October is international Breast Cancer Awareness month. Throughout the month, public and private organizations in many countries promote programs and activities aimed at breast cancer risk reduction, early detection, treatment and research. It is well-established that breast cancer is one of the most common cancers affecting women throughout the world. Millions of women are diagnosed with the disease every year and hundreds of thousands die needlessly. Breast cancer is the second leading cause of death among African American women in the U.S., according to the Komen for the Cure organization. There is little reliable data on the incidence and prevalence of breast cancer in Africa because of the absence of reporting, diagnostic and treatment processes. Breast cancer cases in Africa are likely to be documented only when patients come to hospitals, health centers, clinics and laboratories for diagnostic and treatment services. Facilities with mandatory reporting requirements are far and few between in the rural areas of Africa where the vast majority of women live. Few African governments have undertaken breast cancer epidemiological surveys to reliably ascertain the incidence, severity and prevalence of the disease.
Breast Cancer and Health Services in Ethiopia
A review of the academic and popular literature does not show that breast cancer is a priority for health officials in Ethiopia. That is understandable, though not excusable, given the country’s dismal health infrastructure and services. The statistics on health care services in Ethiopia are grim and heartbreaking. According to a 2006 World Health Organization (WHO) report, Ethiopia’s population was estimated to be 77 million. To serve this population, there were 1,936 physicians (1 doctor for 39,772 persons); 93 dentists (1: 828,000); 15,544 nurses and midwives (1: 4,985), 1,343 pharmacists (1: 57,334) and 18,652 community health workers (1: 4,128). Total expenditure on health as a percentage of gross domestic product was 5.9 per cent. General government expenditure on health as a percentage of total expenditure on health was 58.4 per cent, and private expenditures covered the balance of 41.6 percent. Hospital beds per 10,000 population was less than 25. Per capita expenditure on health was US$ 3 at an average exchange rate. WHO’s minimum standard is 20 physicians per 100,000 population, and 100 nurses per 100,000 population. In March 2007, the late Meles Zenawi, responding to a question on the Ethiopian “doctor drain”, shocked health officials and physicians attending a conference by declaring, “We don’t need doctors in Ethiopia… Let the doctors leave for wherever they want. They should get no special treatment.” According to Foreign Policy magazine, “there are more Ethiopian physicians practicing in Chicago today than in all of Ethiopia, a country of 80 million and Africa’s second-most populous country.”
In October 2010, in a five-part series entitled, “Mothers of Ethiopia,” investigative journalist Hanna Ingber Win painted a portrait of a country that is the epicenter — the ground zero– of Africa’s maternal and child health crises. Win wrote, “In Ethiopia, the maternal health statistics suggest that the nation’s health care system needs an overhaul. Less than six percent of women have access to a health professional while giving birth, according to Ethiopia’s 2005 Demographic and Health Survey. The maternal mortality rate is one of the worst in the world. For every 100,000 live births, 673 women die giving birth, according to the survey.”
In light of these statistics and the absence of private and non-governmental organizational efforts to increase breast cancer awareness, little is factually known about the incidence, severity and prevalence of breast cancer in Ethiopia. Routine mammogram screening for breast cancer for the vast majority of Ethiopian women is unheard of and certainly unaffordable. When the disease manifests itself, the vast majority of Ethiopian women are likely to seek the aid of herbalists and shamans for traditional medicine. Chemo and radiotherapy are beyond the means of all except the extremely well-to-do who will often travel outside the country to receive treatment.
The Culture of Secrecy and Silence About Cancer, HIV/AIDS…
There is a strange and confounding culture of secrecy and silence about certain kinds of illnesses among many Ethiopians in the country and those in the Diaspora. Among the two taboo diseases are cancer and HIV/AIDS. The rule seems to be hide the illness until death, even after death. We saw this regrettable practice in the recent passing of Meles Zenawi. Meles’ illness and cause of death remain a closely guarded state secret. It is widely believed that he died from brain cancer. The New York Times quoting “Western officials” reported Meles was “was suffering from liver cancer.” The Committee to Protect Journalists reported Meles died in a Brussels hospital of liver cancer. But cancer in general and breast cancer in particular are taboo subjects for most Ethiopians including those with advanced education and exposure to the outside world. This culture of secrecy and silence has contributed significantly to the needles deaths of thousands of Ethiopians. For instance, there is substantial anecdotal evidence that far too many Ethiopian women living in the U.S. have needlessly died from breast cancer because they failed or avoided to get regular breast cancer screening fearing a positive diagnosis. Often these women would keep themselves in denial about the disease and avoid sharing information with family and friends until they have passed a critical stage where medical intervention is ineffective. Secrecy and silence when it comes to breast cancer is a death warrant!
Developing a Culture of Openness and Free Exchange on Breast Cancer and Other Illnesses
I became very much aware of breast cancer several years ago. Until the disease hit closer to home, I knew very little about its diagnosis, treatment and outcomes. But I did learn a lot; and here are some of the things I learned:
…With the types of treatments available today, breast cancer is a disease that can be treated effectively if caught early… It is a woman’s worst nightmare to be told that she has breast cancer. [Women] go through an emotional roller coaster — shock, denial, anger, and “why me” self-pity when the doctor [tells them they have] breast cancer…. Many Ethiopian women in the U.S. tend to be lax about doing [their] annual checkups or having our regular mammograms. For some of [them], it is a simple problem of not being able to afford any health care. Without insurance, getting health care in the U.S. could be very difficult. But many Ethiopian women who have the means to get regular checkups and mammograms often do not get it. [There are] many reasons for this potentially dangerous situation… one of the major reasons has to do with not being well-informed about breast cancer. Many [Ethiopian women] are so scared of the disease that [they] don’t want to think about it, let alone actively learn information that could save [their] lives…. They will not go to see the doctor unless they are ‘very sick’. With breast cancer, waiting until one is ‘very sick’ means one is just too late to get help to save one’s life…
… Breast cancer is one disease that no woman can hide from or afford to ignore. Ignoring breast cancer is like ignoring a small brushfire in the forest. Left alone, the brush fire will eventually destroy the forest. Breast cancer, if not detected early or ignored after one catches its tell-tale signs, could spread to various organs in the body and kill its victim. It is not uncommon for some women to feel lumps in their breasts, ignore it and not have it checked out because it “does not hurt.” That is a big mistake. Any kind of lump or hard tissue in the breast should be taken very seriously and checked out by a doctor…
These words were written by my wife two years ago almost to the day in a piece entitled, “A Letter to My Ethiopian Sisters”. She beat breast cancer and freely shared her story with her Ethiopian sisters. She explained that the “myths many Ethiopian women believe about breast cancer tests and treatments [are just that]. For example, some [Ethiopian] women avoid getting their annual mammograms because they believe they can get cancer from it. Mammogram does not cause breast cancer. It is a simple and painless procedure just like taking X-rays.” She addressed the fact that “some Ethiopian women believe cancer is something to be ashamed of. They don’t want their friends and relatives to know they have it and keep it a secret to themselves until it is too late or they are in the hospital. There is nothing shameful about breast cancer. It is a terrible disease that does not discriminate between women who are poor or rich, black or white or in whatever part of the world a woman may live in.”
She stressed essential facts that Ethiopian women should understand about the disease: “What I want to stress here more than anything else is the fact that Ethiopian women need to do regular medical checkups and get mammograms to catch any symptoms or signs of breast cancer. Breast cancer is not like the flu, it does not go away with a few days of bed rest. If left untreated, it gets worse by the day until it reaches a point where nothing can be done medically. Early detection of breast cancer is the key to survival.” She regretted the fact that because “Ethiopian women simply avoid doing the basic things that could help catch the disease at its early stage, over the years [she has] lost friends, acquaintances, co-workers and family members to this terrible disease. I have to say many lost their lives because they did not have timely breast cancer screening and diagnosis, or ignored their symptoms until after it was too late.”
Ethiopian Women Breast Cancer Awareness Month: A “Letter” to My Ethiopian Brothers
In her “Letter”, my wife insisted on the need for open discussion and community action in fighting breast cancer among Ethiopian women.
I know for many Ethiopian women in the U.S. there are cultural, language and financial issues that make it difficult to get regular checkups and screenings for breast cancer. I believe Ethiopian women helping each other could help greatly in dealing with these issues. That is why I ask all of my Ethiopian sisters to openly talk about breast cancer with each other at home, in places of worship and social events and gatherings and share information about early breast cancer detection and treatment. As we freely talk about our high blood pressure or diabetes, we should do the same with breast cancer so that we can get help in a timely fashion.
She called on “Ethiopian women doctors especially [to] play an important role in educating women about the disease, doing screenings and suggesting possibilities for those who may not be able to afford health care. There are many local clinics and hospitals in the U.S. that offer free breast cancer screenings for women who cannot afford it.” She hoped, “Ethiopian women could start breast cancer patient support groups in their local communities throughout the U.S. that can provide information and one-to-one support for those diagnosed with breast cancer or going through treatment.” She pleaded with “those in the religious community [to] play an important role by inviting knowledgeable health professionals in breast cancer to their community halls to educate Ethiopian women on how to access free or low cost health care to get checkups and mammograms.” She urged, “In many major cities, there are radio stations serving the Ethiopian community. They could help save many lives if they devoted some air time to breast cancer awareness and treatment. The same can be said of the various Ethiopian websites. I am hopeful that by next year this time, we will be able to have our first annual “Ethiopian Women Breast Cancer Awareness Month” to coincide with the national program.”
We believe it is important to share such information during this month of awareness for two reasons. First, it is important to chip away away at the deadly culture of secrecy and silence about cancer. Perhaps others may feel empowered to share their stories with the disease and spark broad conversation throughout Ethiopian communities worldwide. The best way to beat breast cancer is to be adequately informed about the disease and take prompt preventive and preemptive action. Second, we wanted to reassure our Ethiopian sisters and brothers that there is nothing shameful, immoral, wrong or scandalous about being a victim of breast cancer or any other cancer. But it is shameful, immoral, wrong and inexcusable to live in a country where services are available for early detection, diagnosis and treatment and not take advantage of them because of a misguided feeling of shame or fear of ostracism.
The fact of the matter is that there is extraordinary heroism in being a breast cancer survivor, or for that matter any other type of cancer. I believe the victory of women who have defeated breast cancer is no less than the victory of the valorous soldiers who have earned the Medal of Honor for fighting and defeating the enemy in the field of battle. That is because I have seen the courage, fortitude, stamina, bravery, endurance, determination and perseverance of those women who have fought and won over breast cancer. I have also seen the suffering, anguish, hardship, misery and torment of those heroines who lost their battles.
I believe Ethiopian men could make a special contribution to breast cancer awareness, early detection and treatment by undertaking some simple tasks. First, we should strive to educate ourselves on this deadly disease. Many of our mothers, sisters, wives and loved ones are so fearful of the disease that they will not seek out information or preventive care until it is too late. It should be our moral duty to insist and relentlessly remind them to get regular mammograms and checkups, particularly where they are available and affordable. It is inexcusable and immoral not to take advantage of such preventive services in countries where such services are available regardless of income. We should help out by organizing special outreach efforts for Ethiopian women during breast cancer awareness month and National Mammogram Day (third Friday in October). Various activities including walks and other charity events are organized to raise awareness and funds for breast cancer. We should make a special effort to participate in these events and mobilize the community in places where there are large concentrations of Ethiopians. It is not uncommon for Ethiopian women to suffer this deadly disease in quiet desperation. Support groups are especially needed to help those fighting breast cancer. We can play a central role in helping to create such groups. Information on locally available breast cancer resources (free mammogram services, public and private programs providing treatment) should be systematically gathered and readily made available to Ethiopian women, particularly in urban areas. Above all, Ethiopian men share the greatest responsibility in eradicating the ugly culture of secrecy and silence surrounding breast cancer by freely talking about it in all public forums and private settings.
This month, let us take time to salute our sisters who have prevailed over breast cancer. There are no greater heroines than breast cancer survivors. Let us also remember the sisters we have lost needlessly to breast cancer. Let us resolve to fight breast cancer through a massive community program of awareness, information and education. Routine checkups and early detection are the best weapons against breast cancer. Let’s join hands and defeat breast cancer one woman at a time!
“S/he who does not tell of his/her illness cannot expect to get the right medicine/cure.” Ethiopian proverb.
Amharic translations of recent commentaries by the author may be found at: http://www.ecadforum.com/Amharic/archives/category/al-mariam-amharic and http://ethioforum.org/?cat=24
Previous commentaries by the author are available at: http://open.salon.com/blog/almariam/ and www.huffingtonpost.com/alemayehu-g-mariam/
Ethiopia is known for the best and the worst. Ethiopia is known for the legendary hospitality and charm of its people, unrivalled beauty of its picturesque landscape, fabulous coffee and, of course, unbeatable distance runners. Ethiopia is also known as the epicenter of human rights abuses, citadel of press repression and home to the largest population of political prisoners in Africa. Sadly, famine (or as the experts call it “acute/chronic malnutrition”) has marred the beautiful face of Ethiopia for decades. But Ethiopia is marching out of dictatorship into democracy, or should I say Ethiopians are running away from tyranny to freedom?Ethiopia has produced a high percentage of the most competitive middle distance and distance runners in the world for the last two decades. The great Abebe Bikila was a trailblazer not just for Ethiopians but the entire continent. He was the first African to win a gold medal in the 1960 Rome Olympics. Perceptive observers at the time noted that it took an entire division of the Italian Army to invade Ethiopia in 1935 but one barefooted member of the Imperial Guard to conquer Rome 25 years later. For Abe, it was all about duty, honor and country: “I wanted the world to know that my country Ethiopia has always won with determination and heroism.” So were the noble words of Ethiopia’s greatest athletic hero of all time. Abe repeated the same performance in Tokyo in 1964. Few noted the fact that Abe had triumphed in two former Axis capitals.
Others followed. Mamo Wolde won gold in the marathon event in the 1968 Mexico City Olympics. Mirus Yifter won gold in the 5,000m and 10,000m events at the 1980 Moscow Olympics. Gezahegne Abera became the youngest marathon gold medalist in the 2000 Olympics in Sydney. In the past decade, Haile Gebreselassie dominated the distance events winning two Olympic gold medals and four World Championship titles in the the 10,000m. Haile broke so many world records and won so many titles that Runners World, America’s foremost track magazine, called him “the greatest distance runner of all time”. Kenenisa Bekele holds the world and Olympic records in both the 5,000m and 10,000m winning a double at the 2008 Olympics in Beijing. He had won the same events in the 2004 Olympics in Athens. His victories at the World Championships and other international championships are too numerous to list.
The women champions have been equally impressive. Tiki Gelana won gold in the women’s marathon event at the 2012 London Olympics with a time of 2:23:07, a new Olympic record. Fatuma Roba won gold in the same event at the 1996 Olympics in Atlanta. Derartu Tulu won gold in the 10,000m event at the 1992 Olympics in Barcelona. Tirunesh Dibaba won the 10,000m and 5,000m events in Beijing in 2008 with a repeat performance in the 2012 London Olympics in the 10,000m. Just last week, the Ethiopians made a clean sweep at the Chicago Marathon: Tsegaye Kebede won gold by crossing the finish line in 02:04:38, followed by Lilesa Feyisa at 02:04:52 and Regassa Tilahun at 02:05:27. Atsede Baysa won the women’s race in 02:22:03.
The list of Ethiopian distance runners who have won gold, silver and bronze in the Olympics, World Championships, World Marathon Majors and other international distance events is endless. Many have wondered about the athletic prowess of these distance runners. According to one researcher, “transcending all of the known physiological and environmental elements, the key variable [for the Ethiopians’ unending string of victories] is the hunger to succeed”.
Long Distance Running as a Metaphor for Ethiopian Politics
In a weekly commentary in November 2009, (“The Great Ethiopian Run to Freedom”), I wrote, “… The multitudes were not just running for freedom, they were also running away from tyranny and dictatorship, despair and hopelessness, and from their daily life of indignity and humiliation under a ruthless dictatorship. Sadly, they were all running in circles in the prison nation Ethiopia has become…” The distance run could be an apt metaphor for Ethiopian politics and the struggle to transition that country from dictatorship to democracy. The distance run is not merely a physical challenge but also a formidable test of mental fortitude. Running long distances requires great physical effort, but it also requires extraordinary stamina and endurance. The distance run is often painful, intense, strenuous, laborious and tedious. But the distance runner creates her own rhythm and tempo as she pounds the pavement and dirt road going up and down the hill sweating and thirsty, turning a corner with the wind pushing her back, the hot sun baking her face and exhaustion pulling every fiber of her sinewy muscles. The distance runner always looks forward with his eyes fixed on the prize notwithstanding the pain and strain. As Jacqueline Gareau, the 1980 Boston Marathon champ observed, “The body does not want you to do this. As you run, it tells you to stop but the mind must be strong. You always go too far for your body. You must handle the pain with strategy… It is not age; it is not diet. It is the will to succeed.”
The secret of the distance runners is the “will to succeed”, which for the Ethiopian runners is raised one notch to the “hunger to succeed.” Like our distance runners, we too must have the will and hunger to succeed in the race for democracy, freedom and human rights in Ethiopia. The gold medal for democracy does not come by winning the 100m sprint or the 400m relay. The gold medal for freedom does not come by winning the 400m hurdle or the 1500m steeple chase. The gold medal for human rights does not come by winning the 200m spring. It comes at the end of a long, arduous and exhausting marathon over the mountain ridges of dictatorship, through the valleys of oppression, across treeless plains of injustice and waterless deserts of intolerance, arrogance and ignorance.
In the marathon race for democracy, freedom and human rights in Ethiopia, we must think, feel and act like our distance runners. We must develop the special qualities of our distance runners. What are those qualities? First, they are not superhuman attributes. They are qualities which most of us possess but rarely use. Second, they are not physical qualities, but psychological, intellectual, mental and spiritual ones. Long distance runners are singularly focused. They set their sights on their objective and pursue it single-mindedly. They are not easily distracted. They keep on keeping on until they get to the finish line. They have fortitude, a mental toughness which gives them resoluteness, staying power, tenacity and perseverance. They will not give in or give up even when they experience excruciating pain, thirst and fatigue. They know they are not competing with those behind and in front of them but the voice inside their head that says, “It’s too hard, too long and too difficult. Give it up.” But distance runners who have the will and hunger to succeed have developed the mental, emotional and spiritual strength to face not only the daunting hills and menacing valleys but also any unexpected adversity along their way. They are unafraid and calmly plug away at a steady clip stretching their legs nimbly to the finish line.
Distance runners have steely determination and always prepare to win. They devise a plan of action for victory, but adjust it as they go along. They will even change it completely if the unexpected occurs because they are flexible and adaptive. As they prepare, they always maintain a winning attitude. Haile Gebreselassie said, “First, do enough training. Then believe in yourself and say: I can do it. Tomorrow is my day. And then say: the person in front of me, he is just a human being as well; he has two legs, I have two legs, that is all. That is mentally how you prepare.” They also believe that when they win, it is not a personal victory for them but a triumph for their people and country. That was what Abebe meant when he said, “I wanted the world to know that my country Ethiopia has always won with determination and heroism.”
Distance runners have vision which is the “art of seeing what is invisible to others.” They can visualize their objective even when the finish line is shielded from view by hills and winding roads. In their mind’s eye, they see themselves entering the stadium for their victory lap or dashing the last hundred meters to the finish line to set a new record. They have endurance which is a mental and spiritual quality that keeps them going beyond what they believe to be their limits and helps them overcome weariness of body and affliction of spirit. Distance runners have confidence in themselves and their ability to get the job done. They do not doubt their cause or determination to win. They don’t run looking backwards, but push forward relentlessly believing that every mile they cover gets them closer to the finish line and to victory. Distance runners are self-disciplined, persistent, patient and dedicated. When they lose an event or do not perform as well as they thought they could have, they don’t sit around and mope and wear a long face. They look at their performance, determine the reasons for their deficiencies, identify the things they could have done better and differently, correct their mistakes and prepare for the next race. No excuses, no blaming others, no grudges, no bull!
The prize of democracy, freedom and human rights cannot be won in a sprint, spring, hurdle or relay. It can be won only after a grueling, painful and challenging distance race. It is a marathon race between those running for freedom and running away from oppression and those chasing the ones running away from oppression and towards freedom. The chasers have a leg up on the runaways and will do all they can to trip them up, halt and reel them in. But the fugitives from tyranny must keep on running. They win by outrunning their cruel pursuers. That is why the struggle for democracy, freedom and human rights is not for the sprinters but for the distance runners.
Each One of Us Must be a Distance Runner in the Race for Freedom, Democracy and Human Rights
The distance race for freedom, democracy and human rights in Ethiopia will be won by one individual at a time running alone and collectively with others across the rugged and jagged landscape of ethnicity, religion, language and region. But every Ethiopian must win the race first and foremost in his/her mind and heart. As Gandhi said, “You must be the change you wish to see in the world.” We must first win the distance race against our own prejudices, hatred, intolerance, ignorance and arrogance. With a clear heart and open mind, we will have the vision, persistence, tenacity and courage to win the gold in the “Olympic Marathon” for freedom, democracy and human rights. When we multiply our individual efforts 80 or 90 million times, we can transform Ethiopia from the land of 21 years of dictatorship and oppression to a land of 13 months of sunshine.
Let there be no mistake about prize at the end of the long and arduous distance race. When we win the race, we would have won a society where there rule of law reigns supreme, human rights are respected, abuser of power are held accountable, government governs with the consent of the people, government functions with utmost transparency, government is afraid of the people and the people are not afraid of their government and the people freely exercise their right to live with dignity and without fear, loathing and government persecution. It will be the race of our lifetimes. It may take generations to finish the race and win gold. We may have to create a “marathon relay” where each generation does its level best to struggle and win its leg of the race and pass the baton to the next generation. But to win this formidable distance race, we must have confidence, that is, robust self-confidence, full confidence in each other, absolute confidence in the younger generation and infinite confidence in the future.
Like the Olympic and World Championship distance runners, the distance runners for democracy, freedom and human rights in Ethiopia will feel tired and beat and even despair from time to time for the prize seems so distant and victory unattainable. Their heads might ache, their muscles and bones tired and pained and their spirits broken by a ruthless and savage dictatorship. They might feel like calling it quits because they cannot carry on to the finish line. They may lose heart because the distance is too long, the road too hard, the finish line out of range and the prize out of reach. But the distance runners for democracy, freedom and human rights must think and do what our champions have done time and again. We have to have to develop the mental fortitude to say, “I can do it! We can do it! Not completing the race and not winning are not options. We can outrun, outturn, outleap, outpace, outmaneuver, outperform and outlast those who are chasing us!” That is what it takes to win the “Olympic Marathon” for democracy, freedom and human rights in Ethiopia.
Our champion distance runners do not give in when they see a big hill or a winding road. They do not abandon their course because it is hot, cold, windy or raining. They do not give in or give up because the competition has more money, better resources or facilities. The never, never give in or give up no matter what. In the distance run for democracy, freedom and human rights in Ethiopia, we too must “Never give in–never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.”
“I wanted the world to know that my country Ethiopia has always won with determination and heroism.” Abebe Bikila.
Amharic translations of recent commentaries by the author may be found at: http://www.ecadforum.com/Amharic/archives/category/al-mariam-amharic and http://ethioforum.org/?cat=24
Previous commentaries by the author are available at: http://open.salon.com/blog/almariam/ and www.huffingtonpost.com/alemayehu-g-mariam/
For the past several months, there has been much display of public sorrow and grief in Ethiopia. But not for the millions of invisible Ethiopians who are suffering and dying from starvation, or what the “experts” euphemistically call “acute food insecurity”. These Ethiopians are spread across a large swath of the country (see map above, “Estimated food security conditions, 3rd quarter 2012 (July-September 2012, Famine Early Warning Systems Network FEWS NET).
According to the international “experts”, starving people are not really starving. They are just going through “scientific” stages of food deprivation. In stage one or “Acute Food Insecurity”, people experience “short term instability (“shocks”) but are able to meet basic food needs without atypical coping strategies.” In stage two or “Stressed” situations, “food consumption is reduced but minimally adequate without having to engage in irreversible coping strategies.” In stage three or “Crises” mode, the food supply is “borderline adequate, with significant food consumption gaps and acute malnutrition.” In stage four “Emergency”, there is “extreme food consumption gaps resulting in very high acute malnutrition or excess mortality”. In stage five or “Catastrophe”, there is “near complete lack of food and/or other basic needs where starvation, death, and destitution are evident.” When are people in “famine” situations?
Rarely will the international experts, donors, multilateral organizations, NGOs or ruling regimes use the dreaded “F” word. In Ethiopia, the word “famine” has been deemed politically incorrect because it conjures up images of hordes of skeletal humans walking across the parched landscape, curled corpses of famine victims under acacia trees and children with distended bellies clutching their mothers at feeding camps. It also portends political upheavals. In their analysis of recurrent famines in Ethiopia, Professors Angela Raven-Roberts and Sue Lautze noted, “Declaring a famine was also a complicated question for the Ethiopian government. Famines have contributed to the downfall of Ethiopian regimes… Some humanitarian practitioners gauge their successes, in part, according to ‘famines averted’… President George W. Bush challenged his administration to ensure that famines were avoided during his tenure, a policy known as ‘No Famine on My Watch’; declaring the existence of a famine could be seen as a political shortcoming and, therefore, a political vulnerability.” The one exception to the official embargo on the use of the word “famine” is Wolfgang Fengler, a lead economist for the World Bank, who on August 17, 2011, definitively declared, “This [famine] crisis is man made. Droughts have occurred over and again, but you need bad policymaking for that to lead to a famine.” In other words, the fundamental problem with “acute” or “chronic” malnutrition (short-term or long-term starvation) in Ethiopia is poor governance, not drought.
In January 2010, Mitiku Kassa, the agriculture minister in Ethiopia, declared, “In the Ethiopian context, there is no hunger, no famine… It is baseless [to claim hunger or famine], it is contrary to the situation on the ground. It is not evidence-based. The government is taking action to mitigate the problems.’ The late Meles Zenawi was equally dismissive: “Famine has wreaked havoc in Ethiopia for so long, it would be stupid not to be sensitive to the risk of such things occurring. But there has not been a famine on our watch — emergencies, but no famines.” If a technical definition of “Emergency” was intended, that would mean “extreme food consumption gaps resulting in very high acute malnutrition or excess mortality”. To the average observer, that sounds like old fashioned famine. But it is all a semantic game of euphemisms. Kassa made bold assurances that his regime had launched a food security program to “enable chronic food insecure households attain sufficient assets and income level to get out of food insecurity and improve their resilience to shocks…and halve extreme poverty and hunger by 2015.”
In 2011, according to the U.N., some 12.4 million people in Ethiopia, Somalia, Kenya and Djibouti were affected by chronic hunger and tens of thousands of people died from starvation (excuse me, “acute food insecurity”; or was it “acute malnutrition”?). Needless to say, there is not a single case in which starving Ethiopians have been surveyed to classify themselves into one of the five neat “scientific” categories. There is little doubt the vast majority of people presumed to be facing “acute malnutrition” would readily declare they are actually facing famine. But the fact of the matter is that the scope and magnitude of the “acute malnutrition” (or whatever fancy term is used to describe plain old starvation) in Ethiopia could never be independently verified because there is a conspiracy of silence between the ruling regime, international donors, NGOs and even some members of the international press who mindlessly parrot the official line and rarely go out into the affected areas to observe and document the food situation on a regular basis. So, the chorus of silent conspirators would chime in saying, “4.2 million people face acute malnutrition and need immediate life-saving help.” They would never say “4.2 million people are facing life ending famine”. The fact of the matter is that famine by any other fancy name is still famine and just as deadly!
The so-called “acute” (short-term) food shortages, malnutrition, insecurity, etc., are now a permanent (chronic) feature of Ethiopia’s food political economy. “Droughts” are blamed year after year for the suffering of millions of Ethiopians and year after year the regime’s response is to stand at the golden gates of international donors panhandling emergency humanitarian aid. The regime has done next to nothing to deal with the underlying problems aggravating the conditions leading to famine (see my July 2010 commentary “Apocalypse Now or in 40 Years?”), including high population growth, environmental degradation, low agricultural productivity caused by subsistence farming on fragmented small plots of land, government ownership of land, poor transportation and dysfunctional markets that drive up the real cost of food for the poor and other factors. Instead the regime’s solution has been to give away the most arable land in the country to so-called international investors who “lease” the land for commercial agriculture and export the harvest for sale on the international market while the local population starves. Alternatively, the regime relies on the so-called Productive Safety Nets Programmes (PSNP) which purportedly aim “to prevent asset depletion at the household level, create assets at the community level” by providing vulnerable populations income through public work projects and direct support. A joint undercover team from BBC’s Newsnight and the bureau of investigative journalism at London’s City University, separate investigations by Human Rights Watch and other international organizations have documented that PSNP resources have been used to reward supporters of the ruling party and punish members of opposition parties or non-supporters.
In 2012, to say that millions of Ethiopians will face starvation every year (disguised in the bureaucratic lingo of “acute malnutrition”, “food insecurity”, etc.) is like predicting the sun will rise tomorrow. But it is the long term prospects for “food insecurity” in Ethiopia that are unspeakably frightening. In 2011, the U.S. Census Bureau made the catastrophic prediction that Ethiopia’s population by 2050 will more than triple to 278 million. Considering the fact that Ethiopia cannot feed its 90 million people today, how could it possibly feed triple that number in less than forty ears? But such facts have not stopped the ruling regime from denying the existence of famine conditions and declaring a crushing victory on famine in just a few years. The late Meles Zenawi in 2011 declared: “We have devised a plan which will enable us to produce surplus and be able to feed ourselves by 2015 without the need for food aid.”
Ethiopia and to a lesser extent many African countries face a formidable challenge in feeding their people in the next year or so. In 2011, Africa imported $50 billion worth of food from the U.S. and Europe. Food prices in Africa are 200-300 percent higher than global prices, which means higher profit margins for multinationals that produce and distribute food. With a steady growth in global population, the prospect of transforming Africa into vast commercialized farms is mouthwatering for global agribusinesses and speculators. One of the new “hunger games” that was recently proposed by the G-8 Summit is the “New Alliance for Food Security” aimed at accelerating the “transfer” of hundreds of millions of hectares of arable African land to Cargill, Dupont, Monsanto, Kraft, Unilever, Syngenta AG and the dozens of other signatory multinationals. Working jointly with Africa’s corrupt dictators, these multinationals aim to “liberate” the land from Africans just like the 19th Century scramble for Africa; but will they really liberate Africa from the scourge of hunger, famine, starvation and poverty?
2013 as a Year of “Catastrophic Global Food Crises”
Scientists are predicting that 2013 will be a “year of serious global crises” with significant food shortages and price hikes. The crises is triggered by recent droughts in the main grain producing countries including the U.S., Russia and Australia. According to the U.S. National Oceanic and Atmospheric Administration, 80 percent of the U.S. has undergone some drought or “abnormally dry” conditions this past summer. This has resulted in significant loss of corn, wheat and soybean crops and is expected to reduce exports of grains and trigger increased prices on the global commodities markets. This crises will inflict a double whammy on the food importing countries of Africa. Increases in commodity prices (food, energy) will have a disproportionate impact on large vulnerable populations in Ethiopia because the impoverished households typically spend more than half their total incomes on food.
Two decisive factors for the coming global food crises have been identified. According to a highly regarded recent study by the New England Complex Systems Institute, [NECSI] (a group of academics from Harvard and MIT who specialize in predicting how changes in environment can lead to political instability and upheavals), the global food crises is driven by efforts to replace food crops with biofuel crops and greedy global investors (e.g. hedge funds, investment banks, etc.) who speculate (bet) on commodity (food) prices. NECSI researchers Marco Lagi, Yavni Bar-Yam and Yaneer Bar-Yam argue that because “the American breadbasket has suffered debilitating droughts and high temperatures [this summer], leading to soaring corn and wheat prices in anticipation of a poor harvest, we are on the verge of another crisis, the third in five years, and likely to be the worst yet, capable of causing new food riots and turmoil on a par with the Arab Spring.” NECSI researchers predict that in 2013 a “spike in prices is inevitable.”
Catastrophic Famine and Food Riots in Ethiopia in 2013?
On November 24, 2010, the Ministry of Agriculture in Ethiopia announced that the number of people in need of emergency food aid had decreased from 5.2 million from earlier in the year to 2.3 million. Agriculture minister Kassa was quoted as saying that the “overall good performance of rains in 2010 and successful disaster management endeavors have reduced the disaster risks and vulnerabilities and decreased the number of food beneficiaries”. In April 2011, the Ethiopian regime appealed for emergency food assistance in the amount of USD 398.4 to meet the needs of some 3.2 million people. Later that year, officials reported that the number of needy people had increased to 4.5. On September 12, 2012, the agriculture ministry announced that 3.7 million Ethiopians will need humanitarian assistance between August and December 2012. According to Kassa, “The country needs 314 million metric tons of food to meet the gap.” Of the 3.7 million “food insecure people”, 47 percent of them are in Somali region followed by 27 percent in Oromiya, 10 percent in Tigray, and 7.7 percent in Amhara regional states.
Food prices have been soaring in Ethiopia for the past three years. In August 2011, the Ethiopian Central Statistics Agency reported food prices, which comprise more than half the Consumer Price Index, were up 47.4 percent from 2010. Transportation costs and housing were up more than 40 percent during the past year (the price of a liter of gasoline was 21 birr). In 2011, the regime imposed price controls on basic staples which led to shortages and was subsequently dropped after the controls proved to be ineffective in controlling inflation or increasing supply. Michael Atingi-Ego, head of the International Monetary Fund mission to Ethiopia in a press statement this past June noted, “For 2011/12, the mission projects real GDP growth at 7 percent and end-year inflation at about 22 percent… Gross official foreign reserves have declined to under two months of import coverage… Rebuilding gross official foreign reserves will provide a buffer against potential exogenous shocks given the current volatile global environment.” The fact of the matter is that when the “inevitable global food crisis” hits in 2013 with inflation running at over 20 percent and foreign reserves of two months, the only outcome to be expected is total disaster.
One does not need a crystal ball to predict famine in Ethiopia on the order of magnitude seen in mid-1970s and mid-1980s given the “inevitable price hikes” in the global food markets and the manifest lack of meaningful preparedness and remedial policies by the ruling regime. In a recent “confidential preliminary” report, Tadesse Kuma Worako of the Ethiopian Development Research Institute offers an analysis that exposes the multidimensional effects of food price increases on the population beyond mortality rates:
In Ethiopia, food expenditure of total household income estimated to account for more than 60 percent that any increase in food price has negative effect on the well-being of large majorities… Food-price increases are having serious consequences for the purchasing power of the poor. Affected groups include the rural landless, pastoralists, small-scale farmers and the urban poor. Despite the various causes of food crises, the hardships that individuals and communities face have striking similarities across disparate groups and settings. These include: inability to afford food, and related lack of adequate caloric intake, distress sales of productive assets, and migration of household members in search of work and reduced household spending on healthcare, education and other necessities… Ethiopia is a country which registers one of the highest child malnutrition rates in Sub-Saharan Africa. Child stunting, which is measured as abnormally low weight to height for age in children, is an indicator of poor long-run nutritional status. Although the prevalence of child stunting in Ethiopia decreased during the second half of the 2000s, the prevalence is still significantly high compared to developing countries average. Early childhood malnutrition (among children between six and 36 months) can cause irreversible damage to brain and motor-skill development, stifle human capital formation by causing delays in enrollment and later increasing the probability of grade repetition and drop-out, lower current health status, and increase in lifetime risk of chronic disease associated with the premature mortality.
Tadesse believes that proper policies could have averted much of the hardship on the population yet remains concerend about the decisive role of global food proices and the exchange rate. “The negative effects of high food prices could have been ameliorated if policy makers had been better informed about the food price situation. In the long-run however, domestic food and non-food prices are determined by the exchange rate and international food and goods prices which means that the exchange rate and international prices explain a large fraction of Ethiopia’s inflation.”
An Early Warning for Famine and Political Upheaval in Ethiopia in 2013
On December 13, 2011, NECSI scientists reportedly wrote to the US government alerting policy makers that global food prices were about to cross the threshold they had identified resulting in global political upheavals. Days later, Mohamed Bouazizi set himself on fire in Tunisia and set the Middle East on fire in what is now known as the “Arab Spring”. Emperor Haile Selassie was overthrown in 1975 because he neglected to address the famine situation in the northern part of the country, which to this day suffers from famine or as they say “acute” and “chronic” malnutrition. The military socialist junta that ruled Ethiopia denied there was a famine in Ethiopia in the mid-1980s and was overthrown in 1991 by those who are in power today. History shows that high food prices often trigger major political upheavals. In a study of the “food crises and political instabilityin North Africa and the Middle East”, NECSI scientists argue:
In 2011 protest movements have become pervasive in countries of North Africa and the Middle East. These protests are associated with dictatorial regimes and are often considered to be motivated by the failings of the political systems in the human rights arena. Here we show that food prices are the precipitating condition for social unrest and identify a specific global food price threshold for unrest. Even without sharp peaks in food prices we project that, within just a few years, the trend of prices will reach the threshold. This points to a danger of spreading global social disruption…. Conditions of widespread threat to security are particularly present when food is inaccessible to the population at large. In this case, the underlying reason for support of the system is eliminated, and at the same time there is “nothing to lose,” i.e. even the threat of death does not deter actions that are taken in opposition to the political order. Any incident then triggers death-defying protests and other actions that disrupt the existing order.
The government of PM Hailemariam Desalegn must come forward and explain how it expects to deal with the effects of the “inevitable global food crises” in Ethiopia in light of its depleted foreign reserves and how his government will avert potentially catastrophic famine in the country. Planning to panhandle more emergency food aid simply won’t cut it. Relying on Productive Safety Nets Programmes simply won’t do it. If the government of PM Hailemariam Desalegn cannot come with a better answer or alternative to the looming famine over the horizon, it should be prepared to face not only a hungry population but also an angry one!
ወርሃ ኦክቶበር (ጥቅምት)በአለም የጡት ካንሰር ማሳሰቢያና ማስገንዘቢያ ወቅት ነው፡፡ ወሩን በሙሉ በዓለም ላይ ሕዝባዊና የግል ድርጅቶች የፕሮግራሞቻቸውና የእንቅስቃሴዎቻቸው ትኩረት ሁሉ በጡት ካንሰር መንስኤ ላይ በማትኮር፤ አደጋውን ለመቀነስ፤ ቅድመ ጥንቃቄ ስለማድረግ፤ ህክምናና ምርምር በማከናወን ላይ ይገኛሉ፡፡ በእርግጠኝነት በተረጋገጠው መሰረት በአብላጫ በዓለም ላይ ሴቶችን በማጥቃት ላይ ያለው የጡት ካንሰር ነው፡፡ በሚሊዮን የሚቆጠሩ ሴቶች በበሽታው በየዓመቱ ሲለከፉ ከነዚህም መሃል በሢ የሚቆጠሩት ለሞት ይዳረጋሉ፡፡ኮመን ፎር ዘ ኪዩር የተባለው የአሜሪካ ድርጅት እንደአስቀመጠው በአሜሪካን የሚገኙ አብላጫዎቹ አፍሮ አሜሪካውያን መሃል ሁለተኛው ገዳይ በሽታ የጡት ካንሰር እንደሆነ ያረጋግጣል፡፡ በአፍሪካ ስለዚህ ገዳይ በሽታ የታማሚ መጠንና ስለሚያደርሰውም አደጋ አያም ስለሚሰጠው ትኩረትና ህክምና በትክክል እንዲህ ነው ለማለት ዘገባም ሆነ መግለጫ ስለሌለ ብዙ ማለት ያስቸግራል፡፡ በአፍሪካ የበሽታው ሁኔታ ሊታወቅ የሚችለው ታማሚው በበሽታው ተይዞ ለህክምና ወይም ለመመርመር ወደ ጤና ጣቢያ አለያም ህክምና ማእከል ሲሄድ ብቻ ነው፡፡ አብላጫው የሴቶች ቁጥር በሚኖርበት የገጠሩ ክፍል ስለበሽታው ሁኔታ መዝግቦ መያዝና ማስረጃዎችን ማሰባሰቡ በብዙም የተለመደ ወይም ሁኔታ የተፈጠረለትም አይደለም፡፡ ስለበሽታው ሁኔታ ክትትልና ዘገባም ሆነ ስለበሽተኞቹ ሁኔታ ጥናት ማካሄድን ከምር ይዘው በማስኬድ ላይ የሚገኙት ጥቂት የአፍሪካ ሃገራት ናቸው፡፡
October is international Breast Cancer Awareness month. Throughout the month, public and private organizations in many countries promote programs and activities aimed at breast cancer risk reduction, early detection, treatment and research. It is well-established that breast cancer is one of the most common cancers affecting women throughout the world. Millions of women are diagnosed with the disease every year and hundreds of thousands die needlessly. Breast cancer is the second leading cause of death among African American women in the U.S., according to the Komen for the Cure organization. There is little reliable data on the incidence and prevalence of breast cancer in Africa because of the absence of reporting, diagnostic and treatment processes. Breast cancer cases in Africa are likely to be documented only when patients come to hospitals, health centers, clinics and laboratories for diagnostic and treatment services. Facilities with mandatory reporting requirements are far and few between in the rural areas of Africa where the vast majority of women live. Few African governments have undertaken breast cancer epidemiological surveys to reliably ascertain the incidence, severity and prevalence of the disease.
ኢትዮጵያ በመልካም ስሟም፤በአስከፊ ገጽታዋም ትታወቃለች:: ኢትዮጵያ በመልካም እንግዳ ተቀባይነቷና አስተናጋጅነቷ፤በሕዝቦቿ መልካም ባሕሪ፤ በመልክአ ምድሯ ውበት፤እና በግሩሙ ቡናዋና በማይደፈሩት ጅጋኖች ረጂም ርቀት ሯጮቿ ትታወቃለች፡፡ ተወዳዳሪ በሌለው የሰብአዊ መብት ጥሰት፤የፕሬስ ማፈኛ ተቋሟም፤በአፍሪካ ከፍተኛ ቁጥር ያላቸው የፖለቲካ እስረኞች የሚገኙባት ሃገርም ሆና ኢትዮጵያ ትታወቃለች፡፡ በሚያሳዝን ሁኔታ ችጋር (ኤክስፐርቶቹ እንደሚሉት፤ “ሥር የሰደደ የማይነቀል የምግብ እጥረት”) ከውቢቷ ኢትዮጵያ ጋር ከተሳሰረ ዘመናት አልፈዋል፡፡ የሆነው ሆኖ አትዮጵያ ከጭቆና የፈላጭ ቆራጭ አስተዳደር ወደ ዴሞክራሲ ጉዞዋን ጀምረለች፤ ወይስ ኢትዮጵያዊያኖች ከአምባገነኖች አገዛዝ ወደ ነጻነት እየሮጡ ነው ብል ይሻላል?
For the past several months, there has been much display of public sorrow and grief in Ethiopia. But not for the millions of invisible Ethiopians who are suffering and dying from starvation, or what the “experts” euphemistically call “acute food insecurity”. These Ethiopians are spread across a large swath of the country (see map above, “Estimated food security conditions, 3rd quarter 2012 (July-September 2012, Famine Early Warning Systems Network FEWS NET).