Tiruye Lakew has worked as a Health Extension Worker (HEW) for four years, the last two at Gedaeyasu health post in Gedaeyasu Kebele, Ethiopia. She and one colleague cover 1,722 households, 1,001 children under five, and 374 children under two. She trained at Debre Birhan Health Science College, earning a Level 3 certification over one and a half years after completing grade 10. The work is structured around eight health packages covering maternal and child health, and 18 hygiene packages covering everything from toilet construction to safe food preparation — all reached through regular home visits.
Tiruye registers pregnant women and advises them to begin antenatal follow-up before 16 weeks. They receive iron supplements, meningitis vaccination, and nutrition counselling throughout pregnancy. From birth, children receive BCG (Bacille Calmette-Guérin, a tuberculosis vaccine) and polio vaccinations, followed by a full schedule from 15 days old. Growth Monitoring and Promotion (GMP) continues to six months, after which Mid-Upper Arm Circumference (MUAC) screening is added alongside weight and height measurement to assess nutritional status. Children identified with acute malnutrition are enrolled in the programme; those who recover within eight weeks are discharged.
Since July, 15 children with Severe Acute Malnutrition (SAM) and 17 with Moderate Acute Malnutrition (MAM) have been enrolled. Nine of the 15 SAM cases have recovered and been discharged; six remain in the programme. None have required referral to a higher facility. “We get very sad when we find malnourished children even after all the awareness creation we have done. Including these children in the programme cannot be the only solution — we need to work on creating awareness and solving related problems here in the kebele,” she said.
On infant feeding, Tiruye teaches exclusive breastfeeding for the first six months — including colostrum, which mothers previously discarded without knowing it provides natural immunisation. From six months, she recommends a mixed grain porridge: one cup of legumes combined with two cups of cereals, with eggs, milk, or butter added where available. Breastfeeding continues alongside solid food until age two, and mothers are encouraged to eat four to five times daily.
Vegetables are not reliably available in the kebele. The reason is water. “It is a water problem that hinders us from exercising proper nutrition. We have reported this but still no solution,” Tiruye said. Without irrigation water, households cannot grow cabbage, spinach, or kale, and the diet stays narrow — injera with shiro, teff without mixed grains. The constraint reaches the health post itself: Tiruye buys three 20-litre jerry cans of water daily at 2 birr (~€0.01) each, paying 60 birr (~€0.33) a month to have it fetched. Water placed outside the toilets for handwashing is taken by community members facing the same shortage, so staff go home to wash their hands after using the toilet.
“I wish the water problem to be solved in the kebele, for a clean water alternative created in the area so that my child can live happily,” she said. She is the mother of a five-year-old boy. “My wish for all the children of the kebele is the same wish I have for my son.”