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Ethiopia Health

Breast Cancer Awareness for Ethiopian Women and Men

brOctober 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/

Why is Ethiopia Poor?

First, Why is Africa Poor?

George Ayittey, the renowned Ghanaian economist and president of the Free Africa Foundation swears that “Africa is poor because she is not free”. Like Ayittey, Robert Guest, business editor for The Economist, in his book The Shackled Continent (2004), declares that “Africans are poor because they are poorly governed.” He argues that “Africa is the only continent to have grown poorer over the last three decades” while other developing countries and regions have grown richer. Much of Africa, it seems, was better off at the end of colonialism than it is today.

For Ayittey and Guest, the tens of billions of dollars in Western aid to Africa have done very little to improve the lives of Africans; at best, aid has served to “bankroll tyrants” and facilitate experimentation by “idealists with hopeless economic policies.” Statism (the state as the principal change agent) and dictatorship have denied the African masses basic political and economic freedoms while the few privileged kleptocrats (or thieves that have pirated the ship of state, emptied out the national treasury and plundered the economy) live the sweet life of luxury (la dolce vita), not entirely unlike the “good old” colonial times. As Ayittey explains, much of Africa today suffers under the control of “vampire states” with “governments that have been hijacked by a phalanx of bandits and crooks who would use the instruments of the state machinery to enrich themselves and their cronies and their tribesmen and exclude everybody else.” (“Hyena States” would be a fitting metaphor considering the African landscape and the rapacious and predatory nature of the crooks.) Simply stated, much of Africa languishes under the rule of thugtators (thugtatorship is the  highest stage of African dictatorship) who cling to power for the single purpose of using the apparatuses of the state to loot and ransack their nations. Such is the unvarnished truth about Africa’s entrapment in perpetual post-independence poverty and destitution.

Could it be said equally that Ethiopia is at the tail end of the poorest countries on the planet because she is not free and gasps in the jaws of a “vampiric” dictatorship? In other words….

Is Ethiopia Poor, Hungry, Ill and Illiterate Because She is Not Free and Poorly Governed?

A couple of weeks ago, the Legatum Institute (LI), an independent non-partisan public policy group based in London, released its 2011 Legatum Prosperity Index (LPI) which ranked Ethiopia a pretty dismal 108th/110 countries.[1] LPI’s findings are sobering as they are heartbreaking. Ethiopia has an “unemployment rate [that] is almost 21%, which is the sixth highest rate, globally.” The “capital per worker in Ethiopia is the fourth lowest worldwide.” The country has “virtually no investment in R&D.” The ability of Ethiopians “to start and run a business is highly limited… [with a] communication infrastructure [that] is weak with only five mobile phones for every 100 citizens”; and the availability of internet bandwidth and secure servers is negligible. Inequality is systemic and widespread and the country is among the bottom ten countries on the Index. The Ethiopian “education system is poor at all levels and its population is deeply dissatisfied.” There is “only one teacher for every 58 pupils at primary level, there is a massive shortage of educators, and Ethiopian workers are typically poorly educated.” Less than a “quarter of the population believe Ethiopian children have the opportunity to learn and grow every day, which is the lowest such rate in the Index.”

On  “health outcomes, Ethiopia performs very poorly. Its infant mortality rate, 67 deaths per 1,000 live births, and its health-adjusted life expectancy of 50 years, placing Ethiopia among the bottom 20 nations.” The population has high mortality rates from “Tuberculosis infections and respiratory diseases. Access to hospital beds and sanitation facilities is very limited, placing the country 109th and 110th (very last) on these measures of health infrastructure.” The core problem of poor governance is reflected in the fact that “there appears to be little respect for the rule of law, and the country is notable for its poor regulatory environment for business, placing 101st in the Index on this variable.”

But it is not only the LPI that has ranked Ethiopia at the rump of the most impoverished and poorly governed  nations in the world. Last year, the Oxford Poverty and Human Development Initiative (OPHDI) Multidimensional Poverty Index 2010 (formerly annual U.N.D.P. Human Poverty Index) ranked Ethiopia as the second poorest (ahead of famine-ravaged Mali) country on the planet. According to OPHDI, the percentage of the Ethiopian population in “severe poverty” (living on less than USD$1 a day) in 2005 was 72.3%.  Six million Ethiopians needed emergency food aid in 2010 and many more millions needed food aid in 2011 in what the U.N. described as the “worst drought in over half a century to hit parts of East Africa”. The World Bank this past June concluded that  “Ethiopia’s dependence on foreign capital to finance budget deficits and a five-year investment plan is unsustainable.” The Bank criticized dictator Meles Zenawi’s “dependen[ce] on foreign capital or other means of financing investment in an unhealthy, unsustainable way.” Ethiopia is the world’s second-biggest recipient of foreign aid, after Afghanistan, according to the Organization for Cooperation and Economic Development rankings of developing nations because its “leaders” have perfected the art of international mendicancy (panhandling).

That is not all. Every international index over the past several years has ranked Ethiopia at the very bottom of the scale including Transparency International’s Corruption Index (among most corrupt countries), the Failed States Index (among the most failed), the Index of Economic Freedom (among the most economically repressive), the International Bank for Reconstruction and Development Investment Climate Assessment (among the most unfriendly to business),  the Ibrahim Index of African Governance (among the most poorly governed African countries), the Bertelsmann Political and Economic Transformation Index (among countries most in need of reform) and the Environmental Performance Index (among countries with poorest environmental and public health indicators).

Of course, none of that comes as a surprise to those who are familiar with the  fakeonomics of Meles Zenawi. Zenawi says all of the Indexes, the World Bank and the International Monetary Fund (IMF) are wrong. He boldly claims the Ethiopian “economy recorded an average economic growth rate of 11 percent over the past seven years.” But that incredibly rosy growth rate figure, often repeated and republished mindlessly and unquestioningly by the international media, is based exclusively on statistics manufactured by Zenawi’s statistics department. This past June, the IMF debunked Zenawi’s imaginary economic growth estimate of 11.4 percent for 2009 “saying 7.5 percent is more realistic.” The IMF “forecast is even lower growth of about 6 percent for the coming year” because of a “more restrictive business climate”.

Economic principles, facts and realities are irrelevant to Zenawi. According to “Zenawinomics” (a/k/a “Growth and Transformation Plan”), there are bottomless pots of gold awaiting Ethiopians at the end of the rainbow in 2015: The Ethiopian economy will grow by 14.9 percent (oddly enough not 15 percent). There will be “food security at household and national level.” There will be “more than 2000 km of railway networks would be constructed” and power generation will be in the range of “ 8,000 to 10,000 MW from water and wind resources during the next five years.” The “whole community has mobilized to buy bonds. This huge savings and mobilization is used for infrastructure development… We are getting loans from China, India, Turkey and South Korea, so all these foreign savings are also mobilized… So I think we can perform on the ambitious plans that are in place.”

Zenawinomics is the economics of a magical wonderland, very much like Alice’s Wonderland: “If I had a world of my own,” said Alice “everything would be nonsense. Nothing would be what it is because everything would be what it isn’t. And contrary-wise; what it is it wouldn’t be, and what it wouldn’t be, it would. You see?”

Maybe you don’t see. That is the whole point. In what Zenawi describes as “one of fastest growing non-oil economies in Africa,” inflation is soaring, and by mid-2011, Zenawi’s Central Statistical Agency reported that the annual inflation rate had increased by 38 percent and food prices had surged by 45.3 percent. There are more than 12 million people who are chronically or periodically food insecure. Yet, Zenawi is handing out “large chunks” of the most fertile land in the country for free, to be sure for pennies, to foreign agribusiness multinational corporations to farm commercially and export the harvest. This past July, the U.S. Census Bureau had a frightening population forecast: By 2050, Ethiopia’s current population of 90 million population will more than triple to 278 million, placing that country in the top 10 most populous countries in the world. It just does not make any sense.

In May 2010, the Economist Magazine rhetorically asked: “Ethiopia’s prime minister, and his ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF) expect a landslide victory in the general election due on May 23rd, and are likely to get one (they actually “won” it by 99.6 percent!). The bigger question is whether another five years of EPRDF rule will help ordinary Ethiopians, who are among the poorest and hungriest people in the world.

Ethiopia Can Prosper Only If She Has Good Governance

The United Nations Development Programme and other international lending institutions define ‘governance’ as the “exercise of power or authority – political, economic, administrative or otherwise – to manage a country’s resources and affairs.” Good governance has to do with the “competent management of a country’s resources and affairs in a manner that is open, transparent, accountable, equitable and responsive to people’s needs.” There is substantial empirical research showing that political freedom, strong social and political institutions and proper regulatory mechanisms significantly contribute to economic growth. Stated simply, good governance and “good” (sustainable) growth are based on mutually reinforcing principles.

Where there is good governance, there is substantial political and legal accountability and much greater respect for civil, political and property rights. Leaders are held politically accountable to the people through fair, free and regular elections; and an independent electoral commission ensures there is no voter fraud, voting irregularities, vote buying, voter intimidation and voter harassment. Institutional mechanisms are in place to ensure the rule of law is followed and those exercising political power and engaged in official decision-making perform their duties with transparency and legal accountability.  Where there is good governance, citizens have freedom of association and the right to freely exchange and debate ideas while independent press, and even state-owned media, operate freely along with robust civil society institutions to inform and mobilize the population.

Good governance is an essential precondition for sustainable development. Stable and democratic governing institutions protect political and economic liberty and create an environment of civic participation, which in turn “determines whether a country has the capacity to use resources effectively to promote economic growth and reduce poverty.”   On the other hand, bad or poor governance stifles and impedes development and undermines competition in the marketplace. Where human rights and the rule of law are  disrespected, corruption flourishes and development inevitably suffers aspolitical leaders and public officials siphon off resources from critical school, hospital, road and other public works and community projects to line their pockets.  But where there is good governance, not only is economic development and growth accelerated, even chronic and structural problems of  food insecurity (famine) that have plagued Ethiopia for decades can be controlled and overcome. As Amartya Sen has argued no substantial famine has ever occurred in any independent country with a democratic form of government and a relatively free press.

Because there is little or no political accountability, Ethiopia suffers from poor governance and remains at the bottom of the indexes of the most impoverished nations  in the world. Programs intended for “poverty reduction” have been misused for political mobilization and rewards for voting for the ruling party. The country has been unable to promote broad-based economic growth because business attached to the ruling party have a near-total monopoly and chokehold on the economy making fair competition for non-ruling party affiliated entities in the market an exercise in futility. Because there is little respect for property and contract rights, those non-aligned with the ruling party feel insecure and disinclined to invest. The ruling regime has made little  investment in human resources through effective policies and institutions that improve access to quality education and health services as the LPI data shows. As a result, the rate of flight of professionals, intellectuals, journalists and political dissidents, is among the 10 highest in the world. The  International Organization for Migration has said it all: “There are more Ethiopian doctors practicing in the US city of Chicago than in Ethiopia.”

Ethiopia is universally regarded as one of the least free countries in the world and ranks at the very bottom of the 10 most repressive countries in the world for citizens’ freedoms in expression, belief, association, and personal autonomy. The respected Committee to Protect Journalists says, “Ethiopia is the second-leading jailer of journalists in Africa.” There is little regard for the rule of law as the LPI data confirms. In other words, those who occupy official positions have little respect for the country’s Constitution or laws, or show any concern for the fair administration of justice. The judiciary is merely the legal sledgehammer of the dictator and ruling party. The judges are party hacks enrobed in judicial garb with the principal mission of giving legal imprimatur to manifest official criminality. In sum, the rule of law in Ethiopia has been transmuted into the rule of one man, one party.

Few should be surprised by LPI’s conclusions that the “levels of confidence in the military and judiciary are both very low” and “Ethiopia is the country where expression of political views is perceived by the population to be most restricted.” None of the facts above matter to the dictators in Ethiopia because they are ready, willing and able to do whatever it takes to cling to power.

LPI’s dismal ranking of Ethiopia merely augments what has been solidly established over the years in the other Indexes. The question is why Ethiopia remains at the tail end of the most impoverished countries year after year. Zenawi’s “Federal Ethics and Anti-corruption Commission” (FEAC) conflates corruption and poverty in seeking to pinpoint the answer to this question. FEAC says the major sources of corruption in Ethiopia are “poor governance, lack of accountability and transparency, low level of democratic culture and tradition, lack of citizen participation, lack of clear regulations and authorization, low level of institutional control, extreme poverty and inequity, harmful cultural practices and centralization of authority.” Not quite! Poor governance, lack of accountability and transparency (a/k/a corruption), lack of citizen participation and the absence of the rule of law are the root causes of extreme and widespread  poverty, underdevelopment, aid-dependency, conflict, instability, starvation and injustice in Ethiopia. Have free and fair elections, allow the independent press to flourish, institutionalize the rule of law and maintain an independent judiciary,  professionalize and depoliticize the civil service, the military and police forces and Ethiopians will be well on their way to permanently defeating  poverty and making starvation a footnote in the history of the Ethiopian nation.

Ethiopia is poor, hungry, ill and illiterate because she is poorly governed and not free!

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[1] The Legatum Index is based on 89 different variables covering the economy, entrepreneurship and opportunity, governance, education, health, safety and security, personal freedom, social capital and so on. The Institute uses data collected by the Gallup World Poll, World Trade Organization, World Development Indicators, GDP, World Intellectual Property Organization, UN Human Development Report, World Bank, OECD and World Values Survey.

Previous commentaries by the author are available at:

www.huffingtonpost.com/alemayehu-g-mariam/ andhttp://open.salon.com/blog/almariam/

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Ethiopian Groundhog Year 2010

By Alemayehu G. Mariam

Groundhog Year in Prison Nation

In December 2008, I wrote a weekly column entitled “Groundhog Year in Prison Nation” summarizing some of my weekly columns for that year. I used the “groundhog year” analogy following the title of the motion picture “Groundhog Day” in which a hapless television weatherman is trapped in a time warp and finds himself repeating the same day over and over. I wrote[1]:

2008 in Ethiopia was Groundhog Year! It was a repetition of 2007, 2006, 2005, 2004… Everyday millions of Ethiopians woke up only to find themselves trapped in a time loop where their lives replayed like a broken record. Each “new” day is the same as the one before it: Repression, intimidation, corruption, incarceration, deception, brutalization and human rights violation. Everything that happened to them the previous day, the previous week, the previous month, the previous 18 years happens to them today. They are resigned to the fact that they are doomed to spend the rest of their lives asphyxiated in a Prison Nation. They have no idea how to get out of this awful cycle of misery, agony, despair and tribulation. So, they pray and pray and pray and pray… for deliverance from Evil!

It is December 2010, the end of the first decade of the 21st Century. Are Ethiopians better off today than they were in 2009, 2005…2000?

Does bread (teff) cost more today than it did a year ago…, five years ago? Cooking oil, household fuel, beef, poultry, gasoline, housing, water, electricity, public transport…?

Are there more poor people today in Ethiopia than there were a year ago… five years ago? More unemployment among youth, less educational opportunities, less health care?

Is there more corruption, more secrecy, less transparency and less accountability in December 2010 than in December 2009…?

Are elections more free and fair in 2010 than they were in 2008, 2005?

Is there more press freedom today than five years ago? More human rights violations?

Is Ethiopia more dependent on international charity for its daily bread today than a year ago…?

Is there more environmental pollution, habitat destruction, forced human displacement and land grabs in Ethiopia today than there was in 2005?

Are businesses paying more taxes and bribes in Ethiopia today than in years past?

Is Ethiopia today at the very bottom of the global Index of Economic Freedom (limited access to financing, inefficient government bureaucracy, inadequate supply of infrastructure)?

Let the reader answer these self-evident questions. Suffice it to say, “It is what it is!”

Montage of Scenes From 2010 Time Loop

So here we are in Ethiopian Groundhog Year 2010. As a year-end overview, I decided to select and highlight a few of my columns from the multiple dozens of weekly and other commentaries I wrote in 2010 and published on the various Ethiopian pro-democracy websites, and the Huffington Post[2] where all of my commentaries for the year are readily available.

January 2010 – Looking Through the Glass, Brightly

“Ethiopia is the country of the future,” Birtukan Midekssa would often say epigrammatically. Ethiopia’s number 1 political prisoner is always preoccupied with her country’s future and destiny. Her deep concern for Ethiopia is exceeded only by her boundless optimism for its future… To be the country of the future necessarily means not being the country of the past. Birtukan’s Ethiopia of the future is necessarily the categorical antitheses of an imperial autocracy, a military bureaucracy and a dictatorship of kleptocracy. Her vision of the future Ethiopia is a unified country built on a steel platform of multiparty democracy. Birtukan would have been pleased to explain her vision and dreams of the future country of Ethiopia; unfortunately, she cannot speak for herself as she has been condemned to “rot” in jail.

February 2010- Putting Lipstick on a Pig

Ethiopia’s dictators think we are all damned fools. They want us to believe that a pig with lipstick is actually a swan floating on a placid lake, or a butterfly fluttering in the rose garden or even a lamb frolicking in the meadows. Put some lipstick on hyperinflation and you have one of the “fastest developing economies in the world”. Put lipstick on power outages, and the grids come alive with megawattage. Slap a little lipstick on famine, and voila! Ethiopians are suffering from a slight case of “severe malnutrition”. Adorn your atrocious human rights record by appointing a “human rights” chief, and lo and behold, grievous government wrongs are transformed magically into robust human rights protections. Slam your opposition in jail, smother the independent press and criminalize civil society while applying dainty lipstick to a mannequin of democracy. The point is, “You can wrap an old fish in a piece of paper and call it ‘democracy’ but after 20 years it stinks to high heaven!”

March 2010- Waiting for Godot to Leave

The politics of “succession” to Zenawi’s “throne” has become a veritable theatre of the absurd. The personalities waiting in the wings to take over the “throne” (or to protect and safeguard it) bring to mind the witless characters in Samuel Beckett’s tragicomedy play Waiting for Godot, arguably the most important English play of the 20th Century. In that play, two vagabond characters anxiously wait on a country road by a tree for the arrival of a mysterious person named Godot, who can save them and answer all their questions. They wait for days on end but Godot never shows up… and the two characters keep returning to the same place day after day to wait for him; but they cannot remember exactly what happened the day before. Godot never came. Waiting for Zenawi to leave power is like waiting for Godot to arrive. It ain’t happening. He is not only the savior and the man with all the answers, he is also the Great Patron who makes everything work.

April, 2010- C’est la Vie? C’est la Vie en Prison!

When Meles Zenawi, the arch dictator in Ethiopia, was asked about Birtukan’s health in his prison on March 23, 2010, he was comically philosophical about it. He said Birtukan health is in “perfect condition”, except that she may be putting on some weight. “The health situation of Birtukan, the last I heard, is in perfect condition. She may have gained a few kilos, but other than that, and that may be for lack of exercise, I understand she is in perfect health… I am not surprised that they [U.S. State Department] have characterized Birtukan as a political prisoner, because I understand they have also characterized Ogaden National Liberation Front (ONLF) and Oromia Liberation Front (OLF) terrorists… as political prisoners… But that is life; I think the French say, ‘C’est la Vie.’

May, 2010- Speaking Truth to Power

For the past year, I have been predicting that the 2010 Ethiopian “election” will prove to be a sham, a travesty of democracy and a mockery and caricature of democratic elections. Without my literary and rhetorical flourish, that is now the exact conclusion of the international election observers. The “Preliminary Statement” of the European Union Election Observation Mission- Ethiopia 2010 stated: “The electoral process fell short of certain international commitments, notably regarding the transparency of the process and the lack of a level playing field for all contesting parties.” … Johnnie Carson, the Assistant Secretary of State for African Affairs in the State Department told the U.S. House Foreign Affairs Committee that “we note with some degree of remorse that the elections were not up to international standards… The [Ethiopian] government has taken clear and decisive steps that would ensure that it would garner an electoral victory.” Even Herman Cohen, the former U.S. Assistant Secretary of State who served as “mediator” in the so-called May 1991 London Peace Talks which resulted in the establishment of the Zenawi regime decried the outcome: “… I don’t think it was a fair election.”

June, 2010- Speaking Truth to the Powerless

Now that the hoopla around Meles Zenawi’s “election” is over, it is time for the Ethiopian opposition to take stock and re-think the way it has been doing business. We begin with the obvious question: “What happened to the Ethiopian opposition in the make-believe election of 2010?” Zenawi will argue vigorously that he defeated them by a margin of 99.6 percent (545 of 547 parliamentary seats). If that were the real “defeat” for the opposition, I would not worry much. Losing a sham election is like losing one’s appendix. But there is a different kind of defeat that I find more worrisome. It is a defeat in the eyes and hearts of the people. I am afraid the opposition collectively has suffered considerable loss of credibility in the eyes of the people by making a public spectacle of its endless bickering, carping, dithering, internal squabbles, disorganization, inability to unite, pettiness, jockeying for power, and by failing to articulate a coherent set of guiding principles or ideas for the country’s future.

July, 2010- Hummingbirds and Forest Fires

World history shows that individuals and small groups — the hummingbirds — do make a difference in bringing about change in their societies. The few dozen leaders of the American Revolution and the founders of the government of the United States were driven to independence by a “long train of abuses and usurpations” leading to “absolute despotism” as so eloquently and timelessly expressed in the Declaration of Independence… The Bolsheviks (vultures in hummingbird feathers) won the Russian Revolution arguably defending the rights of the working class and peasants against the harsh oppression of Czarist dictatorship. They managed to establish a totalitarian system which thankfully swept itself into the dustbin of history two decades ago… Gandhi and a small group of followers in India led nationwide campaigns to alleviate poverty, make India economically self-reliant, broaden the rights of urban laborers, peasants and women, end the odious custom of untouchability and bring about tolerance and understanding among religious and ethnic groups. Nelson Mandela and Oliver Tambo led ANC’s Defiance Campaign and crafted the Freedom Charter which provided the ideological basis for the long struggle against apartheid and served as the foundation for the current South African Constitution. In the United States, Martin Luther King and some 60 church leaders formed the Southern Christian Leadership Conference, becoming the driving force of the American civil rights movement.

August, 2010 – Steel Vises, Clenched Fists and Closing Walls

U.S. Secretary of State Hilary Clinton gave a speech in Poland… and singled out Ethiopia along with Zimbabwe, the Democratic Republic of Congo and others to warn the world that “we must be wary of the steel vise in which governments around the world are slowly crushing civil society and the human spirit.”… She pointed out: “Last year, Ethiopia imposed a series of strict new rules on NGOs. Very few groups have been able to re-register under this new framework, particularly organizations working on sensitive issues like human rights.”… Secretary Clinton said the acid test for the success or failure of U.S. foreign policy is whether “more people in more places are better able to exercise their universal rights and live up to their potential because of our actions?” By this measure, U.S. policy in Ethiopia has been a total, unmitigated and dismal failure. The evidence is overwhelming and irrefutable…

September, 2010- Indoctri-Nation

Ethiopia’s Ministry of Education issued a “directive” effectively outlawing distance learning (or education programs that are not delivered in the traditional university classroom or campus) throughout the country… Wholesale elimination of private distance learning programs by “directive”, or more accurately bureaucratic fiat, is a flagrant violation of Higher Education Proclamation No. 650/2009. Under this Proclamation, the Ministry of Education and its sub-agencies have the authority to regulate and “revoke accreditation” of a private institution which fails to meet statutory criteria on a case-by-case basis following a fact-finding and appeals process…. I believe the regime has a long term strategy to use the universities as breeding grounds for its ideologues and hatcheries for the thousands of loyal and dependent bureaucrats they need to sustain their domination and rule. The monopoly created for the state in the disciplines of law and teaching (which I will predict will gradually include other disciplines in the future) is a clear indication of the trend to gradually create a cadre of “educated” elites to serve the next generation of dictators to come.

October, 2010- Birtukan Unbound!

Birtukan was held for months in a dark room with no human contact except a few minutes a week with her mother and daughter. Fear, anxiety and despair were her only companions. Heartache knocked constantly on the door to her dark room needling her: “Did you do the right thing leaving three year-old Hal’le to the care of your aging mother?” Self-doubt kept her awake in that dark room where time stood still asking her the same question over and over: “Is it worth all this suffering? Give up!” But a voice in her conscience would echo thunderously, “Like hell you’re going to give up, Birtukan. Fight on. Keep on fighting. ‘Never give in — never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honor and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'” In the end Birtukan signed Zenawi’s scrap of paper making exception to convictions of honor and good sense. We expected nothing less from such a great young woman…. Prisoners can be brainwashed to say anything by those who control them. Prisoners who have endured torture, extreme degradation and abuse have been known to do shocking things to please their captors and ease their own pain and suffering. Abused prisoners have been known to deceive themselves into believing the cruelty of their captors as acts of kindness. It is called the “Stockholm Syndrome.” When the victim is under the total and complete control of her captor for her basic needs of survival and her very existence, she will say and do anything to please her captor.

November, 2010- Remember the Slaughter of 2005

November is a cruel month. Bleak, woeful, and grim is the month of November in the melancholy verse of Thomas Hood:

No warmth, no cheerfulness, no healthful ease,
No comfortable feel in any member–
No shade, no shine, no butterflies, no bees,
No fruits, no flowers, no leaves, no birds,
November!

//
And no justice for the hundreds massacred in Ethiopia in November (2005).
No redress for the countless men, women and children shot and wounded and left for dead.
No apologies for the tens of thousands illegally imprisoned.
No restitution for survivors or the families of the dead.
No trace of those who disappeared.
No atonement for the crimes of November.
No absolution for the slaughter of November.
November is to remember.

December, 2010- “So What!”

So what are the lessons of Groundhog Year 2010? The first decade of the 21st Century?

Lesson I. Crush your opponents with full force. Alternatively, vegetate them forever.
Lesson II. If you get into America’s face and stick it to her, she will always back down. Always!
Lesson III. “Democratization is a matter of survival.” If democracy stays alive in Ethiopia, Zenawi cannot survive. If Zenawi survives, democracy cannot stay alive.
Lesson IV: If you want democracy, you must struggle and sacrifice for it.
Lesson V. If your rights are being violated, defend them!
Lesson VI. Elections are like children’s marble game where everybody can play as long as the guy who owns the marbles wins all the time.
Lesson VII. If you want to win, you need to organize, mobilize and energize your base. You need to teach, preach and reach the people.
Lesson VIII. You want funding, don’t beg for it; dig deeper into your own wallets.
Lesson: IX. There is one law, one regime, one ruler, one circus master and only one man who runs the show in Ethiopia.
Lesson X: The greatest lesson of 2010 and the first decade of the 21st Century:

DESPAIR NOT! “THERE HAVE BEEN TYRANTS AND MURDERERS AND FOR A TIME THEY SEEM INVINCIBLE BUT IN THE END, THEY ALWAYS FAIL — THINK OF IT ALWAYS.” Mahatma Gandhi.

RELEASE ALL POLITICAL PRISONERS IN ETHIOPIA

[1] http://abbaymedia.com/News/?p=2052
[2] http://www.huffingtonpost.com/alemayehu-g-mariam/