2023-12-31-accounts

Annual Report 2023

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www.hospiceethiopia.org.uk

Introduction

As Chair of Hospice Ethiopia UK, I am delighted to write the introduction to this annual report to share with our donors and supporters the significant work of Hospice Ethiopia UK in 2023. Without the support and help of our volunteers, we would not be able to make a difference to the lives of many in Ethiopia.

“Hospice Ethiopia UK” (HEUK, registered charity no. 1171781) became a registered UK charity in February 2017. Our mission is to promote the provision of palliative care in order to relieve the suffering of the terminally ill in Ethiopia by providing financial, educational and practical support.

Hospice Ethiopia (HE) is an Ethiopian non-government organisation (NGO) in Addis Ababa that provides home-based care for the terminally ill and palliative care education to a range of health care professionals in Ethiopia. It receives almost no funding from within the country. Ethiopia’s population is now estimated to be 127 million (the second most populous country in Africa). The success of HE is largely due to the Executive Director of HE, Ephrem Abathun, who was included in The Guardian Newspaper's list of inspiring figures from 2023. It's fantastic to see his hard work and commitment recognised. HEUK was truly delighted when he was awarded his doctorate after several years of hard work. He researched breaking bad news in the Ethiopian context and was delighted to receive funding to travel with his wife to Pretoria, in South Africa to receive his doctorate in person from the University of South Africa.

There were 9 Trustees during 2023: Sue Mumford (Chair), Marion Bryce, Wendy Smith (Secretary), Jamie Mumford, Rebecca Gascoyne-Richards (Treasurer), Tim Morgan, Jill Morgan, Kit Forrester and Ellie Dharamraj. At the end of 2023 Wendy Smith stepped down from her role as a trustee but will continue as an associate trustee along with Rachel Austin. We were pleased to welcome Riel Karmy-Jones KC as a new trustee to the Board. The trustees work in close partnership with Ephrem Abathun, the Director of Hospice Ethiopia.

Hospice Ethiopia UK trustees 2023

The trustees of HEUK held six meetings during the year when we reviewed our work to inform our planning for the future and reviewed and updated our policies (which are available on our website). We keep in regular touch with our supporters through a monthly online newsletter. Sincere thanks to Alice Roberts for editing and formatting these newsletters.

HEUK could not have achieved all that it has in 2023 without many hours of help from regular and one-off supporters, who freely gave their time and expertise to raise funds for those desperately needing palliative care in Ethiopia. As a small charity we have very low costs: we do not employ anyone, rent offices, or charge for our travel. This allows us to send almost all money raised to Ethiopia where it is so badly needed. Our thanks go to A J Cooper Builders for funding our administration costs. Thanks also must go to those supporters who have helped the trustees of HEUK with our website, social media, and publicity.

Fundraising

As Hospice Ethiopia UK’s accounts show, 2023 has been another great year for raising funds with a total income of £59,231. We’ve held a number of events, almost one event per month, which we could not have done without the generous help of so many volunteers. With a varied programme of events from cake stalls and teas to a Bridge event, we’ve tried to appeal to different audiences. In September a volunteer wrote a script for dramatized readings from Jane Austen’s Emma which proved very popular and raised over £1,000 in an afternoon.

Dramatised readings from Jane Austen’s Emma

A particular mention should be made of individuals who raised funds: Tim Morgan’s sponsored swim raised over £2,000 and Rachel and Ian Napier’s sponsored half marathon has raised over £600.

We were pleased to be accepted to take part again in The Big Give Christmas Challenge, a national fundraising campaign run annually at the beginning of December. Our “project” in

2023 was to raise £11,760 to fund a significant pay rise for Hospice Ethiopia’s programme staff in 2024. For many reasons including the recent civil war and the war in Ukraine, the average annual inflation rate in Ethiopia is 35%. Hospice Ethiopia has worked hard to support and train a highly skilled workforce, and in order to continue to attract and retain staff they need to pay their programme staff a wage that keeps pace with inflation.

To raise £11,760, we needed our donors to give £5,880, which was then matched to raise £11,760 in total. In fact, with Gift Aid the total raised was over £13,000: a fantastic result, which will mean Hospice Ethiopia UK will be able fund a 30% pay rise for all staff working at Hospice Ethiopia.

We are also extremely grateful to those donors who give a monthly donation via a standing order. This really helps with our financial planning and ensures we have regular money to support the work of HE in these difficult times. It is easy to set up a standing order: please contact HEUK via [e-mail] for more information.

We wish to extend many thanks to all our supporters who gave their time to help with organising and running events as well as making generous donations. Without your help Hospice Ethiopia would not be able to continue its vital work.

Education Fund

HEUK provided funding for a 5 day palliative care training course at the new oncology department at the hospital in Dessie and jointly funded the same course run in Debark – see below. The staff from HE provided follow up mentorship and support after these courses to enable palliative care to become embedded in the hospitals where training has been provided. This has been particularly challenging in Debark due to the ongoing conflict in the area.

Group discussion during training in Debark

Reserves

The Trustees have agreed to allocate £15,000 to the Reserve Fund, which equates to six month’s funding of Hospice Ethiopia by HEUK, as a general reserve for emergency funding for Hospice Ethiopia.

The financial statements have been prepared in accordance with the accounting policies set out in the notes to the accounts and comply with the charity’s governing document, the Charities Act 2011, and the Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard for Small Entities, published July 2014.

Transfer of funds

During 2023, £21,000 was transferred to HE; £15,000 was for running costs and £6,000 funded the training course in Dessie. We are grateful to The Forrester Family Trust, Aylsham Rotary Club and Paradigm Norton Trust for funding this training. A second transfer of funds has been delayed due to the unstable economic situation in Ethiopia. With the high inflation rate in Ethiopia and the value of the Ethiopian Birr falling, and following detailed discussions with Ephrem Abathun and Gullilat Korbu (Finance Officer), it has been decided to retain the second instalment of funds for HE’s running costs in the UK until it is needed early in 2024.

Due to the success of our fundraising and in line with HE’s 5 year strategic plan we now have a restricted fund for building premises for HE. This currently stands at £80,000. We also hold restricted funds for the Tewolde Medhane fund (formerly the Comfort Fund), the administration fund (funded by Cooper’s Builders), the education fund and the Big Give Christmas Challenge projects.

The Chair of HEUK holds a monthly online Zoom call with Ephrem Abathun (Executive Director of HE) so that the two charities work closely to ensure the smooth running of HE. HEUK receives quarterly reports from the Hospice detailing such things as the number of patients being seen by HE, the training HE has delivered and budgetary information. This helps to ensure that all the money we transfer to HE is spent appropriately. The money that is transferred from HEUK is used to support patients like Ayana as they approach the end of life. It costs £55 per month to care for a patient on the homecare programme.

Ayana (not her real name) was a 38 year old Christian Orthodox woman, who was diagnosed with HIV 9 years ago. She was prescribed Highly Active Antiretroviral Therapy (HAART) for her HIV disease which she received free from the local health centre. Three years ago she was diagnosed with vulval cancer and subsequently received 11 cycles of chemotherapy (after having first tried Holy water). When she was visited by trustees earlier this year she was waiting for radiotherapy to control her pain, vulval swelling, bleeding and discharge. She was unable to sit comfortably despite taking tramadol 50mg twice daily for pain. Nurse Filagot talked with her about increasing the tramadol but as the ceiling dose is 50mg 4 times daily (QDS) Nurse Filagot was worried about what she would be able to prescribe if the pain got worse (as oral Morphine is unavailable). Ayana also complained of neuropathic pain

down her right leg, so Filagot decided to arrange for amitriptyline 12.5mg at night to be prescribed. This would also help her sleep.

Nurse Filagot visiting Ayana

Ayana’s mobility was much reduced due to the vulval swelling and pain rendering her housebound and dependent on her family. In addition, she had a poor appetite and local skin irritation when passing urine. She lived with her parents and did not have any children. She received food support from Hospice Ethiopia as she had stopped working as a cleaner due to the progression of the disease.

Making a difference

Not only is HEUK making a difference for patients like Ayana described above but we are particularly pleased to report that in 2023 there has been expansion of palliative care services outside of the capital Addis Ababa. There are now palliative care services in a number of hospitals around the country including Jimma, Harar and Dessie. Therefore, HEUK is directly making an impact on people’s lives and without these funds the work would of HE would be severely reduced.

The palliative care team at Jimma University Medical Center

We are also influencing palliative care policy in Ethiopia through the development of the national palliative care training course with the Federal Ministry of Health. Training and mentorship will significantly increase the number of skilled and supported health workers.

Trustee visit

Jamie and Sue Mumford visited Hospice Ethiopia in Addis Ababa on behalf of HEUK in January - February 2023. Supplies (which were all donated by supporters) of colostomy bags (unavailable in Ethiopia), plastic aprons and gloves (PPE), and a range of dressings and incontinent pads were gratefully received by HE. The busy visit involved meetings with the Director and Finance Officer at HE, visits to patients receiving homecare along with one of HE’s nurses, meetings with previous contacts and Health Care Professionals with an interest in palliative care for example at St Paul’s Hospital in Addis Adaba.

Jamie and Sue accompanied Ephrem Abathun and Wengi Yared (Project Co-ordinator) to visit the newly established palliative care department at Jimma University Medical Center (in South West Ethiopia) and were highly impressed with the care that the department was providing. HE had provided training at the hospital in 2022 and had provided ongoing support in the establishment of the new department. They were honoured to meet with Dr Fetiya Awol, Chief Medical Director of the hospital and were encouraged talking with her about palliative care when she said “We strive for better achievement; this is just the beginning”.

Towards the end of the visit to Ethiopia, Jamie and Sue along with Ephrem Abathun, Dr Habtamu and Dr Henok travelled to Debark in North West Ethiopia to deliver a 5 day palliative training course to doctors, clinical officers and nurses from the local hospital, health centres and staff from the Simien Mountain Mobile Medical Service (SMMMS). This course had been requested by the SMMMS and had originally been scheduled to take place in 2021 but due to the coronavirus pandemic and the conflict between the Ethiopian government and the Tigray Peoples Liberation Front (TPLF) had been postponed several times. It was jointly funded by the SMMMS and HEUK and was the first time that the 5 day FMOH approved training course had been delivered in a rural area.

There were 16 participants who attentively engaged with the training and particularly liked the interactive style of teaching. The mean pre-course test score ranged from 15%-75% and the post-course mean test score was 48%-78% – a very substantial increase in knowledge. The participants’ feedback presentations on the final day were outstanding and demonstrated their learning.

A second trustee visit to HE was made in October by Jamie Mumford, Kit Forrester and Ellie Dharamraj, so that HEUK would be represented at HE’s 20[th] anniversary celebrations. It was a great pleasure for the trustees to be present at such an important event in HE’s history.

HEUK trustees Kit and Ellie speaking at H.E’s 20[th] anniversary celebrations

It was Kit and Ellie’s first visit to the Hospice which they found both inspiring and heart rending. Ellie commented “Everyone was so lovely giving up their time for us. It would not be putting it lightly to say it was a life altering experience and we cannot wait to return”.

In particular, the trustees are pleased to report that progress is being made with setting up the oral morphine production unit in Addis Adaba. With the backing of the Ethiopian Minister of Health, Dr Lia Tadesse and the support of the Embassy of the Kingdom of Belgium to Ethiopia and Djibouti a discussion seminar was held after a film about morphine supply issues at the Goethe Institute in Addis Ababa in November 2023, to raise awareness about the need for oral morphine to be available in Ethiopia to treat moderate to severe pain.

National and International Links

Sue Mumford attended the Palliative Care Works (PCW) annual conference themed The Changing Landscape of Worldwide Palliative Care Education. Sue delivered a presentation describing Hospice Ethiopia UK’s experience of providing training in Ethiopia over the last 10 years and the charity’s plans for future training. There were over 100 international delegates from across the world, some in person and some online which generated lively discussions.

HEUK has also continued the link with another UK charity, Ethiopiaid, which has provided financial support to a range of projects in Ethiopia for more than 30 years and has recently made substantial donations to HE.

HEUK has maintained links with a group of small UK charities working in Ethiopia via regular Zoom meetings. Our group, called “Small but Significant”, enables mutual support and information sharing about Ethiopia, charity regulations, and working with non-governmental organisations. In September we organised a joint online fundraiser with Elizabeth Laird, the author of several children’s stories based on traditional Ethiopian tales.

The trustees of HEUK have continued holding international video calls with supporters of HE across the world, particularly Ireland, Uganda, Sweden, and the USA.

We are immensely grateful to our many supporters for their generosity which means we have been able to continue to support the work of Hospice Ethiopia.

In Amharic 'āmeseginalehu'! (Thank you)

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AR'|||41'632||||| |A2 Asset and investment sales,|||||||| |(see table).|||||||| ||||I||||| ||||I||||| ||Sub total||I||||| ||Total receipts||||||| |A3 Payments|||||||| |Purchasing of item.s to|sell||669||||| |Event expenses|||2:2:I||||| |Trips to Hospice Ethiopia|||5'267||||| |Bank charges|||I||||| |Funds used by Hospice Ethiopia||•|. 15'500||||| |Car maintenance costs|||I||||| |Admin Costs|||I||||| |Education and training|||I||||| ||||I||||| ||Sub total||21'663/`',|||||

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CHARITY COMMISSION FOR ENGLAND AND WALES Independent examinerfs report on the accounts Section A Independent Examiner's Report Report to the trusteosl members of Hospice Ethiopia UK On accounts for the year ended 31 December 2023 Charlty no Ilf any) 1171781 Set out on pages 3and4 I report to the trustees on my examination of the accnunts of the above charity ('Ihe Trust.) for the year ended 31 December 2023 Responslbllltles and As the charity trust8es of the Trust, you are responsible for the prèparation basls of report of the accounts in accordance with the requirements of the Charities Act 2011 ('Ihe Act.). rewrt in respect of my examination of the Trust's accounts carried out under section 145 of the 2011 Act and in carying out my examination. I have followed the applicable Directions given by the Charity Commission under section 145(51{b) of the Act. I hav8 completed my examination. I confim that no material matters have come to my attention (other than that disclosed below ') in (xjnnection wbth the examination whith gives me cause to believe that in. any material respect.. accounting recortls werE not kept in accordance with Secti￿ 130 of the Act or the accounts do not accord with the accounting records Independent examinefs statsm•nt I have no concems ar)d have corne across no other matters in connection wbth the examination to which attention should be drawn in order to enable a proper understanding of the accounts to be reached. ' Please delets the words in the brnckets if th8y do not apply. Slgned: 20103124 Nam•: Keith Brian s￿)rten FCCA •Alll*aW•) lx body {11 any): 40 8road18nd Drtve Thor98 kn Notwich Norfolk NR13 5BT Octobor 2018