Elliot's book, Laibon, is out!!!

I am very pleased to announce the publication of my book

Altamira Press 202 pages ISBN 978-0759120686 $24.95 Elliot Fratkin is Professor of Anthropology at Smith College, Northampton MA, and is currently US a Fulbright Scholar teaching at Hawassa University in Ethiopia. Laibon: An Anthropologist’s Journey with Samburu Diviners in Kenya by Elliot Fratkin.  Elliot Fratkin shares the story of his early anthropological fieldwork in Kenya in the 1970s. Using his fieldnotes and letters home to bring to life the voices of those he met, Fratkin invites the reader to experience his cross-cultural friendships with the enigmatic laibon (a diviner and healer of the Samburu and Maasai peoples) Lonyoki, his family, and the people of the nomadic community of Lukumai. Fratkin participated in the daily lives of the Ariaal livestock herders and accompanied the laibon as he performed divination and healing rituals throughout Marsabit and Samburu Districts. After Fratkin reunited Lonyoki with his son and wife, Lonyoki adopted Fratkin into his family, and Fratkin continues his close friendship with Lonyoki’s son Lembalen today. “Elliot dares to use his own research to pose the question: Is there any true objectivity in field research and anthropological inquiry? He dares to depict his own attachments and relationships to this very special community, while also staying true to his research. His insights further the reader’s understanding and appreciation of the culture and of the research process, thus expanding the boundaries of anthropology. Readers from budding anthropologists to aid workers to volunteers will identify with Elliot’s observations, experience, and deep connection to the culture he studied and the people he grew to love.—Kris Holloway, author of Monique and the Mango Rains: Two Years with a Midwife in Mali "A vivid, engaging account of Elliot Fratkin's apprenticeship into the mysteries of divination and healing by a prominent Samburu laibon. This book succeeds on many levels - as an unparalleled exploration of the secret meanings and methods of divination by laibons; as a window into the experience of extended field research - the insights and challenges, the emotions and relationships; and as a compelling story about our shared humanity, a reminder that people everywhere experience love, loss and life in ways that will seem achingly familiar.” —Dorothy L. Hodgson, Rutgers University “Fratkin’s book, a journal of personal as well as ethnographic exploration, is honest, funny, moving, empathetic, and respectful and, as an account of fieldwork, rings absolutely true. It is a superb introduction to Samburu, especially their prophets, and to the experience of field anthropology. It would make an engaging teaching text for engaged undergraduates and graduate preparation.” - Richard Waller, Bucknell University Laibon: An Anthropologist’s Journey with Samburu Diviners in Kenya by Elliot Fratkin Paper price for your students - $24.95. For more information about this text please visit the book's page on our website at www.altamirapress.com/ISBN/0759120684

Referral hospital, dodo birds, elections, and coffee with friendds

Greetings from Hawassa!
Achoo! Sniffle! Spent the last couple of days sampling Hawassa viruses and seem to have come on one of the top 10 Sneezogens. Stayed in bed yesterday but got so depressed reading about malaria that I decided it was healthier to go to work. So I did, and ended up rounding with one of the teams in a much more intense way. These are sick, sick folks that are being treated without the support of decent lab, radiological or cardiology services. I have never, even in Eritrea, felt so much like we were flying by the seat of our collective pants. 
Sickness of patients: One man who was probably 30 but looked like he was 60 admitted for AIDS and gastrointestinal tuberculosis. No possibility of abdominal ct to rule out obstruction, just iv fluids and oral tb meds and hope for the best.
Another man just came in with lower extremity paralysis and headache. It might be guillain-barre syndrome, or perhaps tuberculosis of the the spine. Intern did what she was supposed to do -- a spinal tap, but the lab wrote back that there were no cells. Extremely unlikely! And then they (the lab) did not and will not send the fluid for culture.
Two other young men with valvular heart disease, both in with shortness of breath and cough. One man had obvious pneumonia by chest xray, the other probably had just congestive heart failure. They had VERY different chest xrays but both were read in the same way -- congestive heart failure with possible pneumonia. Not helpful. 

Another elderly man came in with a cough and fluid overload probably from renal failure. But the numbers from the lab about his kidneys were completely unbelievable (a bun of 211 in a man who was answering questions lucidly) and I found out that we are unable to check the most basic chemistries, sodium and potassium.
Another man with HIV and tuberculosis who has been on anti-tb meds for months, but has a huge abscess vs. cavity in his lung, a massive bunch of bloody fluid around it and has been coughing up blood. We cannot culture the fluid even though twice we have taken it out of the pleural cavity, so we don't know if it is caused by bacteria or by tuberculosis. If it is tuberculosis then we have no means of treating, in Hawassa, Multidrug-resistent tb (mdrtb) and he would have to go to Addis. If it is a bacteria, we don't have vancomycin, which is what we would use for Staph infection. If it is actually cancer, we can't get the lab to do cytology on the fluid, either.
I was knocked out by the responsibility that these young men and women are taking. I asked my boss and the general practicioner if it would be all right if I rounded regularly with the same team so I could become more familar with the patients, something that I had not done previously but sort of flitted from one team to another. I feel kind of arrogant here -- I am not an infectious disease specialist by ANY means, but I am reading like crazy.
Have also decided that I will precede with ordering pulse oximeters and peak flow meters and have gotten, perhaps, a line on the Gates foundation so that we can see if we can buck up the lab a little. My boss has agreed that he will go with me to investigate what is going on in the lab that produces such unreliable results.
If you would be interested in sending money for the pulse oximeters  and peak flow meters, or would like to donate a book using your cme money, write to me.
On a less heavy note, took a wonderful walk yesterday and took pictures of some women harvesters and of the ncete plant (false banana) that provides Sunama people with a whole lot of their calories. Also have had wonderful storms and sunsets -- see pics.
And, miracle of miracles, an embassy lady came down from Addis with our absentee ballots and the DVD's from my Malaria Distance Learning Course from the London School of Tropical Medicine and Hygiene! Whoopee! El and I have enthusiastically filled out the ballots for Mayor and Councillors and voted to save the CPA. We send our warmest wishes to the team in Northampton!
We had a great lunch and coffee ceremony with El's colleague Mulye and his wife and sister in law. See pics.
And finally, for those who have been following the blog, you may remember the "dodo bird" that we found living near our house soon after coming here. Well, he is not a dodo bird, he is an Abyssinian Ground Hornbill, he is as big as a domesticated turkey, and he has a novia!!!! I took pictures of him (whom Adam and Emilia downstairs have named Marceau) and novia (llamada Gloria) and attached. His wattle is red, hers is blue, and in the Ethiopian way, he feeds her. We hope to see little dodos, that is hornbills, soon.
Love to you and please respond. Marty

Nov. 5 2011 Go Anthro!

We read (and saw photos) of the hellacious storm that hit our home in Northampton, where Western New England from New Haven to southern Vermont got hit with a rapid snow and ice storm, laying from 10” inches to 27” in the Berkshires. This knocked electricity out for 3 days for our house sitters, and all of Smith College, Hampshire College, etc. Our email was out for 3 days.

                And then two days ago, we got the Hawassa version. We woke up to clouds, which is pretty unusual as the rainy season should have end in October.  But by 3 PM the clouds had turn very dark and the winds picked up. Marty and I went on our balcony and looked east where we could see grey sleets of rain falling over the large rocks to our east. Our roof began to rattle and its metal wrapping started to lift and buckle. And then the rain hit us, massively. We watched as the cattle herders who use the university fields on tried to find any sort of shelter - under a tree, under an old roof. The rain came through our upstairs roof and flowed easily down the stairs into the living room. And through all this, the big black hornbill (who walks around on his two legs like a Dodo) stood stoically by a bush waiting for the storm to pass. By 5 PM it was sun was out, albeit glistening on the wet grass and rocks.

We had a busy week at the university. I am trying to get my students ready for their first quiz, worrying how to construct questions that were important but understandable given their varying degrees of speaking English. My colleague and apartment neighbor Walelign (Wally) invited me to a large meeting of all the faculty in Behavioral Sciences (Anthropology, Sociology, Psychology) for an internal review of the Masters of Social Anthropology degree he is proposing. It was a good proposal, well written and comprehensive, but very ambitious as it called for eleven new courses at the graduate level, but without any increase in faculty size. Wally argued, probably correctly, that you can only get the faculty if you have the masters program in place. This would make us the second program in Ethiopia (after Addis) offering a masters in Anthro. Various faculty from our department argued that there was no better place for this then the Southern Nations and Nationalities Region (of which Hawassa is capital) given all the ethnic diversity in southwestern Ethiopia. I was impressed by the review discussion, attended by twenty faculty and two student representatives. They asked probing questions, some quite strategic, others quite petty (“I see you did not use the correct numerical designations for the courses listed). Christ, just like home! Wallelign acknowledged the good points, but stood by his proposal and curriculum. My main comment was they need a longer period for student research – it is an MA thesis program, but they only dedicated the second semester of the second year for it. I suggested a full year for the tehsis, with preparation and reading in the fall followed by research over winter break and spring semester for the write-up. There are many thesis topics in our own back yard – gender, HIV, street children, immigration, coffee cooperatives, etc. The MA is an ambitious project but I think it will happen. They asked if I would do a graduate seminar in development, which I readily agreed if the program actually is up and running this spring. Ironically, I was asked to develop a masters in development anthropology when I was a Fulbright at Asmara University eight years ago, but it got sidetracked by Eritrean politics (closing the university) and the rather ill use of my time by having me teach Introduction to cultural anthropology for several hundred students. So it is satisfying to work on an actual MA program here.

The day ended fabulously as Adam (the other American anthropology teacher) and I were invited by our students to watch the big soccer match between Anthropology department students and Veterinary Science. This was no nonsense game, with very gifted players (I was told they were all on their secondary school teams), our guys wearing red and theirs maroon. Adam and I were given a big round of applause when we joined the other students in the bleachers (later joined by Emelia, Adam’s wife), and our six female students formed their own cheering section waving purple shirts that said anthropology. We lost 2-1, there was almost a fight when the Vet tem didn’t accept our goal (which bounced off the goal frame), but it ended in cheer and friendship all around.

The routine is starting to feel good.

Exploration and work

October 31, 2011

Greetings from Hawassa and Happy Halloween!

This is one of my favorite holidays and we miss spending tonight on Massasoit Street greeting the 500 or more little ones dressed in their ghoulish best. We get word, though, that there has been early ice and snow, with lots of remaining power outages and cold. We hope that you are safe and warm.

This has been a great week. We are learning more than we ever expected and are trying to give back a little.

I will leave El's report to his most-competent self. Except to say that his class keeps growing and he keeps learning more and more about the history and political situation in Ethiopia and also about how to say his students' names when he takes roll – yes, they do take roll at Hawassa University.

My work has expanded exponentially in scope and difficulty in just a week. I am now giving weekly seminars, it seems, after a successful presentation on tetanus last week. I saw my first case ever and worked with his intern to present the management questions. We searched the literature – god, I love the internet! – and did our best, but everything we presented had to then be recast in the context of severely limited resources. The ultimate treatment for tetanus is placing the patient on the ventilator so that all of his muscles can be blocked from use – called neuromuscular blockade. But.... there is neither ventilator or the chemical to do the blockade here. And, despite our excellent presentation our patient died for that very reason. A 25 year old man from the countryside with a penetrating wound to his leg who had probably never been immunized.

At rounds this morning there was much Monday morning quarterbacking about what should have been done. People with little power, as we all know, tend to blame themselves and others for loss, particularly of life. I spoke up forcefully that, though small mistakes may have been made, we all do that, the man died because he didn't have access to a ventilator.

On Wednesday I will be presenting again, this time on severe asthma. Again, what arises is that though we have knowledge and desire to treat well, we are missing things much more basic than a ventilator. I discussed with my co-presenting intern a case of a man with chronic asthma that died from an acute exacerbation and found that we do not have cheap, accessible means of evaluating the status of the patient – peak flow meters or oximeters. The first is available online for $13 each, the latter for $19.

Though I don't expect to change the world, I have been talking over with my higher-ups the possibility of ordering these and getting payment perhaps through the embassy, perhaps through the hospital itself. Meeting with the big boss – head of the school of medicine – tomorrow.

Today, when I went in, I was told that all the other staff Internists that teach medical students were gone and Dr. Birie, head of the Department, had to go to clinic. Sooooo.... would I teach 25 medical students bedside evaluation of a patient for 2 hours. Hmmmm. It was actually worse than this. There were actually 2 classes to be taught, today and tomorrow, and no-one but me to teach either class. Ok, my baseline spontaneity kicked in and I agreed to do it, totally unprepared. I was told that the patient had diabetic ketoacidosis (diabetic coma) and cerebral malaria. I dug in and started querying and waxing eloquent on causes of coma in each, but especially from DKA, spent about an hour on it, to get to the bedside and after another ½ hour to find that the patient never had diabetes and was just recovering from her cerebral malaria. Oh, well. Good for the patient, bad for me.

Hawassa teaches humility. We make it a point every day to provide some form of entertainment to Hawassans, through dress, stupid questions, poorly pronounced or chosen Amharic, enthusiasm over birds that folks have been living with all their lives. The medical students got theirs today.

We have employed the basics for survival now: we have an Amharic teacher, our young student friend Rhobot who lives the next floor down in the Guest House. We have employed 2 very sweet and funny young women to clean our house and pay them what they consider exorbitant wages – actually less than $2 each for a couple of hours work. And somebody who washes our clothes, since we don't have a reliable clothesline. (We have never seen a laundry machine in Hawassa.) We got a small refrigerator after much tsoris – the first one we bought bled cockroaches from the box and then just plain didn't work, after Elliot and a young man carried it up 3 flights (my feminism has its limits). So El and our friend (El's colleague) Wallelyn carried it back downstairs, somehow fitted it into a Toyota Corolla to take it back to the store and returned in that same Toyota Corolla to re-haul the new one up those 3 flights. Voila! A fridge! And we have located eggs (they don't have them in the supermarket) and fruit (also not in supermarket. And sugar (guess what – also not in supermarket. El has his eggs and I have my oatmeal and we can boil and filter and chill water. Breakfast! Hallelujah!

Yesterday we had a lovely though tough walk up Mount Tabor, which is the hill that extends next to Lake Hawassa between my hospital and the very interesting fish market. We got a fantastic view of the City which sprawls much farther than we figured. We went with our much younger, more agile and patient friends Emilia and Adam and glad that we had done it.

Also last week we went on a pretty boat trip on Lake Hawassa and felt its calming breeze and googled at the shorebirds.

We are making Ethiopian friends and find folks thoughtful and kind. We are grateful.

We have included pictures from the walk – the referral hospital and the lake from the hill, the faint specks of Colobus monkeys in the purple tree – and the boat-ride, and also of men and women harvesting the field around the Guest House. Please look at these. People sit or stoop and use a hand sickle, then gather the grass by hand and load it onto donkey carts to return to their farms to use the hay for dry-season fodder for their cattle, horses and goats. Life is not easy for the poor majority in Ethiopia. It is harsh, sometimes brutal and frequently short. These are our brothers and sisters.

Love to you.

Marty and El