Wednesday, August 15, 2012

Second article in Gazette: Women on the Streets

Dr. Marty Nathan: For mothers in Ethiopian shelter, survival is day to day

Marta Elamura and her children.
Related story: Marty Nathan: Interviews reveal struggles
EDITOR'S NOTE: This is the second of a two-part series on street people in Hawassa, Ethiopia. The first article examined the plight of children.
We learned of Qirchu, the Beggars' Village, from a woman I'll call Miriam, whom we met in front of St. Gabriel's Church on the square in downtown Hawassa, Ethiopia.
My assistant Dagim and I had begun to interview children and women who begged on the streets of Hawassa, prompted by the stark image of homeless children sleeping in the gutters of the city's broad boulevards.
Beggars have traditionally gathered on the premises of Ethiopia's Orthodox churches, where they are given food and clothes, particularly at holiday times, and are able to appeal to the parishioners on their way to services. The church reaches back to the fourth century and has a unique, Ethiopian-centered doctrine and ritual that sets it apart from Christianity throughout the rest of the world.
Miriam had come eight years before from a town more than 300 kilometers from Hawassa, having been told by friends that she should get tested for HIV after her husband left her and her two children. She came and found she was HIV positive, but at that time treatment was not available for the Ethiopian poor.
She also found no home and was forced to beg and to live with her then 7-year-old son and 5-year-old daughter in a shelter constructed of sticks, burlap and cardboard in front of the church.
For seven years she was part of a community of beggars dominated by women and their children until 2011, the 50th anniversary of the founding of Hawassa by Haile Selassie. In the spirit of community pride and beautification, the St. Gabriel beggars, with their few earthly goods, were loaded into trucks one midnight and brought to Qirchu, a long tin-roofed one-story structure with straw mats hung vertically that divided it into apartments and formed the outer walls.
There they were unloaded and took up residence.
We searched for Miriam at her home in order to take her for care at the Hawassa Referral Hospital, where I was working in the Internal Medicine Department. We were surprised by the size of the development. There were probably one hundred people living in Qirchu, with up to 11 people in an apartment space. It stood on the perimeter of the smaller St. Trinity Church next to the cemetery.
There was one outhouse and no running water. People bought water from the church and most bathed in the outhouse for privacy. Otherwise, the church had little to do with the beggars and one woman said that they had been brought there so that the city as a whole could forget about them.
Women's lives
It was here that our study of street women was most concentrated. We had previously interviewed women that we had met along the street called Menaharia, or Bus Station, named for its main feature. One was a young mother begging with her coughing 38-day-old infant and 5-year-old son, her 10-year-old daughter left to beg on her own in their nearby rural community. She had been forced to beg after making and selling the flatbread enjera could not support her family.
Another woman had suddenly been widowed when an accident in the gold mines killed her husband. She had never been notified nor compensation paid by the company, and could not afford to support herself and the new baby her husband had never seen.
She lived with the now-toddler in a makeshift shelter in the market that she rented for 3 birr (about 20 cents) per night.
But Qirchu was a beggars' community, and when we visited we were confronted and challenged by one of the men who lived there: What were we going to do for the inhabitants? Since our study was profoundly ad hoc, I had no answer at that moment, but knew that I needed to formulate one.
We asked women if they would be willing to talk to us. They agreed and our first two interviews were done in the muddy courtyard in front of the row of dwellings. Stools were set up and about 30 people gathered around (to our dismay) to hear the interview of two young mothers in their 20s - friends, neighbors and themselves former street kids.
It was in this set of interviews that I began to understand something of the continuity of street life. Zeritu had been born in a cardboard shelter on the pavement in front of St. Gabriel's Church, the daughter of two beggars, both of whom still beg there. She had two sisters and a brother, with only one sister still living, the other two having died of AIDS.
She had begged as long as she could remember: with her parents, as a lone street child and then with her own children after she married. Finally, two years ago, she was able to stop because her husband found low-paying work as a carpenter and she began to wash and cook for some of the other families in Qirchu.
She has dreams. Not only will all three of her daughters go to school and get an education, but she will build a house for herself and her elderly parents.
We visited her tiny but neat one-room home with its straw mat walls and swept dirt floor. We used it to house our clinic for sick community members that I treated or triaged.
Meselech's story
Her friend Meselech had grown up with her on the street, though she had not been born there. She had run away from beatings and neglect by her stepmother after her birth mother had died when she was two years old. She had been homeless on the streets of Hawassa since she was nine, supporting herself by begging and selling sugar cane.
She had recently married and had a child, but unlike Zeritu, she was unable financially to leave the street.
Her entrapment in begging was the norm, Zeritu's escape the exception.
In our interviews with 25 women, we found that most had little or no education, most came from the countryside and most ended up on the street when they lost husbands through death or divorce, or ran away from abusive, usually alcoholic husbands.
Some begged despite being married. Either their husbands were disabled and themselves were beggars or they worked but could not make enough to support wife and children. Most women had tried to find work but either there was none available or it paid too little for survival.
Some of the last women we interviewed were elderly.
One had been on the street for 38 years and her grown daughter was also a beggar who lived in Qirchu. The elderly said they were "always" hungry, that they were rarely able to beg more than 50 cents per day and they were sustained with one meal of bread and coffee in the morning.
Their hopes had shrunken to merely a place to live with dignity and food to eat.
A city's plans
Coincidental with our interviews, the city of Hawassa was developing plans to deal with the rising number of street people, which they had estimated to be over 600, but which others thought to be in the thousands. A written plan was drawn up to train the street people to break and lay rocks for the cobblestone streets, to shine shoes and to work as bellhops in the city's hotel industry. Children were to be sent back to their homes in the countryside and there was a vague allusion to adoption for some.
We made it a point to speak to women about their options in the Ethiopian economy. One woman stated, "I will do any job, cleaning toilets, it doesn't matter. I want to work and make a living." But women and children have looked hard for work and not found it.
The streets are filled with shoe-shine boys who must beg to stay alive since the work cannot produce a living. Unfilled bellhop jobs are not to be found. Further, hard manual labor cannot be done by children or pregnant or nursing mothers. And in the plan there was no mention of childcare for the begging mothers who are to be put to work.
The plan seems to have fallen apart long before its implementation. It budgeted several million birr to perform the trainings and education, but virtually nothing has been offered by the local businesses and NGOs that were expected to foot the bill.
'Systemic' problems
We wrote a response to the plan based on our interviews. In it we suggested that, since the problems were systemic, that even should the money be raised, the plan was unlikely to stem the tide of migrants to the city's streets.
We suggested alternatives that might start to meet the problems. We recommended that school supplies for children be funded by the government permitting more to stay in school; that food subsidies that were in place in the former regime be re-instituted; that housing for the poor be built in cities such as Hawassa; and that wages for workers be allowed to rise, so that working families need not beg.
We met with the mayor, who said he was too busy to read our report and suggested we were meddlers in affairs that did not concern us.
Did they concern us? Yes. These women and children had shared their pain and their dreams and had taught me in no uncertain terms that their aspirations and their worth were equal to mine. Their passions and concerns for their families, their humor and demand for dignity rang true and familiar.
What differed was their pain, suffering and absence of resources. I recognized that we of the global north ignore their plight at our moral peril.
I am not a development expert, but I know that my country and the World Bank it influences have demanded of developing countries that, in exchange for loans, they eliminate any social safety net for their poor. Those agencies have demanded that necessities - food, housing, medical care - be paid for by those who cannot pay, but who are supposed to benefit from the trickle down of investment. In the main it has not trickled down and despite expanding economies the poorest have become even poorer and hungrier.
This is not sustainable for Miriam, Zeritu, Meselech, Biruk, Ashenafi or Ganda. They teeter on the edge of survival in a world that can and should offer them more.
Marty Nathan, M.D., of Northampton is assistant professor of medicine at Tufts University, a family practitioner at Baystate Brightwood Health Center in Springfield, and a 2011 Fulbright Specialist at Hawassa Referral Hospital in Hawassa, Ethiopia.

1 comment:

  1. Read your article and would love to talk. My daughter is from Hossana and I am traveling back to visit Hossana Hospital which has many needs. Love what you are doing. Please visit my blog ' and/or email me. I look forward to hearing from you. Christine Ieronimo