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?