zenawi(1991-Present)

• Father of Modern Ethiopia (railway, car, bank, postal service, electricity, plumbing)

• Est. trade w/ Europeans

• Unified kingdoms of Ethiopia

• Est. “Cabinet of Ministers” to govern Empire

• “Zewditu I” and Iyasu V cousin

• 1st written Constitution,1931

• Abolished slavery as condition to join “league of nations, 1932

• 1961- Start of Eritrean War of independence

• 1963- formation of OAU (active in decolonization mov’t)

• 1973- famine, oil crisis, high unemployment, military mutinies, student activism led to decline

• Symbol of Rastafarian Mov’t

Zewditu I(1916-1930 (d))

•Derg; led coup in 1974. (ordered deaths of 61 ex-officials and Patriarch)

• 1975/8- “Red Terror” ~1/2 million deaths

• Introduced Marxism/Leninism (land and property nationalized)

•Equality of all religions

•National Literacy Campaign (60% by 1984)

•Improved health care

•1984/5- Famine & internal wars

• Exiled in Zimbabwe, convicted of Genocide & death penalty in 2006

•TPLF led coup in 1991

• 1993 Eritrean Independence

• Redrew map along ethnic lines & Ethnic federalism

Menelik II’sdaughter

Peoples of Ethiopia• Population estimate (2008): 78,254,090

– Total fertility rate: 5.3 births per woman (UN data)– Life expectancy (women/men): 54/52 years (UN data)

• Major ethnic groups: Oromo 32.1%, Amhara 30.1%, Tigraway 6.2%, Somali 5.9%, Guragie 4.3%, Sidama 3.5%, Welaita 2.4%, other (over 50 groups) 15.4% (1994 census)– Many people are of mixed heritage.

• Religion: 60% Christian, 40% Muslim

• Languages: Amharic (Official), Oromiffa, Tigrigna, Guragegna, and over 84 indigenous languages and 200 dialects

• Occupation: 80% agrarian (subsistence), 6% industry, 13.2% services– More than 15 million people derive their livelihood from the coffee sector.

Ethiopians in the Diaspora• Around the World: 1.5 - 2 million Ethiopians live in the

US, Canada, England, Sweden, Australia, and the Middle East.

• In the US (migration started in the 70s): est. 450,0000 (much greater with descendants)– Little Ethiopia in Los Angeles

– 25th annual soccer tournament, Washington D.C.– Gathers ~70,000 from around the world

• In Minnesota: 10-12,000 (Census/ACS)• Remittances from the Diaspora are significant to the

Ethiopian economy.

Cultures & Customs of Ethiopia

• Diverse!!!• Religion-based (Judaic, Christian, Islam)

or Animist• Core elements: respect for elders &

authority figures, modesty, being humble, pride, losing face…

Customs an example: Greetings & social distance

• Greetings: – Formal: “Endemen Not?”

• Respect: Avoiding eyes of and bowing to elders, teachers and persons of authority

• Many Ethiopian languages have a grammatical form to call elders- like French, formal “You”

– Informal: “Selam”, “Tadias”

• Kissing both cheeks, hugging, touching is normal among family, friends for both male and females

Food• Grains (tef, corn, sorghum, barley wheat and millet) • Legumes (chickpeas, field peas, lentils and broad beans) • Vegetables (kale and other greens, carrots, potatoes,

onions tomato)• Fruits (bananas, oranges, limes)• Meats & Dairy (goat, sheep, cow, chicken, camel, milk,

eggs)• Spices (chili peppers, garlic, ginger, etc..)

Coffee & coffee ceremony

• Origins of coffee plant can be traced back to Ethiopia.• Word coffee is said to derive from the Kaffa region of Ethiopia.• Coffee ceremony is important part of Ethiopian culture.

Religious Practices• Two major religions

– Ethiopian Orthodox • Fasting: Lent, Christmas, Wednesday & Friday (Vegan Diet)

– Islam~ 5 Pillars• Fasting: Ramadan, Monday & Thursday

Naming• Concept of “Middle Name” & “Family Name” are Western• Naming is

– Given Name, followed by– Father’s First Name– Grandfather’s First Name (to differentiate 2 persons with the same

name)• ex: Blain Mamo (Kifle)

– When applying for official U.S. document, many are required to identify a “Middle & Family Name”

– (ex: Blain M. Kifle) a source of a lot of confusion and discomfort

• Women do not change their names when they get married.• In the U.S.

– Most women keep their maiden name– Some families follow traditional naming methods while others choose

to assign a family name.

Clothing• Urban areas: Traditional dress often worn on

mostly holidays, weddings otherwise western

Language & Literature• Language

– Semitic: Northern highlands (Geez, Amharic, Tigrigna, Gurage, Harari)

– Cushitic : Southern /Eastern lowlands (Oromiffa, Somali, Sidama, Afar)

• Literatureo Kebre Nagast “Glory of Kings”: written

~ 800 years ago in Geez; 117 chapters chronicling the Solomonic Dynasty and Menelik 1st (Son of King Solomon and Queen Sheba, 950 BC), Ethiopian religions and national life

o Zera' Yaekob (b. 1592) thinker/philosopher who critically examined teachings from the Bible, Koran, and Torah.

o Proverbs & metaphors are commonly used in everyday language.

“When spiders unite they can tie up a lion”

Ethiopic alphabet

Music, art & jewelry• Traditional Music:

o St Yared (4/25/505 -5/20/571 AD) – invented Ethiopian church or sacred music (chant) and Ethiopian system of musical notation.

o Manzuma ~ Islamic music From NE Ethiopian, spread to the South and now sang in Oromo

o Secular- Griots, unique musical notations & instruments• Modern Music

Gender Roles• Women are considered to be subordinate to

their husbands; sociocultural & economic dependence

• Girls receive less education than boys– Literacy rate: overall population 43%

• Male: 50.3%; female: 35.1% (2003 est.)

• Daily tasks include carrying loads over long distances, grinding corn manually, working in the homestead, raising children, and cooking

Marriage & Family• Marriage:

– Rural Areas: girls continue to get married when 12-14 years of age (menarche), usually arranged

– Urban areas : at least 18 years of age• Family ties are strong and having extended family at home is

common (personal space or privacy don’t have exact definitions)-sharing everything is expected

• Elders often are the first to attempt to settle disputes

• Important events: births, marriages, deaths, and religious holidays

• Community support systems: – “edirs”: supports grieving families (emotionally & financially) – “mehaber”: structured social, religious, or family groups which typically

meets monthly– “equb”: financial network through which members save money

dispersed monthly

Ethiopian calendar & time“13 Months of Sunshine”

• 12 months of 30 days and 1 additional month of 5 or 6 days (leap year)

• New Year: Sept 11 or 12 of Julian Calendar• Now 2001 (E.C.)• Time: 7 a.m = 1 morning

Noon = 6 lunch3 p.m = 9 afternoon6 p.m = 12 evening7 p.m = 1 eveningetc,….

Health Beliefs & Traditional Medicine

• Health is balance between the body and the outside (avoid excess heat, cold, food, water, draft, to keep equilibrium)

• Concept of “contagious disease” is understood

• Bad news not disclosed to patient- partially disclosed (psychosocial reasons) or family members involved.

• Almost all men and women are circumcised

• Many disease causation beliefs (ex: syphilis caused when urinating under a full moon)

• “Injections work better than pills”

• Traditional healers and procedures are sought regularly– Holy water often used to

treat many ailments, esp. mental health

– Common use of herbal medicine

– Scarring, cupping, “Burning”or wearing amulets to protect against “evil spirits”, prevent disease or treat disease

– Uvulectomy (to prevent presumed suffocation during pharyngitis in babies)

– Extraction of lower incisors in infants (to prevent diarrhea)

– Incision of eyelids (to prevent or cure conjunctivitis)

Ethiopian proverb“He who conceals his disease cannot expect to be cured.”

Health Care System & Basic Statistics (2006/7)

• One of the least developed in the World; unable to handle basic health care needs of growing population.

• Government is the primary health care provider

• Expenditure: $1.55 per capita

• Facilities: – Government

• 143 hospitals, • 690 health centers, • 9,914 health posts, • 1,376 health stations

– Private• <50 hospitals & 2153

clinics – 320 pharmacies

• Providers: – One physician for 42,636– One nurse for 4,243

• Buying medications without prescriptions is common (anti-malarials, antibiotics)

Major Health Concerns• Infectious diseases: TB, HIV, Intestinal

parasites, Hepatitis A & B, & malaria• Under- or malnutrition: Aggravated by

widespread poverty, low education levels, inadequate access to safe water, sanitation facilities and health services:

• Health Indicators– Infant mortality (97 per 1000); under 5

morality (140.1 per 1000) – Maternal mortality (871 per 100,000)

antenatal coverage (2005) ~ 50%– Life Expectancy: 54 years (expected to

decline to 46 with current HIV infection rates)

2006/7 Report

2006/7 Reportable Disease Report

To sum up…Ethiopia, diverse, &

beautifully complex!

Thank you!