Tag Archive: Ethiopia

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 www.twinningagainstAIDS.org),  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.

I will be heading off to Ethiopia the day after Thanksgiving to do some teaching for the American International Health Alliance (AIHA).  That should be an interesting exchange related to quality improvement in health care, and I will be working with partners from Ethiopia.

I am also going to attend the 16th Annual Conference on AIDS and STDS in Africa (ICASA).  I”ll be involved in two sessions, one about quality of care and one about care for orphans and vulnerable children. I expect to learn a lot about HIV/AIDS and the most current issues and challenges.  (See ICASA website http://www.icasa2011addis.org).

While in Addis I have also arranged to visit some sites related to my work with Save the Children.  I’d like to identify a community to participate in the Wisconsin Without Borders Marketplace.  The hope is that we can support a community micro-enterprise effort designed to benefit vulnerable children (due to AIDS or other causes) by buying and reselling their products — scarves, jewlery, baskets — these are some of the crafts that I expect to find.

A few friends and students have suggested that I cover my field work and the conference on my blog www.globalhealthreflections.wordpress.com  so that I can share what I am learning with the UW community, especially our growing community of global health students. Please feel free to visit and see my posts about previous trips to Ethiopia.  And sign up to follow the blog if you want to get updates by email!

Ethiopian Masinko and other Traditional Instruments

I made it home from Ethiopia yesterday. It was a wonderful trip in so many ways.  I was so busy and with the time change and limited internet access I did not have a chance to write the usual news from the field to family and friends so I thought I would do so here now while everything is fresh in my mind.

I have been to Ethiopia before, so I had a good sense of what to expect and I knew it was a very interesting and hospitable culture.  However,  all the good expectations were doubled by the fact that I already knew 8 of the Ethiopian colleagues that we were working with since they had had fellowships at UW, and because the QA advisor working with me, Roman Aydiko, a UW-Madison student who I really enjoy working with, is from Ethiopia herself.  We trained 60 hospital leaders in quality improvement and followed up on 8 projects that were already underway. There has been good progress on all the projects but two have been very successful, one related to infection control (improvement from 33% to 69%)  and one related to fully implementing triage (from less than 10% to 100%).

The Black Lion Hospital is the largest hospital in the country, and serves the most serious cases and has the most active emergency department.  We are working with the emergency department and the pediatric emergency departments in particular.  During my first day I visited those wards which I have been hearing about for months.  I think you can imagine that visiting these sites is a powerful experience, with such serious resource limitations and lines of patients hoping to get care.  The health care providers are among the most talented people in the country –chosen for medicine because of their intellectual abilities.  It is hard to see them struggle to provide care in a ward where water systems for basic sanitation are not always working and there are shortages of basics like sheets, gloves, face masks, etc.  Roman and I brought 4 suitcases full of sheets and gloves and masks and hand sanitizer as a gesture of solidarity.  We thought this made sense because we know the hospital is working to get these things in place so jump starting them on something like sheets helps — they can manage replacement as they wear out etc.  We also brought scrubs which they were delighted with because they can use them as uniforms.  It was a very joyful thing for us to give them things that we know will be put to immediate use.

In addition to working very hard I got a chance to get a feel for Addis Ababa.  I went shopping and really enjoyed buying some beautiful scarves, wonderful Ethiopian coffee, and a drum and masinko — two traditional instruments.  I also visited the national catherdral and an old orthodox church.  Spent time strolling around Addis which is a really nice African City — so much that is ancient right along side modern buildings and city bustle.   In addition to eating great Ethiopian food every day at lunch time we also went to a traditional ethiopian restaurant that had all kinds of cultural dancing going on during dinner.  I loved the food and music and dancing!

The other wonderful and unexpected aspect of my trip was that two very good friends from the DC area  happened to be there.  Tessie and I had worked together and spent lots of time together when our children (now in high school) were babies.  Marie Eve and I had shared some very important work related to vulnerable children but we had lost touch -what a gift to reconnect with her.   She is now working for Save the Children and we enjoyed reconnecting as friends.  She, Tessie and I are hoping and planning to do more work for vulnerable children together  in the near future.

There were extremes to digest in all this as you can imagine.  It was quite something to be working in solidarity with the mothers in line at the pediatric ER by day, and dining at the what is reputed to be the best Italian restaurant outside of Italy with old friends in the evening!

One thing that has always bothered me about development assistant projects (and I have worked on many) is the way the money flows, as they are very strict about procuring items on the local economy, yet they give very generous allowances for hotels and lodging.  I decided to deal with this by using the food allowance for a local cause, and then I can buy my own food, which I would have had to do at home anyway.  A girl’s gotta eat, right?   I shared my plan with Roman who, through her Ethiopian network, knew a very worthy young man who is trying to get funds together to pursue a masters in development with a focus on environmental sustainability.   He is very smart but “behind” some of his peers because he had to help raise his 8 siblings before he could consider this.  He still has lots of family responsibilities, but is getting started with his studies.  I am using the food money that I got for the week to help him out (in installments with reports from him) and I am also going to find him an academic buddy at UW who has similar interests. We met twice during my visit and he is so appreciative of the help and so hard working and deserving. And the only cost to me is a cleaner (but not totally clean) conscience about how development assistance money is used.

This trip was full of things that I expected and I did not expect, both named and unnamed here.  I am considering it a message from the universe about my life and what I am doing and what I should be doing.  Unfortunately, I cannot actually decipher the scroll in my hand !   I am hoping that continued reflection and finding the right balance between planning  and being open to life will help me find out what it all means …

It was great to get home where job one is to decorate for Christmas and make a big pile of potato gnocci for my family!

Based on email December 2010.

During my first visit to Ethiopia I was working with partners from Save the Children and had a chance to visit their programs for vulnerable children.  Some of these children had lost a mother or father due to HIV/AIDS, some had lost both. Some were HIV positive, some were not.  Some had watched their parents die with little help and no pain relief.  While many children facing this situation are taken in to the loving care of the extended African family, these children had fallen through the cracks.  Many of them experienced the  ravages of hunger, poverty and abuse, on top of the pain of parental loss.  The programs we visited were working with these children and their caretakers to assist them with shelter, food, education, health care, psychosocial support, legal assistance, and income generation activities.

Education: The school was made of corrugated tin.  There were about 270 children in three small rooms.  We stooped to enter to find tables in neat lines on the dirt floor, school supplies in good order, and children in matching uniforms singing for us!  As I scanned the room it was like a roomful of kinds anywhere, some singing out of duty, others pure joy.  But it was different than the classrooms I was used to also. Among these children, who are all here because they need some kind of help, a few stood out as needing more. I pause here, because I resist describing the telltale signs of damage on a child. The front room was windowless, but had both a doorway and a hole in the roof to let in light.   We were led in to the room behind, darker still with no egress, where the older children were working on reading and math.  They stood to attention when we entered, except for a girl in the front row who looked to be about nine (likely she was older), who kept at her arithmetic.  She caught me looking at her and offered me her notebook.  Rows of arithmetic.  Getting them right. I looked at the simple structure, breathed in the thick heat in this back room, and wondered at what it would be like to study here all day.  Yet real learning was taking place.

Selling Eggs

Income generation:  We visited an income generation project where the community was keeping chickens and harvesting eggs to eat and sell.   They were doing well and had a big basket of eggs for sale to show for it.

Down the road at the chicken farm we were regaled with the story of how the women were opening a restaurant.  They were so proud to be making money and taking care of their families.

Dance Club

Psychosocial Support-DANCE! We also visited a youth club that is oriented toward providing recreation, psychosocial support and education about how to stay healthy and AIDS free.  This group had specialized in dance,  and they became so good that they won a number of competitions and had had a chance to travel together to Cuba to dance!  The school  drama club joined in with acts and songs related to healthy lifestyles, addressing the stigma that they sometimes experience, and other topics of their choosing.  It was great to see these young people excelling in a physical activity and supporting each other.

School Garden

Food:  While all kinds of food assistance is taking place here, from breakfast programs to food distribution to households, one wonderful and hopeful program we saw was a school garden when children in vulnerable situations grow their own food, learn gardening skills, and benefit from enjoying it also.

It is sobering to know that programs like these are reaching only a small proportion of children who need them. But being with these children, even in this cursory way, made me want to work very hard in the following weeks and months to make a difference for them.
Based on journal entries and emails from February 2007.

Dee Dee Yates, Dr. Alemseged, Lucy, and Me

This trip was not all work!  I got to see the real bones of Lucy the 3.5 million year old human ancestor, found in Ethiopia.   It turns out my guide was none other than the paleoanthropologist, Dr. Zeresanay  Alemseged, who found her and studies her.
My colleage Dee Dee Yates and I went over to the National Museum not expecting much.  We were told by our more cynical friends that Lucy’s bones would likely no even be there, because they travel around the world to be studied and shown.  We set off anyway, happy to at least see a replica, but as you can see from the photo we got lucky.  Lucy was home! And we got to spend time with Dr. Alemseged.  At the time of our visit he told us was very close to publishing a more recent discovery, a complete specimen of a baby, who would have been of the same species as Lucy.  He had named the baby Salam, which means Peace.  My eyes darted around, betraying my  my hungry eyes.  Alemseged grinned and told me to put my camera away…..Then he showed us Baby Salam!
Note:  In June of 2007, Zeresenay gave a TED talk  about his work which you can view at:http://bit.ly/lwZEx.
I also visited the  St. Georges Coptic Church and  a smaller Coptic church in the neighborhood where my colleague from UW-Madison, Dr. Girma Tefara,  was born.  I met his sister and his mother, and visited the house where he grew up.  His mother gave me a beautiful woven Gabi.  She made the thread from cotton herself, her daughter told me — hand spinning is a great hobby of hers, and a traditional Ethiopian craft..  She also made me coffee the traditional Ethiopian way (roasting the beans right before drinking them).  I was so thankful to be her guest.
With a busy work schedule and new friends to visit, I had been too busy to shop for even one gift.  I could not go home like that!  On the last day I made a quick trip to the market place to buy some scarves and jewelry and got a henna tattoo (my tattooed sisters would have been proud). From the tattoo shop I hurried to my hotel, packed and got on the evening flight to Amsterdam.  That’s 8 hours, followed by a second 8 hour leg to Detroit, then on to a final leg to Madison.  Miraculously all the snow did not affect my trip, and I was  in Madison within 24 hours of leaving Ethiopia, including layovers.  Now I am home, with everything normal, marveling at how large and small the world is.
Journal entry, February 2007.