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!

Rift Valley Road Trip

I had been eagerly awaiting this weekend as we had planned on a trip to Awash National Park. It is about 100 km from Adama and follows the paved Dire Dawa road along the southern part of the Rift Valley. The trip did not disappoint!

Leaving Adama around 9:30 am Sunday, we saw the usual heavy transport truck traffic - so many huge trucks carrying a variety of items - from other trucks to camels! Yes, we saw camels... first in a field but weren't able to stop for photos, then peeking out of the back of a truck in front of us. Luckily on the way home we had a great photo opportunity when we saw a whole herd following the road in the late afternoon. We also saw a dead hyena along the side of the road at one point.

It was interesting to see how the landscape changed along the way - there were the usual agricultural fields and grazing sites with cattle, goats, donkeys and their herders; but we also saw irrigated sugar cane fields, dry scrub, dark volcanic rock and to the north, evidence that we were in the great Rift Valley based on the cliff-like areas to our north in some spots. There were lots of little settlements where it looked like several families lived and farmed together.

At one high point, we looked out and saw what seemed to be a very large body of water. Turns out this was Lake Beseka, 5 minutes outside the small town of Metahara. The road crosses one edge of the lake and it must flood easily since it was already partially under water and it hadn't even been raining.  According to the guide book, this is a shallow lake that is expanding and it attracts a lot of birdlife and houses crocodiles. Unfortunately we missed out on a potential night light show - the volcano in the park, Fantelle Volcano, apparently spews fireworks from the crater on a regular basis.

Only 5 km further on after Metahara was the park entrance. The rules of the park are posted in English, and the fee schedule is in both Amharic and English. We paid 90 birr per person - less than $6. A guide was assigned to us (70 birr) and since he was armed with a rifle, maybe he was also part guard? We drove into the park and the guide led us out into a savanna area dotted with acacia so we could find some big mammals. Not too far in, he spotted a Soemmerings gazelle. Then the guide spotted oryx, but I couldn't see them. He suggested we hop out of the van and walk towards the game - we were more than happy to stretch our legs. In fact, Deman had just said that the grasslands were so beautiful she wanted to run through them, arms outstretched like in a Bollywood movie! We walked several hundred yards off the dirt road in search of the oryx and from quite a distance, could see at least the outline of these large animals. With my zoom, I could even get a decent close-up look. After lots of photos out there, we trudged back to the van and almost immediately the guide spotted a huge number of oryx on the other side of the road. We went off-roading and Amir guided the van towards the herd. We got magically close and although some of the animals were skittish, they didn't bolt away. We weren't able to get out of the van, but we took probably a hundred photos or more, between us. It was quite exciting! We also saw some more gazelle at that point, too. There are supposed to be about 80 species of mammals in the park - mostly bats and small rodents, but also the gazelle, beisa oryx and baboon we saw, plus kudu, waterbuck and warthog which we did not. Predators have been reported but not frequently seen - lion, leopard, cheetah, hyena and jackal. Zebra have not been seen for years. There are tons of birds and we saw a few colorful ones while touring around.

After that, we made our way back out to one of the main park roadways and drove about 10-11 km to the Awash falls. Wow - they are amazing! The river widens up at the top so there are probably 5 to 6 separate falls areas, at least. The water is brown, but it's such a beautiful spot. Supposedly Awash translates from Oromifa as 'the beast that consumes everything in it's path' - based on the falls, maybe I can see why.  There was a little stairway down to the river at the bottom of the falls and we had a great time posing for photos, skipping rocks into the river, and just enjoying the lovely spot. It was great to be out of the dusty, exhaust-fume filled city and into a bit of wilderness. It really felt like we were definitely in Africa! Especially after we saw the big croc sunning itself on a rock across the river.  I also spied a baboon doing a little fishing and resting just a few yards away. It didn't stay long, but long enough to get a few photos.

We hiked back up to the top and had lunch at the Kereyou Lodge overlooking the falls, the only accommodation in the park. After lunch, we headed back to the main gate, saw a dik-dik (looks like a miniature deer), dropped off our guide/guard, and started the 2 hour journey back to Adama. More of the same as on the way in, and once we made it back to our hotel, we were all exhausted - especially Amir, who had to drive the entire way. Because of all the trucks (and livestock!) on the road, it's no easy, relaxing Sunday drive here.

A few words about the Great Rift Valley before I end this post. Most of this is paraphrased from the Bradt Ethiopia guidebook, 5th edition. It is the largest geographical feature in Africa - visible from space - and in Ethiopia runs from the Red Sea to lake Turkana on the Kenyan boarder. The rifting process began about 20  million years ago along a 4000 km faultline. Where were at the Kereyou Lodge, they said the continent is breaking apart in 3 directions.  The expansion of the Valley has been accompanied by lots of volcanic activity and will eventually lead to part of Africa 'breaking off' as the Valley fills with ocean water. In northern Ehtiopia, the Rift Valley forms the Danakil Depression - at some points up to 110+ km below sea level, one of the lowest spots on earth. It is barely accessible and definitely inhospitable. In the south, many parts are covered in acacia woodland and dotted with lakes, making it one part of Ethiopia that definitely looks 'African'.

SRS Training Week 1 - how rewarding!

Today we finished up with the Specimen Referral System Training of Trainers which will facilitate the national roll-out of the program. I can hardly put words to how rewarding the experience has been. For all the time we put in, I got more out of it many fold over. And I was a bit surprised that I almost got choked up at the end during the closing comments. The students really were a wonderful group.

This week, we worked with students who were engaged, enthusiastic and really passionate about how they can apply what they've learned to strengthen the laboratory referral system here in Ethiopia. They participated fully in all the activities and discussions, they challenged us with their questions, and we all had a good time doing it.

I've never been responsible for so much training at one time - 4.5 days of teaching several modules per day and all the facilitating involved, never mind the prep work. It's been exhausting and energizing at the same time. Thankfully, I've had a wonderful team to work with in Debbie, Joan and Adrian. Of course I have to mention the awesome team of curriculum developers who came up with the material, the group who must have worked tirelessly to print and pack the binders, and the teams who provided feedback from the 2 pilot programs back in January and August. Last but definitely not least, a great group of attentive students, willing to learn. Actually, I feel like a lot of the students knew most of the content we were delivering but they were still all ears and eager for more.

Today the groups gave their teachback training sessions and they were all very good - I even picked up some pointers from them! It was just as great to hear the praise and appreciation their colleagues heaped on them during the feedback part of each session, along with some astute observations and constructive criticisms. The feedback continued on the evaluation forms the students filled out. Most were very complimentary of the curriculum and the training as a whole, but several took the time to include constructive feedback on the class and how it can be improved. I really liked how Getachew, the EHNRI partner, suggested the students think of themselves not as teachers but rather they were facilitators yesterday as we sent them off to prepare for the teachbacks. Based on today's performances, I think they took this to heart.

Comments like, "The program is very interesting and it should be given for all lab personnel at health facilities level because most of results from the lab wasn't quality due to unawareness." and "I got many things, even things that are minor that I should know before. Surprisingly, I find many things from my instructors." lead us to believe the course content is relevant to their needs. One person even wrote something like "are you crazy?" when answering the question about what was least valuable about the course!

I've had a great time this past week and I can't wait to see how things work out in 2 weeks' time when we help new trainers from 2 of the Regional training centers give the first roll-out sessions to health care workers in their regions.

Working on the Process Mapping tool exercise

Drawing a safe packaging system

Alex demonstrates packaging safely with his cool PPE

Debbie, Deman, Getachew, Adrian, Joan in the front row - 2 students in the back

Group shot - SRS Training of Trainers, Adama, Nov. 28 - Dec. 3, 2011

Food and water

One of the other team members, Joan, mentioned something the other day about how thankful she is for unlimited clean water. Here, we are only drinking bottled or boiled water - including for brushing our teeth.  There aren't always a lot of options during meals that are 'diet', so I find myself drinking a lot more water than I usually do. It's also very dry and often dusty, so water is the thirst-quencher I'm looking for. I find I get into a bit of a hoarding mode when it comes to having enough bottled water available. What is 'enough'? What if I get thirsty at night? What if I run out and don't have any for brushing my teeth? What if we can't find any on a long drive? What if, like this morning, my mouth is so dry during training I feel like I can barely speak?

It's kind of eye opening. I mean, I know that not everyone has enough water - let alone clean and safe water. I think of it at home sometimes when I'm doing dishes or the sprinklers are on. But here, it's kind of an in-your-face reality. I don't think the locals are affected by any lurking bugs in the water we've been exposed to so far - they know these bugs! But our stomachs do not and it means that we have to be careful when we think about choosing what we eat or drink - were those yummy-looking fruits and vegetables washed in water that wasn't boiled or from a bottle? What about the ice in my drink? At the Hilton, we were pretty confident everything was OK. Today I decided to eat the cabbage salad during lunch at the training and so far, so good.

Now, on to the fun stuff - the food! The food here, on the whole, has been pretty good. Yes, it's injera at breakfast, lunch and dinner, but there have been other options thankfully. After my bout with whatever that was on Sunday, I'm having a hard time getting back to the injera. What's injera, you ask?  It's made from a grain - usually something called tef - but sometimes from barley or other grains. It's fermented so has a sour flavor, and then is made into a very thin and spongy circle. They cut it into sections, roll it up to serve, and then lay some down on their plate before adding the rest of the food. More is taken to eat with - it's kind of like a utensil. Ethiopian meals are eaten with your hands - your right hand, specifically - and the injera serves as a vehicle to get the food from the plate to your mouth. You tear off a piece, kind of wrap it around the bite you want, and shove it in your mouth. For those of us without a lot of practice, it can be kind of messy.

The tibs (strips of meat in sauce) has been one of my favorites - I've only tried the beef, and it's definitely well done, but generally it's a pretty decent dish. I haven't tried any of the 'wot' dishes yet and there are lots of mystery things I see in the lunch buffets. Plus the super spicy berber sauce. Since there are 'fasting' days (Wed and Fri?) they have a lot of vegetables, rice and pasta which is nice.  There's this one lentil-based dish that is my favorite - I hope I find out what it's called before we leave. It's all very colorful - beets, green beans, carrots, the red berber sauce, spinach, potatoes, and more! Plus they have wonderful breads here - probably because of the Italian influence. I think that influences the lovely little cookies and cakes they have out at tea time, as well.

I'm pretty sure I'm forgetting something - like all the Western food we've had available, the great Italian lunch we had in Addis before coming to Adama, and the cheeseburger I had for dinner tonight - but maybe I'll sneak things in to other posts along the way. Initially I also wanted to mention smells in the post, but it's probably worthy of a completely separate post of it's own!

2 kinds of injera, berber sauce, and some tibs along with rice and  ?

lunch buffet at the hotel where we are training in Adama

'Western' meal of roast chicken and vegetables from Kelly's in Adama

had to add this one in - Coca Light (Diet Coke) in Amharic

Training Day 1

Today was training day 1 here in Adama. Before I get to that, though, I had a pretty much 'lost' day yesterday. Our first night here I woke up at 2:30 am and was pretty ill all night and most of the rest of the day. I was worried it was from dinner and since 4 out of 5 of us had the same thing, that would have taken the whole team out!  Turns out it was just me, and thankfully I was on the mend by about 7 pm. I wasn't too helpful when we went to the training site to set up the room and assemble the tote bags with the training binders, etc. I think it was Deman who helped make me feel better when she joked during a photo op. The 4 volunteers had our company T-shirts on and asked her and Getachew, the EHNRI training coordinator, to get in the photo. When we said they should get in the middle, Deman shot back, "Why? Because we are black?". We all howled with laughter. I'm sure this will be the joke of the trip - in fact, it came up again today already!

So, back to training today. Somehow I slept well last night and wasn't up tossing and turning, being nervous about the presentations today. That probably helped things go as smoothly as they did. We were up early and at the hotel a few doors down well before 8 am, doing the final set up and settling ourselves down. We started with 21 students (we were expecting 30), but by the end of the day we had 25. I was surprised that only 4 of those were women - I figured it would be more evenly matched based on photos from the previous pilot trainings. Another obvious difference was the participation rate in our group - apparently in past sessions the students had been too shy to say much until a couple of days into training. Today, we had no trouble getting a great level of engagement during the various activities, and there were even some heated (but good-spirited) discussions.  It's very gratifying teaching a group of people who are so interested and willing to learn. Our group is a little bit different, being higher level managers and/or trainers from regional centers versus the local health care workers in the other sessions. Our training this week is a Training of Trainers session so these students are expected to go back to their regional centers and deliver this material to other groups, making the program sustainable once our involvement in the SRS program is over.  We also have 2 CARDNO external consultants observing - they are a 3rd party group assessing our public/private partnership and this was one trip they were able to coordinate with.

Overall, it was a great day and makes me excited for the rest of the training this week, lab assessments and prep work for some of the new 'trainers' next week, and finally observing and mentoring the trainers when they in turn deliver this material at another region the following week.  Off to review materials for tomorrow's sessions....

Today's joke came about after I had climbed the 4 flights of stairs back up to the training room after the break and as soon as I sat down, Deman asked me to fetch her a cup of coffee. Debbie asked, "Why? Because she's white?"...

The photos below show the students working on various parts of the Process Mapping activity, which can be a bit confusing and difficult, but makes for great team building and discussion opportunities.

Adventures in Adama

I'm falling behind on blogging - sometimes because I'm too tired, sometimes because the internet connection is so slow it's painful... This was supposed to be posted yesterday.

Yesterday we made the trek from Addis to Adama - we were expecting worse, but it only took us about 2 hours to get here, even with the Saturday traffic. Our driver said that this is the road to Djibouti where there are major ports, so it's quite busy. Lots of huge trucks - lots of overwhelming fumes. We followed the 'China road' which is in excellent condition almost all the way here. I think this means it's another projected funded by or contracted out to the Chinese.

I jotted down some impressions along the way.  As we were leaving mid-city, Avril was blaring from our driver's speakers - as Adrian called it, we were definitely in the 'party bus'! I also saw they had kind of bus lines in the middle lanes of the highway in the outskirts of town.  It's very pastoral - lots of agriculture going on. Comments in the bus were that it looked like central California. There were Brahma bulls and cows all over the roadsides, along with donkeys and goats. We also started to see donkey carts as a mode of transportation (and some little 3 wheel taxis!). Then the dwellings changed and there were more of what we are told are the typical rural round huts with mud/straw walls and thatched roofs.

The hotel looked pretty good upon arrival with a very nice lobby area and a pool, but based on the rooms, it's a far cry from the Hilton - which itself needed some updating.  Pretty small, no storage, 3 hangers, 2 outlets (both occupied) and mosquito netting over the bed. Wow - we've finally made it to something closer to the REAL Ethiopia!  And did I mention, the rate is around $27 a night - more than 10x less than the Hilton. So it keeps looking better - except for the crazy road noise.

Oh, don't let me forget. After practicing the Process Mapping exercise for a couple of hours, Friday night Deman took us to a cultural restaurant for dinner. We ate from an Ethiopian buffet, compete with a hand-washer at the beginning of the line! There was typical Ethiopian music and dancing - definitely the best part of the evening.

Thanksgiving in Addis

Back home it's still technically Thanksgiving - here it's already Friday morning. Yesterday was a busy and exciting day! 

We finally met Deman, our local Global Health participant in the SRS training volunteer program from the Nairobi office. She took us to the EHNRI office (Ethiopian Health & Nutrition Research Institute), which houses the local CDC building among others.  We were in search of the 56 boxes of training materials sent over from the US so that we could assemble and organize the materials for the Train the Trainer session next week, plus the subsequent 6 regional trainings to follow. We ended up moving all the boxes out of the crowded lab they were in to better get into everything. And in the end, we schlepped them all back into the lab in a much more organized fashion!

After all that work, we picked up some wayward luggage at the airport and then did some shopping in a neighborhood market area. We all got some nice souvenirs & gifts to bring home.  Deman was kind enough to find us somewhere to celebrate Thanksgiving with a buffet dinner at a nearby hotel, so apparently if you look hard enough, you can find a little bit of home wherever you are.

I'm also adding a few links to the blog so check those out if you're interested.

Tourist day

This morning I was woken up by the front desk calling to see why I wasn't down at the shuttle to the airport... geez, I just got here! At least that meant I didn't oversleep and miss meeting the gals for breakfast and our quick tour of the hotel grounds - tennis courts, huge swimming pool, mini golf, basketball court - all kinds of stuff!   We had a bunch of housekeeping to do after that - we all needed to exchange some money, Debbie & Joan both had to change rooms, and I had to find evidence that I really did book my first night's stay on points....   Anyhow, after a late start we finally met up with our driver, Sami, and got off to see some of Addis!

First impressions - bustling, noisy, chaotic city of ~ 5 million where vehicles have no traffic lights or signs (or laws?) to obey and everyone does what ever they want. Thank goodness Sami is a great driver! California smog checks are obviously not happening here - the exhaust fumes are pretty hard on the nose and lungs.

He took us past the palace, Piazza, the University and the roundabout Siddist Kilo (Yekatit 12 Monument) up a sharply winding road onto the Entoto Mountain. We passed a lot of women going down, carrying huge bundles of eucalyptus wood branches on their backs. Apparently they cut the wood and carry it into town to home or the market to sell and it gets used for cooking fires. There is eucalyptus everywhere, so not sure why they have to go all the way up and carry it all the way back down - there might be plantations where it is 'farmed', perhaps. I found this link reading someone else's blog - check it out for more info on the Women Wood Fuel Carriers: http://go.worldbank.org/S9UF4PDRN0

Sami let us out to take some photos from a high vantage point and we all got in a bit of a situation that started when I took a photo of one woman's donkeys. She asked for money for taking the photo - I had just got some changed to Birr and had no idea what the small bills were worth. I gave her something and she wasn't happy - apparently 1 photo = 10 Birr. In any case, I guess I did get her included in an earlier shot so not that big of a deal. Poor Joan got surrounded by other women, though - but we all made it out OK and the women got a few extra Birr this morning.

We went up higher and ended up at our goal of the Entoto Maryam Church. 50 Birr each for entrance, not including the museum, and we didn't get to go inside because there was a service going on. Our self-appointed guide did take us around back to see the very modest palace of the Emporer Melenik & his wife Taitu. It was a collection of mud and stick buildings with high and intricate ceilings, hand hewn wooden floors, and thatched roofs. I think one was a living room, one was a dining room and storage area for meat and other foods, and one was maybe a living quarters. The floors, ceilings and inner walls were supposedly original from the 1880;s. We also saw one of the 'ladies' or nuns in the monastery area behind the church along with all the spices and foods set out to dry in the sun, an old guard and his 3 sheep, a small barley field, and beside the current working church, the small, round church that is supposed to be the first built in Addis.  Tombs for Haile Selassie, Melenik and Taitu (all now moved to another location) and for some aristocratic families are also there.  Reading the guidebook, looks like we missed out on seeing a 13th century rockhewn church that was only another 2 km away.

After coming down the mountain, we drove through the Mercato - the biggest shopping area in Addis. I had been picturing a pedestrian area with open sided stalls, but not so. While there are a ton of pedestrians, they are all competing with the cars, trucks and 'blue donkeys' (taxi minibuses) that clog the roads of the Mercato area. It's HUGE and has sections for everything under the sun - produce, textiles, jewelry, shoes, clothes, spices, building & construction supplies, and what our driver called the most dangerous area with all the, um, reclaimed car parts! It wasn't really somewhere we could get out and roam around, so we just took in the sights from the car.  From the Mercato, he drove us by the huge and very new-looking American Embassy, and later the Canadian Embassy with a Canadian flag painted on the gate.  Then he pointed out the almost complete, shiny new and very tall headquarters of the African Union. It's quite a modern and impressive campus - and it's a gift from the Chinese government. On the way back to the hotel, we also saw the UN offices, the Sheraton which was all decorated for Christmas, and a lovely park that was all gated and looked like it might have been closed to the public.

Pretty good first day! Tomorrow we probably have some of the morning off, but after that it's time to start prepping for the upcoming week of training.