Second article in Gazette: Women on the Streets

http://www.gazettenet.com/2012/08/15/field-work

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

By MARTY NATHAN

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Wednesday, August 15, 2012

MARTY NATHAN

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.

First Gazette Article: Children on the Streets of Hawassa

http://www.gazettenet.com/2012/08/14/field-work

Marty Nathan: Interviews reveal struggles of destitute in growing Ethiopian city

By MARTY NATHAN

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Tuesday, August 14, 2012

MARTY NATHAN

A child in a beggars’ village area in Hawassa, Ethiopia.

This is the first of a two-part series on street people in Hawassa, Ethiopia. The second article examines the plight of street women and explores local efforts to help the town confront the needs of beggars and homeless people.
Early one morning I was riding my bike to work at the Referral Hospital in Hawassa, Ethiopia. My husband, Elliot Fratkin, and I had lived in the city for six months, sent on federal Fulbright grants to teach students at the University of Hawassa. He taught undergraduates at the main campus and I lectured and oversaw medical students and interns in the internal medicine department at the hospital.
As I pedaled down a broad boulevard in this, the fastest-growing city in Ethiopia and a tourist center due to its location on a beautiful Rift Valley lake, I noticed two gaunt 6- or 7-year-old boys in tattered clothes and bare feet rising from under a gutter culvert. They stretched and climbed onto the street.
No adults were to be seen. I stopped and stared.
When my husband and I first came to Hawassa, we had been moved by the plight of the hundreds of street kids and beggars found throughout this burgeoning Springfield-sized city about 100 miles south of the capital of Addis-Ababa. But soon the sheer numbers of beggars overwhelmed our compassion, and suspicion and irritation replaced empathy as our internal defense against the onslaught of need.
We rationed our giving and excused our parsimony by blaming the beggars: Children were widely said to be fronting for criminal adults; men were "known" to be alcohol- or drug-addicted; women "borrowed" others' infants in order to augment their begging.
But that morning bike ride caught me up short. Here was a real crime, not the petty chicanery ascribed to the street people. Small children were sleeping directly on the filthy, cold concrete gutter. No adults defended them, fed them or guided them. They were homeless and alone on the streets of Hawassa. The image haunted me.
Within a few days I brought my camera downtown and started taking pictures of beggars. But as I snapped pictures of a woman and her baby sitting on the sidewalk, I was confronted by an angry medical student who demanded to know why I was photographing these people.
He implied that I was supporting the embarrassing and somewhat racist stereotype of an impoverished, squalid Ethiopia, not his country of professionals and businessmen and the much-vaunted 9 percent yearly economic growth.
I was offending the dignity of middle-class Ethiopians, whose independence throughout the history of the European colonization of Africa had created a world-class pride. He made it clear to me that if I was to investigate Ethiopia's street poor I would need to contextualize it in the country's rich history and fierce struggle for development.
Though mindful of his reproach, I continued to walk the streets with a university student named Dagim, inviting street kids to join us at nearby cafes where they told their stories over eggs or Ethiopian beef and the flatbread enjera.
The first three little boys we met were fishing for bugs in the gutter on a street near the university. Biruk thought he was 5, Ashenafi 6 and Ganda 7.
None was sure. None had eaten that day; all were too ravenous to be able to share a plate without a fight breaking out.
All had lost a parent, very likely to the HIV/TB epidemic that has killed millions of Ethiopian parents. Biruk's and Ashenafi's mothers were beggars in front of the large Ethiopian Orthodox Church in downtown Hawassa. They could not support their boys, so the two lived with a group of homeless youths on the cement sidewalk under a shop awning. Ganda and his father slept in a makeshift plastic- and burlap-covered shelter on the street next to the town dump. All three begged for bread to eat, peed by the roadside and bathed in the town lake.
They were threatened and beaten by "big boys" who "lived in houses" and stole their food and money. Ashenafi whispered with obvious sorrow that he had gone briefly to school until his shoes were stolen, a loss for which his mother beat him. He never went back.
In all we interviewed 27 girls and boys, aged 5 to 17. Some were literally born on the street. More were part of a flood of migrants from the countryside where low agricultural prices and decreasing farm size destroyed their parents' ability to feed, clothe or educate them. Though free public education has expanded rapidly over the last several decades, few of the children we interviewed had been able to afford the notebooks, pencils and shoes necessary to attend school.
At a cafe in another section of town, we interviewed three preteen boys near the bus station. All had come on their own or with a friend or sib from failing farms in the countryside. They came searching for jobs and all were sleeping on the sidewalk and scrambling to carry loads for bus passengers.
One child had been sent back to his village by the police, but had returned hungry and rejected by a family that could not maintain him. We discovered three others selling toothbrush sticks (raw pieces of wood cut from local trees, widely used to clean teeth) on the street by the lake. They had journeyed from farther away, one just two weeks before. He was particularly lonely, frightened and homesick, but had no options since his parents had sent him to find work.
Rural Ethiopian children as young as 8 are being directed or allowed to leave for the city to support themselves and, hopefully, their families - selling small items on the street, shining shoes, carrying burdens or washing cars - because there is not enough food at home.
But on the city streets their hunger is not appeased. Almost all we interviewed said they were "always" or "usually" hungry. Frequently they eat no more than one meal of bread a day, and almost all I saw were underweight and stunted. Further, they face the violence, fear, loneliness, cold and discomfort of homelessness.
Many of the children we met displayed a tough front, but for most profound anxiety and grief lurked below.
One boy who had come from far-off Wolayta two years before was so malnourished that, at age 12, he could not get work carrying baggage at the bus station. He collapsed in tears as he remembered his family. Ten-year-old Abatu, who still went to school and lived at home but begged and carried loads on the streets to pay for school supplies, silently wept when talking of his widowed mother's hopelessness in the face of their poverty.
The teenage son of a beggar with AIDS dedicated his life to supporting and protecting his mother, working long hours on the street so that she and his two younger sisters could survive.
The girls we met made us dizzy with their courage and vulnerability. Meskerem was the 13-year-old daughter of a widow who had been forced to beg after the death of her first husband. Meskerem herself had been begging since she was 7, had learned to fight for her own "turf" in front of the Orthodox Church on the town square, and had become the protector for her 8-year-old half-sister Tsehai. (Tsehai's father had been an abusive alcoholic and had left the family, which now lived in permanent "beggars' shelter" near the church.) When men in cars offered money to "sleep" with Meskerem (a euphemistic translation from the Amharic), she told them to go "sleep" with their money.
Some had been on the street for nearly a decade; most had arrived within the last three years. It was interesting to note that the youngest usually retained the most ambitious dreams. Ashenafi and Biruk smiled as they said they wanted to be doctors. Ganda pantomimed a flying jet and energetically brrrroooomed an appropriate sound effect when he told us he was going to be a jet pilot.
But a 15-year-old's dreams had shrunk to simply hoping "to get out of this life and to get a job." The exception to this rule was a 5-year-old girl born on the street who just wanted "to grow up."
Quick fixes
It is cities like Hawassa that are facing the consequences of the countrywide problem of profound impoverishment of the rural areas. The clamor to rid the streets of these young "eyesores" that impede tourism and hinder development has led to quick-fix schemes in Hawassa no less than in the metropolises of Addis Ababa, Harare and Nairobi.
But our findings indicate that local fixes can't work. The problem is systemic and the desperate poor always return because they must.
The growing numbers of these children in cities across Africa are a rebuke to development policy that focuses all attention on support for business growth at the expense of economic justice and human survival. They bear witness to its failure for millions, and beg for re-examination of the developed world's approach to aid to the global South.
Marty Nathan, M.D., of Northampton was a 2011 Fulbright specialist grantee at the Hawassa University Referral Hospital School of Medicine in Hawassa, Ethiopia. She is an assistant professor of medicine at Tufts University School of Medicine in Boston and a family practitioner at Baystate Brightwood Health Center in Springfield.

Gazette article about Medical Work in Hawassa

http://www.gazettenet.com/2012/08/14/schooled-in-poor-land039s-realities

Trip to Ethiopia provides many lessons for Dr. Marty Nathan of Northampton

By CHAD CAIN
Staff Writer

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Tuesday, August 14, 2012

Dr. Marty Nathan of Northampton, left, attends a coffee ceremony in her honor after months of service in Ethiopia this year.

• Related story: Interviews reveal struggles of destitute
NORTHAMPTON - When she landed a Fulbright Program assignment to teach medical students in Ethiopia, Dr. Marty Nathan could not have predicted the many ways she would become the trainee during her stay in the impoverished African country.
"It really was a two-way street," Nathan said. "It's hard to measure whether I gave or took more."
The Northampton resident and her husband, Elliot Fratkin, recently returned after nearly nine months in Hawassa, Ethiopia. Nathan worked at a government-run facility, the Hawassa University Referral Hospital, and taught students at the University of Hawassa School of Medicine. Fratkin, a cultural anthropologist at Smith College, taught at the University of Hawassa, also under the Fulbright Program.
Nathan, a family practitioner for 35 years, said her time in Ethiopia gave her a new perspective on the field of medicine and the discrepancies between the modern world and a resource-starved country.
"Medicine is so technological that the lack of technology just slams you in the face," she said.
Nathan discovered that fact early on as she collaborated with general practitioners who were diagnosing diseases that she doesn't encounter in her work at Baystate Brightwood Health Center in Springfield. Patients in Hawassa were dying every day from tuberculosis, malaria, HIV, meningitis, unusual parasites and more.
"I grew to respect my colleagues so much because their lives were just so overwhelmed by the illness of the people that they were dealing with, day and night," Nathan said.
It took her awhile to fit in on Referral Hospital's internal medicine ward, where she spent most of her time. Doctors didn't have time for a "ferengi," or foreigner, she said.
At first, Nathan simply followed physicians on their patient rounds. These visits were difficult, she said, because of the language barrier and her penchant for asking questions. She grilled the doctors about tuberculosis and other diseases she had little experience with, so she could take that knowledge back to the students she was training.
"I experienced many new cases while I was there, cases that were diagnosed right there in the ER," Nathan said. "My poor general practitioners who were having to put up with me were absolutely right. I was a burden, and I laughed with them later that I was a real pain in the neck."
But knowing that she would be there for months, Nathan began to search for ways to help. She focused on two areas: using technology as a diagnostic tool and treating diseases of the affluent such as weight gain, diabetes, hypertension and asthma.
Nathan said general practitioners at Referral had good clinical skills and could diagnose bacterial and other diseases on the spot. There was no functioning laboratory, however, to confirm those diagnoses, so she helped them advocate for the needed resources.
"That became a campaign," she said.
Nathan also set up a clinic to treat street people and beggars. When patients with no money to pay for their prescription medication visited, Nathan started paying for the medicine herself. Then she started seeing people who couldn't afford any medical care at all.
She eventually helped negotiate an arrangement in which Hawassa's private hospital allowed the public facility to use its medical equipment at a reduced rate. Nathan and her husband helped establish a fund to pay for care for those who can't afford it.
While in Hawassa, she said, she discovered a love for teaching.
"I really found myself trying to be in their shoes and face those difficult situations with them," Nathan said, "and also talk about the future in which perhaps they were going to have access to more - so they needed to know it."

Home

Dagim (left in striped shirt) translates our goodby to women and men and children at Qircho

Greetings from Northampton!

Leah and Gavin at homecoming supper

Actually we are starting this on the plane from Dulles to Hartford, where daughter Masaye will pick us up. Had a warm (in all dimensions – temperatures in the 100's) trip to Mt. Pleasant, DC with daughter Leah and son-in-law Gavin with our first taste of non-Ethiopian food in a very long time and sleeping in a very wide bed without a mosquito net and with the air conditioning on. No hyenas and no smell of coffee and incense pervading all.

Hardworking interns in Referral emergency room.

Interns and GP Dr. Saba (right) in emergency room

Dr. Birrie, Chair of Referral Internal Medicine

We each enjoyed a great going-away party by our respective sets of colleagues on Thursday before leaving. Marty's wonderful group of general practitioners led by Dr. Saba threw a party at the Lewi's Hotel in downtown Hawassa and Marty began to realize just how much these dedicated folks mean to her and how much she will miss them.

Patients and their families on Referral ward

Front steps Referral Hospital (unusually calm!)

Ethiopian medical culture is demanding and strict in its standards. One sacrifices much to become an Ethiopian doctor and continues to give despite much lower pay, huge patient loads and little backup in terms of continuing medical education and options for specialty referral of difficult patients. Marty was told for the first time that she was the first provider to stay and teach and treat for more than a month at Referral, and it took a while for her colleagues to invest emotional and collegial energy in the relationship. However, by the time she left she had shared responsibility for cure and for death of patients, had puzzled and gone to the books over more than a few, and had learned the tragedy of the limitation of care where the resources simply do not exist. There is a particular sinking feeling hooked to outrage at losing a patient to renal failure when one is used to taking access to dialysis for granted. Hepatitis B and C are treatable diseases in the United States, but not in Hawassa or, in fact, in any part of Ethiopia. She found herself embarrassed when she had unthinkingly expressed that outrage. Ethiopians are proud and she sometimes detected shame in admitting the lack of those resources, a lack for which they hold no responsibility but which they feel acutely and daily.

Ell's going-away party was much less formal – lots of beer over tibs at the local Bira hall (translated “beer”) where shining copper tanks of German beer tower over partying Hawassans. His relationship with his colleagues has also been rewarding: Walelign, Awoke, Wubayed, Aqmel, and Meskano are respected colleagues and friends, and he expects to stay in touch. Awoke will be coming to the States entering a PhD program at Washington State in the fall. He is an expert on the cultures and issues of the Southern Nations and already has contributed much to the Konzo, helping to build a United Nations Heritage Site in several walled Konzo villages.

The coffee ceremony at Qircho

A final, very different goodby greeted Marty at Qircho, where residents had prepared a coffee ceremony in the open courtyard for her departure and the women presented Marty with Orthodox Church pictures. It was moving and warm, and she was honored to be called the Mother of Qircho for her mini-clinics and her advocacy to the city. She felt welcome and at home among the women who beg for survival and wonders what will be their fate. Unlike our middle-class colleagues, there is no internet or even phone connection to these people to communicate births, deaths, movements among people that she has learned to respect. Marty left them her phone, and hopefully they can set up a small 'telephone business" for the neighborhood.

Women at Qircho

She and Dagim met with the Mayor of Hawassa to discuss her report http://elmartyhawassa.blogspot.com/2012/06/report-to-city-of-hawassa.html and the City's plans for the street people. Not too encouraging. The Mayor said he was a busy man and had not had time to read the report. He was angry that we were interfering and told us that what we could offer were money and medical care (both of which we had given directly to the street community, but not to the City for its plans.) This is something we have learned to expect from the government - very bureaucratic and highly authoritarian.

The City's plan has not been implemented because its appeal for almost 6 million birr ($350,000) for job training (in breaking rocks for cobblestone, shoe-shining, hotel service and garbage collection); return of kids to their homes (without, as far as we could tell, support for the families who could not afford them to begin with); and adoption of some had not been fulfilled by the NGO's and churches and businesses to whom the city had appealed. He seemed angry and frustrated and particularly irritated by our questions about the basic viability of the plan.

Qircho men, women and children at coffee ceremony.

Since most of the street kids are homeless and sleep under awnings (as do quite a few of the mothers) we asked about the lack of provision of housing in the proposal. He said that was for the subcities to deal with, that it is being taken care of. Further, since the core of the proposal is job training and many of the women, who expressed to us the desire for jobs, have been impeded in finding or doing any available work because they have small children (quite a few on the breast) but no childcare that would allow them to take those jobs, we asked what provisions would be made for them. Would free childcare be provided? There were no such plans in the City's proposal, but the Mayor did not want to discuss the issue. The transcendent issue, though, that was not on the table, and which he is in no position to address, was the worsening endemic poverty in the countryside that is forcing men, women and children into the streets of cities like Hawassa searching for a living, and finally into begging when they encounter no work that can sustain them. We tried to address this as he told us the meeting was over, but he was in no mood.

Woman coaxed to join us at coffee.

We have learned a little about the government's Safety Net Program, funded by international NGO's, which actually does provide very limited cash for work mainly for farmers in the non-harvest season and for the disabled. Though UNICEF states that disabled families get up to 350 birr ($18) per month in relief, all Marty could find on the web or in talking to those who administered the program was 70 birr per month (about $4) per family, given in return for 5 days work. Do the calculations: from a little over $.50 to $.13 per day for a family, which can easily be six people. There is about 50% unemployment in Ethiopia. Average wages for a laborer are about $1/day. No one that Marty spoke to was receiving even these miniscule Safety Net benefits, but were surviving frequently on $.25 per day in begging, enough to pay for one meal of coffee and bread. But then again this is Africa, where no country, with the exception of South Africa and possibly Rwanda, has any direct help to the poor and homeless.

Men, women and children of Qircho.

Marty sent her report to the Embassy, to USAID and to UNICEF in Addis Ababa. She was disheartened by the response by UNICEF, whose representative seemed to interpret it as requesting immediate help for these particular women and children, instead of being a plea for systemic intervention to support women and children forced by poverty to migrate to the cities where they become homeless beggars. Marty tried to explain her perspective, but detected here an all-too-common defensiveness on behalf of the government, which touts 9% growth but steers clear of examining increasing disparity in income between rich and poor and what appears to be accelerating impoverization in the countryside. She will pursue these contacts and hopes to widen the dialogue.

Two Days Later...

Home to a lush, green and hot-as-hell Northampton. Greeted by kind and thoughtful neighbors, and celebrated Arky Markham's 97^th birthday yesterday with good friends who have borne her hip fracture like the family that every person should have when one gets to 97.

Northampton, with its sensible progressive politics and culture of kindness and intellectual honesty, is our home. We are so frigging lucky. 

Now it is time to weed the garden, to fix all the electrical appliances that we haven't had for 8 months – dishwasher, clothes washer, electric garage door opener, air conditioner – while we take a moment to ponder why we have them.

Horse-drawn cart stops bajajes at Hawass intersection.

Hawassa seemed like a dream while we were there. We often woke up wondering where we were in that fog before full consciousness. It is a function of the older brain that doesn't adapt to transitions too well. (We understand, Arky!)

But, of course, Hawassa is not a dream to our friends there, with whom we will continue to communicate and whose fates we care about. It is another country, but we know something about it and more, we care about it and those who touched us with their kindness, generosity, and courage in the face of adversity we have never before experienced.

Elliot on chosen mode of transport.

Donkey-cart solid waste management in Hawassa.

We will not miss the mosquito nets, the leaky pipes in the guest house, the furniture that disappears, the “You, you, you!' from street kids, the bajajes (motorized tricycle taxis) playing chicken at intersections, the lack of solid waste disposal and its consequences. We will miss Ethiopians – not just our friends, but the great diversity of cultures of Hawassa and their fascinating differences from our own. We will miss Ethiopian dignity that so quickly morphs into friendliness and generosity at minimal contact. We will miss the incredible physical strength of those who guide donkeys and plow-oxen, carry children, sugar cane and firewood long distances, and build streets from rocks. We will miss children who are still able to hug and sit in a lap, and women who nurse and comfort their babies despite homelessness, hunger, abuse and poverty. We will miss the intellect of professors and doctors building a modern society on centuries of feudalism and war.

Marty and Ell both have a tradition of looking for heroes that goes to our days in college. We found no dearth of heroes in Ethiopia.

We will miss the hyenas, the Abyssinian ground hornbills, the grey-back fiscals, the mountain nyalas, the fish eagles, the green vervets and baboons and the mountains that, no matter where we are, rise up at the horizon. We will miss the omnipresent smell of bunna and incense, of sweat and manure, of woodfires and over-ripe bananas. We will miss the constant cool, dry breeze and the sudden thunderstorms rolling over the Rift Valley. And both of us will miss the exotic sound of Amharic (which Marty now greets with a sense of familiarity but, unfortunately, not understanding), Sidama and Oromo.

It is a different country, but a country we have briefly been part of, and that we deeply respect and will remember forever.

Happy birthday to Elliot! Yes, we still need him, yes we'll will still feed him, now he's 64!

Marty and Ell

Responsibility and Friendship

 

 Greetings from Hawassa!

We didn't expect to blog so soon, but the emotional impact of events impels the fingers to tap the keys.

Marty just returned from interviews that she enjoyed tremendously because of the existential force and humor of the women involved, but also infuriated and saddened by the tales of perfidy, violence and grinding poverty that she recorded.

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She had met all three women weeks before. To one she had given amoxicillin to cure a bronchitis, but the young woman had developed a horrible rash for which Marty had felt guilty, but which disappeared with a short course of prednisone. All three were young, unclear of their ages because none had ever been able to go to school, but all thought they were about 20. They had become friends at Qircho (Marty finally has the spelling right, maybe.) the Beggars Village and sat down to encholal en siga en enjera (eggs, meat and Ethiopian bread) at the Ledet Cafe joking while babies slept in two of their sets of arms.

Though all had come from different parts of the Southern Nations, Nationalities and Peoples Region (Ethiopia's southern state, with Hawassa its capital) each had fallen in love with a man who abandoned her. The first whom we will call “Yelena”, was orphaned as a young child in the town of Dilla, and was forced to work as a servant in others' houses until she was 14. Then a seemingly kind woman told her that she would give her a good job in her house in Zoay. But it turned out that the “house” was actually a bar and she was expected to work as a prostitute. She escaped to work in a tea house where she fell in love with and lived with the owner, who was unfaithful to her and she left him. Soon she began to feel ill and was diagnosed with HIV. She came to Hawassa for treatment at the Holy Waters at the Orthodox Church five years ago (still probably only 15 years old but having seen a full lifetime of troubles). Two years later she again fell in love and was brave enough to disclose her status. He accepted it and Yelena UNTIL she became pregnant, at which point he denied he was the father and left her. The beautiful baby was born, and Yelena has loved and cared for her diligently, but she wants to find another home and family for her, so that she does not have a life like her mother's.

The second, “Ana”, was the child of an extremely poor farming family outside of Hawassa. She met a young man who promised to save her from poverty and took her to the town of Shashomene, where they both worked and lived together. One night she told him that she was pregnant. The next morning she awoke to find him gone, having taken all the money they had saved, and leaving her with a rent due that she could not possibly pay. A friend who was begging in Shashomene was able to sell her own goods so that Ana could pay that 200 birr and thus ransom from the landlord her few remaining possessions. The two moved to the streets of Hawassa where they lived in “street shelters” and begged to feed themselves. Young men threatened to rape her after she delivered, which she ultimately did, on the pavement in the street shelter.

The third, “Terry”, was born to poor parents who divorced soon after her birth. Her mother struggled to survive breaking rocks for cobblestones and carrying loads for people. Terry stayed home to help her mother. A man proposed to her and, against the wishes of her mother and brother, she left home with him. She became pregnant, but, in the seemingly endless refrain of poor young women, he ran out on her. Her mother was unable to support her, though Terry did live with her for a while, so she began begging. Her baby was stillborn. She has met another man, another beggar, who is alcoholic and constantly abusive. When Marty asked her why she does not leave, she asked in return what she could do, where she could go? Excellent questions.

All three live in Qircho, the Beggars Village, with up to ten people in a room. They beg on the street, none making as much as a dollar a day, Terry making only $.35 since she has no children. The two who have children are insulted on the street by passersby who tell them the only reason that they got pregnant was so that they could use their children to beg, and that they should give the children up to an NGO so that they can work.

Their lives and potential futures were put into perspective by the stories of two other, elderly women whom Marty and Dagim had interviewed just two days before. Both were in their seventies, and one, “Frances” had been thrown onto the streets by the revolution 38 years ago against Haile Selassie, when her husband disappeared into the forest. She has never been able to recover and now lives in Qircho with her youngest daughter, who also supports herself by begging. She usually is able to eat only one meal a day – bread and coffee – and describes her situation as like that of a “wild animal”, no better. Her friend “Tina” was orphaned many years ago and lost her husband after one of the Derg's involuntary resettlements to distant Gambela. She has worked her whole life, when she could, cooking for and serving others. Both are asked why they don't a) “get a job” breaking rocks on one hand or b) return to their homes on the other. Frances responds to the latter that she can't eat her bamboo walls.

In the face of the hunger, filth and degradation of spirit, two counteracting forces emerged in the interviews. One was the women's friendships that were displayed in their ability often to answer for each other or to express opinions in one collective voice. The second was a self-deprecating humor about their situation, their weaknesses, their men. Some have managed to retain religious faith, for others that seemed to be less important if it existed, though Marty did not delve deeply here.

Marty leaves Ethiopia extremely troubled by what she found on the streets. She has known poverty in the general and on an American scale but never taken the time to understand its victims in this way. Her sense of disgust at her own privilege, her helplessness in affecting lives of those who are truly suffering, constitute a big punch in the nose. Women look at her with longing and touch their mouths and their stomachs in what must be a universal language of hunger. She gives, but never enough, and it never really dents her own wealth.

She and Dagim will follow up on the letter to the mayor and Dagim plans on educating students at the University.

Where the little ones eat at Hawassa Children's Center.

Ell , Marty and Dagim have visited two wonderful institutions, the Hawassa Children's Center and the Mother Teresa Home. The HCC has an orphanage for about 100 children who have lost both parents. It schools them all the way through college. It also sponsors scores of Hawassa orphans who remain with extended family, giving them money for food and education. (There are 5,000 orphans in the City.) Finally, it runs training programs in computer sciences (for women only), electrical, wood and metal work (for poor young men in their 20's) and gives them micro-loans to start businesses. It is funded by German and American philanthropy and we were impressed.

Residents doing Saturday wash at Hawassa Children's Center

The Mother Teresa Home likewise was a source of inspiration. The spunky, outspoken Austrian Sister Servita talked with anger about the treatment of the Ethiopian poor. The home takes in anyone who arrives at its door – hungry, sick, physically abused, penniless, mentally ill – and gives nursing care and feeding and shelter. Sister Servita is interested in following up on advocacy for the street people, and there is a ferocity in her approach that demands admiration.

Marty with Dr. Birrie (to her right) and hospital administrators

Ell would say, “You have picked the most depressing subject to research. But Ethiopia is not just about poor people. Think of all the friends we made and places we have seen." Right. All is by no means hopeless poverty. This week was a week of celebration of our leaving. Saturday both friends Mulye of University of Hawassa Sociology Department and Dr. Birrie of the Internal Medicine Program at Referral Hospital hosted good-by parties. Mulye's was a low-key feast of tibs (roast meat) and enjera (teff pancake bread) and spaghetti and wine and beer followed by the coffee ceremony. Yum and thank you, Mulye and Achu! Then we had supper at our favorite hotel with Dr. Birrie, Chief of Internal Medicine, and the top administrators at Referral Hospital. It was a lovely surprise and honor to be appreciated like this. They presented Marty with two bracelets, a dress, and a beautiful commendation letter saying how appreciated she was by the hospital staff and how sorry they were to see her go. (Elliot adds this because Marty is way too humble to include this).

Achu and Mulye, second and third from left.

Elliot winds up his stay with, of course, grading and hosting the defense of their senior theses by his 4 third-year anthropology advisees. Marty is grading medical students and continues her work in the emergency room STILL amazed at the incredibly ill men and women that she sees every day and that the Ethiopian medical system does its best to treat.

We are deciding to whom to leave all our stuff to (bikes, fridge, extra clothes, books, DVDs, cookware, etc. We have it pretty well figured out between students, friends, folks at Qircho, and Mulugeta's family in Addis. We'd like to leave it all if we could!

What a year! How we miss you! Will be back in a week.

Marty and Ell

Bale Mountains Part II

Our final visit to Bale Mountains National Park

Mountain Nyala - gorgeous!

With only two weekends left in Hawassa, we decided to visit the Bale Mountains one more time. Besides being relatively close to us (2-3 hours) it really was one of the most scenic places we have visited in Ethiopia. The first time we went there (in February) we took a three day horse trek from Dodola town up steep river valleys and thick hemlock forests, spending a night in an Oromo hamlet at 9000 feet. Austere but beautiful.

This time we decided to go to the Bale Park headquarters in Dinsho, about an hour up the road from Dodola. We hitched a ride with Walelign and Beza, who were going to Addis where Beza will have her baby. They dropped us off in Shashomene on the main road to Addis, a very crowded and bustling town with a huge bus station leading to points all over the south of Ethiopia. We got a small bus whose driver was kind enough to take us to the park gate. For a sum of about $6 we entered the park and walked the two kilometers or so to the park lodge. This was an old stone building, with an out building for showers and water. It was completely deserted, except for the animals which we saw immediately as we started walking up the road. Warthogs, Mountain Nyala, Redback deer and Bushbucks were some of the few fellows who greeted us. 

Redback Deer

Pasture and Forest in Bale National Park

 There was no food in the lodge – we are not quite sure why they call it a lodge, so we walked back into town for a nice meal of tekavino and tibs (lentils and meat), bought some bread and bananas, and made our way back. An older man stopped us on the way; his name was Abdulai and he was the park guide/ranger/ everything. He let us into a small but comfortable room with two narrow beds. There was a much larger common room, with comfy chairs and lots of stuffed animals (by a taxidermist) and bones on display, including a warthog jaw with its two shiny tusks.

We read for a while on the back balcony – we were both immensely absorbed by the last Harry Potter (Deathly Hallows). Elliot had never read them before, and read all of them on his Kindle this year in Ethiopia.

Chilling with Harry Potter on the Kindle

 

But the mountain was too beautiful, so we put Harry down and went for a late afternoon walk into the fields above the lodge. We were at 9000 feet so the going was slow. But we were rewarded with a beautiful panorama, and lots of animals who walked around us as we sat quietly on the ground. A huge warthog family scampered around fifty yards from us, three adults and seven babies. So cute, the baby warthogs were prancing, dancing, and head butting each other practicing to be grownups.

 

"Look who just came in, God's gift to warthogs"

(Gary Larson)

 

We saw a herd of Mountain Nyalas grazing, big dark beautiful antelope with white stripes on their chest. The males have large and beautifully curved horns, as you can see.

 

 



 

We headed back down at sunset and crawled into our beds – it was really cold up there but there were plenty of blankets – and got reabsorbed by the battle for Hogwarts and JK Rowling’s heartfelt message that you must fight fascism and never accept it! Good book to read during an election year.

The next morning, Abdulai was there when we woke, and we asked to take a shortish walk – 2 hours – as Marty was getting a head cold. He took us on a different route than the one we took the previous evening, up a river bed that opened onto a big pasture with many deer and the ubiquitous warthogs again.  Abdulai had amazing eyes; he could spot animals hiding in the trees long before we ever could. We walked into a forest, beautiful and quiet in its lush green following the recent rains. Abdulai explained various bushes and trees to us: “Those berries are poisonous; those flowers are used for medicine to clean the stomach.” “Does it help clean you out?” Elliot asked, familiar with the strong purgatives used by Samburu in Kenya. Abdulai smiled in embarrassment, ‘Yes, it moves right though you!”

 

Abdulai - our mountain guide

 A highlight of the trip was Abdulai taking us to a tree and pointing to a very rare owl – the long-eared Abyssinian owl which we would have never noticed. He said many birdwatchers come from Europe to see this bird. He was wearing a hat given to him by a German ornithological group; he really knew his birds, and could identify every bird call we heard. “That’s a flycatcher, that’s an Ethiopian mockingbird.”

A truly wonderful walk.

Abyssinian Long Ear Owl - a rare sight

Around 11 AM we decided it was time to go into town and find some food, and especially coffee. We figured it would take us the rest of the afternoon to get back to Hawassa by Sunday evening. We had met a lovely Ethiopian woman on the road, who told us her name was Sophie and had a coffee shop nearby (a tiny room near the road where she brewed fresh coffee) so we stopped there and were very happy that we did. We had 2-3 cups, brewed the Ethiopian way by roasting fresh coffee beans, grinding them, and soaking in water.

Sophia in her coffee shop 

Dinsho town Backyard. Cool!

 Abdulai joined us for coffee – he seemed to know everything that was going on in town. He gave us each a picture of an Ethiopian Wolf, a reddish animal that looked like a coyote. Although these are not found in Bale Park, they are the symbol of Ethiopian wildlife and we were happy to take one.

Not our photo, but just so you know what they look like.

 We then headed down to the restaurant where we ate the day before, this time ordering eggs and enjera.  Very few cars or vans were coming down the road. The guy who ran the restaurant posted another guy on the road to flag a bus or van down. But after an hour, Elliot went out there, and almost immediately saw a bus. We managed to stop it and got to occupy the last two seats in the back. Young boys come on board to sell roasted barley (a favorite snack), and there was a lot of jostling to get on. Once we managed to sit down, a young Ethiopian with stylish long hair (twists) and very good English introduced himself as Teddy (for Theodros). He worked for an NGO called PACT and was going to a three day workshop in Nazret. He played us the latest song by Teddy Africa, the most popular singer in Ethiopia who was jailed for criticizing the government’s lack of democracy. Teddy asked if I had any daughters his age to write to! The ride home was peaceful, through gorgeous Ethiopian countryside, with the Bale Mountains to our left. We got to Shashomene, quickly found another bus to Hawassa, and made it home around 6 PM. 

Marty and Teddy on the bus - bumpy ride makes the photo look like an art shot!

We arrived in Hawassa Sunday 6 PM. Church was getting out so the streets were full of folks, mainly Evangelical Protestant, we assumed (Orthodox women wear long white cloths over their head, Protestants seem to  purposely reject that.)We talked about religion to each other, a favorite topic here, especially as Marty’s assistant on the homeless project, Dagim, is so devoutly Orthodox and loves to explain his religion to us. We were a bit disconcerted when he told us that when the anthropology students took their long 12 day bus ride to the historic sites of the north, including Lalibella and Axum, the priests would not allow one of the Moslem students to enter unless she took off her head scarf. She refused (naturally) and was asked by the other students to sit in the bus, lest a fight break out. (The priests will physically attack those who wear Muslim symbols.) We were a bit astounded she would be rejected from not only a famous site in Ethiopia, but a UNESCO World Heritage site. But Dagim was firm that no Moslem should enter a church. I told him how I was welcomed into a Mosque in northern Kenya when I wanted to get away from the noise and the hustle bustle. He couldn’t believe it when I said all people –Christians, Moslems, Jews-- were welcome in our National Cathedral in Washington. Religion continues to plague us.

Last two weeks, and invitations are starting to come in – to visit a colleagues’ house for coffee (i.e. a huge meal) this Saturday, to be wined and dined by Marty’s medical colleagues Saturday night. Departure is coming, and we feel great that we got to go to Bale Mountains as a parting visit.