Change

little girlOne of the tasks assigned to me during my time in Ethiopia is to look at various health centers and explore which ones are best suited for the expansion of SCOPE’s Soul Fathers as Health Educators project. I have visited all five sites being considered and found the task not nearly as straightforward as expected. Each location has its own set of strengths and challenges and it is hard to separate myself from what I imagine could be and sit with what is.

Last week we had dinner with a lovely Swiss midwifery student, Laura who is here for a five-week clinical rotation. When asked what impressed her the most about her experience she replied, “the strength of the women.” She spoke of how brave they are during the birthing process. She then shared one tragic story, which had also left an impression on her. A mother had tried to deliver at home but the presenting part was the baby’s arm rather than the head, which stalls the passage of the baby through the birth canal. In the U.S. this represents an emergency and the mother likely would have been rushed to the operating room for a cesarean delivery. The woman in Laura’s story lived over four hours from the hospital and by the time she arrived, the baby’s life had been lost. Laura described the wailing and sobbing of this poor mother as the baby was literally torn from her. She labored the baby out after the baby’s arm had been removed. I cannot begin to imagine the trauma of this experience for that mother. As a hopeful mother I mourn along with this woman and all women whose lives are needlessly altered by similar stories and all children whose lives will never be realized as a result. I hope for physical and emotional healing for that mother and father. I hope for meaningful change that will prevent such tragedies.

Laura’s story served to personalize the statistics I have been gathering during my time here. One of the health centers I visited is seeing only about 11% of the pregnant women in their catchment area. The remaining 89% are receiving no care at all. Receiving antenatal care and giving birth with a skilled attendant can be life saving for the mother and the child. 

Doubts and questions cloud the hope I hold onto for mothers and children like the ones in Laura’s story. How does change actually happen? Where will it come from? Whose demand for change will be heard? Who will be the hearer of their demands? Change… progress… development. Sometimes the needed change seems so obvious and easy, yet it exists within a complex system of real people with real struggles and the process is anything but simple or straightforward. I’m glad to be here. It’s a privilege to have the opportunity to ask these questions and sobering to be reminded that there are no easy answers.  

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The Other

Who is she? The other. The one who is different than me. There is always an other. The one I see as completely different than who I am or what I am about. We all have others in our life. We think we understand them without ever having asked if our understanding is accurate, or every considering if we might not know everything there is to know about their story. The tragedy is that the other is our own creation. Otherness was not in the plan. We created otherness. Oneness, unity, peace, love, understanding and communion, these were all in the plan, but otherness was not.

Yesterday morning I found myself missing my home church, so I decided to listen to the pastor’s sermon from a few weeks ago. The sermon centered on the story of Abraham, Sarah, Isaac, Hagar, and Ishmael. This is an admittedly messy story. God chose Sarah’s husband, Abraham as the father of Israel. Abraham’s concubine, Hagar threatens Sarah because Hagar bore Abraham’s first son and was therefore higher in social status than Sarah. Sarah eventually bore Isaac, but he was Abraham’s second borne son so there were likely questions surrounding whose son would inherit Abraham’s lot. So, Sarah separates herself from Hagar and labels her as other. While God does not stop her from doing so, God also does not join her. Hagar was a disruption in Sarah’s world. As a result of their problematic presence in Sarah’s story, Hagar and her son, Ishmael are cast out into the desert to die. God hears the cries of Ishmael and Hagar. God had chosen Israel to bear a message to the world, but he did not turn away from those whom Israel labeled as others. Similarly, those whom we have cast aside, thrown into the desert, or whose stories inconvenience us or whose suffering we forget, those whose stories we will never hear because we choose to label them as other and close our ears to their words, God does not forget them. For God, there is no other.

In light of recent events in Palestine and Israel, and in the midst of my experiences here in Ethiopia, the presence of otherness in the world has been a prevailing topic in my thoughts. As I walked to the hospital today I saw a man, naked walking down the street toward me. His testicles were swollen to the size of a small melon and he was displaying his deformity and begging for money. People walked by trying to avoid eye contact and I joined them. I gave him an awkward smile and kept on my way. What is his name? What is his story? Who will listen? Who has cast this man out? Likewise, as we walked back to the hospital after a visit to a local health center with our colleague Adino, I noticed some young women sitting in the grass. They waved hello and I waved back. Adino explained that they were fistula patients. These women were likely married off at a young age and their bodies were not ready to bare children when they became pregnant. This fact paired with the lack of a skilled birth attendant can lead to prolonged labor lasting several days, which can cause the formation of a fistula (Click the link for more detailed information about fistulas). Due to the malodorous nature of their condition, they are cast away to live in isolation, and are often subject to desperate circumstances. These are just a few of the others of our world.

Those labeled as the other are often those whose reality makes us uncomfortable, or whose needs inconvenience us, or whose opinions seem irrational. The only way to overcome this otherness is to hear the stories we don’t want to hear and to acknowledge the likeness that we all share as those who are loved and fully accepted by God.

Stories. We all have them. Some of our stories are told often, while others are never heard. What stories are we not hearing? Who is the other? So often we create otherness where there should be oneness. We create division where there should be unity. We create war where there should be peace. Lord, have mercy.

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The gate that Kate and I walk through to get to the University of Gondar Hospital. The sign celebrates the repair of 60 women’s fistulas.

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The Fistula Training Center at the University of Gondar Hospital

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Ethiopian Orthodox Christians performing their morning ritual of prayer

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A beautiful view from a morning run. My morning runs here have provided me space to think and process my experiences.

Lessons from Misbah

Nothing can make me smile like the sight of Misbah. As I round the corner from our guesthouse apartment building and walk toward the main road, I find myself always crossing my fingers, hoping that Misbah will be playing in the street so I can feed off his infectious smile. This boy of 10 years has stolen my heart. As I have realized his effect on me, I have wondered just what it is about this small boy that draws me so eagerly toward him. I came up with three life lessons I have learned from Misbah.

Lesson 1: Life is all about love. It has become a joke that Kate and I want Misbah to come with us to America. Whenever Misbah is asked if he wants to come to America with us he wrinkles up his nose and exclaims with conviction, “No, no, no!” At first this surprised me. I have grown used to people from the developing world proclaiming their dream of one day coming to America. Not this boy. When asked why he wouldn’t want to come he replies something like, “my family and my life are here.” What a beautiful sense of place and belonging this boy has. I found myself inspired by his commitment to fully embrace his life and those whose love surrounds him.

Lesson 2: Accept hospitality when it is given. Misbah, along with his family and his auntie Gamila have welcomed Kate and me with open arms into their lives. Kate and I were walking up the street to grab some food the other evening when Misbah spotted us from across the road. He came over and shook our hands and then said, “come.” We followed, and he kept peering back and repeating the phrase, “come on, come on” to make sure we were still in tow. He lead us into Gamila’s one room apartment and ordered us to sit on the floor cushions while he filled a basket with the bread he had just purchased. I have never seen a more satisfied look on anyone’s face. He had invited us in and we had accepted his hospitality. We have eaten at Gamila’s a handful of times now and she has given us milk and honey, and warm smiles and kisses on the cheek, and I find myself feeling guilty because I am so heavily on the receiving end of things. I am trying to shake this sense and learn from Misbah’s satisfied look, which reminds me that sometimes accepting hospitality is a gift in and of itself.

Lesson 3: Laughter heals. This kid can laugh. His joy is contagious and I can’t get enough of it. Kate and I have shared our surprise when we realize that the strain and energy expenditure associated with cross-cultural interactions doesn’t apply when we are at Gamila’s. Misbah’s laughter is no small part of this phenomenon. His laughter melts away the worries of the world and the cares of the day. He lives in the moment and brings me into that moment with him. As a future healthcare provider, I find this lesson invaluable. Being present with people and bringing them joy is a special gift this boy has been given and I am grateful for its timely presence in my life.

This boy has been such a gift. I am trying to avoid the sad thought of leaving this place, and Misbah behind in September. For now, I’ll try to remain an attentive student to the many lessons he has to teach me.

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Misbah sharing his smiles.

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Misbah goofing around with Kate.

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Misbah showing his dimples.

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Gamila preparing coffee for us.

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Gamila pouring us some of her honey.

 

Getting Out of My Own Skin

Our skin, or integumentary system is the largest system in our entire body. It plays so many roles both positive and negative, from keeping us safe and healthy, warm and dry, to creating separation and discrimination based on its color. The barrier it creates between us and the world is essential for survival. Without our skin our body would be inundated with bacteria, parasites and viruses that would overwhelm us. Our skin allows us to live, and in some ways defines our experience of living. When others look at us they see our skin, and we in turn see the world around us from within that skin.

This past week’s work was dominated by interviews. I sit down with the interviewee and ask the predetermined questions. I am not sure what exactly I expected, but my surprise at many of the answers I received evidence the fact that I did hold some sort of expectations at the outset of the interviews. As an interviewer listening is of utmost importance, and not just to the words that are spoken, but also to the meaning behind the words and the lived experiences that bring those words to utterance. As humans existing in our own skin we see the world from our own perspective, with our own unique biases. We see problems and solutions from within our skin. There is no way out of it. From the moment we are born, our skin is our companion here on earth. As I interviewed people this week I stumbled upon moments when I allowed my mind to wander outside of my skin and catch a glimpse of the world from within another’s. While we will never be able to do this fully, the moments life gifts us with when we can shed our skin and sit in another’s world are precious; I believe this is the birthplace of life’s slivers of wisdom.

Dr Shitaye, an Internal Medicine Doctor here in Gondar who has worked with SCOPE for many years shared some beautiful words during a casual conversation following her interview. She shared her passion for knowing her patients as people with stories to tell rather than as diseases. She cares for Magda the fierce mother and Misbah the gentle farmer rather than the diabetic and the hypertensive. Her face lit up as she talked about her passion for making sure medical students here in Gondar know how to listen to patients and gain wisdom from their stories. This requires stepping out of one’s own skin, shedding assumptions and preconceptions and listening, really listening to what another’s life has to tell us. If I have learned nothing else from my education at UW, I have learned that as a healthcare practitioner I am powerless without my patients’ stories. I believe Dr. Shitaye holds many slivers of wisdom from her 30 plus years of experience getting out of her own skin and stepping into the lives of her patients.

As I head into another week of interviews and clinic visits, my practice will be to step out of my own skin and to listen. Knowing that I will never fully master this practice, I will keep trying. After all, life is full of practices that we will never master, but that doesn’t excuse us from trying. With each attempt our practice grows and we gain those little nuggets of wisdom.

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A couple of shots from an interview with Kesis Dawit, an Ethiopian Orthodox priest who has been involved in SCOPE for a long time. His passion for the SCOPE’s mission was inspirational.

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Kate goofing around with our favorite neighborhood boy, and me with Gamila, our favorite local shop owner who has taken us under her wing.

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Gamila preparing coffee for our Iftar meal. She is a Muslim and is fasting for Ramadan. She invites us almost daily to break the fast with her in the evening.

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Waiting in line and then sitting in the stands at University of Gondar’s graduation ceremony. This year marks the University’s 60th anniversary so there was plenty of celebrating!

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A beautiful sunrise greeting me on my morning run.

 

 

 

 

Meaning

The last week has been a bit less of a whirlwind than the previous, which has afforded me time to think. The pervasive, reoccurring theme in my thoughts has been meaning. As you may have gathered from my previous post, almost every name in Ethiopian culture is meaningful, which is often shared during the initial meeting and greeting. “Hello, my name is _______, which means________.” Similarly, everything in the church has a meaning. Now, when I say that everything has a meaning I mean EVERYTHING. There are often multiple, layered meanings; this holds true for names, objects, designs, ideas, you name it. This has become a bit of a joke between the American fellows and some of our Ethiopian colleagues. Be careful when you ask an Ethiopian Orthodox Christian what something in the church means, you better have some time to sit and listen. Adino, the name of one of our colleagues, means healer. His mother had a particularly difficult pregnancy and labor and when he was born, her health improved dramatically. Her improvement was attributed to the arrival of this baby boy, this “healer.” One of my favorite “meaningful” explanations thus far was in response to my inquiry as to why Orthodox churches are round. The answer was that the round shape represents the world, and the fact that God’s grace has no boundaries… or something like that.

In the midst of my thoughts and reflections about meaning I started reading the book of Ecclesiastes. One of our less religiously observant, Ethiopian colleagues mentioned that it was his favorite book in the Bible. He likes the way it contradicts the meaning ascribed to life throughout much of the rest of the scriptures. Ecclesiastes speaks of the meaninglessness of life and of all our activities on earth, and the backwardness of our world. “There is something else meaningless that occurs on earth: the righteous who get what the wicked deserve, and the wicked who get what the righteous deserve.” As I walk amongst people who live such a drastically different life than my own, and who have arguably received the “what the wicked deserve” undeservedly, I sit with Ecclesiastes. I sit with uncomfortable questions left unanswered and frustrations unsettled. Comfort and explanation evade me and somehow the unease feels right, appropriate. I am trying to embrace the complexity of this place and lean into the questions, even if I know there will be no answers. In the midst of the “meaning” ascribed to all things here, I acknowledge meaninglessness. Ironically, the question that I end up with is, “what does meaninglessness mean?”

On a lighter note, Kate and I had a rather humorous weekend as we attempted to make a cake for our colleague, Getahun’s upcoming birthday. Luckily we had designated this a trial run because we failed miserably. The main culprits, among many were the wrong oil, and “butter” that absolutely could not have been intended for human consumption. We laughed and learned from our baking woes and on the up side our hunt for ingredients gifted us with some very fresh milk and some new friends.

This morning we had the privilege of attending a lecture by Kefyalew given to third year medical students. It was fun to see our colleague up front commanding the attention of his students. He spoke about the cascade of disease transmission and primary, secondary and tertiary disease prevention… what a necessary and vital topic for these students! They were attentive and participatory throughout Kefyalew’s well prepared lecture.

The upcoming week holds a visit to the Woleka clinic where the original SCOPE Soul Fathers project was implemented as well as a visit to the North Gondar Diocese. As my thoughts meander from the mundane to meaningful, I look forward to the activities and experiences that lie ahead, and the continued unanswered questions that will undoubtedly meet me.

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 What Kate and I looked like for most of the week.

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Dr. Getahun, who always greets us with a warm smile and shares his office and desk with us.

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Notice the scale. The presence of scales in the street stems from the original HIV/AIDS outbreak in Ethiopia when people monitored their weight as a way to measure disease progression.

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In other news, the hair didn’t last long…

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Mickey: trusted taxi driver and owner of the barber shop responsible for my fresh do.

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“butter”

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One of the views on our almost daily walk to the hospital where Getahun and Kefyalew work.

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Kefyalew in this morning’s lecture.

 

Surprises

Today was a day full of surprises. I woke at 6:15 and headed out for my first run. The first surprise came in the form of an Ethiopian running partner. A young man dressed in blue jeans, an Obama T-shirt and plastic sandals spotted me from across the road and began running along with me. Soon he made his way across the street and ran next to me for about a mile or so. I huffed and puffed while his sandals scuffed along the ground and he sounded as if he could carry on a perfectly normal conversation while keeping pace. Eventually he said, “go, go” and turned back. We exchanged smiles, shook hands and I said a quick thanks and continued on.

The next surprise came when Kefyalew, the Ethiopian SCOPE fellow picked me up in a Land Cruiser for our morning trip to visit the Dabat Health Center, located about an hour outside of Gondar toward the Simien mountains. His sweet wife, Ferehewete, meaning fruit and his friend and colleague, Adino, whose name means healer, accompanied him. Kefyalew and Adino implemented the second chapter of the Soul Fathers project at the Dabat Health Center beginning around 2 months ago. I was under the impression that we would simply be touring the clinic, but I soon found out that this was an official monthly meeting with the priests and religious women who had been trained to teach their communities about the importance of antenatal care, assisted births, HIV transmission, prevention and treatment and a few other complimentary topics. I was again pleasantly surprised when all of the priests and religious women showed up for the meeting, relatively on time and Kefyalew, who is small in stature took command of the room. The respect for Kefyalew and the project was palpable. The highest ranking priest who had recruited the other participants reinforced the church’s support for this important project. According to Kefyalew he referred to these health teaching activities as a very important part of their priestly duty and emphasized the importance of integrating the teachings into their routine. The meeting concluded after about 2 hours.

From there I expected we would head back to Gondar for an afternoon of reflective note taking and project planning; however, I was surprised to find that we had been asked to a coffee ceremony at Adino’s mother’s or brother’s house in Debark, abot 20 minutes further north and the jumping off point for trekking in the Simien mountains. I was very thankful for our Land Cruiser as we made our way through the mud to Adino’s brother’s house. His eldest brother Meseret, whose name means foundation, insisted on hosting us. The coffee ceremony was absolutely beautiful and was performed by Meseret’s wife, named Zena, whose name means news or good news. The coffee was hands down the best coffee I have ever tasted! Smooth, dark, earthy flavors with a flawless finish left my palate begging for more.

After leaving Meseret and Zena’s house, I was sure that we would be heading back to Gondar. After all, the trip had already gone on far longer than expected. Kefyalew surprised me with the news that we would first head further into the mountains so we could see a road called the Lima Limo road named after the Italian man who designed the windy path through the mountains. I went along in confusion as to why he would want us to see a road. Well, I was again thankful for our Land Cruiser and trusty driver as we barreled first up then down the very muddy road, hugging the side of a beautiful, lush green mountain. The road was not the point. The view was spectacular. We took some moments to take pictures and ogle at the unbelievably gorgeous landscape. I also managed to teach our new Ethiopian friends about jumping pictures.

As we left the “road” I was sure we were headed straight for Gondar. I was mostly right this time aside from a quick stop to buy the most exquisite honey and another to pick up a sick child and his parents who required transport to Gondar for care. We finally arrived back in Gondar 11 hours after we left.

This day taught me so many things. My conversations and observations were priceless. My heart is happy and my soul sings sweetly as the day draws to a close. I can only imagine the lessons and surprises that lay ahead. Now it is time for sleep. It has been a long day.

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A view from the drive to the clinic.

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One of the priests giving his report.

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Some of the women and priests being restocked with green, antenatal care referral cards to give to the pregnant women they talk to in their communities.

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Coffee ceremony – The beans being crushed with a mortar and pestle after roasting over the fire and the water heated and the pour

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The view from Lima Limo Road.

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Our most successful jumping picture – clearly we have work to do!

First Few Days

I’m sitting here watching the World Cup sipping a beer… not too bad. The last few days have been nothing short of a whirlwind. The trip over was relatively uneventful aside from Kate’s swollen ankles and lots of salty airplane food. When we landed in Gondar we were greeted by Dr. Getahun’s warm smile in his gray Toyota, which carried us to our place of residence for the next three months. After being wowed by the beauty of the countryside, I was pleasantly surprised by the size of our apartment along with the presence of running water and flushing toilets! On our first night we met up with Nancy and Peggy, the co-directors of SCOPE, for a meal and a drink. We, not surprisingly slept very well that night.

Our first full day began at 8 a.m. with a meeting at the University of Gondar Hospital. After meeting Peggy and Nancy we sat Dr. Sisay’s office to discuss financial matters. I floated through the rest of the morning until we met with a group of interested parties from the University of Gondar in the afternoon. This was when the excitement hit. My enthusiasm became hard to contain when we arrived at the Woleka clinic and received a tour from Dagne, the clinic administrator. Walking through the exam rooms and finishing in the birthing room, I had to remind myself that there would be time for all of my burning questions.

The last few days have been filled with meetings, meals and more thoughts than could ever be put on paper. My mind is still reeling as I attempt to digest all that I have seen, heard and felt. In the end I am unbelievably thankful to be here. I found myself thinking, I wish that I had 6 months instead of just 3. Tomorrow we will visit a second SCOPE site and then head out to visit a Food for the Hungry project in rural Gaiynt on Sunday. Now, it’s time for sleep so I can put my full energies toward tomorrow’s activities.

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Dagne showing us the flip chart the Woleka clinic uses to teach the importance of male partner participation in antenatal care and HIV testing.