Operating Room Haiku

Iodine stained walls

Rhythmic click of fan above

Sight returning soon

Days in Gambella

walkway at the Baro Gambella Hotel

Every morning at the eye camp we would rise early in the morning for an egg breakfast at the hotel before heading out to Gambella Hospital where the day's work would take place.

 the group at breakfast

 

bajajs we rode to the hospital one morning

 setting up in the operating room

When we arrived at the Gambella hospital that first Saturday, we found to our dismay that the hospital lacked running water.  Our only option to remedy this problem was to transport plastic yellow jerry cans full of purified water from the church down the road to the hospital.  Rolling blackouts were not uncommon, and occasionally Dr. Samuel would have to close up a patient's eye halfway through surgery until electricity returned to the operating room.

 tree full of bird's nests outside the operating room

fallen bird's nest

During the times I was not in the operating room or assisting the patients waiting outside, I would spend my time helping out in the eye clinic, where patients were readied for the surgery.  Those who wore a piece of tape above either eye indicating an operable cataract would enter the clinic, where we would perform keratometry and biometry to obtain a measurement of the patient's eye.  From these measurements, we could determine what size lens Dr. Samuel would need to insert during cataract surgery.  During this time, we would also clip the eyelashes of the eye to be operated on, and take the patient's name and age.  Though the cataract surgery was free for all patients, we charged 50 birr (about $2.70) for the medications patients would use after the operation.

performing biometry on a patient

If anyone believed that all Ethiopian women were oppressed, one need look no further than Sister Kaffa, a Daughter of Charity in her early 20's, as an exception to that rule.  With a big personality, a big voice, and a big smile, Sister Kaffa would not hesitate to speak exactly what was on her mind.  Her intolerance for disorder and noncompliance was matched only by her sense of humor and love for Ethiopian pop star Teddy Afro.

Sister Kaffa's primary role at the eye camp was intake- registering patients' names and ages, and collecting their money for medications.  Since the patients' names were typically in Nu'er or Anuak, languages as foreign to Sister Kaffa as they were to me, her attempts to record patient names often turned comical.  After a patient would calmly state their name, Kaffa, having never heard these names before in her life, would incorrectly repeat the name back to the patient.  Across the room, an eavesdropping nurse would overhear Kaffa's mistake and repeat the patient's name a little more loudly.  Still struggling to understand, Kaffa would restate the patient's name incorrectly a second time.  Finally, the kids poking their heads through the clinic window to observe the happenings inside would all shout the patient's name in unison, at which point Kaffa would understand and, with a big laugh, would record the patient's name correctly.

If obtaining a patient's name seemed difficult, however, it was a walk in the park compared to figuring out a patient's age.  Many elderly Ethiopians never had a birth certificate and thus had no way of knowing their true ages.  One patient with graying hair stated he was 10 years old, while another young-looking patient claimed he was 120!  Still others saw the question as a sort of trivia game in which they were the hosts and we were the contestants, replying with such cryptic answers as "I was one year old when the Italians invaded."

In the meantime, the rest of the clinic would be no less chaotic.  Dragonflies would find their way inside, zipping back and forth as they crashed into patients and staff alike until finally getting knocked out by the spinning fan above.  Some of the blind patients would often get confused or just impatient and start pushing the other blind patients around them, leading to full-blown fights between blind people which required us to intervene.

 view from the hospital

Some of our younger patients provided some much needed comic relief.  One twelve year old boy came to us telling us he couldn't see the board in class and wanted his eyes checked.  Yet upon visual exam, his vision came up 20/20.  It turned out that his mother was having a baby in the maternity ward across from the operating room where Dr. Samuel was performing cataract surgeries, and he had grown bored while waiting and figured he would get his eyes checked to pass the time.  Another day a crazy three year old boy wearing a pink hoodie and no pants ran back and forth through the hallways doing karate moves and mugging for no one in particular.

One of the strangest and funniest conversations I had with two teenagers waiting outside the clinic went as such-
Teenager:  "What's up?"
Me:  "Not much.  What's up with you?"
Teenager:  "You don't know what is up because you are doctor.  We know because we are nigs."

***

One day a local news crew, having heard about the eye camp, came to the hospital to interview Dr. Samuel.  Dr. Samuel characteristically declined, since doing an interview would rob him of time he could be spending on additional patients.


***

Our first day in Gambella, we also had the chance to visit the town of Abobo, 20 miles south of Gambella.  Though we had gone to scope out possible future camp locations at the clinic there, we culminated our visit with a trip to the Abobo dam.  For some reason, officials were worried that if they allowed pictures of a certain bridge in town or of the dam at Abobo, terrorist attacks would ensue, and thus photos of these structures were illegal.  We quickly snapped some shots anyway.

***

One morning as I went down the line of patients waiting to undergo cataract surgery, I came across a small elderly woman who was missing the piece of tape above her eye which would indicate which eye was to undergo cataract surgery.  As I motioned back and forth between her eyes to ask her which eye had the cataract, she eagerly grabbed my hand and pointed my finger at her left eye.  The woman's daughter, standing nearby, reacted with a mixture of amusement and embarrassment, laughing and putting her hand to her face, in a manner which reminded me more of American mannerisms than Ethiopian.

The daughter, who spoke English well, turned out to be a worker at a dispensary far out in a remote corner of the province of Gambella, and had also brought her husband and young son- a fan of John Cena and aspiring wrestler- to the eye camp.  She said she worked alone at the dispensary and that things were often slow because visitors needing medication could be few and far between.  Still, it struck me that without people like this woman, who was perhaps the only healthcare provider the people in her area would ever meet, medications for an array of conditions would be entirely inaccessible.  It dawned on me that sometimes it's the unknown people doing the least glamorous work that are the true heroes.

The Man from South Sudan

In the midst of our breakfast one morning at the Baro Hotel in Gambella, a tall man with the characteristic horizontal forehead scars of the Nu'er people and clad in a black suit approached our table.  "Good morning," he said in a jovial manner.  "My name is David and I am the ambassador from South Sudan to Ethiopia."

It turned out that one of the Nu'er men who had joined us at dinner the previous night had spotted David at the restaurant and explained the goals of the eye team to him.  "My son is also from America, visiting here with his mother," David explained, gesturing to the young boy sitting at the table next to us. "This is his first time in Africa and he hates it here," he laughed. "He's asking for hamburgers, complaining about the heat, and refusing to eat his food because there's so many flies on it."

All was not well with the two-year old nation of South Sudan, which David reminded us was the youngest country in the world.  Though Ethiopia and many other countries were supporting her, the new country lacked the necessary infrastructure to achieve anything resembling stability.  After living through decades of fighting, the South Sudanese people knew the culture of war better than the culture of peace and couldn't fully comprehend the needed shift in mentality to build South Sudan into something prosperous.

As we later found out, conditions deteriorated even further in the weeks after our meeting with the ambassador- land disputes and historic rivalries between people groups in the eastern South Sudan province of Jonglei, the province bordering Gambella, eventually led to mass violence and the displacement of over 100,000 South Sudanese from their homes into the wilderness.

And shortly thereafter the president of South Sudan fired his entire cabinet in what was interpreted to be the final move in a power struggle between him and his vice president.

Amidst the discussion of political issues, Dr. Samuel piped up.  What was the level of medical services available in South Sudan?  Inadequate, came the answer.  The capital city of Juba possessed decent but insufficient medical services, and the rest of the country fared far worse.  As we headed out, a few members of the group asked for David's contact information.  David assured us he would stop by the eye camp at the hospital later that day and provide the information then.  When night fell at the hospital we realized David hadn't made an appearance.

Perhaps he got caught up in his official business, or perhaps he never truly intended to visit us at the hospital.  Nevertheless, the figurative door was open.  South Sudan was in need of ophthalmic services, and Dr. Samuel and team were only too ready to serve should the opportunity arise.

The Restorer

Dr. Samuel (far left) checks the vision of a patient after cataract surgery 

Dr. Samuel Bora Imana projects such an air of tranquility that if I didn't know he was a Christian, I might think he was a Zen Buddhist.  Soft-spoken, patient, and wise, he's one of the most laid-back ophthalmologists I've ever met, which, if you know any ophthalmologists, is saying something.  Born to humble origins in Aira, Ethiopia, to farmer parents, he excelled in school and gained acceptance to Ethiopia's top medical school, Addis Ababa University.  Though he initially trained as a general practitioner, he later became an ophthalmologist after witnessing how transformative ophthalmic surgeries could be, and is now one of the 80 or so ophthalmologists in Ethiopia, a country with a population of nearly 90 million.  When he was offered a position to teach at Addis Ababa Medical School, he declined in favor of working with Tropical Health Alliance Foundation and the Daughters of Charity, which allowed him to fulfill his desire to provide services to the poor.

Dr. Samuel has been called "the best ophthalmologist in Ethiopia" by the former ophthalmology division chief at the Loma Linda VA, but he's also the kind of doctor who will apologize for reaching past you to empty a syringe mid-surgery even though it's actually you, not he, who is in the way.  He's the type of person who prefers the simplicity of the farming town of Aira to the urban sprawl of Addis Ababa, and the type of doctor who will pause for five minutes to explain a teaching point with illustrations even though he still has thirty patients left to see.  His intention was always to practice medicine in Ethiopia, not in higher-paying countries like many of his classmates intended, and his prayers always include the patients he will be treating.  The very rare occasions when he raises his voice are, in his own words, to use it as his only weapon during surgery to a patient who refuses to hold still, thereby risking the integrity of his or her eye as well as the outcome of the procedure.

Dr. Samuel with his last patient at the Gambella camp

Arriving at the Gambella hospital each morning during the eye camp gave me a small taste of what it may have been like to live during the time of Christ.  Hundreds of people who had been waiting since the early morning would turn and watch Dr. Samuel and our team as we entered, gazing expectantly, in hopes that we would be able to cure their optic ailments.  Some would cry out to be examined, or even reach out their hands to tug on our clothing.  For many, because of their limited access to any healthcare providers, this could be their one and only opportunity to regain sight, and many had traveled hours, days even, for the chance.  Being treated almost like a god could go to many people's heads, but astonishingly, Dr. Samuel maintained his humility despite the extreme reverence afforded him.

I've observed that the people who achieve greatness in one sense of the word are driven as if by some invisible force.  These people accomplish superhuman feats stemming from a sense of urgency not to build up themselves and their own reputation, but to fulfill some sort of need in the world.  For Dr. Samuel, that motivating force seems to be the millions of Ethiopians who lack access to eye care.  This same force also seemed to carry him through 276 cataract surgeries in one week, almost as many as the typical Ethiopian ophthalmologist completes in one year.  "If we have one more lens left, I feel we need to use it," he said. "If we return home with unused lenses, I will think to myself that there were more people who could have been able to see."

Child Guides

Before traveling to Ethiopia, Larry and Dr. Guzek, a Washington ophthalmologist who supports and performs cataract surgeries at the eye camps annually, had told me about the high prevalence of child guides leading the blind around in Ethiopia.  They were interested in finding out the extent of these child guides and the economic and social effect of having a child lead a blind person around- if it required them to miss school and, in turn, earn lower wages.  So Anne-Berit, a nursing PhD student at UCSF, Mario, and I discussed and brainstormed how we could get to the heart of this issue in the months leading up to our trips to Ethiopia.

Once I arrived here, it would have been hard not to notice the many children leading the blind around.  In fact, one day in clinic a young boy of about seven years old entered the gate pulling an elderly blind man named Kajela behind him.  Alami and I asked the boy about his situation- Was he a relative of Kajela?  Was he being paid to help?  Did he need to miss school in order to lead Kajela around?

The boy's answers were far more innocuous than we might have suspected.  His family was neighbors with Kajela.  Although Kajela had children of his own, they were tired of taking care of him, so the boy's mother, feeling sorry for Kajela, directed her son to help lead him to the eye clinic.  Although the boy wasn't receiving any money for being a guide, he wasn't missing any school either, as he was on summer vacation.

As we investigated further into the issue, it seemed we had opened a Pandora's box.  Trudie, a Peace Corps worker in Dembi Dollo, explained that from her observations, education wasn't a very high priority for the typical person in the area, regardless of whether or not a family had a blind person who needed to be led around.  She had seen that children were regularly kept home from school by their families if they were needed to help in the fields or around the house.  Although children were required to be present in school a minimum number of days to progress to the next grade, in her conversations with a government education official, he had admitted that, in actuality, many students who did not meet the required attendance were still advanced to the next grade.

At the Gambella eye camp, we began implementing surveys we had designed to the patients waiting to receive cataract surgery and discovered additional complexities.  Some of Jango's public health students who helped us administer the surveys seemed mystified by the questions.  One student informed us that the family was a tight-knit unit in Nu'er culture, so if one member was in need, the others would do whatever they could to help- so it was a given that children would help guide an elder if he or she were blind.  Furthermore, their families were often large enough that children could switch off in their duties so that, even if they had to miss school, they would only miss a minimal amount.  Another student chimed in that he had only observed children guiding the blind after school, meaning our questions about missing school were essentially non-questions.  These comments revealed that the child-guide situation was much more nuanced and complex than we had initially believed, and that a sufficient understanding of the situation would require, as a prerequisite, a much deeper knowledge of Ethiopian culture than we possessed.


Ultimately, the boy who had led Kajela to clinic returned the next day with his mother.  He excitedly pointed me out as the one who had taken his picture the previous day.  It seemed the whole experience had been, on the whole, fun for him.  Will we ever know the whole story about Ethiopian child guides?  For now, we have to accept the fact that we have likely only scratched the surface.

Entering Gambella

 

 our truck on the way to Gambella

"Malaria is like a friend who comes to your house and won't leave."
-Gambella resident, referring to the frequency with which malaria was contracted in Gambella

When I first told my Ethiopian-born classmate I would be working at an eye camp in Gambella over the summer, she was shocked.  "You know those pictures of Africa you see in National Geographic?  That's what Gambella is like," she warned.

So when I arrived in Gambella the afternoon of Saturday, July 6th, I was expecting something like this-

courtesy of National Geographic

and ended up seeing this-

Although the town of Gambella was more developed and structured than I had imagined, the people we encountered seemed straight out of the pages of National Geographic.  Everywhere we turned, tall, thin, dark-skinned people walked gracefully, as if the town were populated by models.  If the Oromo language prevalent in Dembi Dollo was the mellifluous tones of Japanese, then the language of these people, the Nu'er, was the harsh, seemingly-angry sounds of the Cantonese dialect.  The Nu'er men bore horizontal scars stretching across their forehead, as a demonstration of their masculinity, and the women of another group, the Anuaks, bore sticks and nails through their lower lips, from which to hang jewelry.

Gambella's distinction as virtually another country within the country of Ethiopia stemmed not only from its lower elevation, but its history as well.  The British, wishing to take advantage of Gambella's prime location as a port city on the Baro River, a tributary of the Nile, controlled the town during the beginning of the 20th century.  Gambella later fell under the jurisdiction of Sudan, which explains why the Nu'er people who largely reside in Sudan comprise a significant proportion of Gambella's population.

Gambella's proximity to Sudan and, as of 2011, South Sudan resulted in a influx of Sudanese refugees into the area.  Sudan has been a place of unrest for the past 50+ years, suffering through two civil wars, the Darfur genocide, the cleavage of the country into Sudan and South Sudan, famine, and continued violence.  The UNHCR (UN High Comissioner for Refugees) trucks I had seen on my initial arrival in Gambella had been headed to the town's sub-office, which helped to manage the large number of Sudanese refugees.

According to an Oromo infectious disease nurse and public health instructor at the Gambella hospital named Jango (the invisible "d" is silent), rates of disease were many times higher in Gambella than in the rest of Ethiopia.  As opposed to the 1% prevalence rate of HIV in Ethiopia as a whole, nearly 6% of the population in Gambella was HIV positive.  Furthermore, the prevalence rate of tuberculosis in Gambella was as high as 10%.  In treating ophthalmic patients in Gambella, we noticed a particularly high rate of trachoma- one of the primary causes of blindness in the developing world, which is typically contracted in poor, crowded areas- and band keratopathy- scarring of the cornea, the central portion of the front of the eye.

 baby with cleft lip whose family couldn't afford surgery

Due to the refugee situation and the unusually high rates of disease in Gambella, a number of foreign NGOs (non-government organizations) were set up in the area to provide assistance.  Johns Hopkins-affiliated Jhpiego, with the aid of US initiative PEPFAR (President's Emergency Plan for AIDS Relief), had provided funding to a center for HIV/AIDS testing in the Gambella hospital.  The Red Cross, Franklin Graham's Samaritan's Purse, and many other non-profits had all previously or currently worked in the region.

sign outside the Voluntary Counseling and Testing center

As we unpacked and set up all of the eye camp equipment in the hospital the Sunday after we arrived, we knew we were in for an interesting week.  If only we had known just how interesting it would be.

Mossy Foot

As Sean, Joey, and I made our way to the auditorium of the clinic in Addo, a large crowd of people gathered outside began clapping and shouting "lelelelele," an Ethiopian way of expressing joy.  Confused, we exchanged glances with each other, wondering who inside the auditorium the people were cheering for.  By the time we had entered the packed auditorium, the noise had grown to a dull roar and the realization hit us- they were all cheering for us.

We had journeyed to the nearby town of Addo in order to learn more about podoconiosis, a disease which causes one's legs and feet to swell up.  The disease, which affects nearly 1 million in Ethiopia, is a major focus of Tropical Health Alliance Foundation's efforts in the country, and gained further awareness after efforts to fight it were discussed in the bestselling book Crazy Love by Francis Chan.

Podoconiosis, or "podo" for short, is caused by the absorption of certain types of metals particularly common in volcanic soil into the human body.  Over time, the immune systems of people with a genetic susceptibility to podo attack these metals and immune cells accumulate in lymph nodes, leading to a build up of fluid and the swollen appearance characteristic of the disease.  So far, no treatment has been developed to reverse podo, although wearing shoes seems to effectively prevent the disease.

the Addo auditorium

 "Who here has been personally victimized by Regina George?" ...sorry, couldn't resist

The three of us had only expected to observe the happenings at the clinic and chat with some of the patients there about their experiences with podo, so we were largely unprepared for the overwhelming reception that greeted us.  The hundred-plus attendees in the auditorium expected speeches from us, so Sean and Joey posed questions to the audience.  It turned out that nearly everyone in the room had podo, and a large majority understood that they had contracted podo because they had walked in the soil barefoot.

What was surprising to us was that 2 out of 5 people with podo feels constant pain, and that the majority of those treated for podo at the Addo clinic were women.

We also learned about the numerous challenges facing those with podo.  While some patients could not even afford shoes, others who could obtain shoes noted that the shoes available to them often broke after a few months.  Still others had feet which had grown so large that they could not find shoes that fit.

Near the end of our session in the auditorium, a man from the audience rose to address everyone.  As he spoke of his parents and others like them, whose feet hurt so badly that they could not even leave the house to buy shoes or come to the clinic, tears began to fall from his eyes.  One by one, the other members of the audience began to weep as well, as they commiserated with the man and his parents' situation.

Following our time in the auditorium, we moved to the outside faucets where podo patients came to wash their feet.  Proper and regular feet washing is often not practiced due both to cultural norms and lack of access to clean water.  Though podo cannot be reversed, keeping one's feet clean can help alleviate symptoms of the disease.

During the feet washing, some of the patients took the time to share their stories with us.  One man in his mid-30s related how he had been an avid soccer player in his younger days until he contracted podo, his feet  now permanently disfigured and disabled.

Efforts by organizations like THAF, the Addo clinic, and the Mossy Foot Project in southern Ethiopia are making headway in educating people about and treating people with podo, but as we saw, podoconiosis is still a reality for many and challenges still remain.

Celebrity

When I traveled to Yunnan Province, China in 2008, the students from the countryside there thought I resembled the pop star Wu Chun.

A picture of Wu Chun- you be the judge

Thus far in Ethiopia, I [thankfully] haven't been told I look like any local celebrities, but the sensation of feeling like one is perhaps even more pronounced.  Because the town of Dembi Dollo is a rather close-knit, homogeneous community, newcomers are strikingly apparent, and even more so when the newcomer looks entirely different than the rest of the town's population and dons blue scrubs and knee-high clam-digging boots everywhere he goes.

It's slightly bizarre to enter the town "cinema"- a room full of benches and TVs playing B-action movies- and realize that everyone in the audience has shifted their attention from the movie to you.  Or to walk through the roundabout in the center of town and feel the unflinching, soul-piercing glares coming at you from all sides.

Trudie, a Peace Corps volunteer who has worked a year here in Dembi Dollo, has theorized that the residents of this town have so little contact with foreigners that they have essentially "other-ized" them, in effect viewing foreigners as some sort of non-human entities.  While some of my experiences have lent credence to this theory, the excitement in the eyes of most of the children who spot me on the road leads me to believe that a sizable proportion of the population here is genuinely- and innocently- curious about these people who look and speak so differently from them.

One time, when our car was stopped to pick up a sick man to take him to the hospital, a few kids spotted me in the passenger seat and began running up to the car to shake my hand.   One little boy, confused as to what the other kids were doing but aware that he should be following them, imitated the others by shaking my hand then looking around at his peers to see if he had done it correctly.  I've even had experiences where young kids no older than 7 will spot me riding along in the car, and happily chase the car all the way down the road, gathering more and more children along the way.

two girls who would shout hi at me then run and hide when I waved back

kids playing in the dirt

On another occasion as I was riding to clinic, a stranger hopped into my car and started asking me about myself, explaining that he had seen me walking through town and wanted to meet me.

candid poses

One day during my lunch break at the eye clinic, I took the opportunity to explore the nearby area and stumbled upon Bethel Church.  Curious as to what the local Protestant churches in Dembi Dollo were like, I poked my head through the gate and spied a man inside motioning for me to come in.  Upon entering, I found the man and some of his fellow teachers supervising a group of elementary school children, who were whispering and giggling nervously.  One by one, the teachers directed their students to introduce themselves to me, and they each mustered up the courage to deliver their carefully practiced phrase, "Hi, my name is _____ ."  One of the teachers directed me to continue on to the rear of the church, where the church's school for Kindergarteners to 3rd graders was celebrating its last day of classes.  As the principal came up to greet me, I heard a low rumble emanating from the classrooms as the kids scrambled to get a better view of the foreigner who stood in their school courtyard.

I'm not sure it's possible to know real joy until one has seen 210 four to ten year olds dressed in bow ties and dresses pushing their heads out their classroom windows and doors, smiling from ear to ear, shouting "China!" and screaming with delight when I waved to them.

I acknowledged that it almost seemed self-serving to knowingly enter a school where I knew I would be the center of attention, but as my entrance had been solely serendipitous, I decided to enjoy the moment for what it was and share in the joy of the students.  Unfortunately, I didn't have my camera that day, but in some ways that may have been better- the memories of that visit are now purely memories, unadulterated by the distorted recollection produced by a digital image.

Life in Dembi Dollo (or The Summer I Lived with Nuns)

"The weather here is quite erratic.  Just like my mind."

-Sister Evelyn [The weather in Dembi Dollo typically shifted from sunny to stormy and back to sunny again within a matter of minutes.  Sister Evelyn typically shifted from serious and business-minded to silly and random within a matter of seconds.] 

The town of Dembi Dollo lies near the western edge of Ethiopia in the province of Oromia, and is one of the major coffee producers for the country.  It is home to a largely Oromo population who speak Afan Oromo, the fourth most spoken language in Africa, as their primary language and Amharic, the national language of Ethiopia, as their secondary language.  Due to Dembi Dollo's elevation over 5,500 feet above sea level, the weather changes rapidly and at times giant clouds envelop the town in a giant mist.  The average household salary is not particularly high, and most families can only afford to eat meat about four times a year.

The Daughters of Charity, with whom Dr. Thomas and Tropical Health Alliance Foundation have partnered, live in a compound in the Danka district of Dembi Dollo.  They've had as guests the founder of Toms Shoes, the son of a prominent actor on "24," and many other less famous but equally, if not more, humanitarian-minded people.

the compound (my room is the second window from the right)

Water-collecting tanks funded in part by THAF

Sister Kaffa and Sister Evelyn on the way to visit some neighbors

A surefire way to jumpstart a conversation here in Dembi Dollo is to bring up the quality of the roads.  Though I enjoy the unpaved nature of the roads here, which are alternately like the Indiana Jones ride when dry and like a muddy Slip-n-Slide when wet, most residents of the town can hardly bear it.  In fact, most of the major roads in the rest of Ethiopia are now paved, save for the majority of the province of Oromia here in Western Ethiopia.  Though the Oromo people are, population-wise, the majority in the country, they have little power politically, and they view the poor quality of the road as emblematic of the injustices perpetrated on them by the governing Amhara and Tigray people from the north.

building a road in town

abandoned Shell gas pumps

dogs often sleep in the middle of the road, oblivious to cars nearly running them over

old car parts on the side of the road

Kids and teenagers can often be found along the roadside playing foosball and ping pong.  I didn't realize until after I had been playing with them for a week that I was supposed to be paying each time I played.

the Dembi Dollo "cinema"

the Dembi Dollo supermarket

A billboard urging people not to practice female genital mutilation

Wednesdays and Saturdays are market days, when people from near and far descend on the city center to sell and purchase goods from coffee to high heel shoes to live chickens.

The smells of animal feces, various spices, and body odor combine in the marketplace to produce an overwhelming, to say the least, olfactory experience.

woman at the market selling butter in mini ice cream cones

This woman was actually very happy when I showed her the picture I had taken.  The baby, on the other hand, was still terrified of falling.

Ethiopian cuisine initially reminded me of Indian food, as both offer various curry dishes, lentils, and flat bread- injeera for Ethiopians and naan for Indians.  Some of the more well-known meat dishes include doro wat, chicken and eggs cooked in a spicy curry-like sauce, and tibs, which is sort of an umbrella term to describe many varieties of grilled meats.

A typical meal at the compound- noodles, beans, and lentils

Though breakfasts at the compound typically consist of pancakes or fresh pita bread, the Ethiopian dish "fir-fir," or scrambled injeera, is also served.  My favorite discoveries thus far have been the deep-fried foods, including samosas, deep-fried leaves, and fried potato slices.

fried leaves dipped in batter

Everyday around 10 am in clinic, we have tea time, with all the staff convening in the break room to sip tea loaded with sugar and munch on deep-fried balls of dough.

"biscuits"- aka extra-fried doughnuts

One afternoon, Mario, a medical resident who just finished his intern year, and I had a chance to help prepare injeera by pouring out the injeera batter onto the pan to cook it.  We quickly discovered that we needn't quit our jobs to become injeera cooks, as it was quite difficult to pour the concentric circles which form the injeera without leaving any gaps.

Another afternoon, I had an opportunity to witness a Toms Shoes distribution at the church across the street from the compound.  Large white bags of shoes had arrived from their manufacturer for distribution to the various groups who would then venture far out into their communities to distribute the footwear to children who lacked them.

Despite its quirks, Dembi Dollo has a certain charm that only a town with bumpy, unpaved roads and misty, fog-filled days can.  And at the end of the day, the nuns' compound is a nice place to find some rest after a long day's work.