Full Circle

Although meetings here can often be a frustrating and tedious experience, I had two today that not only made me smile like a little girl in a candy store but also reminded me why we chose to come to Ethiopia this year.  


Two of my biggest responsibilities has been to create a safe water program in the four villages we work with and to grow their newly formed women’s groups.  Like all things in public health they have both been a slow and arduous process that often made me question if either would prove effective.  One of my last tasks before leaving is to start drama groups in the villages that will focus on health issues as a tool for increasing education.  Today we met with two of the villages, Ogeya and Gessa, to discuss this new project and at each meeting a great surprise awaited me.  Well, it must have been my lucky day as I showed up for these meetings and saw firsthand just how well everything is taking shape.  If this was back home I would assume both things had been planned in advance, but knowing the way things work here I can safely say it was just dumb luck.

At the first meeting the village chairman asked us about buying more WaterGuard. WaterGuard is an amazing product that if used properly can cut water borne illness in half—which is pretty remarkable seeing as one of the leading causes of deaths in Ethiopia is from water borne diseases.   He said that he would like ten more and immediately people started to pull money from their pockets asking to buy one.  Then my co-worker explained to me that they wanted 10 cases, not 10 bottles….making that 150 bottles. We began this not knowing if anyone
would be willing to spend the money on water treatment, but clearly we were wrong.  So yes, it seems as though this intervention is indeed working, check!

We said our goodbyes and after a nice hike to the road we drove to Ogeya.  As we pulled up I noticed a few of our volunteers were surrounded by a group of women.  I walked up and saw what was going on—the gardens we built is growing extremely well and the women were all there to split up and take home tomato plants.  Not that long ago we had the initial meetings with women about creating these gardens and now they were already seeing the literal fruits of their labor.  I was able to take a quick tour of the rest of the garden and again found myself smiling from ear to ear at what a success this program has been.

Things For Our Things

We came to Ethiopia with two bags each; admittedly mine were pushing the 50 lb. limit, with all that we would need for our time here.  Clothes for the rainy season, games to keep us occupied on weekends, books, DVDs, a crazy creek for each of us and even some of our favorite food all made the cut.  Lalmba’s Director forewarned us during our orientation that while we would be worried we wouldn’t have enough stuff; in all likelihood we wouldn't even unpack half of what we brought.  While I thought she was nuts at the time I must admit that I have an entire bag of things stored under our bed unused and not missed. Obviously being here puts you into a different mind frame. Whereas at home it wouldn't be appropriate to wear the same outfit for three days in a row, here no one gives it a second look.  I used to wear a simple twenty-five dollar stone necklace I bought at the Washington DC flea market, but noticed it attracted too much attention and so have foregone it. People here simply don’t have much and being excessive, ie-- changing clothes every day and having a gold necklace, draws attention. It’s funny how something in one situation can be looked upon so differently in another. The clothes that have holes and stains, which my sisters and friends love to tease me about at home, are considered high fashion and top quality here.  If I used all the clothes I brought, changed them everyday and had them washed each time they were worn I would feel like a complete snob.   

As I have described in other posts, some of my hikes to get to the communities we serve are quite difficult.  A few are two hours plus each way, up and down mountainsides and not very forgiving. Needless to say I bring plenty of water and an energy bar or two.  A few months back I was hiking along and began to think about the Camelback bag I had with me.  The other Ethiopian staff members either didn't have water at all or maybe had an old plastic disposable water bottle that was a cast off from one of our trips to Addis or Jimma.  Not only did I have a special water bottle, but also I had a special bag to hold my special water bottle. Then I noticed my shoes.  Not only did I have shoes, but I had special waterproof hiking shoes--different from my special (trail) running shoes-- and special insoles, not to mention special pants and shirt that wick away sweat.... heaven forbid I wear I cotton shirt. 

Daniel and I talked about this and then came up with all the many “things for our things” that we have back home.  Just yesterday I saw in a magazine a contraption to cut your banana into perfect slices, as if using a knife is just too difficult or archaic.  A towel heater to ensure its warm after you get out of a hot shower, paper towels so that you don’t have to be troubled washing a dishrag, pre-made peanut butter and jelly sandwiches, a phone that can use the internet so that I don’t have to bring a recipe to the grocery store or write down directions before I leave the house... the list is endless.  

Here we see kids making toys from anything they find; scraps of wire can become a wheel, plastic bags can be made into a soccer ball and patients use our old cans for cups.  I think it will be interesting to see what its like when we go home.  Being here you see very clearly just how little you need to survive and be perfectly happy.  I would like to think I’ll be able to resist the urge to buy unnecessary things just because they are there and able to make life a little easier, but I have my doubts.  I have a feeling I will be making an b-line to the first Starbucks I see at the airport, eager to go to Ikea to furnish our new house in Ann Arbor and ready to have my smart phone back.  I know there are things to do to curb this ever-present temptation to buy and consume yet it’s still a challenge. Now that we are six weeks away from returning home Daniel and I have begun talking about what it will be like to be back.  I hope this is one of the things I can take with me and try to integrate into our lives back home-- that you don’t “need” so much.  Obviously we work so that we can make our lives comfortable and nice, but to what extreme does it take us? How much time do we spend at work so that we can buy a nicer car, stay at a fancier hotel on vacation, have the newest flat screen tv?  These things are all so out of place here, it almost seems crazy after being in a society where most people work to survive and nothing more.   People here barely have things, let alone things for their things....  

  

Mistaken Identity-- Ethiopian Style

A few weeks ago Daniel called me into his office to see a patient who had come to the clinic complaining of shortness of breath.  Sitting on the bench was a middle-aged woman with a huge tumor growing out of her neck.  It was pressing on her throat, thus making it almost impossible to breathe.  While there are many people who come to our health center with enormous goitres from lacking iodine this one was different.  Daniel drained it and was fairly confident that it was cancer and if not removed soon, probably going to kill her.
    When patients need care that is beyond what we can provide they either go to Bonga, about 45 minutes away, or the larger city, Jimma, four hours away.  Daniel knew she would need more serious help and therefore brought her to see the health center director who would help her figure out the next steps to get her to the hospital in Jimma.   We advised her to return to her town and request a “free letter” (when people are very poor the village chairman can write them a “free letter” which attests to their need to have treatment given at no cost), gather some money for her journey and to come with us to Jimma the following week. We weren’t exactly sure what date the car would be leaving so we collected her contact information and said we would be in touch once we knew for certain.
    A few days later I was in her village on outreach and sent her a note letting her know that a car from Lalmba would be going to Jimma in four days.  (Keep in mind that I am using my very limited Kafanono and hand gestures to explain who I was looking for). As I have written about in other posts, proper communication here is painfully lacking....with no home phones, cell phones, mail, home addresses or internet we often have to rely on letters passed on from one person to the next in order to communicate. As I have seen in other situations and again here-- it doesn’t always work so well.  
    Three days later a woman did in fact arrive in Chiri with a large neck tumor and eager to see what the doctors in Jimma could do for her.  Unfortunately, she was not the same woman!  Our note must have been given to the wrong person....  The lady did have a huge goitre for over 15 years and while we don’t typically take goitre patients to Jimma (its not life threatening) it seemed like it was the right thing to do considering the circumstances. Ironically, she didn’t have a free letter and so would have to return home and come back with one for our next Jimma run. So thus, we went to Jimma without any woman or any neck tumors. 
    Luckily, the real patient returned a week later, still breathing and ready to go to Jimma.  Free letter: check. Family member to escort her: check.  Correct tumor: check.
Ahhh, the pleasure of working in the developing world.    

It's got to be tough

As I have written about in the past, there are 13 children living at Lalmba.  Some are true orphans while others have a parent but for whatever reason they are not able to care for them.  I think it is safe to say that they may be 13 of the most talented, smart, beautiful and all-around amazing children in the world.  They are always eager to help (literally running up to the car every time we return from the market or with a new visitor), they love learning new things, they seldom complain and they are always happy to dance, draw, braid your hair, play a game, cook...and just about anything. 

I have found that the kids can put a smile on my face no matter how rough my day has been, and that overall they are a huge reason why our stay in Ethiopia has been so great.  All I need to do is walk down the hill to the children’s home and seeing them run up to me with with their arms flailing automatically puts a smile on my face.  I have been struck several times at how mature and good natured they are, whether it’s helping translate for me or their excited willingness to work on a new project (such as the mountain bike trail they recently built with Daniel).  Every week or so I try to bring them up to our house to bake something yummy. I wish you could see how patient they are, all 13 of them mind you, while they each get a turn to pick out and mix one ingredient.  They don’t complain, grab, yell or fight over who gets to crack the egg or add the chocolate chips...they all leave smiling and happy to take part in what I think most American kids would think was slow, boring and dull. 

Lalmba’s goal with the kids is not to have them adopted into American or Ethiopian homes as a few people have asked me.  Rather, Lalmba sees them as the future of Ethiopia and aims to give them the resources (mostly by way of a stable home, basic life skills and extra tutoring) needed to make sure they succeed in life.  They are all exceptionally bright and I have no doubt that they will pass the exams needed to get into university here. 

Overall, they are happy and healthy children who laugh and smile often, get good grades and basically are no different than any other Ethiopian kids in the village.  I can’t help but think that even with the benefits they get from living here, it’s got to be tough.  What I can’t seem to get out of my mind is that they are, for all practical purposes, orphans-- they don’t get to run into their moms’ arms when they come home from school, they will never know what it’s like to crawl in bed with their parents or be able to see their parents’ smiling faces when they graduate from high school or college. 

Just today one of the youngest girls, Italey (it-ah-lay), had something wrong with her eye.  I brought her to see Daniel and after some poking around her eye ultimately he had to irrigate it.  During all this she was crying and was obviously in a lot of pain.  I went to check on her just now and she was still not feeling up to speed.  Her eye was still hurting her and you could just tell she felt like crap.  It’s moments like these that I realize how unfair it all is.   While I was able to hold her hand during the procedure and give her a hug just now when I checked on here it’s still not the same as what a mom or dad can do for a sick kid just by being there.  I offered her water and other than that knew I had to just let her be....no silly game or piece of candy could make her feel better.  I’m sure soon enough she will be her usual perky fun self, but in the mean time I’d say that it’s got to be tough.

What's The Right Thing To Do?

On Wednesdays and Fridays, with three other Chiri Health Center staff members, I visit one of the ten villages to which we provide immunizations.  It’s a real perk for me as the drive and hikes are all amazingly beautiful and it allows me to spend time in the local communities. Vaccinations have been a large part of our public health program since Lalmba began working in Chiri twelve years ago.  A few years ago the Ethiopian government started a community health worker program that assigns one or two health workers (called Health Extension Workers, or HEWs for short) to every village.  They are trained to give vaccines, assist in deliveries, provide family planning, and other general health promotion activities.  Community health worker programs are not uncommon and have worked really well in some countries, improving maternal and infant mortality and sanitation-sensitive illnesses.   

Unfortunately we have found the HEW program in our area to be less than ideal.  The workers are often young, placed in very rural communities far from family and friends, and are seemingly somewhat unmotivated to do their assigned tasks.  It seems that in many cases the HEWs spend a substantial amount of time in Chiri (a relatively large village) rather than in their assigned, more remote villages.  Frequently, when we show up to outreach to do vaccinations they are no where to be found and had not told people  in the community that we would be coming. 

I held a big meeting with all the HEWs who serve in our target areas and the village chairpersons to talk about the vaccination program.  I made it clear that from now on the HEWs had to be there when we were scheduled to be in their village, both to help give the vaccines but more importantly to keep track of the records (if both the HEWs and Lalmba are giving vaccines without coordinating, there is a good chance we are over vaccinating people, which is not good). It was a very productive meeting where both their concerns and ours came out and solutions were found.  I made it clear that if we showed up and the HEW was absent we would turn around and go home, no vaccines would be given.  Unfortunately, the very next day and again last week we showed up to outreach and no one was there.  

So here is where the predicament comes up, do we continue to provide vaccines in these areas where the government has its own program to be doing it?  Are we enabling these workers to not do their job by our continued presence?  While it would be easy to understand why we would drop the program altogether (even though the HEWs are adamant that they want us to come) there is a good chance that the people who would be most affected are the community members who would no longer get vaccinated.  It seems like this is the big dilemma for all types of development/nonprofit work- even though the work may positively affect people, in the long run is what we are doing causing more harm than good? 

Friends were recently here visiting and this question came up.  Is it ever okay for outsiders (i.e., white, American, educated folks like us) to work in a country like Ethiopia?    Is our presence here imperialistic?  To me it is a very grey area, with no obvious right or wrong answer.  There are days when I really question our presence here.  Yet on others where I feel very confident that our being here is beneficial.  After-all, by being here, we’re able to bring some of the training and skills that we’ve been fortunate enough to receive and that are not yet available to the local community. I think the vaccine situation is a good example of this dilemma. On the one hand, we are able to vaccinate thousands of people each year against diseases that might otherwise kill them.  On the other hand, we are doing a job that someone else, i.e., the government, should be doing (which is the case with many other issues that NGOs work on all over the globe -- building schools, hospitals, orphanages, doing advocacy work, etc). Is there ever a situation for which it is permissible for outsiders to work?  What about university professors who teach abroad?  Engineers or doctors who come to the US to work? Is there a difference when it is people from one developed country going to another developed country versus developed to underdeveloped?

I am curious to know what your thoughts are on this...where do you weigh in on this complicated issue? Any comments are greatly appreciated!

The Little I've learned So Far

As I have written in other posts, I am continually amazed at how strong and supportive communities appear to be here.  Just last night Daniel told me about a young child that was brought in after being bitten by a baboon. I haven’t seen any baboons around our area so I asked where they came from.  Turns out they were from Angola, nothing less then a twelve hour walk.  So what means is that about twenty or so friends and family members made a stretcher and took turns carrying this kid up and down windey roads, barefoot, without water, Powerbars, Gatoraid, or really anything that you or I would bring on even a leisurely hike.  Just to give you a sense of how difficult this must have been, when we went to this area for outreach there were points where I wasn’t sure our “super-duper can get over anything tank” Landcruiser would make it. 

So why I am telling you all this? 
Unfortunately I found out recently that someone in my family was diagnosed with a pretty rare tumor.  At first they thought it was in the lung which would require opening up the chest to remove it but after a second opinoin it was actually found to be on the pericardium. A tumor on the pericardium is extremely rare, so much so that they have no idea what the chances are of it being benign or malignant. On the flip side, it means that the surgery no longer involves opening the chest (which is pretty invasive and difficult) but can be done thropscopically, which allows for a much easier recovery.  

Obviously being a zillion miles, time zones and without good cell or internet connection makes this a pretty difficult situation. I can’t be at the doctor’s appointments or able to give good moral support.  At the most recent appointment with a highly respected surgen he said that because the surgery no longer requires opening the chest it wasn’t necessary for family to come in from overseas.  No, this would be routine, in and out in a day or two with a recovery time of up to two weeks. And as it goes in the US, If she needs some help afterwards making food, getting to a follow-up appointment, filling a prescription.....well, hiring someone is always a possibility. 

Perhaps being here for four months has had a stronger impact on me then I first thought because his response seems just absurd to me.  At our clinic when we transport patients to bigger hospital we have to fight with families because they all want to come with.  I’ve seen patient’s families wait patiently for days and weeks by their loved one’s bed with little more to do then stare at the walls (no wifi, tvs or magazines in these parts).  When a patient needs to go to a bigger hospital we make sure they have enough money to pay the hospital fee and get transportation home, which can be no less then a year’s income.  I’ve seen people tell us there is no way they can come up with that amount of money, and somehow their community is able to come together to sell a cow or collect from one another the necessary amount.  

Everyone said that coming here would be a great learning experience and I can’t help but feel like I am being given the ultimate test right now.  Yes, I can listen to this doctor and tell myself that its not worth coming home.  The money, the time, the inconvenience--- all add up to being there not worth it I suppose for him.  If I go home, it will mostly likely mean we can’t go on the trip to Tanzania we were hoping to, my work plan will have to be adjusted and people at the clinic will all have to pitch in to fill in for my absence.  Are these the types of things the doctor was thinking about when we said returning was not necessary? Maybe its more that he only thinks of the physical surgery and nothing else.... not the emotional side that comes with being sick.  I feel confident that the surgery will be fine, but what about everything else?  Don’t people need their family to help them through the scared feelings, the worry, the anxiety?

I can’t help but think about the different things here that might seem so absurd to people back home; from having chickens living in your house to the necessity of collecting firewood in order to cook dinner. And yet I think what this doctor is suggesting would be equally shocking to my friends and colleagues here.  Not being with your loved one in a time of need like this and paying someone else to help them....I just don’t think people would even be able to fathum this as being a possibility.   When someone is sick, everyone pitches in. 

While being here had taught me a lot about public health, malnutrition, driving a stick shift, etc. I think the biggest lesson I have learned is that you should do anything and everything for your family and friends...that you should treat people the way you want to be treated.  If it was me I would  want everyone to drop what they were doing, put off vacations, reschedule meetings and be by my side. So contrary to what this doc said, I will be coming home to be with my mom while she watches tv and runs errands(anything really to keep her mind off of this) leading up to the big day, be waiting in the hospital while the surgery is taking place, have her favorite meal ready for her when she wakes up and make sure she has all she needs when she goes home.  It’s funny that we often think as the developing world as being “behind” and yet in a situation like this they seem to make us look like we have it all backwards.   

Africa Is Not A Country

When I first thought about coming to Ethiopia I expected a dry, brown, sad place where life was difficult and hard and anything but enjoyable.  I would venture to guess that when most people think about Africa there is little positive that comes to mind.  From movies, magazines, newspaper articles and books, I have found there is little positive said about this large and diverse continent (which is often lumped into one place, “Africa”, and rarely its individual countries).  Daniel is in the middle of one of these books, where the only things discussed are how terrible everything is here-- the corruption, the poverty, how NGO’s have destroyed people’s work ethic, the spread of HIV, etc. 

I can’t help but think back to an assignment I was given in graduate school to do a community needs assessment of the Delray neighborhood in Detroit.  My professor wisely told us that we were to look at the area’s strengths--not to focus only on the problems.  As those of you who are familiar with Detroit know, it would have been very easy--and most likely what we would have done. Only focus on the bad....the run down houses, the boarded up buildings, the liquor stores and miss what positive things were very much there but easily overlooked when going in with a negative mindset, the houses with beautiful gardens, the churches, an active community center, etc.  

While I am sure that all the bad things people write about and highlight in movies about Africa are true for some people, it is for sure not the case for everyone.  Where we are in Chiri, I am often times jealous of the life that people have here.  Children grow up in green, lush mountains able to run around and play without worries, families are unbelievably close, people will go to great lengths to help others (even if it means carrying a neighbor who is in labor on a stretcher up mountain roads for up to eight hours in order to get to a doctor), because no one has a car people walk everywhere giving them ample opportunity to spend time with friends and family, there isn’t the constant advertising of products and things that can make you feel like you never have enough...the list could go on but I think you get my point.  Of course there are a lot of hardships that come with living in a developing country like Ethiopia-- the chances of dying from a treatable illness is huge, people don’t have a ton of opportunities for a meaningful career, most people can’t turn on the tap to get water or have a stove to cook.

While I realize no situation is black and white and that neither place is better then the other, I can say without a doubt in my mind that Ethiopia is an engaging country with beautiful, happy and generous people which turns any assumptions about what “Africa” is on it’s head.  I just wish there were more journalists and filmmakers that saw the other side that exists here.  I wish there were articles about the families who sit by their loved ones beds and bring them food for days on end while at the clinic, or the parents who carry their children for hours, and even days in some cases, when they are malnourished.  I wish there were movies about the many families who are surviving just fine working their fields and don’t rely on food aid.  I wish there were NY Times articles about people who work hard, go to college and work in places like our clinic helping their community.  I wish there were films that conveyed how green and mountainous and lush this country is.  I wish the news told the story of the men and women who are entrepreneurs who are growing towns like Chiri.  

What I really wish is that you could see all this for yourself....I don't think that this blog can give justice to all that I have seen and felt in just the short time I have been here.  I do wonder though why this is the case....is there something we get out of labeling places like Ethiopia as poor and in need of saving?  Why don't we hear more about all that is positive here? 

(If you are wondering where the title to this blog comes from, a classmate in social work school wore a button with “AFRICA IS NOT A COUNTRY” which really amused me)