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
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