March 25: Neoliberal birds, stupid death, student walkout, and social jogging

Greetings from Hawassa!

Marceau and Gloria on our porch

We had another great Saturday, biking further north up the main Ethiopian North-South route than we had last week when we visited the lake at Tequr Woha (Black Water). We got sick of the lorries and buses threatening us with extinction and turned off onto a path (couldn't call it a dirt road) that led through fields that probably are owned by the richest guy in Ethiopia, a half-Saudi, half-Ethiopian named Sheikh Mohamed al-Mudi, who owns much of the land along the road from Addis Ababa. This is neoliberalism ushered in by the present government of EPRDF after the more state socialist land policies of the Derg. Al-Mudi is a rather shady behind-the-scenes financier for the Tigrayan-led EPRDF which took over in the 1990's. Marty thinks that she saw him feted at the ICASA conference last December but was too politically dense to understand the significance.

Auger Buzzard (from web, not ours unfortunately)

In those fields, though, we saw a gorgeous augur buzzard (How can a buzzard be gorgeous, you ask? Just look him up on-line.) standing in the middle of the field allowing himself to be admired. Also got to look at another Abyssinian ground hornbill. Our AGH friends, Gloria and Marceau, have abandoned our fields recently, so we were happy to see one of their cousins still hanging around. Then we took sandy roads back to Tequr Woha and then to the main road. We stopped at the fanciest resort in the region, the Haile (owned by and named for the famed Ethiopian marathon star Haile Gabriel Selassie) and ate lunch and watched the monkeys play in the huge false fig tree overhanging the lake. 

Vervet near Lake Hawassa

Last week meant a lot of hard work for Marty. She was rounding in the Emergency OPD, Referral's emergency room, and in the last three days testing medical students on their physical exams and assessments of internal medicine patients. The week started out gang-busters. In the EOPD was a pregnant patient with what we think, though we haven't an MRI to test her, is neuromyelitis optica, an extremely rare neurological disorder that may be a form of multiple sclerosis and for which we have treated two patients in the last month! The interns had not noticed that she had deteriorated quickly, developing something called adult respiratory distress syndrome, and the team was able to assess her using our new pulse oximeters (thanks again, Jake and Domi), get her oxygen and steroids and move her upstairs.

Right after, Marty was walking down the hall and her eye was caught by a remarkable chest X-ray being examined by 2 of the interns. The patient had the biggest heart she had ever seen on an X-ray. The team went to see the 20-year old man who was bent over instead of lying on the gurney, cold and clammy and losing consciousness from shock. He had rheumatic heart disease, which is a scourge in Ethiopia. He had been fairly stable on medicines but then had decided to get cured with holy water and had been told that he had to stop his medicines, which he had done one week before. His blood pressure was unobtainable and the team needed to start a medicine named dopamine that would raise his blood pressure. However, the only dopamine in the hospital had expired and the pharmacy refused to release it. Marty did her inimitable “Fuck that shit” routine under her breath (she has learned a little bit of diplomacy in Hawassa.) and was jogging off to the pharmacy to pull rank to acquire the dopamine, expired or not. Fortunately, she ran into the beloved general practicioner Dr. Teddy, who said, rightfully, “I think I had better do this,” and took over for her and, amazingly enough, secured the dopamine.

Unfortunately, though the young woman has improved quite a bit, the young man died during the night. A “stupid death”, to quote Paul Farmer, himself quoting his Haitian patient. First of all, his disease was totally preventable if he had received penicillin for his sore throat ten or fifteen years ago. Second, he should have been able to have had his heart operated on, as would have happened in the United States, to fix the valvular problems that were killing him. Third, profiteering through religious quackery should not be allowed in Ethiopia any more than in the United States. Desperation from lack of good science-based treatment drives Ethiopians to traditional and religious healers, which usually offer benign interventions. It was not benign in this instance. His death was tragic and preventable, and drove Marty back to reading Paul Farmer's Pathologies of Power. His discussion of social and economic equity as a human right are a divining rod in her search for sense in medicine in Hawassa.

At the fruit stand

(This just in: Farmer's partner and co-founder of Partners in Health, Jim Kim has been nominated by Obama to head the World Bank. It illustrates just how inconsistent this administration is in approaching the crises we face. Judging by his past record, Kim could be an amazing leader of an organization that could make change for good in the developing world.)

Wednesday, Thursday, and Friday were stressful and interesting. Marty has never thought of herself as capable as a teacher. Yet she enjoyed working for hours with medical students who presented the histories of patients and examined them as part of their testing. The training is spotty because the resources – teaching and technical – are so limited. But the students are smart, dedicated and so very anxious! More than once she wanted to just hug them and tell them that they should work hard now, but also know that their training would go on and on and on, if they are wise.

Elliot is still having a rocky start at Hawassa University this semester. The class has only met 3 times since the beginning of semester in February. (The first 2.5 weeks were bust, as the classrooms were occupied by first year students taking their final exams. Great planning, once again, by the fabulous – not – Hawassa administrators.) This week the students were on a walk-out protest - unbeknownst to Elliot - protesting (rightly) that the university was restricting their travel allowance for anthropological field trips. A great thing about the Anthro program is that each year students are taken on an 8-12-day trip to one of three regions in Ethiopia - for cultural and archeological training. It is a great program that the University formerly supported by providing a cook and food for the trip (students take mattresses to sleep at field sites). This year the university said no more cook or food, but would provide 26 birr ($1.50) per student per day. Unbelievable, and completely ridiculous. Students are struggling with meetings with administration, but they don't seem to be getting anywhere. They are intending to go this week - we may throw in $200 to keep them alive, at the very least.

The students' trip will give us a break to visit the Southwest part of the country - the truly tribal area occupied by Konso, Hamer, and possibly the southern Omo where the Mursi people live (those are people with the famous clay lip-plates no one quite understands - they possibly date to the slave trade when Mursi disfigured their young women to prevent their kidnapping by slave traders). Although after our Kenya trip we certainly don't need a 'tribal adventure" (which lures busloads of tourists to the Omo), we do want to see the possible effects of the government's radical resettlement plan for their pastoralists with the construction of the big Gibe dams on the Omo. Will report back on that later.

Mursi woman (from the web)

Addendum: Marty just back from a goal-directed jog through town, the goal being eggs and bananas. In Massachusetts she jogged in order to clear her head through the privacy and endorphins. In Hawassa, that just doesn't happen. Privacy is not a concept that, if understood, has much value. Huge numbers of folks on the street, who always say hello, shout encouragement, laugh, ask where she is going, want to shake hands or even jog with her. Little boys yell out “You, you, you!” which may be because that is the only English word they know or may be jeering. Adults shake their heads in usually friendly disbelief combined with amusement that a gray-haired woman would ever want to do such a foolish thing as to waste precious energy on running (no matter how slow.) They work so hard and food is scarce enough that energy is a precious commodity. Marty has learned two lessons: 1. Don't wear shorts, and 2. Greet everyone possible in order to establish further community. As much energy as is spent in the 3-mile trek (the last mile walking since she was carrying eggs) is spent in trying to remember all those greetings with their appropriate gender and number and class suffixes. Whew!

The front porch of our apartment house -- University as backdrop

Do you see why we love cattle?

Black Water, Breakthroughs and Background

Marty and her admirers by Lake

Greetings from Hawassa!

Elliot is tired of talking about Kony2012 because it diverts from our experience of Ethiopia, which is neither mad killers with guns or helpless victims. It is life in a highly social and complex community that is difficult and challenging but engaging and frequently fascinating. It is not violent or frightening though poverty and need constantly raise questions of resource allocation for the common good. The issue of international resource redistribution is what drew us here, not men with guns.

Lovely little girl in Tyiqur Woha

 

We took a nice bike ride on Saturday, heading north on the main road, with the Lake to our left. After crossing the little creek that divides SNN region from Oromiya, we saw a dirt road off to the left through a cluster of houses and headed through a small village until we reached the northern part of the Lake. We drove by a man plowing his field with two oxen – a common enough site in Ethiopia, but Ell really wanted a good photo to use in his anthropology classes. He stopped his bike and asked if he could take a photo, and offered ten birr (.60 cents) which probably wasn’t necessary but polite. Ethiopia is one of the only countries in Africa (south of the Sahara – excluding Egypt, Libya, Morocco, etc) that uses oxen for plowing – it sure beats the tractors that World Bank and Green Revolution constantly peddle.

We biked further and got to the shoreline of the lake. Here we saw naked boys swimming, older boys (teenagers) with cattle in the water, and men on narrow reed boats fishing with long poles, occasionally pulling up the small (but delicious) tilapia to sell in town.We asked an old man if this area was Oromo (people) as we were no longer in SNN (which was mainly Sidama people near Hawassa), and he said it was Oromo.

Ibis in cemetery

Goliath Heron with lily pads.

We proceeded left to see if we could find any hippos. The bird life was spectacular, as usual on Lake Hawassa. We saw a male and female Goliath Heron (possibly the biggest herons in the world) plus egrets, plovers, and others. We met a young man who spoke good English, told us his villages name was Tyiqur Woha (“Black Water”) and we were welcome. It was a nice end to the week

The week for Marty has been full to overflowing with teaching. She prepared one lecture for her colleagues and interns about interpretation of electrocardiograms. She planned it for Wednesday but there was no electricity(!) at the hospital. When she finally presented it on Thursday, it was overly long and she expected glazed looks on all faces but was surprised that folks seemed to be into it. It was encouraging that there was consensus that the effort should continue and one of the other internists agreed to take over tachyarrhythmias (thank god!) while she would do heart block. There is huge irony here: Marty has never seen herself as a medical instructor and has shied away from medical academia. To pretend she is a cardiologist is over the top, as any colleague at Brightwood will understand.

Even more shocking, on Friday she presented TWO HOURS of fluid and electrolytes for the medical students. Ugh. Every physician's nightmare – hypernatremic and hyponatremic hypovolemia. But she pounded through it for a week's preparation until she felt that EVEN SHE maybe understood it. And the students, fortunately, had studied well and were able to follow her, though they have no tools – can't measure sodium, potassium, bicarb or chloride – to measure what she was talking about. She is growing extremely fond of them and feels as though it is becoming mutual. They are so young and earnest and clearly shocked and pleasantly surprised when she acts out the role of a confused and frustrated red blood cell rejected by the left ventricle and finding itself back in the left atrium after having passed through a regurgitant (leaky) mitral valve in the heart. Her colleagues are seemingly a little more formal.

She has been playing her favorite role in the department – rounding in the emergency department. She is still amazed by how ill the patients are. It is not uncommon to treat patients empirically for cholera; the staff still does not routinely culture for severe gastroenteritis at Referral, though she is impressing on the general practitioners and interns that they need to and informing them when and how to do it.

This week brought a major breakthrough. There are huge numbers of patients with what is called (euphemistically) AFI for acute febrile illness. They have fever, headache and may have associated seizures and coma. In other words very, very sick. Marty has written before that the hospital's capacity to diagnose them so that they can be treated properly has been very limited. The major decision to be made is, Is this malaria or is this meningitis? And the answer has usually been, Who knows? The doctors do their best, but 1. The microscopic tests of the fluid taken from a spinal tap are poorly done and unreliable. 2. Ditto the microscopic test for malaria, and 3. There have been no cultures for bacterial meningitis, which is what most doctors in the global north ultimately rely on. So, usually Referral doctors have treated, as her boss says, “gunshot”, or for both. But that is expensive and exposes the patient to drugs that are not without side effects, and they may be missing an entirely different alternative.

Marty's colleagues, Drs. Tariku and Andergow.

For the first time this week, the Department was told that it could get CSF (spinal fluid) cultures! It is supposedly for “research” only, (our wonderful lab supervisor winked as he said it) and only under certain circumstances, but it is a wedge through which it is hope a truck shall be driven. Hallelujah!

There may be a second breakthrough, soon. Marty is working with administrators of the Ethiopian Malaria Consortium to see if the hospital can obtain a. rapid diagnostic (antigen) tests or b. further training for lab staff for the routine blood film test for malaria. She and her boss are doing a stealth attack on that flank, with the full support of the rest of the department, the pediatricians, the lab supervisors and, probably, if they were asked, the patients.

She is struggling mightily with Amharic, amazed that one language can be so difficult and take so many syllables to say something fairly simple like “I walk.” Eyeterameudkuny no.” Seven syllables, no less. And both vowels and consonants are a constant challenge to the tongue. But another breakthrough. On Thursday she was able to ask a patient whether she had a cough or fever. She expected the poor patient to look at her in mystification, but instead, she readily answered, “No.” Shocking to both Marty and her colleagues. Keep hope alive.

 

Speaking of which, Marty just finished Congressman John Lewis' Walking with the Wind and it provoked a lot of thought and discussion about how social change takes place. John Lewis is one of the primo nonviolent organizers of all time, leading the way over the Pettus Bridge in Selma in 1965 and getting his skull fractured by Alabama police, but that was the culmination of constant door-to-door organizing with SNCC for the right to vote and to be free of violence. We both feel tremendous admiration for his radical ideas about democracy – especially economic justice – and the eloquence of his nonviolent stands and his god-awful stubbornness and tenacity. His story reminds us of and challenges our own radical past. Marty wishes, particularly, that she had known more history when she was organizing in North Carolina thirty some years ago.

The anthropologist at work

One nice thing about living here, and having a lot of spare time when not teaching, is that Elliot is doing a lot of reading and talking to people about Ethiopian culture, society, and history of surely one of the most interesting places in the world. Like most African countries, Ethiopia is a hodgepodge of different ethnic groups, some large and powerful, some small and isolated. Ethiopia has over eighty groups, the largest being Oromo in the south, and the Amhara and Tigray in the north (and the related to Tigrinya in Eritrea). In addition there are Somali and Afar (Danakil) pastoralists in the east, Sidamo and Wolaita coffee growers in the south west. To the west and southwest near Sudan and Kenya are truly tribal people including Mursi, Suri, and Bodi on the Omo River (they wear the large clay lip plugs) and the Nuer and Anuak in the far west (Sudanese cattle people who are very tall and dark). By far the two most important groups, who shaped Ethiopian society and culture as we know it, are the Amhara and the Oromo. They are almost opposites of each other in culture and society – Oromo are egalitarian cattle herders and agro-pastoralists, organized by age grades without any chiefs or true centralization. Amhara on the other hand are a very hierarchical society with (in the not-too-distant past) feudal lords and Orthodox Christian bishops at the top (these are the people whom Haile Selassie comes), followed by a huge majority (90%) of farmers who raise teff grain with their ox plow agriculture, and low caste blacksmiths and wood workers at the bottom. Amhara inherited the high tradition of what they call the Solomonid Dynasty – the belief that all their kings and emperors descend from Menelik I, the illegitimate but beloved son of King Solomon and the Queen of Sheba. According to their national epic the Kibre Negest (written in various forms between AD 600 and early 1300s ) Menelik came to Ethiopia, “God’s intended and favored country,” bringing the Ark of the Covenant (with the ten commandments) with him. It is believed to this day that the original ark is hidden in a church near Axum in Northern Ethiopia.

Black Madonna Axum Cathedral

High culture of Ethiopia began with the Tigray whose kingdom of Axum was a trading empire that dealt with the Mediterranean, Indian, and Egyptian worlds through the port of Adulis (that our archeologist friend Daniel Habtemichael studies) between 1000 BC and 700 AD. Axumites had a written language (Ge'ez, which is the script in use here).After the spread of Islam in 7^th century, Axum was isolated from the Red Sea trade by the formation of Islam and the spread of Muslim culture and networks. The Axumites were early Christians, adopting the eastern Orthodox religion from Syrian priests in the 4^th century and forming one of the world’s oldest Christian communities.

Axum at Tsion Festival

The Ethiopian Christians built Lailibella (with its eleven churches carved out of rock and connected by tunnels), they even sent Christian knights to fight in the Crusades. They built Gondar, a medieval town of castles and monasteries which was the center of the Zagwe Dynasty which reached its zenith in the 15^th century and spread Amharic language and culture throughout the north. By 1520, however, the Turks, the greatest military power in the world at that time, expanded their influence to the Red Sea and helped arm Muslim Somalis and Afars to launch jihad against the Solominid Kingdom. Under the charismatic leadership of Ahmad Grañ (“the left hand”) from the walled city of Harar, the Muslims reached the highlands where they were stopped by a combined army of Amhara and Portuguese troops.

Menelik II

 By far the strongest of the Amhara emperors was Menelik II (1844-1913, taking his name from guess who) who expanded from the Shoa highlands in the center to the south incorporating Oromo, Somali, and southwestern cultures under Amhara dominance. It was Menelik II who, at the urging of his wife, created Addis Ababa (“New Flower”) at the turn of the 20^th century. It was Menelik who defeated the Italians in 1896 in the Battle of Adwa. The Italians, who had colonized Eritrea and southern Somalia, tried to add Ethiopia to their colonial conquests. Defeat at Adwa was a great humiliation to the Italians, and Mussolini tried to avenge Adwa when he invaded Ethiopia in 1935, bombing Addis and setting up colonial rule until 1941 when the British forced them out. In 1936 Haile Selassie went to the League of Nations to plead for intervention by the Europeans, but like the Spanish Republicans fighting their own fascist Franco, his pleas fell on deaf ears. “I ask what measures do you intend to take? What reply shall I have to take back to my people?" France and Britain were too afraid of starting a second world war with Germany and Italy, so they sat on their hands until the war came to them three years later.

Selassie at the League of Nations June 30, 1936

 Haile Selassie came to power in 1930 following an interregnum after Menelik’s death in 1913 where power was held by Menelik's wife (some say Selassie, tired of waiting, suffocated the queen mother ( - the same fate that Selassie himself met at the hands of Mengistu in 1974). Haile Selassie means “Power of the Trinity”: his real name was Tafari Mekonen, and he was called Ras (head or prince) Tafari – hence the origin of Rastafarians in Jamaica who saw him as the Lion of Judah and leader of all Black People. Selassie's reign and the remnants of Ethiopian feudalism were overthrown by Mengistu who set up a pro-soviet regime – he is remembered for returning land to the peasants but also for his murderous rule that killed hundreds of thousands of people opposed to his regime, including Marxist students in the 1970s and huge numbers in the liberation movements in Eritrea, Tigray, and Oromo in the 70s and 80s until his downfall in 1991 by combined national (i.e. ethnic) liberation movements of Tigray (TPLF) and Eritrea (EPLF), with additional movements in the Soamli region (OPLF) and Oromo area (OLF).

The Amhara, who until recently constituted the most educated and powerful group in Ethiopia, have been characterized as individualistic, hierarchical, beholden to both Orthodox priests and feudal lords, taciturn and, in the past, the group that could rule others. Under Menelik, Amharic culture spread by force to the south, south west, and east as Menelik expanded Ethiopia to its present borders, in part to keep out the British (in Kenya and Somalia) and the Italians (in Eritrea and Somalia).

In contrast to the Amhara, the Oromo are non-hierarchical, bound by their kinship groups and age grade system known as Gada but lacking in kings. They remind us much more of the Ariaal and Rendille people we know from Kenya. The Oromo are livestock keepers – they own the majority of cattle in the country and much of its goats and sheep (camels are the domain of Afar and Somalis in the eastern lowlands); the most nomadic of the Oromo are the Borena, and probably all Boran were pastoralists 400 years ago (now many farm maize and other crops as well as keep livestock). The Oromo were fabulous horsemen of the past – they probably gave Menelik II his divisive edge over the Italians at Adwa. These were the people we went horse riding with in the Bale mountains a few months ago. In the 16^th century the Oromo spread to many regions, including the Shoa highlands in Amhara and into Kenya as well. This Oromo Expansion assimilated other groups so that today they are 55% of Ethiopia's population.

When Menelik conquered the Oromo areas in the 1890s, he imposed an Amhara feudalism over them, rewarding his officers with land in the south and making the conquered people pay tribute including several months labor each year. The Oromo have felt dominated by the Amhara much of this century, including during the Derg time of Mengistu (1974-1991). Mengistu was overthrown by both the Tigray Peoples's Liberation Front (TPLF) and the Eritrean EPLF in 1991, the TPLF leader Meles Zenawi became president. But because he believed in ethnic sovereignty, Meles established a federal government that gave some autonomy to different regions, and Oromo have stepped up to the plate as equals to the Amhara. There still are resentments and ethnic favoritism played out all over the country including at Hawassa University, but we believe that most Ethiopians seek a greater Ethiopian identity than just that of their own ethnic group. Amhara is the national language, but the music and cultures of all regions are promoted, at least according to the music videos on national TV. Most Ethiopians see themselves and their country – its history, customs, and peoples- as unique, and we do too.

 Mengistu Haile Mariam (ruled 1974-1991)                 Meles Zenawi (1991- present)

The final and mandatory cow picture

 We miss you, as always, and will return in late June.

Marty and Elliot

Kony2012: More thoughts

Greetings from Hawassa!

 

We have been mulling here in Hawassa and by email with friends the meaning and impact of the Kony 2012 and Invisible Children phenomena. We have received a little more information about Jason Russell and it has helped to flesh out the character and perhaps the intent of the film and the crusade. 

 

Our earlier critique http://elmartyhawassa.blogspot.com/2012/03/kony2012-our-thoughts.html was that:

1. The Kony2012 campaign was not factually based.

• Joseph Kony years ago moved from Uganda to Democratic Republic of Congo where he has only a few hundred followers. He is no longer a threat to the people of Northern Uganda (though he, like many other violent militias, is a threat to the people of DRC).
• The “victory” proclaimed by the film of the sending of 100 advisers by President Obama to Uganda was misplaced, since by international law neither the Ugandan Army nor these advisers have jurisdiction in DRC.
• In the DRC, Kony's is one of multiple militias killing, raping and looting a wealth of gold, diamonds and coltan (for our cellphones) which they are providing to western multinationals, with the particular involvement of Uganda and Rwanda.
• The film, which calls for the capture of Kony for his human rights abuses, never mentions the widespread human rights abuses committed by the Ugandan Army in its anti-Lords Resisstance Army (Kony's group) campaign against the very same people victimized by Kony (giving some indication of the complexity of a campaign to capture Kony.)

2. Millions of dollars given to the Kony2012 campaign has never been accounted for.
3. The Kony2012 campaign seems to demand military intervention, presumably in Uganda or DRC, which would mean further violence (and inevitable mean civilian deaths) and a US military presence in Central Africa. The mineral wealth of Africa – not just that in DRC, but oil discoveries made in the last decade throughout the continent – has not escaped the interest of US multinationals, but because of lack of security in many of the regions of interest, military intervention will most likely be necessary to extract these riches. Desire for a military presence is evidenced by the US plans for establishing Africom (like Centcom in the Middle East) to oversee military actions on the continent. Yet an American military presence in Africa is not something that either most Africans or most Americans desire. But the “human rights” cover given by the Kony2012 campaign dovetails with those designs.
4. It smacked of racism. The Africans presented in the film were either victims or mad men with guns. The problem of Kony thus demands American saviors. Africans are without agency (except as murderers) and cannot be relied on to take care of business in their own countries.
5. There are real, pressing issues of international peace and justice that Americans have much more control and responsibility for: over a hundred thousand civilian deaths in Iraq, Afghanistan and Pakistan resulting from our ongoing wars and occupations. Kony2012 diverts youthful anger and idealism from the actions taken by a military that American youth actually pay for through taxes and, theoretically, direct through the democratic process. It spends precious youthful energy on something that doesn't make much sense and could do very real harm for Africans.

This all bears repeating. Nothing has refuted it since we wrote it.

 

But since then we have learned that

1. Ugandans are angry about the film's seeming plan to meddle with and disrupt their region, which is now pea ceful and rebuilding. http://www.telegraph.co.uk/news/worldnews/africaandindianocean/uganda/9131469/Joseph-Kony-2012-growing-outrage-in-Uganda-over-film.html
2. Jason Russell and Invisible Children are linked to the religious right-wing through funding by viciously anti-gay Christian fundamentalist backers, including those that have supported the proposed anti-gay death penalty law in Uganda. http://www.truthwinsout.org/blog/2012/03/23165/
3. Jason Russell was showcased (along with the young man who hooked up Chuck Norris with Mike Huckabee) last November at Liberty University (the late Jerry Falwell's school) declaring his fundamentalist beliefs and providing a model for Liberty students who want to “do something”, in his case stating that he was fighting against “genocide” in the Kony2012 campaign. http://www.youtube.com/watch?v=wkB8o5VWAjE&feature=player_embedded

This may not be news to others but it was to us. And it has helped us understand the campaign a little better but also provoked important questions about the source of the campaign and the direction it is going.

First, it made us realize that this was prompted and probably seen by its creators as Christian missionizing, something that has an, at-best, duel character in Africa and around the world. Missionaries are frequently motivated at least in part by genuine compassion and concern for victims of poverty, violence and disease. And that is admirable and can be very inspiring. However, there are also selfish goals involved: the hegemonic saving of souls for one's sect, the self-serving aggrandizement resulting from redeeming the missionized, and the potential for raising money for one's efforts. Rarely does it involve thorough investigation of the situation and culture of those whose souls are being saved or who are being helped, because subsumed in the other goals is that of transforming the culture that is being missionized into that of the missionary. 

 

Elliot has written a bit about the African missionaries he has encountered and has captured both the irony and the actual good deeds of the various players in Northern Kenya where he has worked for many years.

But there is another role that missionaries have played on the global stage and that is, consciously or not, to accompany political, economic and military power from the West into the host country. We fear that even though Jason Russell's own goals may be (mostly) pure – or not – it looks as though he may be accomplishing most of the nasty results of more than a few Christian missionaries throughout history.

Bringing in the military, ignoring the facts and local people's own agenda, taking the money, refocusing attention from real issues of inequality, poverty and violence promoted by our country, perhaps encouraging the plunder of African resources. Hmmmm...

And the religious hegemony thing. The recent results of American fundamentalist meddling in Ugandan Christianity has led to the proposal of the death penalty for gay men. We don't know how much Jason Russell and Invisible Children have bought into this aspect of the fundamentalist agenda for the region, but it is a question that should be asked.

 

A wonderful friend in the States who teaches high school to mainly poor and working class Latino and white kids wrote asking our thoughts. Her students, for the first time, are looking at maps and asking questions about Africa because they are caught up in the Kony2012 thing. Her own critique of Kony2012 is negative, but she is so thrilled by their interest that she is not sure how to approach it.

 

Good question. Right on, interest in Africa! But real interest, investigating the culture, history, expressed needs, diversity, hopes, politics, economics, all of it of Africans, not the imposition of our own agenda.

 

We agree with Jason Russell: we can make a difference, but not the difference that benefits us or Christian fundamentalism or the US government and multinationals. It must be a partnership, not a crusade.

There have been political ironies attached to Kony2012 that are interesting to think about. The first we noticed was the film's agenda to turn Kony into the International Criminal Court, which has indicted him. Ironic because the ICC is anathema to the right-wing in the US and has not been supported by the government because it would hamper our human rights violations. Though we believe there are deep right-wing ties to Invisible Children, it doesn't look like every aspect of the campaign was coordinated.

Second is the history of Kony and the roots of the LRA which combined Christian Fundamentalism and African mystical beliefs. This movement started in 1988 when an Acholi woman named Alice Lakwena established the Holy Spirit Movement, which she says was based on messages to her from the 'Holy Spirit of God'. She said the Acholi people of northern Uganda could defeat the government of Yoweri Museveni if they abandoned their traditional religion and followed her cult; she said her followers would be immune from bullets if they put shea nut oil on their bodies. Kony was a rebel militia leader who joined the Holy Spirit Movement, claiming he was Alice's cousin; he transformed it into the LRA. Kony claimed he too was possessed by spirit and could use witchcraft against his enemies. He also advocated making a cross from oil on one's chest to protect from bullets. It is a bit ironic that American fundamentalists choose to castigate Kony as something wildly different from themselves.

Marty and Elliot 

Kony2012: Our thoughts.

 

We just finally viewed the video and must say that it is compelling, with the producer's adorable little son and the heartbreaking story of the abducted Ugandan boy. But our critique and questions are:

1. The film is very misleading in terms of the facts: Joseph Kony has not been in Uganda for years, but is in Democratic Republic Congo where he only has a few hundred followers. He is a threat to local people, but is not, under international law (which the film keeps referring to) under the domain of the Ugandan Army which

2. Was responsible for human rights violations – murdering of villagers who, themselves, had been victims of Kony’s terror.

3. The disaster that is eastern Democratic Republic of Congo, where many armies and militias plunder, murder and rape over the spoils of coltan (used in your mobile phone), gold and diamonds will not be resolved if Joseph Kony is captured. It is the result of multinational-supported looting of one of the most minerally-rich areas of the world. Uganda and Rwanda are particularly guilty for the continuing violence in this area.

So if the film ignores important facts, what does it do?

1. It likens Kony to with Hitler on posters, in the footage and in the date for the actions (Hitler’s birthday, 2012). That is extremely inflammatory and equates a mass-murdering dictator who threatened all of Europe with the leader of a small militia in an isolated jungle in central Africa.
2. It says that young people can make a difference and almost all of the young people pictured in the film seem white.
3. It demands the arrest of Kony and, though never quite clear, seems to say that that should be done by intervention by the US military (presumably along with Ugandan military). It implies guilt on behalf of the US government (with reactionary oilman Senator Inhofe leading the charge for justice) for not having done more.
4. It diverts youthful righteous anger about violence and war away from the violence and war that the US is committing: Afghanistan, Iraq, soon-to-be Iran where much broader devastation and killing of children has occurred.
5. A very small amount of the money raised by Invisible Children is going to benefit the victims of Kony’s violence. They advertise it as 37% but that does not account for millions that “disappeared” from the records – taken in but not accounted for.

Kony is a horrible, evil man and does need to be brought to the International Criminal Court. No question. And there needs to be support for rebuilding of Northern Uganda’s infrastructure and security. But focusing American youth’s energies in support of military intervention in Africa is dangerous and diverts that longing for justice and peace from the genuine peace movement to bolster further violence and war. There are oil discoveries all over the continent now that oil companies would love to take advantage of, but cannot do so without the support of the military. This “human-rights-based” intervention could help pave the way.

Further, there is more than a hint of racism here. Once again Africans are portrayed as either helpless, suffering victims in need of (white, American/European/Christian, etc) support, or vicious and crazed gunmen who only know how to plunder, murder, mutilate and rape. There is an appeal to “save Africa and Africans” that does not respect African agency and ability to take care of their own business.

And let us not forget that this intervention is being called for at the same time that the United Nations’ Global Fund’s spending on treating and preventing AIDS, Tuberculosis and Malaria is being cut. Costly military intervention comes at the expense of many other things that have proven effectiveness on the ground in countries such as Uganda. 

For peace and justice, Marty and Elliot

March 8: Poverty and Power -- Electric and Otherwise

Greetings from Hawassa! March 8, 2012 - Happy International Women's Day!

Hawasssa U. students

Young mother with infant on Hawassa's main street.

Young woman carrying her baby. (Emilia's photo)

From Marty: Rain at last after three months of dry season! The ground was cracked, all grass was brown, the cattle and goats who roam the town and the fields seemed to be eating dust which filled the air and coated our skin and clothes whenever we went out (or stayed in, actually.) Elliot has lived in a desert for almost two years and has never seemed to be alarmed by dry seasons. I am a Midwesterner and a gardener at heart and become anxious with extended periods of blue skies. Actually, neither of us was attuned to Hawassa, where normal is a dry season from November or December to March or April. It is hot and rainless and windy and the animals either graze off what remains or survive on the hay that was cut in December. We have now had 3 days of afternoon and evening showers and are beginning to see the little green sprouts at the base of those lifeless brown floral carcasses. We are both sleeping better, though we worry that the mosquitoes will start breeding again and carrying their nasty little Plasmodia (malarial parasites) from person to person.

Walking back to Guest house, Nathan-Fratkin Residence

Our neighbor pounding hot peppers for berber.

Speaking of which, I am plowing through my London School of Tropical Medicine and Hygiene course (Freudianly initially written “curse”) and am now teaching what I have learned about those evil little parasites (Stop anthropomorphizing!) to medical students. Every day I learn something different about teaching medicine:

1. That it is perfectly ok to answer, “I have no clue whether Herpes Simplex Type 1 is more likely to cause encephalitis whereas Type 2 more likely causes meningitis,” and “I am going to have to check if Cryptococcus causes a rash.”
2. If I am supposed to do teaching rounds on a patient that is in severe respiratory distress (might any minute die from lack of oxygen due to disease) it is not only correct but imperative that I stop what I am doing and help the patient.
3. If I am scheduled to teach a two-hour power point lecture in the medical school, I do have a right to a room, no matter what the room-matron says.
4. When the electricity fails in the middle of the power point, it most likely will come back on.
5. When my students look asleep, they probably are.

I am also learning how to approach teaching all the diagnostic and therapeutic methods that are available in the US context but not in Hawassa. I forge ahead saying: a. These things exist but are not available here now; b. They should be available to save Ethiopian lives in the future and here is how they work and c. Think about how we can secure these important things so you can use them. I've used this approach on everything from sublingual nitroglycerin, cheap and essential for treating heart problems, to a functioning blood bank for patients dying from bleeding, neither of which do we have.

I am excited about my little place as an observer and sometimes an actor and teacher in the improvement in Ethiopian medicine. Referral now can culture urine and stool for bacteria (sorry if you read this as you are eating your breakfast!) and the main problem is making interns accustomed to their use when appropriate. And there is a plan by the lab to start culturing the fluid that comes from around the brain – the CSF – so that we actually can tell what kind of meningitis we are treating.

There is a functioning nebulizer now on the Internal Medicine Ward, though no-one but our chief, Dr. Birrie, knew it existed till this morning – he was gone last week – so asthmatics with trouble breathing can get relief. Again, we need an in-service now to tell all the staff how to use it. The interns do know how and do use the pulse oximeters to tell them if a patient has enough oxygen in his/her blood.

And low and behold, we will start adopting a way of evaluating whether we are treating our patients better – something called Quality Improvement or QI. Dr. Birrie just came back from a week course in Addis Ababa about it. We had already talked about compiling our figures on mortality and other outcomes based on diseases so that we could know if we are improving. I must say that QI in US institutional medical settings is probably the least exciting of any possible undertakings. But in Hawassa? Suddenly it gets my little heart thumping.

Thoughts on all this. I've been reading Paul Farmer's Pathologies of Power which I relate to almost thoroughly. (Though I really respect liberation theology, as an atheist, the God thing is not a functional approach for me. There are non-religious ways to come to the same moral, political, social and medical conclusions.) In many ways I am a luddite who believes that we should, as much as possible, tread lightly on the earth, that carbon-based fuels especially and manufactured chemicals should be used very judiciously. However, I agree with Farmer that the basic, miraculous advances of western medicine should be available to all people, including the poor around the world. Treatment for HIV, multi-drug resistant TB, diabetes, heart disease, but particularly treatment and prevention of the diseases of childhood – malaria, meningitis, pneumonia – are human rights. I am refining and tailoring my rage against the machine. I still ride my bicycle and will do anything to stop war, the most environmentally toxic, unsustainable human activity of our age (and maybe any age). But I've found clarity with Farmer's well-directed diatribe against the lack of inclusion of health and thus economic rights as human rights. In the United States the victims of poverty, the “throw-away people”, those who could not afford adequate food, shelter, clothing, education or health care, are hidden from the mainstream. In Ethiopia they are the mainstream, but hidden from the US and Europe.

Urban children

I agree with Farmer's “preferential option for the poor.” Not news to all my Brightwood colleagues, folks with Arise or Beloved Community Center or Northampton Survival Center, all of whom do what they do because they believe in this brand of human rights. But it is a clarification, a restatement of the reason that I am a doctor.

Farmer's analysis also recasts medical care in a broader sense, the same sense that my beloved boss Jeff Scavron sees it: passing a pill (if that pill works) is good, but health is a complex and contextual matter, and requires nutrition, a home, intact family, running water and sanitation, healthcare and education to guide choices and provide work and sustenance. Almost all Hawassans lack at least one of these things, and probably a majority lack several or all of them. This is both a medical and human rights issue.

Rural children with sugar cane

Man begging on main street in Hawassa

Old man with cataracts in front of his house in Bale Mountains with pile of firewood used to heat and cook.

Enough! I am going to be rounding with the interns and general practitioners in the Emergency Room on a regular basis, at least for this month. This is one of the Referral jobs I like most, a surprise since I was not, by any means, an ER jockey in the States. I also am creating and will be teaching all staff a course on Basic Reading of EKG's (though the ward EKG machine is missing at least one of its leads) and a lecture on fluid and electrolytes to the medical students (though we cannot measure electrolytes.) More on all that next blog.

The Professor on his way to work at Hawassa U.

Elliot’s Thoughts:

We have reached some sort of ‘compromise’ about the electricity with the university, namely that they will give us in the Guesthouse power twice, mornings and evenings. Of course what they need is more power, a separate cable to the guest house that doesn’t make ours run through the water pump for the dormitories. I guess they feared a real riot if 25,000 students could not wash.

I am into the second semester teaching Development Anthropology; I am not as enthusiastic as I was first semester. I must say I am getting weary teaching students of whom only a few speak decent English but the majority of whom brazenly copy papers, occasionally cheat, etc. Marty says this behavior is part cultural – “not to help your friend is shameful” - but it is also desperation. If these students don't do well, or even if they do, job prospects are pretty dim, particularly for Anthro majors. Unemployment is still 50%. The Federal Government's goal of mass education is notable, but they are expanding much faster than they can provide for.

Hawassa U has 25,000 students and they want to double that in 5 years. The Anthropology Dept has just proposed (and was accepted) an MA program, but who will teach these courses is beyond me. The other faculty (there are six of us) have now been asked to teach four courses each per semester (for a monthly salary of $240 or so). I offered to teach another course, but was outright rejected – I think they think that is shameful to use me that way. But at least I am one of the guys now (only female professor is pursuing PhD in Italy), and we can bitch over our beer and Tibs (roasted meat) together. Four other faculty are pursuing their PhDs out of country (in Norway, US, India) so in the long run this will be a strong department. It is the short term that weighs down on us.

Marty seems to have a more satisfying job, even though it seems exhausting. She goes off every morning (by cross town bicycle) and directly engages focused medical students and very sick patients. Unlike us academics, she gets to see the results of her actions everyday - the patient gets better, the patient doesn’t get better and you try a different approach. I am less directly engaged with my students here, much less than at Smith. The students are shy, deferential, and do not come to see me during office hours, although some like to walk and chat with me which is actually the highlight of the day. But I can’t get students to break out of the ‘learn by rote and don’t ask any questions’ mode of education here, something that seems common in developing countries.

While I am not doing direct research, I am becoming very interested in Ethiopia's policies towards pastoralists and agro-pastoralists. The government has an ambitious plan to develop irrigation agriculture, hydroelectric power, new roads and universities, and hospitals. All well and good, and their main strategy is to attract foreign investment, including large scale agribusiness (for bio-fuels, sugar cane, rice, cut flowers), much of it coming from Saudi Arabia and India. But many of these projects are in underpopulated regions of the country, meaning the dry lowlands where pastoralists live. (The government’s base are peasant farmers, which is where the TPLF came from.) For the most part, the government sees nomadic pastoralists as ‘primitive’ and wasteful, and would like to seem them settle down, ostensibly to improve access to health care, education, social services. But this has meant displacing and resettling pastoralist groups from the river valleys being converted to irrigation agriculture (i.e. Awash, Omo, Gambele rivers valleys). Human Rights Watch recently released a report on barren resettlement villages for Nuer and Anuak agro-pastoralists in Gambela region, and the Awash River has had long term displacement of Afar (Danakil) pastoralists for sugar cane production, although their clan chiefs cut their own deals with the main companies for grazing access. Anthropologists are seen as troublemakers who want to "keep people as living museums" rather than “improve” them. I organized a panel for the next year’s American Anthropological Association meetings in San Francisco that will deal with land issues and displacement, something I look forward to writing about.

Cattle in Oromiya

Still, things are not bad here on a daily basis. Had my flat tire repaired on a sidewalk bike stand; Marty and I had pasta and mango juice for lunch at our favorite balcony restaurant on the city’s Piazza – Hawassa’s main thoroughfare, lined with palm trees and bougainvillea. And the wind is pleasantly blowing through our apartment as I write. Cheers for now, Elliot
Here are some photos, just pretty or interesting I think

Calf lying in street. (Ell says never too many cattle!)

Distributing the Coca Cola in Dila

"Motel Muluu" in Shashomenie

Young people on the back of a lorry.

Art shot of Ethiopian baskets in market. (Thanks, Emilia)

Art shot of grains in market. (Again, thanks Emilia.)

Woman selling coffee pots in market. (Emilia, again)

Woman in market (Elliot's shot)

School children in Kenya

Sunset over Hawassa (Marty's reliable sunset shot)