In the spring of 2021, I spent three months in Tigray, Ethiopia. It changed me in ways I never would have expected.
Explore This IssueACEP Now: Vol 41 – No 10 – October 2022
As a new field worker with Médecins Sans Frontières (MSF), I was eager to respond to the humanitarian crisis in Tigray, a northern region of Ethiopia. When Tigray entered into a civil war with the Ethiopian government in November 2020, invading troops drove tens of thousands of people from their homes. With the few possessions they could carry, these internally displaced people (IDPs) resettled in camps in cities in Eastern Tigray like Shire, where I was headed.
When I arrived in Shire, there was a sense of being in the eye of the storm. In front of our base, MSF staff and locals gathered in the afternoons to drink coffee and people-watch. But a short walk to the massive IDP camp down the street revealed a grim reality: thousands of people living in and around an abandoned school. As an on-site clinic supervisor, I worked alongside a talented and compassionate group of Ethiopian medical professionals treating patients with upper respiratory infections and diarrheal illness, as well as those with chronic conditions who couldn’t access medication.
The situation in Tigray destabilized as fighting flared over the following weeks. Our Ethiopian colleagues did not feel safe walking to work – they reported being harassed and sometimes assaulted. Tensions grew higher every day. One night, military troops entered several camps and abducted hundreds of Tigrayan men. Our patients were terrified.
Amidst all of this, something strange began to happen to me. About eight weeks into my time in Tigray, my right hand started to swell and ache. Day after day, the swelling and pain got worse until I was unable to use my hand for even simple tasks. A week later, I woke up with swelling and pain at the base of my right big toe. Next it was my left ankle, then my right elbow. I struggled to walk. One of my colleagues, a logistician, crafted a makeshift crutch from a tree branch. My resolve that I was “fine” gradually weakened, and I confronted reality: something was very wrong. My supervisor made the decision that I couldn’t. I had to return to the capital for medical assessment. I knew I would not be coming back.
One long, painful car ride later, I was on a plane back to Addis Ababa. Other joints began to swell and ache: my left hip, right sternoclavicular joint, and the small joints in my feet. At the same time, I grappled with overwhelming guilt and sadness at leaving my Ethiopian colleagues on such short notice. Compounding this grief was my awareness of the privilege I had as a foreigner to have access to the best possible health care when the people of Tigray had nothing.
The doctor in Addis made a diagnosis: reactive arthritis. MSF flew me back to New York, where a specialist confirmed my diagnosis and started me on prednisone. I read up on the disease, having never seen it outside of textbooks. As medical students, we’re taught the mnemonic “can’t see, can’t pee, can’t climb a tree.” I cheerfully informed friends that I could indeed see and pee, but definitely not climb a tree. I read that most people would recover fully within six months, but some would go on to experience chronic or recurrent symptoms.
As I faced my diagnosis at home, the MSF team still in Ethiopia was struck by tragedy: three MSF employees based in Mekelle were killed. Yohannes Halefom Reda, Tedros Gebremariam, and María Hernandez. I never knew them. They worked in a different city, though only 150 miles away. I wondered what went through their minds as they faced the last moments of their lives. Meanwhile, the communication blackout in Tigray meant that I had no way of contacting my colleagues there. I felt both extremely lucky and profoundly pained to be so far away.
My condition gradually started to improve. After two months on high doses of steroids my joint pain had improved, but I was still in daily pain and had limited use of my right hand. My rheumatologist suggested I start a biologic. It would be another two months before I returned to work and three months before I was fully weaned off steroids. I faced the gamut of side effects, including weight gain and moon facies (now immortalized on my hospital ID badge).
Now, it has been over a year since my reactive arthritis first started. I am grateful that I’m 95 percent back to normal. Aside from minor aches and pains, my disease has very little effect on my day-to-day life. But I’m still waiting, month after month, to see if I will ever fully be myself again.
I think about Tigray less than I used to. As is natural, the depth of my sadness has lessened with time. But I still often stop and think, “Are my Ethiopian colleagues ok? Are they alive? Do they have food to eat? Do they wonder why we’ve abandoned them?” I hope they know I still think of them. I want to say that I would be there if I could, that if the political situation allowed it I would return in a heartbeat. But the truth is that my heart is still so heavy with memories of my time there, my illness, and what it did to my family to see me go through it. I hope one day the war will end, and I will be able to visit Tigray and appreciate its beauty and history. I hope my Ethiopian friends will still be there.
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October 18, 2022Senait
I am glad to know you are doing great and praying for you to go back to your normal self soon.
In behalf of Ethiopian/Tigrayan descendent I just want to extend my selamta and to let you know how great-full we are for your kindness service.
Thank you so much
November 29, 2022Rachel T. Moresky
As your Columbia University Global Emergency Medicine Fellowship Director responsible for sending you with MSF to Tigray during a conflict, I was admittedly concerned about your security. The government-imposed lockdown of Tigray and the communications blackout affecting the internet, cell phones, and landlines caused me frustration as I could not check in on your safety. Your husband and I texted daily. Having also worked in Tigray as a Global EM Fellow in 2001, precisely 20 years before, I had mixed emotions. I was delighted that you might contribute in valuable ways to the Tigrayan communities; however, I was concerned for your safety. The recent ceasefire took two years too long and getting food and medication into Mekelle. As Alex De Wall has written about for decades, famine and mass starvation are used as weapons of war. https://global.oup.com/academic/product/accountability-for-mass-starvation-9780192864734?lang=en&cc=az
I am grateful to the Tigrayan people, MSF, and your Rheumatologist that you are almost back to normal. I wish you that last 5% soon.