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
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