Sunday, July 25, 2010

Climbing new mountains

Our deworming work in Mekele has officially come to an end. I still find it hard to believe that I spent only about a week on this project and that it has already come to a close. However, thats how life is at times; you can never expect the curveballs that are thrown at you, but when they come you can either choose to take them in stride or let them overcome you. My original Duke Engage approved plan was to stay in Mekele for the entirety of two months helping out solely with the deworming effort. However, since the school-kids are now leaving school for summer break, we cannot continue with the drug-distribution phase until September, which is well after the time I leave. Regardless, an intial anlaysis of the data from the follow-up surveys of the stool samples are already showing a 50 percent reduction in schistosome prevalence in the school-kids. Once Jemal had finished paying off the lab technicians and our van driver, I bid him good-bye as he departed for Gondar to administer final exams to his students.

For the remainder of the week, I spend time rotating through the different units of Ayder Referral Hospital. Ayder is one of the five teaching hospitals in Ethiopia and has by far the best maintained facility here in Mekele. There is so much I've learned and experienced this past week about the medical world, its culture, and its players that I don't think I can put all of them adequately into words. From day 1 itself, the doctors ranging from the clinical year students, to the final year interns to the senior physicians took me right under their wing and I faithfully followed them for their routine bedside teachings, rounds, history-reporting sessions and surgeries. I spent the the first two days at the Internal Medicine Ward, where there were many patients that were infected with the routine infectious diseases largely prevalent in Sub-Saharan Africa like HIV, TB, malnutrition and anemia, as well as NTDs like Schistosomiasis and hookworm infection. All of the patients (most were female) I saw these first two days in the wards were severely weak and many were anemic. Many of the female patients were pregnant or were about to deliver and this made their existing illness even more complicated to treat. One especially tough case was a female patient who was pregnant and had a rare form of a infectious rheumatic fever, which led to a ethical dilemma for the doctors as to whether they should prioritize the health of the mother or the baby since the drugs taken by the mother would impact the infant's health. Dr. Senay, the senior Internal Medicine physician wisely pointed out to us that without prioritizing the health of the mother at this point, there would be no child. I also spent a good amount of time during these first two day with my Internal Medicine GP, Dr. Lulu, in the OPD as he checked in various patients that had been referred from other rural health centers and private clinics. The most surprising thing I observed here was the fact that there were a large and growing number of patients, who came in and were admitted with common chronic illnesses such as Diabetes Mellitus, chronic hypertension and other cardiac problems commonly found in the West. Dr. Lulu told me that that lifestyle changes were occurring all around Ethiopia as development continued, which in turn impacted and added onto the already existing pattern of infectious health burden present here.

During the weekend, the city became alive with graduation spirit as many college students and school children were celebrating educational milestones in their lives. People from all over the country and even from abroad flooded into the city and suddenly the hotel I was staying at was constantly bustling with family friends and relatives who had arrived for the graduation ceremonies. Moges' brother had just graduated from veterinary school and I attended his graduation party at his home. When I first entered the living room, I thought I was entering a green pasture as the floor was completely covered with grass. Tadele, the friend who had accompanied me, told me that this was a sign of celebration and of good-times. I could indeed see this on the faces of the family members, who were all thrilled to have a doctor in their family. I was received warmly by Moges' mother and his family, who immediately began to set plates of food and sweet drinks before me. When Moges' brother finally arrived in his graduation attire along with Moges, the whole family jumped to their feet and ran to give him hugs and to congratulate him. He looked very much like Moges and he told me that he was so happy to have me at his graduation party. Later that day, as Tadele and I walked back to my hotel, I realized that there was so much similarity between the U.S. and Ethiopian culture, yet also so much difference. Often times, people in U.S and other developed Western cultures celebrate milestones with large parties and expensive gifts. Here, while people also celebrate, the emphasis is more on people and less on material gifts.

On Sunday, Mohammad, Tadele and I set out to summit Mt. Chomaa the tallest mountain that could be climbed here in Mekele. Ever since I arrived here in Mekele, I have seen the mountain loom above the city from my hotel room. Since I was also reading Mortenson's Three cups of tea, an odyssey of an ex-mountaineer who turned his climbing life into summiting harder mountains by building schools for children in some of the most rural ares in northwest Pakistan, I had an added desire to try on some novice mountaineering myself. As we began our journey up the mountain's base, we came across tiny villages edged between patches of small forests and sights of horses feeding on pastures built against the mountain wall. Kids in the village were either calling out to me in my new official name, ferengi, or even "China," since the city was always never short of Chinese visitors in charge of road development and construction. The climb was challenging; although there were narrow dirt roads built around the mountain in steep curves that made it easier for climbers, we took some harder and more challenging shortcuts directly up the mountain face to save some time. My walking shoes were not adequately built for this type of activity and I constantly found myself on the verge of either twisting my leg or loosing my hold on some big rock or ledge. Mohammad and Tadele were there to help me out and with some brief stops, we finally made it to the top. We could see the entire city from up there and even the desert stretching further along from the city that contained the industrial factory of Mekele. It was perhaps the best view I've ever had from a summit and I thought about how small each of us looked in that city from that perspective. The descend was even more harder, as now I found myself constantly slipping on the mountain's steep mud and rock slate and I had to constantly hold onto Mohammad and Tadele, who seemed to have adapted mountain goat type feet despite wearing shoes that were clearly not meant for climbing. I gained two valuable things from climbing that day. Not only did it give me some much needed exercise since I landed in Mekele, but it gave me a renewed sense of purpose and energy for why I had come here: to climb new mountains that will challenge me and that will help me to learn new things about the world and myself.

Sunday, July 18, 2010

And so the work begins

Day 2 in Mekele and I have already embarked on my deworming service effort. At about 8:00 in the morning, Jemal and I set out to the city’s health bureau office. It was a small stone and brick building that had separate small offices for the heath officers working on different health and education projects in the community. The person running the day to day affairs of the office was an elderly gentleman with a very kind face and demeanor and went by the name of Hay Ilom. Hay Ilom had worked in that office for nearly 30 years and spoke good English. There I met the first member of our deworming team, Moges, and our van driver Shi-Sha. Moges is a very interesting persona; he seems like a prototype combo of an intelligent, philosophical, hardworking guy with a very amiable character. Above all other things, he is faithful in all his commitments, whether it’s his work or his friends and family. As we set out, we were joined by three more members of our team, all of them women. Tsege (pronounce segee), Flores, and Birham were all lab technicians on the team, with Birham being the youngest.

Soon, we were travailing in our old and dilapidated Toyota Land Cruiser across even more dilapidated roads and stone city streets, with our bodies constantly jumping up and down the seats. When we arrived at our first school site, out in a remote part of the city, we were greeted by a host of children who had been neatly sitting outside waiting for our arrival. They jumped up at our arrival and there were shouts of excitement as Jemal jumped outside and pulled out his camera. The kids love having their pictures taken and as I pulled out my camera, I discovered to my anguish that I had forgotten my batteries in my baggage back in the hotel. However, I pulled out my mino video-camera and approached them requesting them to say hello. They were shy at first to see a ferengi (foreigner) like me, but soon they began warming up to me and the camera. However, when I asked if they could sing a song for the camera they started cracking up and I decided it was time to move on. We dropped off Moges at this first site to administer the KAP (Knowledge and Attitude Practice) survey and gather stool samples and continued on our way to the other school sites. At each school, I was greeted by a host of children who were very interested in seeing me and at each site we dropped off one of our team members.

The final stop for Jemal and myself was a school called Ethio-China, a school that was helped to be built by the Chinese. The Chinese apparently have ties with Ethiopia and seem to be doing a lot of road construction and development here. We assembled about 30 to 40 children in one classroom, who were between the ages of 7 and 11. Jemal explained to them in Tigriniya the purpose of the project and what was expected of them in regards to the KAP survey and the stool sample. At the mention of them having to collect a sample of their stool, many of the kids burst out laughing, but soon realized that we were serious. I began a conversation with the little bald headed kid, about age six standing next to me and in time, a crowd of children formed around me asking me questions ranging from who I was to why I was there. They girls at first were all really shy, but they too in time began to warm up to me and seemed curious to know whether I was a Hindi film actor. Apparently many of the kids here watch Bollywood films and are well-familiarized with stars like Shahrukh Khan and Kajol and with films such as Kuch Kuch Hota Hain. One of the girls asked me to sing the title song from the last film and so I sang a part of it. Later on I asked them to return my favor and so they began to sing K’Naan’s Wavin flag. Apparently, the noise was too much and the school's headmaster came and asked everyone to sit down and finish the survey sheets. I felt bad for getting the kids yelled at and when I later apologized to them, they just smiled and asked me how the video looked. Every minute I spent with these kids were truly special. One of the little girls, who the headmaster stated was the brightest in her class, questioned me about my work and about life in Ethiopia and in the U.S. One of the more startling questions that she asked was this, “They say that English is the king of languages. How can this be?” I was surprised by this simple yet potent question, as the very question she was asking me was part of a much broader one about how was it that one part of the world still struggled to feed and clothe its people while the other continued in its unparalleled state of consumerism, uninhibited spending, and waste of resources. I answered her question the best I could by telling her that all languages are unique and that her native language, Tigriniya, was also a king in languages due to its rich history and age.

Later that day, our survey team reassembled in a lab-room on the campus of Mekele University. We were joined by three other young men, who were laboratory technicians but also lecturers in the department of microbiology. We spent the next few days preparing wet mounts of the stool samples, analyzing them under the microscope and identifying the number and type of parasites present. I was able to view about six different types of parasites including Schistosomiasis mansoni, Ascuriasis, taeni, Hymophlys nana, tropocyte (amoeba), and hookworm.

As we returned back to Mekele city on Friday evening, the streets were once again alive and vibrant with people and music. The various shops lining the streets were crowded with the weekend shoppers and people just hanging out relaxing in the pleasant and sunny weather. It’s so surprising and unusual to hear Justin Bieber and Usher’s music blasting through my hotel windows as I write this post reminding me that even in this place, music is universal and part of the entire development and modernization occurring here.

Sights and sounds of Mekele

Salam everyone,

It's been about three days since I've landed in Mekele and so much has already happened in the span of these three days. My flight to Mekele was perhaps the longest and most tiring flight I've taken that consisted of multiple stops, baggage reclaims at airports and security checks. Perhaps the most interesting yet unsettling airport experience I had was when I was waiting for the last flight from Addis to Mekele. It was about 3:00 in the morning and I had to leave the international terminal of the airport; in other words leave the airport building in the pitch black hours of early morning and walk to the adjacent domestic terminal, about a 5 minute walk. Once I reached the entrance, I was greeted by a soldier wielding a large army rifle and was told to wait beside him outside in the dark until the terminal opened. To make the experience even more unsettling, there were other figures hooded by the dark, sitting in a large tent nearby and staring at me. The wait seemed like forever, until a middle-aged white woman arrived at the terminal with her local guide and seemed like the only person in that area speaking fluent English. She was apparently from Canada and part of an NGO that was doing a lot of medical and hospital infrastructure development throughout Ethiopia, but especially in Mekele. I was really relieved to see another foreigner in that place at that time and who was also heading to the same place to do similar work. Interestingly, the flight from Addis to Mekele was packed with a large group of students from Europe, a Jewish doctor, and a group of Chinese men.

I was met in the airport by my project supervisor, Jemal, who is in charge of the NTD deworming campaign here in Mekele and is also a lecturer in the Microbiology department at Gondar University. On our ride to Mekele city, we reached the peak of a hill overlooking Mekele city and was greeted with an amazing view of the entire city with the city landmark, the Mekele tower, standing tall in the distance. As we started entering the city, I began seeing the true city life in Mekele. There were lots of children everywhere, either playing on the street or preparing for school. There were donkeys all over the place, carrying bundles of sticks that were probably used as firewood by the villagers. There were signs of poverty all around, but much greater were the signs of peace and contentment.

The first day I mainly rested in my hotel room at the Atse Yohannes. Although when I first entered the room and noticed that there was no AC/ceiling fan and that the only sign of any air conditioning was an open window that allowed mosquitoes and flies to freely enter and leave, I was slightly perplexed. Now I am getting used to it since the weather here is surprisingly pleasant. I mostly rested during the day and in the evening I went to meet Jemal's family. Jemal's family is one of the few ones that speak Arabic in the city, so I was able to use my limited skillset of greeting them with 'Salaam Aleykum.' After that, Jemal and I spent most of the evening traveling around the city either walking or taking a bajaj (a mini taxi also known as an autorickshaw in India) to check out different hotels and to get a glimpse of the city life in Mekele. For dinner, we were joined by Jemal's younger brother, Mohammad, an engineering student at Mekele university. We had a specially roasted beef sandwich with some hot pepper sauce and needless to say, it was delicious. Later as we walked back to the hotel room, the entire city streets were just vibrant with activity and music of all sorts. All in all, my first day in Mekele was good but tiring and I was really happy to see my bed and go to sleep.