Saturday, 3 November 2012

Hippo tracks, Sagittarius, and more along the journey


Thursday 11 October

So another day in paradise.  I awakened around 0600, hit the snooze button twice, and climbed out of my web-enshrouded cocoon (a white canopy suspended from the ceiling swathed over the bed).

Got a shower – thank goodness for hot water!  Not a forceful stream, but refreshing nonetheless!  Enjoyed the 20 minute walk from the Bonga guest house to town, stopping here and there to photograph people and sights, enjoying the filtered rays of sunlight through the tall green trees and the various scents along the path.  A woman carrying a bundle of sticks strode alongside me for quite some time—she had her burden, and I had mine: a bulging heavy black backpack.  Schoolchildren vied for my attention, giving ‘high 5s”, posing for pictures, giggling as they “dared” greet me with “hello” and “how are you?”  I stopped at the only place in town that serves machiatto (which I discovered was made with powdered milk (at least at that location)—but still quite tasty) and ran into one of our course participants, Sharew.  He invited me to share a table with him, and I learned that he was first a nurse at the Bonga hospital before becoming a health officer and relocated to a more rural post (by the government) 2 years ago.  Very good natured man.  He paid for my coffee, and we walked to the government building together for our day ahead.

And I am finally sitting down after a very full day – it is 2200, and I’m just in from gazing at the clear night sky—the northern cross, Sagittarius, and shooting stars within view, crickets chirping, dogs howling, donkeys braying, and distant voices singing make up the background music.  I’m thinking to myself, “Is it possible that I wrote the short paragraphs above today?!?”  Wow! What a very full day indeed!!

After a very full three days of teaching ALSO w/ our 5 instructor candidates from Jimma, I cannot be more pleased with how the Instructor Course turned out.  We had 17 students attend, and how they blossomed over the course of the day, which included 4 highly interactive workshops, complete with “role play.”  They really hammed it up, acting various forms of difficult learners—the “overachiever/know it all,” the “unprepared one,” the “angry/argumentative learner,” and the “disinterested learner.”  I’m not kidding you, some of the quietest students played their parts so well that I spontaneously broke into laughter—which spurred them to join in!  We had such fun learning to cope with different learning styles, manage small groups, and give meaningful feedback in a relatively short amount of time.   And I just had to smile when I heard Mara tell Sharon, “and when the student told me ‘it was good,’ I asked her, ‘what was good about it?’” J  And when a student would say to me, “it was nice,” finally continue by saying (in response to my expectant gaze), “…because he/she did such and such.”  Such joy in these small but memorable interactions.  I am blessed indeed to be a small part of their life journeys.  We culminated the course with a few words from the zonal health official and handing out certificates, CDs with course materials, and a taste from home: Jelly Bellys. J And a group photo, of course.  Three of the top instructor candidates (one health officer, two clinical nurses) agreed to help teach the BLSO course we will conduct over the next two days.  Speaking of which, I need to go prepare for the work groups I’m facilitating…

But first a quick glimpse into our evening—we drove to the “suburbs” of Bonga to the head of a road that leads to a river.  Specifically, a location where hippos are known to reside.  It was dusk when we started, and somehow the sun took an accelerated path to the other side of the world.  We could see dimly when we arrived at the river that there would be no hippo sighting tonight.  But we did see evidence of hippo tracks and crushed grass where a hippo might have lain.  Worth the effort and always enjoy the opportunity to walk, especially with the night air filled with the sweet scent of what I call “trumpet flowers.”  I’ll have to look into their official name but the custom is for people to put bunches of these fragrant flowers on the fenceposts to alert passersby that the owners sell “tej,” or honey wine.  Dinner was at a local spot, where we enjoyed beyaynet for the second time today (lunch was at another local spot and was quite tasty), good conversation, team toasts—Sharon and Mara depart tomorrow morning—and planning for the weekend ahead. 

‘Nite.

Friday and Saturday, Bonga: BLSO!

We said good-bye to Sharon last night and good-bye to Mara early this morning (Dawit arrived at 6:15 this morning to pick her up), as they head to Addis via Jimma and then back to the US Saturday night.  They will be missed greatly!!

Wow. The last PeaceCare course!!  We anticipated 20-24 health extension workers (HEWs), but this was not to be—we had 14 registrants, and frankly, I think it was the perfect number. We were able to consolidate some of the sessions into larger lectures without (I hope) compromising the quality of the course, and we were able to keep the teacher:student ratio at 1:4 to 1:5 for most of the workstations and 1:7 for two of the workstations.  The instructor candidates were instrumental in the success of the course, not surprisingly.  The HEWs were a fairly shy bunch, but attentive and engaged in the hands-on practice.  Several told us that they’d never had training like this before, and they hope they will have other such practical training in the future.  These courageous women (there were only women) were selected for HEW training (or they might have responded to a government posting) after completing the 10th grade.  I believe they receive one year of training in a variety of health topics before they are assigned to remote locations, sometimes 1-5 hours from the nearest health post.  At the end of the course, I queried some of them regarding future aspirations.  Not surprisingly, some of the sharper students shared their dream of becoming a nurse or midwife of health officer.  I encouraged them to pursue their dreams and to consider returning to their current posts, armed with more skills and capabilities to help women (and men and children) in their area.  We emphasized the power they hold in their hands—to stop the major cause of postpartum hemorrhage (and leading cause of maternal death in Ethiopia), uterine atony, with bimanual massage.  We discussed the importance of using our senses to assess and treat patients, particularly in resource-limited settings: eyes to see, ears to hear, hands to touch and intervene, mouths to speak words of comfort and call for help as needed.  What a true privilege to teach these women.  The fact that they all passed the group practical testing without any problems contrasted with the <50% initial pass rate for the written exam.  Needless to say, I took the time to “remediate” them through direct questioning and clarifications so that 100% of the students successfully completed the course, with a stamped and signed certificate to prove it.

Friday night was a very special evening—Andrew and Faith Hoskins, with their beautiful daughters Alea and Emry, drove to Bonga from Chiri/Lalmba to spend the night with us at the guest house and enjoy a “homecooked” meal together with the gang.  Well, the power had been out all day (we’ve learned to flexible by now, with variable availability of the projector, etc...thank goodness for relatively long battery lives on our personal computers/Macs!), and the guest house was no exception.  I walked there at dusk, to be greeted by candlelight, Dawit and Milkiyas sautéing carrots and onions on a charcoal hot-plate on the porch; Ellie (another PCV who works 3 hours south), Andrew, and Faith chopping vegies and preparing food in the kitchen and front room; and Mike tending to a fire which provided warmth and a beautiful glow.  We enjoyed stir-fried vegetables and rice around a table lit with 3 flickering candles and two headlamps.  We laughed, told stories, and laughed some more.  It is an evening I won’t soon forget.

And now Jeff and I are once again in Chiri—with Andrew and Faith and Alea and Emry.  We arrived around 4pm, got settled, and went our separate ways for the afternoon.  Faith had time to read.  Jeff and Andrew got their “guy time” on a long walk, and I explored some of the wooded trails meandering through Chiri, off the main roads.  I was essentially solo until I came upon a cow…and a young boy.  As soon as he saw me, he somehow alerted his friends of my presence…and soon I was surrounded by at least half a dozen happy, friendly, energetic children who were more than eager to be photographed.  They scampered along with me for at least a mile, perhaps more, shouting my name, posing this way and that to be photographed.  More and more children joined us.  One boy in particular would go ahead of me, hoping for me to capture him in multiple shots.  Another boy, a teenager, practiced his English with me—“I go to school.”  “That is a cow.”  Seme-mano? Masai.  Etame.  Mehret. And many others.  Along a wide road of red packed dirt, we passed a father and his son standing at the welcoming arch in front of their home.  The boy wanted to join in with the crowd of kids, and his father joined us, too.  He walked just a short distance in front of me, as if to serve as my guide or protector.  I imagine he was really there to be with his son, perhaps 8 or 9 years old (although no other parents seemed to be concerned about the whereabouts of their children!), but I was touched nonetheless.  We walked along together on that red dirt road, across a stream, through a quaint neighborhood, until we got to the main road to town.  There he left me to navigate my way back to Lalmba—no problem. I’d driven on that road now twice before, and it was easy to find my way.

We enjoyed a “normal” family evening—Jeff and Andrew prepared rice and curried vegetables for dinner, along with a fresh green salad w/ zesty lemon dressing.  I did the dishes while Faith got the girls to bed and Jeff strummed Andrew’s guitar.  Once again Jeff, Andrew, and Faith enjoyed playing Settlers of Catan while I journaled and viewed my now 2700+ photographs, then we played “catch phrase,” a game similar to Taboo provoking much laughter and a good competitive spirit.  Faith and I enjoyed a conversation about our faith, mutual respect for John Piper & his far-reaching ministry (desiringGod.org podcasts in Ethiopia!), parenting, and God’s goodness and grace.  How the Lord has provided for me and our team again and again and again.  Whom shall I fear?  For surely Thou art with me, through valleys and moutaintops, between tukuls and health centers, amidst believers and seekers and agnostics, all the days of my life.

Sunday—travel
Dawit arrived at Lalmba a bit ahead of schedule to take us back to Jimma via Bonga.  A quick farewell to the Hoskins—complete with family photographs, of course—then on the road we went.  Clouds nestled in the valley below like whipped cream melting atop a hot brownie sundae.  Reminded me a bit of Haleakala.  We made a quick stop at Coffeeland to finish last minute business and say goodbye to John, met Adianez along the road to Mike’s (she and Chuck ran together through a wooded hilly area), and made an even quicker stop by Mike’s to bid him farewell.  He and John have just over 5 weeks left in country—what an experience for them, and I’m certain amazing impact they’ve had on countless lives, mostly in ways that they will likely never know.  Praying for them as they transition back to the States and the culture shock they are sure to encounter.

On the way to Bonga, Dawit told me he wasn’t comfortable delivering my excess bags to me in Addis due to the multiple checkpoints between Jimma and Addis.  In its attempt to control contraband accumulation and sales, the government stops cars coming into Addis for material goods.  No more than 2 kg of coffee are allowed to be in anyone’s possession at one time, unless a licensed merchant.  Because he would be transporting medical “equipment” (two mannequins, a pair of forceps, vacuums, etc), and would be travelling alone without an official letter authorizing him to have such goods in his possession, he was understandably nervous about making it through the checkpoints without the bags being confiscated (and he perhaps suffering some unwanted consequence).  So, I bit my lip and braced myself for a heavy fine for the excess luggage at the airport (in sum, I had my beast of a black backpack, vibrant green duffel bag, two mannequins stuffed in an extra large duffle bag, and two rolling duffels—one with my personal belongings and the other with nothing but teaching materials).  Imagine my surprise when the hefty sum was 320 birr—approximately $18.  How the Lord provides, esp as I am running low on birr!

The propeller “Bombadier” plane took off without event after waiting over two hours in the modest Jimma airport lobby.  Security – if you can call it that – was a flashback to perhaps the 70s or 80s in the US.  A simple metal detector, attendants going through our carry-on luggage by hand (no xray)—“that’s candy, that’s a converter, those are my clothes, pack of pens, towel, that’s a battery,”—“turn on your camera”—“that’s ok”, and we were through security.  We touched down in Arba Minch to exchange passengers, then finally en route to Addis, arriving 40 minutes later than scheduled due to the detour.  There was no problem getting our luggage, wheeling it down the ramp to the parking lot to find a vibrant Amenti there to greet us.  Jeff took his chances and stayed behind at the airport (after calling earlier to confirm seats available—at unknown cost—on a flight to Dulles that night).  He sent me a gleeful text message letting me know that he was able to change his flight from Tuesday to Sunday at no charge!  And he later called me to explain further, “the guy was so nice…there were so many people waiting in line, yet he simply told me to follow this woman, and I was personally escorted to the proper area without having to stay in line.”  I told him that God was looking out for him.  Indeed.

Amenti and I had a fairly uneventful drive to the Red Cross Guest House, which had no record of my reservation.  Seems that the woman Amenti communicated with failed to pass the details along to whomever keeps the books.  As the Lord would have it, there was room for me and a suite available for the Zubers’ Monday arrival.  All good.  We then headed to “Habesha 2000,” a cultural restaurant featuring traditional Ethiopian food, music, and dancing.  Oh my word!  The ride there was the scariest driving experience I’ve ever had!!!  The streets were abuzz with masses of people, all ages, but mainly young people, celebrating Ethiopia’s soccer victory—bringing Ethiopia one step closer to the coveted Africa cup!!  It was a happy throng, with cars honking, people shouting, lighting long matchsticks, climbing on vans, filling truckbeds, running through the traffic, taking up entire lanes of the highway, banging on our doors…I did pray for safety, and the Lord heard my prayer.  It took nearly an hour of waiting and weaving and too-close-for-comfort proximity to other vehicles before we made our destination.  Never was I happier to get to dinner!  And it was worth the wait and the effort—yummy food, great entertainment and a glimpse into different regional dancing styles.

Monday, 15 Oct.

Hit the pillow like a rock and slept like a baby until awakened by newly-arrived guests around 0230.  They kept me awake for thirty minutes with their early morning chatter and settling in but after a time I dozed again til the alarm rang at 6.  Delightfully hot shower, a little yoga before breakfast, then toast w/ honey & peanut butter served with buna w/ hot milk and sugar filled me up quite nicely.  Surprise!  Wi-fi access at the guest house afforded me an opportunity to quickly check email and send a message home.  Amenti’s driver friend Antene arrived just passed 9 to bring me to the Project Mercy office, where I found Deme composing a letter, and  I met Ato Solomon.  Feels good to be here, windows open, trees swaying in response to the gentle breeze, birds chirping merrily, and me attempting to make progress on the trip report.  God is good.

Deme told me I look tired.  How to take that?  I suppose I am, between interrupted sleep last night and cumulative days of being “on”.  After working in the office for awhile, I was invited to take a nap in a bedroom upstairs in Marta & Deme’s home.  “Next time,” he says, “you’ll stay here.”  Sounds good to me.  So now I sit in a comfortable bedroom, MacBook plugged in and music from my iPhone playing in the background, and I’ve just been served a thermos of buna in a white Lenox mug w/ butterflies -- exactly the same as mugs I have in my own kitchen in Vacaville.  Just like home.  I’m amused and thankful.

Monday, 15 October 2012

Train the Trainer & Kodak Moments


Saturday 6 October—Bonga, Ethiopia--lush, green, and beautiful landscape, warm and gentle people...

I reflect on today and yesterday with wonderment.    And now as I type, I hear the gentle but steady split-splat upon the corrugated tin rooftop that provides shelter to this guesthouse.  Now the rain is coming down faster and faster—tap tap tap tap tap.

And almost as quickly as it started, it has now come to an end…with simply the thud thud thud of what sounds like a single stream of rain repeatedly hitting the same target on my roof above.  Perhaps I’ll open the window before I sleep (good thing for mosquito nets!) to allow the fresh night air to flow freely in my modest but comfortable room.

Back to the past two days—yesterday, we conducted an ALSO Instructor course for a dozen of the most motivated students who completed the ALSO Provider course.  These were primarily medical interns (see 4 Oct entry for further details).  They did a phenomenal job preparing their brief lectures ahead of time.  One or two really grasped the concept of providing feedback in relationship to how well the student taught or conveyed information, rather than focusing on the lecture content itself.  I think they got stretched beyond their comfort zone as they learned to give feedback to one another, and in the process, further develop their skills as teachers.  At the end of the day, we “graduated” a dozen of Jimma University’s first ALSO Instructor Candidates.  And 5 of them volunteered to use their vacation time to join us in Bonga to teach an ALSO Provider Course to midwives and health officers next week.  Win-win situation, but in the immediate short-term, a windfall for us.  They bring with them not only energy and zest, but also language skills that will help bridge the gap between the learners and us.  God is so very good and faithful.

Speaking of which, before we left Jimma on Saturday, I was able to connect with the BLSO Course coordinators in Addis.  Dr. Lou will be the course director – he and Jenny split from our team to head north to Addis for this purpose – but the course itself is being coordinated through Addis Ababa University/Black Lion Hospital.  I’d previously suggested to Project Mercy that they send 2 nurses to this training but hadn’t heard an update…then touched base with Deme on Friday, who confirmed that two midwives had been identified by Dr. Fekadu…but how to get them registered at this late hour?  As the Lord wills, that’s how!  I spoke with Dr. Sofia, the appointed Ethiopian ALSO Champion, who connected me with Dr. Aklilu and Haimonot in Addis.  After a few persuasive conversations, they agreed to accept two new students, our Project Mercy midwives.  A call to Dr. Fekadu in Yetebon and  a few more text and email exchanges, and it seems that these two midwives will indeed travel to Addis on Monday for the three-day training.  They will return to Yetebon as BLSO Instructor Candidates, ready to teach their first course with the Zubers and me 18-19 Oct.  How the Lord provides!!

Our drive to Jimma was beautiful and rather uneventful, save the stops to capture “Kodak moments” and interact with the baboons traipsing along the road, eager to steal a snack from a willing driver.  The team split in two—one half staying in town at “Coffeeland Hotel” with the rest of us staying at the guest house at the edge of town—a lovely, quiet dwelling nestled upon a hill with visions of colorful flowers, fragrant trees, and the sounds of dozens of songbirds filling our senses.  We enjoyed a quiet evening of much-needed rest.


Sunday 7 Oct—we awakened with a plan: hiking to the waterfall.
We parked at the Catholic Mission and were blessed to hear the sound of hundreds of voices singing songs of praise.  Two school-aged boys voluntarily led the way up the muddy, uneven path flanked by tall eucalyptus trees.  On the way back, I was flanked by two young boys, each holding my hand…one a little more eagerly and longer than the other.  On my iPod I listened to “On Christ the solid rock I stand, all other ground is sinking sand…” with such joy in my heart.  Any time I freed my hands to snap a picture (or two or a thousand), the boy on my left would immediately place his so I could easily grab it again.  Such warmth.  I thought to myself, these two precious boys beside me are like Ashley and Harrison roaming freely through the forest, befriending a stranger and leading him or her along the way.  Hmmm.

Moved


(Late posting due to lack of internet access--in the interim, we've completed training in Jimma and Bonga, visited Chiri, and now am back in Addis for a few days before heading south to Yetebon)

4 October 2012--Jimma University School of Medicine:  Today marks the end of our first ALSO Provider Course, which we taught over 3 days.  Let’s just say our team is exhausted but thrilled!  25 of the 27 students who tested passed the course!! (>30 people attended the course each morning, but several of the OB residents did not complete the course because they spent the afternoons studying for their advancement exam on Monday.)  And we are revving up for a one-day Instructor Course tomorrow, for which 12-13 students are enrolled.  Then, up to 5 of tomorrow’s students, “Instructor Candidates” will join us in Bonga to teach a series of courses to midwives and health officers (Mon-Wed) and health extension workers (Fri-Sat).  This fulfills one of our team’s primary missions—to not only provide training, but to “train the trainer” so that the information can be meaningfully propagated in a way that is put into effect to improve outcomes for moms and babies.

Two instances particularly moved me today.

The first was this morning, when a senior OB resident requested a CD I’d prepared with various references for teaching future courses.  We navigated through each folder, and he shared with me his desire to incorporate the ALSO Course into OB intern orientation!!  YES!  I highly applaud this idea and will make myself available through email or whatever means to help, as needed.  I then encouraged him to consider taking groups of senior OB residents to rural communities and teaching the BLSO Course to the front line workers of the community health posts.  To build bridges via community outreach.  To gain at least a glimpse/first-hand understanding of the circumstances in which rural providers must operate.  And to provide guidelines for prenatal and intrapartum care which result in improved outcomes.

The second instance was this afternoon.  During the course, it became obvious that the language skills among the learners were quite variable.  To maximize our ability to communicate clearly, we invited several of the interns (actually 5th year medical students who, upon graduation, will spend 2-4 years “paying back” the government in return for their medical education; the number of years correlates with the location where they serve—the more rural/removed, the less time required) who had completed both the written and practical aspects of the test to assist us with the “megadeliveries” via serving as translators.  They agreed—we only needed 3 students, and that’s what we got.  They were truly a Godsend.  I am so proud of them, their work ethic and willingness to go above and beyond!

Calling it a night—
Sarah

Tuesday, 2 October 2012

Birds, Butterflies, and Baboons



0600 3 Oct, looking out my balcony window I see colorfully-clad women walking the packed red clay street.  3-wheeled taxis vie for passengers amidst the bright blue buses.  There is a constant rumble of motors running, and the air has a somewhat burnt smell and haziness about it. Beep! Goes the taxi driver, followed by the deeper honk! of a bus.  It is the start of a new day, and I pause to reflect on what’s passed since our arrival.

Mon, 1 Oct: The windy road to Jimma brought with it vibrant views of post-rainy season (well, nearly post-rainy season--it poured again last night!!) hills lush with green grass, acacia and eucalyptus trees, and tall green forests.  Traditional tukuls and plentiful mosques dot the neighborhoods.  The sounds of warbling weaver birds punctuated the curvy drive now and again, and we were even blessed to witness a small flock of these bright yellow birds flit treetop to treetop, chirping merrily (and loudly) in their course toward their upside-down beehive-shaped nests.  Imagine my surprise when I spotted the grey-brown tail of a baboon, who then simply stared at me...what a treat!  And moreso, to see two maribou storks standing regally in a field of tall yellow grass.  Scarlet red poinsettia bushes and fields of meskel abeba (yellow "cross flowers") brightened the colorful landscape, along with the purple and green uniforms adorned by the schoolchildren walking along the roadside. Rainbows of patterned cloth swathed gracefully over women, many of whom carried the day's burden of water jugs atop their heads or bound wood upon their backs.  Such a life.  

The ride from Addis to Jimma took nearly 8 hours.  We filled our time with a mix of conversation, comfortable silence, and short catnaps.  I don’t know how Dawit managed to stay so focused and good-spirited for the entire drive, but I do know that I am thankful that he is with us for these two weeks!  Such a mild-mannered, gentleman with an easy warm smile, able to negotiate the crazy rush hour traffic of Addis Ababa without a blink of an eye and the windy mountainous roads without making us carsick-prone individuals lose our lunch.

Tuesday, 2 Oct was the first day of our initial ALSO Provider course.  We planned an 8am start time…but didn’t begin until close to 0930.  We planned for 32 students…and 38 showed up.  We planned to have 3 workstation rooms…and had to work really hard to find (and clean) 2.  God perpetually calls us to depend on Him to meet our daily needs, and today was no exception.  We learned to be flexible, to communicate effectively with our Ethiopian colleagues, and to “go with the flow.”  The students – ranging from health officers to nurses & midwives to medical residents – were attentive and, though initially shy, were easily engaged and shared beautiful smiles as we worked through the afternoon’s hands-on workstations (Maternal resuscitation/postpartum hemorrhage, Neonatal resuscitation, and Emergency breech delivery).  The last student of the day that I worked with smiled at me, said, “thank you, we love you so much.”  Unexpected but genuine warmth, so freely expressed in this beautiful culture, makes my heart swell, especially when I am missing the warmth of my family every day.  The Lord provides.

As I stand back a bit and consider all the hands that have made this one day alone possible, I am humbled and awed—but isn’t that just like God, to give us what we can handle in the increments we can handle?  It is so natural to get caught up in the “to dos” of each day—and indeed we are called not to worry, to focus on today, “for today has enough cares of its own…” and we are not promised tomorrow.  Yet I would be remiss not to consider the many arms and hands and eyes and ears—many members, one Body—that worked together to put this series of courses in motion.  The coordination between PeaceCare and the Peace Corps volunteers—I haven’t even talked about John and Mike, who are both completing their two years of service in Bonga, and who are young, capable, compassionate servants (with a good sense of humor and amazing command of Amharic, to boot!), and who’ve been instrumental in handling the on-the-ground logistics.  Meeting with the Jimma University OB faculty.  Securing a location for the course.  Inviting participants from places near and far.  Ensuring the twice-daily “shy/buna” (tea/coffee) breaks are woven into the schedule—non-negotiable!  Making last minute copies.  Getting SIM cards, flip charts, markers, and the like.  And not to mention our team of 7 professionals (6 physicians, 1 nurse) – we are gelling and working together in a way that makes it seem that we’ve known one another for much longer than the 3 months (or less!) it’s actually been…

So birds, butterflies, baboons…and BONDING.

A new day begins, and with it, much hope and inspiration to serve others and thankfulness for the opportunity to do so.

Sarah