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Last sync:2023-09-24 01:45
In which John Green visits rural health care centers in Ethiopia with Bill Gates and Gates Foundation CEO Sue Desmond-Hellman and learns about how Ethiopians are working to improve health outcomes with minimal resources.

The Gates Foundation:
The Last 10K Project, which works to improve health care in rural Ethiopia:
Bill Gates: Good Morning Hank! It's Tuesday!

John Green: Woke up very early in Addis Ababa a few weeks ago and began a long drive South. Slums at the edge of the city gave way to  beautiful vistas and then the road worsened and I became a bobblehead until at last, we reached a rural healthcare center. 

So Hank, here's a story I heard a lot in Ethiopia. Traditionally, Ethiopian women haven't named their children for several months after they were born because the risk of losing the babies was just too high. But lately, thanks to the astonishing drop in mortality rates due to smart aid and good government investment, Ethiopian women have begun to name their babies at birth. 

It's a great story and it's one that tugs at the heartstrings and makes you want to open your wallet. It's also - well, the truth turns out to be maybe less narratively interesting, but, in a way, more encouraging.

So the Ethiopian health care system is organized into tiers. You begin with hospitals, but with more than 80% of people living in rural areas, the next level, the healthcare center is vital . Here there are lots of medications and vaccines, there's a lab technician who can diagnose parasites and operate this centrifuge. Some healthcare centers even perform C-sections. All this despite the fact that almost none of them have running water. When I asked center manager, Abd Al-Kadir what he needed most he answered immediately - water.

While we were there, I also met Bill Gates, the founder of Microsoft and Sue Desmond-Hellman, the CEO of the Gates Foundation. To be honest with you Hank, I kind of assumed that Bill and Sue were visiting Ethiopia for like, a photo op. but yeah, no, they were there to ask questions and lots of them -  to ask how the lab tech typed malaria without a particular type of microscope, which vaccines were stored in what quantities, how many workers were needed to run the center efficiently and so on...

And watching Bill and Sue gravitate away from cameras and toward health workers, it became clear to me that the Gates Foundation's fundamental principle, that all human lives have equal value isn't just rhetoric.

So then I traveled to the next healthcare tier, the outpost where health extension workers like Utagazu, with a tenth grade education and a year of training, provide basic care in rural areas. Utagazu showed me her well-organized medical records, the delivery room in which many babies are born and wall charts measuring vaccination rates.

But mostly, she and her coworkers were busy taking care of people, like this little boy was being tested for malaria with a pin-prick test that has dramatically improved diagnosis and treatment. When he was found to be positive, the health extension workers could begin treatment immediately.

This little guy was extremely sick with diarrhea that was suspected to be a virus. Diarrhea remains one of the leading causes of child death in Ethiopia, even though it is always almost survivable if kids can stay hydrated, so this boy went home with a rehydration solution that might well have saved his life. 

And there is one last tier of the Ethiopian health care system, the women's health army. My favorite army of all time! These are volunteers who take maternal and infant care into their communities, talking about everything from family planning to how to get folic acid. A member of the health army invited me into her home and showed me the map that she uses to keep track of who's sick, who's pregnant and who has a small child, and this is how, with limited resources, information and care travels the last few miles into rural communities. 

Hank, I don't wanna minimize the amazing work that the Gates Foundation and other organizations are doing in Ethiopia, or the importance of technologies like the easy to read malaria tests or this amazing thermos that keeps vaccines cold for 50 days without electricity.

But the real heroes of Ethiopia's health successes are Ethiopian. The women volunteering in their communities, health extension workers treating disease and compiling data, mothers fighting to keep their kids healthy despite the immense challenges of poverty. Their progress has been real and should be celebrated, but there's also much to do. Kids should not die of diarrhea or pneumonia  or malaria, and far too many still do. 

So, about that naming at birth thing. I asked these women about it and they all agreed that kids do get named at birth now which never used to happen. Some said that it might be because child mortality is lower these days, but most felt that it was because now they have to fill out birth certificates. That doesn't tug on the heartstrings in quite the same way, but in the end, it's maybe an even better sign because good health records are vital to good healthcare.

In short Hank, when it comes to healthcare, heart warming narratives and boring bureaucracy are not always mutually exclusive. Anyway, then I rode in a helicopter with Bill Gates which was terrifying and hilarious, and I will definitely tell you about it next week unless I get meningitis again or something...

Hank, DFTBA, I will see you on Friday!