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Interview with Francesco Silenzi, Engera President.

On the occasion of the delivery of an ultrasound scanner MyLab50 – given from Esaote to the no profit Association Engera – we have asked some questions to dr. Francesco Silenzi, Engera President, to better understand the activity of the Association and to look not only on how technology can improve living conditions but also how it can develop relationships, creating trust and breaking down inequalities.

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Q. Mr. Silenzi, Engera can carry out its activity out of the generosity of many physicians and paramedics. What stimulates them to engage in this activity and what do they take home after their volunteering?

A. In more than a decade of activity, we took more than 300 operators to Ethiopia, including physicians, paramedics, midwives, and volunteers. I think that what stimulates them is first and foremost the wish to embark on a professional and human adventure in a disadvantaged context, where they can contribute with their experience, test their skills, reintroduce a simple medicine based on semeiotics, while maximizing poor diagnostic and therapeutic resources. It is often a “shot in the dark”, a somewhat irrational attitude that is absolutely necessary to make this first step.
For some it remains a once-in-a-lifetime experience, albeit valuable and unforgettable; for others, including myself and my closest co-operators at Engera, it is by-now an ongoing commitment and an almost vital need to keep travelling to Ethiopia.
Actually, once those physicians, paramedics, midwives, and volunteers have been there, they return to their daily life with a broad human and professional wealth and, in my view, also improved in their professional performance at home, and they will value passing time, simple things, real basic needs to a greater extent.

Q. What do you use diagnostic imaging most often for and on what kind of prevention are you working in particular?

A. In Ethiopia, our Association is focused on the Gurage region, about 250 km away from the capital Addis Ababa, and operates in a rural environment with few hospitals, often inaccessible to the population due to high treatment, diagnostic, and therapeutic costs. In ten years of fund-raising efforts, charity events, partner generosity, and Projects for Regional Initiatives, Engera has helped build, equip, and support a number of Health Centres fitted with examination rooms, including for emergencies, delivery room, and drug dispensary, operated by local paramedics and midwives when no physicians are available, and acting as true “health outposts” for the population in need.
The main focus of Engera is the promotion of mother-child health, primarily in disadvantaged groups, and diagnostic sonography is crucial in terms of mother-child health promotion and “antenatal care”. The opportunity to perform a FAST, to identify possible pregnancy and birth-giving complications, and to refer new mothers and their infants to the local hospital, at an over 50 km drive on often rough roads, is a valuable option capable to change significantly mother and infant mortality rates in the region.
Additionally, some lives were lost in the past due to the absence of ultrasound equipment capable to provide valuable information. The promotion of local staff training is also crucial.

Q. Based on your experience, what is different in establishing a relation with patients? How do you make them trust you and the new technological options or treatment methods that reach beyond tradition?

A. While we operate in a rural environment, culturally underdeveloped in some respects, the demand for “health” is so high that since the inception of our activity we have been enjoying unconditional trust, both with respect to our people and to the technologies that we introduced over time.
Therefore, after some initial distrust, patient relations have become gradually stronger, and our missions are eagerly awaited in the reference villages and Health Centres. Children are easily won over with candies and a few jokes, adults trust us after seeing the daily efforts of the local staff, passionately engaged even when we are not on site.

Q. What are the main medical needs in Ethiopia?

A. Ethiopia is a country with great contradictions, huge and largely untapped potentials, a GDP that is growing exponentially, where wealth is an asset for few and the population suffers immense poverty, so much so that it ranks among the poorest countries in the world. Women, children, and elderly people are often left to take care of themselves.
The local University trains medical and paramedical staff that leave the country after completing their courses to move to wealthier nations, and those that stay behind often carry out their activity in big cities or in private offices. Therefore, only a thorough cultural transformation, which should start with the new generations, can help harmonize social imbalance, and physicians should be the pillars of this transformation.

Q. What do you think is needed to bring about a significant improvement in the life of the people you take care of?

A. Improved access to basic commodities, such as clean water and food, access to primary care, prevention, lifestyle, improved infrastructures, promotion of education are the starting points to ensure an actual improvement of the living conditions of people in need, in discomfort, and often neglected by the Federal and regional Government of Ethiopia.

Q. What does it mean to take care and why should we do so for people that are seemingly so far away from us?

A. Taking care of the “last” in Ethiopia actually means taking care of our brothers, our sisters, our parents at home, it basically means being the “testimonials” of the principles that our families taught us as children. For the medical and paramedical staff, it also means focusing on the core of their professional choice, renewing “Hippocrates’ Oath,” i.e. caring for people. This is often neglected in the western world where we usually operate, struggling with bureaucracy, constraints, economic logics, etc.

Q. What is, in your opinion, a community, and what are its boundaries?

A. I will answer this question with a short story. On a windy day about 6 months ago, in a remote village in the Zezencho region, thirty-three tukuls – the typical rural huts built with straw, tinder, and hardened dung – were set to fire and destroyed, with flames quickly spreading from one tukul to the next. In few minutes over 600 people lost everything they had.
Well, the Community set to work; as soon as the news reached Italy, a fund raising activity started, also spurred by Engera and other no-profit organizations operating in the region, in view of rebuilding homes to protect the affected population and, after a short time in which the homeless were hosted by the other village dwellers and temporary shelters were set up, during a recent mission in early March we could witness and experience tukul reconstruction live.
In such situation, the whole village population, none excluded, physically engaged in rebuilding the huts, each one providing his or her contribution – children, women, adults, and elderly people worked side by side to help. This reminded me of other great spontaneous and supportive mobilizations, such as upon the 1966 flood in Florence, or the disastrous earthquakes that followed each other in Italy. A great emotion for all of us in attendance… This is what a “community” is!

Q. What balance to you need to strike when dosing - in medicine - technology and anthropology?

A. This is another crucial point for the activity of Engera: the need for our co-operators to use discretion when approaching a millennia-old environment, to provide their know-how without disrupting local uses and customs, which means to promote gradual integration between technology and traditional approaches, respecting whatever good is done in the country where we operate.
I believe that respect for others is the best way to introduce the use of technology, to turn it into a factor for an actual improvement of the living conditions of people.

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