Weather in Asella, our rural village visits, and more!

It is summer time in Ethiopia right now and you would expect summer to be sunny, warm and hot. Ironically, it has been gloomy, rainy, and very cold in Asella for the past three days. It feels like the temperature is around 20 degrees Fahrenheit, and even though I am wearing a sweater and jacket, I am still feeling cold. I found it fascinating how the world’s climate varies from region to region. If you are interested in learning more about seasons in Ethiopia, visit this website http://www.ethiopiantreasures.co.uk/pages/climate.htm. Anyway, Amy and I just got back from the Fistula Center in Asella Hospital, and this was our second trip to the hospital for today. We made a trip to the Fistula Center earlier this morning to conduct interviews with our patients. We were hoping to do at least three interviews but we ended up doing only one interview since our patient coordinator, Birke, was very busy this morning.

Before I get into details on our three day trip to nine different rural villages, I wanted to share with you that we like Asella more than Addis. And it is not about the wifi connection at Derartu’s that makes us like here more than Addis though that is a huge plus, but it is really about the people we met thus far that make all the difference. We made some wonderful friends and we connected with most of them through Dr. YuHsin Huang, a WAHA volunteer gynecologist from Taiwan, who is awesome and takes good care of us. Most of our friends are physicians from Asella Hospital and we have had the opportunity of getting to know them in person outside their work. I had iftar meals with them mostly with Adem, who gives us some great suggestions regarding our Davis project rural visits.

Speaking of iftar meals with friends some of you emailed and asked me about how Ramadan is treating me. Ramadan is going really well though it is always never easy to fast away from home. The good thing is, I fasted at Denison for the past four years and definitely, that experience taught me how to survive on campus during the month of Ramadan. However, this year, my Ramadan experience is different from my previous ones in the United States. Here in Asella, I wait to hear the Athan (prayer call) to break my fasting rather than looking at the clock. The last seven years I was in the U.S., I haven’t heard Athan from far away. So hearing Athan from a distance brings back memories of my childhood. When I was a kid, my siblings and I would go outside of our house so we could listen to when the Athan call was made. Once we heard it, we would sprint back to our house and would tell our mom and the rest of our family, it was time to break fasting. I really missed terribly fasting with my family and that is something I am looking forward to next year.

Me breaking my fasting in Addis. 

Enough about my Athan nostalgia, and now let’s get into our trips to rural villages around Asella. Amy and I had really great time visiting nine different villages in three days. As Amy discussed in her last blog, we drove on very muddy and bumpy roads and sometimes we came across huge stagnant water with tons of mud in it. I couldn't help but think about our car being stuck in mud and that we would be there forever since we were in the middle of nowhere. Little did I know that we were assigned to a wonderful and brilliant driver who skillfully got us out of these tricky roads. Whenever we came over these obstacles, I would shout out in Amharic “gobaz ante” which translates into “excellent job.” Our driver Hailemariam and Birke, our wonderful maternal health education and obstetric fistula prevent outreach coordinator, would hysterically laugh at my reactions.

One more thing that concerned me during our trip was these livestock, especially the dogs that walked indolently in the middle of the road and didn’t give a crap about cars and buses passing by. I would jump out of my seat and unconsciously would ask Hailemarian, who is a great driver, to be careful. Amy, on the other hand, would say to me, “Abdi, these dogs are smart and please don’t worry they know what they are doing.” Over the course of our three day long trip, we saw only two dogs that were killed by car, and of course, we all felt so sad.

Bunch of animals casually walking on the road. 

Hailemarian, Birke, Amy and I got along so well and we had tons of fun together. We stopped by little restaurants nearby the villages we visited so three of them could grab a bite to eat while I watched them eat (they would always remind me how wonderful the food tastes). In return, I would pick on Amy, who struggles eating with her hands, and would make fun of the way she eats. Here is another story of Amy’s initial struggle! My second day in Addis, I was breaking my fasting with Amy and we were traditionally sitting on the ground and having some Somali rice. Amy who was so afraid of offending me quietly says to me, “Abdi, I have a question.” “Oh sure, what is it?” I said. How do you eat rice with your hands? Amy asked.” I couldn’t help but laugh because by the look on Amy’s face it seemed that she was about to ask me a very important question regarding our Davis project. I grew up eating food with my hands so unconsciously I was expecting Amy to start eating with her hands too. But now that I think about it, her question was a very important one. How on earth would someone who grew up eating rice with chopsticks be able to figure out how to eat with her hands. It turned out that it was hard for me to explain to her how to eat with her hands as she said, it would be also difficult for her to explain to me how to eat with chopsticks since these are skills that come to us naturally. 

Amy learning how to eat rice with her hands.

Well, there are many little funny things that Amy does that I could write an entire blog. However, for the sake of time, I am better off saving these funny stories for some other time. One of the main stages of our project is to prevent obstetric fistula and other possible childbirth injuries that occur during childbirth. With this in mind, we literally went from one village to another seeking out pregnant mothers. Luckily, we were able to gather pregnant mothers and talk with them about the importance of delivering at the health centers. As Amy pointed out in her last blog, we pledged to support and provide transportation stipend to pregnant mothers who don’t have money to go to Asella Hospital in case of emergency. We also pledged to cover the childbirth delivery service fee cost when they come to Asella Hospital. You can see the relief and happiness on the faces of these mothers, and that really brought joy to our hearts knowing that money won’t be an issue for them to have their babies safe.

Amy meeting with pregnant mothers. 

During our time in the rural villages, we noticed that transportation is a huge issue for the local people, and even though almost every health center has one ambulance, not everyone can use it or can afford it. Usually, the priority is only given to pregnant mothers with very complicated childbirth emergency cases or someone who is in life and death situations. However, these individuals still have to pay the fuel cost (around $30) which most of these people can’t afford. Because of this, we saw family members transporting their loved ones with their own backs and shoulders, not to mention that these people walked miles just to get to the health centers. 

Family members transporting their loved one.

Though this is a touching and inspiring story, I believe that people shouldn’t go through this, especially in the 21^st century when some people from other parts of the world have more than they need. If we were willing to share some of our wealth, reduce our consumption, and most importantly be willing to support and invest in this great idea of providing a quality education to every child, I think we would be able to achieve some of sort of sustainable development at least to one region of the world. Obviously, these are very simple ideas but I think they are practical and something we can incorporate in our daily lives. 

Anyway, what made our visits fun was our interactions with the local people, especially the kids. They were so much fun to greet and converse with as they were all interested in meeting with Amy. As any kids would, they loved posing for pictures and asked for solo pictures of them to be taken. Amy brought some pencils, erasers, and sharpeners from China and the kids really enjoyed having them. What really is nice about here is that people are happy, welcoming, and generous in general. We love dropping by at their houses and talking with them.

One of the kids who asked for solo photo.

She opened the grate as we entered & in return, she got a pencil. Loved her! 

Kids receiving pencils, spreading the power of the pencil. 

Amy meeting with new friends. 

We loved meeting with her and her grandson. 

The other thing that brings joy to our hearts the most is this indescribable and enormous happiness that echoes across the Fistula Center when our patients are being discharged. These patients bond and develop great relationships since they all receive their fistula treatment at once. They support each other mentally, emotionally, and physically before and after treatment, and they literally become one another’s cheerleader. If one of them is weak and not able to feed herself, others would take good care of her. They would walk and sunbath together as groups after their surgical procedures. Now that you have a sense of what I am talking about, you can only imagine what the atmosphere of the Fistula Center is like. The entire room is filled with so much excitement and gratefulness, and these women literally burst out with joy and happiness as they depart and start a new life. On the other hand, Amy and I are caught in the middle of these thrilling and joyous moments, and we can’t help but feel incredibly happy for these women.

As a part of our Davis project and in honor of their new lives, we give each woman a new blanket and integration monetary support. One of the main challenges that fistula patients face after treatment is that they have no means to support themselves. Therefore, our patients use the integration monetary fund to buy at least four sheep and goats so they can have means and generate income of their own. We already supported four patients thus far and we’ve seen how much difference that this small amount of monetary support (around $100) makes on the lives of these women. Since these women have a strong relationship, Amy and I had this idea of taking a group picture and then, giving each woman a framed photo of the group so they can have a memory of each other and us. 

We're with one of our favorite and adoring patients. We love her!

Our remarkable patient with her new sheep, we're happy for her.

Amy handing out the framed pictures.

Patients & their families were so happy to receive these gifts.

Well, it’s way past my bed time and I need to get up early in the morning to start another great week of visiting more rural villages. Tomorrow, we will also visit some of our discharged patients as we are interested in learning more about how they are doing and what their new lives look like. Before I go I wanted to second Amy and thank Dr. Samson Tule very much for providing us with transportation. We couldn’t do it without him and we truly appreciate his tremendous support of our Davis project. 

Thank you so much Samson for your tremendous support! 

On the Bumpy Road

One part of our Davis Peace project aims to prevent fistula. We plan to visit rural villages, talking to pregnant women about maternal health and fistula as well as encouraging them to deliver at health center or hospital, instead of at home without any medical professionals to avoid prolonged labor, thus obstetric fistula and other childbirth injuries. Samson, Assela Hospital's medical director, kindly provided us his SUV to drive into the villages. So last Wednesday, Thursday, and Friday, Abdi, Birke, Hailemarian (our lovely driver), and I made our initial visits to health centers at nine villages around Assela - Boqojjii (Bekoji), Saguree, Tijo, Bilaaloo, Araaxaa (Arata), Ogolchoo, Abraa, Qarsaa, and Goljaa. It was such a rewarding experience for Abdi and me.

For most of time, we were driving on the muddy bumpy road and passing by green farm lands. It is the raining season, so that farming season in Ethiopia. Everywhere we drove to, we saw cows fallowing fields. Herds of cows, donkeys, goats, and horses lazily walked on the same road towards us, until the car was honking at them, and then they would slowly move to the sides. The kids waved at us with big smiles; or some stared and looked so confused. Kids here have to take care of their animals, no matter how little they are or whether they are boys or girls! People live on their lands and farms, and this time of the year is difficult for them, because they just started planting. You can easily imagine that people do not earn that much in these rural areas. Sometimes we were really driving in the middle of no where, and could only see several huts here and there, but the scenery was extremely beautiful. Abdi and I were like curious kids, always taking pictures and asking questions.







Depended on where these health centers are, sometimes it takes 45 minutes drive on the nice road or two hours ride on the bumpy road to get to the center. We were both impressed that each Werka (county) has one health center, and in most cases they have pretty new buildings. Although these buildings look nice and new from outside, it is so common that it is empty in the rooms and they do not have adequate resources, such as lack of health professionals, facilities, equipment, and medicines. At most centers women can deliver there, but for few places the facility does not allow that.

At the Bekoji center, there are only one nurse and two midwives. The nurse has to treat emergency cases first, and then general patients, due to excessive attendance of patients. While we were waiting for pregnant women to attend our health workshop, patients at the waiting area almost had a fight, because they were too impatient to wait for the line. The midwife greeted us, and we were informed that she just finished delivering a baby right before we came and now she had to prepare for another case. For another instance, at the Arata center, the only midwife delivers more than 60 babies per month by himself. All the medical professionals were extremely busy, but they were very dedicated to their work. We give our special respect to these medical professionals at rural villages.






Besides these villages that are relatively accessible to towns like Assela, some of the centers are really in the middle of no where. We drove through hills and farms, and finally brand new buildings appeared in front of us - the Abraa Health Center. At this center, there are only one pharmacist and one midwife, who works as the doctor and nurse as well. We had a nice conversation with them, and they told us that their center just opened eight months ago, but as you can see, there were no furniture or medical equipment inside of any building. Also, they do not have power and lights, so when she delivers baby, she has to light candles. The other girl said, "I am the pharmacist, but I do not have medicine to give to my patients. I do not even have painkillers to give to mothers."



As you can see, this is the condition of health centers in rural areas. I could not imagine how women could deliver at home with even worse conditions. But for many people in rural areas, it is so natural for them to deliver at home, since their ancestors had done that for hundreds of years and they were fine. During our health outreach, Birke and we talked to the pregnant women about maternal health and fistula. We really encouraged them to deliver at the health centers, and if any complicated cases happen, they should be transferred to Assela Hospital immediately, for the safety of the mother and the baby. At most health centers, there are ambulances, and women only need to pay fuel costs when they go to the hospital. However, for some families, they might weigh fuel costs (around $30) more than lives of the mother and the baby when they cannot afford. Thus, as part of our Davis project, we support women who do not have money, with transportation stipend, allowing them to come to the hospital in complicated situations. We hope that small things like transportation support could prevent fistula and save lives of babies. 



Since Abdi will talk more about our village visits in his upcoming blog, I will just share few pictures. People have been very welcoming in the villages, and for most of times, they might think I was mesmerizing, since I looked very different from them (probably not age-wise). When we went to Tijo, kids were chasing after our car for a long way, and they were laughing and waving at us. Finally when we got to the health center, I took a picture with these beautiful and happy kids. Look at the other picture of Abdi, showing these kids pictures of themselves on a digital camera. They were so fascinated. Even though we cannot understand each other because of language barriers, we knew something universal - smiling. While in the villages, Hailemarian took us to the market to get sugar cane, and I also went to a crazy Friday market with Birke and Hailemarian (while Abdi was sitting in the car waiting for us). These visits have been very meaningful!


 
 
 

Two-Week Update

Abdi and I have been to Ethiopia for two weeks, and now I finally pushed myself hard to write my first blog. Everything has been so different here - different from what I am used to and from what I expected. It was quite an overwhelming feeling at first, but I have been enjoying my time here tremendously and people are extremely friendly and welcoming.

We were in Addis for a week, getting ready for our project. While waiting, Abdi and I explored around in the city. I was very impressed by how much construction work has been going on - roads, railway, subway, real estate, etc., and literally it is everywhere. I have noticed that there were many Chinese companies, such as CREC and Huawei telecom that support building this country's infrastructure and do businesses with Ethiopia. On our way to Assela, we drove by the Eastern Industry Zone, which is one of the largest industrial zones in Ethiopia and is invested by a Chinese company. It occupies 500 hectares land and will provide 10,000 jobs when it is at full capacity. I also saw Lifan cars, which are produced in my hometown Chongqing. It was amazing to see how much China has invested in Ethiopia. I met couple of Chinese people in Addis, and they were extremely nice. But they did feel like the heavy taxation and red tape from the bureaus make doing business here difficult. 

In spite of nice shopping centers, hotels, new office buildings, and international movie theaters (we even watched Monster University in English without Amharic subtitles), you can see poverty everywhere you go. According to UNDP, 39 percent of the Ethiopian population lives under the international poverty line of $1.25 per day, and the capital city is no exception. On the side of the roads, there are small venders that sell clothes, beverages, snacks, cellphone cards, fruits, etc. Many women would sit on the street, roasting corns and selling to people passing by with 2 birr each (10 cents). Some people would beg for money with their children or just sleep on the side of the roads. Imagining this what I saw in the capital city, living situation is definitely more difficult in the rural areas.

Another thing is completely out of Abdi's and my expectation is how expensive things are. Abdi's extended family told us, few years ago a bag of sugar would only cost 4 Birr, but now it is 30 Birr. It drives me crazy to think about fried rice in a normal restaurant here costs twice to three times as it does in China, not even to mention their taxi, lodging, gas, and imported products in supermarkets. Even for their cheapest transportation (besides walking) - mini bus, depended on how far you go, a round trip might cost you around 3-10 Birr (15-50 cents). We once asked a taxi driver why transportation was so expensive, he said, because the government imposes high taxation, in order to support further construction. You really have to know how to spend your money well here to survive, especially with average people who do not make that much income. For example, a waitress might earn less than 1,000 Ethiopian Birr a month (around $50) or a driver could only make 2000 Birr per month ($100).

Said enough about my superficial observation on the city, I want to share more about my cultural experiences so far. People here are really friendly and try to take care of us. Abdi's family friend Senayette was kind enough to invite us to her house to enjoy the coffee ceremony -one of the most famous Ethiopian traditional socializing rituals. Senayette's sister Elena and her husband, who is a pilot for Ethiopia airline, picked up us and drove us to the house. They cooked a feast for lunch - Bia'nat (misar, vegets, etc.) you eat them with injera, a soft sour flatbread that is full with mineral and nutrition. It is common here to only eat veges on Wednesdays and Fridays because of the Orthodox Christian fasting tradition which people abstain diary diet. That was the best meal that I have had since we arrived, because it is not only a delicious meal, but also a taste of home and joy. 

After the amazing lunch, their maid prepared us the coffee ceremony. Before the trip, I only knew how famous Ethiopia is for its coffee, but now I understand how important coffee is to them. Here is the setting of a coffee ceremony: they roast their own coffee beans, grind them, put the coffee power in the jar then boil it, and when they serve the coffee, they light a special thing called Ethan, and what makes the coffee even better is that they put a leaf in the coffee, and it smells like mint and makes your coffee fresh. People would gather together to enjoy their coffee couple of times, and normally they would call their relatives, extended families, and friends to come over to chat and enjoy coffee and celebrate the day. There is no other coffee can compare to the authentic Ethiopian coffee. People not only have coffee ceremony at their own, but literally wherever you go - shopping malls, restaurants, hotels, and cafe places. It has been a pleasant experience for me.

One more interesting place we visited is Merkato, the largest market in Addis Ababa. I first saw Merkato from the post card, and it looked absolutely crazy, crowded, and exciting with thousands of vendors and a variety of things they sell. Of course, I like to visit local places like this. So Abdi, my "body guard", was more than willing to take me there and show me around. Merkato is a huge market where you would find almost everything. Local people warned and told us it is a very tough place where people would pickpocket you all the time. Of course, I was too fascinated and excited about going to Merkato so none these warnings registered in my head. Abdi's extended family got so nervous once she learned that we were going there by ourselves. Therefore, she insisted going with us and after an hour of traffic, we arrived Merkato. It was even busier and crowded than it looked on the post card. People were loading bags of goods from the mini bus; some would carry a roll of carpet on their shoulder; or some would have handful of bells and small items and yell to sell, etc. It was raining, so there was mud everywhere on the road and sidewalk. Cars, taxis, and buses drove through the crowds, hulking at people. It was more regulated now than few years ago, because the government built large buildings, so most of the venders had to move inside. And of course, being the only Chinese girl wondering around Merkato, I attracted so much attention and people would literally be so fascinated to see me. Anyways, we ended up only visiting two buildings with traditional clothes, scarves, and souvenirs. It was quite fun to look at Abdi and his aunt bargaining and cutting prices for me. Everybody thinks Abdi is an Ethiopian so that has been a huge plus.

Well, every day I explore and try new things, and I feel like I have so much to write about. But I am sure you all want to know more about our Daivs project and how things have been going with it. Before I share more about the progress, I would like to give a big thanks to Dr. Mulu, who helps us make our project possible, has a special heart for her work to help women with fistula, and tries to take good care of Abdi and me beyond her busy schedule. As you know, Abdi and I stayed in Addis for almost a week to prepare our paper work and modify our plans. When we arrived in Addis, we had an ambitious proposal, but we had to figure out how to implement it. Reality is always not exactly what you would think. I would never imagine how much the government regulates volunteer work and NGO practices. There were moments of chaos and stress, but we were never discouraged, and everything eventually worked out really well. So now Abdi and I are in Assela, where WAHA has its Fistula Center in the Assela Hospital. People here greeted us warmly and really support what we hope to accomplish.

YuHsin, who is from Taiwan, helps us connecting with different key figures in the hospital, and provides us support to our project whenever we need it. She tries to take care of us, too. She doesn't only help us with our project enormously, but also shares us her personal experience and work with fistula patients. She has great heart for these women, and her daily work and interactions with the women mean a lot to these women. Each fistula patient has her own story, but all stories are just extremely sad. Through our short conversations on Monday, a woman asked the doctor how soon she could have another baby after the surgery, because she only has two girls, but her husband wants a baby boy! When we tried to tell her that girls were perfect, she responded, "In the name of God, I think boys and girls are the same to me, but my husband wants a boy." This just makes me extremely sad. We hope to get to know more about the women at the center, understand their stories, and help them.

Although Fistula cases have already been eradicated in developed countries because of the medical technologies available, many people do not even know about or heard of what Obstetric Fistula is. Unfortunately, it is quite common here. According to UNICEF, only 10 percent of births are attended by skilled medical professionals, such as doctors, nurses, or midwives, which means 90 percent of women give birth at home or other places without proper medical facility or having any health personnel attended. Also think about other factors, such as lack of nutrition, poverty, having baby extremely at young age, low/none education, etc.  All these factors contribute to fistula cases here. Once women experience belong labor during childbirth, families normally do not send these women to hospital, since they cannot afford it (even the ambulance is free in some areas, but they still have to pay the fuel), which is probably less than 30 US dollars. By quoting YuHsin, "In the situation, family members choose transportation expenses over lives of the mother and the baby." So, as a part of our project, we will go into rural villages around Assela with Birke, the WAHA health professional, to have educational outreach on maternal health and obstetric fistula as well as to identify pregnant women who really need financial support for transportation to the Assela Hospital if needed.

So far we have visited over seven health centers in towns and rural villages, talking to pregnant women there and explaining to them the importance of delivering babies at the hospital as well as collaborating with the local midwives and health center doctors or nurses. We have had very productive two days during our local visits with Birke, and we got to see the rural areas and interacted with some amazing kids. Abdi will post more about our field visits on his upcoming blog.

 ------- Posted by Amy :)