Sunday, June 24, 2012


Dagim (left in striped shirt) translates our goodby to women and men and children at Qircho
Greetings from Northampton!
Leah and Gavin at homecoming supper
Actually we are starting this on the plane from Dulles to Hartford, where daughter Masaye will pick us up. Had a warm (in all dimensions – temperatures in the 100's) trip to Mt. Pleasant, DC with daughter Leah and son-in-law Gavin with our first taste of non-Ethiopian food in a very long time and sleeping in a very wide bed without a mosquito net and with the air conditioning on. No hyenas and no smell of coffee and incense pervading all.
Hardworking interns in Referral emergency room.
Interns and GP Dr. Saba (right) in emergency room
Dr. Birrie, Chair of Referral Internal Medicine
We each enjoyed a great going-away party by our respective sets of colleagues on Thursday before leaving. Marty's wonderful group of general practitioners led by Dr. Saba threw a party at the Lewi's Hotel in downtown Hawassa and Marty began to realize just how much these dedicated folks mean to her and how much she will miss them.
Patients and their families on Referral ward
Front steps Referral Hospital (unusually calm!)
Ethiopian medical culture is demanding and strict in its standards. One sacrifices much to become an Ethiopian doctor and continues to give despite much lower pay, huge patient loads and little backup in terms of continuing medical education and options for specialty referral of difficult patients. Marty was told for the first time that she was the first provider to stay and teach and treat for more than a month at Referral, and it took a while for her colleagues to invest emotional and collegial energy in the relationship. However, by the time she left she had shared responsibility for cure and for death of patients, had puzzled and gone to the books over more than a few, and had learned the tragedy of the limitation of care where the resources simply do not exist. There is a particular sinking feeling hooked to outrage at losing a patient to renal failure when one is used to taking access to dialysis for granted. Hepatitis B and C are treatable diseases in the United States, but not in Hawassa or, in fact, in any part of Ethiopia. She found herself embarrassed when she had unthinkingly expressed that outrage. Ethiopians are proud and she sometimes detected shame in admitting the lack of those resources, a lack for which they hold no responsibility but which they feel acutely and daily.
Ell's going-away party was much less formal – lots of beer over tibs at the local Bira hall (translated “beer”) where shining copper tanks of German beer tower over partying Hawassans. His relationship with his colleagues has also been rewarding: Walelign, Awoke, Wubayed, Aqmel, and Meskano are respected colleagues and friends, and he expects to stay in touch. Awoke will be coming to the States entering a PhD program at Washington State in the fall. He is an expert on the cultures and issues of the Southern Nations and already has contributed much to the Konzo, helping to build a United Nations Heritage Site in several walled Konzo villages.
The coffee ceremony at Qircho
A final, very different goodby greeted Marty at Qircho, where residents had prepared a coffee ceremony in the open courtyard for her departure and the women presented Marty with Orthodox Church pictures. It was moving and warm, and she was honored to be called the Mother of Qircho for her mini-clinics and her advocacy to the city. She felt welcome and at home among the women who beg for survival and wonders what will be their fate. Unlike our middle-class colleagues, there is no internet or even phone connection to these people to communicate births, deaths, movements among people that she has learned to respect. Marty left them her phone, and hopefully they can set up a small 'telephone business" for the neighborhood.
Women at Qircho
She and Dagim met with the Mayor of Hawassa to discuss her report and the City's plans for the street people. Not too encouraging. The Mayor said he was a busy man and had not had time to read the report. He was angry that we were interfering and told us that what we could offer were money and medical care (both of which we had given directly to the street community, but not to the City for its plans.) This is something we have learned to expect from the government - very bureaucratic and highly authoritarian.
The City's plan has not been implemented because its appeal for almost 6 million birr ($350,000) for job training (in breaking rocks for cobblestone, shoe-shining, hotel service and garbage collection); return of kids to their homes (without, as far as we could tell, support for the families who could not afford them to begin with); and adoption of some had not been fulfilled by the NGO's and churches and businesses to whom the city had appealed. He seemed angry and frustrated and particularly irritated by our questions about the basic viability of the plan.
Qircho men, women and children at coffee ceremony.
Since most of the street kids are homeless and sleep under awnings (as do quite a few of the mothers) we asked about the lack of provision of housing in the proposal. He said that was for the subcities to deal with, that it is being taken care of. Further, since the core of the proposal is job training and many of the women, who expressed to us the desire for jobs, have been impeded in finding or doing any available work because they have small children (quite a few on the breast) but no childcare that would allow them to take those jobs, we asked what provisions would be made for them. Would free childcare be provided? There were no such plans in the City's proposal, but the Mayor did not want to discuss the issue. The transcendent issue, though, that was not on the table, and which he is in no position to address, was the worsening endemic poverty in the countryside that is forcing men, women and children into the streets of cities like Hawassa searching for a living, and finally into begging when they encounter no work that can sustain them. We tried to address this as he told us the meeting was over, but he was in no mood.
Woman coaxed to join us at coffee.
We have learned a little about the government's Safety Net Program, funded by international NGO's, which actually does provide very limited cash for work mainly for farmers in the non-harvest season and for the disabled. Though UNICEF states that disabled families get up to 350 birr ($18) per month in relief, all Marty could find on the web or in talking to those who administered the program was 70 birr per month (about $4) per family, given in return for 5 days work. Do the calculations: from a little over $.50 to $.13 per day for a family, which can easily be six people. There is about 50% unemployment in Ethiopia. Average wages for a laborer are about $1/day. No one that Marty spoke to was receiving even these miniscule Safety Net benefits, but were surviving frequently on $.25 per day in begging, enough to pay for one meal of coffee and bread. But then again this is Africa, where no country, with the exception of South Africa and possibly Rwanda, has any direct help to the poor and homeless.
Men, women and children of Qircho.
Marty sent her report to the Embassy, to USAID and to UNICEF in Addis Ababa. She was disheartened by the response by UNICEF, whose representative seemed to interpret it as requesting immediate help for these particular women and children, instead of being a plea for systemic intervention to support women and children forced by poverty to migrate to the cities where they become homeless beggars. Marty tried to explain her perspective, but detected here an all-too-common defensiveness on behalf of the government, which touts 9% growth but steers clear of examining increasing disparity in income between rich and poor and what appears to be accelerating impoverization in the countryside. She will pursue these contacts and hopes to widen the dialogue.
Two Days Later...
Home to a lush, green and hot-as-hell Northampton. Greeted by kind and thoughtful neighbors, and celebrated Arky Markham's 97th birthday yesterday with good friends who have borne her hip fracture like the family that every person should have when one gets to 97.
Northampton, with its sensible progressive politics and culture of kindness and intellectual honesty, is our home. We are so frigging lucky. 
Now it is time to weed the garden, to fix all the electrical appliances that we haven't had for 8 months – dishwasher, clothes washer, electric garage door opener, air conditioner – while we take a moment to ponder why we have them.
Horse-drawn cart stops bajajes at Hawass intersection.
Hawassa seemed like a dream while we were there. We often woke up wondering where we were in that fog before full consciousness. It is a function of the older brain that doesn't adapt to transitions too well. (We understand, Arky!)
But, of course, Hawassa is not a dream to our friends there, with whom we will continue to communicate and whose fates we care about. It is another country, but we know something about it and more, we care about it and those who touched us with their kindness, generosity, and courage in the face of adversity we have never before experienced.
Elliot on chosen mode of transport.
Donkey-cart solid waste management in Hawassa.
We will not miss the mosquito nets, the leaky pipes in the guest house, the furniture that disappears, the “You, you, you!' from street kids, the bajajes (motorized tricycle taxis) playing chicken at intersections, the lack of solid waste disposal and its consequences. We will miss Ethiopians – not just our friends, but the great diversity of cultures of Hawassa and their fascinating differences from our own. We will miss Ethiopian dignity that so quickly morphs into friendliness and generosity at minimal contact. We will miss the incredible physical strength of those who guide donkeys and plow-oxen, carry children, sugar cane and firewood long distances, and build streets from rocks. We will miss children who are still able to hug and sit in a lap, and women who nurse and comfort their babies despite homelessness, hunger, abuse and poverty. We will miss the intellect of professors and doctors building a modern society on centuries of feudalism and war.
Marty and Ell both have a tradition of looking for heroes that goes to our days in college. We found no dearth of heroes in Ethiopia.
We will miss the hyenas, the Abyssinian ground hornbills, the grey-back fiscals, the mountain nyalas, the fish eagles, the green vervets and baboons and the mountains that, no matter where we are, rise up at the horizon. We will miss the omnipresent smell of bunna and incense, of sweat and manure, of woodfires and over-ripe bananas. We will miss the constant cool, dry breeze and the sudden thunderstorms rolling over the Rift Valley. And both of us will miss the exotic sound of Amharic (which Marty now greets with a sense of familiarity but, unfortunately, not understanding), Sidama and Oromo.
It is a different country, but a country we have briefly been part of, and that we deeply respect and will remember forever.
Happy birthday to Elliot! Yes, we still need him, yes we'll will still feed him, now he's 64!
Marty and Ell


  1. Culture shock is way too mild an expression for what you're both experiencing.....but we're glad to have you back!