Sunday, August 15, 2010

Adventures in grass-root Ethiopia: The Road to Southern Ethiopia and Zuwai

On Monday, we set out from Addis on a mini-bus ride to a town called Zuwai, located about 3 hours south-east from Addis. After multiple delays and stops, during which the bus conductor extended our three person seat ride to cramp about 4 people, we finally began the journey. The trip through the country-side was really scenic and beautiful. We flew past endless fields of corn crop and these unique, lanky-looking trees that quite uniquely symbolized Ethiopian grassland scenery. In between the fields, I could see the cone shaped huts of farmers and other stone and brick houses that had clean grass courtyards in front of it. Many of these courtyards were either filled with little kids playing or cattle grazing. All throughout the ride, the roads were sometimes blocked by the odd donkey wandering across the road to look for a fresh grazing patch or a band of crossing cattle.

When we finally arrived at our stop, I looked about our surroundings and realized that no-one from the local health office with whom we were supposed to work with during the week hadn't come to receive us. Herein, began the first of our many impediments. After we regained all our baggage from the bus, we stood around the site not quite sure what our next step should be. I tried calling our local contact and the unpredictable phone network promptly gave me the message that the call could not go through. We decided that we would wait at a nearby hotel until we could get a call through our contact. The closest hotel we saw was one called Hotel Jibril and since it was already lunchtime, we decided to go ahead and get lunch. I ordered a local dish called lamb tibs and although it looked and tasted good at first, I realized half-way through that some of the meat was not cooked well. Right when we were finishing our lunch, we finally met our contacts from the local NGO with whom were doing the deworming campaign. After we booked our rooms at a hotel called Bakkala Molla, which was supposedly the best hotel that the town could offer, we left with our guides to the NGO office.

The NGO is named Rift Valley Children and Women's Development Association (RCWDA). It was established around 1993 and was funded by numerous foreign aid sources including Oxfam and CEMTA. Our guides gave us an orientation about the NGO and its work. We soon learned that RCWDA wasn't just involved with health sector development, but also actively involved in many other development activities. Some of these projects included livelihood promotion through saving and credit programs, and building farm initiatives such as new irrigation canals. Other income generation programs included non-farming activities such as educating women about saving and through a goat-provision scheme that allowed a family to jump start a cattle-raising business, which was then sustained with the family offering one offspring of their cattle to another family. There were also programs that focused on education, especially for those marginalized populations such as women and the poor through implementation of different tutorial programs, school capacity building, and through community meetings that focused on discussions about local programs and teaching the citizens to write letters to local officials. In the health sector, the organization was involved in HIV prevention and outreach programs, building of health posts that provided basic health services at the grassroots level and the deworming project.

We learned from our guides, Segni and Beyen, that Ethiopia is structured on many different levels. The country is split into different regions, which are then divided into different districts known as woredas. Each district has a certain number of peasant associations (PAs) also known as kavales, which are at the heart of grassroot, rural Ethiopia. Zuwai was one of the bigger towns in the Adami Tullu district. While RCWDA's overall development work extended to 43 different kavales in the Adami Tullu district and a couple of kavales in two other districts, our deworming work would only focus on four different kavales in the Adami Tullu district. The deworming project had already made considerable progress, since about 10,000 people had already received albendadazole and praziquantel treatment on two different rounds. Our arrival in Zuwai marked the third follow-up survey and drug distribution phase. Segni and Beyen mentioned that the major challenges facing the drug distribution were delays in getting drugs to the community, lack of materials such as care kits during drug distribution, greater community request from neighboring villages and recurring health behavior of communities that made them susceptible for re-infection.

We began the next day at the RCWDA doing data entry for the KAP surveys of the Mekele school kids and the Mekedim volunteers. Later that morning, Segni and Beyen took us for a sight-seeing tour to various different kavales where different RCWDA initiatives like the irrigation canals had been implemented. The kavales are some of the most scenic and beautiful areas that I've ever come across. One can see acres of green farmlands arranged in neat squares, which are interspersed with the thatch huts of farmers and those lanky-looking trees. There are lots of cattle everywhere, ranging from cart-bearing donkeys and horses to cows, goats and sheep. We were especially impressed with the tiny kids operating the donkey-led carts down the main road, where numerous cars and trucks were speeding by in all directions at all different speeds. As we were driving down the main road, we saw a 1000 hectare private flower garden that was owned by a businessman from the Netherlands, which was adjancent to a winery owned by a German investor. Segni told us that while these investments had helped to create jobs for people, it hadn't done much good for the local markets as most of the products from these initiatives were exported.

Our next stop was at a healthpost in the Anano kavale serving about 9000 people. This very same health post would later become our headquarters for collecting and preparing the stool samples for microscope analysis that week. Here, we had a good conversation with Segni and Beyen and we learned that this rural community health post served people from about four different kavales. It primarily focused on maternal and child health and in providing immunizations, heatlh education, family planning and other essential drugs. It seemed that each health post was staffed by health outreach and prevention workers, but not by any real physician. It could be that at this extreme grass-roots level, physicians would be underpaid and since the government hasn't taken any initiative to increase salary for those serving at the rural level, there was no real incentive for physicians to serve populations in this rural area. At the health-post, treatment was provided for malaria, but other more complicated cases were referred to higher health centers. Braveen asked a really interesting question about HIV testing and they told us that HIV testing wasn't currently provided. In fact, HIV patients were only provided awareness and counseling. Braveen mentioned providing VCT testing, as this is a really cost-effective, fast and accessible method for HIV testing. Braveen also suggested the possibility of providing essential nutrient supplements such as vitamins for mothers and kids. Since malnourishment is a big problem for kids in these areas, implementing such an initiative would be big step in combating this problem. However, the impediment that comes along with implementing any new imitative is the question of funds. When I asked Segni about possible government support, he told me that the government actually takes resources away from NGOs in the form of cars and money. Segni and Beyen mentioned that the other challenges facing provision of community health care included lack of proper waste disposal and latrines. For immunizations, even though 8 different types of vaccines were provided for mother and children every 20 days, the challenge was to get the people in the community to get the complete dosage, as many are nomads and move from one place to the other.

However, there have been many positive improvements. Cooperation between health post workers and traditional healers has led to a reduction in practices like female genital mutilation in the area. Since traditional healers are a very popular source for many of the rural people to receive health care, critical strides have been made in training and educating traditional healers. Now, many are combining modern treatment to their practices.

That evening, we had pizza without cheese for dinner as our waiter told us that cheese hadn't arrived from Addis yet. The dish was good, but later that night I found myself throwing up the remnants of my dinner. I had fallen ill for the first time since I arrived in Ethiopia. It seemed that the stomach bug had finally gotten me the previous night, during which I threw up multiple times and went sleepless. Waking up the next day was a challenge, since I was feeling a shortage of energy that I hadn't felt before and I decided I would just spend the day recovering. At times, I would start to feel better, only to realize that it was short-term as my appetite was still very weak. I would still feel tired the rest of the week.

During the next few days, we spent time traveling to the different kavales (there were four in total from which we were collecting our data). At each of these kavales, which were located deep in the heart of rural Ethiopian farmlands, we received the unique opportunity to see life functioning in a way that some in the western world would still find hard to believe. Here, in one of the kavales known as Woiso, there was the traditional meeting of the elders, where the older men of the village would sit around in a circle discussing matters of importance to the kavale, while the women would sit in a neat line a little further from them. Our deworming team had to get their permission to do the survey work, even though it was just formal as drug distribution had occurred previously. Tradition and culture are so important and again the single most important thing that struck through my mind was the importance of community and family. Here, family isn't just restricted to your immediate bloodline. It extends to all those who are around you and those who are in your sphere of daily life. Maybe it could just be that we were foreigners and these villagers were simply just friendly and kind to us. However, my own observations as I traveled through three completely different regions of Ethiopia show that is not the case. People in this part of the world still retain what we in the western world now read in cultural anthropology texts about Africa's once strong presence of community. An ideal, which was obliterated with the advance of colonialism and now with the advent of modernization. Maybe, it could be the fact that Ethiopia was never colonized, and maybe it could be that in this small kavale, people had yet to see true development. Whatever the case, here one could truly see and sense the presence of community fellowship with every breath.

Although our experience at these kavales collecting stool samples and administering KAP surveys were truly enriching, we did run into some roadblocks. During the talks with our elders at the Woiso kavale, Beyen mentioned to us that the elders feared that some people were re-infected with the parasites despite the past drug distribution, since people were carrying on the practice of eating uncooked meat and other foods. In addition, we didn't have enough pens for all of the people to finish our surveys and many were completing the surveys in groups even though the survey was meant to test the individual's knowledge. However, we did manage to collect the 200 stool samples we needed from all four kavales and we were able to help out with preparing the slides for microscope analysis.

During our last day, Yonat returned to Zuwai from her trip to Mekele with a sizeable mini-van and told us that we would be going with her on a trip to Wondo Genet, also known as Paradise in the local language. Two Israeli girls, one who was a medical student from Israel and the other doing some teaching work with kids in Addis, accompanied us on our journey. The whole trip was so much more relaxing for the three of us, as we no longer had to sit cramped for 3 hours straight. Touring Wondo Genet was amazing. The place is so scenic and doing the hike was quite fun, especially as there was a group of kids who were keen on showing us around and explaining the significance of our surroundings. It wasn’t completely fun though, especially when I had water rush into my shoes as we were crossing a stream. The capstone moment came in the end, when I finally got to take my first real hot shower in days. Wondo Genet has many hot water springs, some of which flowed into an area where they formed a free falling shower.

Looking back on my experience in Zuwai, I feel that it was truly a challenging time since my arrival in Ethiopia. Like the rest of this trip, it was a growing experience, not only in terms of dealing with illness, but also in experiencing the calm simplicity and resilience of the people we served.

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