Kameleha (Tigriniya for Greetings),
I am now currently trying to communicate with you from the northern Ethiopian city of Mekele (also spelled Mekelle, Mek’ele, Makele, and many other ways). My internet out here has been brutally slow, but I’m doing the best that I can. We’ll see if the pictures upload? I still have no luck viewing my blog from here though. But what can you do? Chigar Yelam (“no problem”) as they say in Ethiopia.
This week, like all the other weeks in Ethiopia, didn’t fail to keep me up on my toes. It’s been full of thrills, adventures, and new insights. Mekele is definitely my favorite place in the country yet! I get a really good vibe from this place. I can’t quite put my finger on it. This city has grown on me considerably in the short time since I’ve arrived here. Already I feel like I know my way around more or less too. If I had to compare Ethiopia to my dear old Ohio (a bizarre analogy, I know), I would say that Addis Ababa is sort of like Cleveland or Columbus, Zeway is pretty much Amish country, while Mekele is more like Akron/Canton. It’s not too big or small. Mekele is just the right size. I love it! It feels kind of like home… except in Ethiopia.
Going back to where I left off from my last post, we had a fantastic last day at Mother Teresa’s this past Monday back in Addis Ababa. Gosh, I’m really going to miss that place. Both Dennis and I agree that our summer has been enriched so much by our short time there. Little Dembalesh followed me around all day as I tried to help out with various tasks around the orphanage. I’m thankful that the nuns allowed me to have one photograph with him. That meant so much to me. I’m going to remember him and everyone at Mother Teresa’s for a long time. They will all be in my heart and prayers. Before I left, I was able to get some contact information for the orphanage from Sister Carmen. She and the other sisters were so kind, loving, and welcoming towards us. I told Sister Carmen that I would return one day if it is meant to be. In the mean time, I hope I can follow through on some ideas to collect school supplies for the kids at the orphanage.
Monday was, indeed, a day for goodbyes. My cousin Thanurshan flew home back to London on Monday night. I’m glad that he was able to join Dennis and me for half of our time in Ethiopia. I hope that he gained a lot from his experience here and now has a sense about how some things operate in the field. Dennis and I definitely enjoyed his company and relentless sense of humor. He’s got a lot of potential, and I trust he’s going to draw upon lessons from his time here in the future as he proceeds onwards with university next year.
Thus the long journey to Mekele was up next to follow! Dennis and I hardly slept at all on Monday night since we only started packing after Thanurshan left at 11:00 PM. We had to get up at 4:00 AM and be at the Selam Bus station by 5:00 AM Tuesday morning. We arrived right on time to find an enormous line already formed. Our taxi driver/friend, Getachew George, was kind enough to wait with us until he was pretty sure that we’d be okay. Oh boy, Dennis and I were pretty clueless that morning. We were surrounded by a sea of native Ethiopians. We were traveling just like the locals do, even though practically all other foreigners travel to Mekele by plane. Still, we did our homework and found out that the Selam bus was the best ground transportation available to us. There were plenty of other more questionable services to select from, but we wanted to go with the most reliable option we could find. After some mild security clearance and Getachew George’s farewell, we approached the two buses that were in the parking lot. Okay, apparently one of these buses was going to Mekele and the other was going to some other random place in Ethiopia. Which one were we supposed to get on? We asked a Salem bus employee and he didn’t understand a single word of English that we spoke. Luckily he caught the word “Mekele” and pointed to the bus on the right. Just before we got on though, another gentleman told us in broken English that this was NOT the bus to Mekele. YIKES! The last thing we needed was to get on the wrong bus! I honestly don’t know what we would’ve done in such a scenario. Luckily it didn’t come to that. I was a man on mission at this point. I asked a bunch of people, “Mekele? Mekele? Mekele? Mekele?” in desperation with my finger pointing in the general direction of the bus on the right. After a while, I got enough confirmation that we were indeed boarding the correct bus. Whew. What a relief.
Our journey on the bus was AN EXPERIENCE! I don’t know how else to put it. In total, the journey took two days with 17 hours of driving. Our massive road trip in Ethiopia was not an easy endeavor. But it was a good mix of being absolutely mind-numbing and absolutely incredible – if that makes any sense? I actually don’t think I’ve been on the road that long before on a journey to a single destination. Previously when we went three hours south of Addis Ababa to Zeway (and later Wondo Genet), I was completely taken aback by the Ethiopian countryside. The epic quest up north this time was no exception either. As I stated before, the bus was full of local Ethiopians and two clueless brown American foreigners. Haha, what a unique cast of characters on that bus! There was a shaman with his cloak + staff, a mom and her naughty child, an old man who stood practically the entire way there, a lady behind us who kept dropping her possessions on us, and so many others. I noticed there were people on the bus traveling in their bare feet too without shoes. The language barrier was immediately evident. The bus driver couldn’t speak any English – let alone could anyone else. Our measly Amharic wasn’t going to save us either, but we still somehow managed as always. We stopped occasionally on the side of the road for potty breaks out in the bushes (sure beats our American rest stops!) and once to buy some strange fruit from some vendors. For lunch on Tuesday, we stopped at a small town called Ataye. I could tell the landscape, atmosphere, and overall feel in general was very different from anything I had seen yet in Ethiopia. Although we were still in the Amhara region, we were being scorched by a hot sun and a kid with a camel walked by me when I stood on the street. SO COOL! There was more of a dry, desert-like climate as we traveled upwards. Finally Ethiopia was starting to meet up to my previous stereotypical impressions before arriving in the country. After using the infamous “hole in the ground,” we were off once again across the hilly terrain. Beautiful scenery surrounded us everywhere. We drove through many little villages and passed countless people with their camels, donkeys, cows, goats, etc. At one point I remember thinking to myself, “National Geographic and the Discovery Channel will never be the same for me.” I also remember driving past a few lakes and seeing children swimming and playing in them. Each time, Dennis and I would turn to each other and say, “Schistosomiasis.” Despite our de-worming campaign efforts, there are still a lot of people to reach in this country. For now, change will just have to proceed forward slowly but surely.
The bus ride was intense at times. The rocky, curvy roads weren’t necessarily gentle to my stomach. When I was a kid I had horrible carsickness, but thankfully I’ve gotten better since then. I was queasy at points, but I never threw up. Our Salem Bus was equipped with a TV up front with a DVD player. If only I had some good DVDs on me! I don’t think they would have let me play them though. Instead, the bus driver’s assistant put in DVD after DVD full of Tigriniya music videos.
ENTER THE MUSIC. Wow, I have never listened to so much Ethiopian music before – deafening cultural immersion to the extreme. I had previously heard a few songs in Amharic but only in passing. Tigriniya music is similar though, and it sure is special. Before I go any further, Tigriniya is the language spoken in the Tigray region of Ethiopia – where the city of Mekele is located in. Interestingly enough, the country of Eritrea also speaks Tigriniya and used to be just a larger extension of the Tigray region before they declared independence. The culture of the Tigray region has some differences compared to the Amhara region. Christianity is the predominant religion here, and Tigray is the land of a lot of biblical references (for example the Queen of Sheba is believed to have been from this area and some theorize the Arc of the Covenant is hidden in the city of Axum).
Anyways, back to the music…Ethiopian music is something else! I never heard anything like it before. The sounds, instruments, and vocals are all so unique compared to what my ears previously perceived as music. The cacophony is both at once jarring and unpredictable. The melodies seem to go up and down occasionally experiencing a sort of harmony in minor chords but only temporarily for a split instant. You’ve got to hear it for yourself to know what I’m talking about. I’d put up a link if I had better internet, but for now I encourage you to go on youtube and search for some Ethiopian or Tigriniya music on your own. You’ll see exactly what I mean. I grew up listening to songs from Tamil movies and Bollywood, so I previously never viewed myself as clueless with regards to international music. But now, I am listening to everything in a whole new away with a new pair of ears. If they ever decide to do an Ethiopian remake of the classic musical “the Sound of Music” here, it would be one crazy ride.
Tuesday night our bus stopped in a town called Alamata somewhere in Tigray. Dennis and I felt like we were in the middle of nowhere, but we figured it’d be alright. Before we got off the bus, they told us we had to board the bus again at 9:30. I don’t think I have ever explained Ethiopian time on my blog before, but it is another interesting facet of Ethiopian culture. They run on a completely different calendar and time from the rest of the world. What’s so special about that you might ask? Plenty of other cultures all over the world have their own calendars and ways of telling time. Well, in Ethiopia, it is especially challenging for us because the use the same system/metrics DIFFERENTLY. When I first arrived in Ethiopia back in early July, I remember being so confused at first. Essentially they use the same clocks and time system that the Western world uses, except Ethiopia makes itself 6 hours behind conventional time. So when they told us to board the bus at 9:30, it actually meant 3:30 AM. Luckily we knew that! Similarly, before even leaving on the Salem bus from Addis, we were told to be there by sharp 11 o’clock (5 AM). CRAZY. It doesn’t end there though. Ethiopia is also presently in the year 2002!!! They just celebrated the new millennium two years ago. Everywhere on receipts, calendars, billboards, etc., they have the year 2002 on record. A few weeks ago, it didn’t take long for me to see that something was seriously out of place here. Apparently prior to the 1500s, the whole world used to be like Ethiopia. But when everyone else switched, Ethiopia refused to change and has been the same ever since. People like to joke that they’re seven years younger in Ethiopia. Haha, I guess the system has its perks. Finally, there are 13 months during the 365 day calendar year which adds to the difficulty in communicating plans.
Anyway, Dennis and I didn’t bother to sleep much since we had to leave so early. There was plenty of time for that on the bus. Our hotel was, um, nice. Many of you may know that I am quite afraid of bugs and critters. Our room had plenty of cockroaches and other creepy crawlers to go around. I sure was relieved to get back on that bus. We left early and drove through the hours of the early morning. Closer to 8:30 AM or so, Dennis nudged me awake to say that we had arrived! Before my eyes was an amazing view of the city from its outskirts. Once the bus came to a halt, we got out and got our stuff off of the top of the bus. It was so great to be in this vibrant new city! Even better was that I was here with Dennis – a Mekele expert! During my last few weeks in South Africa, Dennis had arrived in Mekele to begin his summer in Ethiopia. Dennis got to know Mekele really well during his eighteen day stay here earlier. He already made plenty of friends and contacts here too. As I stated before, our project was initially supposed to be based here the entire time. Things of course changed, but I’m glad that I’ve had the opportunity to see different sites all over the country. Finally landing in Mekele now, it was also refreshing to have the chance to see this particular great city myself too. Dennis and I walked a short distance to our hotel from our bus. It’s named after Atse Yohannes – a legendary Ethiopian emperor and famous historical figure. In fact, the original palace of Atse Yohannes is still intact and located not far from our hotel. Unfortunately, many of the artifacts and priceless palace possessions have gone missing ever since the Italian invasion of Ethiopia back during World War II.
Dennis and I didn’t waste any time on Wednesday to start our work in Mekele. We quickly hurried off on foot to the Mekele City Health Office to see what work we could get involved with. The Mekele City Health Office is a strong partner of the de-worming campaign. Dr. Bentwich has been working closely with them to coordinate many of the de-worming campaign logistics around Mekele. After getting lost on a few streets, we finally found the main office. We met with our contact Hayilom to discuss what work we could possibly get involved with there. Hayilom is a friendly guy who’s been very accommodating towards us. Yonat had previously met with Hayilom during her trip two weeks back, so he had agreed for us to come and work here. Hayilom explained to us the structure and organization of the Mekele Health System in rich detail to start off our meeting. I am very impressed with how the city has organized its system. First of all, the main office has several broad branches including sectors for health promotion & disease prevention, HIV/AIDS, development planning, curative rehabilitation, regulation & licensing, and human resource management. The main office tries to tackle a lot of issues from a city-wide perspective. In addition to this, the Mekele Health System also has eight government health centers (clinics) and seven local health coordinators who work with these centers. Separate from the Mekele Health System’s organization are the hospitals (two public and two private options). The government health centers serve as sort of the first line of treatment that the people of the city go through. When people are ill, they seek consultation from the health centers before going to the hospitals. If their condition is too serious or they’re in need of further treatment, the patients are referred to either Ayder Hospital or Mekele Hospital. Each government health center serves thousands of people and also offers other services such as HIV testing and counseling, family planning, health education services, and a place for mothers to safely deliver naturally. Technically, in terms of organizational structure, below the health centers are the health extension package nurses. These workers are trained to provide home-based care and visits to the 54,073 households in Mekele. Presently the Mekele Health Center Office is conducting a training program to equip each nurse with a staff of 46 volunteers. Each volunteer is undergoing an eleven day training course. The hope is that each volunteer can cover some fifteen houses enabling the nurse a bit more flexibility and oversight over the whole community health process. Dennis and I were fascinated by all this and were eager to assist in any way that we could.
Hayilom decided that it was not best for us to assist in the volunteer training program because of the language barrier, so we sought out other opportunities. He envisioned us working and learning at one of the eight health centers. Thus we all got in a van and headed off to the Kassech Asfaw Health Center. When we got there, we had a meeting with the health center’s director – Etse Dingl. Hayilom did most of the talking at first explaining that we were students from America looking to volunteer and learn. I was pleasantly surprised to discover that Etse Dingl spoke excellent English. Mr. Etse Dingl is a very strong, but slightly intimidating man. He wasn’t too pleased to learn that we weren’t exactly “medical” students. As has been the case this entire summer in both South Africa and Ethiopia, people don’t quite understand the concept of “PRE-medical” students. What’s to be done? Still, Etse Dingl was nonetheless welcoming towards us and agreed for us to work at the health center. He warmed up to us quickly afterwards and gave us a tour of the entire facility. He also introduced us to all the people working there. I was impressed with all the services these health centers offer. I was surprised to learn that the first health center only popped up about 32 years ago or so. Today they are an extremely important institution in the society. As we toured the health center, I was taken aback by one particular room they had. The “abortion room” was available to anyone who was under twelve weeks pregnant. When Etse Dingl showed us this room, he intently looked at us and was curious to see our reaction. I explained to him that abortion is an extremely sensitive and controversial issue in the United States, and many people wouldn’t approve of this practice here at the health center. Etse Dingl said that he was very well aware of this and explained he didn’t show this room to everyone who dropped by. Apparently some other Americans who had visited Kassech Asfaw before had condemned him and stormed out of the health center after finding out about the room. I wonder if these vital health centers would, indeed, lose some of their funding from various organizations if these activities were more known. This was an unexpected but interesting dilemma of Global Health that I did not foresee encountering here. I suspect that the organizations contributing funding do actually know about this and those that disapprove have stopped funding the health centers.
Etse Dingl asked us if we were ready to work on our first day, and we replied that we were certainly ready. However when he found out we didn’t have our own lab coats, he refused us permission. He told us to return tomorrow when we had the proper professional attire. Okay, now we had to go on a mission to get some lab coats! Luckily Dennis knew that we could probably get some at Ayder Hospital, so we headed that direction right away. Ayder Hospital is a state-of-the-art brand facility that was recently built. It is also a teaching hospital and a part of Mekele University and its medical school. Ayder Hospital is another key partner in the de-worming campaign as well. Dennis had previously spent a little over a week shadowing doctors at Ayder prior to meeting up with me in Addis Ababa back in July. We met with our contact at Ayder, Temesgien, to inquire about volunteering at Ayder too. We think we’ll go to Ayder this coming Monday to shadow doctors and see some of the serious infectious disease cases. Last Wednesday though, after getting our lab coats, we did tag along for the Leishmaniasis ward round.. Leishmaniasis is another horrible Neglected Tropical Disease caused by a protozoan parasite that causes so much suffering in Ethiopia and all over Africa/the world. The patients on this ward all had Visceral Leishmaniasis as well – the worst, most fatal kind. I had never seen a Leishmaniasis patient before coming to Ethiopia and here I was in a room full of them. Incredible.
The next day Dennis and I left our hotel in the morning to travel to the Mekele City Health Office to meet up with Hayilom. He wanted us to see another health center that we could possibly work at that was close by. So we got to have another cool tour of this site. The Mekele Health Center (not to be confused with the main Mekele City Health Office) was the first health center started in Mekele! The facility is not as new as the more modern Kassech Asfaw, but I could tell it was just as busy – if not more. All over the facility (all over Ethiopia really), I saw countless USAID stickers. One of the guys showing us around pointed and said, “America helped us here!” I looked closely at the sticker and saw the familiar motto, “USAID: From the American People.” Wow, looks like our foreign aid program is doing a lot more than I ever knew about. I know some people may criticize USAID since it is heavily politicizing humanitarian efforts, but it seems like they’re managing to squeeze in some solid work too. At least America’s attempts to win the hearts and minds of people seem to be paying off to an extent in Ethiopia.
Soon afterwards, Dennis and I headed to Kassech Asfaw Health Center equipped with our “proper attire” lab coats. Apparently, Etse Dingl planned for us just to assist the nurse in OPD, but we were okay with that. Nurse Teverih welcomed us to her room right before she began seeing patients. She is a very kind and intelligent woman. Shadowing her was just like shadowing a doctor since she was extremely knowledgeable and superb at diagnosing patients’ illnesses. She also prescribed medicine for patients too. Dennis and I were thrilled to be getting this inside view on how healthcare operates at the community health center level here in Mekele, Ethiopia. Nurse Teverih also sought our input at times and had us really involved with some hands-on work. For example, there was one patient who had questionable Tuberculosis. Fortunately, the health center has a lab on site that does TB sputum tests, stool analysis, and urinalysis. But there is no X-ray machine available for chest x-rays (only at the hospitals), so one must have impeccable stethoscope skills. Nurse Teverih asked for our opinions on a few cases assuming we knew something! Haha, thankfully, I did! In South Africa, I had seen plenty of TB patients, and I can never forget that special crackling sound you hear as you listen closely. It felt great to actually state my diagnosis and say, “I think it sounds like the patient does not have TB,” or “This patient could have TB.” Throughout the rest of the day, we saw all sorts of other cases in the health center. I saw multiple rapid HIV tests conducted in front of my eyes but was pleasantly surprised to see no positive results. I also started to get a better sense of just how much of an impact parasitic worms have on the community here. So many people came in complaining of abdominal cramps and diarrhea. Every time we asked the patient for a stool sample to check for worms. Many times we found amoebas or soil-transmitted helminthes present in the stool. Even a couple of times where we didn’t find anything, Nurse Teverih still decided to give’em the good old Albendazole just in case. In one complicated instance, a young mother came in with cramps and mucoid diarrhea. Although her stool analysis showed worms present in her system, she also couldn’t take any of the medication due to the harmful effects passed on through the breast milk to her child. The nurse could only prescribe her some pain relievers.
On the way back from Kassech Asfaw that day, we stopped by at the Red Cross headquarters next to the Mekele City Health Office. This base was home for both the International Committee of the Red Cross (ICRC) and Ethiopian Red Cross Society (ERCS) in Mekele. On a brief side note, Mekele also hosts a sizeable office for the United Nations ever since the Ethiopia-Eritrea war during the late 90s. Dennis and I talked to the head of the ERS mission, and he said we could come by on Friday to help out.
On Friday, Dennis and I headed straight to Kassech Asfaw Health Center to see some more patients in OPD. We had another interesting morning and even saw some trauma cases. One boy, around our age, came in holding his head wrapped up in a cloth. We were walking around Kassech when he approached Dennis and said, “Brother. Help. Head Broken.” We took him to see one of the nurses and when he unraveled his towel I saw his head had a very long and deep laceration. Apparently the boy was in construction work, and this accident had happened at work that morning. I still regret not learning to do any suturing or anything this summer amidst all that I’ve seen. I didn’t want to start on this patient though since he had a pretty serious injury and was in a lot of pain. They stitched him up without any anesthetic, and I could tell it hurt a lot. Afterwards, we met up with Hayilom at Kassech. A team consisting of an Ethiopian doctor, Indian doctor, and American consultant were with Hayilom and Etse Dengl in a meeting together here at Kassech Asfaw. I didn’t get to find out the details of their meeting, but I did get to introduce myself to everyone. We were invited for some tea and bread afterwards for an interesting discussion about the overall health systems in Ethiopia and Africa as a whole. The American consultant said she works both in Ethiopia and Nigeria, and she viewed Mekele’s infrastructure light years ahead of her worksite in Nigeria. That was pretty cool to find out! I also learned that Ethiopia has one of the best measles vaccination campaigns in the entire continent – although some outbreaks have still happened. Dennis and I went out to lunch by ourselves afterwards and then went on over to the Red Cross.
Our afternoon was about to get kicked up a notch! Dennis and I arrived at the Red Cross unsure of what we were going to do exactly. In our minds, the only thing we could think of was to possibly ride around in the ambulances, maybe? At Kassech Asfaw, we had several patients that the nurse had called the ambulance for to send to the main hospital. At the Red Cross, we met up with the ambulance service director – a guy named Girmay. Dennis and I spoke with Girmay for a while to learn all about the ambulance services. We couldn’t believe all that they do! The Red Cross provides its ambulance service to over 90% of Mekele’s 250,000+ population. They travel within a 24 km radius of the city. There are only three ambulance drivers as well, and they each operate one at a time in rotating 12 hour shifts. They transport patients everywhere to the health clinics, public hospitals, and even to the private hospitals. I’m highly impressed with this critical service that they provide. Well, Dennis and I then asked if we could help out on board the ambulance? Girmay was more than happy to oblige. He also believed we could give the Ethiopian Red Cross some beneficial feedback based on our experiences from America. Dennis and I weren’t sure about what we could contribute, but this isn’t the first time we’ve been in this position. So of course, we put on our thinking caps and got on board the ambulance just a few minutes later when an emergency was called.
WHAT AN AMAZING EXPERIENCE WE HAD! I suppose I have never had the chance to drive around in an ambulance before in the United States, but I got such an adrenaline rush here out on the rough streets of Mekele. Dennis and I sped around with our driver Akililieu (sp.?) all over town. A seventeen year old Red Cross volunteer named Samson also joined us for the ride. The four of us were a fantastic team! Together our team helped load, drive, and carry patients to the ER rooms of Mekele and Ayder Hospitals. I can’t remember having so much fun in a long time. Dennis and I were having the time of our life! I think we must have transported some 10+ patients during the few hours we were on duty. We got to see so many places around the city too that we never would have seen before without driving around at top speeds in the ambulance. We got to see more of the health clinics around the city amidst our work. We also got to see all three levels of the prison system in Mekele! First we went to a small facility where some guy had been knocked out after a drunken battle with another prisoner. Afterwards we went to a medium-secuirty prison and finally went to retrieve a prisoner from the top-security facility at the edge of the city. Gosh, I never would have thought I’d get the chance to see the prisons here in Ethiopia. It was so cool! I don’t think I’d want to be stuck in one of those. But I wouldn’t have mind driving around in the ambulance and helping out a bit longer. Every time we thought we were finished up and ready to head back, another assignment would be radioed into us. At one point the operator at headquarters radioed us in to see if we needed any more assistance on board, but Akililieu replied in Tigriniya that he had a great team already assembled. We were happy to hear that. Our driver Akililieu didn’t speak much English, but we communicated through hand gestures and with Samson’s help. Samson is a really good kid who is waiting for his university acceptances to come in. He wants to go study English and eventually become a tour guide somewhere nice. He has a brother in Canada too and is looking to go there one day as well if possible. I told him to look me up when he gets to North America. We’re hoping to hang out with him again later on during our stay in Mekele.
Our time in Mekele has gotten off to a great start. Tomorrow Dennis and I are looking to go visit some of the ancient historical sites and churches out in Geralta (a 90 minute drive outside of the city). We haven’t done too much touristy stuff in Ethiopia besides Wondo Genet, so I’m excited to go check some of these sites out. We’ll be leaving to go back to Addis Ababa next Thursday, so our time here is short. Speaking of which, only thirteen days remain for our entire project’s timeline in Ethiopia! I’m looking forward to closing up our work here with a bang and heading back home. What a summer this has been.
