Saturday, December 29, 2007
St. Gabriel's Day Feast
Thursday, December 27, 2007
Starting Work, Slowly.
I've been thinking a lot about how different HIV is here than what I saw in the US when I was working at the AIDS Health Project. I spent the morning in the Opportunistic Infections clinic at the major referral hospital (that is, the highest level of care available in Ethiopia, other than some specialty clinics and labs in Addis) here in Bahir Dar. This hospital is where I'll probably be spending most of my time for the next two years.
I kept thinking about one evening when I was co-facilitating the HIV+ Drop-In Group back in San Francisco and we spent almost half of the group time focused on one man's fears about starting ART. I don't mean to say in any way that I think that that evening was unimportant. I think that it meant a lot to him and to the rest of the group; his fears were absolutely real, and I think that it's fabulous that we had the time and energy--the luxury, I guess--to discuss them. Today we were seeing patients with acute PCP pneumonia, with Herpes Zoster rashes all over their faces, with leprosy, with CD4 counts of 6 (normal is 1000). I suppose that my perception of AIDS in the US might be different if I had worked on the wards at SF General, or if I had been in the Bronx, or in the inner city of any major American city, but I was just so struck today by the differences in the immediate needs of these people. Mental health is (barely) an afterthought in HIV care (in healthcare generally, I suppose) here; there's one page on the 8 page intake form for starting HIV care that explores a few "social" issues (like family support, mental status, etc).
Each patient had between 3 and 10 minutes with the doctor this morning. This doc sees 60-70 patients a day. And when I told him that this seemed like a very busy day, he told me that it's actually much better since they've added another physician--he used to see up to 110 patients a day. It's hard to fathom doing that day after day after day. The burnout must be incredible. It also must be incredibly frustrating as a well-trained physician, to not have every lab test, diagnostic tool, and medication you might want available at your fingertips. There was a man today in whom the doctor suspected deep vein thrombosis, but without a doppler ultrasound, a CT scan, or an MRI, he's out of luck in terms of getting a firm diagnosis. He said that he'll send some blood tests to Addis, and then potentially start treatment with a bloodthinner, but only if the patient can afford it (500 birr, or about $50, which is pretty prohibitively expensive in a place where the average monthly salary is not even quite that high). It makes sense why there are now more Ethiopian doctors working in Chicago than there are in the whole country of Ethiopia. (Which in turn contributes to the problems with the overburdened health system here...)
All of this means that I'm feeling a little bit overwhelmed about how exactly I'm going to be able to find a place in all of this, how anything I can possibly do here will have any effect. There are an awful lot of problems. I'm feeling a bit at sea about how to begin confronting any little piece of it. One thing is certain though. I feel really lucky to be working with the people at ITECH and at the hospital here; everyone seems incredibly dedicated, smart, and thoughtful.
In short, I guess that I'm beginning to see the challenges of being in the Peace Corps, of trying to figure out a way to make your work feel meaningful and to feel as though you're making a positive difference in someone's life. There's a lot of work ahead of me. I'm excited and simultaneously terrified about jumping into it. I keep trying to tell myself that this is week 2, and that I have some time to figure these things out.
All in all, though, I'm doing fine. Christmas was nice; got the day off after all, since ITECH is US-funded, despite "American Christmas" not being an Ethiopian Federal holiday (we'll get the day off for Ethiopian Christmas on January 6). Steph was in town from her site, about an hour away from Bahir Dar, and she and the three of us here (Beth, Levi, and I) made a fantastic, if non-traditional, Christmas dinner of hummus, chicken noodle soup (sent in a package from the US), and no-bake cookies. We also had a nice time singing Christmas carols with a group of British, Swiss, and German relief-workers from Northern Uganda and Sudan who were in town vacationing, and went on a long walk by the lake. I also bought myself a fabulous Christmas present--a new, teal bike called the Viva "Sport Geometry."
Actually, the names of products here (and menu items) is one of my favorite amusements. There's another brand of bike called the "Flying Pigeon." A popular restaurant dish is "Shiro Feces" (ground chick peas and spices). We saw a bag of "Organic Testes," some unidentified white powder, at a grocery store. "Earaccuissene" items at one of our favorite restaurants (Eurocuisine? Maybe?) include "Roasted Lamp," "Hum and Chesses Burger," and "Peeper Stack." I could spend two years here fully occupied as a proofreader.
Thanks for all of the emails around Christmastime. Thinking of everyone especially this time of year. Hard to believe that 2008 is already almost here. This year has disappeared without me realizing it--makes me wonder how quickly the next two will go. Happy New Year!
Tuesday, December 18, 2007
I'm home (?) in Bahir Dar
After 34 mosquito bites to Beth's face, a scraped shin and cut toe, getting locked out twice, and bruised hands (long stories all of them), we're little worse for the wear. Beginning to get set up…it's going to be a looooong process. Here's something I wrote yesterday morning and then promptly forgot at home and couldn't send. Hope you're all well…
December 17, 2007
First morning waking up in my new house in Bahir Dar. Beth and I both slept on new foam mattresses on the bedroom floor in the house (her house won't be ready until after the first of the year, so she'll be staying with me, which is actually a huge relief—it's so nice to be going through this with someone else).
It's been a busy busy week. We swore-in on Thursday afternoon, after a very long day (got up at 4:15 to catch a bus into Addis). My host mother cried when I left and made me promise to call every week. They gave me a going away gift of two plates, three spoons, one fork, one knife, and one cup; they're awfully worried about me living on my own. The small gifts I had collected for them went over well. Wind-up toys were a particular success, with everyone, not just the small kids. I was sad to leave them, but I'm also feeling ready to have my own space and to have a little more control over my own life.
Anyhow, the Swearing-In ceremony was lovely. The worldwide Director came in from Washington, as did the Africa Regional Director. The event was at the US Embassy, which is huge and gorgeous, as was not unexpected. My speech went well, and resulted in lots of people coming up to me at the reception and speaking to me as if I was fluent in Amharic. The Ambassador told me that I get to eat first when all 42 of us come back for dinner after three months.
We spent Friday in Addis, relaxing and shopping for things that are available only in the capital. Bought liquid dish soap, saran wrap and foil, resisted the temptation to spend $10 on a bottle of olive oil, and stocked up on a few "farenji" items. Then Beth and I went on an odyssey to find large wicker laundry baskets (which seemed immediately necessary, because we each had about 14 small bags to bring to Bahir Dar, which could be neatly stuffed into such a basket).
Now, neither of us knew the word for basket in Amharic, but we asked her language teacher where we should go to find them, thinking that they would be immediately obvious and that we could just point and bargain. We proudly got off of a minibus after have navigated our way halfway across the city and found the appointed location with no trouble. We walked down the road a little, looking for this basket store or market. Nothing. Beth called her teacher again, who wasn't too helpful, but who at least taught us how to ask where they might be. We went into a hotel to ask, and were directed somewhere "very close, maybe 5 minutes away" where there was a large market. We started walking, through twisty back streets and alleys, asking people every 200 yards or so where this Shola place was, until was finally found it, maybe half an hour later. The place looked promising—housewares everywhere. We wandered around forever, asking people again and again if they knew where these baskets were. Nope. Finally, we found a taxi and were about to give up. Beth made one last valiant attempt, asking the driver if he knew where to find the baskets. He said he did. We drove in a big circle, directly back to where we had started! The baskets were there, maybe 150 yards in the opposite direction from where we had gotten off of the minibus. We each bought one ($3), and asked the driver how much it would be to take us to the Ras Hotel, on Churchill Rd, near the Piazza and the National Theater. He told us 35 birr ($4), which seemed reasonable. Got in, and went a totally different direction than we had come, but thought, well, maybe it's a shortcut. Not a shortcut. We ended up on a dirt road, under construction, and he stopped the taxi. Here you are, he said, the Ras Ambo Hotel. Not on Churchill Rd, not near the Piazza. We tell him no, no, just the Ras Hotel, near Piazza, Churchill Rd. Oh, right right, he says, smacking a palm to his forehead.
We finally get to the hotel, relieved not to have been kidnapped, and as we pull up to the curb, he says "100 birr." What?! We offered him 50 because we had gone a long way out of the way, but he was obstinate, lowering the price little by little, trying to bargain with us, "okay, 90 birr, or even 80, but no less than 80." No! We all went into the hotel, where we drew quite a crowd, to have the receptionist translate/mediate. In the end he finally stormed off with the 50 birr, and we felt exhausted and defeated. But at least we had the baskets.
Saturday morning we all departed for our various locations on 5 Peace Corps contracted busses. Up at 4:45 again, to be ready to leave at 5:30. What time did we actually leave? 7:42. Oh my, a logistical nightmare. But we finally got loaded up and on our way. It was one of the longest days of my life. We dropped people off all along the way, which involved unloading luggage from the top of the bus, and also passed through the Blue Nile Gorge again, going about 20mph for 2 hours. We finally arrived safely in Bahir Dar at about 9:30pm, only to find that there were no rooms at the hotel we had intended to stay in. We found rooms, much more expensive, but beautiful, and collapsed.
Yesterday was spent trying to figure out how to furnish my house. Made three trips by motorcycle taxi to and from the market, including one trip back with involved me and Beth sitting with a roll of 10 meters of linoleum rolled up on our laps, a mattress stuffed behind our heads and another roped to the top of the taxi, and a can of kerosene wedged between my knees. The bajaj (motorcycle taxi) driver asked what we were doing here, then asked us to teach him about HIV (which we did, a little), and then gave us his name and number; "you will be my customers. I am Muslim. You know Muslim? It means I do not cheat. It is good."
Making boxed macaroni and cheese (sent from the US) on my new kerosene stove with my new pots, and eating it off of paper Christmas plates Beth received in a package was one of the best moments in Ethiopia thus far. It felt as though we were really doing this, like living here was actually going to be okay. Doing the dishes under a little spigot in my bathroom was less appealing—need to get some basins for that.
So here I am, beginning to set up a new life. There's a lot of work (a LOT) ahead of me in getting settled here, but I'm feeling largely optimistic about it. I don't know precisely when I'll start work (it's Monday morning and there's no way I'm going in to the office today—far too much to get done around the house first), or what precisely my work will consist of. Those are big, anxiety producing unknowns, but I'm sure that things will get worked out eventually. For now, I'm safe and have a place to sleep and a way to cook, and that's about all I could ask for.
p.s.--Check out the Peace Corps website in the next few days for a picture of all of us at Swearing-In!