Wednesday, August 24, 2011

Home on the horizon...

By this time next week, I will be settled back into life in Houston and (hopefully) over my jetlag! But I felt like it was a good time to look back on the summer and reflect on my favorite things about Ethiopia:
First, the coffee.

Amazing macchiato in Gondar. (Might have already posted this, but it's illustrative!)

I drank one of the best cups of coffee thus far in Ethiopia from this girl. I asked her where she got her coffee and she told me she bought it locally and roasted it herself. I immediately asked her if I could buy some freshly roasted coffee from her. And there it is!

Second, music and dance. I posted some music videos on an earlier posting, and here are some photos. I have a video that I will post when I get back to the states.

Singer and Masinko player at a traditional restaurant

Band at a traditional club close to where I've been living. The band is made up of 3 generations of men playing a variety of traditional Ethiopian instruments.
Third, food. Ethiopians (if you haven't tried the food before) typically eat different kinds of sauces, or wat, with injera, a type of bread made from tef, a grain which is also a complete protein! Tef is one of the healthiest grains in the world, next to quinoa, and is packed with iron, fiber, complex carbs, minerals, etc. Injera is made by fermenting the tef, rolling the dough thin and baking it on these traditional stoves (pictured below). Then to eat wat, you pull a small square of spongy, soft injera off the roll, scoop up some sauce into a ball in your hand and stuff it in your mouth. It is typical to see bites the size of a fist. It is also typical for Ethiopians to feed one another. Guys feed guys, guys feed girls, girls feed girls. Its the culture and it's so sweet!

Mixture of wats and dark and light injera (the darker one has more iron, hence the color!)
Injera oven
Fourth, history. The first human being was found in Ethiopia. There was also the great Axumite empire, which was one of the most powerful empires in the world around 2,000 years ago, along side of the Roman empire. There is still some evidence of this empire in Axum. There was also a series of great kings that lived plus/minus 500-800 years ago. Evidence of these kings can be seen in Lalibella and Gondar. I've posted some photos of Gondar in an earlier post. Here are some other bits of history....

Over 2,000 year old Axumite stelae in Axum, its old capitol. These structures were erected when someone died. The more rich/powerful you were, the bigger the stelae.
Some ancient relics found near Yeha Temple, the oldest standing building in Ethiopia, also over 2,000 years old. The inscriptions are in Sabaean, the precursor to the Ge'ez language, which is the precursor to Amharic and Tigrinia, two of the major languages spoke in Ethiopia today.

The ruins of the Queen of Sheba's palace, said to be built around the 10th century BC.
In Lalibella, there are 12 churches that are literally carved out of massive rocks. There are different kinds - free standing, or completely carved out of the rock on for sides (monolithic), partially free standing, or only carved out on some sides (semi-monolithic), and cave churches, whose sides aren't carved at all. These churches were built in around the 12th century BY HAND, and the actual tools used to carve them are still unknown. The architecture is so precise, the columns and walls are so straight, its unbelievable that it was done by hand, no less almost 1000 years ago. Although it is unofficial, Lalibella could easily be considered the 8th wonder of the world.

Fifth, scenery. It's a beautiful country.

A waterfall my friends and I found....really off the beaten track, but worth it!!

A funny looking duck.

Local boys swimming in the river.

Women work way harder than men here. Here's a woman hiking through mountainous terrain, probably for miles, with the bundle of logs on her back.

Sunrise in the lake-side city of Bahir Dar.

And last, but certainly not least, the people. I have made some truly amazing friends, and in general, the Ethiopian people are absolutely lovely, warm and down to earth. I'm going to miss them!

It was one of our friend's birthdays, and we were a rowdy bunch. My friend, Nibi, took that instrument (called a Masinko) from a traditional Masinko player on the street, and started playing it. Nibi needs to stick to his day job...
Girls I met at one of the health centers where I was conducting interviews. One girl had had her baby there a few years ago and was bringing her friend in for antenatal care visits. They were both so sweet and pretty AND embarrassed that I was taking their photo.
I got stuck in a hail storm with these boys. They were teaching me Amharic words and I was going over "head, shoulders, knees and toes" with them. Their English far surpassed my Amharic.

A rowdy bunch of kids who followed me around when I was walking through the streets of Axum. They went crazy for the camera!

Best friends!

Tuesday, August 9, 2011

Some (actual) field notes

So far, I've been posting about my travels. But this blog is called field notes, so I think it's time that I actually shared some of them.

My main project here has evolved somewhat. I have been working with an organization called Jhpiego, an affiliate of Johns Hopkins, and one of the USAID NGO partners. When I started, I was planning to assist one of the Jhpiego staff on documenting promising practices in maternal, newborn and child health. This is a lengthy process, and involves input from the ministry of health, USAID, UN organizations, and other NGO partners. Coordinating with all of these organizations has shown to be valuable, as representatives from each organization that have been involved thus far all have great insight. However, it has also proved to be difficult to coordinate all of these partners in a timely manner. So almost a month into the summer, I realized this project was not going to get done while I was here, and although I have continued to assist, I was assigned a new project.

I've been working to document successes and challenges of the implementation of a new management strategy, developed by Jhpiego, called Standards-Based Management and Recognition (SBM-R), which has been piloted in the Regional Health Centers. These health centers act as primary health care units (almost like big clinics, or very small and basic hospitals) for catchment populations of about 25,000-50,000. The purpose of the SBM-R is to help health centers to identify their gaps in performance and quality, create an action plan, and implement changes to improve their services. The SBM-R tool is basically a simple checklist that staff can go over regularly and check off their progress. The intervention has mainly been tailored to improving maternal health care, but also covers improving infection prevention, the pharmacies and laboratories, and management in general. So far, I have had a chance to visit 9 of the 11 health centers where this intervention has been implemented. Here are some photos of my visits:

Entryway to one health center.
Welcome sign at one health center. Unfortunately, I don't understand Oromifa, the language that this sign is in. [As a side note, Oromifa is the language spoken by the people of the Oromia region. It is the largest region in the country, population-wise, however, the official language in Ethiopia is Amharic, the language spoken by the second largest ethnic group. Just some food for thought...]
One of the health center staff with PPE donated to them by the Integrated Family Health Program (a Jhpiego partner). The health center was able to greatly improve their infection prevention measures through SBM-R and these types of donations.

Some health center clients. Mothers with their healthy babies.
Saw these types of stickers all over. USAID has quite a large presence in Ethiopia.
Delivery beds in one of the health centers. They really needed new ones, as you might be able to tell from the rust covering the tables. The blue curtains give privacy if there are two women giving birth at the same time. Completely different from the experience in America.
This is one of the health centers in the northern part of the country, the Tigray region. The health center had a room full of beds, but no funding to buy mattresses for them. This was one typical problem at the health centers - a lack of resources.
One health center was particularly grateful for Jhpiego's assistance and showed it. They posted posters like this all over their health center prior to our arrival. Hannah Gibson is our program director.

All in all I've felt that my visits to these health centers have been a great learning experience. I have also seen how a simple management tool (the SBM-R) can really help to improve the quality of services and patient satisfaction. Although I was not able to see the health centers before the intervention, I was able to infer by the data collected on their performance before and after SBM-R that the intervention really helped the health centers make significant progress. I also got the sense from health center staff that they all felt more motivated and invigorated by their work than before. Staff burnout is still a problem across the country. There is a huge diaspora of health professionals, mainly due to poor salaries, long and arduous hours, and a lack of resources and training that lead to poor service and low patient satisfaction. But I was really impressed by the dedication of most of the staff I talked to. I only hope I can convey the successes of SBM-R in my report and that it will help Jhpiego continue and scale up this type of technical assistance to more health centers.

Wednesday, July 27, 2011

Updates, updates!

Well, it has been ages since I've been able to get back to my blog. Hopefully I can do some justice udpating it since I've arrived in Ethiopia.

I have spent most of my time so far in Addis Ababa, where I have been working through my USAID internship with Jhpiego, an affiliate of Johns Hopkins University that focuses mainly on maternal and child health at a health systems level. Its been incredibly interesting work, and I hope to fill you in on it soon.

But before I arrived in Addis, I traveled with some of my intern colleagues to Gondar, the Simien Mountains, and Bahirdar. Gondar is a city in the northern part of the Amhara region. It was built up by kings of Ethiopia in around the 1200-1300s, and their presence is still felt around the city. We visited the Royal Enclosure, which is one of the UNESCO World Heritage Sites, as well as what used to be the royal bath, but is now used for the Epiphany celebration. Once a year, they fill this massive pool back up and everyone from the city who is celebrating jumps in for a swim. I hear it is a huge party! Here are some photos:

The Royal Enclosure

The old Royal Bath House. The house is half-way submerged when the pool is filled
Tree roots along the side of the pool.

We visited an old Ethiopian Orthodox church up on a hill. There were many people praying and wearing the traditional white cloth.

The priest of the church showed us their small museum.

In the museum, we got to see the skeletons of Queen Mentewab, her son and grandson. They date back to around the 12th-13th century I believe.

This is an old painting of St. George, who slayed the snake and was reported to have given strength to the Ethiopian army in wartime, especially when kicking the Italians out (twice)!

I got my broken shoes fixed and shined by this skilled young man.
As I mentioned, you can feel the presence of kings from most points in Gondar. Here is just your typically view from the street!
One of the best Macchiatos I've ever had! Be jealous! :)

Then we made it to the Simien Mountain range for some hiking. The range was the first UNESCO World Heritage Site to be named in Ethiopia. It is home to the Gelada Baboon, Walia Ibex, some cool birds, flowers, etc. The highest point in the mountains is over 3,500 meters (over 11,000 feet), and although we didn't make it to the highest point, it was still the highest altitude I've ever been. The views were spectacular, despite some fog and rain.

First day was really really foggy!
But amazing!

The second day we got luckier with the weather.


And saw some baboons!
And horses
And hiked to see this incredible waterfall!

Finally, we were supposed to make it back to Addis after the Simiens, then fly to Harar in the east. Harar is the 4th holiest Muslim cities in the world, and is supposed to be one of the most unique cities in Ethiopia. However, there was a volcanic eruption in Eritrea that disturbed air travel. So we went to the lakeside city of Bahirdar instead! A little bit of a bummer, but we definitely made the best of it. Bahirdar is known for its island monestaries that have been settled by Ethiopian Orthodox monks and the like for hundreds of years. It is situated on Lake Tana, which is the outlet of the Nile River. We got to see some hippos that live in the lake, and that was fantastic! Bahirdar is also known for its traditional dancers, and we were lucky enough to find a small traditional club featuring said dancers. It is hard to describe what I mean by 'traditional club' and 'traditional dancers' if you don't know what the tradition is. Unfortunately, I didn't take photos either. So if you're curious, you should check out one of the links below to see the dancing. The internet is not fast enough to support me watching these videos, so I'm just guessing, but I'm sure at least one of them will give you a good idea!
Fisherman on Lake Tana
Hippos at the Nile outlet!