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!