The Ethiopian Life Cycle?

It probably sounds funny, but one of the highlights of my day is
visiting patients who are in the malnutrition room.  Unlike American
hospitals which are usually bright and cheerful (esp. pediatric
units), ours is somewhat drab and dark.  The malnutrition patients,
mostly children, are all in one room which consists of gray walls, one
window and four metal frame beds.  There is a small box of toys; some
wooden blocks, a jump rope, a few balls and some pretty tattered
books.  All the reading I have done on malnutrition suggests
encouraging parents to engage their children in play in order to keep
up their cognitive functioning.  The kids who come to us are in pretty
bad shape as they must be diagnosed with severe malnutrition to be
treated in-patient at the clinic.  Not surprisingly, they generally do
not have much energy and are quite lethargic due to their poor health.
I find that most times when I walk into the room the patients are
lying down with family members beside them sitting quietly and just
staring out into space. It’s easy to understand why parents aren't more
proactive about engaging their child, as the kids are pretty out of it
and I don’t think it is in the culture to “play” with kids in general
the way we do.  Plus, I am not sure how good our staff is about to
passing on this information and encouraging it.


Each day I go into the room and try to make the kids and their
families laugh a little (usually at my expense of being the weird
farengee-- white person) to lighten the mood a bit. I teach the kids
to give me a high five, poke their belly to make them laugh, etc.  I
recently started playing with the toys and showing family members how
to use with them.  People have actually started picking up on it and
several times I have walked in and seen them using the blocks or
reading to their kids—which I should point out is really making up
stories since the books are all in English.


Anyway, for the past week there has been a woman at the clinic with
her baby who had both malnutrition and vitamin D deficiency.  The
woman is about as lovely as one can be, constantly holding her child
while also helping others in the hospital.  One day I went in and
found her braiding the hair of a very sick woman who was being treated
for phenomena.  Her ten year old daughter was also with her, helping
out in any way she could (remember here patients have to basically
take care of themselves—preparing their own food, cleaning, etc). For
the past several days I saw the mom cry more and more as her child was
not improving.  The doctor thought maybe he also had TB and began
treatment for that, but he still did not improve.  I kept hoping this
child might prove to be a miracle baby. Not that anyone deserves to
have a child die (of such a preventable disease no less) but there was
just something so unfair about this situation.

This morning I came into the room and found her crying. The nurses
explained that they would be leaving today as the baby was not
improving. Her family would come and they would walk several hours
back to their village to let the baby die at home.  I tried to express
my pain for her and rubbed her shoulder, though I am sure it was no
consolation in a time like this.  As I wrote in a previous post about
death in the developing world, it is just as painful and heartbreaking
here as it is in the west.
 

Minutes later I was informed that a different malnutrition patient
(this time an adult with severe protein deficiency) had delivered a
baby night before.  In the middle of the night in the malnutrition
room she delivered a baby boy by herself.  By this point she had been
moved to the OB room and mother and baby seemed to be doing well.  The
woman had responded well to treatment and was in the final stage of
being able to eat a high calorie supplement, plumpy nut, on her own.
Now that she had her baby and her signs were good, she would also be
discharged today.  We brought in a blanket and onesie for the baby and
said congratulations to her husband and mother who were there.
     
So in one day, a baby was born and yet another was going hone to die.
I am sure a better writer could come up with a clever ending to this
post, with some deep meaning to why this all happened today….but I
don’t think I am that person.  I guess to me it just shows the
randomness and unfairness that life is for so many people. Who knows
what is in store for either family or what lies ahead of them…but as I
have seen in my short time here, such is the life in the developing
country.

My Commute

I woke up Wednesday morning ready to start my day, looking forward to going Gundra Shala on Outreach. We had to cancel going to this site the previous week due to a lack of vaccines so I was eager to begin the day.   This was the first time going to Gundra Shala for me and I had no idea what was in store for me.  As with other outreach sites, we would drive until the road ended and then hike in.  So far all the sites have been about a 30-45 minute hike, but nothing too tough and overall pretty enjoyable.  We are located in a beautiful part of the country, so walking in these areas is quite a treat.    

As we were about to leave Lalmba I noticed that I hadn't filled up my water bottle. I didn't want to make the other folks wait so I decided to skip it this time. This would soon prove to be a bad mistake.  Just as we got in the car someone pointed out that this was a far site and that we wouldn't back back until 4 pm.  I realized I would probably be hungry by the end of the day as I didn't bring a lunch but figured that if the rest of the staff go without food then I should too.  Oh, what was I thinking??

The car ride was about thirty minutes to a different town where our hike would begin.  As someone who enjoys walking I didn't think too much about a two hour walk to get to the health post where the vaccines would be given. Little did I know that this was no light hike.  It would prove to be some of the hardest, most grueling hours of my life. Unlike in the US where roads are paved and trails maintained, Ethiopia hasn't been so lucky with their infrastructure.  I would say a good half of the road was covered in mud up to your ankles, which made you walk either very carefully from rock to rock or on the edge of the road hanging on to to tree branches to keep yourself steady.   The path was constantly going up and down to the point that it made the highest midwestern hill seem like a joke.  I have heard about heartbreak hill in the Boston Marathon (I think that's where it is anyway) and can I tell you...this hike was made up of at least five heartbreak hills.  We would get to the top of one hill only to walk down to find another steep climb ahead of us.  We also had the fun of  crossing several rivers with nothing more then a few logs to use as a bridge  Two such crossing weren't bad, but at one I thought for sure I was going to fall in and make a fool of myself.  Luckily for me, Ethiopians are extremely helpful and giving people.  Several people helped me across and miraculously I made it over in one piece.  We did eventually make it to the health post to give the vaccinations, but after 2 hours we had to turn around and do this all over again.  Something to keep in mind here is that I didn't have a single drop of water or a morsel of food to eat the entire time.  Unlike in other parts of the developing world where bodegas and little stores are pretty common even the poorest areas, this is not the case here.  I had no options to buy a drink and asking for water at a random house would be chancing getting sick as they don't treat their water. In my head I really did contemplate just drinking the water and taking the chance of being miserably (aka, explosive diarrhea) sick in the not too distant future.  For those of you who knew me in high school, you may remember the amoebas and giardea indecent during Amigos...which is probably why  opted to just  suck it up and go without drinking.  Even though I love to joke that it was a great diet, I think I'd rather not experience that again.

Okay, enough of that detour...  Best of all, about midway back to the car it began to POUR!! The rain here is pretty brutal and this was no exception. Luckily I had planned for this and had my super duper gortex rain jacket.  Ironically, I was so hot and thirsty that I didn't use it as the rain felt so good and I was finally able to cool off.  At this point I felt like I finally had a little insight into life in Ethiopian life.  You walk far to get anywhere and it rains a lot, so you just have to push through it.   Once the rain began I was relieved to stop sweating and felt some relief from the heat.  On the brighter side for the whole experience, I only fell twice throughout the day, and neither time was into the river!
  

When we finally returned to Chiri Health Center my legs ached like no other. In all honesty I have never been so tired in my life, it made all the half marathons and triathlons I have done seem like a walk in the park.  There were times during the hike in and out that I found myself day dreaming about drinking a Gatorade or coke, and what price I would be willing to pay for one.  Honestly, on the way there the going price was $20 and the way back topped off at $50-- which says a lot to those that know how cheap I am.  Whats more-- I was hiking with nothing other then myself.  People do this all the time to get to market, carrying everything from chickens to huge ceramic injera plates to logs of wood.  It is official, I am a wimp!  To think that I used to dread taking the bus in the morning or having to walk home from the train after work.  Looking back, that commute was a cinch! As I write this I can only laugh at myself and what a woos I was.  People walk like this every day to get to school, market, the health clinc...and often carrying heavy bags.  It really is like that old story about "having to walk five miles, barefoot to get to school...."  I can tell you one thing, I definitely learned from this experience and will never leave without water, no matter where I go!

Shana Tova!!

An Ethiopian New Year

      As you probably know, the hardest part for me in being here is missing friends and family.  I knew this going into it and I continually remind myself that even though I am far from home and all the people I love, that this is just part of the deal.  It was no wonder that as the high holidays began I thought of home and all the people I love so much.  I originally was planning on making something special here, veggie soup and cabbage salad. Unfortunately I had a miscommunication with the kids from the orphanage (they go each week to the market and buy our food) about what to get.  Every Wednesday we have a cooking class  at the clinic for the parent's of our malnutrition patients, which we also have the kids buy at the Sunday market.  Seeing as my Amharic is all but inexistent and their English is a little spotty, the kids must not have understood  as they came back with only enough food for the cooking class.  So I found myself in a bit of a bind as far as Rosh Hashana goes with no food options and not a single other Jew hour at least 10 hours away.  Other then the weekly market, there are not many options for buying food here.  With no Trader Joes, Whole Foods or Kroger to run out to I thought that I would just have to make due with what ever we had around...which isn't a ton.  I figured that it was fine, one Rosh Hashana without a special meal wouldn't kill me.
      Luckily though on my way home from a run Tuesday evening Richard (the other doc from New Zealand) and I ran into the pharmacist's wife.  She was handing someone a basket of food and at Richard's suggestion I looked to see what was inside. Truthfully I thought he was trying to trick me and that there were be something pretty unappetizing like intestines or a lamb's head inside....but no, to my enjoyment there were delicious looking samosas.  "Oh yeah, did anyone tell you that she is a cook and will prepare food for you if you need?" Richard asked.  This was perfect timing as RH was a day away and I had all but given up hope of doing anything to mark the holiday.  I put in an order with her right away; food for two nights, a mixture of traditional Ethiopian food (injerga with assorted veggies) and samosas.  What really amazed me was the cost, at three burr per person our meal would total less then $1 for everything.  I can only imagine what the cost of a good brisket is......probably more then our pharmacist makes in an entire month!
      The first night I extremely exhausted from that day's outreach to the village of Gundra Shala.  As the food arrived I was so grateful to have it as I was in no shape to cook after work.  I ordered enough to eat with the other ex-pats, Richard the Kiwi, Faith, Andrew and their kids Alaya and Emry.  It was a pretty low key night and as we ate I couldn't help but think about the upcoming year.  I really hope that this is a meaningful experience for us and that our decision to come here proves to have been a wise one.  Right now I am just beginning my work and it seems like there are immense possibilities to create positive changes in the overall health in our target areas.  I know that effective public health work is a slow process, taking much patience and hard work.  Seeing that I am not the best at any of those, I am quite aware of the challenges that lay ahead of me.  Professionally I hope that this year, and my time here at the Chiri Health Clinic, allows me to continue Erin's great work and begin a new program (safe water systems) in the public health program for Lalmba.  Personally, I hope that I learn to have more patience, be more positive and live more in the moment-- all of which I think may be the byproducts of living and working in this environment.  Nothing gets done quickly or easily, but I do believe that this allows for one to take pride and enjoy the smaller accomplishments made.  Mostly though, this will be a work in progress.....
Shana tova!

Annie's First Pictures

All's Well That Ends Well

Today was my first time out as the official Chiri Health Center Public Health Director, and more importantly as the only driver. Since no one here has cars, literally I think our organization and the other NGO in town are the two cars in all of Chiri, it is very rare for someone to know how to drive. As many of you know, I really dislike driving and have very little faith in my driving ability. Now throw in the facts that the car here is stick and that the roads are unpaved and super mountainous and you can imagine how excited I was to begin my day.


We had to cancel Outreach because there are no vaccines right now (just part of life when working in the developing world I guess) but luckily there was also a scheduled meeting in another village. This last year Erin began a community leaders committee made up of four representatives (two men & two women) from each village to be our public health liaisons. So at nine this morning the public health nurse and I set out to the village of Gessa with my fingers crossed that it would be a good day. We successfully made it to the village of Shedda (only once did I think we were about to go off a cliff) and picked up our field liaison Endarege, whose job it is to work in-depth with four communities we serve, as well as eight of the community reps. It was not soon after I introduced myself to the community members that as I was going up a hill, I tried going from second to first gear and then boom I stalled. Keeping my cool, I started the car and tried to get it going again. Unfortunately, while I did have several stick lessons none included how to start when you are on a hill--- probably a bad oversite considering we live in the middle of the mountains. Each time I tried the truck just kept slipping and slipping backwards. I should have known it was a bad sign when all of the staff members got out of the car. It seemed hopeless, but eventually I slid far enough down that the truck was on flat land. Phew!!! I got it going and went up the hill, motioning for the staff members to meet me at the top. I felt the rush of victory, like I was an Indy 500 driver and just avoided crashing.

It was not 30 seconds after they all got back in that I realized I had underestimated where the hill flattened out. Yup, you guessed it-- I was back in no mans land of not being able to get up the car going! I can only imagine what the community leaders were thinking of this crazy farangee (foreigner) who couldn’t get the car up the road. Everyone was giving their two cents, which luckily I couldn’t really understand much of, but basically they all thought I was trying to go backwards. Again and again I started the car, removed the brake and tried to get it going....only to slide backwards. Eventually I found myself perpendicular to the road and half in a ditch. Lovely....

The men tied a rope to the car and tried pulling it out, but after about five tries the rope broke. I thought the situation was completely hopeless.....there was no one else who knew how to drive, I wasn’t getting any cell service (to try and call the clinic in hopes that someone could talk me through starting on a hill) and I was literally in ditch. WTF came to mind at this point. What would I do???? We were at least a four hour walk from Chiri and there is barely any other mode of transportation. Then, the men found another rope and several other people to help and began to pull once more. HALLELUJAH!!!! I have absolutely no idea how it happened, but it did.....we were off! I think I literally cried out in joy with my arms in the air-- we made it!!!

Very late, we got to Gessa and began the half hour trek to the office where the meeting was to take place. I won’t go into all the details here now about the meeting (I’ll do that another day) but it was great. Really wonderful and inspiring, it made me feel very content about my work here. I know that a year is a short amount of time, and that change is slow, but that my being here has the possibility of being part of something much bigger then myself.

On the drive back a man was asking for a ride on the side of the road which is very common. I knew the car was full but noticed out of the corner of my eye that he held up a baby to show us. After learning some about our malnutrition work at the clinic I could tell that the baby had kwashikor-- a type of malnutrition that is caused by protein deficiency causing the limbs to swell. We stopped to let him in-- at which point I realized we were on a hill!!! Yup, can you believe it, I did it again---- argh!!! This time I thought better and just reversed to a flat part and began again.

As the title of this post began....all’s well that ends well. I am looking out the window on a beautiful sunset while my challah rises, glad to be put for a while with no driving in my future (until Monday