I started this blog in the field on October 18th, but wasn’t able to finish it. This is the report of two trips to the field and some random stories and observations.
I am sitting in the hospital for Woreda (county) Dulecha. I use the term ‘hospital’ lightly, as there is never a doctor here, only a nurse and a few health workers. Nurses here are more like CNA’s in the US. Two years of school. The health centre is rather large, I’d say about 20 rooms. Some of those offices, treatment rooms, patient rooms, and one is the ‘ER.’ Right now there are three patients. Two are elderly with Malaria, it seems, and one is a gun shot wound. The night we got here a fight broke out between clans over grazing land and water for their cattle, and one guy got shot. It was a BIG to do, as violence at that level hasn’t happened here in a very long time. Usually just shoving and calling each other names. I am betting it was a mistake as he was hit just above the knee. Lucky guy, as the only thing they can do here is give him an IV drip of saline, and clean the wound. Before you panic mom, about the gunshot, remember that there has been a murder in Mapleton. It was a similar situation, people fighting over irrigation—livelihoods are serious. We are ‘camping’ here while we do a rapid assessment. Meaning, we need to check out this area, there are no hotels/guest homes so we are using pop tents and mats sleeping here on the grounds of the ‘hospital.’ It’s nice enough.
Many have requested some details on my job—so here you are. I am in charge of rapid assessments and surveys. What that means is, each time you hear a report about malnutrition in this country or that country, or about rise in death or diarrhoea, or malaria, whatever, someone like myself and my team went out and walked around in the bush counting and calculating with some very crude methods in the HEAT of the sun. What happens here in Ethiopia is as follows: First the country is broken down as follows: Starting at the top are Regions (like states), then Zones with in Regions, then Woredas within Zones, then Kebele within Woredas, then villages. Each of these levels (aside from the village level) has a Disaster Preparedness and Prevention Office. They monitor what is going on—if something happens, e.g flood, drought, fire, conflict, cholera outbreak, etc. They pass up the chain what is going on. Word gets to organizations like my own, if something is off. We then send out a team of 3 to 5 people, depending on the ground we must cover, and to do a ‘Rapid Assessment.’ This is a quick and dirty way to assess the situation. It seems it would be easy to just know if there is a problem, but its not. For example, it is easy to know if there is a flood, what you can’t assume is how the people will be affected. People outside of the “West (developed nations)” are FAR more resilient. A little flood may be nothing, or it could cause loss of a substantial amount of crops and an outbreak in Cholera. It’s surprisingly difficult to know which is going to happen until it does. People spend millions a year trying to figure out just that—they are called Early Warning Systems, and they don’t always work. That’s a whole other topic, so back on track. We conduct focus groups with locals, key informant interviews, and of course measure children—lots of children. In the Rapid Assessments you just check the MUAC, or Mid-upper Arm Circumference. No weights or heights. The circumference of the arm of kids 6 to 59 months can tell you a lot about a situation. In areas where children are fed before adults, you also check the MUAC of pregnant and lactating women and elderly.
Then, if the situation is ‘bad’ (to be explained later) we conduct a full blown survey. This takes 2 weeks give or take, and we assess more people, ask more questions of each mother/father/caregiver, measure weights and heights on kids and moms. If the situation isn’t ‘bad’ we walk away. This is where my job can suck. Bad is defined as the percentage of children who are malnourished (low weight for height or small arm circumference). Or a high rate of diarrhoea, malaria, cholera, etc etc. The sucky part of my job is that I am a triage nurse. If the situation doesn’t reach the international standards (hotly contested numbers used by UN and NGOs as cut-offs and to compare different areas or years), then they won’t get help. Even though there are sick children there, malnourished children there, a program won’t be set up there. Resources are limited, so you have to put them where they will do the most good. But, if the situation is ‘bad’ enough, my organization will set up a feeding program, or we will give the info to another organization to do it.
Anyway—I’ll stop ranting about my job and give you some ideas about Ethiopia and random observations. Some have to do with Ethiopia, others things I am learning about British/Irish culture.
1. First—am I the only one in America that just learned that the British/Irish hold their fork upside down? The curve is facing down, and they hold their knife in their other hand pushing the food up onto the fork. When did we change that? Why did we change that? Seriously, I get SERIOUS harassment about being an ‘American Shovelor.’ Seriously, how did that happen?!?!
2. Ethiopia is famous for their juice. It’s DELICIOUS!! It’s not really juice, rather nectar. Thick. And, it’s layered. SO you’ll have a green, pink, orange layered juice. They drink avocado juice, banana juice, mango, papaya, orange, etc etc. Yummy!! I’ll try and get a picture of it.
3. In Ethiopia it is the year 1999. New year is celebrated in September. That means I get to celebrate Y2K again!!!! That’s why Ethiopian Tourism brochures say “Come to Ethiopia, you’ll feel 7 years younger!” Also, there are 13 months in their calendar—so you’ll see brochures that say “Ethiopia, 13 months of sunshine.” Also, their clock is 6 hours different from ours. It actually makes perfect sense, once it was explained to me. The sun rises and sets at 12 everyday (give or take ½ hour), so the first hour of the day is 1, then 2, etc. I work from 2 to 11 (well that is the schedule, I generally go in at 1 then go home at 12. I rather like it. But, it works so well because they are near the equator and the times of sunrise/set don’t change much.
4. I am not a birder (bird watcher), whatever. But, I have fallen in love with several birds here. Near my office there are these beautiful brown and dark red birds. They are small as mice, and they are just beautiful. I know brown and red doesn’t sound pretty, but they are gorgeous. In the field, I’ll be in the middle of dry forsaken place, no colour but the tan of the sand, bushes, animals—then along will come a bird with the most brilliant colours. Bright blue, red, orange, green, white. Vertical and horizontal stripes. Gorgeous.
5. This last bit (before I delve into the two rural areas I visited), is embarrassing, but hilarious. I was out wandering around looking at shops with two of my flatmates. I was bored, shockingly enough—not really a shopper. I saw these kids playing in a side street. I of course went over to join them. I just generally greet them, say ‘Selam’ and shake their hand. That alone will entertain a good 15 kids for 20 minutes! Then, I say the random words I know. I generally beg for money, and sometimes I’ll pretend I am getting money out for them then when they come for it, I tickle them. Anyway, I was sitting on a rock entertaining myself when this little boy sat down next to me. We were ‘chatting.’ The kids generally will touch me, my arms and hair. This little boy was no different, and touched my arm just above my elbow. Then, he discovered something more interesting then just my pasty white skin! He discovered as he tapped my arm, it jiggled. I am sure he had never in his life seen an arm ‘jiggle.’ So, he proceeded with great wonder to play with my flab. It was grand. Just Grand.
Okay, as stated I have been to two places in the field to do assessments since I last wrote. The first is the Afar region. This region is the one I started out talking about, where we camped at the hospital. Afar is in the North East of Ethiopia. I think I talked about it in the previous email, all desert. I wasn’t sure what to expect, but what I saw blew my mind; it was stunning. We had to travel over these rocky steep mountains, then dropdown into a gorgeous desert. I felt like I was home. It was just like Utah, with a few changes in home type, people, and animals—but so much like it. Absolutely gorgeous sunsets and rises. We stayed in the town of Dulecha, then drove out to the affected areas to assess. One half of the area is having a drought, the rains which they rely on for their crops were fewer and further between then normal and crops had failed. They walked 6 hours a day to get water for their families. Imagine, they (the women) leave their homes at 4:00 am, two hours before the sun rises, get to the river after three hours, fill up jerry cans then turn around. They have to gather all the water they need for the day; for cleaning, drinking, and cooking. The women in this culture are given quite a lot of responsibility. In fact it is their job to build the family home. The drought area didn’t’ really have a road into it either. In fact, for a good hour of the journey we drove in dry river beds; sandy and rocky. I saw the full capabilities of a Land Cruiser put to use. It was quality fun. The people were great. They wear skirts and scarves (no shirts) mainly, I was jealous. The men wear white woven material as a skirt, then one as a scarf. They carry their traditional knives, long and in leather cases. They also carry walking sticks and guns. They are agro-pastoralists. The women wear bright coloured patterned skirts, with either a similar scarf or a stripped shirt with a scarf.
While staying in Dulecha I was invited to someone’s house for coffee. Ethiopia is famous for it’s coffee. For those of you who drink coffee, I am sure you know—for the rest of you, FYI it is believed coffee originated here. When you go to someone’s home they perform the ‘coffee ceremony.’ They get the green beans and roast them, then make the coffee. I love the smell of coffee, so I generally enjoy it. I was in this particular home when I experienced one of my favourite phenomenon abroad; the random stuff they can get at the market. In this families mud hut (which they can do wonders with, more on that in another email) they had a small rug hung on the wall. It was the size of a doormat. They had hung it next to the bed, so you could lean against it. The background was an American flag with three men on it. You’ll never guess who! The best part is they didn’t know who these people were, they just knew the American flag and assumed they were American. In the middle was our famous Martin Luther King, on his left was JFK and on his right was Bobby Kennedy. It was great. I told them they were American leaders they should be proud of.
The second day we went to the flooded area. The area is truly inundated with water. The area had a road going into it, just finished last year that was washed out in several places. So, even though I really wanted to try it, the Land Cruiser couldn’t take us. We had to wade in! It was a 1 ½ hour hike into the first village. We had to cross water on three occasions, often coming up to our waste. It was great fun! As I had been reading my lonely planet guide, I saw that Ethiopia has crocodiles, big ones. The book said they can get up to 10 meters!! NOT FEET, meters!! Eek. I asked if they existed in this area, and was told no. Hallelujah. But, along the way in this journey, I was able to see the ‘famous’ Ethiopian Fox (I hadn’t heard of it either, but apparently it is a famous candid?), the bleeding heart baboon (it has a red patch on it’s chest), and plenty of wart hogs. We crossed through these different places to find the people had mainly abandoned their villages and homes. The river had receded, but a few families had come back to take advantage of the now green area with their livestock. However, most families lost a good ½ of their livestock in the flood. We wandered around the area for 2 hours looking for families and asking them how they were doing, measuring children, observing their homes and what food/water they had available. The locals were very surprised to see a firengi (white person) in their area of the planet. They said I was strong. I took the compliment. Then, 1 ½ hour hike back out. It was great fun. On the way out, our guide (a local man who had shown us around to the different areas where families had resettled) pointed over into the bushes next to the water we were crossing. It took me a moment, then I saw it, a crocodile!!!!!!!!!!!!!!!!!!!!!!!!! I am not kidding. Granted, it was a small one, but still!! Eeek. I couldn’t help but wonder if it had a daddy near by. Obviously nothing happened, as I am here typing the story—and the locals were VERY calm about the whole situation, so—I tried my best to seem calm also.
The next area was to the South West of Addis. A place called East Showa Zone, Adama Woreda. This area was not as dry, in fact there was a sugar cane factory in the area. There were reports of severe malnutrition, so bad children were not attending school. My team and I deployed. We stayed in the ‘county seat’ of Adama at a hotel. A big change and I must say I liked the camping better. So, we head out to the door and hop in our Land Cruiser. We get to the ‘most affected’ villages and start talking to local leaders and measuring women and children. Long story short (really LONG HOT DAY), we found fat kids. I am not kidding. Turns out it was overnutrition, not under. Not that that is how it was reported to us, they were looking for assistance money. It’s not that there were no health problems, in fact quite the opposite, many health issues. I’ll put you to the test—if you were visiting an area that was surrounded by sugar cane fields, what would you think is the number one problem? For our answer, I’ll refer to my friend Dr. Nate DDS, who I know would have DIED when he saw these kids. Not only do they all have rotting teeth, but due to high fluoride in the water source, they all have flouridosis of their teeth and high rates of arthritis and osteoporosis. I cut my assessment short by two dies, as our services were not needed, but I strongly recommended someone who does nutrition education and dental health get into the area stat. For those of you familiar with MUAC (the mid-upper arm circumference we measure on kids) this next bit will REALLY entertain you. For the rest of you, MUAC is measured in millimetres/centimetres. So, the reading for children is generally 130mm (13cm), etc. To be accepted to a feeding program they must be below 12cm, and below 11cm is considered Severe. Women on the other hand of course have larger arms. Not as large as ours in the US, but larger. For women, the cut off to be accepted to a feeding program is under 21cm (210mm). In this village where supposedly children were severely UNDER nourished, we found a kid who was four years old with a MUAC of 19!!!!!!!!!!!!!!!!!!!!!!!!! You just can’t imagine. When I first saw him from a distance, I assumed he had SEVERE oedema, and panicked really. Then, when I got up close I realized he was just fat. Obese to be exact. The chubbiest kid I have ever seen outside the US. Fascinating.
Well, I need to actually do some work. More to say, but no time to say it. I’ll put up pictures when I can. Hope you are all well—