Holiday Greetings from Hawassa

Greetings friends and family,

Christmas in Ethiopia is a bit different than in the states, although we did see a decorated Christmas tree in our favorite restaurant downtown. Ethiopia is a mixed Christian/Muslim country (55/45), with the majority of Christians belonging to the Eastern Orthodox Church. We wake up every morning - early! - to monks singing Orthodox hymns, broadcast over a loudspeaker beginning at 3:30 AM. While this music can be quite beautiful, this religion is quite formal and severe (in Elliot’s thinking). The Orthodox Ethiopians are mainly from the northern highland region (Amhara, Tigray, and Eritrea); while here in the south we see and hear more “Protestant” churches, meaning Evangelical and Pentacostalists. Their churches are smaller and more store-front than the large and beautiful Orthodox churches, and we find their broadcasts (also over loud speakers) more jarring and grating; they are not singing but preaching, and judging from the loud and angry tone of the speakers we suspect they are harsh harangues that the parishioners are all going to hell in an enjera basket! Why do all these religions (Muslims as well) feel they have to loudly broadcast their message whether you want to hear them or not? Marty says it is because each religion feels they have monopoly on the truth and that God speaks through them only. Oy vey ist mir. Speaking of which, Orthodox Jewish settlers in the West Bank also feel it is their duty to drown out the local Palestinian communities with loud broadcasts in Hebrew.

What are our impressions of Ethiopia now that we have been here three months? Well first off we are tremendously impressed at how dignified, graceful, polite, and genuinely friendly Ethiopians are, at least in our day to day work environments at the University and Hospital where we work. It is a very different atmosphere than Kenya where we worked previously, with its rushed pace, money hungry police, and obsequity/hostility to whites and other foreigners. Ethiopia really is different. In part, this must be due to its non-colonial past – they were never conquered and occupied by a foreign power, with the brief exception of Mussolini for five years in the 1930s. Some people here in the south say that they were conquered by the Amhara of the north, and ethnic divisions are still manifest here. But the government (which originated as a guerrilla army in Tigray and is quite autocratic in its rule) are really trying to deliver the goods, so to speak, to all the various regions in Ethiopia, They are committed to a regional/ethnic federalism, where everyone gets resources to develop. We see a lot of building – in town, at the university, on the roads – and a commitment to growth and social development. The government is also committed to the World Bank neo-liberal orthodoxy of free trade and foreign investment, and one sees enormous greenhouses growing roses and lilies for export, owned by Saudi Arabia, Israel, India, lining the roads. But the large land grabbing schemes for bio-fuels and grains seem to be in the low density areas of the western region, and the government really does not want to displace and alienate small holder farmers, its political base.

This week we had a wonderful celebration of diversity at the University, in honor of all the different ethnic groups in the county. Our region, Southern Nations and Nationalities, has 54 different ethnic groups (70% of Ethiopia’s diversity), and each student group put on dances and songs, wearing traditional dress. They were incredibly proud of their tradition, and loved it when Elliot joined in one of the stick carrying dances.

On the domestic front, we have a very nice living situation, located in the university “guest house”, really a five story apartment building in a big field, here we have the “penthouse” view (with two floors to boot). But electricity goes off many times, and we eat most of our dinners in the inexpensive (and generally delicious) restaurants nearby and in town. Marty is braver than Elliot when it comes to Ethiopian food, happily eating her ‘wot’ or ‘fasting foods’ (which are eaten on the 250 odd fasting days in the Orthodox system), while Elliot sticks to his spaghetti and meatballs, although he can dig into a plate of tsibs and enjera (roasted lamb and the Ethiopian ‘pancake’ to eat it with) with the best of them. Elliot, when not teaching or preparing for class (which in truth does not take more than 2.5 days per week), spends a lot of time as one of the three editors of the African Studies Review, reading five or six manuscripts a week and communicating with authors, more than a few from Africa, about how to improve their articles. Marty, when not working at the hospital every morning 8 or 9 – 12 noon, depending on the day, keeps herself very buys, both preparing lectures she gives, and spending as much time as she can (literally all afternoon and most evenings) reading her beloved medical texts on malaria, tuberculosis, and HIV/AIDS. ). She is ‘Dr Marti”, whose hospital chief introduced her, “This is Dr Marti, who does internal medicine and is into Everything!” Elliot is ‘Dr Elliot” or simply “Professor”, including greetings on the telephone. We have a good routine, broken by pleasant walks into town center (about 30 minutes), trips to the lakeside resorts to swim, in the pool, mind you, there is schistosomiasis in the lake – tiny worms transmited from snails to humans, lodging in the bladder or intestine while it merrily multiplies to about 100,000 (Marty – please fact check!)

We have developed friends and colleagues here, including two young Americans, Adam and Emilia, who live at our building and work at the university (Adam in anthropology and Emilia in Public Health), our friends from work (Walelign and his partner Beza, also in anthropology and who live in our building), Rehobeth the daughter of a geography professor who lives in the GH), and friends from work (including good friend the ever polite Mulye Girma, who is applying to PhD programs in the US).

We haven’t gotten out of Hawassa much, saving a trip to a wildlife sanctuary no Ethiopian has ever heard of, but there is plenty for us to do and see here. Hawassa is almost a resort town near the lake, and many conferences are held here, including Eritrean expatriates forming a unified opposition to Issais last week. But the downtown streets are full of beggars intermixed with those with jobs. Poor women with small children are the most upsetting to see, while young boys, who can be incredibly annoying with their calls of “You,You! Give me money!”, but in truth could easily have been our own children if life turned out differently.

We miss our kids, although Leah, recently married to handsome doctor Gavin, is the most communicative. Masaye at Hunter College will answer emails and join us on Google Chat, but Mulugetta is quiet and too into Macalester to write or call, although we can occasionally grab him, where he is surprised we are even worrying about him. Shades of being 20 years old. 

We are posting a whole bunch of pictures this time, of harvest, of birds, of Susy, but mainly of the lovely Hawassan students in their traditional dress, celebrating their own diversity. Some are too beautiful for words.  

Masked marauders, criminals and HAART

Greetings from Hawassa!

A Friday afternoon is lovely in our apartment on the third floor in the middle of the fields from which has sprouted Hawassa University. The corn thresher across the dirt road is active, the cows are still in the harvested corn fields, the funny, gregarious bird with the black mask that loves our porch window is raucously calling us, my work at the hospital is done for the week, it is 80 degrees and sunny and life is sweet.

Went to the ICASA (International Conference on AIDS and Sexually Transmitted Infections in Africa) last Saturday, but ended up returning 2 days early. Became sick in the middle of the night on Monday (I am beginning to think it was altitude sickness, because the same thing happened the last time I was in Addis Ababa) and returned on an overpacked (fifteen people in a vehicle that should hold 12) van with friends Walalign and Besa. It was an experience. There no longer is a bus station in Addis but everyone knows to go to a particular section of the city and wait for the vans to drive by with the young men yelling out their destinations. The van doesn't leave till it is (over-) full. So you can take an hour driving around doing the “collecting”. Then five hours down a crowded, bumpy road filled with lorries, buses, vans, cars, bicycles, people, cattle, sheep, goats and sometimes accidents. At one point we stopped to observe a crowd of twenty or so neighbors and passersby desperately trying to pull the driver out of a smashed-up van. No ambulance or emt or jaws of life or even police or fire department. Volunteer human power, which is usually what Ethiopians must rely on.

Arrived in Hawassa nearly crippled from knee pain from being doubled up in the van, but happy to be home. I truly appreciated the conference. Gazillions of papers and posters on the massive human experiment that has taken place throughout Africa in the last 5 years, the transformation of the treatment of the AIDS epidemic by implementation of broad-based, free highly active antiretroviral treatment (HAART). It has been a monumental and heroic effort to get the meds to every isolated corner of the continent, including Hawassa, so that people whose imminent deaths were considered a foregone conclusion, are now facing the possibility of watching their children and grandchildren grow.

There has been so much data gathered in the course of this incredible ongoing experiment, and a lot of it was presented at ICASA. I felt very fortunate to be able to hear and read about the struggles to reach the most at risk – sex workers, men who have sex with men, immigrants and migrant workers, and the small but growing number of injection drug users. The papers were broad-ranging, from when is the best time to start HAART after beginning a doubly-infected person on TB treatment, to how to follow people's clinical course when you have minimal laboratory capability, to preventing transmission by empowering women through education and employment. All around me different languages being spoken but, the most impressive thing to me, the science was by and large being carried out by Africans in their own countries. And though this may be influenced by sampling error – after all the conference was in Addis – I found the best presentations, the most concrete, data-driven and clinically useful, to be Ethiopian. I was heartened and proud.

The over-arching issue, though, was that of sustainability of treatment. In this last year, the United Nations Global Fund which, with the US PEPFAR, has been the main source of funding of AIDS treatment, had its donations cut by about 10%, which is a major blow to the capacity of the African medical systems to treat the disease. The accomplishments so far have been amazing: reduced transmission and death rates, vastly decreased Mother to Child Transmission, increased identification and treatment of tuberculosis, but all at huge cost. Is this going to be lost to the global recession?

There were political struggles over this question, and it was good to hear them. Many of the true AIDS heroes, Peter Piot and those who struggled for HAART treatment in Africa, demanded that funding continue and expand, while others babbled (editorial comment) about Africa “owning” the funding. This smelled rottenly to me of neo-liberalism particularly when a Nigerian spoke of African nations adopting systems of private health insurance. Wait a minute! Is that not the same system that has left 48 million in the United States without care?

One of the best lines in the conference came from the Archbishop of the Ethiopian Orthodox Church, who was being pressed about his Church's (reactionary) position on condom use and anti-homosexuality. He side-stepped those issues (unfortunately) but instead said that Jesus' main tenet was that the rich should give to the poor. Pretty simple, I would say.

I never had a chance in this crowd of 10,000 to mention that the necessary billions could easily come from the over $800 billion US military budget or from re-taxing the Bush billionaires. They were the elephants in the African room.

I did find myself compelled to react when Prime Minister Melas of Ethiopia gave George W. Bush a medal for his role in initiating PEPFAR. I did not disrupt the meeting. I did not want to get arrested and particularly didn't want to get kicked out of Ethiopia. But boy, that is one disgusting, greedy war criminal! So when folks were clapping and standing, I stood up and turned my back. Interestingly enough there were three African women behind me who did not stand up but who smiled and nodded. I shook their hands and that was it.

I am glad George Bush did PEPFAR, despite his intent through it to further enrich the coffers of the pharmaceutical companies. And I am glad for his new proposal, to detect and treat African women's cervical cancer, which is in many countries here the top cancer killer of women and is associated with HIV infection. Good. But it doesn't make up for hundreds of thousands killed and millions made homeless (subjecting them to risk of HIV tuberculosis and STI's, among other fates) in Iraq and Afghanistan, or his anti-gay and anti-woman and anti-poor policies that all worsened the HIV epidemic in the United States.

Enough!

Back in Hawassa it was the week for clinical testing of the first year medical students. They presented the history and physical exam of a designated patient and I was one of the examiners. It brought back in spades all the anxieties of medical school for a shy and hesitant student. (Yes, believe it or not, there was a time when I was painfully shy!) The Ethiopian examiners are pretty rough and I keep finding myself playing the “good cop”. I am impressed, though, by how hard these young people, who have so little resources, work to learn their medicine. I think I have said in past blogs that I am truly and unexpectedly enjoying teaching.

But I am still upset at the lack of resources. For my clinical friends, we do not have the basics of asthma treatment – no nebulizers! There is one man who is in severe respiratory distress, might have been intubated by now in the States, and is not being adequately treated. I have called all around Hawassa to try to get the machine we need – no luck. The one medical supply store in town says they will order them. I hope he is still alive by the time we get what we need. I have bought peak flow meters, but without the medicine to treat, they are fairly useless.

I will be coming home to Northampton on December 27 and hope to see as many of you as possible. Am going to try to get Elliot to write more, as his work at the University is getting interestinger and interestinger.

In the meantime, I miss you and hope you are well and constantly learning.

Love,

Marty and El

International AIDS Day, Tetanus Again, Cheeky Hornbills

Greetings from Hawassa!

December 1, 7 pm: Listening to Amy Goodman's Democracy Now! Lying on the bed where I have been reading about glomerulonephritis and nephrotic syndrome, diseases of the kidneys that I haven't seen for the last few decades but of which I saw a lot this week and am having to scramble to understand and treat. One young man probably has post-streptococcal glomerulonephritis from a case of impetigo that he recently had. The other has severe body swelling from nephrotic syndrome whose origins are not well understood. These are diseases, particularly the nephrotic syndrome, that are usually cared for by renal specialists, but as I look around the room and the ward and the hospital, I don't find any! And when the 16 year old patient with terrible rheumatic heart disease went into a heart arrhythmia called atrial fibrillation today, again I expected to turn to a specialist but he/she just doesn't appear. So I go to the books, discuss with my very knowledgeable Ethiopian colleagues and take a stab at understanding and treating.

Today we lost another patient to tetanus, which just burns me up. Such a terrible waste of life to such a preventable yet excruciatingly painful death. I told my colleagues at rounds today that I wanted to arm myself with syringes filled with tetanus toxoid and go house to house grabbing people and injecting them.

I feel for the lovely young interns with whom I now oversee “the men's side”. They have had 2 deaths this week of young men because we didn't have the equipment we need and we have 2 patients on the ward with severe rheumatic valvular disease for whom there is no hope. There is almost no cardiac surgery in Ethiopia and it is more expensive than 99% of Ethiopians can afford, and these are young people who developed their disease because they couldn't get penicillin for their sore throats. One man began crying after his echocardiogram, knowing that he didn't have the 125,000 birr it would take to replace his valves. The other is a child – only 16 years old, who looks like he is 11 years old – for whom it is a tragedy to be spending so much of his shortened life in a hospital.

It is now December 2, International AIDS Day. I am preparing to go tomorrow to Addis to the International Conference on AIDS and Sexually Transmitted Diseases in Africa. Found out after I applied that George W. Bush will be there to establish his legacy as the PEPFAR President. When I speak to Ethiopians about him, they say how much they admire him, in part because PEPFAR, which provides Highly Active Anti-Retroviral Treatment (HAART or HIV treatment) to AIDS patients. They say that at least he paid some attention to Africa, whereas Obama, for which they had so much hope, has done little or nothing. Their hopes, which were so high for Obama, have been dashed.

I spent the first night after learning that Bush was coming to Addis thinking about protesting his criminal behavior. I didn't sleep much. But I am a guest in a country I love among people that I respect and honor whose experience of George Bush is obviously much different from mine. The issue of PEPFAR itself is a complicated one. It was a day-late, dollar-short proposal that was a huge gift to the American pharmaceutical companies, because its rules are that all drugs must be bought from the multinationals, not from Indian or African companies. It was also poorly funded: only $15 billion which when considering the high expense of the US pharmaceuticals would not have gone very far. However, it was supplemented to $60 billion and in actual fact, as Paul Farmer has said, has saved many, many lives. I cannot argue that. I am grateful for those meds. And though those meds and the laboratory testing used to apply them have been restricted in their intent – only for HIV patients – in fact there has been dissemination of the benefits to non-AIDS patients. The nutritional supplements meant for AIDS wasting find themselves in the bellies of starving people, the electrolyte testing get used to evaluate diabetics, etc. So that I guess the rising tide is lifting some unintended boats. I am grateful for the lives saved by PEPFAR.

On a lighter note, life outside the hospital is good. We are making good friends and enjoying the harvest time – cattle are gleaning the remains in the cornfields, the donkey carts are loaded with the hay that is sickled by hand from the fields. We became very grateful to those harvesters after they hacked down the weeds and grass right around our guest house. Three of our residents had spotted a large black mamba, one of the deadliest snakes in the world, circled and digesting a small animal right on our front porch over a week ago. Weeds must go! They did. Now only the hyenas remain as a reminder of our vulnerability to wilderness. Whoooo—oop!

This morning El had visitors as he was hammering away on his paper on sorcery. A male and female silver-cheeked hornbill, each 2 feet long, began hammering on our big picture windows that mirror from the outside. They are fantastic. We had seen them in the large fig trees by the lake but never up here. El got some great pictures.

This morning we admitted a man who probably has Staph aureus meningitis, which requires a drug called vancomycin, which our hospital does not have. We sent out the family to search for it at the pharmacies in town. At the same time he needed a ct, but the ct machine had broken. And we just found out that we can get no more regular X-rays because there are no more films to develop them on. So we adapt and do without till we can get what we need. The amazing thing is that, since Dr. Birre and I have started raising issues about the poor quality of the microbiology lab we have begun to get positive results from the staining of the original specimens.

As always, we miss you terribly. We love our wonderful friends in Springfield and Amherst and Northampton and our family scattered around the country.

Please write and tell us your news. On to Addis and ICASA. Love, Marty

Thanksgiving Hawassa-Style, Hippos, Asmari & Lab Struggles

November 25, 2011

Greetings from Hawassa!

Just recovered from a full day without electricity that made Elliot, more than me, very frustrated. No coffee, no eggs, and no computer after the batteries ran down. The problem has worsened considerably since we came at the beginning of October. At that point we would get spells lasting no more than a half-hour without power. We thought at first that it was the coming of the 25,000 students to the university that put too much strain on the grid, but are learning that this is a chronic problem that occurs in every dry season (winter-spring) when the water levels in the rivers behind the dams fall and the blackouts affect the whole country. The political aspect is that the Ethiopian government is building several large and extremely controversial dams now – one on the Blue Nile that is sure to infuriate Egypt which unilaterally declared decades ago that Ethiopian damming of the Blue Nile was forbidden, and a series of dams that threaten extremely isolated indigenous peoples on the Omo River – which will not supply Ethiopian needs but will provide electricity for Djibouti and Kenya. It's a pisser.

Yesterday the one-hour power failure was the only hitch in what was otherwise a lovely Thanksgiving, Hawassa-style. Our young friend and apartment neighbor, Emilia Biavaschi, from Portland, Oregon, decided we were going to celebrate this holiday about which Ethiopians know absolutely nothing. So we plotted and schemed. There are no turkeys in the horn of Africa. The closest candidate would be the Abyssinian ground hornbill that wanders around our fields (see the first posting), so we decided on chickens for the omnivores. (Emilia and Adam are vegetarians.) Hard to get whole chickens, so our friend Walelign volunteered to buy chickens at the market and slaughter them. As a young man he was the appointed butcher for his family, which is Ethiopian Orthodox requiring adherence to strict rules of slaughtering, similar to kosher and halal. Then we had to find apples for the pies – not raised in Ethiopia that we know of but we suspected somehow available in Addis – and something that resembles cornbread for the stuffing. Ultimately, I found halal chickens at the US embassy in Addis and that put the kabash on the local chicken holocaust and we located some outlandishly expensive apples from Egypt (Go, Arab Spring!) at a stall on the Addis streets. Emilia had trouble finding sweet potatoes at the market, though Wallelign and his wife Beza told us that they are available in Hawassa, so she substituted yams for my North Carolina sweet potato pudding. And having absolutely no luck locating cornbread or corn meal we shredded what friend Helen has called Hibasha bread for the stuffing. Everything except the pies and yams was loaded with garlic and the yams and potatoes were mashed with spoons (no such thing as a potato masher in Hawassa!) after I came home from work yesterday afternoon, and we were well on the way to Thanksgiving heaven when.... you guessed it, no electricity! It lasted for a whole hour while our guests politely drank wine and beer and ate those great Egyptian apples dipped in Ethiopian peanut butter. At a certain point Lemma, our volunteer economist at the University started to describe the difference between what is said over the chicken-slaughterings by the rabbi, the Orthodox priest and the imam and belted forth “There is no God but Allah!” and the lights came on and the chickens began to roast again. Go figure.

We particularly missed our beloved Leah, Mulu and Masaye on Thanksgiving day. Leah and Masaye were at Sister Susy's and Mulu was... hmmm... we're not sure where, but somewhere in the St. Paul vicinity. Mulu, phone home!

I am most thankful that El is home after a 6-day trip to Washington for the African Studies meeting. He worked like a dog there as editor of the African Studies Review and came back pretty exhausted, but satisfied because his book, Laibon, has come out. It was lonely here without him. We have always been a team and, though there are wonderful people here, as Joanie Mitchell says, “It gets so lonely, when you're walking and the streets are full of strangers.” We have no tv so there is no artificial noise in the apartment and the Ethiopian nights are dark.

Before he came back, though, to occupy myself, I went with Emilia and Adam and Walelign for a boating trip to see the hippos on lake Hawassa. They were cool and BIG and the lake was gorgeous. Walelign had spent all his life in Hawassa and had never been on a boat. That night we went to an Amhari (traditional Ethiopian music) club and were the butt of the singers who do Ethiopian version musical stand-up comedy. My children will be relieved to know that I refused to dance. 

 

El came back to Addis on Monday and I rode up to meet him and to attend a command performance orientation for Fulbrighters at the American Embassy. We were dreading it, but it was actually very informative. There was much to learn about Ethiopia and much to learn about what the American government thinks about Ethiopia and its government. The Ambassador denied that there had been an army invasion of Somalia last week, that it was just Ethiopian-backed Somali militia. And they denied that there were armed drones at Arba Minch, though they really did not deny that there were drones. We will try to find out more about both. We heard and talked a lot about the Ethiopian policy of “massivization” or “flooding” of education. There are so many young people, and they are being funneled into higher education programs that lack sufficient resources or staff, overloading the professors but, at the same time, creating the educated young people that will become the future professors. It is a bold but sometimes outrageous undertaking by one of the world's (if not the world's) poorest countries.

We attended a reception at the home of the Public Affairs Officer and his male partner and wondered about whether DOMA allowed federal benefits to his partner. But most important I got to talk to the CDC representative in Ethiopia about the problems at the Referral Hospital Lab, which are monumental. There are no bacterial, tuberculous or fungal cultures, the microscopic analyses are unreliable and we usually ignore them, and we cannot get basic chemistries, called electrolytes. I was pleasantly surprised when, at the cocktail party, the CDC man not only took my issues seriously but helped me make what seems to be a plan to try to address them.

The hospital work has been challenging. Before I left for Addis I had worked long hours preparing a 2-hour power-point lecture on hypertension for the first year medical students. I have some power-point phobia so, though I was promised there would be both computer and projector, I brought my own computer, my own projector and my own thumb drive just to make sure. And then 1) my computer wouldn't communicate with the Hospital's projector; 2) the Hospital's computer couldn't read my thumb drive and I knocked it over trying to put the drive in and 3) I couldn't use my projector because I hadn't brought its wire! So I “wung it” for 2 hours, actually enjoying the chance to be more Socratic. The interesting thing was that the small group of women medical students all sat in the front row and knew all the answers, allowing me to tease the male students for their lack of bravery.

I am participating more in the morning patient conferences, when the interns present the patients that they have admitted and that have died. I find myself caught. There are problems with patient evaluation and care. Students and interns know very little about cardiovascular disease and tend to give everybody antibiotics, specifically ceftriaxone, which is a pretty potent med. I find myself questioning management decisions, but try to do it in a way that outlines the basis for how those decisions are made. However, as was true in my own training 35 years ago and was true when I worked in Eritrea, questions about management can quickly turn into a “pillory the intern” session, that is humiliating and, in my experience those many years ago, leads to very little learning and instead to a lot of anxiety and anger. I cringe when staff do that – it was particularly bad this morning – and need to figure out how to deal with the patient care issues at the same time paying heed to the pedagogical ones. Appreciate any suggestions from my colleagues and anybody else who has an idea.

After morning patient conference went with the head of internal medicine (who found out by glancing at a memorandum on his desk in my presence that he had been transformed into the acting Medical Director of the Hospital while the official Director was out of town) to interview the chief administrator of the Hospital Lab. He is a young guy, 30 at most, who told us about lacking equipment, having old equipment without technical support or ineffective technical support, about lacking reagents, culture media and other supplies, of receiving specimens many hours after they were obtained, delivered by the patient's family, not by hospital staff. Of the frustration of requesting needed supplies from the pharmacy but never receiving them, of being expected to apply for the (newly-instituted) World Health Organization-derived laboratory accreditation and knowing that there was no way that he could fill the deficiencies in the lab's procedures because he simply didn't have the equipment. My heart went out to him and we are writing up a report to give to a representative of Johns Hopkins with an office actually in Referral to see if he can give support – technical, resources, training, whatever – to improve it so that the clinicians in the hospital can begin to rely on lab testing rather than treating each patient empirically.

I write this as much to see it on paper because it is so different from what I usually do and what I expected to do, and I find the issues more complex than I think I am prepared for. Forgive my ramblings and let us all be thankful for our families, our fragile and beautiful world, the amazing accomplishments and incredible tomfoolery of our species, and our solidarity with one another.

Love, Marty

Exercise, Medicine, Teaching, Hyenas

Greetings from Hawassa!

Day number 2 of Marty sans Elliot in Hawassa, surviving, perhaps thriving. Elliot left yesterday early morning on a public van for Addis Ababa to fly to Washington DC for the African Studies Association meeting. He will be working with the other editors and the Board of the Association's journal, the African Studies Review. Heard from him this morning: he arrived safely but not without some issues. Apparently a psychotic man was roaming the aisles of the airplane and ranting, to the point that Elliot, who doesn't frighten easily, was frightened. BUT...  who should be on board the flight but A DELEGATION OF PSYCHIATRISTS, going to a convention! Apparently they applied valium and the therapeutic touch and all went smoothly thereafter.

Without him I am getting a whole lot of reading done. A lot of medical stuff. Finally was able to start my course on malaria from the London School of Tropical Medicine which, I must admit, is very cool. It is such a complicated disease: this little bugger of a parasite switches into at least four different forms in order to adapt to its mosquito and human hosts and has been able to resist each medicine we throw at it, change its outer cover so that creating a vaccine is extremely difficult, and infects approximately 50 million people a year, of whom about a million die. Most of them are children and most of those children are African children. A formidable enemy.

Also doing the mundane. Am doing a power point for the medical students on the evaluation and treatment of hypertension, the bread and butter of Global North medicine. Should be boring, but am doing a literature search and finding all kinds of things I hadn't known. Am supposed to fill up 2 hours (and Ethiopian education traditionally does not include time for questions from the students. :-(  ) But I think I can do it and maybe have some fun, (also not an Ethiopian educational tradition. :-(  )

And Sunday I had a lovely time presenting a power point lecture to the Hawassa Diabetes Association. Yes, it exists, started by my colleague at Referral, Dr. Tarike. It was a real treat, at least a hundred men and women, some in traditional dress, most non­English speakers, all diabetic, to whom I spoke about the role of exercise in treating diabetes. I interspersed my slides with pictures from the streets of Hawassa, proving that the little bit of obesity in town was directly correlated to transport by motorcycle or car, and that most of the walkers and bicyclers and pushcart folks were skinny as rails. Dr. Tarike translated into Amharic (and, judging by the relative lengths of some of his sentences compared to mine, did some augmenting and embellishing.) The questions were great, and I sure had a good time. 

For fun I am reading a book that several people – Sister Susy, Carolyn Oppenheim, Leah – had told me I must read, Cutting for Stone. I think because I still have an adolescent streak, I resisted it until getting here. Over 3 quarters of it takes place in Addis Ababa in the 1950's to 1970's and it truly is stunning. 
First of all Abraham Verghese is a magnificent writer. Second, it is a great story, woven with a truly multicultural cast of characters who do heroic things in difficult circumstances. Third, Addis Ababa 1960's has a lot of similarities to  Hawassa, 2011, and I can smell the smells, hear the sounds and see many of the sights that the hero does. And fourth, and most fascinating to me (Elliot, you kept telling me this) it is an ode to the practice of medicine, particularly medicine in extremely difficult, resource-poor, Ethiopian circumstances. It is that ode that I am particularly attuned to.

To digress, I was an unhappy medical student almost 40 years ago. It was a hostile, patriarchal, bourgeois profession that did not welcome a working-class socialist girl. I never felt part of the medical educational system at the time. It was closer to hazing than to glorious exploration of the science of the human body. I did well, but I never felt I fit in, and consequently never went the extra mile or claimed it as a fascinating, all-absorbing vocation. My joy was elsewhere – family and politics. 

That has changed over the years, as I have gotten into the mysteries of the science and its relationship to healing and the human life. Each year that goes by, I find myself wanting to know more – both reading the literature and exploring the intersection between that knowledge and preventing human suffering and death. It gives me excitement and joy. Hmmmm...

I have never seen that so well expressed as in Cutting for Stone. The hunger to learn, the frustration of making stupid, lazy mistakes, the inexpressible joy of making a diagnosis and knowing what to do about it.

I got so into this that for a while I was angry at myself for not having become a surgeon, as the Stones did in the book. Now THAT is an ahistorical joke! It took me a while to remember that I quit medical school after the first day of surgery because I was so disgusted by the anti-female, actually fairly anti-human atmosphere in the Duke Surgery Department. 

Well, I came to my senses re the surgical career issue. But I still appreciate the description of the passion for medicine. And then today I went to Referral and diagnosed my first case of Pott's disease, or tuberculosis of the spine presenting as paraplegia or bilateral leg paralysis and made my first diagnosis of Juvenile Rheumatoid Arthritis, both of which are possibly treatable. I was almost dancing down the hall. QED.

I am doing something else that I have always avoided, and that is teaching medicine. In retrospect I have avoided it, I think now, because I had so little respect for the medical educational establishment. Yet I have found that I really enjoy teaching in groups and one-on-one, and find, low-and-behold, that I have a lot to say and I say it in a way that surprises the medical students and interns and makes them smile, something that doesn't happen in Ethiopian medical education (an echo of my own from 40 years ago.) The girls in particular, and they are a pretty spunky lot and are about the same minority ratio as my own medical class, catch my eye and smile and answer. 

SOOO... El, I miss you, but am getting by. I am so glad you will have supper with Leah and Gavin tonight. Mulu, Masaye and Leah you are magnificent and I can't wait to see you. Arky, I would love your commentary on all this. Beloved, incomparable friends, keep Occupying and  know that we are there in spirit.

The hyenas howl every night outside our windows. Haven't heard them yet tonight. It is very odd – I find them comforting. I guess that is because they are outside. 

Goodnight and love to you,

Just Marty

Elliot's book, Laibon, is out!!!

I am very pleased to announce the publication of my book

Altamira Press 202 pages ISBN 978-0759120686 $24.95 Elliot Fratkin is Professor of Anthropology at Smith College, Northampton MA, and is currently US a Fulbright Scholar teaching at Hawassa University in Ethiopia. Laibon: An Anthropologist’s Journey with Samburu Diviners in Kenya by Elliot Fratkin.  Elliot Fratkin shares the story of his early anthropological fieldwork in Kenya in the 1970s. Using his fieldnotes and letters home to bring to life the voices of those he met, Fratkin invites the reader to experience his cross-cultural friendships with the enigmatic laibon (a diviner and healer of the Samburu and Maasai peoples) Lonyoki, his family, and the people of the nomadic community of Lukumai. Fratkin participated in the daily lives of the Ariaal livestock herders and accompanied the laibon as he performed divination and healing rituals throughout Marsabit and Samburu Districts. After Fratkin reunited Lonyoki with his son and wife, Lonyoki adopted Fratkin into his family, and Fratkin continues his close friendship with Lonyoki’s son Lembalen today. “Elliot dares to use his own research to pose the question: Is there any true objectivity in field research and anthropological inquiry? He dares to depict his own attachments and relationships to this very special community, while also staying true to his research. His insights further the reader’s understanding and appreciation of the culture and of the research process, thus expanding the boundaries of anthropology. Readers from budding anthropologists to aid workers to volunteers will identify with Elliot’s observations, experience, and deep connection to the culture he studied and the people he grew to love.—Kris Holloway, author of Monique and the Mango Rains: Two Years with a Midwife in Mali "A vivid, engaging account of Elliot Fratkin's apprenticeship into the mysteries of divination and healing by a prominent Samburu laibon. This book succeeds on many levels - as an unparalleled exploration of the secret meanings and methods of divination by laibons; as a window into the experience of extended field research - the insights and challenges, the emotions and relationships; and as a compelling story about our shared humanity, a reminder that people everywhere experience love, loss and life in ways that will seem achingly familiar.” —Dorothy L. Hodgson, Rutgers University “Fratkin’s book, a journal of personal as well as ethnographic exploration, is honest, funny, moving, empathetic, and respectful and, as an account of fieldwork, rings absolutely true. It is a superb introduction to Samburu, especially their prophets, and to the experience of field anthropology. It would make an engaging teaching text for engaged undergraduates and graduate preparation.” - Richard Waller, Bucknell University Laibon: An Anthropologist’s Journey with Samburu Diviners in Kenya by Elliot Fratkin Paper price for your students - $24.95. For more information about this text please visit the book's page on our website at www.altamirapress.com/ISBN/0759120684