Faith healers and Health Extension Workers

Wednesday, 5:30pm: Rain pelted the windows as I sat in the back of the van with seven men, interviewing a young woman about administering health information in the Gondar region.

We were pulled over on the side of the road on the outskirts of Gondar city, asking the woman about her role as a Health Extension Worker. This eight-year-old program trains and employs women to provide basic health education, information and supplies to each kebele (small municipality) throughout Ethiopia. The HEW program responds to the limited formal health care in the country, with very few doctors and nurses to meet the population’s needs.

We were meeting with the woman, whose name translates to “Love,” to learn more about the role of HEW and if/how they could be helpful to the rabies plan.

We (Danny, Javed, Niraj and myself, plus our three guides/translators from the University of Gondar, and our driver Amhara) were sitting in the van because of the rain outside, and because the HEW’s post was far away.

Surprisingly, this wasn’t our first van interview of the day. We started the afternoon by visiting the health station near Gondar city. The Ethiopian health system has a set structure operating from the kebele to the regional level. The HEW operate from a local kebele post and visit families door-to-door. Above them is a health station, with nurses. Above that is a health center. And the highest level of care is provided at the hospital level, but only two main hospitals (in Addis and Gondar) can provide a wide range of health services.

health infrastructure

health infrastructure

At the health station we could meet with a HEW coordinator. Our van idled for a few minutes in front of the short cement building while the team members discussed with our hosts what we wanted to ask. A young woman approached our van to ask what we wanted. Our hosts spoke with her in Amharic, and then the young woman left and shortly returned carrying an umbrella over the head of another woman, wearing a white coat. Sister Abanesh entered the van, sat in front and answered some of our questions about Ethiopia’s 17 health priorities which the HEW workers focus on. She was the coordinator and managed six HEWs. But we didn’t get to talk to her long, since an angry man also wearing a white coat soon approached our vehicle. He was the director of this health center and did not appreciate that we were holding an informal meeting in the van. We needed to speak with him formally.

So we got out and walked to his office in the health station compound. On the walk we saw some cool posters promoting different positive health behaviors, which the marketing team (me and Danny) were very interested in for our part of the project.

Poster depicting meningitis vaccination

Poster depicting meningitis vaccination

We filed into the director’s office, sitting in chairs around his desk. He spoke with our three university hosts in Amharic for several minutes first. We don’t know exactly what they said, but it seemed to be an argument about why we didn’t ask him to visit in advance, why we didn’t speak with him directly and acknowledge his role as director and leader of the health station. The argument grew a bit heated, one of our hosts took out his ID to show his position at the university, and eventually we were told that we would be leaving. We all filed out of the office, but our hosts and the director continued talking outside. The GAP team walked a little ways down the hallway platform. After several more minutes, our hosts apparently made an agreement with the director, because we were told we could continue our interview. We all filed back into the office. The director answered our questions about the training and reporting processes for HEW, and Sister Abanesh gave us some pamphlets that they use for family health education. One important thing we have learned is that, while there is an overall 40% literacy rate in Ethiopia, almost all households have at least one child who can read, and so the child will read information for the whole family, leading to an almost 100% literacy rate at the household level. Then they showed us the storage area where they keep the vaccines cold.  Javed, Akilew, Niraj, Director, Sister Abanesh, Danielle, Danny We left with smiles, thank yous and handshakes all around, then drove to our second van meeting of the day – this one less confrontational, thankfully.

It is worth noting that the health station is located in a Jewish area just outside Gondar. We saw a house with a wooden Jewish star outside painted blue and white.

Our first meeting of the day had been no less surprising. We met with a group of faith healers who were having their association meeting at 9am. We all gathered behind their shack in downtown Gondar, which had posters for remedies like aloe vera curing HIV.

Aloe Vera

Aloe Vera

We had heard that a lot of people in Ethiopia use traditional or faith healing (bahwali hakeem in Amharic) instead of or in addition to modern medicine, especially the rural population. Since 90% of Ethiopians live in rural areas, we really wanted to understand our “competition,” if you will. Thankfully, our university guides Akilew and Debasu had contacts with them and were able to set up a meeting.

Consistent with what we had learned about Ethiopian culture, the association was quite hierarchical, and though we directed our questions to the group of about seven men and one woman faith healers, for the most part only the chairman responded. We asked about their motivation for becoming faith healers (for some it was a change from their strict religious backgrounds, for others it was passed down in their family), and if they had or would ever collaborate with doctors or other medical scientists in their treatment. We were pleasantly surprised to learn that they are open to collaborations, especially with treating dogs who have rabies, since they admit to difficulty treating animals.

We then visited a vaccine storage facility, a health clinic, and a vet clinic (with a very sad-looking chicken outside). The veterinarian told us they had administered 500 rabies vaccines since March, and showed us their cold storage (rabies vaccines have to be kept cold – one of the challenges in warm climates like those in Africa) and even a sample vaccine, which came from India.

Katie lifts a rustic barbell outside the health clinic

Katie lifts a rustic barbell outside the health clinic

After our morning meetings, our host Tameru suggested we go to Hotel Taye for traditional Ethiopian coffee. In the second floor lounge area a woman was roasting coffee beans and cooking ground coffee in a traditional pot over hot coals. Rose petals were strewn in front of her cooking area.

coffee ceremony

coffee ceremony

It was a very long, insightful and rich work day which lasted about 12 hours, and I retired early to be well-rested for what will surely be another full, surprising and enriching day.

And go!

From our first few days in Ethiopia, we knew we were out of our element. Nothing seemed normal and our expectations were nothing close to what we were experiencing, if only for the fact that we had no idea what to expect. These expectations continued to evolve as we started our first real work day of the project. After having a brief meeting with one of the key stakeholders of our project, we took the walk to the University of Gondar’s Veterinary Medical Campus to meet with some of our partners.

Our research team!

Some of our research team!

After a brief introduction session, we dove head first into the nitty-gritty of our project, and were impressed by the passion and knowledge that our hosts maintained.

During the meeting, we partook in a delicious traditional Ethiopian coffee served out of a ceramic craft,

The BEST Coffee!

The BEST Coffee!

and snacked on some sort of toasted barley snack (called cookies and kolu) that was ridiculously addicting. One thing we as business students struggle with is ambiguity. We like structure, with specific meeting times, tight agendas, and set objectives. Ethiopia is really, really putting our team to the test and we have had to put our faith in the idea that everything will work out. Also, it’s Ethiopia. Everything is flexible.

Today we scaled back our anxiousness and began to accept and even embrace the unknown. A great example of this was with an outing with our marketing team. After meeting back with our hosts after lunch, we walked over to the main U of Gondar campus to start knocking on doors until we found a Marketing and Cultural Anthropologist professor to talk with. This happened with no advanced email, no phone calls, nothing. Unfortunately, we found that all of them were out of the office due to an emergency meeting to try to prevent protests and the subsequent government crackdowns that are happening in other regions of Ethiopia from happening in Gondar.

So what do we do next? Our gracious hosts asks, “Who do you want to see now?” As we flip through our list of people, throwing out the last hour and a half’s worth of prep work he had done for the meetings we were supposed to have, we suggest talking to someone who works for the national telecommunications company. We get the simple answer, “no problem.” So our host calls our driver and twenty minutes later (five minutes before closing) are walking up to the office of the district manager of Ethio Telecom (imagine the guy in charge of Verizon for all of Columbus). Our host introduces us and we talk for the next thirty minutes. This was shocking and amazing from American standards because not only did he take a meeting with us without an appointment, he stayed after the workday without thinking twice about it. We began to feel more at ease as since we only have three more business days in Gondar before going back to Addis Ababa, and having no meetings “scheduled” for the next three days will not create a barrier for us.

Something that we are also not used to is being in such a hospitality based culture. Today was Niraj’s birthday (Happy Birthday Niraj!) and our team mostly forgot about him. His wonderful fiancée Priyal did not though and sent him with lovely messages and a box of chocolate buckeye’s, giving him a little taste of home. So as we were about to sit down for dinner, Danny and Danielle were talking about how they had stopped for pastries with one of our hosts, and Niraj pointed out, “What, didn’t bring me back any cake for my birthday?” So after Danny and Danielle pulled their head out of the sand, they asked the front desk if they could do something special for him, either like a cookie or a piece of cake. At the end of dinner, they roll in blasting an Ethiopian happy birthday song with this!  In the 45 minutes since we had mentioned this to the front desk, they had run out to a store and got him an amazing birthday cake with candles, creating a magical Ethiopian Birthday for Niraj. photo(3)

Happy Birthday Niraj!

Happy Birthday Niraj!

This goes to show the love and care of the Ethiopian people, and they have continued to share with us their warmth and acceptance as guests in their country.

“John of Gondar”

Day 4: Gondar City-

May 5th (Monday) is an official holiday in Ethiopia and all government offices are closed. However, a subteam of our Gondar hosts had promised to make time to meet us at 1.30p. We decided to go to explore the city and check out the local market before our meeting. What an adventure it turned out to be!

First, we went to a souvenir shop which was filled with great local craft pieces – including wall hangings, dolls, decoration pieces, clothes, shawls, musical instruments and many other interesting pieces. Even though we promised ourselves that we will window shop, seek comparisons, not fall victim to impulse decisions and try our bargaining skills, the moment of truth was interesting. The pieces were so beautiful that it was hard to resist the urge, especially since we would automatically make mental calculations of how low the dollar-converted costs would be!

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Our first real adventure of the day was right outside the souvenir shop where a group of 2 young boys approached us and tried to “exchange” a 20 dollar bill for an interesting story. Their concern was that they had an “old” 20-dollar bill from 1981 which the local merchants would not accept. They wanted the nice Americans to help them by exchanging it for a newer bill since we could easily pass it on when we got back home. We had an interesting dialogue about the authenticity of the bill and in the end decided to agree to disagree.

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From there we got in the van and were taken to the local market which was bustling with activity of every sort – from fresh vegetables to chickens to clothes, utensils and hardware. Almost everyone we met was extremely friendly with smiles all around. We all noticed that many of the shopkeepers spoke very good English and didn’t try aggressive approaches to sell to the visiting “freinji” (local word for light skinned foreigner). We also noticed that there were quite a few women entrepreneurs who confidently ran their shops.

During this visit to the market we happened to stumble upon John, a 10th grade student who made our day! There was something about his demeanor that put our whole group at ease with him. We struck up a conversation with him to find out about how he loved fashion forward shoes which he then converted to soccer shoes when his 5 brother team rule over other kids in the neighborhood. He told us about his dreams of becoming a doctor one day and serving his nation. We not only got great advice from him about which fabric to buy or how to avoid fast colors but also got a pleasant surprise – an offer to show us where the beautiful fabric was weaved by the locals.

We had set a deadline for ourselves to leave the market by noon so that we could head back to the hotel, have lunch and get ready for the 1.30p client meeting. However, the offer was just too good and all of us make a group decision to flex our time in favor of this unbelievably authentic experience. John took us through the market until we reached a semi-residential area where small shacks housed families as well as a cottage industry of 1-2 person manufacturing units. John showed us where a person was hard at work at a small hand-powered loom weaving a beautiful fabric from threads of cotton. John would later also show us where the raw picked cotton was sold and along with the bobbins used to convert piles of raw cotton into thread which would then be used in the weaving process.

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On our way back, we were taken thru another route in the neighborhood where we saw ladies cooking the day’s lunch. John took us to one of the ladies and we were able to see how pancake type batter was first prepared and then poured over a heated plate to make Injeria – the staple of the Ethiopian diet. As we watched this process, we were surrounded by many curious and smiling children. For some reason, they found trust and comfort in the faces of Danny and Niraj—whose hands they held and started to walk thru the alleys back to the market. Only after we reached the van did they finally say smiley goodbyes and went off their way.

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As we said farewell to John, he offered to take us on more experiences like this should we choose to. Since he was off school for the summer, he was willing to take time off from soccer and show us around while someone covered his shop. A definite stop that we all agreed to put on our itinerary was the visit to the Jewish blacksmiths. Knowing of the historical struggles of the Ethiopian Jewish community, this experience was a must have.

Oh how lucky we got with finding John!

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We got back to the hotel recounting our many adventures (some of which we couldn’t list here) in time for our client meeting. We ended up having a 3 hour meeting with them and then a 3 hour strategy session which shed new light into how to proceed with our mission in Ethiopia. Tomorrow is a packed day and if things go well, a packed week full of work.

We can’t wait to meet up with John again!

Drive from Addis to Gondar

Screeeech! Thump.

I braced myself against the back seat of the van and waited to see what had happened. Our driver for the day pulled over to the right side of the road. A goat herder in a white turban carrying a walking stick approached us. To our left, the goat we had apparently just hit ran to the grass for safety. Kids started slowly collecting to our van like filaments to a magnet. Our driver and guide got out, while the guide’s beautiful young wife stayed with the rest of us. The seven of us looked at each other in shock and confusion. “Close the doors,” Ale said, as the crowd gathered. Javed and Niraj got out and stood at either side.

The goat herders, our guide and driver walked to the grassy area on the left, where the goat stood, its face bloody. They were talking in Amharic, arguing from the looks of their dramatic arm gestures. Our guide picked up the goat several times, perhaps weighing him, or indicating that he wasn’t badly injured. On our right, children from around ages 4-14 gathered. They had varying hues of dark skin and eyes, with closely cropped hair, a few shaved in geometric patterns. Big bright eyes, open and looking, mouths smiling when we smiled. By then, we had determined the temperature of the situation and had opened the door. To entertain the kids, Alejandra recited the few words in Amharic she had written down: “Hello,” “Nice to meet you,” “What is your name?”

Kids

Kids

On our left, the men were still arguing, lifting the goat.

Back on the right, Alejandra asked, “Should we count to ten and impress them?” So she did. One of the kids told us her name in perfect English. We looked at each other in awe. “Pencil?” another one asked. But we didn’t have any pencils available; everything was packed in our luggage and loaded in the back.

The driver came back to the van and got money out of the glove compartment. He brought it to the goat herders; later we found out he paid 500 Ethiopian birr, or the equivalent of $25. Our guide walked back to the van carrying the goat upside down by his legs. Some of us started clearing room for him, but others loudly refused. We had three more hours til Gondar, and barely enough space for the 10 of us and our luggage as is.

* * *

Banana stand in Addis

Banana stand in Addis

The day had started about 10 hours earlier, when we left Addis Ababa bright and early 6:30 Sunday morning. Plenty of people were walking to church wearing thin white shrouds, sheer fabric wrapped around their hair and bodies like a toga.

We were surprised to notice many runners up the steep hilled streets around Addis. Lots of men running, stretching, doing push-ups on the side of the street.

Banana, people at church, Rift Valley

Banana, people at church, Rift Valley

As we drove further from Addis, crowded city streets gave way to houses and shacks further apart. The soil was red. We passed a cement factory, horses, donkeys, people herding cattle, oxen and goats. After a few hours the elevation grew higher, the air grew colder and thinner as we approached the Rift Valley. We stopped for gas, some kids approached us and we gave them some marbles.

The Rift Valley was extremely winding and extremely beautiful, mountains full of clouds and trees. A baboon ran across the road, then another and another, and we saw about seven or eight in one small curve of the road, including a mom holding her tiny baby. Near the top, women and children were selling plates of fruit, and Alejandra bought two full plates from a woman with intricate tattoos (either a pattern or script writing) covering her neck. It cost 60 cents for all the bananas and limes we then ate.

Rift Valley

Rift Valley

It got warmer as we descended, and then cooler again once the elevation once again rose.

We stopped for lunch in the afternoon, during a rain storm. Out of the restaurant window we saw at least two wedding processions around the street’s roundabout, including several donkeys wearing woven blankets, songs pouring out of cars, bajajs (small three-wheeled rickshaws), guys dancing in the back of a pick-up truck and dump truck, and the wedding parties wearing flowing outfits. By the end of our weekend, we’d counted over 10 weddings (asseh in Amharic).

Niraj stays classy with bottled water

Niraj stays classy with bottled water

We bought some cake for the road. Some of us were carsick and took more medication. Further along the route we encountered the beautiful light of the setting sun, people of varying skin tones and clothing styles carrying wood down the side of the street, and eventually, the goat.

* * *

After the guide heeded his wife’s quick response to our unease with the goat’s accommodations, and piled the goat onto a bus that had just stopped, we continued in the deepening dusk to Gondar. The roads were very winding and trucks were using their high beams in the dark. Our driver was exceptional, however, at navigating the potholes, sharp turns, people and (almost all) animals with grace and precision. We arrived in Gondar just before 9pm, grateful to have made it to our destination, to no longer be crunched in the van, bouncing around with luggage, and thankfully no goat.

Arrival in Addis Ababa

Fifteen hours is a long time to spend on a plane. But it makes sense when the journey you’re going on is to such a different place from Ohio as Ethiopia.

tracking our flight

tracking our flight

We had a smooth flight. There were many adorable yet crying babies on the plane, so sleep was limited. The arrival process was fairly smooth and quick too. Asres, our kind guide from the University of Addis Ababa, met us at the airport and drove us to the hotel.

The hotel helped us hire a driver who took us to the Piazza area, a busy center with many stores, cafes and restaurants. We had our first cup of strong Ethiopian coffee at the popular Tomoca cafe, and then walked around to find places to meet our basic needs: an ATM, pastry shop (!), and phone card for additional cell phone minutes.

Tomoca Cafe

Tomoca Cafe

Some things we noticed our first day in Addis:

Traffic: is basically organized chaos. There are few street signs and street lights, many roundabouts, tons of cars, buses and pedestrians. Yet everything flows together somewhat smoothly. Cars drive very close to each other and people, yet somehow nobody got hurt (at least not yesterday. Carla mentioned that Addis has one of the highest car accident rates in the world). Also, horn honking was surprisingly low and considerate.

Poverty: Yes, there is poverty here. We saw some small areas that looked like shanty-towns where the houses were basically concrete slabs with simple corrugated metal roofs and tarp walls, and many people begging or sleeping in the street. A few little kids came up to Danny and Niraj, grabbing onto their pants and begging them for money with their sweet little smiles and open hands. For the most part we ignored beggars, but brought little trinkets (pencils, marbles) that we will give out to kids during our trip.

Busy, bustling street life: Even amidst some poverty, many cafes were full of people drinking coffee and tea, eating snacks, relaxing and talking with friends on a Friday afternoon. People waited in long lines for buses that choked the streets. There were people working; with many active construction projects in progress and tall buildings scaffolded with long wooden poles.

 

Coffee

Coffee

Friendly and polite: We met several locals who were willing to help our clueless tourist selves navigate language barriers with bilingual assistance. One very kind shop owner helped us add minutes to our Ethiopian cell phone, and several times people helped me (Danielle) while I was waiting in line to buy something, (apparently) looking confused. Thank you, kind people!

Prices: We knew the cost of living here would be much lower than US standards, but we still experienced reverse-sticker-shock when buying things. One doughnut and three cups of tea cost about $1(total!) in a cafe, and our delicious meals at the hotel restaurant were about $3-5 each.

 

Painting in Hotel Taitu

Painting in Hotel Taitu

Style: The women in our group had been concerned about wearing appropriate clothes here, wanting to blend in and dress modestly. But I was surprised by how fashion-forward many of the women in Addis are. Skinny jeans, colorful makeup (especially bright lipstick), trendy hairstyles (braids, twists and side-sweeps), and leopard-print scarves are popular here. Many women wear stylish hair coverings made from sheer, jewel-edged fabric or with varying patterns. Cute flats and some high heels were spotted too, though I’m glad we were advised to wear comfortable shoes for walking.

Rain!: There was a very strong thunderstorm yesterday afternoon. Some of the streets were muddy.

ViewMost strongly we have notice scenic beauty with mountains in the background, colorful flowers everywhere, lots of trees and birds… mixed with exhaust from so many cars and buses. We keep seeing hints of other places we’ve visited or lived in here. The traffic reminds Niraj of India (but minus the cattle), the beggars are less aggressive than those Alejandra has encountered in Peru, and the narrow elevators remind Carla of Tel Aviv. The beautiful landscape and flowers look like Hawaii, and the hustle and bustle, busy activity and organized chaos remind me of New York City.

View

View

Overall, we’re so happy to be here and can’t wait to explore more!

Off to Ethiopia!

Seven Master of Business Administration students from Ohio State’s Fisher College of Business will visit Ethiopia for three weeks in May as the in-country portion of our Global Applied Projects class. The class is taught by Kurt Roush and advised by Professor Scott Livengood.

We are: Javed Cheema, Katie Fornadel, Carla Garver, Alejandra Iberico Lozada, Daniel Meisterman, Niraj Patel, and me, Danielle Latman. Combined, we are from three different countries, have traveled to almost 70 countries, and have 65 years experience in sales, marketing, operations, financial services, nonprofit and military industries.

The Ohio State / Ethiopia One Health Partnership asked us to harness our business skills to help operationalize the partnership’s rabies elimination project, adding a layer of practical implementation to the research and training that veterinarians and scientists have already developed. We have split up into teams focusing on the finance, marketing, operations, logistics and data collection functions of the rabies elimination project. Our goal is to develop a proposed roadmap that will allow the U.S. and Ethiopian partners to implement the rabies elimination One Health model project on a targeted region in Ethiopia.

We will travel to Ethiopia from May 1-25 to work with officials in Addis Ababa and Gondar. For the past seven weeks, we have met with the CDC, Drs. Gebreyes and O’Quinn, cultural anthropologists and social service agencies to prepare for our trip. We have also eaten at the lovely Lalibela restaurant here in Columbus, received our travel visas, and gotten a lot of shots — and were dismayed to find a shortage of the yellow fever vaccine in the U.S.!

For all of us, this will be our first time visiting Ethiopia and sub-Saharan Africa in general, and we are excited for what are sure to be many new and rich experiences! We are looking forward to exploring the natural environment of the Blue Nile Falls and Simien Mountains, driving overland from Addis Ababa to Gondar, seeing the history of ancient castles and churches, visiting marketplaces and drinking delicious coffee with each other and our new colleagues and neighbors. We are thrilled for the opportunity to contribute our business skills and passion to build on the One Health Partnership’s success and help eliminate rabies in Ethiopia.

From left: Katie Fornadel, Alejandra Iberico Lozada, Daniel Meisterman, Danielle Latman, Niraj Patel and Carla Garver. Not pictured: Javed Cheema.

From left: Katie Fornadel, Alejandra Iberico Lozada, Daniel Meisterman, Danielle Latman, Niraj Patel and Carla Garver. Not pictured: Javed Cheema.