Re-entry

We’re beginning the slow painful process of re-entry. What a strange word, re-entry. Really, the misleading part is the “re.” The “re” (as in return, replay, remember) implies that everything is the same. It implies that our return to life in the US is a return to the normal, the same, the comfortable.

It's not that we aren’t happy to be home. We are. We are also not experiencing the romanticized culture shock that I imagined… breaking down in tears in the produce section of the grocery story, for example. In fact, I felt no emotion whatsoever when I walked into our local grocery store to buy sesame oil for my mom. I am not particularly amazed by the smoothness of the roads… or lack of livestock in the yards. Nothing really appears different from when I left a year ago.

The best I can describe it is that the color is different… its like when you put on sunglasses and all of a sudden the world looks different and the same all at once. Or maybe it’s just that we’re homesick for our lives in Ethiopia…

Whatever this feeling is, it’s what motivated us to celebrate our third wedding anniversary in a small Ethiopian restaurant on the north side of Chicago. We ate familiar food, listened to familiar music videos, and reminisced about a year ago… when we ate dinner watching the monkeys play in the trees as the sun set over the mountains. Maybe it was the honey wine, but we were also overcome by an urge to seek out the only table of Ethiopians (or Habasha, as they call themselves) in the restaurant to say hello.

After exchanging greetings in Amharic, we were quickly invited to sit down to join them for honey wine. They told us that they noticed that we knew how to eat our injera properly. We laughed together as we listened to a woman at a nearby table ask silly, uninformed questions about their home country: “Is Ethiopia near India?” “Isn’t Ethiopian food an oxymoron?” We talked to them about the frustrations of traveling in Ethiopia, and the difficulty of working with the local government. They understood.

Maybe that’s what we were hungry for… not the food, not the honey wine, not the music videos (which I still think are horrible if we’re being honest). We were hungry to be listened to by someone who knew exactly what we were saying.

As we shook hands, and said goodbye to our new Ethiopian-American friends, they mentioned a party they were having in a few weeks for an Ethiopian holiday. “Oh, but wouldn’t we be intruding?” we asked. “Don’t be silly,” they said. “You are Habasha now.” And we smiled.

Signing Off

This is our final blog post. We still have no idea how many readers are out there.
Probably just our parents and a few bored friends. But we wanted to thank you for following along on our adventure and supporting us with your letters and emails and packages and phone calls. Without the love, support, and basement storage space that you provided, we could have never had this experience. And for this, we are eternally grateful.

With all our love, Erin and Jeff

Saying Goodbye

The last few weeks in Ethiopia were emotional and painful. As we prepared to leave, everything became “the last” for something. The last work party, the last Sunday market in Chiri, the last Glee episode, the last breakfast of ful, the last trip to Bonga, the last trip to Jimma, the last coffee ceremony with the kids. And on and on.

During the second half of our year in Chiri we fell into a comfortable routine….just in time to leave. And leaving hurt, but we knew we couldn’t stay forever. Too many family members and friends to see. Too many loan dollars to pay off. Too much time away already.

Over this year, we have learned and grown much more than we expected. The education that we received from our Ethiopian family of friends, co-workers, and orphans was more valuable than any degree we’ve received or any school we’ve attended. In fact we can safely say that the most profound change that happened over this year did not happen among the staff or patients that we served… it happened within our own hearts.

But as we packed up our belongings, Ethiopia had one final lesson for us. It came in the tearful, heartfelt embraces. It came as the stern old gray-haired manager kissed us with wet cheeks. It came in the twenty kisses planted on my lips by a poor woman. Ethiopians are willing to feel your emotion, to connect to your pain and sadness. And they do it openly without fear of looking weak or feeling silly. They hold you with open arms and open hearts. They are not afraid to feel fully, and they force you to do the same.

And so we said our painful goodbyes. We traveled many days and many miles by car, bus, and airplane, from this tiny speck in a giant continent to our other home on the other side of the globe. And in a dazed wonder, as we dined over seafood and wine and crawled under a soft down comforter, we couldn’t help but wonder, “was it all real?” Was that tiny town in Ethiopia, which can’t be found on maps or google-earth imagery, the town that suddenly felt worlds away… was it still there?

But in the silence of the night we closed our eyes and listened… listened to the change we felt in our hearts and knew it was always there. Always there with us.

Home

It’s happening a lot these days… this feeling I get as I perform random everyday tasks.

Like in a cold rainy morning when I lean over a steaming hot bowl of ful in a tarp shelter full of the sweet smell of incense and charcoal; or when I squeeze into a small mud hut to drink hot, thick, bitter cups of coffee and eat sour cocho cakes with a family of 12; or when I walk through the market and recognize a man selling scarves, stopping to exchange warm greetings and hugs.

It’s a feeling that, somehow, a place that at one time seemed so foreign and strange is now so comfortable and familiar. A feeling that life here has become so natural and easy. A feeling, that this small little corner of the world has become my home.

Medical Miscellaneous

As our time here winds down, I find myself reflecting on the year, and on the patients who have come through our clinic gates and the unlucky ones who never made it home. I realize that the blogs I wrote in the beginning of the year were emotional medical sagas and over time, these stories seem to stop. But the patients didn’t stop coming. I guess part of the reason I stopped telling them is because I didn’t want to overload the blog with medical stories. But maybe also because the cases started having less of an emotional effect on me.

A two year-old boy came in the other day with severe pneumonia and measles. He had previously been in our hospital for 2 weeks with severe malnutrition followed by 6 months of TB therapy leading up to this current episode. The nurses and I talked about how unfortunate his year has been – malnutrition, TB, measles, pneumonia – not the best luck. We even laughed for a moment about the irony of it all. And then, I looked back down at the little child who might be on his death bed and felt shame for my emotional detachment. Maybe it’s just a protective mechanism.

Here’s a sampling of some of the other interesting cases we’ve seen this year:

- A lady presented with vaginal bleeding. The most common cause of this in a young woman here is a first-trimester miscarriage. But in her case, she had a leech attached to her labia.

- A 5 year-old boy came in after coughing up two big beetles. His mom brought the dead beetles in to show to me.

- A schizophrenic 20 year-old presented one evening after being slashed by his mother with a machete about 20 times. He was apparently attacking his sister. For four hours, three of us sutured up his tendons, muscles, and skin lacerations. His mother came in with him on a follow-up visit and kissed my hands for taking care of her son.

- A man came in with tetanus and died within hours. Later in the year, another man came in with tetanus (up to 60% mortality rate) and lived. Tetanus, or lockjaw, causes your body to spasm so badly that you can’t move. With every loud noise or touch or other stimuli the muscles spasm even more forcefully causing excruciating pain. The man sat in our hospital for 2 weeks moaning in pain, unable to eat, but slowly he got better.

- A small infant came in with a fever and a petechial rash all over his body. As this is an ominous sign of meningococcal meningitis, we rushed to give him the medicine. He died moments before I attempted a spinal tap.

- A few children were found to have an extra digit on their hands. We helped take care of these for them.

- A schizophrenic lady delivered her baby with us, but almost did a back flip off the head of the bed because she was having a hard time pushing. I delivered the baby and ended up sprawled out on her bed trying to catch him. It was quite a scene.

- Several women presented with thyroids almost as big as their heads, a common finding here. We try to promote iodized salt in the community.

- A woman went into preterm labor. Hours later, she delivered a stillbirth with anencephaly. This is a severe malformation where the biggest part of the brain never develops, and is incompatible with life.

- A woman’s baby was in the breech position. She delivered the body at home but the head wouldn’t come. Babies can’t live like that for more than a few minutes. Six hours later, she arrived on a stretcher to our clinic. It took us an hour to get the head out. But the woman lived.

- A woman from the primitive tribal regions to our south came in after being stabbed in the abdomen by her husband. The knife penetrated into her peritoneum (abdominal cavity). She eventually had surgery, recovered, and went home. Her husband went to jail.

-In March, we took 5 women with fistulas to a hospital in Addis. A fistula is a hole between the bladder and vagina that develops when a woman’s labor fails to progress and the baby’s head is stuck low in the pelvis for hours or sometimes days. The women are completely incontinent, and become ostracized in their community. The operations are done in Addis Ababa at the Fistula Hospital for free. They are life-changing for the women.

For some patients, their lives were saved as a result of visiting our health center. For others, there was nothing we could do. What I have learned this year is that we are not going to save everyone who comes through our gate. But, the stories that you must hold onto are the happy ones, the successful ones, the miraculous ones. And in everything, everyday, you must look for the joy and humor of life.

Managing the Impossible

Prior to coming to Ethiopia, we hadn’t anticipated how difficult being a manager would be. Lalmba Ethiopia is a unique place to manage. We’re an NGO-run health center but also considered governmental; we pay most of our employee’s salaries yet some receive theirs from the government or even other NGOs; we, the head management team, are expats but the employees are all Ethiopian, and the cultural differences can be huge. We learned to listen closely to our Ethiopian managers who try to interpret these differences for us. If a government employee goes away for 2 weeks and comes back to tell you he needs another week off because his brother is sick, that is code for “I’m looking for another job but don’t want to tell the government so my paycheck keeps coming.” If you tell an employee that you are taking away some of their pay as a penalty for an unexcused absence and they agree, be aware that they will not agree when payday comes around.

The examples of management difficulties here are endless. Every time there’s a chance for the nurses to get per diem pay (extra pay for going to a training or meeting) there’s going to be some trouble. Fighting about which or how many nurses go will doubtlessly ensues. And there’s always the issue of productivity at work. How does a manager who’s in a place for a year deal with tardiness and laziness of his staff, especially when his expectations may be too high coming from the U.S.? There’s no easy answer. And sometimes the problems escalate even more…to the point of a strike. What do you do when your government nurses threaten not to work at night because the government isn’t meeting their demands? Do you close the clinic completely so that it becomes a real threat to the community so the government actually does something about it? Or do your expat doctors and one private nurse work because you can’t let a sick patient not be seen, even if it means potentially burning out these staff? Or do you just go to your office and hide and hope that someone else will fix the problem? Regardless of the answers to these difficult questions, I have a newfound respect for those who manage.

A Car Full of Gold

Here in Ethiopia, the early summer is famine season. All of the crops harvested during the dry season have been eaten long ago, and the summer maize harvest is still weeks away. This is the time that our inpatient unit begins to fill up with malnourished children—children who have too little food and are wasting away, or those whose bodies are so protein starved their limbs and face swell up like balloons. For children such as these, our malnutrition re-feeding program literally saves their lives. But we can’t do it alone.

UNICEF provides special re-feeding formula that is specifically designed for malnourished children. Our local health department is responsible for collecting the supplies from a distribution center (which is a two-day drive away) and delivering it to us. But like so many other things here in Ethiopia, the system doesn’t exactly work. There are so many reasons why… Political ones—like the fact that this area isn’t supposed to have any malnutrition. Logistical ones—like the car needed to pick up supplies is broken. Personnel ones—like the person responsible for picking up supplies changed jobs.

And so, for a year, as our supplies dwindled, we asked and asked for more. And for a year, UNICEF formula sat in their distribution center and expired. And for a year, we talked about how this was just another frustrating example of why the work of saving lives here is so difficult.

And so, as our hope diminished as fast as our last box of re-feeding formula, we prepared to make our own two-day trek in our private car to pick up the UNICEF supplies. And then the phone rang. The supplies had arrived. They were nearby in Bonga waiting for us to pick them up! Within a few hours Jeff was in our car driving back from Bonga with a 6-month supply of malnutrition formula. With his window rolled down, and the music blasting, he had more than one thing to be thankful for. Because just when you’re ready to give up, something about this place surprises you just enough to keep you going.


Pictures of Kwash Girl:
Above: Before
Below: After

The Unknowns

Hello Erin and Jeff’s fan-base! Tiffany Hall here, long time reader first time blogger. I was lucky enough to get to visit Jeff & Erin at the lovely Lalmba compound for a couple of weeks, and it was nothing I expected, everything I expected, and more. I could write pages about their big hearts and wonderful intentions, but these are givens at this point. Instead, I’ll write about some things I didn’t know.

Let’s start with the setting – I had no idea that the buildings where they work are only 50 yards from where they live. While on the one hand, this makes for the best commute EVER, on the other it must wreck havoc on the division between work and home life. Throughout the evening/night, people can come ask for help, for anything from an emergency overflow of patients after a machete fight, to having run out of basic supplies because one of the workers from town didn’t bother to check the storage cabinet before they left for the day. Maybe if they didn’t have the security blanket of staff sleeping 30 seconds away, they would have been more careful?

Next are our friends. I have known these two for over 10 years, and was comforted to see the old familiar habits and traits I equate with each of them. I knew them in college, so I’ve seen them both in work and play. However, the way these characteristics have developed with them into their professional lives is perfect. Too perfect. Erin still focuses on making sure she does the best job she can do, while keeping a sense of humor about slipping in the mud, and speaking in Kafenono to children and worried mothers to put them at ease. The trust and love people feel both for and from her are made clear by the looks on everyone’s faces – the staff, the orphans, and the community. As for Jeff, he’s as much a goofball as ever, as well as a professional, respected, and just plain good doctor. He trains and tests the people working for him constantly, but in the supportive and lighthearted way that makes people want to learn. He is serious when talking about the gravity of patients’ situations, but still takes the time to try to make them smile.

Finally, the similarities to Pomona. While they do have someone who makes them lunch during the week, and cleans the house and washes the laundry, these are not the main points I want to make. Somehow it doesn’t feel quite as extravagant in the middle of rural Ethiopia. I’m referring to the familial atmosphere they’ve created. Every night after work, the entire Lalmba family (E&J, Richard from New Zealand, the other American couple Andrew & Faith, and their daughters Alea & Emry) gather around the dinner table to share food, stories about their day, and the unspoken bond of having at least some shared ideals. They play games, watch movies, and tell fart jokes; they have disagreements; they make everything work.

Jeff and Erin will miss Ethiopia - the country, the work, the community they’ve created around them. More than this, Ethiopia will miss Erin and Jeff, from the positive changes they’ve made in their jobs to the laughter they bring everywhere they go. Before visiting I didn’t know any of these things, but having learned them, I’m not at all surprised.