Falash Mura updates - August 9, 2001

As you know, the JCPA has been deeply involved in the issue of Ethiopian Jewry for many years – Operations Moses and Solomon, the subsequent aliyah of the Quara Jews, the Falash Mura issue and the challenge of absorption in Israel. Having called for greater attention to the special education needs of Ethiopian immigrants, we are delighted that the federation system -- working with the JDC, the Jewish Agency and the Israeli government -- has decided to undertake as its special national project a comprehensive program to support Ethiopian absorption. Below, for your information, are two memos (from Michael Schneider and Dr. Rick Hodes) that describe recent efforts of the JDC in Ethiopia related to the Falash Mura community.

I might add that, this coming October, JCPA Chair Leonard Cole will be co-chairing, along with Shoshana Cardin, a fact-finding mission to Ethiopia under the auspices of the Conference of Presidents.

To:                   Federation Presidents and Executives
From:              Michael Schneider
Re:                  Ethiopia Update
Date:               July 23, 2001

JDC has received requests from several Federations for an update on JDC’s current activities in Ethiopia.

In recent years, more than 18,000 Felas Mora have migrated to Gondar City and Addis Ababa from rural villages in the Gondar region in the hopes of going to Israel. Formerly a self-sufficient agrarian community, they now live under difficult conditions in urban Addis Ababa and Gondar. Thousands of other Felas Mora remain in their villages in the Gondar region.

According to the most recent information we received from the Israeli Embassy in Ethiopia, there are currently over 19,000 people in Ethiopia with active files. Between September 2000 and mid-July 2001, 3,318 people made aliyah from Ethiopia. Of the more recent approvals, some are for people who have applied without relocating from their villages.

JDC’s health and nutrition program -- observed and reviewed by three different UJC site visit groups and one site visit from New York UJA-Federation -- provides essential medical support and a health safety net for its beneficiaries.

These medical programs are directed by Dr. Richard Hodes, a Johns Hopkins-trained medical specialist and Fulbright scholar with many years of experience in developing countries, who has spent the last decade in Ethiopia.

JDC runs clinics in both Addis Ababa and Gondar. In Addis, the clinic is open daily; in Gondar, it is open six days per week. In Addis Ababa, there are two full-time and one part-time medical doctors, three registered nurses, and support staff; in Gondar, there are two medical doctors, two registered nurses, and support staff. JDC has arranged procedures for patients in need of care after hours. JDC covers all expenses related to medical treatment. The two clinics average over 2,500 patient visits per month.

JDC’s supplementary food programs are open to children and adults who require supplementary nutrition, pregnant women and lactating mothers who are in need, special social cases and people with tuberculosis.

The annualized mortality rate among the population under our care is below 7 per thousand in both Addis Ababa and Gondar. The mortality rate in Ethiopia is 20 per thousand.

For your information, I am enclosing the latest status report on JDC’s medical program from Dr. Hodes.

Recently, a document purporting to be an official US Government report was distributed by Felas Mora advocates to certain UJC and Federation leaders and the media. This document presented erroneous information. The American Ambassador to Ethiopia, Tibor Nagy, stated: “Let me be perfectly clear for the record: the anecdote… is not an official USAID report, and does not represent U.S. government policy or concerns… I have the highest regard for the work of the AJJDC.” [Full letter enclosed.]

JDC’s clinics in Ethiopia provide a level of care inaccessible to the vast majority of Ethiopians. JDC continues to provide humanitarian care to this populace while they await a decision on aliyah eligibility.

To reiterate what I have written in the past, JDC’s position on the Felas Mora situation in Ethiopia is as follows:

· JDC does not decide who is eligible for Aliyah; that is the responsibility of the Government of Israel.

· We are providing medical assistance for the Felas Mora. We are providing supplementary food for malnourished children and others.

· We are providing additional pre-Aliyah assistance for those Ethiopians approved for Aliyah by the relevant Israeli authorities.

· We continue to urge the Government of Israel to complete processing so that the Felas Mora population will know where it stands – who will be accepted and who will not.

TO:                  Michael Schneider, Executive Vice-President
FROM:            Richard M. Hodes, MD, FACP, Medical Director
DATE:             July 20, 2001

I would like to review some aspects of our program and to update you on the health situation of our beneficiaries.

The Joint Distribution Committee provides medical care for approximately 16,000 people in Ethiopia.

JDC runs clinics in Addis Ababa as well as in Gondar. In Addis, the clinics are open daily and in Gondar, they are open 6 days per week. In Addis Ababa, there are 2 full-time medical doctors and one part time medical doctor, 3 registered nurses, and support staff. In Gondar, there are 2 medical doctors and 2 registered nurses. [In Ethiopia, there is approximately one doctor per 40,000 people.] I oversee these clinics and have written treatment protocols for the more common ailments treated in them. If I have a question about a difficult case, I consult a faculty member at Johns Hopkins in Baltimore where I trained.

We have arranged procedures for patients in need of care after hours both in Addis Ababa and in Gondar. In Addis, those in need of treatment are sent to a local private clinic. In Gondar, they are directed to the Medical College Hospital. JDC covers all expenses relating to their care. In Addis, patients in need of hospitalization are sent to a private hospital or to one of several government hospitals. In Gondar, they are hospitalized at Gondar Medical College Hospital. Again, JDC pays all expenses.

We also write prescriptions. Those receiving prescriptions can have them filled at a pharmacy free of charge. If drugs are not available, we import them. For example, in Gondar, we currently import tamoxifen from Italy for a patient with breast cancer.

In Addis, we average approximately 2,878 patient visits per month and in Gondar about 2,503 patient visits per month. The three most prevalent medical concerns in Addis are upper respiratory infections, intestinal parasites, and fevers; in Gondar, they are conjunctivitis, parasites, and diarrhea.

Each clinic has a modern tuberculosis program using directly observed therapy (DOT). Dr. Jack Adler, who previously served as the Chief of TB Control for New York City and is now Director of TB Elimination at Mount Sinai, suggested that we use this method. At present, we treat about 17 tuberculosis patients in Addis and about 13 in Gondar.

In each clinic, there is a laboratory equipped with a binocular microscope for the use of the Ethiopian technician working there. We perform basic tests of blood, urine and stool. In Addis, between October of 2000 and March of 2001, our lab performed up to 347 blood tests, 162 urine tests, and 431 stool tests per month. In that same period, our lab in Gondar completed up to 218 blood tests and 424 stool tests per month. Malaria is rarely seen.

We run daily health education for all patients who come to the clinic. We focus on well-baby care, the prevention of AIDS and sexually-transmitted diseases, hygiene, and the avoidance of harmful traditional practices such as female circumcision, cutting of the uvula, and the extraction of baby teeth (believed to prevent disease). We also distribute condoms to anyone who asks for them and maintain a discrete site where people may obtain condoms without being seen.

We weigh newborns every 2 weeks for the first year of life, plotting their growth on the latest version of the CDC Growth Charts. We intervene on behalf of those who require it.

Family planning services are available to all who wish for them. In Addis Ababa, by the end of June 2001, there were 782 women making use of such services, with depo-provera (injections every 3 months) proving the most popular method. At the same time, in Gondar, 608 women were benefiting from family planning services.

Immunizations are offered according to Ethiopian Ministry of Health protocols at both clinics. We immunize for polio, tuberculosis, diphtheria, pertussis and measles. We believe that our rate of complete immunization is well over 80%.

We run supplemental feeding programs for the malnourished and for others with specific needs both in Gondar and in Addis Ababa, following a diet designed by Vered Kater, the Director of Pediatric Nursing Education at Hadassah Hospital. In Addis, we feed 245 people, with 122 of them between the ages of zero and five and five of them between the ages of six and fifteen. In Gondar, we feed 238 people, with 139 of them between the ages of zero and five and 37 of them between the ages of six and fifteen. Most people receive one meal per day, but we feed severe cases twice daily. We also provide infant formula for babies whose mothers cannot or should not breast-feed and we feed malnourished pregnant and lactating women. Some people who are adequately nourished but have social problems are also included in our feeding program. Finally, we address the issue of micronutrient deficiencies. Several hundred children have graduated from our feeding programs.

Our program has been thoroughly reviewed and commended by Dr. Dorit Nitzan Kaluski, the Chief of Nutrition for the Israeli Ministry of Health.

In Addis Ababa, we have a part-time obstetrician/gynecologist who cares for women before and after delivery. In Gondar, our doctors do this, recording the results on a special form that we designed for pregnant women.

We have trained traditional birth attendants in Addis Ababa and in Gondar. We encourage women, however, to deliver in hospitals or health centers by paying their traditional birth attendants more to bring them to the hospital than to deliver the baby at home. Well over half of our babies are born in clinics or in hospitals. The great majority of women receive pre- and post-natal care from us.

There are 12 health facilitators in Addis and another 12 in Gondar. They aid in community outreach, in health promotion, in follow-up of patients, and in keeping track of births, deaths, and other events. They help alert medical staff to people who may need medical treatment at home. They meet daily with a senior nurse.

Vered Kater, Senior Pediatric Nurse Educator at Hadassah Hospital, generally travels to Ethiopia twice a year in order to update the staff and to help with education and quality assurance. In addition, we recently benefited from our first student volunteer, who spent several months helping to computerize important aspects of our project. Another volunteer is due to arrive next week.

In Addis Ababa and in Gondar, from January 2000 through June 2001, the annualized mortality rate in our program was below 7/1000. The annual mortality rate in Ethiopia is 20/1000.

The population served by the Joint Distribution Committee must be viewed within the context of Ethiopia as a whole. For this reason, I have included recent Ethiopian statistics:

[1] Central Statistical Authority, Addis Ababa, and Macro International (Maryland): Ethiopia Demographic Health Survey, 2000, Central Statistical Authority, Addis Ababa, 2001

[1] State of the World’s Children, 2001

[2] World Development Report, UNDP, Oxford University Press, NY, 2001

[3] UNAIDS, 2001; www.unaids.org

[4] DHS, Ethiopia

[5] Ministry of Health, Ethiopia, Personal Communication

[6] Central Statistical Authority, Addis Ababa, and Macro International (Maryland): Ethiopia Demographic Health Survey, 2000, Central Statistical Authority, Addis Ababa, 2001