Travelling between frontlines to get TB medicines for patients

Personal experience of a TB and DR TB nurse from Woldia, during the 2021/22 Northern Ethiopia War. 

Thank you for inviting me to share my story, my name is Mitku Mekonen, currently I am working at Woldia Hospital as TB and HIV coordinator and focal person of the TIC (Treatment Initiation Center of Drug Resistant TB). I am a BSC Nurse by training and I am on the care service for the last 20 years at different level and I am on the current position since 2018. I am married and blessed with three beautiful children. Before the erupt of the conflict, we had decent professional and family life in Woldia.

In the rainy season of 2021, the war intensified between the government forces and Tigray rebel group around Mekelle, Maichew, Alamata, kobo and then descended down to Woldia. Woldia is a very strategic town in Northeast Ethiopia and confluence point of Addis Ababa, Dessie, Mekelle, Gondar, Bahirdar and Afar-Djibouti junctions. The propaganda machines on both sides continuously broadcasted confusing headlines and breaking news about the military confrontation and who controlled what.

I try to provide the full dose of TB medicines to each patient residing around before the chaos, I made repeated phone calls to each TB patients being treated in the TB clinic of the hospital before the connection and power blackout. The TB kit was very helpful for easy distribution of medicines to each patient in such situation.  After the government forces evacuated from Woldia and entrance of the militants in mid-August 2021, unimaginable looting, lawlessness and destruction of health facilities, public institutions followed. The militants used our hospital as a camp site for a brief period but they left it for resumption of emergency services following the request of the peace committee led by our father Abune Ermias.  Coincidentally I meet Dr. Ayele, one of the selfless seniors of the hospital who himself saved many laboring mothers without proper equipment and tools.  We have discussed to start emergency services, then with the help of our fathers, we have mobilized professionals remained in town like us and opened the hospital in a week time. 

Unfortunately, we found the hospital in a very bad shape, all laboratory equipment, imaging center, operation theatre, all units were looted. Big machines like chemistry machines, respirators/oxygen concentrators, laundry machines, X-ray and imaging centers were destroyed and knocked down to the ground. All patient records medicines were littered around and left in the rain for a while. The TIC found in the backyard of the hospital, nothing left functional except the building, no furniture, patient bed and delivery couches left in the hospital. To begin the interrupted service, we used blocks as a chair, broken timber/benches with stone support as patient bed.

Then we tried hard to retrieve ART, diabetes mellites, hypertension and other essential medicines from the rubble, I manage to find some TB medicines left unaffected in the corner of the lotted and broken store, I was so happy and immediately distributed it for TB patients came from other areas mostly from Kobo. The demand was building up time to time. We learned that all facilities in Woldia was looted, especially the TB clinic of Woldia health center was completely destroyed and knocked down to the ground, so my hope of finding medicines in other health facilities in the town was vanished. We heard that there might be medicines in health facilities far from the main road, mostly in Gubalafto Woreda over the famous mountain range. We decided to go and look for essential medicines with a support letter from the peace committee for needy and stranded patients in Woldia. I volunteered myself to go but Ambulances, all vehicle including motor bikes were taken and there was no private or public transportation means in the area. We have to walk 8 hours and came with some ART, TB and other essential medicines. Then it became a weekly routine, we used to work in the hospital for few days and again traveled further and further to look more medicines, IV floods left in health facilities for about 4 months nonstop.

On our way, we found a spot where telephone network was available, I checked the safety of my family and I used to report our performance to the regional health bureau experts to send us list of essential medicines with all possible means. That couldn’t work well, rather they usually told me the name of health facilities around where there may have medicines by checking the recent distributions data.

Unfortunately, the health facilities over the mountain and the spot where the connection works is the frontline and heavily militarized zone. As we go further to look for medicines, we have faced countless challenges. The load become difficult to carry and walk such long distance, sometimes we have to borrow a donkey to transport medicines from nearby farmers, returning them is another challenge.

Twice at Gun Point

The terrifying experience was the encounter with patrolling militants; they order you to kneel down with non-stop questions and scrutiny before they see the support letter and medicines at hand. They treat you as a spy smuggling information to the government forces, that is terrible experience I had. One day they almost killed me, they order me to kneel down pointing the gun at my head and then beat me for an hour. Then when they became willing to do so, I showed them the support letter and explained why I am there, they have regretted and allow me to go and get the medicines and back to Woldia. I have to run back where we were in the morning to get the donkey as the donkey went back to the owner while I was investigated by the rebel group.  Lucky enough, I found it with the load just mid-way grazing in the field. Though, we tried hard, we couldn’t reach Woldia before 6pm which is forbidden and dangers to move around. We were still on the mountain top where there were no villages around. We were worried about the possibility of hyena attack as they may be attracted by the donkey but the mark of mountain goats informed us the absence of the risk in the area. We have spent the night in the cave used by mountain goats, the frost bite will never fade in my mind. We have arrived Woldia in the next day with a medicine carried by donkey, we found colleagues very concerned. 

No bank, no salary, the money I had were depleted, our survival and the service we started become under question. The food stored at home depleted too, the cost-of-living escalated time to time. The peace committee led by Abune Ermias understood the situation we were working and paid us 3,000 Birr as a loan by mobilizing from blessed people of the area, the understanding, the compassion and the prayer to each other was amazing. I sometimes wish to have such governance led by religious person. Everything was fair and lovely. That love and religious service, gave me the stamina and courage to travel such distance in search of medicines to needy patients.

There was an incident I thought it was the end of my life. I was searching patient information out of the rubble in the hospital compound and I was capturing pictures for my record. Unfortunately, an armed member of the militant saw me and directly come to me pointing his gun to my head and the second more aggressive militant run to me with similar position. I remain my hands up. They were very angry and agitated. They took my phone and ordered me to kneel down face to the wall, not to see their faces with loud and violent voices. I was speechless and frightened; they can shoot me at any moment. They searched me, took whatever they found, I was crying and telling them that I was organizing patient information to supply the required medicines, but they don’t want to listen. With the grace of God, one of their bosses appeared from nowhere and asked me what is the matter. He ordered to return my phone and shouted over them to leave the scene immediately. He saved my life and I feel he is a messenger of God for me. From that day onward I have a difficulty to see a face of a person with a gun. In spite of the horrible experiences, the level of satisfaction [I get from helping TB patients] was immense and moving.

When the militants manage to control Dessie and Kombucha towns of South Wollo Zone, those all fled the area returned back to their home town. Things become worsen, we were forced to suspend the service again for about a month. Then the counter offence started and Woldia was freed after 5 months. Team of experts came from the regional health bureau and ministry of health to evaluate the level of damage and helped us the cleanup process for immediate service resumption. Black lion hospital twined with Woldia hospital and provided us significant support to resume the basic services as much as possible. USAID Eliminate TB project, helped us to reestablish the TIC and TB diagnosis services.    In August 2022, Raya and Kobo Woreda of North Wollo Zone were recaptured again by the militants and another round of violence looming around Woldia. I was very worried and confused what actions to take, fortunately, the government controlled the situation and regain order and stability.

One year after the drama and trauma everything got back to normal. Sometimes I feel like it was  a dream or a movie, not an actual experience I had passed through. Glory to his Almighty God and great people around, I survived the horrible experience of war and continue working the Job I love most. My family and colleagues returned back to Woldia, we are trying to resume normal life & serving my beloved people of Woldia & Gubalafto with managing the aftermath of war & conflict.

Thank you again for inviting me to share my story. Thank you for reading my story too, I hope it represents the amazing work of many more health professionals who saved thousands of lives stranded in the war fronts. My story is not the only story, I know many greater professionals out there who saved the entire health facility and provided lifesaving health care services risking their own life in our Zone and beyond.