Hartebeasts and pedagogy

Greetings from Hawassa. Another sunny, 80-degree day. The rainy season is definitely over and we can expect very little rain from now to next July. It will get hotter as the months go on.
The sky is hazy, not sure what that is about. There is little source of human-made air pollution-- no factories and not a whole lot of cars or trucks. Possibly it is dust from the desert in Sudan to the west? Don't know.
Sunday was a lovely day. El and our friends Emilia and Adam and Rhobot rented a car and drove to the northwest to the  beautiful, isolated Senkele game preserve for the endangered Swayne's hartebeast . We were the only visitors at the time, having reached it after bouncing over 10 kilometers of rutted dirt road through high-altitude Oromo farm country. We had previously asked several other local Ethiopian acquaintances about the park, and none knew about it, though it has existed for 40 years only about 50 kilometers away from Hawassa.
We visited the park with a guide provided by the Ethiopian military who led us on foot to the hartebeasts. We got within 30 yards of a group of more than 50 and just watched while they watched us. It was lovely, and very different from other experiences in game parks. In Kenya visitors are never allowed out of cars and the cars pile up on one another to see the animals.
On the way back to Hawassa we passed the Mulu Motel in the town of Aje. Will upload the pictures when we can get the card.
Elliot has finished his second week of teaching and is beginning to enter the groove. I was suddenly asked to teach the medical students today at the Referral Hospital when the head of the Department, Dr. Bire, said without warning that I should lead teaching rounds since he needed to go to neurology clinic. So I led 25 medical students down a 2-hour search for what makes an "elderly" -- I believe he is 50 years old! -- man with asthma, a past history of tuberculosis and ongoing hiv infection "swell up". It was fun and interesting since I spend most of my time as a doctor treating patients and do not take the time to explain the steps of gathering information through history and physical and then sorting through differential diagnosis. The students are smart but very shy and they speak very softly with -- to me, of course -- thickly accented English. And I found that I talked too fast for them. So we did our best to suit each others' needs. I need to spend more time with them on the physical exam part since there were some real weaknesses there, but all of us will learn in this process.
I also have been asked to "moderate" (still don't know what that means) a lecture by one of the medical students on tetanus or lockjaw. I have never seen tetanus in all my years of training and practice but it is relatively common in Ethiopia and the rest of east Africa. A young man was admitted with it and I had only the vaguest idea of how to treat it.  So the medical student and I decided to put together a powerpoint on it. Once again, the learning should be good.
On the social front, we had a lovely dinner last night at a popular Italian restaurant with one of Elliot's colleagues in Anthropology at Hawassa University and his wife.  It was the first time we had ridden in a car in 2 weeks, all our travelling having been either by foot, bike or bajaj. Gasoline is over $5 a gallon here and academics' salaries are very low, less than $250 a month. Thus we don't expect a whole lot of joyriding in Hawassa.
Tonight we will eat with Laila Dharabi and her co-workers. Laila was a high school friend of Leah's and is the daughter of our old friend Kathy Fennelly. She is on the Planned Parenthood staff and coincidental to our stay here is visiting PP affiliated organizations in Hawassa. It will be interesting to get her take on women's rights and access to contraceptives in Ethiopia. The Ethiopian Orthodox Church has considerable power in the country and is firmly against birth control, but Orthodox friends have told us that, for them, that is not a tenet that they follow. Educated couples put off childbearing until their mid-late 20's but poor young women get pregnant in their teens, sometimes early teens.
Tomorrow night will be the first of what we hope will be regular Amharic lessons with our young friend Rhobot, who lives with her family in our apartment building and will begin her first year at University of Hawassa. I now have the numbers down, at least to 20, and am starting on telling time and the parts of the body. I am determined to learn the writing, too, which is probably most closely related to Arabic.  Boy, I wish my mind were several decades younger!
We are well, we are getting plugged in, we may even get a refrigerator soon! We have a water filter and now have a system of boiling for health and then filtering in order to be able to stand the taste! This morning I had my first home-made oatmeal. This afternoon El put up a line so we could hang out our unmentionables on the porch and out of public view.
Life is good. We miss you and read avidly about the growing movement for economic justice in the US. Send us your thoughts. Love, Marty

Greetings from Hawassa!

El and I just returned from a lovely walk behind the Guest House where we stay to a small village and the  Langano Lily project. We walked on a dirt road past the lovely red lava rocks behind our apartment to a turnoff where lived about 20 farming families who had gardens and goats and cattle. The village is surrounded by fields of tobacco and corn. The houses are neat mud-stucco with wood beams underneath. After the village we followed the signs to Langano Lily, a large Saudi-owned flower-raising project with long rows of green houses and irrigated fields. We could smell the pesticides (present but not overwhelming) and see the water tanks. Ethiopians do work there but this was land presumably previously controlled by small farmers for subsistence production.  The government has leased large sectors of the country for agricultural use by multinationals, esp. Chinese and Saudi investors in flowers and biofuels.
The up side was the gorgeous Rift Valley with the cliffs rising to the East toward which we walked, the 
beautiful birds, and the ubiquitous kids playing soccer with home-made rag balls in the midst of the goats and cattle that they were supposed to be herding.
Our other great adventure this week was the Thursday trip to the Hawassa market. It is much bigger than we suspected with hundreds of stalls filled with vegetables from the countryside, clothing -- both traditional and western, cheap chinese-made housewares, Ethiopian bedding and, of course, cattle, goats and kids. It was beautiful and chaotic and exhausting. We got lots of essentials, even the clothespins that El insisted we would never be able to find, and with our new pots are starting to boil our own water so that we don't have to buy those *!#% plastic water bottles. Our friend Emilia took pictures (we forgot our camera) and will download for us soon.
My work at the Referral Hospital is taking shape. I have no real program to follow, so am spending time trying to figure out how to be most useful. I am able to provide my colleagues with some sense of how things could be improved for them and our patients. We serve people who are overwhelmingly afflicted with life-threatening infectious diseases and yet we have access to minimal resources to evaluate and treat. For my medical friends: We are constantly treating meningitis but the lab will not/cannot do adequate Gram stains or cultures. There are no blood cultures and no cultures for tuberculosis, when a good 1/2 of our patients have or probably have tuberculosis. Yet there is some good medical knowledge here among the physicians and a real desire to teach the medical students. I am watching and learning and adding what I know from my western training when it is helpful, having a real fear of displaying arrogance that WOULD NOT be helpful.
El is preparing for classes next week. I am uploading some of the pictures from our walk.
We feel supremely lucky to not only live in a lovely town with great friends, magnificent family and satisfying work in Massachusetts, but to have come to a place that is truly fascinating and inviting. Ain't life sweet!
Our love to the Occupiers and congrats on Obama finally announcing the end of the official occupation of Iraq. Let's get rid of the mercenaries and end the occupation and wars in Afghanistan and Pakistan.
Love, Marty

Elliot from Hawassa University

(Photos above - 1) university apartment where we live - in middle of cow pasture!; 2) ping-pong game on nearby road, 3) university run hotel where we stayed first two weeks in Hawassa)

This is Elliot now writing on Oct. 21 2011. I started teaching classes this past Monday at Hawassa University, teaching Development Anthropology to ‘second year’ students in the three year anthropology program. This is a large and spread out campus (really three campuses – the main campus, where I teach, the medical school where Marty works, and the agricultural campus, which, oddly, is in the middle of town.) It is the oldest of the three. There are about 25,000 students here, and anthropology, with sociology and psychology, is in the School of Behavior Sciences. I have 37 students, about 2/3 young men and 1/3 women, and the class is manageable. Anthropology is a relatively new major in Ethiopia, and I think these students are trying to find jobs in the development sector, such as with the government or NGOs, or work in heritage studies and tourism, which revolves around Ethiopia’s classic medieval sites at Gondar and Lalibela. Hawassa is capital of the Southern Nations and Nationalities, and Peoples Province, in SW Ethiopia, and home to many of Ethiopia’s ‘tribal’ people including Mursi, Bodi, Dasenech, etc.

The students come from a variety of backgrounds, both ethnic and class. Some are quite fluent in English, others much less so. They are drawn form around the country to the six large universities (Hawassa has about 25,000 students), and it is very competitive to get into university. Students here come from all over the country, but with the new federalism, there are many from this region which is predominately Sidama, famous for growing coffee. Students also come from the capital, Addis Ababa (Amhara people), Harare (Muslim and Somali) and Tigray from the north. The students are polite but a bit quiet, and I am getting used to them not asking questions (I don’t think they are encouraged to do that).

I had to jolt the students by the second class, as the fact was that only about 5 students were taking notes of the lecture. So I stopped and said "If you have any hope of passing this course, you better start writing notes, beginning with everything I write on the board. There is no text book for this course and the readings, although few, are difficult to follow for non English speakers." They started writing. Several eager young men sit up front, erase the blackboard, want to carry my briefcase. These are the “group leaders”, elected by the students, whose job includes passing out the one copy of the readings to everyone else. I decided to type up my lecture notes and pass those around as well, something I do not typically do at Smith College.

The government still pays for their education and board, which is remarkable as Ethiopia has embraced the neo-liberal orthodoxy of the World Bank so completely they seem to invite any and every company and country to invest. We’ve seen greenhouses growing flowers and vegetables for the  northern world run by Saudis and Israelis, concrete factories and road building by the Chinese, and hear about large agribusiness growing bio-fuels (including sugar cane for ethanol) by India, Djibouti, etc. The poverty is among the highest in Africa. As I was explaining colonialism and globalization, I discussed the question of cheap labor as an important reason to colonize (as well as getting at natural resources not available in the global ‘north’.) I asked what was a typical daily wage for someone with some skills, say construction or truck driving. They told me it was 15 Birr, about 88 cents. I told them someone at a similar occupation in the United States, making $10 and hour, would earn 1360 birr a day, something incredible to them. College professors make $235 a month, something with a $50 monthly housing allowance. My colleagues are friendly and helpful but overwhelmed - they normally teach 3 courses per semester and not infrequently are asked to do four or five. No one has a PhD, everyone teaches with a Masters degree, but it is difficult to matriculate through the PhD and keep their jobs. I am called Dr Elliot (as Marty is Dr Marty). Who needs second names in Ethiopia? (Actually the second name is one’s father’s name, and the third name is one’s grandfather.)

Good news as Marty said is we finally got into our apartment, which is like a large pent-house (2 floors) on the top floors of the University Guest House (4 story building). The down side is the building is in the middle of a cow pasture and corn field attached to the university, not quite prime real estate next to the lake (which is beautiful). But it is big and quiet, plumbing and kitchen a bit basic (and we are still waiting for a fridge from the University). Marty and I bought bicycles - I think most Ethiopians think we are crazy (why don't they have a car like the other Europeans?). The upside is that the university runs a hotel for their Hotel Management department, a stone’s throw from our apartment, where no dinner costs us more than $2.40 each.

We have two American neighbors, a fellow teacher in anthropology, Adam Boyette and his wife Emilia. Adam is a graduate student at Washington State University, and worked with Barry Hewlett (who was the Fulbright last year) studying socialization among Aka pygmies in Central African Republic. He shared a funny story, saying that corruption was so bad in the CAR that he and his professor had to bribe the Government Ethics Committee to get clearance! Fortunately Ethiopia is not like that. You can bargain with street sellers, but Marty and I have not had much luck with shop keepers, even in their extensive and lively market (more about that from Marty).

I’ll stop here, undoubtedly there will be much more to say in the future,

Cheers, Elliot

October 14 -- end of an eventful week

Hawassa blog 10-14-11

Greetings from Hawassa!

Sitting in our hotel room on the Hawassa University Main Campus with the ravens, kites, vultures, maribou storks and some form of eagle flying and perching out our porch window. Smells of food from the restaurant downstairs. Clear blue sky and a pleasant 75 degrees. Elliot is asleep on the bed after struggling to get our apartment set up this morning and beginning learning Amharic phrases and numbers. After we both bought bikes in the Muslim Sector a couple of days ago, I have biked to the Referral Hospital and back this morning, about 5 miles across town each way. It is an enjoyable challenge with every fraction of a second employed in scanning for emerging bajajes, suv's and trucks (rarer), horse and mule-drawn carts, bicycles and pedestrians. The hardest to deal with are the carts -- they don't stop no matter what. The bajajes never look before pulling out. The pedestrians are far more humble than our Northampton crew -- zebra crossings are meaningless and to stay alive you bow to the more powerful. We are lucky it is a relatively small town, only about 150,000, but still growing fast and chaotic.

My hospital experience has begun to absorb my thoughts and emotions. I work on the internal medicine ward and for now trail the rounding clinicians, act as consultant when appropriate and asked for, and ask a lot of questions about procedures and resources available for the terribly sick people that are being treated. Like the pedestrians, I am humbled in the face of superior forces -- hiv, tuberculosis and malaria being the main. When someone has a headache and fever, the main concerns are malaria or tubercular or bacterial meningitis, not the flu. Huge numbers of people are hiv infected. Antiretrovirals (for treating hiv), many antibiotics, and antitubercular drugs are available and used. I have no idea about the critical piece in this if people survive the hospital phase -- do they have support to continue their medicines? Also, patients must pay for many treatments and tests -- not clear which ones. Ah, yearning for single payer.

The Referral Hospital is a teaching hospital with medical students but not residents. The last year of medical school is the internship year, and the interns are really the physician workforce for the hospital. They do not have a whole lot of backup as they admit patients and treat. My heart goes out to them -- they are young and hardworking and the staff physicians can be highly critical. I get flashbacks from my own internship year.

The patients are poor and surrounded by family who do much of the nursing care. Unlike in most American hospitals where the critically ill are elderly, in Referral, most of the adult patients are in their 20's and 30's, reflecting disease patterns and morbidity in much of Africa. They are the age of my children.

Pain and suffering hit one over the head here in this beautiful land.

Will tap El next week to talk about his teaching. Please keep us informed. We follow the Occupy work with  huge hope and support. Add the suffering of the Ethiopian poor to the library of crimes committed by the CEO's and Pentagon as you protest.

Much love to you,

Marty and El

pictures and bicycles

October 10 -- a good day.

Hawassa, Ethiopia October 10,2011
Greetings from Hawassa. Today was a good day for Marty and El. Marty went to her first day at the Hawassa Referral Hospital and participated in rounds with attendings and medical students. Of course it did not start smoothly, as things rarely do when working in a different culture and language and place. I was not able to find the head of the Department of Medicine, who was in a meeting but who, it turns out, had waited for me as I had wandered around the hospital searching for him. Apologies and introductions made and off to rounds on patients on the medical ward.

The first patient had hiv and was in continuous seizures unresponsive to many medicines for seizures, tuberculosis, meningitis and and malaria. Very sick and would have been on the icu and probably intubated if he were at Baystate. Others less sick - much hiv, tuberculosis, pneumonia, a little bit of diabetes and heart disease. I told my colleague that I expected to learn more from the medical staff than they learned from me. No laughter or denial in response. Rounds are mostly in English, but people speak softly with thick accents and I wished I could borrow my husband's hearing aids.

Yet it was exciting - the tiny bit of medicine that I saw appeared sound and the physicians showed respect for the patients. There are limitations to testing and medicines, but not as much as in my experience 8 years ago in Eritrea, but that was a different time and a different country. Most of the practicioners are extremely young. Hawassa is something of a frontier - part of the Southern Nations, Nationalities and Peoples Region (SNNPR). Ethiopia's capital, Addis Ababa, has long had a respected medical school where doctors from around the region have trained. However, the knowledge and technology have been centralized and areas of minority peoples have been undeveloped in many ways, including medically. The recent policy of "federalization" - dispersing both resources and autonomy, has benefited areas like the SNNPR which includes the rural poor. However, it has stretched Ethiopia's fund of medical (and technical and academic) personnel to the max. The head of Internal Medicine could not have been more than 30 years old, and he was about the same age as most of his colleagues. I also rounded with a woman, which was great.

Other great news: it seems we have an apartment that is large, bright and spacious (though at the moment lacking a stove, refrigerator and hot water). It is on the Hawassa University Campus, where we have been staying for the last 5 days. It is a ways from the hospital - I would guess 4 miles, which I walked today thinking it was a whole lot shorter. But we will buy bikes and helmets (and thus become even more of an item of entertainment for Hawassans, who though themselves bike a lot, have never seen a helmet it seems.) When lazy we ride the bajajes, 3-wheeled taxis that use an engine comparable, I would guess, to a riding mower.

El will walk to work and will be teaching 2 days a week. He met with his dean today, who arranged the housing. So far his colleagues have been very kind to us, included us in a wedding yesterday with great food but, unfortunately, no dancing, since the couples (2 sisters were married in the same wedding - makes sense for those of us who know what weddings cost, and they are relatively more expensive in Ethiopia!) were Christian Evangelist. Too bad, since what we have seen of Ethiopian dancing beats anything we have seen anywhere else - lo siento, mis amigos latinos. Don't worry, friends and family, when there is a chance to dance, we will not embarrass you.

A los mismos amigos latinos, estoy apriendo Amharic ahora! Translated, I am learning Amharic now. I can say yes and no and thank you. Still haven't gotten please or the differentiation between good morning, good afternoon and good evening down, but old brains move slow.



We are healthy, happy & fascinated by all around us. We are not yet capable of downloading pictures but will overcome that disability. We love and miss you!

October 6, 2011

Hello, Friends and Family.

Greetings and love from Hawassa, Ethiopia.

Elliot and I arrived in Addis Ababa late Monday night Ethiopia time after 19 hours of flying, to be greeted by a wonderful lady from the US embassy, Eyerusalem or Jerry. She set us up in a hotel in Addis for the night, the Addis View, high on a hill overlooking the sprawling city. Jet-lagged and much more affected by altitude than either of us had remembered (Addis is over 9,000 feet), we spent the next day waiting for our ride to Hawassa (which didn't come till Wednesday), getting a briefing from the local CIA guy at the palatial US Embassy, trying to get phone and internet service and going for a walk in our neighborhood. Addis Ababa is huge, and the people represent many of Ethiopia's ethnic groups. There is 40% inflation and 60% unemployment in the country as a whole, but unlike Nairobi, we felt safe in the city streets at night.

The next day we finally connected with a car that had been sent from the University of Hawassa and took the 6-hour drive to Hawassa which is much lower in altitude and located on the lovely lake Hawassa, one of a series that dot the Rift Valley down into Kenya. The country is green and warm, with maize and vegetables and coffee grown. Hawassa is a lively and very enjoyable African town, with few forenjis (europeans), much small business, but the major economic force being the public Hawassa University where Elliot will teach anthropology. It is a new university, part of the government's plan to federalize and extend education to all the provinces. It is so new and the brain drain so severe, that noone else in his department has a PhD. We had a great night out with 3 of his new colleagues in Anthro, who began discussion of the complicated politics of a complicated country in the middle of a very compicated region of the world, surrounded by Egypt, Somalia, Kenya, Uganda and Sudan, not a one of which is without violent conflict. It is a conversation that I hope will continue for the next 9 months.

We are staying in the University-run hotel, staffed by students in the hotel department, where the food is great – lots of fresh tilapia from the lake – and the staff is very kind. Good thing: we still are sort of stumbling around and I still am not falling asleep at the proper hour. We take our antimalarials and pull down the mosquito netting over our bed at night (yes, Leah, we are being good!) drink lots of bottled water (which kills my environmental soul but we will soon be able to boil our own from the tap) and watch Maribou storks, Egyption vultures, kites, and many other exotic birds from our porch.

The first night I grappled with extreme homesickness, despite the good conditions. I miss all of you and your wisdom, thoughtfulness and kindness. Friends and family are irreplaceable, but hope that we can help and learn here.

Will write again soon after meeting with the hospital staff tomorrow. Love, Marty

Thanks to all who made this possible!

It is Sunday, October 2, morning, and we are thinking about the wonderful friends and family that we are leaving at the same time that we frantically try to put too much stuff into suitcases, cut down the wilting sunflowers, pick the remaining vegetables to give to Helen, send thankyou's to those who made the MNF auction a huge success, transfer emails and phone numbers into the traveling computers, download to the kindle, pack the books we have wanted to read for 10 years, and hug the cats. (No more dogs! :-( ) We love you and miss you and hope you write to us and maybe, hope against hope, join us in Hawassa.