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.