The Anglo-Ethiopian Society

Project Harar

Author - Tom Hoyle

I have been a pro bono adviser to Project Harar Ethiopia, the health outreach charity that helps people with serious facial disfigurements, since Summer 2006. In September I became its first Development Manager. I would like to describe my most recent visit to Addis Ababa and my first trip to Harar, where it all began for the charity founded by Jonathan Crown back in 2001...

On reflection, the third trip to Ethiopia was really my first. An eye-opening encounter with the unforgiving and at times gruelling conditions faced by the 80 percent of Ethiopians who live outside modern urban places like the Addis Ababa I visited in 2006 and 2007.

It was also an inspiring opportunity to gauge the growth of Project Harar and the transformation in several of our patients I had met on a hospital ward last October, and who kindly and quietly met us on our arrival in Harar – a hot, old dusty town some 250 miles east of the capital.

In the course of volunteering and now working full-time on the charity’s development I have used and explained ‘Harar’ countless times – but now, having spent some time walking its streets and meeting its people, I can say I understand ‘Harar’ not as a word on a map but as a living, breathing, and deceptively brutal place. It jars me a little to use such strong words to describe a town that has tremendous significance in the origins and daily work of this charity. In many ways, Harar is something of a mecca for us. But they are justified.

Staying in Harar and travelling the surrounding country gives strong clues as to why it was here, and not elsewhere, that Jonathan Crown encountered Jemal, the noma survivor who galvanised him to establish this health outreach charity helping facially-disfigured people access specialist surgical care. The Toyotas, cement bags and mobile phones give the impression that modern life has arrived in Harar. But the stark reality is that this is country living on the margins, vulnerable to the elements, teetering between drought and flooding, life and death. It has an intermittent water supply, the transport infrastructure comprises a precarious Chinese-built highway littered with crumpled upturned lorries, there are no emergency services as we would understand them, and its many farming families battle to produce sufficient cash crops to escape the cycle of poverty.

A visit to the museum house of Arthur Rimbaud, a French poet who moved to Harar in 1880, illustrates the point further. It is difficult to differentiate Harar today from the black and white photography of 19th century French and Italian explorers on display.

Yet, the everyday discomfort and cruelty of life gave me an even greater respect for the resilience, determination and self-reliance of the people we met, especially of our youngest patients.

Ahmedin, before (left) and after (right) surgery to heal his face and repair his smile.
Photos - © Morag Livingstone

Ahmedin, 12, was attacked by a hyena outside his home last year. Before the operation on his mouth, cheek and forehead last October he bravely told us: “I am not afraid. I hope the doctors make the correction successfully – I hope they make it look nice afterwards! I am happy and looking forward to things.” We had a Fanta together when we met in Harar, which he slurped cheerfully favouring the left side of his lips. He will always carry the scars of the starving hyena who ambushed him. But thanks to Project Harar and the British surgeons who treated him, his mouth is sealed, his risk of developing infections has been removed, he hardly dribbles, his speech is clear and his smile a joy. Despite the great anxiety his father felt at his son’s bedside, he was clear that he would tell other parents to go ahead – to take the opportunity to receive surgery hundreds of miles away in Addis Ababa.

We travelled out of Harar to Asbe Tefari and Dedar, remote villages around 60 miles west of Dire Dawa, to meet groups of former and future patients at their local clinics. In the first hour, our driver respectfully passed around two funeral processions. It hit me how slight the wrapped corpses were. Here is the everyday reality of Ethiopia’s public health data – over 500,000 children a year in Ethiopia do not make it to their fifth birthday.

At the clinics we were delighted to see treated patients, proud to show off healed, fully functioning faces – noma, tumours, clefts no longer plaguing their lives. Asking the past patients what they thought of their experience in hospital and of their lives now was deeply humbling. It’s striking sometimes how brief the interviews are. On my first two trips I would have attributed the shortness to the language barrier. But, really, how many words does it take to explain the difference that being able to speak or to share a family meal makes? Life is simply better when you’re not worried about infections or the nasty looks of strangers. Coming out into the open to go to market with friends and take your place at school – there is nothing complicated to say about being given a new chance to be included in ordinary life.

Hawa, a 22-year old noma survivor, waits with other young patients before setting off for life changing surgery.
Photos - © Morag Livingstone

What was really encouraging about the meetings was that it brought together treated patients with those about to make their first journey to hospital. Though they may live scattered away in the hills and valleys, those new patients, perhaps apprehensive of the next stage, now know they are not alone. Our former patients really are Project Harar’s best champions.

Some prospective patients, however, were not able to make it to the clinic. The first of Ethiopia’s two rainy seasons was brewing. All the Ethiopians we met had their eyes to the heavens, anticipating rains that had, worryingly, not yet materialised. It would be catastrophic if they did not come. But the skies began to rumble and giant spots of rain fell during our closing days in Harar. The patients who had not come to be registered and photographed were staying put by their farmland ready to plant next year’s crop. It put into sharp relief the dilemmas faced by the poorest of the poor in a country like Ethiopia – leave your land and your crops might fail, don’t leave your land and your child will go without the chance of life-changing surgery.

We discussed the dilemma with Sebsibe Ayele, our Ethiopian Director, and talked through some solutions. We and our partner doctors manage treatment most cost-effectively in groups of 10 – just £300 to give a new chance in life to a child. We decided to offer help to a family member, such as a brother or an uncle living in outlying areas, to come and caretake at the farms. It means taking on more logistical arrangements and miles, but when the rains come someone trusted will be on standby to sow the seeds – while the child receives proper, timely hospital treatment. Project Harar is fortunate to have in Sebsibe someone with several years’ experience as a Government Agriculture Officer who can overcome these barriers. Poverty, transport, meteorology and farming all interlinked in our small health charity.

Project Harar has always impressed me for its ingenuity and the difference it makes using its modest staffing and financial resources. But back in Harar, having met the patients, seen their everyday struggles and dilemmas for myself, it struck me in one word why Project Harar treated 136 patients this year and why, with support, we will be able to reach 250 patients in 2008. Empathy. Without it, we could not help solve the problems faced by our patients. Putting yourself in other people’s shoes is really the only way you can identify how you can overcome a barrier together. I hope my ‘first’ trip to Ethiopia has instilled me with all the empathy I need to make an even greater contribution to Project Harar and those in need in Ethiopia.

Contact details: Project Harar Ethiopia, 4C Park End, London NW3 2SE

First Published in News File Summer 2008

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