Tuberculosis: the Untold Story
by Nikki Therrien (Masha 2009-2011 and Addis Ababa 2011-2013)
We’ve all been there on that long bus ride cross country in Ethiopia: hour six, 90 degrees, sweat beading on your forehead and all the windows sealed. There are countless stories the people on that bus could tell about why they are on the bus, but there is one story that’s not being told. It’s the reason many of the passengers are taking the six-hour bus trip to the hospital for the seventh time this year; it’s the reason why everyone is suffering through the heat; it’s the reason why, despite the stuffiness, the windows are all shut. It is the story of tuberculosis (TB).
In 2011 Ethiopia ranked seventh among the 22 high-burden TB countries in the world with a prevalence rate of 560 per 100,000 or nearly 150,000 cases (WHO Global Update Report 2011). Despite its ubiquity the disease is largely misunderstood and can become a more serious problem.
Many cases of TB are untreated, and those who do receive medication often do not finish the six-month regimen. Patients often stop taking their medications due to barriers such as their poor awareness about the disease, yet even those most informed about the disease have few resources to address it. The obstacles include: the unavailability of daily TB care in their communities, the long distance from home to a health facility, the long wait-times at the facilities, the high volume of patients in the hospitals where doctors and nurses don’t have time to counsel them about the disease and treatment plan, nor do the hospitals have the proper facilities to isolate and treat people with suspected TB, and finally the high stigma around TB. All of these impediments create the risk of patients developing multiple drug-resistant TB. And the disease continues to spread in the community.
During my service in Ethiopia I found that TB was severely neglected. Even as a PCV it was difficult to obtain funding and build programs around this highly communicable disease. While the framework has expanded a bit since my time, during my service all of Peace Corps-Ethiopia’s projects were meant to focus on HIV/AIDS. While those programs were important, I often felt that diseases like TB were a much more pressing issue. For the most part people knew how HIV was spread, but TB was more mysterious. After returning home from Ethiopia in January of 2013, I continued to seek out ways to continue working for my second country. That’s when I found United for Health Abyssinia. UHA is a nonprofit based in Boston, MA that aims to prevent and control the spread of TB and reduce morbidity and mortality through building the capacity of hospitals and communities in Ethiopia one community at a time. As an RPCV, this organization appeals to me for a number of reasons. It’s addressing a real need, it follows the Peace Corps standard of helping communities help themselves, and the director, Sisay Akalu, who founded the organization, is deeply committed.
Dr. Sisay Akalu grew up in Gondar, Ethiopia but has spent much of his adult life in the US practicing medicine. A few years ago he was informed that his brother had become ill and needed help. Dr. Akalu visited his family in Ethiopia and learned that his brother, like many other Ethiopians, had TB. Because of improper medical management, his brother’s case became increasingly difficult to treat and he spent years in and out of the hospital. Alarmed by his brother’s lack of knowledge and the realization that if his brother was having these troubles then so many others were too, Dr. Akalu decided to do something about it.
In 2013 Dr. Akalu founded United for Health Abyssinia. Partnering with regional hospitals, the non-profit aims to identify gaps in services, evaluate existing programs, conducted local health education programs and organize communities to be active participants in their own health.
To achieve these goals, United for Health Abyssinia has a three-pronged approach starting in Debre Tabor in the Amhara region. The first step is to improve the physical capacity of Debre Tabor General Hospital by building an isolated ward for the treatment of patients with active TB. The special ward will have well ventilated rooms with negative pressure systems that minimize the chance of spreading the infection to other patients and staff. The second step is to train and utilize health extension workers (HEWs) to employ the DOTS (Directly Observed Therapy – Short Term) strategy of medical management. This strategy requires HEWs to educate patients on their treatment and also watch patients ingest their medicines daily to ensure adherence. The final step is to increase awareness and minimizing stigma in communities through rural education campaigns.
The real beauty of UHA is its approach to development. As RPCVs we are trained and retrained on the idea of sustainable development. UHA’s role in the fight against TB is to mobilize resources and train community members. The actual programming and implementation is entirely Ethiopian based. Dr. Molla Belay, the CEO of Debre Tabor Hospital, along with the classes of medical students at Gondar University, has taken on the responsibility and will carry the mission of UHA. Once the programs are proving successful UHA will pull out and move on to another community in another area of Ethiopia. It’s an organization that I am proud to be a part of.
If you’d like to learn more or get involved with United for Health Abyssinia please check us out at United for Health Abyssinia or email me at
For those of you in the Boston area stay tuned, we’d love to meet you at future fundraisers throughout the year.