10-15-2010 0800 EST 19 Buzzards Bay Ave Woods Hole MA. Well, if it quacks like home and it smells like home and it feels like home then...then it is! Back into the windy quackings of a `noreaster, but a kind of friendly version of one..a lot of water and wind during the night, and now mostly wind. Fuji the little dog was happy to see me, and it was quite a kick to drink the water out of the tap. Probably the water in Addis was fine, but since "everyone"said not to drink it, I didn't .But then, I didn't do malaria prophylaxis either; never actually saw ,heard or felt a mosquito, and we didn't go low
The 6 hours in Business Class alta luxe of the Lufthansa Frankfurt airport, which does not actually have any wurst of any kind, but does have a very upscale 8 option button coffee and cocoa dispenser, was not that bad.I got a of work done comparing the two proposed medical education curricula that I have been tasked with comparing,and also sorted some of of the pictures taken. (Usually I just do the electronic equivalent of sliding them into a box on top of all the others from previous rolls). And the trip on across the North Atlantic was relatively short and sweet...business class, it makes me a little sorry I am not in business.As it happens,the bus to Woods Hole was expected 15 minutes after I got through customs. I made kind of a point of not knowing exactly when...I'm trying to figure out ways to decrease travel anxiety, and not knowing things like that turns out, for me, to be essential. Then Ray, my Woods Hole neighbor, got on the bus at South Station, coming back from a day of self directed research at the Harvard Library, so I learned more about his underwater archeology as I started falling asleep towards the end of what was actually a 24 hr travel time.
So waiting on the computer was a note from Suzanne that makes it clear I didn't write anything about my visit to the ER at St Pauls Hospital, which should have gone into the Day 14 dispatch.
This was in no way a scientific study, but having hung around Emergency Rooms and Departments (since they have grown into almost small hospitals of their own in the USA) in various parts of the world, I wanted to see what was happening at St Pauls, one of the better developed and staffed hospitals in the Ethiopian public health system. This is the hospital whose general medical curriculum I am reviewing also. (It was initiated by Haile Selassie, and has a large tryptich painting in the front entry way,showing Ras himself in various poses of lifegiving and bountitude). As we all know, if you want to talk ER docs, come in the morning. If you want to see what they do, come at night. So it was already dark when we arrived, and there was already a crowd. The ER is an add on..single story, about 800 square feet including the roofed but open waiting area to the left, and the triage area inside t he door to the right. Further inside, there's a kind of multipurpose moving around area, with the nursing station to the right, and a room labeled Nurses Duty Room, which looked like an office cum sleep room, and was closed. The multipurpose room stretches across the whole 30 feet of the building, and leading back from are a hallway with small rooms to the left, and a 12 bed double sided open ward with curtains, to the right. Guerneys to the left, sit-able patients to the right. Behind the desk, which if the entrance is to the North, is on the West side running E-W, with the open ward, running NS across the multipurpose room right in front of it.
Yes, it might be easier to send a picture, but we're getting to why I didn't save any pictures.
The joint was jumping, although no acute street trauma arrived while I was there. (Ambulances are associated with hospitals, and not a big presence...very few sirens in Addis..my guess is that most of the drivers are still professionals, speeds aren't that great yet, so the amount of closed head injuries per capita is still low...but just a guess. In Hanoi, as they added motorized trishaws, things got very bad...and when we were there 15 years ago, they still didn't have a working CT, so I helped with the first and only burr hole placement I've ever done, based on clinical exam as to where to drill the hole). There were two or three interns..meaning docs enrolled in the medical education program who have been certified as physicians (each medical school does its own, there is no national standard) and a resident, plus an older man in a white coat and hospital nametag whom I didn't meet who acted like an attending, but definitely was not making the disposition decisions. There were several young women in green scrubs who were acting like nurses (lots of moving around, hands on both charts and patients, putting charts in front of doctors), but not speaking Amharic mean't that I wasnt overhearing any conversations to be sure. What the nurses were not doing was procedures...the person I saw missing three IV insertions was certainly doing all procedures, and perhaps was a more advanced nurse rather than a rotating advanced medical student. Name tags were not much in evidence.
They use a 'surgical side'/ 'medical side' system...very common everywhere and easy to use. Charts go up into two holders on the nursing station desk as medical or surgical.They move from in to out depending on progress of the diagnosis and treatment, and may be filed in a bank of chart holders along one wall, for example as t hey wait for paper results. Lab work is slow, taking minutes to as long as an hour. This lab wasn't doing lactates, for example. A basic complete blood count might take 30 minutes. Plus,probably due to the not very complete safety net of medical expense coverage, at least in one case the family had to go across the way and apparently purchase, or sign for, the gloves, iv tubing, fluid and medication to treat their loved one. They brought it back. by hand.But the actual catheter, the ones that they missed with three times, came froma drawer behind the nursing station.
What was the matter with people? A obviously very ill manwith a major pneumonia, prob HIV plus tB. A man with an oxygen cannula taped up one nostril breathing at a rate of 30/min and with 8 meds on his home med list. Two men with painful abdomens and high white counts. A woman in her third trimester, first baby,who didn't feel good. An older woman whose right foot didn't smell good and with a fever. In other words, some of the same things as are the matter with us in any hospital here.
But don't get injured in Ethiopia,not yet. And, come to think of it, if you have to get sick emergently, get sick in Oakland.. The system I saw is a lot like the state of ER's in the USA in the 60's...before EMTALA ( 1986) the transportation based law that provided the impetus for much of the emergency system we see today. Emergency medicine everywhere has always been driven by neglect...since post-war periods in the US, our non support of routine neighborhood care has ensured ER visits for non emergent situations..while EMTALA ensures penalties for not providing care for medical problems (...the 'AL' part of 'EMTALA' refers to 'Active Labor',and one of the major triggers for that happened on my watch, so to speak, when our health plan operator could not find a specific woman on the list of people certified for care, and a private hospital decided to transfer a woman in active labor, whose baby died. Vale,Sharon). There will be changes...the note from Suzanne says they are involved in a project to assist with emergency medicine in Ethiopia..but the changes aren't there yet. In most Ethiopian hospitals, the ER is just that, a room where you come with an emergency.
As I was hanging out, muttering into my Flip camcorder, using the sound as a voice recorder and not paying attention to the picture part, a man about my age who had been in a group with one of the patients (Crowd control is as difficult as it would be at Highland in Oakland if there was no door on the ER there) came over and demanded 'who are you?' I had my name tag on,but not a white coat. He spoke not too much english,but was clearly concerned about my presence. Crowds in every country gather rapidly in situations like that. Luckily, before a major incident occurred, another family member with good english started translating,and it turns out he was only concerned that I might be taking pictures. And thats why, for good ethical reasons, I dont have any pictures to share.
Level of care? Hmm...certainly way better than Delhi 15 years ago, or Jamaica 20 years ago. Probably in terms of infrastructure about like Garberville CA in the 60's...definitely not up to Jackson Memorial or Mission Emergency in the late 60's. But the diagnoses I heard were right on, and a training plan that included nursing training and job descriptions comparable to ER nursing in the US will fit right in. A few used CT scanners would help. ..St Pauls has only really had an ER for a few years, and just started their residence training program. And I am hoping that as a country they will look for something like CALS, the Combined Advanced Life support system of teaching and certfication that was worked out by some family docs in Minnesota...instead of the overly possessive non integrated combination of ATLS, ACLS, and PALS that I had to struggle with in my life as an ER doc.
So the 'noreaster is still prowling around, its time to join Sala for breakfast (what a joy!)and then go check the boat for water level before settling down to my comparison work...on the other side of the world.
But somehow,I don't think the next dispatch from Addis is that far off!
salama
alan
Tuesday, October 19, 2010
Ethiopia 2010 Day 15
Tekemt 3, 2003 0900 Bole Apartment, Addis. Oh, did I forget to say that we are in the year 2003? As you can read ( http://members.shaw.ca/ethiocal/ ) the calendar used here makes great sense for equatorial lands...you've just been pushed into the year 2010 by some Popish guy named Julian...think how different it would be if you were in the year 2003, as I am.
I made my maybe last visit to the family who live along the wall near the cathedral. All female, three kids and mom. Each time I notice more things, now that the initial shock of a whole small family living along a wall is easing. The kids are more relaxed. They dont seem to have any of the diseases of neglect. The little ones cough is gone. And they werent allergic to peanuts, thank you for cautioning me, Ellie. Today I had some of Kevin's left over loudly colored sweetened breakfast cereal (Puff-Pops or something), which generated intense interest. I'm glad that movie stars, who can, occasionally just gather up people like this and take them home. It doesnt solve any problems on a national level, but is that any reason to not alleviate suffering? I try to emulate Aminta...just give away what you can afford to give away. I think it fits with what i continue to read in Suzuki Roshi...I am also trying to work in a way that consumes the personalized traces of the construction process...to burn yourself up, leaving no trace in the finished work. Another take on the creative process.
They're down to two huge green John Deere tractors at the OiLibya gas station temporary storage. Presumably they are part of a Saudi sponsored rice farming project. I sure hope that doesnt intercalate with the big dam project. When several corporate sponsored schemes fit into a single resource extracting money making little value added much environmental destroyed picture, NOT doing said project to produce said picture becomes very difficult.
The power went off during the night sometime...long enough to soften up the sausages some previous occupant left in the apartment freezer, and it was still off when I came back from the walk.So I used up all my battery working on the power point, which I would like to finish before leaving. Its so helpful for people to have some more accurate idea of the magic, the 'emergent properties' of the student centered small group process that I've become quite passionate about sharing with anyone who will listen. Being there is, of course, the best. But any experience with things like this can be helpful.
Well, I got a chance yesterday at St Pauls. St Pauls was, as I think I mentioned, initiated by Haile Selassie, and moved to its present site above Merkato in the late 70's. Missionaries also contributed to its construction. Its a multi story hospital that, except for the low level of lighting that is preferred here indoors, might fit into a comparable era of building anywhere in the USA. It has a well developed internet 'cloud', thanks in part to the Tulane University initiated project that brought me here. And it has a medical school, with a curriculum that is lecture and organ system module based, as are the majority of medical schools everywhere in the english speaking world I know. The curriculum is very progressive (and only a few years old) in having very early clinical experience, a robust portfolio keeping and reflective practice requirement, and an admission process that encourages women and students from, literally, Afar.
So why dont they just adopt such a curriculum for the nation? Well, that might happen. So I jumped at the chance to attend a lecture in Module 4..which features Neurosciences..rather like the Brain and Behavior component of the UCSF curriculum.
Lectures are given in the School of Nursing building. I arrived for class at 8:30, but was told that the lecture was actually scheduled for 10:30 because the hall was being used for something else. So Direr, the driver of the Toyota SUV that is used by the Tulane program, and I went off to look for a small piece of cheap cheap ikash luggage that I needed to transport back the touristical items I've managed to accumulate. Direr and I get along well, so I understood at once that I needed to keep my narrow white face in the suv while he found the item, otherwise the price would inexorably double...nothing he could do about that. And so now I own a locally made synthetic fiber gym bag that thinks its an Adidas but seems more likely to be an Addis, given what I have been told about trademark enforcement. Then we drove up the hill, through the local markets, past the women woodcutters carrying large loads of eucalyptus branches, past the stands of eucalyptus that are parklike cleared by such women, past the small herds of donkeys with their humans trotting behind, and eventually to the Road from Hell in Heaven...worst road, best air, best view (of smog, unfortunately, its unmistakable from on top) and a nice break from city streets. Then back down again, arriving in time for a machiata coffee before going to class. As with any hospital/medical school, there are plenty of small coffee places unofficially snuggled up close. Then I went along, asked for help in finding the lecture hall for module 4, and was guided by a tall beautiful really blue black skinned man with decorative scars on his face and gentle perfect english who must have been 20 if that. A student.
The class, about 80 of them, were gathered in moveable student deskchairs in a lecture hall that could have held twice that many, but with low ceiling and almost no lighting (the flourescent fixtures were burned out). The chalk blackboard running across the front loomed in the dimness, unreadable. There was plenty of light outside, but little coming through the small windows. The lecturer, in a white coat with stethescope on neck, was explaining dress codes and responsibilities...the module was just starting. When he asked for questions, and a general buzzing started, I made my way up to talk to him. Fitzumberhan Girma is an MD, recent graduate, and hopes to continue as a medical educator. What now, I asked. The lecturer is coming...in about an hour...but the first real lecture will be tomorrow. What will the students do now, I asked, looking at the animatedly conversing group. Oh,I will keep them here for some time.
Hmmm. Well, my personal deal with myself is not to try anything strange for the first week in a new place, but this is day 15...so...
'Would you like to try a communication experiment with them?' I ask my new colleague. ' It would only take about 20 minutes...I can explain to you, and if you think it would be good, we could do it?' He agrees, and so, as those of you who know the contents of my teaching trickbag can guess...I did a dyad!
It takes very little time to explain how the exercise of listening and talking works; make a group of 2, one person talks for a minute while the other listens, then on a signal, switch roles. At the end, I extemporized, I'll ask you to combine in a group of 4, and at the end, I will ask one person from the group to report. OK
Talk about what? Talk about 'what I know about the skull' (the topic of the first lecture). Then, in a group of 4, choose one word that conveys what you would most like to learn about the skull.
Well, it took a little longer to set up, of couse. To get them laughing, I tried some amharic, and it always gets a laugh to make an agreement about no hitting, before asking them to agree to really talk and really listen, not combine the two. And they laughed when I said if they knew nothing about the skull, they could spend a minute sitting in silence.
If its possible to fail in a dyad, assuming basic language competence, I have certainly never seen it happen.
But whats the experiment?
Well, I wanted to see if this group of young students would get into it. Of course they did, with the usual happy increase in noise level. I put in the group of four process to produce a product, the one word...and got a great selection..ethmoid bone, cavernous sinus, cranial vault, petrous bone, eustacian tube, sphenoid sinus, frontal bone...and so on...
But I wanted to go a little farther, to see if some storytelling by an expert would be appealing. Because an expert, me in this case, can of course take any of those words and spin out a clinically or science based story about their personal experience with sphenoid infections (one of the more difficult diagnoses I have made, along with cavernous sinus problems), or how eustacian tube dysfunction leads to the clinical dilemma as to whether to treat middle ear infections with antibiotics. Do the students remember it all? Of course not. But it gives an expert a chance to jumpstart their lecture, and just by keeping a list on the board, and occasionally ticking off one of the student requests, it creates some back and forth. The next step, as Kosta did for years, is to create groups within the lecture that meet each session for a period of time within the lecture period to discuss what they have just heard. And all of these, I believe, are stepping stones to student centered inquiry directed learning.
But suppose there arent enough experts in the country? Suppose lectures devolve into boring recitations of recently boned up material given by a GP who is adverse to lecturing in the first place? It may be 'traditional' curriculum in the first world, but in other worlds, perhaps in Ethiopia, the idea of creating the infrastrucure to support a 'traditional' curriculum in as many medical schools as they need is, perhaps, not the best plan. But I guess it sounds good.....
I got some nice applause at the end, which I'm not deluded enough to think means much, but the students who came up ask questions afterwards did seem to appreciate the exercise. And I dont need to tell you how amazing looking and how alive THEY all were!!!
Well, I've used up all the time for dispatches on medical education. But actually, aside from a few machiato breaks with Oluma and a wonderful lunch with Yodit and her big brother who are part time farmers as well as educators and businessmen, I didnt do anything else. It will be much the same today, and tonight...the 11:55 to Frankfurt, a 6 hour layover (but thank god for the business class lounge with its showers and its edibles and its plush although Germanic banquettes with internet access), and then back to Boston and on to Cape Cod.
Aloha
Alan
I made my maybe last visit to the family who live along the wall near the cathedral. All female, three kids and mom. Each time I notice more things, now that the initial shock of a whole small family living along a wall is easing. The kids are more relaxed. They dont seem to have any of the diseases of neglect. The little ones cough is gone. And they werent allergic to peanuts, thank you for cautioning me, Ellie. Today I had some of Kevin's left over loudly colored sweetened breakfast cereal (Puff-Pops or something), which generated intense interest. I'm glad that movie stars, who can, occasionally just gather up people like this and take them home. It doesnt solve any problems on a national level, but is that any reason to not alleviate suffering? I try to emulate Aminta...just give away what you can afford to give away. I think it fits with what i continue to read in Suzuki Roshi...I am also trying to work in a way that consumes the personalized traces of the construction process...to burn yourself up, leaving no trace in the finished work. Another take on the creative process.
They're down to two huge green John Deere tractors at the OiLibya gas station temporary storage. Presumably they are part of a Saudi sponsored rice farming project. I sure hope that doesnt intercalate with the big dam project. When several corporate sponsored schemes fit into a single resource extracting money making little value added much environmental destroyed picture, NOT doing said project to produce said picture becomes very difficult.
The power went off during the night sometime...long enough to soften up the sausages some previous occupant left in the apartment freezer, and it was still off when I came back from the walk.So I used up all my battery working on the power point, which I would like to finish before leaving. Its so helpful for people to have some more accurate idea of the magic, the 'emergent properties' of the student centered small group process that I've become quite passionate about sharing with anyone who will listen. Being there is, of course, the best. But any experience with things like this can be helpful.
Well, I got a chance yesterday at St Pauls. St Pauls was, as I think I mentioned, initiated by Haile Selassie, and moved to its present site above Merkato in the late 70's. Missionaries also contributed to its construction. Its a multi story hospital that, except for the low level of lighting that is preferred here indoors, might fit into a comparable era of building anywhere in the USA. It has a well developed internet 'cloud', thanks in part to the Tulane University initiated project that brought me here. And it has a medical school, with a curriculum that is lecture and organ system module based, as are the majority of medical schools everywhere in the english speaking world I know. The curriculum is very progressive (and only a few years old) in having very early clinical experience, a robust portfolio keeping and reflective practice requirement, and an admission process that encourages women and students from, literally, Afar.
So why dont they just adopt such a curriculum for the nation? Well, that might happen. So I jumped at the chance to attend a lecture in Module 4..which features Neurosciences..rather like the Brain and Behavior component of the UCSF curriculum.
Lectures are given in the School of Nursing building. I arrived for class at 8:30, but was told that the lecture was actually scheduled for 10:30 because the hall was being used for something else. So Direr, the driver of the Toyota SUV that is used by the Tulane program, and I went off to look for a small piece of cheap cheap ikash luggage that I needed to transport back the touristical items I've managed to accumulate. Direr and I get along well, so I understood at once that I needed to keep my narrow white face in the suv while he found the item, otherwise the price would inexorably double...nothing he could do about that. And so now I own a locally made synthetic fiber gym bag that thinks its an Adidas but seems more likely to be an Addis, given what I have been told about trademark enforcement. Then we drove up the hill, through the local markets, past the women woodcutters carrying large loads of eucalyptus branches, past the stands of eucalyptus that are parklike cleared by such women, past the small herds of donkeys with their humans trotting behind, and eventually to the Road from Hell in Heaven...worst road, best air, best view (of smog, unfortunately, its unmistakable from on top) and a nice break from city streets. Then back down again, arriving in time for a machiata coffee before going to class. As with any hospital/medical school, there are plenty of small coffee places unofficially snuggled up close. Then I went along, asked for help in finding the lecture hall for module 4, and was guided by a tall beautiful really blue black skinned man with decorative scars on his face and gentle perfect english who must have been 20 if that. A student.
The class, about 80 of them, were gathered in moveable student deskchairs in a lecture hall that could have held twice that many, but with low ceiling and almost no lighting (the flourescent fixtures were burned out). The chalk blackboard running across the front loomed in the dimness, unreadable. There was plenty of light outside, but little coming through the small windows. The lecturer, in a white coat with stethescope on neck, was explaining dress codes and responsibilities...the module was just starting. When he asked for questions, and a general buzzing started, I made my way up to talk to him. Fitzumberhan Girma is an MD, recent graduate, and hopes to continue as a medical educator. What now, I asked. The lecturer is coming...in about an hour...but the first real lecture will be tomorrow. What will the students do now, I asked, looking at the animatedly conversing group. Oh,I will keep them here for some time.
Hmmm. Well, my personal deal with myself is not to try anything strange for the first week in a new place, but this is day 15...so...
'Would you like to try a communication experiment with them?' I ask my new colleague. ' It would only take about 20 minutes...I can explain to you, and if you think it would be good, we could do it?' He agrees, and so, as those of you who know the contents of my teaching trickbag can guess...I did a dyad!
It takes very little time to explain how the exercise of listening and talking works; make a group of 2, one person talks for a minute while the other listens, then on a signal, switch roles. At the end, I extemporized, I'll ask you to combine in a group of 4, and at the end, I will ask one person from the group to report. OK
Talk about what? Talk about 'what I know about the skull' (the topic of the first lecture). Then, in a group of 4, choose one word that conveys what you would most like to learn about the skull.
Well, it took a little longer to set up, of couse. To get them laughing, I tried some amharic, and it always gets a laugh to make an agreement about no hitting, before asking them to agree to really talk and really listen, not combine the two. And they laughed when I said if they knew nothing about the skull, they could spend a minute sitting in silence.
If its possible to fail in a dyad, assuming basic language competence, I have certainly never seen it happen.
But whats the experiment?
Well, I wanted to see if this group of young students would get into it. Of course they did, with the usual happy increase in noise level. I put in the group of four process to produce a product, the one word...and got a great selection..ethmoid bone, cavernous sinus, cranial vault, petrous bone, eustacian tube, sphenoid sinus, frontal bone...and so on...
But I wanted to go a little farther, to see if some storytelling by an expert would be appealing. Because an expert, me in this case, can of course take any of those words and spin out a clinically or science based story about their personal experience with sphenoid infections (one of the more difficult diagnoses I have made, along with cavernous sinus problems), or how eustacian tube dysfunction leads to the clinical dilemma as to whether to treat middle ear infections with antibiotics. Do the students remember it all? Of course not. But it gives an expert a chance to jumpstart their lecture, and just by keeping a list on the board, and occasionally ticking off one of the student requests, it creates some back and forth. The next step, as Kosta did for years, is to create groups within the lecture that meet each session for a period of time within the lecture period to discuss what they have just heard. And all of these, I believe, are stepping stones to student centered inquiry directed learning.
But suppose there arent enough experts in the country? Suppose lectures devolve into boring recitations of recently boned up material given by a GP who is adverse to lecturing in the first place? It may be 'traditional' curriculum in the first world, but in other worlds, perhaps in Ethiopia, the idea of creating the infrastrucure to support a 'traditional' curriculum in as many medical schools as they need is, perhaps, not the best plan. But I guess it sounds good.....
I got some nice applause at the end, which I'm not deluded enough to think means much, but the students who came up ask questions afterwards did seem to appreciate the exercise. And I dont need to tell you how amazing looking and how alive THEY all were!!!
Well, I've used up all the time for dispatches on medical education. But actually, aside from a few machiato breaks with Oluma and a wonderful lunch with Yodit and her big brother who are part time farmers as well as educators and businessmen, I didnt do anything else. It will be much the same today, and tonight...the 11:55 to Frankfurt, a 6 hour layover (but thank god for the business class lounge with its showers and its edibles and its plush although Germanic banquettes with internet access), and then back to Boston and on to Cape Cod.
Aloha
Alan
Ethiopia 2010 Day 14
10-12-2010 0720 Bole Apartment, Addis.
Yesterday I headed out in the SUV with Direr, the driver and an empty back seat; poof, no team, they have flown away. So with the improved clarity a shotgun seat brings, I immediately started correcting his driving…no; kidding!! Hes a great driver, and believe me, my life hinges on it. Its nowhere like India, but it is intense, and one of the rules seems to be the same; IF YOU ARE AHEAD, YOU ARE AHEAD. This simplifies events in unregulated situations, but in roundabouts/traffic circles it makes it a bit hair raising. However, as with all situations, Ethiopians handle it with a kind of gentle aplomb. Not a long of language lavished on the situation. And speaking of that…
Am I getting too old for a new language? Writing this, back at the apartment, I try to count…’And’ (one)..and I am stuck. What happened to ‘hulet’, that should be right there doing its dance beside ‘and’ , and for that matter to ‘sost, arat, and amIst’? Only yesterday, I was prattling away with wordy expressions like ‘sost michina’ and ‘and dinknesh so’ (excuse my non phonetics, any real Amharic speakers) and now I can’t get past ‘and’. Well, I seem to be ok with ‘dehna aderk’ and sometimes with ‘dehna ider’ at the beginning and end of the day, and ‘salama’ for pretty much everything in between. But for the rest, I feel like Hazel, the character in ‘Cannery Row’ who simply liked to listen to the flow of speech, and structured his social interactions purely to keep the flow coming.
If there is an enraged version, a road rage version, a NY Taxidriver version of this language, I sure haven’t heard it yet. The drivers or pedestrians or bystanders who you might expect to be getting into it in Chicago seem devoted to helpful solutions.
I had gotten up to Oluma’s office about 9:15, as we had arranged. The beautiful askari with the very Ethiopian gap between her two front teeth in the semi military uniform at the front desk smiled. The elevator was working. Oluma was at his desk. We started to scan through the St Paul’s Medical School curriculum, and then he remembered that he wanted me to go to a Health Center and Health Post. Actually, I had previously suggested it, to try to complete in some very un-thorough way my experience of the depth of the Ethiopian health system.
Oluma left to arrange the visit, leaving me with Birna, the economist attached to the project. We continued through the written curriculum, the first time I had really done this. Very well thought out, and although driven by lectures in discrete modules based mostly on organ systems, there is a communications and cultural curriculum and a skills curriculum that are structurally the equal of UCL/RFH in London, and close to the system used by UCSF. Plus, an explicit and very strong requirement for a reflective portfolio that includes specific mention of projects such as recording intractions with a family with a newborn, and a family that has experience disability. Additionally, the St Pauls admission process has a specific metric regarding gender and origin that should facilitate a ‘pipeline’ encouraging student school leavers (the end of HS, when most English speaking countries begin medical school) and post-bac students (those who have a undergraduate degree, which is when the USA begins medical school) to apply. Wow!!!
(There is a history for St Pauls, and I don’t really know enough to comment, but yes there was an expatriot in the mix. The current dean is Dr M, who attended the meetings we had last week…I described him as a perfect ‘Dean figure’..distinguished bearing and dress, and a gentle reflective accepting manner. )
We were working along through this, and I was beginning to fantasize of working with Birna to construct not only an excel based table to compare the two side by side with live links to the actual documents, but an excel model to cost out the two program. At that point, Oluma returned, a bit breathless from the trip up the stairs, and announced the car was ready, right now, to take me to the health posts…I was to be meeting L, one of the projects field workers, since she routinely visited them.
We barreled along out on Bole, and then turned onto the Ring Road, all this becoming somewhat familiar by now, and then again onto the road towards Adoma and beyond it, on the Red Sea, Djbouti. ( I can still only guess at the complexity of using Eritrean ports to ship Ethiopian goods, but Djbouti has been a port for Ethiopia for years.)
During the next 4 hours, we visited a Zonal/District hospital, a Health Center, and a Health Post, all in the vicinity of Bishops**…which I immediately transliterated to ‘Bishops Castle’, a town of perhaps comparable size in Shropshire that I happen to know because Tom and Molly have a home there. Talked to the administrator at the hospital and Health Center, and to one of the two health extension workers stationed at the Health Post. If I have time tonight, I will fix up a picture of Almaz, the 20 something that I interviewed via a translator (she was reticent about her English).
The one major thing all the visits had in common was enthusiasm. The hospital had a trained MBA as CEO, the Health Center was administered by a grizzled very reserved man who had started working there when it opened several decades ago and had recently become chief, and at the health post everyone seemed to do everything...except of course only the extension workers actually saw, visited or touched patients (thats why they are all women).
Another was sense of purpose. Whenever I asked, and whatever I saw, it seemed people were looking and reaching beyond their current work. Perhaps they have a vision, maybe they are just ready for a vision. And of course, some funding wouldnt hurt. And some more training.
Its hard to describe exactly what 'capacitance' is. In electronics, a capacitor is a device that stores charge, and can deliver it when the need arises. To continue the metaphor, capacitors 'slow down' the rate of change of an electronic device, but also extend, even out, and stabilize its function. I guess I view capacitance in a health worker as 'being powerful'...the feeling that comes when you realize that finally your experience, your training, all the factors are actually giving you the ability to encounter a situation, make a rapid analysis, act, and later reflect on the action in order to improve your response in the next instance. The 'self help' that one of the administrators we met spoke of. The 'can do' that is famously ascribed to North Americans. 'Se Puedes' is the same thing, I guess.
Anyway, it was very inspiring and, of course, daunting. The educational system here is heavily teacher centered...and reinforced by the tradition of religious rote teaching that all major religions seem to adopt. I remember talking to secondary level educators in Ladakh and hearing their disappointment at the ability of their students, often schooled by monks, to spout back memorized text, and their inability to reason...their lack of 'capacitance'. We are repeatedly told the same thing here.
But back her on Bole, looking at the St Pauls curriculum, it seems very possible...even perhaps done already. Why not just do what we can to add our knowledge of assessment and professional development to the 'modified traditional' curriculum they have developed?
Well, its off to St Pauls to continue that very question with some direct observation...auditing one of their first year medical school classes.
No time to talk of my gift of peanut butter sandwiches to the kids living along the wall...tomorrow for that.
salama
alan
Yesterday I headed out in the SUV with Direr, the driver and an empty back seat; poof, no team, they have flown away. So with the improved clarity a shotgun seat brings, I immediately started correcting his driving…no; kidding!! Hes a great driver, and believe me, my life hinges on it. Its nowhere like India, but it is intense, and one of the rules seems to be the same; IF YOU ARE AHEAD, YOU ARE AHEAD. This simplifies events in unregulated situations, but in roundabouts/traffic circles it makes it a bit hair raising. However, as with all situations, Ethiopians handle it with a kind of gentle aplomb. Not a long of language lavished on the situation. And speaking of that…
Am I getting too old for a new language? Writing this, back at the apartment, I try to count…’And’ (one)..and I am stuck. What happened to ‘hulet’, that should be right there doing its dance beside ‘and’ , and for that matter to ‘sost, arat, and amIst’? Only yesterday, I was prattling away with wordy expressions like ‘sost michina’ and ‘and dinknesh so’ (excuse my non phonetics, any real Amharic speakers) and now I can’t get past ‘and’. Well, I seem to be ok with ‘dehna aderk’ and sometimes with ‘dehna ider’ at the beginning and end of the day, and ‘salama’ for pretty much everything in between. But for the rest, I feel like Hazel, the character in ‘Cannery Row’ who simply liked to listen to the flow of speech, and structured his social interactions purely to keep the flow coming.
If there is an enraged version, a road rage version, a NY Taxidriver version of this language, I sure haven’t heard it yet. The drivers or pedestrians or bystanders who you might expect to be getting into it in Chicago seem devoted to helpful solutions.
I had gotten up to Oluma’s office about 9:15, as we had arranged. The beautiful askari with the very Ethiopian gap between her two front teeth in the semi military uniform at the front desk smiled. The elevator was working. Oluma was at his desk. We started to scan through the St Paul’s Medical School curriculum, and then he remembered that he wanted me to go to a Health Center and Health Post. Actually, I had previously suggested it, to try to complete in some very un-thorough way my experience of the depth of the Ethiopian health system.
Oluma left to arrange the visit, leaving me with Birna, the economist attached to the project. We continued through the written curriculum, the first time I had really done this. Very well thought out, and although driven by lectures in discrete modules based mostly on organ systems, there is a communications and cultural curriculum and a skills curriculum that are structurally the equal of UCL/RFH in London, and close to the system used by UCSF. Plus, an explicit and very strong requirement for a reflective portfolio that includes specific mention of projects such as recording intractions with a family with a newborn, and a family that has experience disability. Additionally, the St Pauls admission process has a specific metric regarding gender and origin that should facilitate a ‘pipeline’ encouraging student school leavers (the end of HS, when most English speaking countries begin medical school) and post-bac students (those who have a undergraduate degree, which is when the USA begins medical school) to apply. Wow!!!
(There is a history for St Pauls, and I don’t really know enough to comment, but yes there was an expatriot in the mix. The current dean is Dr M, who attended the meetings we had last week…I described him as a perfect ‘Dean figure’..distinguished bearing and dress, and a gentle reflective accepting manner. )
We were working along through this, and I was beginning to fantasize of working with Birna to construct not only an excel based table to compare the two side by side with live links to the actual documents, but an excel model to cost out the two program. At that point, Oluma returned, a bit breathless from the trip up the stairs, and announced the car was ready, right now, to take me to the health posts…I was to be meeting L, one of the projects field workers, since she routinely visited them.
We barreled along out on Bole, and then turned onto the Ring Road, all this becoming somewhat familiar by now, and then again onto the road towards Adoma and beyond it, on the Red Sea, Djbouti. ( I can still only guess at the complexity of using Eritrean ports to ship Ethiopian goods, but Djbouti has been a port for Ethiopia for years.)
During the next 4 hours, we visited a Zonal/District hospital, a Health Center, and a Health Post, all in the vicinity of Bishops**…which I immediately transliterated to ‘Bishops Castle’, a town of perhaps comparable size in Shropshire that I happen to know because Tom and Molly have a home there. Talked to the administrator at the hospital and Health Center, and to one of the two health extension workers stationed at the Health Post. If I have time tonight, I will fix up a picture of Almaz, the 20 something that I interviewed via a translator (she was reticent about her English).
The one major thing all the visits had in common was enthusiasm. The hospital had a trained MBA as CEO, the Health Center was administered by a grizzled very reserved man who had started working there when it opened several decades ago and had recently become chief, and at the health post everyone seemed to do everything...except of course only the extension workers actually saw, visited or touched patients (thats why they are all women).
Another was sense of purpose. Whenever I asked, and whatever I saw, it seemed people were looking and reaching beyond their current work. Perhaps they have a vision, maybe they are just ready for a vision. And of course, some funding wouldnt hurt. And some more training.
Its hard to describe exactly what 'capacitance' is. In electronics, a capacitor is a device that stores charge, and can deliver it when the need arises. To continue the metaphor, capacitors 'slow down' the rate of change of an electronic device, but also extend, even out, and stabilize its function. I guess I view capacitance in a health worker as 'being powerful'...the feeling that comes when you realize that finally your experience, your training, all the factors are actually giving you the ability to encounter a situation, make a rapid analysis, act, and later reflect on the action in order to improve your response in the next instance. The 'self help' that one of the administrators we met spoke of. The 'can do' that is famously ascribed to North Americans. 'Se Puedes' is the same thing, I guess.
Anyway, it was very inspiring and, of course, daunting. The educational system here is heavily teacher centered...and reinforced by the tradition of religious rote teaching that all major religions seem to adopt. I remember talking to secondary level educators in Ladakh and hearing their disappointment at the ability of their students, often schooled by monks, to spout back memorized text, and their inability to reason...their lack of 'capacitance'. We are repeatedly told the same thing here.
But back her on Bole, looking at the St Pauls curriculum, it seems very possible...even perhaps done already. Why not just do what we can to add our knowledge of assessment and professional development to the 'modified traditional' curriculum they have developed?
Well, its off to St Pauls to continue that very question with some direct observation...auditing one of their first year medical school classes.
No time to talk of my gift of peanut butter sandwiches to the kids living along the wall...tomorrow for that.
salama
alan
Ethiopia 2010 Day 13
10-11-2010 0705 Bole Apartment. So today the largest of the three kids that live with their mother along the wall was in charge, under a different green gabi. She was happy to see my 10 birr, and was busily telling the others about it as I walked on along the paver smoothness and order of the sidewalk at that point. I wonder if that contributes to mom's choice of the location; easier to do housekeeping with a good floor. I hope mom was just off on her morning ablutions; I reversed my usual route today, so arrived a little later than usual. I think one of the kids may have a little impetigo, so perhaps a good use of my tube of mupirocin. Google, who not only knows the time of day here, and that its going to be sunny, also offers to translate what I type into amharic. I havent tried that yet. But as we continue to talk about medical education, its clear that an investment in internet access will carry farther and reach more than an investment in text books.
Yesterday there were few books in evidence around here. I continue to read "Cutting for Stone", and of course each day here adds a new dimension to the already pretty gripping novel. The general consensus is still that the background story of the book is pretty accurate. And it was read as 'the summer book' by a fair number of American educational institutions, because of its edgy treatment of medical skill development and decision making. And so many more people will begin to have some vision of Ethiopia that comes a little closer to the complicated green and beautifully brown truth.
'Dinknesh' is the Amharic word used insteady of 'Lucy' to personify the fossil remains of Australopithicus afarensis that famously put the Rift Valley on everyone's world map. And I actually heard it used as a descriptor...beautiful...the other day, passing a conversation. My amharic is still at less than a handfull level, but alone, I am making a little more progress. However, any real conversations are in English.
Yesterday after working on a powerpoint to describe what actually happens when students are 'working' a case in a Problem Based curriculum, I called Berhanu, and ended up at his house, where his younger son needed the car. This meant time to have something to eat, which of course meant my first actual in home Ethiopian dining experience. The wot was very tasty, with a rich reddish color and a few shortribs with bits of lamb left on them. The seasoning brought on a brief period of hiccups, a sure sign of sufficient capsaicin. And the the kitfo leb leb (minced meat marinated and cooked lightly) was great, along with a minced vegetable that Berhanu didnt identify other than saying it was popular in his home town, to the West of Addis. It tasted a little like parsnips, with a crunchy texture. I am still a very messy right handed injera aided eater...Berhanu of course barely gets his fingers into the wot at all, and none of that dribbling of rice that happen when i try. Part of the problem was that I didnt line my plate with injera first, and then ladle on the rest of the meal...a good base of injera keeps the kitfo in place...just as honey keeps the peas on the knife, I guess.
I am coming to really love the ritual of washing before and after. Its always women serving, of course, and that is always noticeable, but its something we might do for each other. Healthy, too, even for the surgical 'hands off ' approach to eating that Europeans developed and us colonials perpetuated.
Its also a slow down and appreciate the moment event, and for hurry up and get busy guys like me, any event like that is a treasure.
Eventually, after a brief power nap for Berhanu and a period of just sitting in their small but very functional living/dining room, the second son came back with the car, a Corolla, which now did not idle correctly. There was a brief confab under the hood, including Berhanu's wife Saba (=Sheba), two friends of the son, the neighbor and Berhanu himself, and it was decided that Saba would drive her car instead. This was a major step up...it seems very new and elegant..Korean I think...and meant I had Berhanu to myself in the back seat to ask my endless questions.
We drove out to the new Ring road, and then around through literally kilometers of new condominium residences that are mushrooming out of land previously occupied by tin roofed mud and wattle walled shacks. Large boxy multi unit buildings. Most are still uninhabited. Cement and rebar construction, and although I have to admit the joints seem better in these than in central Addis, I still wonder about their safety. Be that as it may, they are going up, thousands of units of them. The plan is for small stores in the ground floor, and thus each building, with perhaps 30 residences, could replace a hunk of shacks with associated small stores. But with water and sanitation, and electricity.
And who will live in them? Berhanu explains that land had no value in the recent past, and by moving squatters off vast tracts, the government has created potential value. By building, real value. By then selling to landlords and banks, increased and tradeable value. And by creating a system of ownership with mortgages, the potential for ongoing issues of payments that will require work in order to make money. Nothing wrong with the system that a participatory democracy couldnt fix, many of the people I talk to affirm.
How much will it cost? Perhaps 300 birr a month...$20 US. Of course, its much more than the people in he shacks were spending, and some wont have the money to make the downpayment. Some may be transferred...further away of course. And some...well...hmmmm.
Scattered around, often by themsleves, sometimes growing out of a field of shacks along the road, like a magic castle sprouting from some magic bean, there are much larger dwellings, often with angles and tiny useless cantilevered balconies...well, useless unless you are Juiiet...(cf, Christopher Alexander et. al, "A Pattern Language", Oxford Press 1977, thank you again Helaine) that look to me more beautiful in their monotonic teenage skeletal selves than in their later glassed and stuccoed adult personas.
The style here is to put in the new road, with roundabouts, complete with curbs and drainage, and with some underburden, and if needed, open it up to traffic before putting on the tarmac. Yep, quite a demonstration of the mechanism of pothole formation. In the rains, just finished, it must be a mire of mythic proportion.
We get to Sebata, and the road to Meta Abo Brewery. Berhanu has been coming here for several decades; he loves the quiet of the park like place that the brewery has maintained next to its plant. A lane extends up along a small valley and ends in several waterfalls. Now there is a large outdoor swimming pool, and several covered halls, an Ethiopian Brauhaus. Yesterday it was not so tranquil..several weddings, large groups of student age people, family units, small children running, teenagers slurping and, because there is no public transport, thus anyone here is likely of some moneyed family, texting, picture taking, game playing and generally interacting with their phones as much as themselves. But very fun. Saba, through custom or prefference (she is very religious...orthodox..confides Berhanu) stayed with her car...and drove both ways. "She doesnt lend it easily", says B.
On the way back, a call from Oluma, and we arrange to meet for dinner. The powerpoint is coming along, its a right brain process for me, a calming change from left brain developmental planning work. For dinner, we walk through the gathering gently windy African night along Bole to The Ginger Tree...a coffee house restaurant on the third floor of a modern building with an associated english language bookstore. Oluma immediately sees one friend at a table, and as we sit talking several others come by. Finally, an absolutely prototypically gorgeous woman and a solid friendly looking man come by, both friends, both of an age with Oluma...that is, with kids the age of my grandchildren...and we join them for dinner. She also has one of those voices with amazing modulation, tones that make any language sit up and sound intriguing and significant. I catch a few envious glances from ferengi sitting nearby. I have Ethiopian friends, in some small way I have moved beyond the curtain of custom that separates the traveler from the society she travels in. Or perhaps they are admiring Oluma or his friends...all very attrative people.
And so I learned a lot about background and even something about the political realities. How the tribalism that Nyerere warned about is alive and doing he devils work here, as it is throughout Africa. How the development, or the Underdevelopment as Walter Rodney (now dead of an assasins bullet, the author of the most important book ever written on the subject, "How Europe Underdeveloped Africa") taught, comes down to who has the power to make change.
""The decisiveness of the short period of colonialism and its negative consequences for Africa spring mainly from the fact that Africa lost power. Power is the ultimate determinant in human society, being basic to the relations within any group and between groups. It implies the ability to defend one's interests and if necessary to impose one's will by any means available. In relations between peoples, the question of power determines maneuverability in bargaining, the extent to which a people survive as a physical and cultural entity. When one society finds itself forced to relinquish power entirely to another society, that in itself is a form of underdevelopment." ( from Wikipedia).
We lived next to Walter in Dar es Salaam, shortly after the book was written, both families expatriots with vastly different backgrounds, but drawn to Tanzania by Ujamaa..the possibility of working together. And he is dead. Vale, Walter!
Well, that reflection makes me a little sad, but I am glad for the morning, for the noises of people doing things outside, for the light coming through the newly peeled back curtain, for the thought of a day working, and perhaps a trip to visit a health post and a health center, and tonight to visit the ER when its up and running.
More later
salama
Alan
Yesterday there were few books in evidence around here. I continue to read "Cutting for Stone", and of course each day here adds a new dimension to the already pretty gripping novel. The general consensus is still that the background story of the book is pretty accurate. And it was read as 'the summer book' by a fair number of American educational institutions, because of its edgy treatment of medical skill development and decision making. And so many more people will begin to have some vision of Ethiopia that comes a little closer to the complicated green and beautifully brown truth.
'Dinknesh' is the Amharic word used insteady of 'Lucy' to personify the fossil remains of Australopithicus afarensis that famously put the Rift Valley on everyone's world map. And I actually heard it used as a descriptor...beautiful...the other day, passing a conversation. My amharic is still at less than a handfull level, but alone, I am making a little more progress. However, any real conversations are in English.
Yesterday after working on a powerpoint to describe what actually happens when students are 'working' a case in a Problem Based curriculum, I called Berhanu, and ended up at his house, where his younger son needed the car. This meant time to have something to eat, which of course meant my first actual in home Ethiopian dining experience. The wot was very tasty, with a rich reddish color and a few shortribs with bits of lamb left on them. The seasoning brought on a brief period of hiccups, a sure sign of sufficient capsaicin. And the the kitfo leb leb (minced meat marinated and cooked lightly) was great, along with a minced vegetable that Berhanu didnt identify other than saying it was popular in his home town, to the West of Addis. It tasted a little like parsnips, with a crunchy texture. I am still a very messy right handed injera aided eater...Berhanu of course barely gets his fingers into the wot at all, and none of that dribbling of rice that happen when i try. Part of the problem was that I didnt line my plate with injera first, and then ladle on the rest of the meal...a good base of injera keeps the kitfo in place...just as honey keeps the peas on the knife, I guess.
I am coming to really love the ritual of washing before and after. Its always women serving, of course, and that is always noticeable, but its something we might do for each other. Healthy, too, even for the surgical 'hands off ' approach to eating that Europeans developed and us colonials perpetuated.
Its also a slow down and appreciate the moment event, and for hurry up and get busy guys like me, any event like that is a treasure.
Eventually, after a brief power nap for Berhanu and a period of just sitting in their small but very functional living/dining room, the second son came back with the car, a Corolla, which now did not idle correctly. There was a brief confab under the hood, including Berhanu's wife Saba (=Sheba), two friends of the son, the neighbor and Berhanu himself, and it was decided that Saba would drive her car instead. This was a major step up...it seems very new and elegant..Korean I think...and meant I had Berhanu to myself in the back seat to ask my endless questions.
We drove out to the new Ring road, and then around through literally kilometers of new condominium residences that are mushrooming out of land previously occupied by tin roofed mud and wattle walled shacks. Large boxy multi unit buildings. Most are still uninhabited. Cement and rebar construction, and although I have to admit the joints seem better in these than in central Addis, I still wonder about their safety. Be that as it may, they are going up, thousands of units of them. The plan is for small stores in the ground floor, and thus each building, with perhaps 30 residences, could replace a hunk of shacks with associated small stores. But with water and sanitation, and electricity.
And who will live in them? Berhanu explains that land had no value in the recent past, and by moving squatters off vast tracts, the government has created potential value. By building, real value. By then selling to landlords and banks, increased and tradeable value. And by creating a system of ownership with mortgages, the potential for ongoing issues of payments that will require work in order to make money. Nothing wrong with the system that a participatory democracy couldnt fix, many of the people I talk to affirm.
How much will it cost? Perhaps 300 birr a month...$20 US. Of course, its much more than the people in he shacks were spending, and some wont have the money to make the downpayment. Some may be transferred...further away of course. And some...well...hmmmm.
Scattered around, often by themsleves, sometimes growing out of a field of shacks along the road, like a magic castle sprouting from some magic bean, there are much larger dwellings, often with angles and tiny useless cantilevered balconies...well, useless unless you are Juiiet...(cf, Christopher Alexander et. al, "A Pattern Language", Oxford Press 1977, thank you again Helaine) that look to me more beautiful in their monotonic teenage skeletal selves than in their later glassed and stuccoed adult personas.
The style here is to put in the new road, with roundabouts, complete with curbs and drainage, and with some underburden, and if needed, open it up to traffic before putting on the tarmac. Yep, quite a demonstration of the mechanism of pothole formation. In the rains, just finished, it must be a mire of mythic proportion.
We get to Sebata, and the road to Meta Abo Brewery. Berhanu has been coming here for several decades; he loves the quiet of the park like place that the brewery has maintained next to its plant. A lane extends up along a small valley and ends in several waterfalls. Now there is a large outdoor swimming pool, and several covered halls, an Ethiopian Brauhaus. Yesterday it was not so tranquil..several weddings, large groups of student age people, family units, small children running, teenagers slurping and, because there is no public transport, thus anyone here is likely of some moneyed family, texting, picture taking, game playing and generally interacting with their phones as much as themselves. But very fun. Saba, through custom or prefference (she is very religious...orthodox..confides Berhanu) stayed with her car...and drove both ways. "She doesnt lend it easily", says B.
On the way back, a call from Oluma, and we arrange to meet for dinner. The powerpoint is coming along, its a right brain process for me, a calming change from left brain developmental planning work. For dinner, we walk through the gathering gently windy African night along Bole to The Ginger Tree...a coffee house restaurant on the third floor of a modern building with an associated english language bookstore. Oluma immediately sees one friend at a table, and as we sit talking several others come by. Finally, an absolutely prototypically gorgeous woman and a solid friendly looking man come by, both friends, both of an age with Oluma...that is, with kids the age of my grandchildren...and we join them for dinner. She also has one of those voices with amazing modulation, tones that make any language sit up and sound intriguing and significant. I catch a few envious glances from ferengi sitting nearby. I have Ethiopian friends, in some small way I have moved beyond the curtain of custom that separates the traveler from the society she travels in. Or perhaps they are admiring Oluma or his friends...all very attrative people.
And so I learned a lot about background and even something about the political realities. How the tribalism that Nyerere warned about is alive and doing he devils work here, as it is throughout Africa. How the development, or the Underdevelopment as Walter Rodney (now dead of an assasins bullet, the author of the most important book ever written on the subject, "How Europe Underdeveloped Africa") taught, comes down to who has the power to make change.
""The decisiveness of the short period of colonialism and its negative consequences for Africa spring mainly from the fact that Africa lost power. Power is the ultimate determinant in human society, being basic to the relations within any group and between groups. It implies the ability to defend one's interests and if necessary to impose one's will by any means available. In relations between peoples, the question of power determines maneuverability in bargaining, the extent to which a people survive as a physical and cultural entity. When one society finds itself forced to relinquish power entirely to another society, that in itself is a form of underdevelopment." ( from Wikipedia).
We lived next to Walter in Dar es Salaam, shortly after the book was written, both families expatriots with vastly different backgrounds, but drawn to Tanzania by Ujamaa..the possibility of working together. And he is dead. Vale, Walter!
Well, that reflection makes me a little sad, but I am glad for the morning, for the noises of people doing things outside, for the light coming through the newly peeled back curtain, for the thought of a day working, and perhaps a trip to visit a health post and a health center, and tonight to visit the ER when its up and running.
More later
salama
Alan
Ethiopia 2010 Day 12
10-10-10 0740 Apartment, behind DH Geda Building, Bole, Addis Well, I finally know how to say where I live, because not knowing created a 'communication difficulty' as Beranu put it, when I said I was at the Kaldi Coffee bar on Bole. That turns out to be a little like saying I'm at the Starbucks on Lexington...
Kaldi uses a round Green/Black sign that is immediately recognizable, and obviously intentional. There are other similarities; the coffee is good, and the waitstaff are young and attractive, in their knockoff t shirts and serving aprons. The differences; nothing plastic (so the waitstaff also dry dishes when not waiting), there is table service (no behind counter barristas here) and I like the machiata for both size and taste
Of course, perhaps Kaldi's was where Starbucks got the logo plan, The myth (dating from the 17th centuray apparently) is that a goatherd named Kaldi noticed that his goats jumped higher after eating fruit from a local bush. He tried it too, and felt a lift. He took it to the head monk who, hearing its effect, disapproved and threw the fruit in the fire. The aroma was so good they raked them out and made the worlds first cup of coffee. OK, I didnt say you have to believe it, but as creation myths go, its pretty harmless.
On the way to Merkato yesterday, Direr the driver in charge of the SUV that belongs to the project we are working for, and who was my guide yesterday, wanted to stop and treat me to a coffee. There are many ways to do coffee in Ethiopia. This one was the walk in, pay for what you want and get a plastic marker, take that to the barristas, and get your coffee, cake, whatever. Lots of beans, lots of good smell, lots of newspapers frazzled about on the stand up tables, and the coffee was great, black, slightly grainy, so you get those tasty little bits to crunch towards the end. Direr was dressed for the market in the zip up top of a yellow and green ETHIOPIA warm up suit, jeans, and track shoes. I was dressed ferengi, as usual. We drove on, through increasing foot traffic, and finally crept the final few yards along a potholed lumpy street absolutely packed with people engaging the market. This is one of those circuses where you simply cannot watch the horses and the clowns and the smiling lady on the caparizoned elephant at the same time..one of those movies where De Mille has hired doubles for the extras and thrown in some cameo guest appearances as well. We jolted up to the guarded gate of a fenced parking lot, and left the SUV. A guy I thought was a parking lot guy talked with Direr and then led us off up the hill, around the corner, down a lane, over a construction mound, behind a long haul truck, in front of a herd of donkeys and then up some stairs and into a building where on the third floor (huff, puff) there was a Gallery aka store.
No, I am not going to say it was authentic and cheap. I have no idea if all of it was authentic, and it certainly wasnt cheap by Ethiopian standards. But it was one of the greatest hauls of stuff that I've ever encountered. Comparable to that mostly furniture and suchlike place in Santa Fe..I cant remember its name, but it goes on and on back into the dark corners of what seems like a whole city block. Or to what the New England Demolition place in New Bedford is for clawfoot bathtubs. But this was wooden head pillows and silver necklaces and orthodox crosses and carved wooden gizmos that open to show a large eyed vision of Mary on one side and Jesus on the other, all painted in that trans Mediterranean manner. And brass anklets, and clay labrum plugs and calabashes smelling of beer and of milk and mostly of human use. And bows and swords and camel bells and spoons....whoa...did I see spoons? Oh yeah, there was spoons. There were dark wood ones and light wood ones and horn ones and metal ones. And then, of course, there were some actual old ones.
There is a clarity of purpose and a determination of strength to a useful object that endures. Or maybe it was just lost under the flooboards or behind the stove. Anyway, it seemed to me the older stuff had a line, an attention to detail and finish, and a balanced feel that made it quite different than the new.
The prices, as I say, were pretty high at first. I usually deal with this by getting the first price, and then when I have about 5 first price items (it used to be 7 or so, but my memory isnt so good these days) I compute a price for all of them, and then ask the sellers price, and then haggle for a while on that, and then start taking away things i dont really want down to the 1-2 items that I do want. We were seated, by this time. No coffee...we werent at that level of transaction. Thats only happened with higher value (when we were buying bulky sweaters and tire sandals in Toluca to stock a store in P-town back after graduating from college) or with a different sense of time (as in Leh, Ladakh, and then it was thick sweet yak butter tea in small cups). This shopkeeper/salesperson was younger, and quite intense. It got complicated because I didnt have enough birr, and the dollar has a value of anywhere between 160 and 180 birr. But yes, I did end up with what I wanted, or at least part of it. Then the guy who had picked us up in the parking lot, and whom I had thought was a friend of Direr's (but was just a guy; Ethiopians are so cordial its sometimes hard to tell about actual intimacy) wanted to take us to look for Gabi's and neTela's, but on the way Direr communicated this should be a looking only experience. So we did. Then shook hands goodbye, and plunged further into Merkato.
Its supposed to be the largest market in Africa, but if so, I have an exaggerated memory of the souk in Cairo. But as rough and tumble markets go, on a Saturday Merkato is pretty grand. For one thing, the streets are as cobbled and rocky rough as any in Manali or Mwanza or Manaus. There are really potholes large enough to cripple an incautious SUV or even a Tiger tank. And in between the streets, the alleys and lanes, often covered to make a dim underworld of color and smell and human presence, are as powerful as anything I've experienced. The women and girls crouching under sales tables kneading dough. The wicker cages of chickens being doled out to men and boys who will carry handfulls of them to some awful fate. The clanging and banging of metal on metal in the lane of sheet metal, and the more muted and more regular clumping and banging of men in the street of leatherworking, where they turn rawhides and hard tanned leather into saddles and bridles. The smells of the lane of spices, vats of them, baskets of them, little carefully weighed smidgens of them...and not to far away, the high pitched shrieking ammoniacal smell of too many donkeys in too little space. Wedged in at various points are khat merchants, and khat chewers. Did I remember the oil sellers, and the coffee merchants...these are the green shelled beans...or sometimes just dried. Direr bought a kilo...I think I have to have sealed packages to bring in vegetable products these days.
If I sound like a Merkato convert, I guess I am. Found some admirable horn spoons...the wooden spoon nitche has been taken over by a chinese product wrapped in plastic...and fingered, smelled, even tasted a lot of other stuff. And looked. In most Ethiopian street situations, direct gaze isnt always appreciated or comfortable, but here it seemed normal. Smiling helps. Taking photographs of people is definitely not appreciated, and to their credit, just because you are buying something it does not mean you can photograph the seller. So I have to admit I resorted to suremptitious video...the Flip that I have looks like a phone rather than a camera, and so by just leaving it on, I did take some pictures, while Direr worried about it being wrenched from my hand.
And then we went, on our own, to the Gabi and neTala section, and bought some more stuff...pretty much exhausting my supply of birr. The Gabi is made by sewing together two of the standard widths of cloth, and thats done while you wait, on a foot powered sewing machine down the way. Give 10 birr to the tailor, please.
Whew, a tiring morning..4 hours in the market.
Spent the afternoon working on the project (meaning sitting at a computer in the apartment) and then met a new friend, Beranu, who when we eventually worked out on cell phones which Kaldi's Coffee I was at, picked me up in his dented but functional car and took me to the Che Guevara bar.
Yes, lets take a moment to remember that 43 years ago, on October 9th, Dr Guevara, physician, author, and revolutionary, was murdered after leaving Cuba to bring change (and presumably medical advice) to South America. Vale, Che!
The Che Guevara bar in Addis is on a side street not to far off Bole, and has an outside section, where we met with two of Beranu's age mates, which makes them slightly younger them me. We all turn out to have two children, but they dont have grandchildren yet. These are guys who have been down the river, over the waterfall and through the mill...time in prison, time out of the country, time in the government, and mostly time on the planet. It was a real pleasure to get buzzy on beer (they switched to Scotch) and hear about some aspects of life in Ethiopia that I hadn't heard much about before. In some ways, they have the same bemusement that I often feel...which is countered by the certainities of family and friendships, and to some extent mitigated by...well, remember what Sala once said (forgive my paraphrase if I have it wrong) ' You can't always win, but you usually know who the a**hole is"
So later than usual I was dropped off behind DH Geda tower with its multiple neon lit boutiques and its coffee bar, and said goodnight to the dog pack, the solitary and opaque cat, and the night watchman, and went to bed.
This morning, the beautiful family under the green cloth were just waking up. The three little ones shivered, still huddled together around mom. I passed over my usual contribution. Oh, the smile! Break my heart. The amplified calls to prayer were loud from the Orthodox Cathedral down the street. Its Sunday, and I will get back to work on the project now, I guess
Salama
Alan
Kaldi uses a round Green/Black sign that is immediately recognizable, and obviously intentional. There are other similarities; the coffee is good, and the waitstaff are young and attractive, in their knockoff t shirts and serving aprons. The differences; nothing plastic (so the waitstaff also dry dishes when not waiting), there is table service (no behind counter barristas here) and I like the machiata for both size and taste
Of course, perhaps Kaldi's was where Starbucks got the logo plan, The myth (dating from the 17th centuray apparently) is that a goatherd named Kaldi noticed that his goats jumped higher after eating fruit from a local bush. He tried it too, and felt a lift. He took it to the head monk who, hearing its effect, disapproved and threw the fruit in the fire. The aroma was so good they raked them out and made the worlds first cup of coffee. OK, I didnt say you have to believe it, but as creation myths go, its pretty harmless.
On the way to Merkato yesterday, Direr the driver in charge of the SUV that belongs to the project we are working for, and who was my guide yesterday, wanted to stop and treat me to a coffee. There are many ways to do coffee in Ethiopia. This one was the walk in, pay for what you want and get a plastic marker, take that to the barristas, and get your coffee, cake, whatever. Lots of beans, lots of good smell, lots of newspapers frazzled about on the stand up tables, and the coffee was great, black, slightly grainy, so you get those tasty little bits to crunch towards the end. Direr was dressed for the market in the zip up top of a yellow and green ETHIOPIA warm up suit, jeans, and track shoes. I was dressed ferengi, as usual. We drove on, through increasing foot traffic, and finally crept the final few yards along a potholed lumpy street absolutely packed with people engaging the market. This is one of those circuses where you simply cannot watch the horses and the clowns and the smiling lady on the caparizoned elephant at the same time..one of those movies where De Mille has hired doubles for the extras and thrown in some cameo guest appearances as well. We jolted up to the guarded gate of a fenced parking lot, and left the SUV. A guy I thought was a parking lot guy talked with Direr and then led us off up the hill, around the corner, down a lane, over a construction mound, behind a long haul truck, in front of a herd of donkeys and then up some stairs and into a building where on the third floor (huff, puff) there was a Gallery aka store.
No, I am not going to say it was authentic and cheap. I have no idea if all of it was authentic, and it certainly wasnt cheap by Ethiopian standards. But it was one of the greatest hauls of stuff that I've ever encountered. Comparable to that mostly furniture and suchlike place in Santa Fe..I cant remember its name, but it goes on and on back into the dark corners of what seems like a whole city block. Or to what the New England Demolition place in New Bedford is for clawfoot bathtubs. But this was wooden head pillows and silver necklaces and orthodox crosses and carved wooden gizmos that open to show a large eyed vision of Mary on one side and Jesus on the other, all painted in that trans Mediterranean manner. And brass anklets, and clay labrum plugs and calabashes smelling of beer and of milk and mostly of human use. And bows and swords and camel bells and spoons....whoa...did I see spoons? Oh yeah, there was spoons. There were dark wood ones and light wood ones and horn ones and metal ones. And then, of course, there were some actual old ones.
There is a clarity of purpose and a determination of strength to a useful object that endures. Or maybe it was just lost under the flooboards or behind the stove. Anyway, it seemed to me the older stuff had a line, an attention to detail and finish, and a balanced feel that made it quite different than the new.
The prices, as I say, were pretty high at first. I usually deal with this by getting the first price, and then when I have about 5 first price items (it used to be 7 or so, but my memory isnt so good these days) I compute a price for all of them, and then ask the sellers price, and then haggle for a while on that, and then start taking away things i dont really want down to the 1-2 items that I do want. We were seated, by this time. No coffee...we werent at that level of transaction. Thats only happened with higher value (when we were buying bulky sweaters and tire sandals in Toluca to stock a store in P-town back after graduating from college) or with a different sense of time (as in Leh, Ladakh, and then it was thick sweet yak butter tea in small cups). This shopkeeper/salesperson was younger, and quite intense. It got complicated because I didnt have enough birr, and the dollar has a value of anywhere between 160 and 180 birr. But yes, I did end up with what I wanted, or at least part of it. Then the guy who had picked us up in the parking lot, and whom I had thought was a friend of Direr's (but was just a guy; Ethiopians are so cordial its sometimes hard to tell about actual intimacy) wanted to take us to look for Gabi's and neTela's, but on the way Direr communicated this should be a looking only experience. So we did. Then shook hands goodbye, and plunged further into Merkato.
Its supposed to be the largest market in Africa, but if so, I have an exaggerated memory of the souk in Cairo. But as rough and tumble markets go, on a Saturday Merkato is pretty grand. For one thing, the streets are as cobbled and rocky rough as any in Manali or Mwanza or Manaus. There are really potholes large enough to cripple an incautious SUV or even a Tiger tank. And in between the streets, the alleys and lanes, often covered to make a dim underworld of color and smell and human presence, are as powerful as anything I've experienced. The women and girls crouching under sales tables kneading dough. The wicker cages of chickens being doled out to men and boys who will carry handfulls of them to some awful fate. The clanging and banging of metal on metal in the lane of sheet metal, and the more muted and more regular clumping and banging of men in the street of leatherworking, where they turn rawhides and hard tanned leather into saddles and bridles. The smells of the lane of spices, vats of them, baskets of them, little carefully weighed smidgens of them...and not to far away, the high pitched shrieking ammoniacal smell of too many donkeys in too little space. Wedged in at various points are khat merchants, and khat chewers. Did I remember the oil sellers, and the coffee merchants...these are the green shelled beans...or sometimes just dried. Direr bought a kilo...I think I have to have sealed packages to bring in vegetable products these days.
If I sound like a Merkato convert, I guess I am. Found some admirable horn spoons...the wooden spoon nitche has been taken over by a chinese product wrapped in plastic...and fingered, smelled, even tasted a lot of other stuff. And looked. In most Ethiopian street situations, direct gaze isnt always appreciated or comfortable, but here it seemed normal. Smiling helps. Taking photographs of people is definitely not appreciated, and to their credit, just because you are buying something it does not mean you can photograph the seller. So I have to admit I resorted to suremptitious video...the Flip that I have looks like a phone rather than a camera, and so by just leaving it on, I did take some pictures, while Direr worried about it being wrenched from my hand.
And then we went, on our own, to the Gabi and neTala section, and bought some more stuff...pretty much exhausting my supply of birr. The Gabi is made by sewing together two of the standard widths of cloth, and thats done while you wait, on a foot powered sewing machine down the way. Give 10 birr to the tailor, please.
Whew, a tiring morning..4 hours in the market.
Spent the afternoon working on the project (meaning sitting at a computer in the apartment) and then met a new friend, Beranu, who when we eventually worked out on cell phones which Kaldi's Coffee I was at, picked me up in his dented but functional car and took me to the Che Guevara bar.
Yes, lets take a moment to remember that 43 years ago, on October 9th, Dr Guevara, physician, author, and revolutionary, was murdered after leaving Cuba to bring change (and presumably medical advice) to South America. Vale, Che!
The Che Guevara bar in Addis is on a side street not to far off Bole, and has an outside section, where we met with two of Beranu's age mates, which makes them slightly younger them me. We all turn out to have two children, but they dont have grandchildren yet. These are guys who have been down the river, over the waterfall and through the mill...time in prison, time out of the country, time in the government, and mostly time on the planet. It was a real pleasure to get buzzy on beer (they switched to Scotch) and hear about some aspects of life in Ethiopia that I hadn't heard much about before. In some ways, they have the same bemusement that I often feel...which is countered by the certainities of family and friendships, and to some extent mitigated by...well, remember what Sala once said (forgive my paraphrase if I have it wrong) ' You can't always win, but you usually know who the a**hole is"
So later than usual I was dropped off behind DH Geda tower with its multiple neon lit boutiques and its coffee bar, and said goodnight to the dog pack, the solitary and opaque cat, and the night watchman, and went to bed.
This morning, the beautiful family under the green cloth were just waking up. The three little ones shivered, still huddled together around mom. I passed over my usual contribution. Oh, the smile! Break my heart. The amplified calls to prayer were loud from the Orthodox Cathedral down the street. Its Sunday, and I will get back to work on the project now, I guess
Salama
Alan
Ethiopia 2010 Day 11
10-9- 2010 0730 Apartment, Bole, Addis.
I think I finally have the day sorted out...since I know Kevin and Bob were staying 10 days and they left last night..the big 747 fan jets are much noisier than anything else, and when they take off from Bole its the kind of sound that makes people believe in cargo cults and gods from the skies. But I didnt hear them, was asleep by their departure time, which will be my departure next Wednesday. So now the apartment is even more quiet than usual...whenever I can hear my own key clicks I know its quiet...and I am enjoying the solitude, although missing K and B.
We did well as a team. I loved NOT being the leader, continuing the course I set over a decade ago of trying not to be in charge of things, or at least to be part of a team if charge is needed. The uncle role. And since I am often the oldest in an assemblage, its also fun to feel the contrasts within myself...feeling intensely young and impatient and madly creative at moments, and at other times absolutely spinning at the changes, the pace of events, the direction human society is taking. I'm aware that I walk like an old guy, unless I am running and then I RUN like an old guy, There's no escaping what for years I consigned to those friends who had less able nerve, less able joints. I knew, with increasing certainity, that they were leading the way, that, as my friend Hale once put it, 'you temporarily abled people have a lot to learn'. Hale, a long term Berkeley resident and man about town was one of my first students, when as a young (really, chronologically less than 30) assistant professor I started teaching a course called Physiology 10, modeled on Dick Strohman's Zoology 10, and George Wald's Harvard course. And as friend and patient we've both been on the planet, sometimes together, often apart, every since. Salama, Hale!
But hey, I could maunder along adressing each of you by name, and where would that leave us?
OK, after my walk this morning, and yet more time to reflect anxiously at the obviously badly poured and minimally reinforced pillar joints of the multistory buildings going up all around, I came back and googled earthquakes and Addis. Oops...
"...More interestingly, the low to mid-rise reinforced concrete buildings that have mushroomed in Ethiopia’s major cities over the past 20 years or so share very identical design and construction characteristics with their counter-parts in these countries. As seen in the August 17, 1999 earthquake of Istanbul, the September 7, 1999 earthquake in Athens, the September 21, 1999 earthquake in Taiwan, and the January 21, 2001 earthquake in Gujarat, India, such buildings that consist of poorly designed reinforced concrete farmes with un-reinforced masonry infills experience severe damage resulting in loss of life. Ethiopian building officials, engineers and architects, therefore, should take note of the probable fate of these builings in the country’s major cities in the event of an earthquake. ...
http://www.ethiosun.com/earthquake-risks-in-addis-ababa-and-other-major-ethiopian-cities-will-the-country-be-caught-off-guarded/)
Just what I was afraid of. Its the usual factors, of course, The country has a modern building code, but its not enforced. Enforcement takes training and funding. And if you can get funding without having to adhere to codes, and your expected investment should pay off within a few years, and the chance of an earthquake is...well, low, right? Then why not?. This dammed market driven model we are using is more flaws than fabric!!!
And of course, most of the hospital building we have visited, perhaps EXCEPT for Adoma/Nazaret, which is single story, are at major risk.
On the subject, I remember sitting with a structural engineer whom we met over coffee in Oaxaca, and hearing for the first time the concept of elasticity explained clearly. People there were busily bringing their buildings 'up to code' by retrofitting rebar in the adobe walls of their buildings. 'Thats like putting a stiff stirring rod into a frozen daiquiri' said the expert, apparently no stranger to cocktails or building codes. 'When something bigger than 7 hits, the rebar stirs the mud and the whole thing comes down in a heap".
But, then, I live in the Bay Area much of the year. And on the coast!! Another reason to consider Woods Hole on Cape Cod as home, I guess. Soon our house on a hill will have a beach in the back yard.
OK, enough of engineering and fear mongering. Its another gorgeous post-rains day in Addis. On my walk I now regularly pass the young mother with the three kids and the green neTela, and smile at the kids, who now smile back, and pass her 10 birr, or sometimes a bit more. Today the older kid was looking over a handwritten sheet of paper with a adult drawing of an airplane and block lettering saying 'TOMORROW I FLY BACK TO MY COUNTRY...". Left by another admirer. Shes so attractive, I am sure any ferengi coming by feels drawn to her, as I do. And as far as I can see, that part of that wall is her nighttime camping place. It being Saturday, there was live call to prayer from the Cathederal, amplified of course, but with very human pauses and even a cough or two. Nothing like the hawking and throat clearing of the older monks that accompanies Tibetan prayers in the Gompa's of Ladakh. People all around are just going about their business, but others are in various degrees of attendance. Some come inside the fence, across the wide paved space that is NOT used for parking (as a megachurch in the midwest might use it..) Some come up to touch the doors or walls with their foreheads. And at the times of regular services, some go in. Across the street, there is a dwelling place made by piling up broken cement sidewalk blocks to form incurving walls, and covered with corrugated steel and tarpaulins. In front, every morning, a man with robes and a head covering, chanting. A life of prayer? Next to the fence around the cathedral, there are many transient sleepers, some holding down prime places from which to sell religious paraphenalia. And also several older men who sit, ensconced in possessions, more or less continuously praying with or without books. Or perhaps they are just mumbling 'duh, duh' over and over, I can't really hear. Whatever, they are swept into the practice and process we recognize as religious behavior. Good in that it helps bear the slings and arrows. Less good in that it deflects people from earthly solutions to social problems.
Meanwhile, back in the meeting rooms, the mission continues. We had a kind of non-meeting yesterday, as events became primarily political rather than informational. After various caucusing, and rapid work to create a comparision of the 'traditional' lecture based model and the possible inquiry directed model, with diagrams and summary matrices, we reassembled. But it became clear, by the unexpressable but clearly percepitable decrease in tension of our Ethiopian colleagues, that in the world of Ministries and politics outside, there had been a shift. After lunch, Oluma, our prime host, sat affably chatting with colleagues, and then proposed that we should separate and have an afternoon off. Hmmm. Luckily, we had introduced the idea of Check Out last week, and so were able to propose a last checkout. It went well. From it we learned that they had enjoyed the process play, and learned from our meetings. From the two most obviously oppositional individuals, we learned that their differences continued, and were not resolvable at the present. We distributed small gifts for our hosts, and the process was over.
Well, not quite. Bob and Kevin were scheduled to leave for the airport at 9, and at about 6 we got word that the Minister of Health would like to meet with us all as soon as possible. As an intensity junky, an ex birth attendant and ER doc (who are all intensity junkies de facto) I love this part of international work. The scramble for a necktie and presentable shirt, the comandeering of the institutional vehicle for the ride through traffic to the Ministry, the quiet and calm that surround the office and officer, the courteous and almost always pleasant interaction itself, and the realization afterwards that most political decisions have been made by the time the meeting is callled. Will the planned develoments be easy? No, of course not. But as usual I am both awed and aghast at the realities of how human societal change occurs.
So now the work of the KAB team is over, KB are sitting in Frankfurt waiting for a connection, and A is sitting here looking forward to going to Merkato to search for the perfect neTela. And yes, Sala, looking for the perfect wooden spoon.
In the coming days, I will be working with Oluma , Birna and others to try to make more specific plans on how information technology can help assessment processes keep track of professional development and communication skills, etc. Yes , I have ideas and even opinions about that is going to happen, but you know what? It's Ethiopians who must make the plans and execute them, and expressing my ideas even to my extended family would be trespassing on territory that now belongs to them. After all, one of our basic group agreements was confidentiality.
I have plans to observe in the ER at St Pauls on Monday night, and to sit in on a class on Tuesday. And time perhaps to get to the Museum of the Red Terror...as well as other cultural sites and touristical attractions. And more wot, more injera, more fit-fit.
Time for breakfast and the day.
Salama
Alan
I think I finally have the day sorted out...since I know Kevin and Bob were staying 10 days and they left last night..the big 747 fan jets are much noisier than anything else, and when they take off from Bole its the kind of sound that makes people believe in cargo cults and gods from the skies. But I didnt hear them, was asleep by their departure time, which will be my departure next Wednesday. So now the apartment is even more quiet than usual...whenever I can hear my own key clicks I know its quiet...and I am enjoying the solitude, although missing K and B.
We did well as a team. I loved NOT being the leader, continuing the course I set over a decade ago of trying not to be in charge of things, or at least to be part of a team if charge is needed. The uncle role. And since I am often the oldest in an assemblage, its also fun to feel the contrasts within myself...feeling intensely young and impatient and madly creative at moments, and at other times absolutely spinning at the changes, the pace of events, the direction human society is taking. I'm aware that I walk like an old guy, unless I am running and then I RUN like an old guy, There's no escaping what for years I consigned to those friends who had less able nerve, less able joints. I knew, with increasing certainity, that they were leading the way, that, as my friend Hale once put it, 'you temporarily abled people have a lot to learn'. Hale, a long term Berkeley resident and man about town was one of my first students, when as a young (really, chronologically less than 30) assistant professor I started teaching a course called Physiology 10, modeled on Dick Strohman's Zoology 10, and George Wald's Harvard course. And as friend and patient we've both been on the planet, sometimes together, often apart, every since. Salama, Hale!
But hey, I could maunder along adressing each of you by name, and where would that leave us?
OK, after my walk this morning, and yet more time to reflect anxiously at the obviously badly poured and minimally reinforced pillar joints of the multistory buildings going up all around, I came back and googled earthquakes and Addis. Oops...
"...More interestingly, the low to mid-rise reinforced concrete buildings that have mushroomed in Ethiopia’s major cities over the past 20 years or so share very identical design and construction characteristics with their counter-parts in these countries. As seen in the August 17, 1999 earthquake of Istanbul, the September 7, 1999 earthquake in Athens, the September 21, 1999 earthquake in Taiwan, and the January 21, 2001 earthquake in Gujarat, India, such buildings that consist of poorly designed reinforced concrete farmes with un-reinforced masonry infills experience severe damage resulting in loss of life. Ethiopian building officials, engineers and architects, therefore, should take note of the probable fate of these builings in the country’s major cities in the event of an earthquake. ...
http://www.ethiosun.com/earthquake-risks-in-addis-ababa-and-other-major-ethiopian-cities-will-the-country-be-caught-off-guarded/)
Just what I was afraid of. Its the usual factors, of course, The country has a modern building code, but its not enforced. Enforcement takes training and funding. And if you can get funding without having to adhere to codes, and your expected investment should pay off within a few years, and the chance of an earthquake is...well, low, right? Then why not?. This dammed market driven model we are using is more flaws than fabric!!!
And of course, most of the hospital building we have visited, perhaps EXCEPT for Adoma/Nazaret, which is single story, are at major risk.
On the subject, I remember sitting with a structural engineer whom we met over coffee in Oaxaca, and hearing for the first time the concept of elasticity explained clearly. People there were busily bringing their buildings 'up to code' by retrofitting rebar in the adobe walls of their buildings. 'Thats like putting a stiff stirring rod into a frozen daiquiri' said the expert, apparently no stranger to cocktails or building codes. 'When something bigger than 7 hits, the rebar stirs the mud and the whole thing comes down in a heap".
But, then, I live in the Bay Area much of the year. And on the coast!! Another reason to consider Woods Hole on Cape Cod as home, I guess. Soon our house on a hill will have a beach in the back yard.
OK, enough of engineering and fear mongering. Its another gorgeous post-rains day in Addis. On my walk I now regularly pass the young mother with the three kids and the green neTela, and smile at the kids, who now smile back, and pass her 10 birr, or sometimes a bit more. Today the older kid was looking over a handwritten sheet of paper with a adult drawing of an airplane and block lettering saying 'TOMORROW I FLY BACK TO MY COUNTRY...". Left by another admirer. Shes so attractive, I am sure any ferengi coming by feels drawn to her, as I do. And as far as I can see, that part of that wall is her nighttime camping place. It being Saturday, there was live call to prayer from the Cathederal, amplified of course, but with very human pauses and even a cough or two. Nothing like the hawking and throat clearing of the older monks that accompanies Tibetan prayers in the Gompa's of Ladakh. People all around are just going about their business, but others are in various degrees of attendance. Some come inside the fence, across the wide paved space that is NOT used for parking (as a megachurch in the midwest might use it..) Some come up to touch the doors or walls with their foreheads. And at the times of regular services, some go in. Across the street, there is a dwelling place made by piling up broken cement sidewalk blocks to form incurving walls, and covered with corrugated steel and tarpaulins. In front, every morning, a man with robes and a head covering, chanting. A life of prayer? Next to the fence around the cathedral, there are many transient sleepers, some holding down prime places from which to sell religious paraphenalia. And also several older men who sit, ensconced in possessions, more or less continuously praying with or without books. Or perhaps they are just mumbling 'duh, duh' over and over, I can't really hear. Whatever, they are swept into the practice and process we recognize as religious behavior. Good in that it helps bear the slings and arrows. Less good in that it deflects people from earthly solutions to social problems.
Meanwhile, back in the meeting rooms, the mission continues. We had a kind of non-meeting yesterday, as events became primarily political rather than informational. After various caucusing, and rapid work to create a comparision of the 'traditional' lecture based model and the possible inquiry directed model, with diagrams and summary matrices, we reassembled. But it became clear, by the unexpressable but clearly percepitable decrease in tension of our Ethiopian colleagues, that in the world of Ministries and politics outside, there had been a shift. After lunch, Oluma, our prime host, sat affably chatting with colleagues, and then proposed that we should separate and have an afternoon off. Hmmm. Luckily, we had introduced the idea of Check Out last week, and so were able to propose a last checkout. It went well. From it we learned that they had enjoyed the process play, and learned from our meetings. From the two most obviously oppositional individuals, we learned that their differences continued, and were not resolvable at the present. We distributed small gifts for our hosts, and the process was over.
Well, not quite. Bob and Kevin were scheduled to leave for the airport at 9, and at about 6 we got word that the Minister of Health would like to meet with us all as soon as possible. As an intensity junky, an ex birth attendant and ER doc (who are all intensity junkies de facto) I love this part of international work. The scramble for a necktie and presentable shirt, the comandeering of the institutional vehicle for the ride through traffic to the Ministry, the quiet and calm that surround the office and officer, the courteous and almost always pleasant interaction itself, and the realization afterwards that most political decisions have been made by the time the meeting is callled. Will the planned develoments be easy? No, of course not. But as usual I am both awed and aghast at the realities of how human societal change occurs.
So now the work of the KAB team is over, KB are sitting in Frankfurt waiting for a connection, and A is sitting here looking forward to going to Merkato to search for the perfect neTela. And yes, Sala, looking for the perfect wooden spoon.
In the coming days, I will be working with Oluma , Birna and others to try to make more specific plans on how information technology can help assessment processes keep track of professional development and communication skills, etc. Yes , I have ideas and even opinions about that is going to happen, but you know what? It's Ethiopians who must make the plans and execute them, and expressing my ideas even to my extended family would be trespassing on territory that now belongs to them. After all, one of our basic group agreements was confidentiality.
I have plans to observe in the ER at St Pauls on Monday night, and to sit in on a class on Tuesday. And time perhaps to get to the Museum of the Red Terror...as well as other cultural sites and touristical attractions. And more wot, more injera, more fit-fit.
Time for breakfast and the day.
Salama
Alan
Ethiopia 2010 Day 10
well, actually there was a day 10...but it became day 11 because of a slippage of dates...so go on to day ll please.
Ethiopia 2010 Day 9
10-8-2010 0745 Apartment Bole Addis
Well, my ambitions have finally led my abilities onto a river with class IV holes and a flow rate of 30,000 cfm and I dont have either the strenth of ability to power through this.
In other words, this will be short because I've been working on a last minute power point to try to illustrate how our case based method works, at a level that would be intelligible to a smart person with no background but pivotal to the decision as to which direction a counry takes.
We, Bob, Kevin and I, are sitting around the dining room table. All on computers, on line.
Bob said yesterday,'nothing has changed since medical school; sitting around pecking on computers with a bunch of roomates in underwear'.
Except I am older, with less memory and far less finger to brain connectivity.
And so it goes...homage to Kurt Vonnegut.
More meeting today, the last one with the full team, since K and B leave tonight. I stay on through Wednesday.
Yesterday we went to Adama, aka Nazreth, named by Ras Tafari himself after the biblical town. Its on the main road to Djibuti, and thus the truck transport corridor of the country. Along the way, an incredible rolling view of the feats and folly of development. The country itself is Eden, high enough to be healthy, enough rainfall and soil to be bountiful. Along the highway, a more or less continuous development zone. There are collections of eucalyptus poles for sale; eucalyptus being the bamboo of this nation at the moment. About half of the structures are unfinished reinforced concrete and cinder block buildings in skeletal form only. Some are clearly years old...others are currently going up. Of the in progress half, about half of that are finished, but surrounded by barbed wire and not clearly operating. The others are functional factories of some sort...the finished ones include trap rock and perhaps gypsum...plus cement block manufacturing. There are also a few assembly plants, for Korean cars, and a huge Chinese sponsored site that will be the base for a new highway, 8 lanes wide.
'The Chinese' are definitely the largest investors. More on the mechanism later, but, as in Tanzania so many years ago now, the Chinese policy of not making internal policy a matter of concern regarding investment is extremely attractive to emerging nations. If you want a road, they will contract to build it, offering a loan to facilitate. Then, of course, you have to find the money to pay off the loan somewhere else, like the World Bank. Then, of course, the World Bank has conditions, looks at human rights, etc etc. But the Chinese dont let that possible impediment hold up the project. You need electricity to support rapid growth of the agricultural sector, or new industrial development? You want a big dam? The Chinese are ready to help.
At this time, I'm not sure how 'the chinese' are really structured, but whatever it is it clearly matches up with the corporate monster that the USA led the world in developing. Ah well, so it goes.
The hospital at Adama probably has the most specialists of any in the country. Originally developed in an old warehouse, primariliy by missionaries, it was nationalized during the Derg regime, and now operates as an independent cost center. They have a CEO who has all the current industry standard jounrals on his coffee table, and gave us a warm welcome and a concise description of their operation, which I will expand on later.
The actual physical plant would be a severe shock to anyone accustomed to Alta Bates, The Brigham, or even Montefiore or SF General. Ethiopian indoors tend to be dimly lit in any case, and the wards at Adama are no exception. Dont look here for the tools of modern midwifery. Or multistoried buildings requiring power to operate the elevator. But the range of services is good, and in some sectors (the lab) the computerization is parallel to what we had in Garberville. And the consequences of downtime on the machine is the same; no lab results until fixed. No backup.
Yes long lines, but no longer than Highland in Oakland. Yes limited resources, but not really much different than rural USA. Yes dirt in the corners, but the infection rates are not higher than many rural hospitals.
And then we returned, after lunch at a luxurious 'safari lounge', where the wood paneled rooms with private baths ranged around a pool and spa with an open air restaurant, shaded by tropical vegetation and where Kevin finally had his cheeseburger...whew, that sentence got away from me...where the rooms cost about $30 a day, and the meal was about $7 each.
We returned to addis, and to visit St Pauls. Initially commissioned by Ras Tafari in his manifestation as Haile Selassie the President, the current modern multistoried building was finished by missionary money in the 70's. We've been meeting with the Dean for the past week, and on this reciprocal visit, we met some of his teaching faculty. They've implemented a very successful lecture based early curriculum, with a Prologue and immediate clinical attachments. They use assessments that revolve around a student portfolio, and include mentoring. Sounds great; im going back tuesday to sit in on one of the classes. And I hope MOnday night to check out the ER.
Whew...and now its on to the meetings of today.
later
Alan
Well, my ambitions have finally led my abilities onto a river with class IV holes and a flow rate of 30,000 cfm and I dont have either the strenth of ability to power through this.
In other words, this will be short because I've been working on a last minute power point to try to illustrate how our case based method works, at a level that would be intelligible to a smart person with no background but pivotal to the decision as to which direction a counry takes.
We, Bob, Kevin and I, are sitting around the dining room table. All on computers, on line.
Bob said yesterday,'nothing has changed since medical school; sitting around pecking on computers with a bunch of roomates in underwear'.
Except I am older, with less memory and far less finger to brain connectivity.
And so it goes...homage to Kurt Vonnegut.
More meeting today, the last one with the full team, since K and B leave tonight. I stay on through Wednesday.
Yesterday we went to Adama, aka Nazreth, named by Ras Tafari himself after the biblical town. Its on the main road to Djibuti, and thus the truck transport corridor of the country. Along the way, an incredible rolling view of the feats and folly of development. The country itself is Eden, high enough to be healthy, enough rainfall and soil to be bountiful. Along the highway, a more or less continuous development zone. There are collections of eucalyptus poles for sale; eucalyptus being the bamboo of this nation at the moment. About half of the structures are unfinished reinforced concrete and cinder block buildings in skeletal form only. Some are clearly years old...others are currently going up. Of the in progress half, about half of that are finished, but surrounded by barbed wire and not clearly operating. The others are functional factories of some sort...the finished ones include trap rock and perhaps gypsum...plus cement block manufacturing. There are also a few assembly plants, for Korean cars, and a huge Chinese sponsored site that will be the base for a new highway, 8 lanes wide.
'The Chinese' are definitely the largest investors. More on the mechanism later, but, as in Tanzania so many years ago now, the Chinese policy of not making internal policy a matter of concern regarding investment is extremely attractive to emerging nations. If you want a road, they will contract to build it, offering a loan to facilitate. Then, of course, you have to find the money to pay off the loan somewhere else, like the World Bank. Then, of course, the World Bank has conditions, looks at human rights, etc etc. But the Chinese dont let that possible impediment hold up the project. You need electricity to support rapid growth of the agricultural sector, or new industrial development? You want a big dam? The Chinese are ready to help.
At this time, I'm not sure how 'the chinese' are really structured, but whatever it is it clearly matches up with the corporate monster that the USA led the world in developing. Ah well, so it goes.
The hospital at Adama probably has the most specialists of any in the country. Originally developed in an old warehouse, primariliy by missionaries, it was nationalized during the Derg regime, and now operates as an independent cost center. They have a CEO who has all the current industry standard jounrals on his coffee table, and gave us a warm welcome and a concise description of their operation, which I will expand on later.
The actual physical plant would be a severe shock to anyone accustomed to Alta Bates, The Brigham, or even Montefiore or SF General. Ethiopian indoors tend to be dimly lit in any case, and the wards at Adama are no exception. Dont look here for the tools of modern midwifery. Or multistoried buildings requiring power to operate the elevator. But the range of services is good, and in some sectors (the lab) the computerization is parallel to what we had in Garberville. And the consequences of downtime on the machine is the same; no lab results until fixed. No backup.
Yes long lines, but no longer than Highland in Oakland. Yes limited resources, but not really much different than rural USA. Yes dirt in the corners, but the infection rates are not higher than many rural hospitals.
And then we returned, after lunch at a luxurious 'safari lounge', where the wood paneled rooms with private baths ranged around a pool and spa with an open air restaurant, shaded by tropical vegetation and where Kevin finally had his cheeseburger...whew, that sentence got away from me...where the rooms cost about $30 a day, and the meal was about $7 each.
We returned to addis, and to visit St Pauls. Initially commissioned by Ras Tafari in his manifestation as Haile Selassie the President, the current modern multistoried building was finished by missionary money in the 70's. We've been meeting with the Dean for the past week, and on this reciprocal visit, we met some of his teaching faculty. They've implemented a very successful lecture based early curriculum, with a Prologue and immediate clinical attachments. They use assessments that revolve around a student portfolio, and include mentoring. Sounds great; im going back tuesday to sit in on one of the classes. And I hope MOnday night to check out the ER.
Whew...and now its on to the meetings of today.
later
Alan
Ethiopia 2010 Day 8
10-6-2010 0645 Apartment Bole Addis. More aware of the small bird noise this morning, getting up a little before sunrise, which is just after 6. No major warbles or prolonged arias, but a good solid middle-bird chirping and tweeting...gives the dignity it deserves to the electronic mimicry. Could anyone really say something of substance as a 'tweet'? And something riled up the local dogs last night...more barks than usual, as well as the big noises of 747's at Bole.
It was a little cooler today.. imagine East Coast temperatures, and you'll be about right. It makes the gabi (smaller head and shoulders scarf) and boro (larger body wrap) that both men and women wear the most sensible garment. Layers. Because it does get warmer, although not hot this time of year at this altitude. Also most anopheles mosquitos apparently dont live well above 3 thousand feet...although, with the usual inventive genetics of all life, there are varients that are coming up the mountain after us. And since 2008, MVI-PATH, financed by Bill Gates, is using the power of funding to seriously support development of a vaccine.
There was a very small woman with three small children in a sleeping ensemble under a green boro along the wall of one of the nascent buildings...those with concrete skeletons and piles of construction poles (Eucalyptus mostly, a decision by Memlik II to import, apparently)..and I slowed to offer a 1 birr note..about 6 cents. The very youngest, still in arms, asleep. The middle, sitting and gaping. But the 4 year old was doing exactly what Ursula would be doing at that hour and with that family...paging through a picture/word book. And the smiles..the beautiful blend of features, all the noses and lips and cheeks and eye shapes you might encounter anywhere...and of course, thats exactly right, the gene pool amharics are drawing from is probably a wee bit larger than mine. After all, my family left a fair while ago, whereas this cousin's family stayed right here.
The thickbilled ravens are out in force today, hopping, pecking, croaking. But the pair that catch my eye are silouetted against the western sky, on the ride of a red roof. Its the tender croaks they are exchanging that I hear first. Then I notice they are beak to beak, caressing each other. Croaking...just the way I might croak at Sala in the early morning. And then, another small hand, another hopeful face.
On a similar subject, Bob and Kevin came out on a somewhat shortened version of the morning walk after work yesterday. Its a very different scene at 6 pm than in the early. Battered blue and white kombi's scurrying up and down, longer haul busses blatting and blowing huge smokes, and major crowds walking. At the corner gas station, someone has stockpiled huge shiny green multi tire John Deere tractors..at least one with a sticker saying 'Washed carefully in Baltimore". And the small children are out in force, some with a plastic wrapped bundle of tissue to sell, some gum, and some just hoping you will have a small bill or coin for their hand. Coming between Bole and the street of the Cathederal, we acquired two very persistant small boys..looking to be about 4-5. They happened to be tissue salespersons, out with a single packet each. Unusual, most small children stick pretty close to an adult...but these guys hustled right along with us down the unpaved street, onto the pavement next to the 4 small restaurants in a row..your choice of Antique Italian or Classical Chinese...and around the corner onto the main street. They hung in there past the greengrocer on the corner, with piles of green papaya, avocado, onions and collards (well, they function as collards), and all the way north along to Elsies Bar and Cafe. But at that point, we encountered a woman and her two children, one a very slim and agile girl, slightly taller than the small boys. We gave the woman a small bill, the girl, sensing opportunity, came along with us. She averted her eyes after she made contact; obviously not just a kid, she was a responsible part of her family, working for the family good. Her lips, her chin, her brow...every feature designed to express her human enotions was increasingly stormy. 'These small annoying boys', you could almost hear her thoughts,' this is MY territory, the territory of MY MOTHER.' A glance back. Mom was not far behind, with sister. With that support, our little furie edged over and crowded one little boy. He pushed back. She mixed right in. As they stopped progress in combat, we happened to pause for Kevin to check out the Munich Bakery. Watched mom and an askari separating the kids. They circled, watchful, hovering. We continued on. This time, our girl wasted little time. With mom and the askari safely behind, she accellerated, grabbed towards the offending small boy, and the chase was on. She routed both of them; they laughing, she most serious. During this entire encounter, her gabi stayed securely on her head, her rubber sandals on her feet, and her composure generally remained perfect. She chased those two boys right up the street. Yes, I paid her as she came back past us, heading back to mom. And she accepted, now with eye contact and a rather serious smile. Eventually, I gave ther rest of the lifesavers to the small boys, but the young lady got the birr. The walk was over in any case.
The work seems to be going well. Several new colleagues, one from Education, attended We came to a nexus..which I felt really boiled down to whether everyone felt comfortable with the idea that students can learn. I know it sounds obvious, but I've found, everywhere I have been, that teachers seem to divide on this point..in actions if not in words. But Bob made it clearer when he commented ' You mean, that students don't have to be taught'. Yes, thats it, Bob! Students can learn if you provide the opportunities, the tools, the encouragement, even the examples, the tales of success, the joys of discovery, the passion of inquiry and understanding. And by the same dog-door, students who are sat in rows and made to memorize eventually get the message that they cannot learn, and must be taught. The basic problem surfaces over and over in our discussions. Surely there must be lectures, just for the basics. Surely they must need anatomy before... Surely there must be a time when the teacher sets things right... Yes, of course, but can't it be in the form of a clearly understood set of hurdles/benchmarks/competency exams, and a much larger set of opportunities for formative feedback? Can't the curriculum allow students to discover the clinical reasons they need to know how the endocardial cushions form before they try memorize all the incomprehensible and arbitrary nomenlature? Can't we just get past the idea that human behavior in any way ressembles a tetrahedronal pile of blocks? And of course, I believe we can. In the meantime, the discussion goes on.
So the work seems to go well. But who knows. There was a cabinet shuffle yesterday, and our colleagues waited eagerly beside a cell phone receiving a podcast of some kind to learn that it seems likely that the Minister of Health will not be changing. We can work as hard as we like, but everyone is aware that human plans can be swept away by more than hurricanes or earthquakes.
And now, time to eat a bit and head up to work. If it sounds like I am having an amazing time, you got it, baby!! I might even get to be a tourist on the weekend. Meanwhile, share as much as I can, and do what i can to inform Ethiopians making what must be Ethiopian plans.
be well, Salama.
Alan
It was a little cooler today.. imagine East Coast temperatures, and you'll be about right. It makes the gabi (smaller head and shoulders scarf) and boro (larger body wrap) that both men and women wear the most sensible garment. Layers. Because it does get warmer, although not hot this time of year at this altitude. Also most anopheles mosquitos apparently dont live well above 3 thousand feet...although, with the usual inventive genetics of all life, there are varients that are coming up the mountain after us. And since 2008, MVI-PATH, financed by Bill Gates, is using the power of funding to seriously support development of a vaccine.
There was a very small woman with three small children in a sleeping ensemble under a green boro along the wall of one of the nascent buildings...those with concrete skeletons and piles of construction poles (Eucalyptus mostly, a decision by Memlik II to import, apparently)..and I slowed to offer a 1 birr note..about 6 cents. The very youngest, still in arms, asleep. The middle, sitting and gaping. But the 4 year old was doing exactly what Ursula would be doing at that hour and with that family...paging through a picture/word book. And the smiles..the beautiful blend of features, all the noses and lips and cheeks and eye shapes you might encounter anywhere...and of course, thats exactly right, the gene pool amharics are drawing from is probably a wee bit larger than mine. After all, my family left a fair while ago, whereas this cousin's family stayed right here.
The thickbilled ravens are out in force today, hopping, pecking, croaking. But the pair that catch my eye are silouetted against the western sky, on the ride of a red roof. Its the tender croaks they are exchanging that I hear first. Then I notice they are beak to beak, caressing each other. Croaking...just the way I might croak at Sala in the early morning. And then, another small hand, another hopeful face.
On a similar subject, Bob and Kevin came out on a somewhat shortened version of the morning walk after work yesterday. Its a very different scene at 6 pm than in the early. Battered blue and white kombi's scurrying up and down, longer haul busses blatting and blowing huge smokes, and major crowds walking. At the corner gas station, someone has stockpiled huge shiny green multi tire John Deere tractors..at least one with a sticker saying 'Washed carefully in Baltimore". And the small children are out in force, some with a plastic wrapped bundle of tissue to sell, some gum, and some just hoping you will have a small bill or coin for their hand. Coming between Bole and the street of the Cathederal, we acquired two very persistant small boys..looking to be about 4-5. They happened to be tissue salespersons, out with a single packet each. Unusual, most small children stick pretty close to an adult...but these guys hustled right along with us down the unpaved street, onto the pavement next to the 4 small restaurants in a row..your choice of Antique Italian or Classical Chinese...and around the corner onto the main street. They hung in there past the greengrocer on the corner, with piles of green papaya, avocado, onions and collards (well, they function as collards), and all the way north along to Elsies Bar and Cafe. But at that point, we encountered a woman and her two children, one a very slim and agile girl, slightly taller than the small boys. We gave the woman a small bill, the girl, sensing opportunity, came along with us. She averted her eyes after she made contact; obviously not just a kid, she was a responsible part of her family, working for the family good. Her lips, her chin, her brow...every feature designed to express her human enotions was increasingly stormy. 'These small annoying boys', you could almost hear her thoughts,' this is MY territory, the territory of MY MOTHER.' A glance back. Mom was not far behind, with sister. With that support, our little furie edged over and crowded one little boy. He pushed back. She mixed right in. As they stopped progress in combat, we happened to pause for Kevin to check out the Munich Bakery. Watched mom and an askari separating the kids. They circled, watchful, hovering. We continued on. This time, our girl wasted little time. With mom and the askari safely behind, she accellerated, grabbed towards the offending small boy, and the chase was on. She routed both of them; they laughing, she most serious. During this entire encounter, her gabi stayed securely on her head, her rubber sandals on her feet, and her composure generally remained perfect. She chased those two boys right up the street. Yes, I paid her as she came back past us, heading back to mom. And she accepted, now with eye contact and a rather serious smile. Eventually, I gave ther rest of the lifesavers to the small boys, but the young lady got the birr. The walk was over in any case.
The work seems to be going well. Several new colleagues, one from Education, attended We came to a nexus..which I felt really boiled down to whether everyone felt comfortable with the idea that students can learn. I know it sounds obvious, but I've found, everywhere I have been, that teachers seem to divide on this point..in actions if not in words. But Bob made it clearer when he commented ' You mean, that students don't have to be taught'. Yes, thats it, Bob! Students can learn if you provide the opportunities, the tools, the encouragement, even the examples, the tales of success, the joys of discovery, the passion of inquiry and understanding. And by the same dog-door, students who are sat in rows and made to memorize eventually get the message that they cannot learn, and must be taught. The basic problem surfaces over and over in our discussions. Surely there must be lectures, just for the basics. Surely they must need anatomy before... Surely there must be a time when the teacher sets things right... Yes, of course, but can't it be in the form of a clearly understood set of hurdles/benchmarks/competency exams, and a much larger set of opportunities for formative feedback? Can't the curriculum allow students to discover the clinical reasons they need to know how the endocardial cushions form before they try memorize all the incomprehensible and arbitrary nomenlature? Can't we just get past the idea that human behavior in any way ressembles a tetrahedronal pile of blocks? And of course, I believe we can. In the meantime, the discussion goes on.
So the work seems to go well. But who knows. There was a cabinet shuffle yesterday, and our colleagues waited eagerly beside a cell phone receiving a podcast of some kind to learn that it seems likely that the Minister of Health will not be changing. We can work as hard as we like, but everyone is aware that human plans can be swept away by more than hurricanes or earthquakes.
And now, time to eat a bit and head up to work. If it sounds like I am having an amazing time, you got it, baby!! I might even get to be a tourist on the weekend. Meanwhile, share as much as I can, and do what i can to inform Ethiopians making what must be Ethiopian plans.
be well, Salama.
Alan
Ethiopia 2010 Day 7
10-5-10 Apartment, Bole Ave, Addis. One of the people I work with during the day comes from Harar, and he says the hyena issue is greatly over-rated. Like people from Chicago stuck with the stockyard-hog butcher metaphor, I guess. But he does confirm that Harar is very old.
Reading about it suggests that it's one of the nicest places to visit in Ethiopia. But I doubt I get there this time. It's a couple of days by car..days I dont seem to have, cars I dont seem to have. Aside from the hyenas, it seems an arms dealer with a poetic bent named Rimbaud lived and perhaps taught there. And Burton passed through there on his way to look for the Nile origins, apparently not put off by the historical imperative to kill any non moslems who entered the city. Well, perhaps someday.
Khat. Yeah, it is. Yeah, I have. Yeah, it does.
from the internet (http://www.mainliners.org.uk/pages/methedrone-cathinones.html )"Cathinone is a naturally occurring stimulant found in the khat plant and cathinones are a group of drugs related to amphetamine compounds like ecstasy. Cathinone derivatives are currently being sold online and in headshops as ‘legal highs'." (There is also a methylated relative, bearing the same relationship to cathinone that methamphetamine does to amphetamine) "A stimulant drug with effects similar to MDMA producing euphoria, alertness, talkativeness and feelings of empathy. It can also cause anxiety and paranoid states and risk overstimulating the heart and nervous system to cause fits. Severe nosebleeds have been reported after snorting. Mephedrone has been linked to the death of a young woman in Sweden in 2008. A white or off-white powder usually sold on the internet as a legal high and described as a plant food or a research chemical not for human consumption. Sometimes mixed with other cathinones and caffeine. "
Well, la-de-dah, and so much for my stuffy contenion that amphetamine is a totally foreign substance. As if there were some 'natural law' that makes it intrinsically more evil, more dangerous. Nope, once again, as with so many, you have to choose. The only saving grace is that it takes some work to chew khat (pronounced chat here). I still find amphetamine the scariest human development since sliced bread. But khat....
I bought mine with the help of our driver at a little shack by the side of the road. 50 birr for a half bundle (16 birr to the dollar). No question its in use by a lot of the people of the markets, perhaps for the usual reasons; you can work harder and carry more and tolerate more pain and fatigue with the drug. In my (purely for the sake of science, you understand) experiment, the effect as a tea is a very mild exhilaration and probably more talk. The effect of chewing is a definite buzz and..well, here I am writing away....and often finding myself drifting into what the German fairy tale anti-hero Till Eulenspiegel calls 'Cloud Cucucu Land'.
Khat is legal here...in fact, the third largest export. Perhaps one of the reasons the railway to Dubhai was developed. Doesnt travel well..the active ingredient degrades into a much less active ingredient, something that my grower friends in the Emerald Triangle assure me happens to cannabis as well. Features in at least the early part of 'Cutting for Stone', that book that many peope want to be sure I am reading ( I am). Doesn't taste great, but nothing on the order of peyote or mescal. So, as a friend of mine once said, perhaps a kind of 'good drug'. Unfortunately, see above, continued use is very very prolematic.
It was another day in the conference room yesterday, thrashing through specific issues and concerns of a possible curriculum. I think its a good sign that our colleague/hosts spontaneously got into sponatenously animated conversations in amharic today, the substance of communication becoming more important than the courtesy towards visitors. We are talking about things that if implemented anywhere would really improve medical care, really move this nation into a lead positon. But they really have priorities that are so different from those in the USA. For example, there are so few specialists here, particularly rurally, that when doctors graduate from medical school, GP's are expected to be able to do c sections, appies, and the like, and also advanced trauma procedures, such as tracheotomies and cutdowns. They have recently completed a survey of capability, and its clear that considerable upgrade is needed. But then, if one is 50 km away from a major hospital, any major trauma is just fatal, barak.
So, there is no Mission aka 'Missing' Hospital in Addis, but in my internet search for a possible inspiration for the hospital of that name in "Cutting for Stone", I ran across Fistula Hospital. Not to go into unwelcome deail for those who dont want to know, suffice it to say that this project was founded in 1974 "by Australian obstetrician-gynecologist, Drs. Catherine Hamlin, and her New Zealand born ob-gyn husband, Reginald. The Hospital has restored the lives and hopes of more than 32,000 women who would have otherwise perished or suffered lifelong complications brought on by childbirth injuries, specifically obstetric fistula. Today, the hospital provides free fistula repair surgery to approximately 2,220 women every year and cares for 35 long-term patients." ( http://www.fistulafoundation.org/hospital/) Of course that got me wondering if a major reason for these terribly debilitating traumatic holes between parts of the female anatomy that shouldn't have holes connecting them might be infundibulation, or FGM...female genital mutilation. But from both direct questioning and the literature, this is a relatively rare cause. The major one is just plain old unattended births..and of course sexual abuse in times of war. ( Yes, Yeshi, I will try to find out more about the TBA upgrading projects ). Still, as if unintended trauma and rape wasnt bad enough, there are an estimated 130 million women and girls subjected to FGM. Folk practices are often really beneficial, but sometimes truly frightening. And it's often girls who encounter what Suzanne Vega called 'the steel side of the knife' in one of her songs. So consider supporting one of the NGO's that work in this area, or Fistula hospital itself through its Foundation.
So on the walk today I became more acquainted with two of the charismatic megafauna of the 2000 meter level . Corvus crassirostris, the Thick Billed Raven, and Corvus albus, the Pied Crow. Albus is the one with the white vest..about the size of an American raven, typical cawing call. Crassirostris has a truly impressive Roman nose, a small white headcrest, and is big enough to give one pause. Both of them were hopping around the garbage cans this morning, as the incredibly brilliant sun broke through the clouds and lit up the green green green hills that surround this city at this time of year. And the song sparrows sound so different. And no rats...where are the rats? Must be a balanced predation, but by whom?
OK, time to pull it together and head off for work...or soon, at least. Kevin and Bob have only 4 days more, and although I have a few more than that, we need a 4 day plan.
aloha
Alan
Reading about it suggests that it's one of the nicest places to visit in Ethiopia. But I doubt I get there this time. It's a couple of days by car..days I dont seem to have, cars I dont seem to have. Aside from the hyenas, it seems an arms dealer with a poetic bent named Rimbaud lived and perhaps taught there. And Burton passed through there on his way to look for the Nile origins, apparently not put off by the historical imperative to kill any non moslems who entered the city. Well, perhaps someday.
Khat. Yeah, it is. Yeah, I have. Yeah, it does.
from the internet (http://www.mainliners.org.uk/pages/methedrone-cathinones.html )"Cathinone is a naturally occurring stimulant found in the khat plant and cathinones are a group of drugs related to amphetamine compounds like ecstasy. Cathinone derivatives are currently being sold online and in headshops as ‘legal highs'." (There is also a methylated relative, bearing the same relationship to cathinone that methamphetamine does to amphetamine) "A stimulant drug with effects similar to MDMA producing euphoria, alertness, talkativeness and feelings of empathy. It can also cause anxiety and paranoid states and risk overstimulating the heart and nervous system to cause fits. Severe nosebleeds have been reported after snorting. Mephedrone has been linked to the death of a young woman in Sweden in 2008. A white or off-white powder usually sold on the internet as a legal high and described as a plant food or a research chemical not for human consumption. Sometimes mixed with other cathinones and caffeine. "
Well, la-de-dah, and so much for my stuffy contenion that amphetamine is a totally foreign substance. As if there were some 'natural law' that makes it intrinsically more evil, more dangerous. Nope, once again, as with so many, you have to choose. The only saving grace is that it takes some work to chew khat (pronounced chat here). I still find amphetamine the scariest human development since sliced bread. But khat....
I bought mine with the help of our driver at a little shack by the side of the road. 50 birr for a half bundle (16 birr to the dollar). No question its in use by a lot of the people of the markets, perhaps for the usual reasons; you can work harder and carry more and tolerate more pain and fatigue with the drug. In my (purely for the sake of science, you understand) experiment, the effect as a tea is a very mild exhilaration and probably more talk. The effect of chewing is a definite buzz and..well, here I am writing away....and often finding myself drifting into what the German fairy tale anti-hero Till Eulenspiegel calls 'Cloud Cucucu Land'.
Khat is legal here...in fact, the third largest export. Perhaps one of the reasons the railway to Dubhai was developed. Doesnt travel well..the active ingredient degrades into a much less active ingredient, something that my grower friends in the Emerald Triangle assure me happens to cannabis as well. Features in at least the early part of 'Cutting for Stone', that book that many peope want to be sure I am reading ( I am). Doesn't taste great, but nothing on the order of peyote or mescal. So, as a friend of mine once said, perhaps a kind of 'good drug'. Unfortunately, see above, continued use is very very prolematic.
It was another day in the conference room yesterday, thrashing through specific issues and concerns of a possible curriculum. I think its a good sign that our colleague/hosts spontaneously got into sponatenously animated conversations in amharic today, the substance of communication becoming more important than the courtesy towards visitors. We are talking about things that if implemented anywhere would really improve medical care, really move this nation into a lead positon. But they really have priorities that are so different from those in the USA. For example, there are so few specialists here, particularly rurally, that when doctors graduate from medical school, GP's are expected to be able to do c sections, appies, and the like, and also advanced trauma procedures, such as tracheotomies and cutdowns. They have recently completed a survey of capability, and its clear that considerable upgrade is needed. But then, if one is 50 km away from a major hospital, any major trauma is just fatal, barak.
So, there is no Mission aka 'Missing' Hospital in Addis, but in my internet search for a possible inspiration for the hospital of that name in "Cutting for Stone", I ran across Fistula Hospital. Not to go into unwelcome deail for those who dont want to know, suffice it to say that this project was founded in 1974 "by Australian obstetrician-gynecologist, Drs. Catherine Hamlin, and her New Zealand born ob-gyn husband, Reginald. The Hospital has restored the lives and hopes of more than 32,000 women who would have otherwise perished or suffered lifelong complications brought on by childbirth injuries, specifically obstetric fistula. Today, the hospital provides free fistula repair surgery to approximately 2,220 women every year and cares for 35 long-term patients." ( http://www.fistulafoundation.org/hospital/) Of course that got me wondering if a major reason for these terribly debilitating traumatic holes between parts of the female anatomy that shouldn't have holes connecting them might be infundibulation, or FGM...female genital mutilation. But from both direct questioning and the literature, this is a relatively rare cause. The major one is just plain old unattended births..and of course sexual abuse in times of war. ( Yes, Yeshi, I will try to find out more about the TBA upgrading projects ). Still, as if unintended trauma and rape wasnt bad enough, there are an estimated 130 million women and girls subjected to FGM. Folk practices are often really beneficial, but sometimes truly frightening. And it's often girls who encounter what Suzanne Vega called 'the steel side of the knife' in one of her songs. So consider supporting one of the NGO's that work in this area, or Fistula hospital itself through its Foundation.
So on the walk today I became more acquainted with two of the charismatic megafauna of the 2000 meter level . Corvus crassirostris, the Thick Billed Raven, and Corvus albus, the Pied Crow. Albus is the one with the white vest..about the size of an American raven, typical cawing call. Crassirostris has a truly impressive Roman nose, a small white headcrest, and is big enough to give one pause. Both of them were hopping around the garbage cans this morning, as the incredibly brilliant sun broke through the clouds and lit up the green green green hills that surround this city at this time of year. And the song sparrows sound so different. And no rats...where are the rats? Must be a balanced predation, but by whom?
OK, time to pull it together and head off for work...or soon, at least. Kevin and Bob have only 4 days more, and although I have a few more than that, we need a 4 day plan.
aloha
Alan
Ethiopia 2010 Day 6
10-4-2010 0630 The Apartment, Bole Avenue, Addis. Yes, Bole is the name of the airport, and this is also Africa Avenue, which if you follow it leads to Kenyatta, Tito, and even Chino-Ethiopia Street (or Ave, cant recall which), The small duka where we bought khat (yes, pronounched 'chat') is just off Bole and a little South of China. The National Museum is further along, past Tito and further North than the Addis Sheraton (more about that later also) and yesterday was a day of rest from the medical work, so we went to the museum. After the walk, of course.
Yesterday began clear, and relatively smog free because of it being Sunday, and later, coming out of the National Museum, there were towering cumulus nimbus clouds off to the Southwest, real castles and dragons. But perhaps I was influenced by the museum.
Sala and I have played at assigning levels to the museums we have visited. This one was mostly level 2, but the approach to Lucy is, as you might expect, level 4, a little shopworn with use, but still definitely level 4. Not geographically; its actually in the lower floor, with all the windows sealed off and very controlled lighting, one of the attributes of many level 4 museums.
But why is the floor of art, the floor of artefacts, the floor of ancient artefacts and the exhibit of the clothes of past emperors along with a case of their swords level II? It's not level I because things are separated into floors, and into subject cases. There are no two headed calves next to the bloody smocks from past revolutions (in fact, no two headed calf at at all). But the labeling is only mildly informative, and the themes of each case seem to be things like 'anything made of wood' rather than 'the story of plowing', which you would find in a level 3 museum. The lighting is reminescent of the national museum in Hanoi...subtle aka available daylight. And the art section ranges 17th century religious wall art across the way from an exhibit of smiling contemporary women creating lovely multi colored baskets.
The two exceptions are the video crowned kiosk in the middle of the emperors-costumes-and-swords room when you come in. It concerns Homo sapiens idaltu, who is the current cantidate for immediate grandpa.
From Wikipedia:
"The fossilized remains of H. s. idaltu ('old one') were discovered at Herto Bouri in the Middle Awash site of Ethiopia's Afar Triangle in 1997 by Tim White, but were first unveiled in 2003.[1] Herto Bouri is a region of Ethiopia under volcanic layers. By using radioisotope dating, the layers date between 154,000 and 160,000 years old. Three well preserved crania are accounted for, the best preserved being from an adult male (BOU-VP-16/1) having a brain capacity of 1,450 cm3 (88 cu in). ((We average 1300...Lucy's kind were 375 to 500)) The other crania include another partial adult male and a six year old child.[1]These fossils differ from those of chronologically later forms of early H. sapiens such as Cro-Magnon found in Europe and other parts of the world in that their morphology has many archaic features not typical of H. sapiens (although modern human skulls do differ across the globe)."
The video that runs on screens at the middle of the glass walled kiosk that houses a reconstruction model of h.s.idaltu's skull is quite touching and level 5..technically flawless, informative, and emotive. After dissolving through the reconstruction of a male face, based on the skull remains, it dissolves through representatives of the usual varients of human, each view ending as a smile begins. Really well done. I think it was prepared for an international pan-africa exhibit.
The downstairs section was partly non functional (typical of level 4) but also really intersting...exhibits of models of the very fragmentary remains that take us back towards 300,000 BCE...and up to the sapiens level. I particularly liked the introduction of sharp rock tools, and, without much comment but very clearly, their refinement as the centuries rolled along. The non working parts (darn!) are videos about fossiking, about dating, and fascinating things like that.
As you turn towards Lucy, the lighting diminishes, the plywood partitions break things up into absorbable chunks,and the legends and wall charts become informative and written at a perky 8th grade level. We see how pig fossils are used as a surrogate for human dates. We learn about giant and pygmie hippos, about different fossil croc's. And, most important for me, we learn about how the rift valley was formed by the collapse of a chip off a broken continental plate, and what it might have looked like 160,000 years ago, Lucy's time. Bob says, 'It looks just like all of our idealized parks..the garden of Eden'. And in the little diorama presented, it does. The arid conditions of today are our legacy, along with the fossils, But then there were grasses, shrubs, and other evolving mammals to say nothing of tasty insects and reptiles. And then finally, around the last corner,Lucy.
Of course its actually reproductions. Next to the skeleton is a reconstruction. So little. She would be terrified by the traffic.She was about as big as the child with the face so disfigured by a healed burn that I could barely see its body, the child that came crowding up to the SUV as we got back in after a stop to buy scarves. Kevin, so pierced he really had no option, gave Direr a quite large birr bill to give the child . Of course, by the time the window was down, the child had been mobbed by older children, indeed by beggers of all ages. Aiiyiyiyi!! But begging is modern hunting and gathering, something that Lucy was probably pretty good at, already.
The clouds were boiling, the traffic was thicker, but it was still clearly Sunday and no rain yet. Kevin decided he would take us by the Addis Sheraton. He wanted to take us to dinner later, and since there are four (4) restaurants there, he wanted us to see them in advance, and decide which. And of course, see the swimming pool. If the manicured and well fenced grounds havent already told you this is something very different than your regular Kansas hotel, the entry way immediately conveys it. The security system is the equal of Washington DC federal buildings; uniformed guards, under car mirrors, open hood inspections, open all bags, and a flip up bomb proof barrier along with a steel gate. OK, enough, right? Nope, there is an additional personal security check at the door, complete with belt x ray and walk through metal detector.
The hotel is said to be the best in Africa,,,rooms over $300 for a single, and the dinner menus start at 200 birr for appetizers. We ended up selecting a buffet style venue, passing up Italianate, Indian, and jus plain posh. Stepping out of the Eastern side, we walked past tiered fountains that the designers possibly hoped would evoke Versailles, and then down a long paved walk to the pool. The overall style is Cement Realism with a touch of Early Colonial Ostentation. We were accompanied under the now blue again skies and balmy weather by two very blond and very excited children and their parents, their entire presence shrieking 'beach'. We arrived at the large, beautiful, and very posh pool with seemingly endless yellow terry cloth and wooden lounges. A gate. a gatekeeper. And were told it was for guests only. But wait, surely there must be a way. There was in Dar...you could pay for a day pass. We asked the South African parents of the excited children, and sure enough...for only $200 birr per person, you can bathe. And you know what? Remembering back to traveling in Sudan with Aminta and Tirien, and the vigor with which we used our American skin privilege to get into the pool at the embassy club, it would probably be worth it even at that price.
It was showering lightly when we returned, and I spent the afternoon doing a powerpoint for todays work session. This one is really about engineering..the scrolls and clicks that we use to assess and track student and faculty competances. Perhaps not the stuff of high level planning, but I find it comforting to make power points..and it will perhaps help .. manage anxieties while we encourage our colleagues to stay with the planning a little longer, to really sort the issues of what kind of curriculum they want. I totally appreciate the work that the Tulane team, with Kevin in the later stages, put in already. It lets us really grapple with the core issues. And yet...time runs short, and the Minister must be presented with a curriculum soon.
Back at the Sheraton for dinner, the dinner and salad bar were A+, and the little dish labeled coffee creme brulee was...well, stick with the delicious little caramel puff pastries instead, should you have the opportunity.
And at 3 am I woke with a intermittant deep definitely nagging pain in my right elbow. Dogs barking. Some stars showing through the slight haze. Rolled over. Rubbed it. Did alphabet exercises. Finally turned on the light and took two ibuprofen. Read 'Cutting..'. Went back to sleep. It's still there, the pain, of unknown origin, but very tolerable now. It reminds me of how fragile is our peace. That's aging for ya, something new every day. Or as cynthia said once, enjoy it while you can.
Have a wunnerful day. From now on, I am not certain of the agenda.But hope it will include some travel out of town, and a visit to a working healthpost and hospital.
Alan
Yesterday began clear, and relatively smog free because of it being Sunday, and later, coming out of the National Museum, there were towering cumulus nimbus clouds off to the Southwest, real castles and dragons. But perhaps I was influenced by the museum.
Sala and I have played at assigning levels to the museums we have visited. This one was mostly level 2, but the approach to Lucy is, as you might expect, level 4, a little shopworn with use, but still definitely level 4. Not geographically; its actually in the lower floor, with all the windows sealed off and very controlled lighting, one of the attributes of many level 4 museums.
But why is the floor of art, the floor of artefacts, the floor of ancient artefacts and the exhibit of the clothes of past emperors along with a case of their swords level II? It's not level I because things are separated into floors, and into subject cases. There are no two headed calves next to the bloody smocks from past revolutions (in fact, no two headed calf at at all). But the labeling is only mildly informative, and the themes of each case seem to be things like 'anything made of wood' rather than 'the story of plowing', which you would find in a level 3 museum. The lighting is reminescent of the national museum in Hanoi...subtle aka available daylight. And the art section ranges 17th century religious wall art across the way from an exhibit of smiling contemporary women creating lovely multi colored baskets.
The two exceptions are the video crowned kiosk in the middle of the emperors-costumes-and-swords room when you come in. It concerns Homo sapiens idaltu, who is the current cantidate for immediate grandpa.
From Wikipedia:
"The fossilized remains of H. s. idaltu ('old one') were discovered at Herto Bouri in the Middle Awash site of Ethiopia's Afar Triangle in 1997 by Tim White, but were first unveiled in 2003.[1] Herto Bouri is a region of Ethiopia under volcanic layers. By using radioisotope dating, the layers date between 154,000 and 160,000 years old. Three well preserved crania are accounted for, the best preserved being from an adult male (BOU-VP-16/1) having a brain capacity of 1,450 cm3 (88 cu in). ((We average 1300...Lucy's kind were 375 to 500)) The other crania include another partial adult male and a six year old child.[1]These fossils differ from those of chronologically later forms of early H. sapiens such as Cro-Magnon found in Europe and other parts of the world in that their morphology has many archaic features not typical of H. sapiens (although modern human skulls do differ across the globe)."
The video that runs on screens at the middle of the glass walled kiosk that houses a reconstruction model of h.s.idaltu's skull is quite touching and level 5..technically flawless, informative, and emotive. After dissolving through the reconstruction of a male face, based on the skull remains, it dissolves through representatives of the usual varients of human, each view ending as a smile begins. Really well done. I think it was prepared for an international pan-africa exhibit.
The downstairs section was partly non functional (typical of level 4) but also really intersting...exhibits of models of the very fragmentary remains that take us back towards 300,000 BCE...and up to the sapiens level. I particularly liked the introduction of sharp rock tools, and, without much comment but very clearly, their refinement as the centuries rolled along. The non working parts (darn!) are videos about fossiking, about dating, and fascinating things like that.
As you turn towards Lucy, the lighting diminishes, the plywood partitions break things up into absorbable chunks,and the legends and wall charts become informative and written at a perky 8th grade level. We see how pig fossils are used as a surrogate for human dates. We learn about giant and pygmie hippos, about different fossil croc's. And, most important for me, we learn about how the rift valley was formed by the collapse of a chip off a broken continental plate, and what it might have looked like 160,000 years ago, Lucy's time. Bob says, 'It looks just like all of our idealized parks..the garden of Eden'. And in the little diorama presented, it does. The arid conditions of today are our legacy, along with the fossils, But then there were grasses, shrubs, and other evolving mammals to say nothing of tasty insects and reptiles. And then finally, around the last corner,Lucy.
Of course its actually reproductions. Next to the skeleton is a reconstruction. So little. She would be terrified by the traffic.She was about as big as the child with the face so disfigured by a healed burn that I could barely see its body, the child that came crowding up to the SUV as we got back in after a stop to buy scarves. Kevin, so pierced he really had no option, gave Direr a quite large birr bill to give the child . Of course, by the time the window was down, the child had been mobbed by older children, indeed by beggers of all ages. Aiiyiyiyi!! But begging is modern hunting and gathering, something that Lucy was probably pretty good at, already.
The clouds were boiling, the traffic was thicker, but it was still clearly Sunday and no rain yet. Kevin decided he would take us by the Addis Sheraton. He wanted to take us to dinner later, and since there are four (4) restaurants there, he wanted us to see them in advance, and decide which. And of course, see the swimming pool. If the manicured and well fenced grounds havent already told you this is something very different than your regular Kansas hotel, the entry way immediately conveys it. The security system is the equal of Washington DC federal buildings; uniformed guards, under car mirrors, open hood inspections, open all bags, and a flip up bomb proof barrier along with a steel gate. OK, enough, right? Nope, there is an additional personal security check at the door, complete with belt x ray and walk through metal detector.
The hotel is said to be the best in Africa,,,rooms over $300 for a single, and the dinner menus start at 200 birr for appetizers. We ended up selecting a buffet style venue, passing up Italianate, Indian, and jus plain posh. Stepping out of the Eastern side, we walked past tiered fountains that the designers possibly hoped would evoke Versailles, and then down a long paved walk to the pool. The overall style is Cement Realism with a touch of Early Colonial Ostentation. We were accompanied under the now blue again skies and balmy weather by two very blond and very excited children and their parents, their entire presence shrieking 'beach'. We arrived at the large, beautiful, and very posh pool with seemingly endless yellow terry cloth and wooden lounges. A gate. a gatekeeper. And were told it was for guests only. But wait, surely there must be a way. There was in Dar...you could pay for a day pass. We asked the South African parents of the excited children, and sure enough...for only $200 birr per person, you can bathe. And you know what? Remembering back to traveling in Sudan with Aminta and Tirien, and the vigor with which we used our American skin privilege to get into the pool at the embassy club, it would probably be worth it even at that price.
It was showering lightly when we returned, and I spent the afternoon doing a powerpoint for todays work session. This one is really about engineering..the scrolls and clicks that we use to assess and track student and faculty competances. Perhaps not the stuff of high level planning, but I find it comforting to make power points..and it will perhaps help .. manage anxieties while we encourage our colleagues to stay with the planning a little longer, to really sort the issues of what kind of curriculum they want. I totally appreciate the work that the Tulane team, with Kevin in the later stages, put in already. It lets us really grapple with the core issues. And yet...time runs short, and the Minister must be presented with a curriculum soon.
Back at the Sheraton for dinner, the dinner and salad bar were A+, and the little dish labeled coffee creme brulee was...well, stick with the delicious little caramel puff pastries instead, should you have the opportunity.
And at 3 am I woke with a intermittant deep definitely nagging pain in my right elbow. Dogs barking. Some stars showing through the slight haze. Rolled over. Rubbed it. Did alphabet exercises. Finally turned on the light and took two ibuprofen. Read 'Cutting..'. Went back to sleep. It's still there, the pain, of unknown origin, but very tolerable now. It reminds me of how fragile is our peace. That's aging for ya, something new every day. Or as cynthia said once, enjoy it while you can.
Have a wunnerful day. From now on, I am not certain of the agenda.But hope it will include some travel out of town, and a visit to a working healthpost and hospital.
Alan
Ethiopia 2010 Day 5
10-2-10 0735 Bole Ave, Addis. Another dazzlingsunny day at 3000 m, where things dry fast and cook slow. As I explained to Bob and Kevin, the water in your body boils off faster, too, because of the lower total pressure, and that means dehydration. People over 50 should strongly consider packing their fiber and sennacoids. And walking...move those joints, exercise those muscles, get those orts orting. So this morning I got up, put medical curricula out of my mind, and went walking.
At 7 on Sunday, people are doing the predictable things. Families are heading for church, and the nearest is a large place of worship, the Medhane Alem Cathederal. (http://www.travel-images.com/ethiopia4.html ) No, I still havent quite got Ethiopian Orthodox and Coptic faiths sorted, but I am working on it. The cathederal is quite beautiful, and new. Its in the middle of a whole Addis style block (Addis is not a linear city) including a place of high grass and discarded paving blocks out in back where I observed a black robed man sitting with a small book. In fact, I ran across a lot of older men wrapped in a shawl and sitting, studying or perhaps praying,with small books along the sidewalk. The place to sleep at night if you have no other is along the railing or fence around the cathederal. Its also the place to sell religious paraphenalia...which doesnt seem to feature candles in any prominent way. The sidewalks along Bole and other main streets are generally a mix of treacherous potholes and welcoming pavers...in about equal proportion and pretty random, making night walking exciting. But in the bright morning, with the sounds of calls to worship coming from a variety of directions (mostly from the cathederal, where bells are not the norm), and men and women walking alone or in groups or in families its pretty calming. No sense of danger whatsoever. And off the main street, a mixture of urban renewal a la the Bronx of three decades ago, and walled compounds with jasmine and other wonderful smells that I can't name draping over the walls and creating a little world within. Lots of new buildings, many reinforced concrete skeleton, waiting either supplies or workmen or money, hard to tell which.
Its usual not to make eye contact here when walking, particularly across genders. The small children begging start off with eyes averted, but if you allow or seek out eye contact, they latch right on. They can tell a genuine contact when they see it, and it raises the small hope that you will give them money. Kevin says that Wuleta, the epidemiologist who is the major moving force behind our project, buys bananas and doles those out when she is in smaller towns. I went through my pack of lifesavers almost instantly. And as you probably know from your own experience. its endless once you start. Aminta simply gives away whatever change she has and then smiles and indicates, and people can see its true, that there is no more just now. I am not yet so graceful.
But at least I am not repeating the embarassing mistake of 43 years ago, which happened in Lisbon at the Zoo. A woman, presumably Rom, came up and asked in Portugese if she could tell my fortune. I, hubritic of my minimal language capacity, made up a sentence that apparently came out 'I dont have a fortune'. Whoa!!! She was in my face with rebuke and scorn at a rapid pace in at least three languages for another 10 minutes. So I dont pretend that I don't have any money. The most persistant child stayed with me for three blocks.
Yesterday we walked out of the door into the sun and into a SUV that, with a driver, is supposed to be available to take us places. Direr, the driver, skillfully negotiated the newer faster streets on the way to Merkato, the market district. This is about 5 km from the SW part of the city, which is towards the airport, where we are staying. Asyou approach the Merkato district, the streets narrow, the traffic slows. But unlike so many of these situations, horns do not blare, drivers do not gesticulate and shout, pedestrians do not fix you with a scornful eye or curse your camels. Everyone just kinda moves along, goats, donkeys, small boys with shoeshine boxes, strong men with 150 pounds of corrugated iron, women with money belts and shopping baskets, wearing the traditional Ethiopian headscarf or not, old men with canes, young men rolling truck tires, guys with bundles of khat, guys sitting by the roadside chewing leaves of khat, small dark shops that Direr tells us are places you can consume khat as a tea. The street of tire replacement which strangely is also the street of cooking oil. The street of small metal stoves. The alleyway of recycled plastic containers, The street where they cut up the terminally worn tires. A whole block, dense and delicious with bright fabrics, bundles of kitchen utensils, and of course booths and tables of tchotchkies for tourists. But Direr is intent on getting us back for our meeting, so we dont descend into the gentle but growing melee to try to shop, Instead its a tour by SUV, where the images are somewhat passive, unlike a visit that will have to come later, when I will be on my own two feet, and feeling, a bit nervous about my wallet.
And of course, there are the smells...gasoline and oil, leather and cotton, coffee and tea...people. On the way home, Direr warns us in advance, so the assult of the abbatoir smell isnt as shocking as it would be otherwise. This place of death sprawls along a hill beside a small stream, and along it, perched on dry brown earth, the largest collection of vultures that I have ever seen. And then, we are past that, and from a walled compound, comes a whiff of jasmine.
Back at the meeting, I have made a powerpoint to explain our ideas on how the Ethiopian Medical Education Plan they have been working on aligns with the 'Vision' of medical education recently published by Molly Cook and other UCSF medical educators. The presentation is well received; I repeat it for a latecomer. The question remains, not whether individualized education and a stronger standardized assessment process is better but how to implement it. How far can they move from a conventional lecture driven teacher centered process, which everyone admits is not really capable of producing the doctors they need, without causing apoplexy and angry revolt in the older stakeholding doctors and administrators? Is diplomacy ultimately just staying at the table until the discussion trickles and bumbles along to a stop, until either the enormous snags and rocky barriers dont matter, or have been worn down into smaller agreeable negotiable bits by skilled communcation? Sure seems that way. And when can I tell that things really wont work, that there are terminal differences? That this is a matter of faith, belief that is not amenable to proof or disproof, something that no matter how much I believe is NOT so, it equally strongly held to BE so by the wonderful human being sitting across from me.
And such may be my relationship with Yodit,, a physician whose father was killed during the time of the DERG, sometimes now referred to simply as 'The Communist Regime'. Impressively accomplished, ex Dean of the military medical university, relatively new mother, I feel very comfortable with her as a person, but perhaps we disagree about curricula? After presenting the powerpoint, and talking with her while the others take a break, I still cant tell if any amount of argument will ease her concern for moving away from a lecture based curriculum. The others assure me that Ethiopia simply does not have the lecturers to enlarge a lecture based system.
Today, Sunday, a break. Off to the National Museum,and perhaps another. Time to read further in 'Cutting for Stone' which yes, I am reading, and liking. Time to think more about assessment, and time for more powerpoints, more outlines, more of the work weve come to do.
And suddenly I remember a bit of kiswahili...nenda salama!
alan
At 7 on Sunday, people are doing the predictable things. Families are heading for church, and the nearest is a large place of worship, the Medhane Alem Cathederal. (http://www.travel-images.com/ethiopia4.html ) No, I still havent quite got Ethiopian Orthodox and Coptic faiths sorted, but I am working on it. The cathederal is quite beautiful, and new. Its in the middle of a whole Addis style block (Addis is not a linear city) including a place of high grass and discarded paving blocks out in back where I observed a black robed man sitting with a small book. In fact, I ran across a lot of older men wrapped in a shawl and sitting, studying or perhaps praying,with small books along the sidewalk. The place to sleep at night if you have no other is along the railing or fence around the cathederal. Its also the place to sell religious paraphenalia...which doesnt seem to feature candles in any prominent way. The sidewalks along Bole and other main streets are generally a mix of treacherous potholes and welcoming pavers...in about equal proportion and pretty random, making night walking exciting. But in the bright morning, with the sounds of calls to worship coming from a variety of directions (mostly from the cathederal, where bells are not the norm), and men and women walking alone or in groups or in families its pretty calming. No sense of danger whatsoever. And off the main street, a mixture of urban renewal a la the Bronx of three decades ago, and walled compounds with jasmine and other wonderful smells that I can't name draping over the walls and creating a little world within. Lots of new buildings, many reinforced concrete skeleton, waiting either supplies or workmen or money, hard to tell which.
Its usual not to make eye contact here when walking, particularly across genders. The small children begging start off with eyes averted, but if you allow or seek out eye contact, they latch right on. They can tell a genuine contact when they see it, and it raises the small hope that you will give them money. Kevin says that Wuleta, the epidemiologist who is the major moving force behind our project, buys bananas and doles those out when she is in smaller towns. I went through my pack of lifesavers almost instantly. And as you probably know from your own experience. its endless once you start. Aminta simply gives away whatever change she has and then smiles and indicates, and people can see its true, that there is no more just now. I am not yet so graceful.
But at least I am not repeating the embarassing mistake of 43 years ago, which happened in Lisbon at the Zoo. A woman, presumably Rom, came up and asked in Portugese if she could tell my fortune. I, hubritic of my minimal language capacity, made up a sentence that apparently came out 'I dont have a fortune'. Whoa!!! She was in my face with rebuke and scorn at a rapid pace in at least three languages for another 10 minutes. So I dont pretend that I don't have any money. The most persistant child stayed with me for three blocks.
Yesterday we walked out of the door into the sun and into a SUV that, with a driver, is supposed to be available to take us places. Direr, the driver, skillfully negotiated the newer faster streets on the way to Merkato, the market district. This is about 5 km from the SW part of the city, which is towards the airport, where we are staying. Asyou approach the Merkato district, the streets narrow, the traffic slows. But unlike so many of these situations, horns do not blare, drivers do not gesticulate and shout, pedestrians do not fix you with a scornful eye or curse your camels. Everyone just kinda moves along, goats, donkeys, small boys with shoeshine boxes, strong men with 150 pounds of corrugated iron, women with money belts and shopping baskets, wearing the traditional Ethiopian headscarf or not, old men with canes, young men rolling truck tires, guys with bundles of khat, guys sitting by the roadside chewing leaves of khat, small dark shops that Direr tells us are places you can consume khat as a tea. The street of tire replacement which strangely is also the street of cooking oil. The street of small metal stoves. The alleyway of recycled plastic containers, The street where they cut up the terminally worn tires. A whole block, dense and delicious with bright fabrics, bundles of kitchen utensils, and of course booths and tables of tchotchkies for tourists. But Direr is intent on getting us back for our meeting, so we dont descend into the gentle but growing melee to try to shop, Instead its a tour by SUV, where the images are somewhat passive, unlike a visit that will have to come later, when I will be on my own two feet, and feeling, a bit nervous about my wallet.
And of course, there are the smells...gasoline and oil, leather and cotton, coffee and tea...people. On the way home, Direr warns us in advance, so the assult of the abbatoir smell isnt as shocking as it would be otherwise. This place of death sprawls along a hill beside a small stream, and along it, perched on dry brown earth, the largest collection of vultures that I have ever seen. And then, we are past that, and from a walled compound, comes a whiff of jasmine.
Back at the meeting, I have made a powerpoint to explain our ideas on how the Ethiopian Medical Education Plan they have been working on aligns with the 'Vision' of medical education recently published by Molly Cook and other UCSF medical educators. The presentation is well received; I repeat it for a latecomer. The question remains, not whether individualized education and a stronger standardized assessment process is better but how to implement it. How far can they move from a conventional lecture driven teacher centered process, which everyone admits is not really capable of producing the doctors they need, without causing apoplexy and angry revolt in the older stakeholding doctors and administrators? Is diplomacy ultimately just staying at the table until the discussion trickles and bumbles along to a stop, until either the enormous snags and rocky barriers dont matter, or have been worn down into smaller agreeable negotiable bits by skilled communcation? Sure seems that way. And when can I tell that things really wont work, that there are terminal differences? That this is a matter of faith, belief that is not amenable to proof or disproof, something that no matter how much I believe is NOT so, it equally strongly held to BE so by the wonderful human being sitting across from me.
And such may be my relationship with Yodit,, a physician whose father was killed during the time of the DERG, sometimes now referred to simply as 'The Communist Regime'. Impressively accomplished, ex Dean of the military medical university, relatively new mother, I feel very comfortable with her as a person, but perhaps we disagree about curricula? After presenting the powerpoint, and talking with her while the others take a break, I still cant tell if any amount of argument will ease her concern for moving away from a lecture based curriculum. The others assure me that Ethiopia simply does not have the lecturers to enlarge a lecture based system.
Today, Sunday, a break. Off to the National Museum,and perhaps another. Time to read further in 'Cutting for Stone' which yes, I am reading, and liking. Time to think more about assessment, and time for more powerpoints, more outlines, more of the work weve come to do.
And suddenly I remember a bit of kiswahili...nenda salama!
alan
Ethiopia 2010 Day 4
10-2-10 0745 The Apartment, Bole Ave, Addis. Gradually I am getting some idea of where I am...I mean outside of the task at hand, which is to sit in meetings with the Ethiopian medical and administrative people were are here to advise. So although yesterday I didnt really get further than the Coptic church nearby, reputedly the largest in the country, there is still a kind of osmotic transfer of information. Of course, this is still the hemisphere that I am used to, so the sun seems to be moving the right direction (it's always unsettling to be South of the equator, where my direction sense really doesnt work ). And after several days, I am settling down to 9,000 feet elevation.
The work..well, the most interesting part is, of course, the interactions. I think it was Lawrence Durrell who has one of his characters (maybe Justine) quote another (probably Pursewarden) saying something like 'beginnings are such delicate times'. Its one of those things that I tend to lump under 'communication skills', that have been part of what some call the 'hidden curriculum' of medical training. And if you would like to see what I mean, get one of those older doctor movies, like the series 'Doctor in the House', which portrayed medical students as engaged in a running battle of wits with their teachers...basically trying to do as little medicine and as much seduction as possible. Then fast forward to the Rex Morgan MD period, and then on to the ER and Hospital current edition. Or even "House" which by creating a cartoon level social leopard as philosopher king and even, paradoxically, humanist, creates a kind of artistic negative space that shows us the positive qualities we would like to see. Communication is now taught in all modern english speaking medical curricula..the question is how. The way we would like to think is best is to start communicating, in small groups where students encounter themselves over and over, and be mindful about the process. It is, of course, a version of the 'Action/Reflection' model of learning. That's what small groups do, whether its overtly appreciated or not. In a lecture, the communication is moslty one way..although anyone who has lectured to a large audience knows how much feedback they actually receive...the necking couple, the sleeping back rows, the super attentive front benchers, and so on. In a small group, such as our meeting, you hit the ground communicating, and thats the beginning that is so delicate. Thats what anyone in a service profession does, maybe 20 times a day or more, when they walk into the exam room, the office, or whever the enounter takes place, and say 'how can I help you today?' That process, call it 'joining' (as we tend to in family practice residency training) or 'the patient encounter' as internists tend to, is such a delicate and important part of medical care, its hard to believe that in the very recent past its been relegated to the 'hidden curriculum', the learning that took place in the hallways, the dorms, the late night cafeterias, and, yes, the bedrooms associated with the medical school and hospital, but in no way part of the planned or supervised curricular process.
So we are here talking not just about how to make 7000 doctors in 5 years, but how to make that many who are able to communicate effectively, have some sense of cultural humility, a well oiled moral compass, a good understanding of public health, as well as knowing how to intubate, how to crack a chest, and how to manage concurrent AIDS and tB. Hmmm. More to come.
ok maybe I wont get to Harar, but that is probably the city that you would most immediately realize that you are far from Kansas. I had a vague memory that some place here had decided to realize the true potential of the amazing hyena, and of course would love to get there. Take a look for yourself.
http://www.globalpost.com/dispatch/africa/100716/ethiopia-hyenas
I need to find out more myself about the Coptic faith, and its history, Perhaps you already know.
" The Ethiopian Orthodox Tewahedo Church (Amharic:Yäityop'ya ortodoks täwahedo bétäkrestyan) is the predominant Oriental Orthodox Christian church in Ethiopia. The Ethiopian Church was administratively part of the Coptic Orthodox Church until 1959, when it was granted its own Patriarch by Coptic Orthodox Pope of Alexandria and Patriarch of All Africa, Cyril VI. It should not be confused with the Ethiopian Catholic Church, which is a Chalcedonean church." (wikipedia)
This is a very alive and kicking faith, and the church we visited (outside only) is new, modern, and surrounded by assembly space. Services are often in Ge'ez, which is its own Sephardic language, perhaps like Latin in relationship to Catholicism. But as I say, I need to know more.
I became interested in it because of my vague recollection of Prester John. But that came later, . Again from wikipedia,
"Towards the close of the 15th century the Portuguese missions into Ethiopia began. A belief had long prevailed in Europe of the existence of a Christian kingdom in the far east, whose monarch was known as Prester John, and various expeditions had been sent in quest of it. Among others engaged in this search was Pêro da Covilhã, who arrived in Ethiopia in 1490, and, believing that he had at length reached the far-famed kingdom, presented to the nəgusä nägäst of the country, a letter from his master the king of Portugal, addressed to Prester John."
Well there are a lot of guys named John, just as there have been many named Jesus, or Gautama, or Mohammad. Ethiopia has exerted a fascination over all the rest of us for a long time. After all, remember it all started here.
Today, we are going to the market early, and then back for more meetings. What will be in the market? Well, the main exports are (in order) coffee, seseme and other oil seeds, and khat. Personally, I am looking for wooden spoons, but only the good kind, thank you Sala.
OK, ok, I will get going on finding out more about khat. Its definitely not part of the daily meetings, I want to assure you. But coffee is. And good.
Its fun working with Kevin and Bob. Our discussions are like standing around in front of a canvas throwing paint on it, creating something that can then be adjusted to be useful, but for those first creative moments is not well formed, not pretty even. Its just new, as new as 'eggs laid by tigers', to quote Dylan Thomas on the creative process. I love the creative process most at such early stages...find someone else to get the product to 90%..I am definitely a 75% guy. Just now we are sitting around a table in the apartment. Everyone is staring at computers...We all have coffee. There is some light music tinkling from someones computer. Its very gemutlich. But not very deep under any lightness is the sense of the serious level of the task that our Ethiopian colleagues are necessarily undertaking. This is about hyenas AND modern diseases. This is about 40 million people. This is about the place it all started, the uncolonized and amazingly beautiful land that, among other things, has the real city of Gondar within its borders.
OK, enough. Beka.
Alan
The work..well, the most interesting part is, of course, the interactions. I think it was Lawrence Durrell who has one of his characters (maybe Justine) quote another (probably Pursewarden) saying something like 'beginnings are such delicate times'. Its one of those things that I tend to lump under 'communication skills', that have been part of what some call the 'hidden curriculum' of medical training. And if you would like to see what I mean, get one of those older doctor movies, like the series 'Doctor in the House', which portrayed medical students as engaged in a running battle of wits with their teachers...basically trying to do as little medicine and as much seduction as possible. Then fast forward to the Rex Morgan MD period, and then on to the ER and Hospital current edition. Or even "House" which by creating a cartoon level social leopard as philosopher king and even, paradoxically, humanist, creates a kind of artistic negative space that shows us the positive qualities we would like to see. Communication is now taught in all modern english speaking medical curricula..the question is how. The way we would like to think is best is to start communicating, in small groups where students encounter themselves over and over, and be mindful about the process. It is, of course, a version of the 'Action/Reflection' model of learning. That's what small groups do, whether its overtly appreciated or not. In a lecture, the communication is moslty one way..although anyone who has lectured to a large audience knows how much feedback they actually receive...the necking couple, the sleeping back rows, the super attentive front benchers, and so on. In a small group, such as our meeting, you hit the ground communicating, and thats the beginning that is so delicate. Thats what anyone in a service profession does, maybe 20 times a day or more, when they walk into the exam room, the office, or whever the enounter takes place, and say 'how can I help you today?' That process, call it 'joining' (as we tend to in family practice residency training) or 'the patient encounter' as internists tend to, is such a delicate and important part of medical care, its hard to believe that in the very recent past its been relegated to the 'hidden curriculum', the learning that took place in the hallways, the dorms, the late night cafeterias, and, yes, the bedrooms associated with the medical school and hospital, but in no way part of the planned or supervised curricular process.
So we are here talking not just about how to make 7000 doctors in 5 years, but how to make that many who are able to communicate effectively, have some sense of cultural humility, a well oiled moral compass, a good understanding of public health, as well as knowing how to intubate, how to crack a chest, and how to manage concurrent AIDS and tB. Hmmm. More to come.
ok maybe I wont get to Harar, but that is probably the city that you would most immediately realize that you are far from Kansas. I had a vague memory that some place here had decided to realize the true potential of the amazing hyena, and of course would love to get there. Take a look for yourself.
http://www.globalpost.com/dispatch/africa/100716/ethiopia-hyenas
I need to find out more myself about the Coptic faith, and its history, Perhaps you already know.
" The Ethiopian Orthodox Tewahedo Church (Amharic:Yäityop'ya ortodoks täwahedo bétäkrestyan) is the predominant Oriental Orthodox Christian church in Ethiopia. The Ethiopian Church was administratively part of the Coptic Orthodox Church until 1959, when it was granted its own Patriarch by Coptic Orthodox Pope of Alexandria and Patriarch of All Africa, Cyril VI. It should not be confused with the Ethiopian Catholic Church, which is a Chalcedonean church." (wikipedia)
This is a very alive and kicking faith, and the church we visited (outside only) is new, modern, and surrounded by assembly space. Services are often in Ge'ez, which is its own Sephardic language, perhaps like Latin in relationship to Catholicism. But as I say, I need to know more.
I became interested in it because of my vague recollection of Prester John. But that came later, . Again from wikipedia,
"Towards the close of the 15th century the Portuguese missions into Ethiopia began. A belief had long prevailed in Europe of the existence of a Christian kingdom in the far east, whose monarch was known as Prester John, and various expeditions had been sent in quest of it. Among others engaged in this search was Pêro da Covilhã, who arrived in Ethiopia in 1490, and, believing that he had at length reached the far-famed kingdom, presented to the nəgusä nägäst of the country, a letter from his master the king of Portugal, addressed to Prester John."
Well there are a lot of guys named John, just as there have been many named Jesus, or Gautama, or Mohammad. Ethiopia has exerted a fascination over all the rest of us for a long time. After all, remember it all started here.
Today, we are going to the market early, and then back for more meetings. What will be in the market? Well, the main exports are (in order) coffee, seseme and other oil seeds, and khat. Personally, I am looking for wooden spoons, but only the good kind, thank you Sala.
OK, ok, I will get going on finding out more about khat. Its definitely not part of the daily meetings, I want to assure you. But coffee is. And good.
Its fun working with Kevin and Bob. Our discussions are like standing around in front of a canvas throwing paint on it, creating something that can then be adjusted to be useful, but for those first creative moments is not well formed, not pretty even. Its just new, as new as 'eggs laid by tigers', to quote Dylan Thomas on the creative process. I love the creative process most at such early stages...find someone else to get the product to 90%..I am definitely a 75% guy. Just now we are sitting around a table in the apartment. Everyone is staring at computers...We all have coffee. There is some light music tinkling from someones computer. Its very gemutlich. But not very deep under any lightness is the sense of the serious level of the task that our Ethiopian colleagues are necessarily undertaking. This is about hyenas AND modern diseases. This is about 40 million people. This is about the place it all started, the uncolonized and amazingly beautiful land that, among other things, has the real city of Gondar within its borders.
OK, enough. Beka.
Alan
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