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!

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.