More parting thoughts...

I knew it - as soon as I got on the plane from Frankfurt to LAX, I thought of a bunch more things to add to my 'random thoughts' list. Here they are:

• always having to make sure there was some bottled water to use for brushing my teeth, and using the peroxide the few times I forgot and used tap water to rinse
• the Adama class and their 'energizers' - jokes, exercises, clapping
• taking the anti-malarial every day - and still taking it for 5 more!
• the women doing hard manual labor in Awassa repairing sidewalks
• hearing Shania Twain being played in random places
• coffee with milk meaning a cup of steaming milk and a tiny pot of coffee on the side - perfect!
• the massage from the Spa in Awassa that included a belly massage...
• scaffolding made out of sticks (wheelbarrows, ladders, oars, etc. also made out of sticks)
• a fun time at the Post Office in Addis - having to check my camera at the guard house; being crushed by a crowd of people trying to get their mail taken care of while the postal lady was trying to count out stamps for me; the 3-person assembly line putting 4 different stamps on my letters (Amir, a postal guy and me); the guy who asked me for my phone number and business card when I said I was Canadian.
• to Pepto or not
• the students' appreciation of small things like the pens and notebooks we handed out, the class photo we had printed for everyone at the Awassa training, and the requests for things like Biohazard signs and safety manuals
• everyone, including maids, insisting on carrying everything for us - from backpacks to cups of tea
• the hot, stifling room in Adama during training week #1 (the white people are melting!)
• the yummy tea made with hot cinnamon water
• Deman looking so Ethipian everyone tried speaking to her in the local language - she had to explain so many times 'no Amharic' and that she is from Kenya
• the 'oils and greases' shop in Adama that pleased Joan so much
• the lush greenery and red soil (and poor roads) south of Awassa
• Ethipian time (6 hr earlier than 'normal time') and the Ethiopian calendar (2nd month of 2004)
• being shocked at meal prices once we got back to the Hilton in Addis
• butchershops with meat from a single animal hanging from a rack
• how much sugar the Ethiopians add to their tea and coffee - it's crazy!
• all the kids from pre-schoolers to senior high wearing school uniforms. The raspberry pants had to have been my favorite
• the women wood collectors trudging down Mt. Entoto with their huge burden of eucalyptus branches
• the Orthodox Christians fasting until their Christmas/Epiphany on Jan. 7th
• cold mornings, warm dry days and cool evenings
• the harsh reality of the Red Terror Martyrs' Museum on our last day in Addis
• being called 'Farenjii' - although not as often as I was expecting
• the amazingly good, paved roads (mostly thanks to Chinese investors)
• hyenas and the relationship the people have with them - in some places like Harar they are hand fed
• churches and mosques everywhere
• all the ladies in headscarves
• bloody nose and breathlessness from the altitude in Addis (8000 ft)
• thinking that a little could go a very long way .....

Parting thoughts

Wow! 4 weeks went by so quickly. I'm sitting here in the Frankfurt airport with Debbie waiting for leg 2 of the journey home and suddenly it seems almost like it didn't happen at all. All of our goodbyes are done now - Belinda, then Deman and Adrian, last night Amir (and a missed opportunity to say a real goodbye to Getachew), and now Isaac is waiting for his flight in a different terminal and we just saw Joan get on her flight to Chicago. I won't say there weren't any waterworks - thrown together under strange circumstances for 4 weeks, we became a little family with a few additions here and there.

So, some random thoughts, reflections and remembrances that will maybe bring some of it back...

• amazingly generous and kind, gentle people 
• dusty, dirty, smoggy, smoky (incense and cigarettes), nasty exhaust fumes everywhere except Adama
• blue donkeys and tons of real donkeys
• even though it's apparently >50% Orthodox Christian, there are so many Muslim and Arab influences - mosques and muezzin calls to prayer, Aljazeera on TV, lots of Saudi channels, etc.
• injera! tibs, firfir, kitfo - pasta, pasta, pasta - and bread!
• the tons of birds everywhere - in Addis, Adama and especially Awassa
• the lovely sound of Amharic being spoken all around, and the almost pre-historic looking way the language is written
• the challenges of an 11 hour time difference when trying to keep in touch with Elliott
• Auntie Deman, the youngest in the group, taking care of us and telling us of course it's OK to eat the fresh fruit and veggies!
• Amir and the party bus with all of our iPod playlists as he took us - always with a smile - places his van was probably never meant to go
• realizing that most gestures and facial expressions truly are universal
• 'Are you fine?' - 'I am fine' - 'It is possible'
• the long, long flights to get there and back
• men and boys holding hands because they are such a friendly, touchy-feely people, and because they aren't ashamed and they know it doesn't mean they are gay
• the disgusting (for the most part) bathrooms and having to carry 'supplies' around everywhere outside of the hotels
• the absolutely inspiring, engaged and passionate students we met and taught
• street kids calling out 'You! You! You! You!'
• the basic health centers we visited with their 1-2 microscopes and not much else, and the huge number of patients they saw every day
• did I mention the dust and pollution?
• our excitement at every new animal we saw
• Amir telling us we need to think like Ethiopians when we are paying for things or tipping - 100 birr isn't $6 to an Ethipian, it's 100 birr
• the tiny drinks at the Maya and the Haile Resort that cost more than a main entree
• worrying about Adrian's sugar levels on our adventure days
• Deman saying 'You GUYS!' all the time
• feeling sick as a dog one night and wishing for my mom
• the entrees at the Maya and especially the Haile Resort where they were more 'gourmet' that cost less than $5 US each
• Debbie photographing everything
• mosquitoes in Adama and sleeping under the mosquito net after spraying the room and my ankles down with bug spray
• our 'is it because we're white?' jokes almost every day ;o)
• Getachew and his stick toothbrush - and the sellers of those stick toothbrushes on the streets of Addis
• every meal that wasn't a buffet (and some that were) taking at least 2 hours
• that yellow lentil stuff from the training site in Adama that was sooo delicious!
• being on Facebook more than usual just to keep in touch - and getting my mom to sign up so she could see all the photos I'd been posting
• the smells - food, people, animals, trash, coffee, incense 
• the shoulder-popping dancers at the cultural restaurant in Addis, and on the local channels almost every day - can't say I enjoyed the singing, but the dancing sure looks fun
• trials and tribulations of finding Coca Light
• the golden fields, acacia trees and round traditional dwellings
• Adrian's lab coats made out of flip chart paper
• our various intestinal challenges...
• the fresh squeezed orange juice at the Maya
• stealing ketchup and hot sauce from the hotels to represent blood during the class role plays
• 'Carlton' from the ToT class (aka Adem)
• the relative lack of stray dogs and cats, and the over abundance of goats (and kind of wishing we had a goat for Domino to play with)
• trying to avoid an interview with Isaac
• Joan's laughter
• skipping lunch at the Pinna because it just was't very good
• shopping for scarves and anything/everything else our last 2 days in Addis
• getting whacked with a cane by an old man walking back from class one day
• Thanksgiving at the Sheraton with the over-the-top buffet and the Bellagio-like fountains
• Loving the Haile Resort and Lake Awassa so much that Joan and I came up with a detailed master plan of how we could all just stay there in the space of 15 minutes of texting each other one morning
• the huge size and number of transport trucks on the Addis - Djibouti road at all hours of the day
• this stupid cold that won't let me go
• having Muluken teach Adrian and I to count to 5 and say thank you in Amharic
• making the best actor and actress awards and having the class participate in voting on the winners
• bonding with a great group of people - thank you, Debbie, Joan, Adrian, Deman and Belinda for making this an amazing experience! And to Getachew and Amir for spicing up the group with some local flavor. You guys are all the best - sniff, sniff!

There are probably so many more that I'll think of later so I may come back up and update this post over the next few days as I keep remembering things. I can't believe the 26 days are over.

SRS Training take 2

Sorry for the lack of posts this week - not feeling so great and preferred bed to hanging out in the lobby to get a good wi-fi signal.

For our last week here in Ethiopia, our job was to mentor and support some of the trainees from 2 weeks ago as they now presented the SRS curriculum to a selection of lab technicians and technologists from their own regions. Adrian and I stayed in Awassa and helped Bihil, Muluken and Girma from the SNNP (Southern Nations, Nationalities and Peoples) Region, while Joan and Debbie went back to Adama to work with Habtamu and Mestawet.

That meant that our little 'family' had to be split up after almost 3 weeks together. Belinda and Isaac, the videographer flown in from one of our company locations, came down to Awassa and Deman, Joan and Debbie left to go back to Adama with Amir, our driver extraordinaire!  So the fact that we all got sick Sunday night/Monday, I think, is attributable to the break up.... Belinda thought it was because we were all tired of being on the road for so long.  In any case, I'm still congested like never before and can barely speak.

At least I got my teaching part done before my voice took off. Adrian and I had agreed to give the Process Mapping module the first afternoon, since it is a bit complicated and confusing - even on the trainer end. The rest of the modules were to be taught by the new local trainers - in Amharic! Adrian was so sick he wasn't able to attend on Monday so I managed to get through it, even though I hadn't been responsible for it the first week of training. Adrian was back at it the following day. We mainly gave some suggestions in terms of timing (these people can TALK!) and helped set up all of the activities - role plays, group activity stations, handout, etc.

What I noticed most about this class of 38 was how participatory and engaged they were. Based on stories from other training sessions with small lab health center workers, we were told it took up to 2-3 days before they started engaging in discussions. I'm assuming at least part of that was due to the language difference, and maybe that's what turned the tide in our case. When I was giving my module and asked questions or probed for feedback, I got total silence. With the local trainers, the class lit up, had fun and really got into it. So much so that even when role playing in front of the class was not required, they requested to do so!  Adrian and I talked about Oscar nominees, and our last evening at dinner came up with the idea of making Best Actor and Best Actress awards out of the Coca Light bottles left over from our drink order. I stayed up late making these silly awards, but it was actually fun.  We consulted with Bihil, Muluken and Girma and they suggested polling the class for the top 3 actors and actresses and then go to a live vote for the winners. I think they were pleasantly surprised and appreciative.

The class raised their test score average by 41 between pre- and post-test evaluations (43% up to 84%), so we know they didn't just have fun - they learned something during the 4 days of training.  All the feedback was primarily very positive - some even wished it was longer! It was wonderful to have such an involved, active group that were passionate about their jobs and so willing to learn. Once again, training was very rewarding - and I didn't even do that much this time.

As I sat 'listening' to the final discussion (in Amharic) with a big-wig from the Regional Health Bureau just before the certificates were handed out, I was thinking that for all the orphanages and women's organizations and the like, what I would really like to do after going home is find a way to continue to support the Health Center laboratorians. I talked to Getachew last night about it here in Addis and he said that even donating time to help translate manuals, edit documentation, and assist with writing SOPs would be a huge benefit so I am encouraged to think that maybe this is the piece of Ethiopia that I might help to continue to make a difference with.

NGO row

Awassa is some kind of hub for NGO and aid organizations. Driving from our hotel towards the city center, there are probably 5 orphanages, children’s organizations other other evidences of aid within the first 2 miles alone!

SOS Childrens’ Village

The Benevolent School

Mother Teresa’s House

USAID Urban Garden project (funded by PEPFAR)
Plus the YMCA :o)

At our hotel we see vehicles or people from the WHO, UN, USAID and probably others… and at the training site the UN, Unicef, Save the Children…I also saw a UN vehicle and Save the Children/USAID/PEPFAR signs at the Regional laboratory the day we went to see Mr. Goshu last week. And on our way to Awassa from Adama, we saw an ICRC (International Committee of the Red Cross) vehicle going our way.

I found a bunch of others by Googling - Awassa Children's Project, Awassa Youth Campus, SALU Self Help Blind & Handicapped Association (Irish Ethiopian Friendship group), Ethio-American Friendship School, People in Need, etc.

Last night on the local EBS channel there was an ad for AIDS Free Generation Due 2015 – joinred.com. They even said PEPFAR was one of the sponsoring organizations. Check out this link, and I'll post another to the 'related links' section of the blog. http://www.joinred.com/2015Quilt/2015quilt-post.html

ICRC vehicle ahead of us

Rift Valley Lakes

Following the Rift Valley south from Adama are at least 8 lakes on the way to the Kenyan border. The one closest to Adama is artificial - Koka Lake -created by a dam. The other 6 were formed, originally as 2 large lakes, during the last Ice Age.

On our drive from Adama to Awassa last Wednesday, we saw 5 of the 7 natural lakes and probably Koka Lake as well, since all are fairly close to the well-maintained highway running south.  Some of the lakes are huge and either support large communities or are situated within parks and support more bird life than human life.

We passed Lake Ziway a ways into our journey. It had a greenish hue from a distance, and was very large with a surface area of 430 km squared. According to the guide book, it apparently has the best bird watching of them all. It supports good populations of tilapia and likely other fish, and the town of Ziway is supposedly known for it's great fish dishes. We made a quick pit-stop here to get water and find some facilities, and then we were off.  Unfortunately, we didn't get a chance to stop and take a boat ride to see the hippos, any of the 5 volcanic islands, or the Maryam Tsion church on one of them. A church has been present on this island since at least the 12th century, so this may be the oldest active monastery in Ethiopia. According to local legend, this was the site of the Ark of the Covenant for 70 years, before being returned to Axum where it is said to rest now. How cool would that have been to visit!

Next in the string of lakes are a group of 3 - Langano on the east side of the road and Abiata and Shala on the west. Langano is supposed to be safe for swimming and has thus been turned into a resort-like area with lots of watersports available for the weekend traveler from Addis.  Abiata and Shala have been encompassed within a National Park. I read today it was because when the Emperor Selassie saw a nature documentary about some pelicans that lived on an island in Lake Shalla and every day went fishing on Lake Abiata, he went to visit and then declared that the area should be protected. Today, the water levels on Abiata have dropped steadily and the once clear blue waters teeming with fish are now brackish and too saline to support fish. Thus the bird-life on both lakes has changed and supposedly large flocks of flamingos can be seen during certain times of the year on both.  When we stopped at the park, it cost us foreigners another 90 birr each and a guide was thrust upon us again (70 birr) - this guide didn't carry a rifle, though.  We saw some ostrich right away, and then the guide suggested we get out of the van and walk a bit to see the Grant's gazelle. We then got back in the van and went a tortuous 6 km over terrible dirt roads to the shore of Lake Abiata. A surprising number of people live within the park boundaries, letting their livestock graze within the grounds. There weren't thousands of flamingos at the lake, but we did see several out there in the choppy, shallow water. The van got stuck in the sand and we had to push it out, then we bumped our way back up to a viewpoint where we could see both Lakes Shala and Abiata - they are only separated by 3 km. Lake Shala is supposed to be the deepest in Ethiopia, and hold the most water. It is 266 m deep at the greatest depth. There was an enterprising boy selling local crafts at the viewpoint area, so we all ended up getting something to bring back home. On the way back to the main gate of the park, we saw a family of quail, and then the wart hogs crossed our path almost at the same time.

We passed through the busy cross-roads town of Shashamene where all the buses from north, south, east and west pass through. It's reputedly not a pleasant place for foreigners and is best known for it's Rastafarian community that is nicknamed 'Jamaica'. During the later years of Haile Selassie's reign, a bunch of fans of his from Jamaica relocated here and a little 'Jamaica' has spring up.

Only 25km further south lay our destination of Awassa (Hawassa), on Lake Awassa. The lake is relatively small, contains no outlets but has 'fresh' water, supports at least one hippo family and lots of fish and literally hundreds of birds of all kinds, and is set in an ancient volcanic caldera. The place we are staying is right on the shoreline and is a little slice of heaven. Not dusty, no road noise, no exhaust fumes and hardly even anyone smoking! My lungs are regenerating a bit more every day I stay here... The city of Awassa is the capital of the SNNP (Southern Nations, Nationalities and People) region and is really more like towns back home in terms of being laid out in an organized fashion with wide boulevards and a more modern feel. As you may have read in the Health Care Center blog, we have ventured out from Awassa proper and descriptions of landscape, etc. can be found there. We did take a little boat trip (10 min ride) over to see the hippos - we had to stay so far away, though, we could barely discern them from rocks. The one photo below is zoomed with the 36x lens to actually try to see something. We also ventured to the fish market today - not as gross as I was expecting (didn't even see any fish) - but there were tons of Maribu stork, huge, ugly birds. We met the owner of the hotel we are staying at (see URL under links section of the blog page) and got a photo with the Olympic marathon champ, Haile Gebrselassie.

The other 2 lakes in the string - Lake Abaya and Lake Chamo - are quite a ways from Awassa and we haven't made it that far south. It also looks like one would have to switch to another highway in order to access them. Based on the map in the guide book, there is a small National Park in between the 2 lakes, encompassing shores of both lakes.

quail and wart hogs

sunset over Lake Awassa

reed boat

fish eagle

hooded hornbill

hippo

Debbie, Adrian, Haile G., Deman, Amir, Joan and me

Health Care centers

Over the past week we have visited 9 sub-city health care centers in 2 regions, as well as 2 Regional Health Bureau labs. The first Regional lab in Adama was a brand new, beautiful CDC-funded building with great equipment (including a machine made by our company!) and a negative pressure room for TB samples. Compared to their old lab (small, dingy, poorly equipped), this new building is at least 3 times larger and definitely something to be very proud of!

The 3 sub-city health care labs we visited in Adama were so basic in comparison. None of them had more than 2-3 microscopes and 2-3 centrifuges. Most had no generator backup if the power went out. We didn't see gloves in all instances (hopefully they just weren't out in the open) and some openly admitted they didn't have the supplies they needed. They were often single room affairs, maybe 2 at most. Blood was drawn in the same room (some had tubes from our company) and often the lab technician (2 year diploma) or technologist (4 year degree) was also acting as the phlebotomist  - and maybe more. These techs counsel patients on testing, results and treatment - there is no doctor on site, maybe a nurse or two are available.  In Adama, the busiest clinic probably saw >100 patients a day.

Here in Awassa, we visited 3 more yesterday and 3 today. Our first stop was the Regional lab - they are still in their old building but apparently the new CDC-funded lab is in process and they kind of bragged that it would be 'better' than the one in Adama. Mr. Goshu Belay was very generous with his time and even had introductory letters written up for us to present to the 6 labs he suggested we visit. The furthest from the city center were about 45 km away and the roads deteriorated quickly once we were out of town. The potholes were sometimes big enough to swallow us alive! Yesterday the most impressive lab was in Chuko HC. The health officer was very involved, had tons of charts depicting all kinds of metrics about everything from demographics to main diseases over the past 2 years to maternal health stats. They are open 24/7 (on call on weekends). They said that recently, malaria cases have spiked in their region - they said they are 'famous' for it - and in one week alone they diagnosed 259 positive cases. They are working at the grassroots level (their own words!) within the community to try and talk about prevention. They have seen results, too - in the past 3 days, the number of cases have gone down. The lab was very organized, the techs were engaged. They screen upwards of 100 malaria samples a day! The other 2 labs were small and less organized.  At one of the labs they had posted pricing for pharmaceuticals - I think pretty much all were under 50 cents US. We should be able to make a huge difference at that rate if funds can be directed properly. We had thought we'd make it to all 6 labs in one day, but after a bit of a late start and terrible roads, we only got half way through. (Darn - I just missed the sunset over Lake Awassa because I was writing this blog!).

Today we went in the other direction and visited 3 more HC labs, the first one by mistake - must have been some miscommunication with the locals... In any case, they were more of the same - a couple of microscopes and centrifuges, sending ART and CD4 samples to a referral hospital or the Regional lab, no (or no functional) generator, lots of patients every day. The last lab was in quite good shape, though, and had 3 rooms with some additional equipment in the back room. I don't think it was functional, but they said they did clinical chemistry in the past since they had the means, but now send it off to the Regional lab with the CD4 samples. The health officer was happy to tell us that their lab is well known throughout Ethiopia and is used as a model for others within the region. The downfall was that they don't get to attend much training because the Regional lab knows very well how they are working and are satisfied. We all thought that was not a good excuse to miss out on trainings.

Pretty much all these sub-city HCs are cookie-cutter in shape - a few are a bit bigger than the others - but the layouts are almost identical for each. The basic level of each is almost the same, as well. Turn around time for samples that are reffered to other sites for testing because the local site doesn't have the ability to perform the test seems to range from same day to about 3 days, depending on geography and what kind of test it is. The other stunning thing that came up during SRS training last week was that none of these health care workers, no matter sub-city tiny lab or brand new regional lab, get any kind of preventative vaccinations provided to them. There's another area of opportunity for sure!

It makes me grateful to have so many options available and to have clean, well equipped facilities near by when I go home.

Our mis-spelled names in Amharic

Typical equipment in the lab

Food (part II)

A couple of things to add to my previous food post....

Dinner here at the hotel in Adama usually goes something like this. The group decides what time we think we want to eat. We started subtracting a half hour so maybe we might get the food sometime around when we thought we would be hungry. 2 hours later, maybe we have been provided with the bill and can leave. We've got the menu basically memorized by now so we order quite quickly. I keep hoping they will have the roast chicken one of these nights, but so far, no luck - even though we've seen chicken salad, chicken pizza, and chicken soup be served! Then we wait - for our drinks, and much, much longer for our food. Like 30-45 minutes long. Poor Adrian, the diabetic, usually gets his food last. Tonight, they forgot about Adrian's order and my order, so everyone else was pretty much finished eating (after the usual 30-45 min wait) and we still hadn't even seen our food. It's quite usual for the food to come out at vastly different times, but this was taking it to another level.  The food is usually pretty good, however, and definitely more than plentiful in terms of portion size so sometimes that makes up for all the waiting.  Also, most dishes are in the $2.50 to $5 range - incredible!

Last time I forgot to mention the Italian food. Based on the brief occupation by Italian forces back in the mid 1930's, Italian foods are common and plentiful on Ethiopian menus. The bread and pastries may also have Italian influences. I haven't eaten so much pasta and bread in a 2 week period since I can remember! I think it's affecting my waistline, especially since there is no gym or exercise opportunity here in Adama.

Butter - this is one of the reasons I'm not venturing too far back into the local food items.  I really like the tibs here (strips of meat with a few peppers tossed in), but they are so greasy and salty from the butter sauce it's a bit too much to handle. A lot of the dishes are swimming in butter - like the vegetable soup I had the other night.

The best lunches we had were from the buffet line at the training site last week. I mentioned them in the last food post, but wanted to add that fasting by the Orthodox Christians is happening now every day in preparation for their Christmas (Jan. 7th). They started at the end of November and until Christmas are not eating meat, eggs or dairy until the holiday.

So, while I'm not outright complaining, food is a bit of a love/hate thing for me right now. I can't wait until we get to see a new menu tomorrow when we arrive in Awassa just in time for dinner!