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)

What Makes a Day Great?

Today was a typical day for me here at Lalmba.  I set out early to go on outreach to the village of Angela, a newer site for us, which was a two hour drive from Chiri.  Turnout was good and we gave over 200 hundred vaccines.  We were there most of the day and returned to the health center around 3pm.  I was sitting in my office when Faith told me that one of my favorite malnutrition patients, a little girl named Mizrat, had returned with her father for her follow-up appointment.  As I have mentioned in other posts, I spend a lot of time in the malnutrition room playing with the kids and interacting with the parents.  They are here from one to two weeks, depending on how bad their case is, so it gives me a god opportunity to get to know them.  There was something really special about Mizrat and instantly I just adored her.  When she first came to Lalmba she could barely walk, I should mention she is two and a half, and was in such bad shape that she basically couldn’t do anything but sit in her bed all day. Slowly but surely her health improved was and she became more active, walking all around the clinic with me (my version of physical therapy I guess) and began to actually interact with the world around her.  When her time here ended I sadly said goodbye to her father and her, hoping they would return for follow-up so that I could see them again.  Patients can live very far away, theirs is a six-hour walk, so it’s not a sure thing that they return. 

I was glad to hear that they came back for their appointment but was a bit said to have missed them.  Faith said they waited a bit but must have left.  Bummer…..I was wondering how she was doing and if she would remember me, but I would have to be satisfied with just reading her follow-up paper work. 

As I was imputing data from today’s outreach one of the clinic guards came into my office to say that my friend was here.  I looked and up and wouldn’t you know—it was Mizrat!!  Her father said that he really wanted to see me so they spent the afternoon in town (not sure what they could have done since there isn’t much to do here).  Literally in a matter in seconds my day went from fine, to amazing.  I really can’t tell you how happy it made me to see them and to be able to give her a hug and see them for a bit. I must have had the biggest smile on my face and I think I yelped with delight when I saw it was them.   There happened to be another patient and her father here for malnutrition follow-up, so the four of us chatted for a bit. Something new I am starting here is to give patients who return for follow-up seeds to plant vegetables in their gardens.  People here mainly grow and eat cocho and teff, plants that don’t provide enough protein or calories which causes malnutrition.  While patients are here we counsel them on different foods, show them our demonstration garden and have them attend a cooking class all in hopes of teaching them about the different foods that can be grown here--carrots, beets, spinach, etc. (Unlike in the US where people often know how to prevent diseases, here surprisingly people have no idea that their diet can cause malnutrition.) I gave the fathers some seeds and tried to pick their brains on how to make the program better.  While they didn’t have any criticisms of the program Mizrat’s father did have a lot to say about why it was good.

            

             Before coming people in his town said he was crazy to bring Mizrat to Chiri as it was obvious she was going to die.  No one thought she would make it and the journey would be for nothing.  He came anyway and sure enough she was not only alive but doing better.  When he returned home everyone was so happy and excited to see that she was in fact alive and well.  He went on to describe how he learned here how to change their eating to make sure this doesn’t happen again and about other health issues that can cause illnesses such as poor sanitation, cleanliness, etc. Clearly, the health center had done a lot for Mizrat and he was tremendously grateful as he came with only 35 birr (about $3) and Lalmba paid for all of her treatment and his food while they were here. He thanked us and promised to be back for his last check-up in a few weeks.

             There are moments when I wonder if the work I am doing here really matters.  I can’t help but question if the communities I go to on outreach would be any different if I (or any other ex-pat) wasn’t here….and if there is any real change from the work we are doing.  But then there are times like this afternoon when the sight of Mizrat and her father just made my day.  Knowing that they stayed to see me makes me think that the little itty bity part I play here might just matter after all. 

             

Being Poor Sucks

As the day was ending at the clinic I noticed Daniel and Richard, the other ex-pat doctor, walking into an office with their last patient.  Seeing as I had just finished up with my work I thought I would sit in.  The young man looked pretty healthy but as it turns out he had TB.  This is a pretty common illness here, one which is treated with two months of daily medications given at the clinic followed by six months of medication taken at home.  The key to treating TB effectively is that the patient cannot miss a dose of their medication and if he or she does the infection can become drug resistant which is really bad-- therefore we initially require patients to stay in town and come to the clinic each morning to take their meds.  If you have read Tracy Kidder’s book about Paul Farmer, Mountains Beyond Mountains (which I highly recommend) this probably rings a bell. 

Anyway, the patient was about 17 years old and from a village very far away.  When it was explained to him that he had TB and what the treatment protocol involved, he got a very sad look on his face.  While you might guess this was due to the new information about having TB, the truth was that he was more stressed about how much it would cost for him to be able to stay in town to be treated.  He explained to us that last year his family and he had been moved from another area of the country and resettled to our zone because of the limited amount of  land where he is from.  We sat there listening to him as he told the story of his family’s finances, they used to have more money but now are quite poor, and how he now only has 50 birr to his name (about $4).  He quickly calculated how much it would cost him to rent a room for the two months and to buy food, less then $15 a month, and immediately his head sunk.  This was too large an amount, impossible for him to come up with.  Could he go home and borrow money from family and friends we asked?  He did not seem too optimistic about this.  Could he start treatment today he wondered?     He clearly understood the danger of TB and wanted to start medication as soon as possible. 

Normally we require a 75 birr deposit, but all he had was 30 birr.  Lalmba does have a special fund for people who truly cannot afford their treatment, but I had a feeling he might not qualify.  This may sound crazy but since he had shoes and new(ish) pants and a shirt I had a feeling the committee that decides these cases wouldn’t believe him.  Now whether he can come up with the money or if the committee will find him needy enough to pay for both his treatment and living costs, I don’t know.  I don’t think Lalmba would ever let a person go without being treated, especially for something as serious as TB, but the situation still pains me just to think about it.  If that were me or probably any one of you reading this blog this would never be our reality.  TB is almost nonexistent in the US in the general public largely due to our higher standards of living and better health care, when we need to get from point A to point B it usually doesn’t involve walking for hours or days, most teenagers wouldn’t have to travel and be on their own when seeking health care in a different city, and most obvious--- if we were facing a potentially deadly illness that would cost less than $50 to treat, it would not cause us an unbelievable amount of stress. 

Daniel and the other doc, Richard, sent him home to collect his stuff and bring back as much money as he can come up with.  TIme will tell what the outcome will be for him as he said he could be back by Thursday (it’s about a day’s walk from Chiri to his town).   

Everyday we see patients like this and the same thoughts run through my head.  Whether it’s a child who is so severely malnourished they look as if they just left a concentration camp, or a woman who was burned after having an epileptic seizure and fell into the fire they use for cooking, it all just seems so unfair.  So much of the illness and injury we see is completely avoidable it really makes you wonder if life is playing a mean joke on so many billions of people whose reality is like this patient.

Man's Search for Meaning

I am not sure if this post will make any sense, but I have a few different thoughts running through my head that I wanted to try and share with you....so bare with me on this one.

Last year one of my favorite graduate school professors (Sallie Foley for all of my U of M people out there) recommended to our Grief and Mourning class that we read Viktor Frankl's book, Man's Search for Meaning.  Frankl was both a Holocaust survivor and a well respected psychiatrist. In his book he argues that "life is potentially meaningful under any conditions, even those that are most miserable" and that "people have enough to live by but nothing to live for; they have the means but no meaning." Frankl credits his surviving the Holocaust to the fact that he was in the middle of writing a book when placed in a concentration camp. His strong desire to survive in order to finish and publish it kept him going in even when he was the sickest.  Even in the bleakest of human situations, he was able to find meaning and it was this meaning that made life bearable. 

While I am in no way comparing my life here to living through the Holocaust, it's quite the opposite really-- our life here is pretty amazing....this morning I ate breakfast with Daniel while watching the monkeys play, I spent the day training community leaders from four villages in public health programing, and I sit here on my porch drinking a beer, listening to the birds and looking at  beautiful sunset over the mountains.  Yet, I feel like I am beginning to understand what Frankl writes about in his book.  Yesterday I drove to a meeting in and on the way saw a patient who was beginning his journey home, nothing less then a four hour walk mind you, even though he is missing a foot and on crutches.  He happened to be going to the same village I was and so I was able to give him a lift.  It actually made my day to be able to give him a ride as I knew the walk would have been long, hot and brutal. 

In the end, the meeting I was going to didn't happen as not enough people showed up. Even though I had spent all morning getting there and hiked half an hour in and out of to the meeting place, I still felt the day was a success because of giving the man a ride.  That made me think about Frankl's book and his argument about our ability to be happy in life, no matter what our circumstances.  It really is all in the way you look at things.  One might think that there is no way a CTA bus driver could be happy with his job or find meaning in driving in traffic all day, stopping every block to let passengers on and off, having to give directions to tourists all day long on how to get to Michigan Ave. or the zoo, but now I see how it is all in their point of view.  Without the driver people wouldn't be able to get to work,  to a necessary doctor's appointment, to see the friend they are visiting in town... yup, his job can in fact provide endless amounts of meaning.  And when we see the meaning in life, this makes us content.  It doesn't matter what kind of car we might drive or the vacations we can afford to go on, its these little things. 

Everyday here I am given these opportunities and I feel so blessed that this is the case.  Whether it's playing with a patient in the malnutrition room and getting them to smile or holding someone's hand while Daniel stitches up their arm, these moments provide me with what Frankl describes in his book as opportunities to find meaning in life.  Something I struggle with in my own life is being appreciate of what I have and living in the moment.  I hope that throughout this year I am able to curb my negativity and find the meaning in each day, to which Frankl suggests allows us to be happy and fulfilled.   Hmmm......here's to trying.

Generosity

When I go on outreach to the different villages we work in I am reminded of how rough the toughrain is  here.  I am just blown away when I think about people  the fact that often times patients are carried here on handmade stretchers by anywhere from 40-75 community members.  I think I have mentioned this before, but when someone is really sick and can't walk, they are carried here overland-- in many cases taking up to several hours to a day-- by friends and family as there are no cars or busses and ambulances are unheard of.  Yesterday on the way to the village of Goize we came to walk with a women and her son.  We all began chatting and it turned out she was also going to Goize to visit with her mother.  I asked how far it was from her own village to Goize and she replied three hours. Yup, this woman and her ten year old son were walking six hours in one day just to see her mom for the afternoon.  Can you imagine?  If we had to walk hours up and down mountain sides, would families still exist in America?  Our family times holiday meals around when parking on Lake Shore Drive opens up...walking three hours each way--- I have a feeling there would be a few empty chairs at Thanksgiving if this was the case back home.  Obviously, its a different world here and people's lives don't operate in the same way but it stops to make me think about how much more I can do to be a better sister, daughter, wife and friend. 

On the way we got to a super muddy area and as usual I lost my balance on a rock and my leg sunk deep into the mud.  There was a little stream up ahead where my co-worker Alias convinced me to take off my shoe and wash off my foot.  The woman were were walking with immediately jumped into the creek and began scrubbing my foot and cleaning my pants, shoe and sock.  Even her son helped out.  Now really, can you picture this happening back home?  People don't even stop to help when they see someone fumbling with a map, can you imagine cleaning a stranger's feet?  Also worth mentioning is that her son offered to carry my bag and when I said no he took the backpack filled with a cooler and immunizations from another staff member and carried it for at least two hours. 

Fast forward a few hours....we are in Goize and in the middle of doing vaccines when I notice a woman whose child looks really small.  Since I am not trained to give vaccines I use the time on outreach to check children for malnutrition.  This woman had three kids with her, ten months, two and six years-old and after looking a little closer it was apparent that both younger ones were severely malnourished.  The women herself wasn't in great shape either, she had one of the biggest tumors I've seen so far growing off her neck (possibly a goiter).  We convinced her to come back with us to the health center where we have a malnutrition program and could treat her kids.  While I won't go into it now, hers were just two of the MANY children I saw with severe malnutrition in Goize, something pretty alarming to me.  Honestly, we could have brought back eight more families if we had the room in the car. (You might be asking yourself how I can tell if someone has malnutrition since I am not a doctor or nurse....luckily there is a very easy to use measurement strip for upper arm circumference that I have begun taking to all outreach sites.)

As we began the trek back to the car a random woman invited us all into her home for some coffee, which again made me stop and think.  Have I ever invited a complete stranger into my home?  Sure I am always happy to have friends and family over for shabbat dinner or to hang out, but a complete stranger off the street?....can't say I have.  As we continued  back people stopped to ask the mother why she was with us.  After she explained they were all tremendously concerned and threw their arms in the air to show their sympathy and giving words of encouragement.  At one point it began to rain and we ducked into a hut that is used for selling tela (a fomented barley drink).  Again, the women asked what was going on and immediately hugged the woman, grabbed their chest and poured her a big drink.  In a place where people have so little, giving things away for free can't be easy. You could just tell that these women so cared and felt for the mother, even though I don't know that they had ever met before.  As a co-worker explained to me a while back, people here really feel for one another......this was more then evident on this hot, rainy afternoon. 

As we continued with the walk the woman began to struggle with her two kids, one tied to her front and the other to her back.  My co-worker Sebsibe took matters into his own hands and carried the baby back himself.  Just to set the stage for you, this was no simple walk in the woods.   We were walking basically straight up and down a mountain in the middle of a hot and humid day after going all day without anything to eat and little to drink (the Ethiopians aren't big on drinking water unless it's with a meal).  We made it to the car and eventually back to Lalmba.  As I pulled up I mentioned to the guard that we had a patient in the back of the truck.  He followed me in and halped carry one of the kids to the clinic. 

I am not sure if these stories will do justice for what I experienced today or be able to convey how telling each instance was to me.  I feel like I have so much to learn from the people I meet here.  I hope that one day I can do for others what I have seen others do so selflessly.  I hope that I can feel for others the way people here do.  After thinking about this I realize just how much I have a lot to learn about life and generosity....and luckily for me I have a seemingly endless supply of teachers all around

PS- for those of you who are follow the weekly Torah portion you will share in my amazement at the similarities with my experiences on Friday and what you read this Shabbat about Avraham's generosity towards strangers......beshert, coincidence.....???

Over the past 24 hour I have experienced several moments of immense generosity, directed both at myself and to complete strangers.  In a place where people have so little I am always amazed at the things people do for each other. 

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Some of My Favorite Photos...So Far