Sunday, January 22, 2012

Timkut, family affairs, germs and pastoralists: photos


Harvesters
Fisherman on reed boat
El lecturing
Mescano, Adam and Emilia celebrating after El's talk at new Brewery
El and Marty celebrating
Poster against female genital mutilation
El's office building at Hawassa University

Boys swimming in Lake Hawassa
The Day's Catch
Maribou storks


Egyptian goose
Genet
Miriam and Meron
Marty, Genet, Miriam, El,  Ermiyas, Meron and Iba
Friend and translator John and Ermiyas
Ermiyas, Marty, Miriam, Genet, El, Meron and Iba

Timkut, family affairs, germs and pastoralists

Greetings from Hawassa.

Timkut

A hot, blazingly sunny day that is really feeling like the dry season (which should go from December to April, but started late this year) in Southern Ethiopia. The ground is gray and hard and all the grass has dried. The mountains on 2 sides of us are hazy with the dust and smoke from fires. The nights are cool and breezy and the hyenas (jib) still sing their songs. It is the tail end of the harvest with many fewer donkey-drawn haycarts on the roads.

This weekend was Timkut, and despite our best intentions, we never made it to the celebration. It is an Ethiopian Orthodox holiday in January celebrating the Epiphany – different from my memory of the Epiphany as the time when the Angel Gabriel told Mary she was going to have a baby whose father was god. Ethiopian Orthodox Epiphany celebrates the baptism of Jesus by John the Baptist and the revelation was to John that Jesus was the Son of God. In Hawassa, there is a procession of thousands from St. Gabriel Church at one end of the main street, Piasa, to the lake at the other end. All women (and many men) wear traditional white dress and at the lake all are baptized the next day from a fount. That was Thursday night and Friday. Then on Saturday, another procession took place from the Lake back to St. Gabriel's Church bearing the tablet of St. Michael, because it was his saint's day.

It is a time of public and family celebration, and the streets were full of folks. On Thursday El and I walked down to and then on the promenade along the lovely Lake Hawassa, where many people had gone after the religious celebrations to sit, drink soda or eat and take a vacation day. Men fish on handmade small reed rafts, pulling up small tilapia. The birds wander among the reeds and lily pads and at one point there was a gaggle of young boys swimming.

Going home I walked with friends Rhobot, Adam, Emilia and their visitor all the way to the extremely fancy Haille Resort, at a certain point leaving the promenade to walk with about 30 children from the adjacent fishing village up to the Haille Road. The contrast between the elegant Haille and the poor fishing village where women were processing the local false banana (ensete) to eat while men stood barefoot on their rafts was fairly striking, as happens with so many contiguous phenomena in Ethiopia.

Family Affairs

Yesterday we had visitors from Addis Ababa: Mulugeta's birth-mother Genet and his brother and sister Ermiyas and Meron and nieces Miriam and Iba (ages 9 and 5). Elliot and I were both conflicted about it, worried if we would have anything to say to each other; if we would be able to talk across that ocean of language and culture and history that divides us about such a sensitive issue as our mutual son; whether we would know what foods and sleeping facilities to offer!

The upshot was that it was a wonderful visit. There is a reason that our kids are as wonderful as they are, and it is not just their American upbringing. We have known Masaye's sisters for a long time, and they are fairly remarkable young women. The more that we know of Genet and her Ethiopian children, the more we are able to attribute much of Mulu's success in this life to his birth family as well.

We spoke extensively of the kind of poverty that most in America do not ever have to see, fortunately – hunger, homelessness, disease and violence – that many Ethiopians are way too intimately acquainted with. It is this desperation that drives families apart and frequently is the source of international adoptions.

The talk was moving and revealing in a new way for El and me. (We thank Rhobot and John for their compassionate and empathetic translation.) We were and are invested in this story. We cannot walk by it as part of the Ethiopian scenery, but felt the pain of parents whose children have been torn from them by a harsh society.

Prior to this, last week I had been yanked around by a moment in the hospital when I had found myself looking in the eyes of the mother of one of my very sick patients. Her despair stopped me in my tracks, the tracks of a clinician there to do a job. Her unflinching sorrow held no blame or embarrassment, yet it spoke to me more powerfully than any contact I had had here that I JUST CAN'T FATHOM WHAT PEOPLE HERE SUFFER AND ENDURE. From that moment I saw myself looking at the street children and the crippled beggars and the old women carrying huge loads in a different way.

I discussed it with El and I think we were a little better prepared to talk to Genet about her suffering and the limited choices she has had in her life, all of which she tried to make with the best interest of her children in mind. I had also started reading Paul Farmer's Pathologies of Power in which he speaks to just this issue. I thank him for his insight and recommend that all of you, my friends, read it. He is pissed on behalf of the poor. He is right.

Germs

The last two weeks at the hospital have been full. I have started to teach medical students on a scheduled basis. Before, my work “schedule” had consisted of walking onto the ward and doing whatever I was told for the day. I now teach bedside diagnosis a couple of times a week to a class of about 25 students. Other days I round with the team of interns and a general practitioner who treat the male patients on the ward – they call it the “male side”. I have been struck with the amount of tuberculosis that we see. Potts disease – infection of the spine – is, if not normal, certainly not rare, and tuberculous meningitis is the diagnosis of exclusion in most cases of fever and headache. We have been fooled when diffuse disease of the lungs presumed to be caused by fluid from heart failure has turned out to be tb.

My respect for my colleagues continues to grow. Their willingness to argue medicine on the basis of science is quite remarkable, given how difficult it is to have access to that science. And their experience far surpasses mine in many fields, especially, of course, infectious diseases. Humility – hard for an American – is an important commodity, as is the willingness to hit the books.

Which I will do this afternoon, helping the interns prepare a lecture on diagnosis and treatment of opportunistic infections of the brain and spinal cord that come with the AIDS virus. Deadline Friday.

There are some major breakthroughs in expanding the lab. We expect the microbiology lab reagents to come in this week (finger-crossing or prayer – whatever your forte -- is appreciated) which would mean that, just maybe, we will be able to start culturing specimens and no longer best-guessing diagnoses.

I have been asked to help institute a serum test – detecting the malarial antigen, not just seeing the little devils in the red cells under the microscope – for malaria. The microscope test is very useful but is not sensitive if the tech a. is not well-trained and b. does not take a whole lot of time searching every field for the little malaria forms on the smears. Thus, again, we more often than not treat empirically. In such conditions, the antigen test (which is used in isolated clinics where they don't have microscopes but not at the big hospital, where we do) is more likely to be positive. If we get a positive antigen test a. we can feel more comfortable treating with quinine and b. we can go back to the lab tech and ask that another look be given to know how heavily and with which species the patient is infected. Am visiting the local Malaria Consortium and talking to my teachers at the London School of Tropical Medicine (online course in Malaria) about the best test for us to adopt.

The struggle to get the nebulizers (to treat severe asthma) to work is ongoing. We THINK that perhaps tomorrow we will receive a transformer from Fulbright friends in Addis Ababa via an ambulance that transferred a patient from Hawassa. All that looks easy is hard and all that appears hard is impossible in Southern Ethiopia.

The nebulizers were to have been a huge breakthrough, but they work on 115 volts and electricity here is 220. Most computers are easily adapted, but we tried all the usual adapters, without success. Finally, we resorted to searching for the kind of transformer that El and I used in Kenya more than 25 years ago, and hope its arrival here tomorrow will mean that some people, literally, will breathe easier.

The irony was that Thursday a big deal, with photo-op, was made of our donating the medical books and supplies, including the so far-useless nebulizers, to the hospital. Hopefully, by the time I teach about asthma to the medical students on February 8, we will be able to demonstrate their use.

Pastoralists

Elliot presented our research about the effects on maternal and child health of settling Northern Kenyan pastoralists in towns. Pastoralists live by raising livestock -- camels, sheep, goats and cattle -- in drylands where they are forced to move from place to place to find pasture and water. Our research found that women and children suffer hunger and malnourishment when these groups of folks are forced to stay in one place because they are separated from their animals and don't have milk to drink.

We are excited about going back to Northern Kenya in February to visit El's adopted brother Kanikis and his family. By bus to Moyale and then and then south to Marsabit district. It will be another huge adventure.

We plug along, encountering so much that we never expect and, ultimately, feeling exhilarated and thankful for health and family and friends and amazing opportunity. We, like Paul Farmer and so many of you who know the score, remain pissed and trying to figure out how to be so effectively.

Please write.

Marty and El in Hawassa

Saturday, January 14, 2012

From Elliot: crocs, shoes and weavers









When Marty visited the states over Christmas, I took a road trip with Adam, Emelia, and Adam’s brother Jeff to the southwest, to Lakes Chamo and Abaya and to the Rift Valley highlands. This was a chance to see crocodiles in the lake and the famous weavers of Dorze (Dor-zey) in the mountains. We went for five days, 2 were spent driving, one spent with police and courts because someone pinched Emelia’s running shoes from the car (we got them back, miraculously), and a day and a half on the lake and in the highlands. This country is so frigging big, it takes many hours to get anywhere. The area is around the town of Arba Minich (meaning 40 Springs) is beautiful, occupied by Gema and Wolaita people. Besides getting to see the crocodiles sunning on an island in Lake Chamo, we also travelled to the highlands and visted a Dorze village, famous for their weavers. Traditionally (pre-China imports), cotton was grown in the lowlands around the lake, and traded to the highland weavers, who are renowned in Ethiopia. Today the village of Dorze is run as a cooperative to serve the weavers and take advantage of the increasing tourist business (mainly Europeans and some Americans). The cooperative also ran a rustic hotel which was a series of bungalows around a central open dining area. It was cold in the evening, we were around 7500 feet, but quite beautiful. Children could be very annoying, thrusting goods into your face to buy and not leaving until they sold you something. Our Dorze host said the kids come from other towns, their parents send them with the hope of gaining something from the forenjiis.
           When we stopped for mangos a young man stuck his hand in the back window and grabbed Emelia’s running shoes, taking off into the small town. We would have just let it be, chalking another one up to the experience, but our hired driver was an ex-military policeman who insisted on justice. We contacted the local police, and the following day were told they caught the thief, someone well known in the community. We went to the police station in Arba Minich (really just a building with a courtyard and prisoners sitting at one end), identified the guy, and then were told to come to court the following afternoon. It was a “rapid adjudication and small court” and kind of amazing to see Ethiopian justice in action. In Kenya, the cops would have just beaten the thief to a pulp and thrown him away’ here no one beat him, but had him and us tell our stories to a magistrate. Punishment was swift – the boy pled guilty and was given a six month prison sentence. He looked in pretty bad shape, poor, high (drink or khat), and with dim prospects in life. But the shoes were returned, cleaner than when they were stolen as they had been washed to sell in the marketplace.
           Finally got back to Hawassa in time to get a ride to Addis to pick up Marty on January 6, the day before Ethiopian Christmas. As I had a whole day in Addis before Marty came in, I contacted, on a whim, Mulugetta’s brother Ermias, who had contacted us on Facebook. In no time at all his (and Mulu’s) mother called and said she was coming over to the hotel. It was a very sweet reunion, she brought her two granddaughters, everyone was dressed to the nines, and we called Mulu in the States who, polite as always, said hello to his biological mom. The nine year old granddaughter, Merima, translated in amazingly good English. We have kept in contact with Mulu’s family in Ethiopia through the years, and Marty and I support them with monthly checks. Genet was incredibly grateful, not just for the money, but knowing that her son Mulugetta, given up at 2½ years, was in good health and situation. She phoned later and said she would visit us in Hawassa, five hours away, next week.
That will be the next blog. I am very glad Marty returned, glad my first semester is coming to an end, and glad that we will be taking a trip into Kenya in February to see my other African family, Kanikis and Lugi (the main characters of my book Laibon: An Anthropologist’s Journey, which Marty brought me copies to see).

Monday, January 9, 2012

A quick trip home for Marty


January 9, 2012

Greetings from Hawassa!

I just got back Saturday from a whirlwind 9-day (plus 4 day travel time) trip to Northampton. Never had such an easy and pleasurable transition between two such different places. In the past have found the return to the States very disconcerting with all the EXCESS. Too much food, too much activity, too much media and too much stuff. For some reason this time was not such a jolt. Perhaps it was the internet which keeps us all attached despite the distance. I know a little more about friends and family. Perhaps also it is our community in Western Mass, which is not quite as excessive. Friends and family are ok giving underwear or donations to good causes for Christmas presents. Or maybe I am just old and don't think as deeply as I used to.

It was wonderful seeing my terrific family: Leah came in from DC (sorry that new son-in-law Gavin had to work); Masaye warmed the upstairs bed for me on arriving from Hunter and Mulu trekked all the way by train (with buddy Eli) from Macalester in St. Paul. We did a belated Christmas feast with Lisa Baskin and Arky Markham and Daniel and Helen Tesfalidet/Kinfe at our beloved Great Wall Restaurant and then stumbled home, drunk with food.

Leah is working hard as a film producer with Eye Candy and having to deal with the uncertainty of Gavin's upcoming posting after finishing his residency in June. We hope that she and Gavin might be able to come to Hawassa and perhaps Gavin could work at Referral Hospital in June. What a treat that would be!

Mulu and Masaye both are doing great and finding themselves to be serious students in their respective colleges. They too are considering coming out after school lets out.

Helen and I were foolish enough to accompany Mulu and Leah to the Holyoke ice skating rink where Mulu wanted to practice because he is on the Macalester hockey team. Masaye was wise enough to stay away. Leah maintained her dignity skating around the rink, but Helen who, as a respectable Eritrean, has never put on skates, and I who last skated at age 6 on Alum Creek in Westerville, both clung at all times either to the wall or to an upright person's hand or else found ourselves on our backsides on the ice. How embarrassing. We might have done better had we slept in late like Masaye. But, life is an experience.

Friend Arky is more than holding her own at age 96, and I dragged her around Leeds, Holyoke and Springfield picking up all the asthma goods – nebulizers, albuterol, masks and peak flow meters – that were donated by Lisa, Tom Plaut (via Jane Cross), and Louis and Clark Medical Supply to bring back to Hawassa. All that with the pulse oximeters sent by Brother Jake Fratkin and Lisa's monster Harrison's medical text filled up a whole huge suitcase that I will be taking in to the hospital tomorrow.

Was able to spend a Saturday Occupying Northampton in front of the Bank of America with buddy Paki Wieland, vigil against the wars with the Northampton Committee, and listen to some hellaceous fiddle music at First Night. I had a moving discussion with Robby and Elli Meeropol about the terrible moral dilemma posed by the upcoming Presidential election.

A huge treat was visiting mis companeros รก la Clinica Brightwood on Wednesday. What an amazing crew! How I miss them. What good work they do in Springfield's North End.
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Time spent with the kids and friends impressed me with my undeserved great luck in life. If I were religious, I would say that I am blessed, but I am not (religious, that is) and am simply grateful for a world in which such joys come my way.

My hero Elliot came all the way to Addis to pick up me and my truckload of luggage. On Friday night he met with Mulu's birth mom Genet and Mulu's brother Ermiyas and sister Meklas and Meklas' two daughters Mariye age 9 and Hida age 5. We have stayed in touch over the years and watched his sibs grow to adulthood. Ermiyas, whom we met as a teenager, trained and works successfully as a mechanic near Addis.

Back in Hawassa this weekend we joined Elliot's Hawassa U. colleagues Walalign and Amalo at their respective houses for Ethiopian Christmas parties. The Ethiopian calendar is nine days (plus seven years) behind the European and Christmas is celebrated on December (Tasas) 28th or 29th, depending on the year. We ate more njera and tibs (Ethiopian bread and beef dish) than we should have.  We drank homemade beer and joined in coffee ceremonies and felt the comfort and welcome of Ethiopian hospitality.

Today am back at Referral seeing patients with problems that confound me – two new admissions with spinal tuberculosis, another who came in with a headache and fever and had malaria but ALSO probably disseminated tuberculosis, and two who suffered endocarditis (bacterial infections of their heart valves) due to their severe rheumatic heart disease. Interns handed me electrocardiograms to read that were more abnormal than any I have ever seen, and I looked around for the cardiologist and realized that old Trumanism: the buck stops here. Oh, dear. In over my head again. Time to run back to the books.

El will be writing very soon to tell about his journey to Arba Minch. Baboons for him, kids for me.

Happy, just and peaceful new year!

Marty