Category: Around the World & Back Again

“You cannot save what you do not love, and you cannot love what you do not know.”

Aldo Leopold said that, or something close, and I think of it as I enter Zambia’s Mosi y Tuna National Park to experience my first safari game drive.   It is  6:30 am, and it is cold. I am wearing a coat, I am under a blanket, and the jeep’s windows are all shut.  As Jason Paltzer, who is driving, tells us about an encounter he had with an aggressive elephant in this very park,  I am both disappointed and comforted by all the layers between me and the animals that we hope to see …. After a few moments, the grimy pane compels me. I open the window, leaving only air between me and wild nature.

Soon we see an impala.  It looks fragile, knowing.  It freezes, but then, at the sound of a camera shutter, it runs.  Its effortless gait reminds me of the way my daughter Kristen runs.  I love the impala for a moment, and then move on.  Next up is a warthog, awkward and muscular.  There is nothing beautiful to recommend this animal, yet we are taking photos and saying his butt bounce is cute. If we can love the warthog as he is, maybe there is hope for us?  We slow down for some guinea fowl who walk in the road in front of our jeep, seemingly unaware of us.  For some reason completely at odds with ornithological precision, I am reminded of Flannery O’Connor and how she loved her pea hens, and saw a map of the world in their plumage.

Next I am struck by the eyes of the giraffe, plaintive and loving, not unlike my golden retriever at home.  Then the zebras amaze me.  They are all perfect specimens, as if a doting zookeeper has been following them around. Their stripes are so contrary to any idea of camouflage. They don’t want to hide.  Instead, they are designed to find each other,  for the purpose of solidarity and survival. Their stripes also cause them to blend into each other, which makes life safer for the young and vulnerable. They have no natural predators in this park.  They pretty much thrive in peace.

I am the first to spot the crocodile.  He is underwater, but I see his long slender nose.  In the face of this fast, sharp-toothed endangered species, loving wild things becomes complicated… He is the reason we cannot swim in the river. I want life for this crocodile, yet the idea of his extinction provokes a whisper of relief in me that I cannot deny.

Baboons are a nuisance, we have been told. A few weeks ago one of them actually fought a tourist for a candy bar (or something), knocking him to his death, near Victoria Falls.  Now several baboons are prowling around our truck.  I am uneasy, and avoid looking them in the eye, afraid I will accidentally send the wrong message.  Then we see one in a tree — likely a female, she has a baby in her arms.  Slowing down for that we see another, also with a baby in her arms.  Once I know how to look, I see that the tree is full of mother and baby baboons, as if it is a scheduled play group!  This incredible act of social organization fills me with awe.  I decide to defend the baboon from now on.  It seems they are judged unfairly.

After an hour or so we arrive at the far end of the park where we can get out and stretch before we head back. There are some guards and another car nearby.   I wish I could walk alone for a bit.  I wish that the cars, and my friends, and even the strip of road that we rode along, were gone.  I would linger here, trust the peace, and accept the occasional predation– which seems to be the price of this particular kind of beauty.  I would live from truce to truce like the animals, abiding by their cautious rules of engagement.  Would I be able to freeze and run and fight at the right times, I wonder? ….  I stand under a tree for a bit, then explore a little ways in each direction, but I don’t stray too far from my tribe.

As I get back in the car I realize that there are things that I will never do–like hang glide, or swim with crocodiles, or walk alone in the wild.

I am 35,000 feet in the air, moving at 550 miles per hour toward Lusaka, Zambia. It is -47 degrees Farenheit outside. Although I have been travelling for 27 hours, it is only now, on this final 9 hour leg of the trip, that I begin to seriously contemplate the freefall that is possible from here.  During the first 4 legs of the journey I had been distracted by a missed flight, several reroutes, 2 “flying pills,” and 4 compensatory glasses of wine. But now that I have procured the desired place in the air, I am hit with the realization that I am seriously and dangerously far from everything I know and love.

The other passengers seem nonchalant, even confident, completely unaware of how helpless and absurdly unfit for life we are up here. None of us could withstand the cold temperatures at this altitude for more than 30 seconds, we could not breathe without the pressurized cabin, and there is only enough food and water for a day or two. We are physically incapable of getting ourselves home, both in terms of physical endurance and temporal feasibility. None of us would know the way home anyway.

I am so far away from my children! This thought makes the vertigo the most profound. I try to put down what I feel in my veins, turning my attention to the numbing mechanical buzz of the plane. But the mental and emotional clarity lingers. This trip which I have chosen, not just once but as a regular part of my life, is completely contrary to the instinctual logic, be it maternal, human or animal, that is hard wired  into me. Better to measure things in time than distance, I reason. It is only 10 days. They go to camp for a week in the summer…Going 7000 miles away to a landlocked country in Africa is sort of like that, isn’t it?

I have never been to Zambia, but as I watch the locator arrow move across the map of Africa I am comforted by the idea of getting there. Right now I am in an unnamed space between Cairo, Addis Ababa and Johannesburg. The Lybian Desert and Darfur Mountains are labeled, but other than that I cannot say where I am with much precision. Zambia, a landlocked country the size of Texas,  is still 2500 miles away.  Formerly Northern Rhodesia, the culture is a blend of Bantu and European influence.  It is one of the poorest countries in the world, per capita income is about $1000/year, life expectancy is 41 year of age,the  infant mortality rate is 119/1000 and the maternal mortality rate is 591/100,000.  The economy is showing hopeful signs of growth, with copper and agricultural as principal sources of livelihoods.  Zambia is home to 13 million people, and 3 or 4 of those people are expecting my arrival. I am going to work with a variety of health and social service programs, and visit a village where my colleague Jason worked and lived for two years. I hope to see a hippo and avoid altercations with baboons, and I am going to stand in the mist of Victoria Falls.

I know I will be able to fall asleep soon, and the flight is beginning to feel normal.  I realize that the noplace between places is always like this. God makes a flash appearance, reminding me that this space, so many miles above everything, is something sacred, to be savored. I am the same distance from everything, and from here the world is interconnected and whole. I will try to enjoy how large and small the world is. I will trust sleep and time to take me where I am going, and home again.

On my recent trip to Ethiopia, I decided to reread Cutting for Stone by Ethiopian-American surgeon Abraham Verghese.  I first read it when it came out in 2009, a beautiful novel that  also provided a window into Ethiopia’s health system.  Now I wanted to test it out on its home turf.

From Addis I was less focused on the ways in which the book could “take me there,” since I was already “there,” working in hospitals, walking the streets, meeting people who had lived through the challenging times that Verghese described.  I wasn’t troubled by the license that Verghese had taken with some of the factual details relating to Ethiopian history or “Missing” Hospital itself…. He had told us it was fiction.  A fiction writer myself, I understood that sometimes you have to make some stuff up or move things around a bit to tell an authentic story. Would Verghese’s story and its messages about life and place and love and fate ring true?  For me, that was a more interesting question than whether his story corresponded to the material and chronological facts.

Reading from my hotel room in Ethiopia, where the hall light streamed into my room all night and the dogs began barking just before dawn,  I realized how much this novel transcends it’s particular setting, and speaks to so many of us who have been shaped by immigration, by separation, and by living in ways that leaves us with more than one place that we can plausibly call home.

Verghese tells us the story of twin boys, with two fathers, two mothers, two countries, and one woman they both love.   We all have so many possible lives and possible selves, and the story of Marion and Shiva his twin reminds us that it is hard to contain all we can be in one life and place, and it may be even harder to contain it in two.

The boys are attached a birth, share a bed, and then are separated by miles, oceans, time, revolution, and their own differences. The story unfolds through the eyes of Marion, as he tries to understand and reconstruct the truth of his past.  What happened?  And why?  There is always more than one answer — a double, an opposite, a twin.  The boys have two parents who raise them, and two others who gave them life.  Their birthmother, Sister Mary Joseph Praise, lived a prayerful life of submissive service, and, we are led to believe, also experienced the spiritual passion of Theresa of Avila.  Thomas Stone, their biological father, also had a divided life, on the one hand a focused, tireless and dutiful surgeon, and on the other a man possessed by binges of excess.

As I read in Addis I realized that many of the diaspora Ethiopians that I am working also have two lives and two places that are home.  I too, am divided, both the person who wants to go home, and the person who wants to stay.  Can we live these double lives, or does one of our selves have to sacrifice itself for the other?  Cutting for Stone asks this question and, as might be expected, shows that there is more than one answer.

For me the special thing about this book was not the fact that “it takes you there.”  In fact, when I look for scenes that capture what is like to walk the streets of Addis or be immersed in the setting, I find that they are few.  This made me realize that while I thought I was experiencing this place in a close up and personal way, Verghese was writing from a more intimate perspective, a surgical distance where the background fades as the human heart is dissected in ways that reveal truths common to all.  Verghese finds the truth and healing of our brokenness through the act of fiction, because, as he puts it,  “where silk and steel fail, story must succeed.”

Sitting at the Java Den at University and Mills before class,  I was not sure what to expect.  Students from PHS 370 were invited to drop in to meet me, connect with each other, and talk about local to global perspectives on public health.  I was armed with a computer, a short novel, and the New York Times in case no one showed.  But I did not even get to read one headline….

Maggie arrived first wanting to explore how to make global health work a part of her life.  Relatively new to UW, she is shifting from a political science focus to a public health focus.  She told us a bit about her work in Bulgaria where she worked with the Roma population.  this video portrays the challenges that this ethnic group faces.

Abby had been on the Uganda Field experience led by John Ferrick and James Ntambe and she has done a lot of coursework related to public health and health disparities.   Pascale who joined us later will participate in the same Uganda program next year.   Laura, a global health certificate student,  joined us and shared that she will be working with Araceli Alonso on the Health by Motorbike program this summer.

Tahiya joined later in the hour and very generously shared stories about her summer in Bangladesh where she worked in the Geneva Camp focusing on children with disabilities.  The camp, established in 1972 to meet the needs of Pakistani’s who were still in Bangladesh after the transition, is now a crowded multi-generational community.  The video focuses on the health risks for children in the camp.

Liz, who is doing an  honors project for the class, hopes to consider homelessness in Madison in a global context through case studies or oral histories.  Stay tuned as she may be willing to share her project in  class or discussion section!

I blog as a reflective practice and to share information and experiences with my students, colleagues and friends. Some of the topics that I will cover this semester include my upcoming global health work in Tanzania in March — I will miss a few classes but will make up for it with some blog posts!  Also, I am working with a group of students who are planning to go to Ecuador to do service learning in a community where I have worked for the past six years.  I am going to “back blog” for them from my journals, so I can share some of my favorite memories and photos with them  and introduce them to the community where they will work.  I am going to cover campus events like lectures by Ruth Levine, who is coming on March 14th, to our annual Global Health Symposium.

I am also planning to do some global health-related book reviews.  Coming soon Is Cutting for Stone, by Abraham Verghese, which takes place in Ethiopia.  I am also reading Haiti after the Earthquake by Paul Farmer.  I will review A Sand County Alamanac, by Aldo Leopold, to explore the implications of a his “land ethic” for a new global health ethic.  Finally, I will reread one of my all time favorites, Cry of the Earth, Cry of the Poor, by Leonardo Boff.   I wonder if it will seem as good as it did when it changed my life many years ago….

Please feel free to comment on this post or make suggestions for future topics!

UW Madison Alumna Sweta Shrestha and I visited the Hamlin Fistula Hospital on behalf of our students on Friday, December 2, 2011.

The fistula ward was not what I expected.  For one thing, I thought it would smell.  I had prepared myself to smile, stand close, show no sign of revulsion.  I did not want to add one iota to the pain or shame that these women (many were young girls, actually) had experienced,  having been shunned by their communities, where they were often relegated to an outdoor shack because of the odor and  incontinence related to fistulas the were caused by obstructed labor.

A series of paintings that hang in one of the entrance halls to the hospital (signed Dawit B.), tell the typical story of how these women got to this place. I could not help but think of the stations of the cross as the story unfolded, beginning with a very young bride and early pregnancy, during which time her in-laws expect her to do the heavy work like hauling wood, carrying water and grinding grain. Fasting might also be practiced, for all or part of the pregnancy, further compromising health.  Then, if labor is obstructed (small stature places a woman at higher risk) and no medical care is sought, these young women can suffer for 3-9 days, with a still birth the likely outcome in 96% of the cases.  Another common outcome is a hole in the bladder wall (fistula) that can leave the woman incontinent.  Her husband is likely to leave her.  Then his parents send her home to her own family, where she will sleep outside because of the leaking and odor.

There are 9000 new cases of fistula every year in Ethiopia, according to Dr. Gordon Williams, who kindly gave us the tour, and this year 2500 got care through this and affiliated fistula hospitals.  While they can accommodate  4000 patients/year (only enough to meet 1/2 the need) this capacity is not realized because the women who need care are isolated.  They do not know that other women are living with the same problem.  They do not know that there is a cure.   The journey of the “Fistula Pilgrims,” a term that  founders Reg and Catherine Hamlin used to refer to these women who came to them for help, is portrayed in a moving award-winning  documentary called “A Walk to Beautiful” (see trailer at which tells the story of 5 women who make the journey to the Hamlin Fistula Hospital to seek care.

Fistula Patient –photo from Hamlin Fistula Hospital Website

When women arrive at the hospital they are given a clean gown and a brightly colored patchwork blanket that will be theirs to keep.  It provides warmth and comfort, and  later it is a reminder to them to tell others about the care and cure that is possible for women who suffer from obstetric fistulas. These blankets are donated by people who care from a distance all over the world.  I saw women in their beds, in the clean well-lit ward, urine bags in place, patches of color everywhere. They were at rest, comfortable, some smiling, a few reading (either because they are just learning or because they already had rudimentary skills). There is a garden on the grounds, and a “house” where they can go for a traditional coffee ceremony, and also hear taped stories in their own languages (since many speak languages other than Amharic).

Surgery will cure most of these women, but 25% of patients will need to try other strategies or continue to live with the incontinence.  To provide choices for women who can’t go home, the Hospital has also developed a rehabilitation center that includes a farm, a simple restaurant, and other income generating activities.   It was wonderful — and a lesson in what beauty truly is– to witness the healing of  these women, and to see them treated with such dignity and care.

Women with their blankets relax in the Garden at the Hamlin Fistula Hospital (from official website)

Of course I wish I could do more than just walk through the ward, smiling and saying “salaam.”  And thanks to my students I can ! Sweta Shrestha and I made this visit on behalf of our freshman honors global health students, who had learned about fistula and watched “A Walk to Beautiful” as part of a film series that Sweta has been leading for the past year.  The students  wanted to go beyond merely studying the problem — they wanted to do something personal for the women, to send a message of hope and care across the world.   Dr. Williams assured us that blankets and/or financial donations from UW-Madison students would be welcome, and we made sure we got the specs before we left.

For people from the Madison area: the UW-Madison students are organizing a showing of the film Walk to Beautiful  on campus on February 5th, 2012 (time and location TBD — check back here).   We hope to discuss the film, learn more about obstetric fistula, and make some blankets to send to Ethiopia.  There will be materials to work with at the event, but if you knit or crochet feel free to make some squares (10″x10″) in advance and bring them to the film showing.  We will patch things together and deliver them to the Hospital. The brighter the colors the better!   This is another way to celebrate and participate in the Wisconsin without Borders initiative.

More information about obstetric fistula and the Hamlin Fistula Hospital in Addis Ababa can be found at: . Also, there is a chapter devoted to this site and work in a book I highly recommend,  Half the Sky, by Nicholas Krustof and Sheryl WuDunn (see Chapter 6: Maternal Mortality: One Woman a Minute, p. 93-102).   Dr. Catherine Hamlin (with John Little) has also written a book entitled, The Hospital by the River: A Story of Hope.  It is a straightforward narration of her life and work, and a very interesting read.

Would you like to go to the ICASA 2011 conference in Ethiopia?  It’s not too late…..

It was such a privilege for me to be at the conference and hear presentations from researchers from around the world.   This post is a gateway to that meeting for my students and readers.  I am providing a summary of some of the bolder plenary remarks, as well as highlights from some sessions that I attended.  Most importantly there is a link that will allow readers to browse the full program and all the presentations.

Challenging words from Stephen Lewis about the Global Fund: Lewis described the decrease in donor funding of the Global Fund as appalling and attributed especially bad behavior to the EU.  Dismissing economic causes, he characterized these decisions as valuing women and children in Europe and North American more than women and children in Africa, favoring fighter jets over human beings, and protecting defense budgets instead of millions of human lives.

Tewodros Melesse was a brave Ethiopian voice for dignity and rights for all:  Melesse emphasized the sexual and reproductive rights of women, children, adolescents and LGBT persons.  Speaking out against stigma and discrimination of all kinds,  he reminded the crowd that  there had to be respect for, and room for, differences of opinion. Melesse words were appreciated by many, especially session co-chair, Miriam Were of Kenya, who dubbed him an honorary woman for his advocacy and willingness to speak out.

The conference papers addressed HIV prevention, testing, treatment(s), co-infection (especially TB), prevention of mother to child transmission, and challenges in reaching and caring for highly vulnerable populations.  Participants reported on many aspects of the diverse and complex epidemic, which Peter Piot described as many epidemics, rather than one.  Researchers presented evidence about the feasibility of lifelong ARV care, male circumcision, microbicides, and care for discordant couples.  I chose to attend sessions that focused on health systems and multi-sector approaches, since that is the emphasis of the Global Health Institute at the University of Wisconsin-Madison.

From ICASA presentation by Fana Abay for Enda-Ethiopia

HIV and Agriculture:  This session, entitled promoting livelihoods for HIV/AIDS affected communities, featured rigorous research, much of it in Ethiopia, related to sustainable agriculture and economic empowerment.  Since I come from a community where local food and urban gardens and farmers markets have gained a lot of attention, I felt at home as I heard about strategies for urban populations that included bio-intensive gardening and small-scale dairy efforts through south-based NGOs.  This study documented improved CD4 counts!  A second study, which reported improved nutritional status, focused on low input gardens and local food production that increased access to eggs, vegetables, and beans. Another study explored the relationship between HIV status and land use, finding that 43% of HIV affected households have lands that they are not able to cultivate.  Strategies that address basic food security alleviate hunger, and they do so much more.  They can enhance the effectiveness of treatment, enable HIV positive persons to be strong enough to work their land, and they can contribute to reduction in transmission by reducing the incidence of transactional sex (girls having sex for money because they are desperate for food).  Community-based HIV efforts are increasingly  going beyond health care services to address hunger.

HIV and Non-Communicable Diseases (NCDs):  There has been much talk in the last few years that vertical programs like those that address HIV/AIDS could  contribute to overall health system strengthening, because of overflow benefits, such as the development of general clinical and management skills,  and the potential for more rapid horizontal integration of services. This session made the case that drug supply and quality assurance systems developed for ARVs could make it easier to develop similar systems for NCDs.  While insulin and asthma inhalers are expensive, many of the drugs needed to treat NCDs are affordable.  Presenters also stated that the MDGs neglect non-communicable diseases — and HIV care and monitoring fail to use the opportunity to detect NCDs, even thought HIV treatment likely increases susceptibility to some NCDs. With modest adaptations, HIV testing facilities could be adapted to test for diabetes, cholesterol, and BMI, and early diagnosis in the context of HIV care and monitoring would be possible.  Presenters also made the case that the trajectory of HIV care was similar to care for people living with NCDs. There is a similar focus on early diagnosis, continuity and multi-disciplinary, family centered care, as well as referral, self-management, and community linkages.  Therefore, the headway made in HIV care could be leveraged for more rapid and effective scale-up of care for non-communicable conditions.

 You can access and learn from the ICASA presentations and proceedings at the link below.  All the presentations are there. To browse the program and find presentations that interest you, scroll down toward bottom left and click on ICASA program book or ICASA pocket program.  Note the date, room and last name author and presentation title.  Then go to the folder and look in the room where the presentation took place for the file with the author and title that you noted (most are power points).

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Zero new infections, Zero AIDS-related deaths, and Zero discrimination.  On December 1st, World AIDS Day, while these goals were being explicitly discussed in various fora around the world,  I was in a hospital in Addis Ababa working with colleagues from Ethiopia and Tanzania to develop plans to improve healthcare quality.  We mentioned World AIDS Day, but we spent most of the time talking about concrete changes we could make for trauma patients in local hospitals, for clients in local health centers who need HIV testing, for patients who need pain relief.  For me, working for tangible change against the backdrop of big inspiring ideas, was the perfect way to mark the day.

A few days later I found myself engaged in a different way.    I headed down Bole Road in Addis Ababa toward the 16th Annual Conference on AIDS and STIs in Africa (ICASA 2011), part of a throng of 1o,000 people who all, in one way or another, were part of the fight against AIDS.  Today we were coming together to share 1000 scientific papers and 175 workshops, and to imagine how to create an AIDS free generation.  We would be celebrating the successes of the last 10 years, including the facts that 32 countries have stabilized the epidemic,  22 countries have reduced new infections by >25%, and countries like Botswana are leading the way with universal access to care and virtual elimination of mother to child transmission of AIDS.  Kenya is leading in important ways also, with the establishment of tribunals to assure rights and address stigma and discrimination.

We followed the sound of drums emanating from the main hall of the Millennium Conference Center, where many political and public health leaders were on the agenda.  In the final hours before the event it was rumored that former President  George Bush would be making an appearance…

… and he did.  Acknowledged for his courage as a first responder to the call for care for people with AIDS,  and praised for the establishment of PEPFAR,  a program which (in spite of its imperfections) has dramatically changed the landscape for people with AIDS,  George Bush was greeted with a standing ovation by the predominantly African crowd.

Did I stand up myself you may be wondering?  Well, first I should disclose the I am a life-long Democrat.  I consider myself open-minded and I care most about integrity and competence. I would vote Republican if the right candidate came along..but my bi-partisan credentials are weak.  I have never actually pushed the button….

I should also say that I am kind of  persnickety about standing ovations.   I think they should be rare, and I save them for near perfect performance.  The abstinence only campaign was definitely a wrong note that I could not overlook….

When Bush took the podium, and nearly everyone stood up, those who did not kept their hands in their laps, looking incredulous, uncomfortable, or just plain still.  There was a lone shout of “what about Iraq.”  I myself stayed seated.  As I listened to Bush from the audience I was a bit surprised by what I heard.  “In order to advance as a society we must focus on the needs of women.”   “We can’t retreat from the need in the world.”  “Isolationism is always a mistake.”  “Even when economic times are difficult we have to stand against human suffering and make saving lives a priority.”  A cynical voice in my head asked if Bush would be willing to go on tour in the US with these messages. But the mood in the room told me that this was bigger than partisan politics. Bush was saying the right things, and he was not triumphal.  He gave credit to both parties for what the US began in 2003 and continues to do under the Obama administration.  He went on to describe the new pink ribbon/red ribbon campaign, a global effort to use the capacities developed in the fight against AIDS to address cervical cancer, which can be detected easily, and if caught early, can often be treated in a clinical setting with a very simply procedure.  It is interesting to me (though really not surprising!)  that all the ex-presidents, in one way another, have discovered that global health is the thing that really matters.

I felt  privileged to be part of this assembly, moved by what those in the room had accomplished, by what PEPFAR (and other efforts!) had meant for people living with AIDS, and even by Bush himself.  At the end of his remarks people rose again.  Yes, I remained seated, but I clapped my hands until the end, until they tingled a bit, and I meant it.

Today we visited an NGO that is making a difference in the lives of children with programs that provide food, health care, education, protection, psychosocial support and, perhaps most importantly,  income generating activities that address poverty.

Beza Lehiwot Ethiopia, which loosely means “giving for life,” serves people who live in or near the Mercato, Africa’s largest market in Addis Ababa.  Because the Mercato is such a place of exchange and concentrated population (and the location of truck stops, bars and the bus station) it is also a place where there is a lot of poverty and high rates of HIV/AIDS.  The  unpaved streets are lined with food stands and shops made of corrugated metal sheets.   One shop was adorned with bunches of bananas, and a side of beef hung in another.  Vendors were carrying all of goods to and fro.  One man had a large wooden bench strapped on his back, while another carried a stack of red plastic chairs that towered over the crowd.  Donkeys laden with sacks of grain made their way around our taxi and toward the center of the market.  Our destination, the Beza Lehiwot Ethiopia “headquarters”  is made up of a series of rooms around a courtyard, and houses a feeding center called My Father’s Kitchen, as well as a small day care center.

The purpose of our visit (myself,  Sweta Shrestha, Kate Konkle and Laura Laskofski) was to meet with women from the vocational program that teaches women to sew, then launches them into small businesses though provision of a sewing machine that they pay off over time.  We wanted to explore whether this group might become a partner for the emerging Wisconsin without Borders Marketplace.  I am hoping that UW-Madison students can serve and learn with this community in a number of ways that enhance health and well-being, including support for the microenterprise.

We met the group  in the local school where they have  a workroom. There were about 10 women, along with 4-5 children, clustered around their sewing machines (the non-electric foot pump kind!), some doing handsewing while they waited.  We shared awkward translated introductions, but generally smiles prevailed, as we told them about ourselves what we were interested in, and asked them ithey would like to sell some of their products in Wisconsin!  They told us a bit about their lives, both before and after the program,  and then we made our way to the table where their goods were displayed.  Brightly colored napkins, embroidered pillow covers, pieced balls with the amharic alphabet on them, and small stuffed animals — alligators, hippos, an elephant.  They also earn money by making uniforms for local schools.

We asked the women if we could take a group photo to display it with the products, and we asked them what they would like us to tell the buyers about them and their work.  “Our vision is to support our children and send them to school,” said one woman, who went on to explain that she has been earning 1000 birr (about $60) a month through the sewing work. Previously she had been washing clothes to try to make ends meet.   “Tell them we are very thankful,” said another, “we do need markets, the government gives us some opportunities but this additional one will help us to get enough.”  Another woman only smiled and held my hands for a moment, but she spoke up later on behalf of the group when it came time to discuss how ordering and shipping would work.  The women also sold us sample items to bring bring back to Wisconsin as the basis for an order that we will place.

I am so grateful to Dereje Shiferaw of Save the Children and Dawit Gultneh of Beza Lehiwot Ethiopia for sharing their work with us.  After working at the policy level on programs for orphans and vulnerable children for the past 4 years, this short visit meant so much to me, because  I was able to see that change is really happening for some of the people we wanted to touch.   Stop the world I want to get on!  That is what I was thinking.  I would love to spend more time here, be partner and friend to these communities, as they change their lives.  I very much hope I will be able to stay engaged through my students and supporters of University of Wisconsin without Borders.  Any takers?

One of the wonderful things about this visit has been the chance to taste many traditional Ethiopian dishes.   During the season just before Ethiopian Orthodox Christmas many people fast (refraining from eating meat and dairy) which means that there are wonderful vegetarian dishes to try.  Our lunch at a delicious local restaurant included chick peas, lentils, green beans, chopped greens, and ingera, the local flat bread, made of teff, a local grain.

I was amazed at the complex flavors and textures that could be coaxed out of a variety of preparations of lentil and other legumes.  It is hard to understand why this is called fasting, unless you know that Ethiopians love meat, and one traditional favorite is raw beef.

Coming from our Thanksgiving feast last Thursday, to this plentiful traditional meal soon after, I can’t help but think about the close proximity of abundance and want in our world.  While I thought about the hunger and bouts of famine experienced in Ethiopia when I was at my family table, I think about it in a different way, here, at this table.  Closer to the hunger, but also and paradoxically further away,  I am responding no better because of the closeness.

There are so many ways to think about and understand food scarcity in our world:  issues of basic justice,  issues related to land use, technological challenges related to efficient cultivation and storage of food, the challenges of food distrubution,  and the need for food policy and collective action that recognizes that everyone has a right to share in our world’s abundance.

Do I give money to the women and children who tug at my sleeve, tap on the window of our taxi,  putting their hands to their mouths, showing me their hunger?  Does it encourage a behavior that demeans them further, or does it meet a basic need in the absence of any kind of safety net? I don’t know the answer and my responses reflect my confusion.  Donate to an NGO that might help them, support a local student who is working on agricultural development, look at them, look away, pray, have a second helping because it tastes so good.  There is no way to order these actions in a way that hides the double truths of my life.

But I do know one true thing that must be said:  If these same people were able to live their traditions in a healthy and whole way,  and I was the same wandering traveller that I am here now,  they would be offering me a place at their table.  They would smile at me and feed me first, using the same hand gesture to show me how to eat from this world’s common plate.

New technology for the Emergency Room is now in use.

I first visited Tikur Anbessa Hospital one year ago to work with colleagues from the hospital and Addis Ababa University.  My partners are exchange fellows with UW-Madison, and we are working together to develop healthcare quality improvement efforts in the hospital.  These are some of the most talented and well-trained health professionals  in the country, and I have had the privilege of  collaborating with them through shared work and study in both Madison and Addis for the past two years.

The Hospital, whose name means Black Lion in English, is a large public hospital and faces the problems you would expect in a sprawling African city with a high rate of traffic accidents.  This hospital receives those trauma patients, and serves as a referral hospital for the more difficult cases seen in other hospitals, ranging from emergency obstetrics, to pediatrics, to multi-drug resistant tuberculosis to HIV/AIDS, to advanced cancers.  So just about everything is happening here….

There are visible changes since my last visit.  Last year the pediatric emergency ward was really in disrepair and creating very challenging con!ditions for health care providers, patients and their caretakers.  There was talk that a new pediatric  was in the works.  As several people described it to me,  I looked at that patch of ground they were pointing at, trying to imagine the new building, and worrying that this “six month” project might take years…. Well, the good news is it did not take years!  I peered into the windows this afternoon!  It is nearly finished with the ribbon cutting soon (maybe this week?) and patients will be moved from the temporary ward early in 2012.

A 24 hour pharmacy is now in place in the ER.

The other wonderful development was hearing about how the QI program is moving forward and maturing.  There was no building to point to, but as I sat at the table with my colleagues, who shared their successes and honest appraisal of the things that had not worked, and how they would keep trying new strategies,  I realized that the reality of what they had  “built,” terms of improved care was just as impressive.  They have developed and implemented a functional triage system and are sharing it with other hospitals.  They have made huge strides in infection control.  While we can’t see the cases of infection that have been prevented (always a problem for successful prevention programs!),  the cleanliness is evident on the wards in the adult emergency room, and plans are in place to replicate this in the new pediatric emergency ward.  They are also improving drug distribution in the hospital (imagine yourself in one of the beds and then think more effective treatment and better pain management), and are improving a number of registration systems that will lay the foundation for better information for case management and planning at the ward and hospital level.  In addition to all the projects, they have developed their own capacity to train others and, appropriate to their role as a national teaching hospital,  they are looking toward sharing experience and skills with other hospitals around the country.

One of the really special aspects of this project is that it is a Twinning Program, (see,  which means that we work through mutual partnerships and exchange.  It is  really joyful to walk the grounds of the hospital, and see the familiar faces of the fellows who have shared experiences with us in Madison.  In addition to being part of the valuable medical exchange,  we have walked the Lakeshore Path together, and some have visited my home.  During one visit the  fellows experienced snow, and another visit coincided perfectly with the peak of tulip season, so we skipped out of class to visit a local tulip garden!  This week  I am on the other side of the Twinning the equation– in my visits to Ethiopia I have begun to experience the beauty and hospitality and incredible history of this country, and I hope to return many times myself, and with my family.

Everyone gets their daily fix of hope and inspiration in a different way I guess, but for me today it came from revisiting this hospital, and seeing what is needed, what is happening, and what is possible.  It was a visceral  reminder to me that small changes matter. Perhaps we don’t have to develop complex   plans  to  “scale up change.”  I don’t want to scrap that idea entirely because it is the  topic of the talk I am supposed to give at the ICASA Conference next week (!), but I am beginning to believe that the most important thing we can do is to let the reality and possibility of the tangible changes that are within our reach capture our imaginations, befriend us, get out of control, and enable us to work together to change the world around us.