The Mourners

The four women sit, fixed on the floor
Here in the darkness of the hut
Dirt ground below, thatched walls around
Holes in the roof stream sunlight in
On bare walls hangs but a single face
European Jesus
Smoke rises and envelops the room
We chew on sour injeera
Remembering the sorrows of life
And raise chipped porcelain cups to our lips
Taking in the deep, earthy coffee
And recalling life's sweetness also



In Oromo culture, after a death the deceased's family will stay at home for a week in mourning, never once leaving the house.

The Million Dollar Fields

During my first week in Dembi Dollo, an Irish man named Alex was concluding a three-week permaculture course, run with the support of the Daughters of Charity at their fields in Samaro.  The town of Samaro lay down the hill from the eye clinic, and the fields there were vast and expansive.  According to Sister Evelyn, the European surveyors who had assessed the land proclaimed the landowners could be millionaires if they could only make proper use of it.  Though Alex had been training students from the community in the ways of permaculture in hopes that they might be able to harness the land and maximize its potential, he feared that his hopes might not be realized.  The majority of the students had enrolled in the classes entirely for the monetary stipend the Daughters of Charity were offering upon completion of the course, and would often stand on the crops during lessons, oblivious to any of the curriculum being taught.

eggplant, okra, carrots, tomatoes, and other crops being grown

Still, there were a handful of students who seemed to genuinely want to apply their learnings in permaculture to land cultivation, so perhaps there was hope after all.

the steep road down to Samaro

the fields of Samaro

On one of my lunch breaks from clinic, I took the opportunity to explore the fields at Samaro.

Magersa, area coordinator, Sister Kaffa, and Hawi at Samaro

After visiting the fields where crops were growing, we stopped by the chicken barn where many of the eggs I ate every morning were laid.

From there we continued on to the cow barn, where one of the cows had just given birth to a young, timid calf [which I recently learned has already died].  In case you're wondering, no, these cows were not my daily source of milk and beef.

Mary Moo Cow

Next we headed up the hill to the undeveloped fields where it was obvious, even to someone as ignorant of agriculture as I, that this land was brimming with potential, not only because of its size but because of the richness of its soil as well.  A large water tank, funded by Tropical Health Alliance Foundation, also sat on top of the hill, designed to purify the local water and distribute it to the Samaro fields and nearby residents.

The tour concluded with a visit to the silkworm factory where thousands of silkworms fed on tasty leaves harvested from the field.  Once these silkworms became cocoons, they would produce raw silk, which could be manually threaded and sold at the market.

a forgotten shoe in the field outside the Kindergarten at Samaro

As I left Samaro that day, I reflected on how many different avenues existed to raise the standard of living for people in Dembi Dollo.  Though I felt, and still feel, that healthcare was an important component of enabling people to better themselves, it would all be for naught if not for people like the agriculturists who enabled people to find work to sustain themselves and their families.

Days of Being in Clinic

A few days into my time at the Dembi Dollo Eye Clinic, an elderly man came in wearing a musty jacket and carrying a bag on a stick over his shoulder.  The flies which had been swarming around him as he entered continued to do so as he sat in the exam room, and it soon became apparent that his hearing was beginning to go as well.  After examining him and scheduling him for cataract surgery the following month, I led the man out the door to the gate of the clinic.  As I placed a hand on his shoulder, he grabbed my hand and fervently shook it.  At that moment I felt something I have experienced quite frequently over the past few weeks here- a reminder of why I wanted to become a doctor.

entrance to the clinic

Working at the eye clinic has been an enlightening, sometimes strange, yet often affirming experience.  Many of the rules of American medicine have been thrown out the window- whether because of culture or necessity.  Medications which would be standard treatment in the US are unavailable in Dembi Dollo (and sometimes in Ethiopia, for that matter), the power frequently goes out without warning, on occasion female patients will breastfeed their children during their exams, and once a man blessed me for simply taking his blood pressure!

Having the privilege of working with great Ethiopian coworkers has made the experience all the better.  The first day I met Alami, one of the assistants at the clinic, she laughingly told me she thought I was 18 and that I looked just like "Dr. Larry."

me with the man I'm a "doppelganger" of, Dr. Larry Thomas

Alami proved to be an extraordinarily kind and helpful coworker- one of the nicest people I've met in Ethiopia, in fact- which was made all the more remarkable by the fact that she suffers from podoconiosis, a form of elephantiasis which causes one's legs and feet to swell up and often makes walking painful.  Tamima, another assistant, and Getahoon, one of the clinic guards, also provided many interesting conversations and did their best to make sure I felt at home.

Tamima, Getahoon, and Alami

A 15 year-old girl with a remarkable command of English named Hawi has worked as my translator at the clinic.  After her mother died from complications due to HIV and her father essentially disowned her, she moved to Dembi Dollo to live with the Daughters of Charity at their hostel for girls.  An Australian woman who regularly works with the Daughters of Charity has been applying for guardianship of Hawi, in hopes that she might move to Australia to fulfill her aspirations of becoming an eye doctor.

One of the most exciting aspects about working at the clinic was being able to recognize in real-life patients the ocular disorders and conditions I had learned about in my Physical Diagnosis course in the first year of medical school.  These included (described in layman's terms)-

Allergic conjunctivitis (pink eye)

Inflammation of the conjunctiva, or covering of the white part of the eye and inner part of the eyelid, due to some allergen rather than a bacterial or viral cause.  A large number of the patients at the clinic are affected by this, and usually have itchy eyes and sometimes tears.

Glaucoma

An increase in pressure in the eye leading to damage of the optic nerve, which transmits visual stimuli to the brain.  Patients with glaucoma lose peripheral vision before losing their central vision.  Typically in the US, applanation tonometry is used to ascertain a patient's eye pressure, but at the clinic the Schiotz tonometer, a mini handheld plunger-like apparatus, is commonly used instead.  When screening patients for glaucoma, clinicians here will often feel a patient's eyeballs through their eyelids- a healthy eye should feel like the fleshy part of the hand below the thumb whereas a glaucoma-affected eye will feel considerably harder.

Cataract

A clouding of the lens which causes a decrease in vision, and also one of the main reasons I'm here in Ethiopia.  Cataracts are one of the major causes of blindness in Ethiopia, and the eye camps run by THAF in conjunction with the Daughters of Charity aim to restore vision by providing cataract surgery in regions where cataract surgery is not readily accessible.  Cataracts can be caused by aging as the lens gets larger or by trauma, and has been associated with exposure to UV light and smoking.


Keratoconjunctivitis sicca

Dry eyes which typically occur in post-menopausal women.  It can also be associated with autoimmune disease called Sjogren's syndrome.

Pingueculum

A harmless raised area on the conjunctiva of the eye

Pterygium

Derived from the Latin for "wing," a pterygium is a harmless growth of the conjunctiva (covering of the white part of the eye) horizontally towards the cornea (clear front part of the eye).  These can prove problematic when they grow so much that they cover the cornea and block the patient's vision, and are associated with exposure to UV light.

the eye clinic

As much as I thought I had learned about and memorized in first year, there were still many more conditions patients came in with which were completely novel to me-

Vitamin A deficiency blindness

Vitamin A plays an important molecular role in the eye in converting photons of light into signals to the brain.  A lack of Vitamin A has also been linked to a decrease in secretions which would normally keep the eye clean, putting those afflicted by the deficiency at increased risk of eye infection.

Macular hole

What I observed in clinic was likely a pseudomacular hole since the patient's central vision wasn't affected- a real macular hole is a break in the macula, or the part of the retina (back of the eye) responsible for central vision.

Phlyctenulosis

A raised area on the eye commonly associated with Staphylococcus infection or tuberculosis.  Phlyctenules can occur in the conjunctiva- the covering of the white of the eye- or the cornea- the clear central part of the eye.

Ocular rosacea

Ocular rosacea typically occurs in older fair-skinned people, which made it all the more interesting when a young, dark-skinned Ethiopian girl came into our clinic with this condition.  She had patches of dry, discolored skin on her face, neck, and back, and burning and tearing in her eyes.  Interestingly enough, she also had the phlyctenule described above, a common symptom of ocular rosacea.

Hematoma

The boy in the picture above came into clinic one day and pushed a mass, which was tucked into his lower eyelid, completely out of his eyelid as seen in the picture.  The ophthalmologist, Dr. Samuel, suspected the boy had a mass of blood (hematoma) and sent him to the hospital to have it removed.

One non-ocular infection I learned about at the eye clinic is called noma.  When I first saw the poster for Noma posted on one of the clinic doors, I assumed that it was depicting uncorrected embryological defects in children and adults.  Yet upon doing more research, I found that noma is actually a gangrenous disease which has largely been eradicated except in poorer regions of the developing world, and which causes rapid destruction of facial tissue.  Click here to see a picture (warning- image may be disturbing).

The clinic not only provides the requisite medical care a clinic should provide, but also provides a sort of societal benefit as well.  Clinic patients pay a deeply discounted rate for their procedures and medications, and exams are completely free of charge.  Poor members of the community are identified by the clinic staff, and these patients simply pay whatever they can.

An elderly woman with bilateral cataracts came in one day accompanied by her young grandson- she had essentially lost her vision aside from the ability to detect light.  Her and her grandson's clothes were old and beginning to wear down, and when Sister Evelyn served the boy a plate of food, he ravenously scarfed it all down.

***

On another day in clinic, an 11 year old boy who couldn't stop smiling came in with his grandma.  He eagerly listened to all of my conversations with his grandmother, peeked at everything I wrote on her card, tried to help with her eye test, and even listened as the nurse gave the medication instructions.  I discovered that he wanted to become a doctor, so I let him take the eye test himself, listen through the stethoscope, then look through the ophthalmoscope.  It was a remarkable thought that, should this boy continue pursuing his goal of becoming a doctor, he could not only raise his own economic level, but better the lives of other Ethiopians as well.

Into the Wilderness

"If they do not stop denuding the trees, soon they will have nothing nothing nothing!"
-Sister Evelyn  [The Ethiopia Lonely Planet guidebook states that over 95% of Ethiopia's forests have been denuded thus far]

On Sunday, June 23rd, I found myself bouncing along a bumpy dirt road past baboons and jungle foliage as UNHCR trucks raced past.  Beside me in the old Toyota Landcruiser, a stone-faced Ethiopian driver pushed on the gas while behind me, a small but effervescent Filipino nun named Sister Evelyn provided commentary as the landscape sped by.  I had  parted ways from the rest of the group and flown out of Addis Ababa earlier that afternoon and journeyed to the airport in Gambella, a town in western Ethiopia near the border with South Sudan.  From there, I had met up with Sister Evelyn and her driver en route to the town of Dembi Dollo, which lay three hours up the mountain from Gambella.

Map of western Ethiopia- Gambella on the far left, Dembi Dollo at the red "A" marker, and Addis Ababa on the far right

There was a palpable sense of excitement in the air as we bounded down the unpaved road, deeper and deeper into the forest, bordered on either side solely by wildlife and plantlife without any sign of human inhabitance.  As the truck climbed further up the mountain, the temperature began to drop as did the rain.  After a quick "bathroom" stop, we headed back into the car and drove in the pouring rain past rolling pastoral landscapes.

My mom has been requesting I post a picture of myself... so Hi Mom!

The nicest view I've ever had while using the "bathroom"- even better than Namsan tower in Seoul

About an hour after we had left Gambella, we saw our first houses on the mountain- thatched huts lining the side of the road.  The landscape at this higher elevation reminded me of Kauai- reddish-brown dirt, mountainous terrain, no shortage of rain, and lush, green tropical foliage.

An hour and a half later, after passing by two weddings, a number of men peeing on the road, and kids who excitedly shouted "China!" as I passed, we arrived in the town of Dembi Dollo, which would be my home for the next two months.  It was time for the real work to begin.

West of Djibouti

Mention the town of Shashamane to a resident of Ethiopia, and he or she will inevitably mention the Rastafarian population there.  It seems that in the 1950s, Emperor Haile Selassie (formerly known as Ras Tafari) designated 500 acres of his land for use by Rastafarians from Jamaica.  These Rastafarians, who basically revered Haile Selassie as God, settled in and established what would become modern-day Shashamane.  One plausible explanation for the high rates of crime in the town is that Rastafarians believe in the spiritual use of marijuana, the use of which could lead normally peaceful people into violent acts.

In the midst of this Rastafarian community sits one of Ethiopia's few schools for the blind.  At the Shashamane school, visually impaired children complete their primary education, with some eventually going on to become lawyers.  It's a pretty remarkable feat considering the fact that many blind Ethiopians are kept inside 24/7 by their families to the point that their muscles waste away and atrophy due to disuse.

the dining hall at Shashamane School for the Blind

canes for the students

handiwork made by the blind students

All is not perfect at the school- behavioral problems are especially pronounced because of students' frustration with their visual limitations.  Still, the students are able to accomplish an enormous amount, and even play soccer during their free time with a ball wrapped in a plastic bag (so they can hear it).

The school had ended for the summer by the time we arrived, and all the students had left for vacation, save for one young girl named Bantu.  After touring the school, we packed Bantu and her belongings in with us for the car ride back to Addis.

Along the four hour ride back to the capital, we made another pit stop, this time at the Kuriftu Resort in Debre Zeyit.  Entrance to the resort required the purchase of a buffet and kayaking package, so we made our way to the buffet line, where all-you-can-eat pasta, beef roast, and brownies [the first and so far last time I've seen brownies in Ethiopia] were served up to diners while Rihanna and country music played from the speakers overhead.  With the help of a waitress, Bantu loaded her plate up with injeera, the Ethiopian sour pancake-like bread.  Nearby, some Arab women in burkas ate their fill of brownies and trifle, while at another table, a group of Westerners chatted while their adopted Ethiopian children raced each other around the table.

After filling ourselves, we hopped in kayaks and paddled around the lake, with Joey taking Bantu on her first ever kayak ride.

The wealthy owner of the Kuriftu resort is said to be half Arab, half Ethiopian, and as we headed out, I spotted a prominently displayed picture of him with a certain infamous personality.

 The owner of the resort with everyone's favorite ex-Libyan dictator Muammar Gaddafi

As we exited the Kuriftu resort and with it the town of Debre Zeyit, we merged onto the highway leading westward out of Djibouti.  This highway was populated with big rigs transporting shipped goods from the ports of Djibouti all the way to the Ethiopian capital of Addis.  As our pace slowed due to the traffic caused by these trucks, the music of "Gangnam Style" and Justin Bieber playing on Ethiopian radio carried us into the night.

Adventures on the Ethiopian Plains

If you peruse a map of Ethiopia, you might notice that a string of lakes runs from central Ethiopia all the way to the country's southwestern border.  These lakes, which were formed at the time of the Ice Age, sit in the depression of the East African Rift Valley, which stretches from Eritrea/Djibouti, through Ethiopia, then southward to Mozambique.

 cliff overlooking Lake Langano

It was at one of these lakes, Lake Langano, that we stopped for a breather en route from Project Mercy to the town of Shashemane, about three hours southeast.  The instant we stepped into the bathrooms at the Sabana Beach Resort overlooking the lake, I knew we were in a different part of Ethiopia.  These bathrooms, far from the smelly, unkempt holes in the ground that served as restrooms in some other parts, had actual toilets and boasted facilities that rivaled those of higher-end hotels in the US.  After dining on steak sandwiches, tilapia, and spaghetti, we headed out to a nearby wildlife preserve.

It seems looks can be deceiving- the water of Lake Langano was as clear as mud, yet it is (one of the) only lakes free of the parasites which cause schistosomiasis

In what was the closest I will probably ever come to an African safari, we strode straight into the grazing fields of such fauna as ostriches, gazelles, and warthogs.  Pumbaa from The Lion King these warthogs were not, as everytime they heard one of us within 30 feet of them, they would dart clear across the field and out of sight.

ostriches, warthogs, and gazelles... oh my

As tempted as we were to turn in for the night at the Solana Beach Resort at Lake Langano, we figured we had better make our entry into the town of Shashemane- a town known for its dangerous streets and criminals.  Lucky for us, we had a mission in this den of thieves- to find a young blind woman named Bantu and bring her home safely.

The Strangest Dream

Since I've arrived in Ethiopia I've had the strangest dreams, whether from the change in location or anti-malarials I'm on.  The most bizarre of these started off with Justin Bieber and ended with grisly carnage (although rest assured, JB was entirely uninvolved with the grisly carnage for those of you Beliebers out there).

The dream opened when I found out that I had won two tickets to a Justin Bieber concert after calling in at just the right time to win a radio contest.  I then proceeded to contact many of my high school friends to see who would be interested in joining me at the Bieb's concert.  When I caught up with one of my friends, she was talking about how the TAs for one of our classes had been lenient in grading our last paper- she had been given 30 points back out of sheer grace, which had given her a solid "A."  When I checked my grade, however, it turned out to be a B-/C+ which left me utterly depressed.

After sitting in on lecture for the class, which turned out to be on religion/philosophy, I made my way to the second story of a hotel, where it turned out an entire waterpark/resort was contained, and where a raging party was occurring.  I ran into some of my friends from church at the party, then made my way over to watch some of the competitions.  One of these competitions consisted of people riding bicycles with ropes tied to the rears.  The riders would ride until the ropes suddenly yanked them violently a few feet back.

Strangely, none of the riders seemed hurt until someone tried this same stunt with a motorbike.  When the rope pulled back on the motorbike, both bike and rider went flying backwards, hurtling into the nearby pool and resulting in a sea of blood.

Such are the dreams of a prescription druggie.

Mercy

"I once asked her what it was like to run a Christian organization in a Muslim territory.  She replied in a thoughtful, measured cadence, 'You cannot walk around with a Bible.  But you can walk.'"

-Dr. Larry Thomas, regarding Marta Gabre-Tsadick, founder of Project Mercy



Our entry into Project Mercy must have been entirely underwhelming to the denizens of the community, who just a few hours earlier had  played host to the American ambassador to Ethiopia, the president of USAID, a US Senator, and hundreds of other guests.  The occasion had been a celebration of the approval of a major USAID grant to Project Mercy to support the development of a hybrid cow to produce milk for the malnourished people of the region.  Marta Gabre-Tsadick, founder of the project, had no less a distinguished past than many of the prominent guests that day- she had been a member of Haile Selassie's inner circle and the first woman senator of Ethiopia.  After being forced to flee the country with the rise of the Derg, she and her husband returned to found Project Mercy to aid the area with community development programs.

The four of us- Dr. Thomas, Sean, Joey, and I- arrived in a slightly disheveled state just as the dust had begun to settle from the day's event at the project, and shared a light dinner with Marta and her husband Deme.  We were also joined by their daughter and grandson from Philly- their grandson was the spitting image of a young Barack Obama- as well as Thomas, a Princeton in Africa fellow finishing his year teaching at the project, and Angelique, an Air Force officer who had arrived to assist with the day's festivities.

It wasn't until the following morning, however, that we were able to fully appreciate all that Project Mercy had to offer.

main courtyard

 

guesthouses  

Our tour began with the gardens where crops such as corn, olives, and avocados were being grown.

Bacon grapes were all the rage

We then continued on to the basket weaving area, beehives, stables, and girls' orphanage where a few of the orphans (or "housekids" as they're called at Project Mercy) recited Bible verses for us.

basket weaver

 the stables- Instagram style




 where the "housekids" lived
  

Joey, Dr. Thomas, Angelique, and our tour guide

chillin like a villain

 

a surreal scene of Middle America in the midst of southern Ethiopia

After visiting the housekids, we journeyed up the mountain, stopping first at the worship center, then at the kindergarten.

heading up the mountain

travelers heading down the mountain

Most striking of all our stops was the Glenn Charles Olsen Memorial Hospital, owned and operated by Project Mercy, which ran completely counter to my ideas on what a rural Ethiopian hospital would be like.

hospital reception area

Not only was the hospital well-staffed, relatively clean, and (strangely) low occupancy, it also boasted modern radiology equipment, a fully-stocked pharmacy, and a laboratory conducting most all of the standard tests one would find at a typical US hospital.  According to the nurse who gave us our tour, the top three reasons for surgery at their hospital were fistulas, benign prostatic hypertrophy, and goiter.

condom man says use your head

the hospital conducted an extensive variety of laboratory tests

Larry and the nurse who gave us the tour of the hospital

One of the more shocking aspects of our tour was less an indictment of the hospital than of the local culture.  In the "Family Planning" room of the hospital hung a poster depicting ways in which blood-borne infections could be spread via common cultural practices.  The first practice was that of removing a child's canine incisors, which is believed to relieve headaches or other ailments.  The second practice was that of female genital mutilation, which is unfortunately still commonly practiced in Ethiopia.  Those I spoke with about this practice said that although it is horrific, mutilation rates are decreasing, though it will take a good deal of initiative and effort by local Ethiopians to continue to advance that trend.

as if to counterbalance the atrocities of the poster, someone had posted a hopeful message near the bottom

As we descended back down the hill to the main settlement, we stopped by the maternity village a short distance from the hospital.  The village, a project cofunded by USAID, allowed expecting mothers with the potential for high-risk pregnancies to stay nearby the hospital should they need immediate medical attention.

We closed off our time at Project Mercy enjoying some time playing sports with the housekids.  A seven-year old boy named "Cesai" eagerly exclaimed "Frisbee!" when he spied one in my hand, and proved to be remarkably adept at throwing the disc.

playing basketball with the kids

Cesai

As I tossed the Frisbee back and forth with Cesai in the middle of that idyllic field in Ethiopia, I suddenly became aware of how different my life was at that moment than it had been a month and a half prior- when I had been locked in a library for two weeks straight cramming as many facts and figures into my head as possible.  With this realization, I felt a sense of thankfulness that I had been able to make this trip and for the ability to enjoy a moment of complete tranquility.