Ethiopia Presentation

Want to know more about our trip? Our team will give a presentation on September 15th to talk about what we did, why we did it, and how it impacted the people of Ethiopia as well as ourselves. All are welcome.

Wednesday, September 15th, noon-1PM
UTHSCSA Room MED 409L

For MS1s interested in participating in Ethiopia Outreach in Summer 2011, applications will become available at that time. We will have an additional "interest" meeting for people to ask questions about the trip and the application process.

For more information, please email uthscsaethiopia2010 (at) gmail (dot) com.

I left my heart in Aleta Wondo

I have been working on this blog entry for about 10 days now. Every time I sit down to write it, I research quotations, stories, personal anecdotes, statistics – everything – with the goal of coming up with some clever vehicle to use for my introduction and conclusion that will tie my story into a nice, neat package. But after the 10^th day of looking for quotations, stories, personal anecdotes, statistics – I realize that the problem isn’t that I can’t find the right vehicle. The problem is that I’m trying to consolidate our 3 weeks in Ethiopia into a nice, neat package; when in reality, my story of Ethiopia is neither nice, nor neat. It’s messy.

Our journey began long before June 13^th. For me, it started on November 1^st when I was offered the position of team leader, charged with the task of forming, organizing, planning, and running the 2010 Ethiopia trip. Of course I had my own worries. Would we be able to raise the money and plan the trip and purchase the medicines and bring the medicines? In the meantime, would we have enough time to study for our first year medical school classes? The ensuing weeks had all sorts of ups and downs: from selecting a team, to hosting a very successful bake sale, to entering our program into the ideablob contest, to watching ideablob go bankrupt mid-contest. Some people might have called that an omen. Me? I had no idea. The Spring semester brought with it a slew of challenges. Between confusion regarding fundraising policies and the recasting of our school’s international program standards, there were times where we thought our trip might not happen altogether. At one point I remember saying that it would be a miracle if our team even made it off the ground. Would our team be allowed to go to Ethiopia? Would we be able to fundraise and run a well-planned trip under such short notice? Now, I look back on all of that chaos and realize (1) yes we could and yes we would and (2) it was all worth it. If anything, I learned great lessons in perseverance. Thank you to all of our supporters who gave us such great encouragement and words of wisdom in that time.

But this post is really supposed to be about Ethiopia! Arriving in Ethiopia, itself, felt like a triumph. Of course, as many of you know, our medicines for our clinic were confiscated by customs shortly after landing. Prior to arriving in Ethiopia, we asked all of our contacts if we needed to file any paperwork or bring any documents to help us get our items through customs. We were informed that we shouldn’t have any problems. Little did we know that a few days prior to our arrival, the Ethiopian government had begun enforcing new policies regarding healthcare and the handling of medicine. What a nightmare. That week, as we shadowed physicians and toured a number of different hospitals, our guide, Negusse, ran around the city pulling all the strings he had to help us get our medicines back. Two weeks later, Dr. U arrived and spent several days getting everything straightened out. Thankfully our medicines were returned, but it was not easy! On a personal note, I am grateful that the government is enforcing rules regarding what is allowed to come into their country. And we’ve learned many lessons that will be very useful for next year’s team!

Our time in rural Aleta Wondo was peaceful. For the first portion of our time there, we conducted a maternal health survey to help Common River evaluate the status of maternal health in Aleta Wondo. Our data will assist them in creating and altering education programs to better services to mothers in the area. I enjoyed performing this survey because it gave us the opportunity to get to know the people whom we hoped to serve and to learn more about the culture and the area. We sat in their homes, shook their hands, pet their animals, played with their children, accepted their embraces, and listened to their stories.

On the first day, Wade and I had been conducting Maternal Health surveys with our translator, Girum, all morning. I’ll be honest, after lunch I was tired and not terribly excited about going out to collect more surveys. Nevertheless, we arrived at another home and asked the head of the household if we could question the women there. He obliged and we reconvened our procedure of asking questions and recording data. Once we finished the survey, the man asked us if we would take a look at his daughters. One had a heart problem and another had fallen off a motorcycle the day before. She limped out and I quickly glanced at her wounds to see that they were infected. Maybe it’s because I was exhausted, or maybe it’s because I was tired of just observing – but I looked at Wade and exclaimed, “She just needs first aid! They’re infected. We have first aid supplies. All we have to do is clean it. I’m pretty sure we can help her.” Girum tells the family that we’ll be back and the three of us walked back to our compound. I frantically search all around our room for whatever supplies that customs hadn’t confiscated. Myra passes me some hydrogen peroxide, gauze, and tape. Wade and I return to the home where Girum proceeds to inform us that the family had already been to the clinic. We proceed to clean her scrapes and gashes again, and cover them with band-aids and gauze. We tell the father that the clinic had treated her correctly, and that he should take his daughter back if her wounds do not get better.

After that, I’d like to say that I felt a profound sense of accomplishment. At the time, I felt like we were doing something novel that would save this girl from getting gangrene and losing limbs. But in reality, she was already in the healing process. We did something very basic and minor. In the end, I was reminded of my own humanity. I was raised in America and was brought up with the mentality that I can control my destiny, I can forge my own path, that I have the capacity to save the world. Just like so many before me, I was so eager to do something. But in reality, I am no knight in shining armor and Africa doesn’t need my saving. I am a person, invited to step alongside the amazing work that is already happening in Ethiopia. 

In the final portion of our trip, we hosted free clinics for the people of Aleta Wondo where we would see 60-100 patients per day. By the end of the week, we had seen over 400 patients! For me, this is where most of my memories were built. One day, we were on our way out to conduct maternal health surveys when one of the Common River staff approached us with a little girl who constantly wore a hoodie over her head. He removed the hood to reveal to us a very bad case of tinea capitis (fungal infection). I remember looking at that and thinking, “I think Dr. U will know what to do… I hope he does…” We told him to bring her to the clinic, and that we would probably be able to treat her. 

Sure enough, they came to our clinic before we even opened on Monday morning. Demekech was the very first person that Dr. U saw. He learned from her grandmother that she was HIV positive. Additionally, he noted a very large, painful mass extending from her cheek to her neck which seemed to be lymphadenopathy. He concluded that she either had an odd-presentation of tuberculosis or some form of lymphoma. A diagnosis of tuberculosis could undergo the standard regiment of rifampicin, isoniazid, pyrazinamide, and ethambutol; with treatment, 95% of TB cases are cured. A diagnosis of lymphoma, which could not be treated in Aleta Wondo, would be fatal in 3-6 months. I remember looking up and seeing Demekech’s grandmother cry as she listened to the news. It seemed like Demekech’s only hope was to be admitted to Mother Theresa’s Mission in Addis Ababa where she could be treated for her HIV and lymphoma. I took Demekech away to take her mind off her illness. She was feverish, and obviously not feeling well. 

I spent a lot of time with Demekech. Every day that week during our free time I would sit and play with her. I love kids, I really do – but my threshold is usually around 3-4 hours. After that I get tired and irritable. But I never got tired of Demekech, I never stopped loving her. I don’t know if I ever came to terms with the differential for Demekech’s illness. I was stuck on the fact that she was HIV positive and orphaned by AIDS. I can’t imagine what it must be like to watch your parents die from AIDS, and then to find that you are destined for the same fate. Demekech’s brother, Zerihun, also had a large mass indicative of lymphadenopathy but he refused to be tested for HIV. One day, Tsegaye and Tesh spoke with him and he decided to get tested.

He tested positive.

Even as I write this, I’m not entirely sure how to share this story, or which parts to share and which parts not to. And I can’t figure out why, but for some reason or another, my heart still breaks whenever I think about Demekech. 

Because we were traveling through Awassa, we agreed to take Demekech, Zerihun, and their grandmother to Mother Theresa’s Mission in Awassa. When we arrived at the clinic, we spoke with one of the sisters, but it seemed like there was a protocol that would need to be followed in order for Demekech and Zerihun to be admitted and transferred to Addis Ababa. I started to worry that they would lose out on their only chance for a cure; I don’t know when the last time was that I prayed so hard. On the bus ride, as I held Demekech on my lap, I couldn’t imagine what it would be like to have to say goodbye to this little girl. And I realized then that no matter how much I loved her, no matter how long I held her, there was nothing I could do that would bring back her parents, that would cure her of her HIV, that would shield her from all the problems that she has and will encounter. And once again, I was reminded of my own humanity. Regardless of what disease she has, she looks forward to a very difficult life.  

We were told by Mother Theresa’s mission in Awassa that we would need to wait for them to get permission from Addis Ababa before we could bring Demekech and Zerihun. In the meantime, we took their family with us to the Hot Springs in Wondo Genet for some rest and relaxation before heading back to the states. It was a marvelous time and I think we all enjoyed those last moments together.  

The next morning, we were getting ready to head back to Addis Ababa when Dr. U noticed Demekech cough. A cough means one thing. The diagnosis is more than likely tuberculosis than lymphoma. Dr. U completed another physical exam on Demekech before calling Dr. H to discuss her case and whether or not she should stay in Aleta Wondo or head to Addis Ababa. Afterwards, Demekech’s grandmother pulled out the medications that Demekech was on.

And there before us was a little bag labeled “Isoniazid." 

Demekech had already been diagnosed and was being treated for TB. And everything was decided. Demekech and her family would return to Aleta Wondo where she would continue treatment for TB (with multiple drugs rather than just one) and HIV. It was very much the epitome of a bitter sweet moment: on the one hand, I think we were all hurt that we had been missing this crucial piece of information; on the other hand, TB has a much better prognosis than Hodgkin’s lymphoma.



The wounds of Ethiopia run deep. On the one hand, there is an extreme lack of healthcare. Every day, hundreds of people who had walked 30 to 40 to 50 kilometers would line up outside our clinic hoping that we would deliver some sort of panacea. On the other hand, despite the poverty, overpopulation, lack of water, lack of access to basic necessities of life – Ethiopians are an extremely loving, hospitable, friendly, happy group of people.

My heart still longs for Africa. There are mornings where I wake up and wish I could step out of my hut to see the cows and horses grazing in the field, to enjoy a fresh (and I mean fresh!) cup of coffee and a simple, homemade Ethiopian breakfast. But mostly, I long to see Demekech run to meet us and give us hugs, or do fist bumps with G-Alshogoleet, and run around and play with Aymanut. My story of Ethiopia is not nice and neat. It’s messy. But life is messy. And it is in the midst of that mess that we find joy, hope and love. I think Ralph Waldo Emerson put it rather well when he said, “It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself.”  I feel like Ethiopians gave me so much more than I could ever have given them. I experienced such love and kindness; and I learned great lessons in what it means to be joyful in hope and patient in affliction.  Admittedly there are times when it seems like the work we were able to do is only a drop in the ocean. But I look forward to seeing the ripple effect of that drop -- in my teammates, in future Ethiopia Outreach teams, and in the community of Aleta Wondo. Upon our departure, we rest easy in knowing that there are amazing people at Common River who continue to seek progress for the people of Aleta Wondo and that really, everything is in God’s hands.

This is Africa.

It has been a week since we got back from Ethiopia. Right before we left, we had an “Ubuntu”, or gathering, and we discussed some issues we could face as we came back to America.

Assimilators were people who, upon return to the US, could easily get back into the swing of things. Alienators would feel guilty about a lot of things, like spending $20 on a new shirt when that money could probably feed a person for 20 days in Ethiopia. Integrators were the best to be – they would take what they learned abroad and somehow “integrate” it into their daily lives here in the States.

To tell you the truth, I didn’t really know what being an Integrator meant. Typically, I’ve always been an Alienator. I had a fantastic trip to Ethiopia, but there were several emotions that I felt the last few days before I left and the first few days back in Texas.
But first, a set of questions.

Did we understand healthcare in a third-world country better? Yes. We shadowed several doctors/surgeons at many clinics and hospitals. Not only were we lucky to get in contact with these very busy care providers, they were extremely compassionate and informative, and they gave us a startling awakening into their access to healthcare – a very dismal picture compared to what is offered to us as Americans.

Did we set out what we accomplished to do? Yes. We had five clinic days in which we met with over 400 patients. Some of them had never seen a doctor before and Dr. Usatine was their first chance, ever.

Did we live simply during our time there? I believe so. We didn’t have electricity some nights and took cold showers several other times (we were just thankful it was clean). We ate without that full, satisfying feeling we are so use to experiencing, but we were grateful for the food we were given.

Did we get a good grasp of family life in Ethiopia? Yes. Our maternal health survey allowed a 3 day window into the lives of some very precious mothers, their children, and their homes.
I had a very heavy heart leaving Ethiopia. I felt that in spite of living the way Ethiopians lived for three short weeks, at the end of the trip, this would not be the final reality for me. At the end, I was sent back on a gigantic plane, only to have my car, washing machine, hot water/tub, and warm bed to greet me. My fridge will always be stocked full of food and I won’t think twice about my electricity or my clean water. Sadly, the people I met in Ethiopia, many that I had gotten to know and love, will stay where they are. Their lack of access to clean water will continue to create a host of diseases that will attack their bodies, while their lack of basic healthcare will continue to leave them mostly defenseless.

My final thought as I left Ethiopia was this: Why were we blessed to have so much while so many in the world have so little? While I am still working out the details of this thought, I have come to one conclusion that I am sure of: Even though I have personally been given so many wonderful blessings in my life, I have also been given a responsibility to not take these blessings lightly. As a citizen of this world whose actions can greatly change the lives of others, it is my duty not only as a medical student but more importantly, as a human being, to help my neighbors here and abroad.

One quick, but shining story during this trip that I completely attribute to the power of God’s timing is the story of Abraham. He was a 10 year old child who was kicked out of his home when he was 6; when his mother had died, his new stepmom did not favor him. He spent the last 4 years working at a teahouse in exchange for food and shelter and a week before we arrived in Aleta Wondo, he fell ill and was thrown out to fend for himself. He eventually heard that foreigners had come into town on a medical trip, so he found us during out week of clinics. We found Abraham lying in a patch of grass outside our clinic with a fever of 106.7 F. After quick action on the part of our team and the healthcare staff at the clinic, we were able to get his fever down. On the last day of clinic, he was healthy enough to be released from the hospital. Abraham is currently being adopted by Common River where he will never have to worry about food or shelter and will be attending school in the Fall.

Though much of our work in the clinics and medications only provided temporary relief, we did make some permanent footprints. We provided quality care to a population where most had never seen a doctor before or had anyone really listen to their clinical ailments. We helped conduct a survey that will hopefully branch into maternal programs for women in Aleta Wondo. And lastly, we helped a young boy get a second chance at life.

There is much I would like to say, but to be brief, this trip was nothing short than incredibly life-changing. As a future physician, I can say that my passion for medicine has not only increased exponentially, but the faces of our patients we saw will drive me to work harder and better for the patients I will see in the future. In addition, I have not only been completely humbled by my time in Africa, but am hopeful to the future as I have seen the compassion for the needy in both my teammates as well as the very competent and caring doctors in Ethiopia.

Needless to say, it will not be my last time to be in Africa.

A new life

Salom!

Or "peace" in English. So, it is near the end of my day, my first day of my second year to be exact, and it is th

e beginning of the day in Ethiopia. Although my jet lag has long passed and I am well on my way to a normal lifef, I still feel like part of me has not returned back from Ethiopia. This trip has been by far the best mission trip I have been on and has left its mark on my heart for life. There were so many special moments i would love to share with you, but the one thing I must tell you

about Ethiopians is their amazing

capacity for love and generosity.

Image: Left to Right: Abraham, Mituku,

Me, "G-Baby"

Imagine you are at home, the doorbell rings, and you see two foreigners and one translator. They inform you that they are doing a survey on your health system and need to ask some personal questions. (each survey also takes about 10-20 minutes) What would your reaction to these individuals be? Would you invite them, go outside to talk, or just say you dont have time to answer their survey and shut the door? I believe, that I and most Americans would choose the latter. This however did not occur in Ethiopia, we (two medical students) and a translator would walk hut to hut doing surveys on Maternal health. When inside the huts, the women or other family members would give us their only chairs. I tried to refuse the first day but by the second day I knew there was no refusing to sit, as the women whom we were surveying would stand and answer our questions.

The second great act of generosity was

when some of the women would invite us for coffee at the end of the survey. I know what your thinking, coffee no big deal right....Well, sitting for coffee in Ethiopia is an hour or more ordeal. It is something people do as a social event, they sit and talk about their days, their families, and just relax. It was amazing that people who have so little offer so much to complete strangers.

The people of Ethiopia are also so welcoming, they greeted us on the streets saying, "Welcome to Africa" or "Hello, How are you?" Lets think about this, how many times have you seen a foreigner, or lets just say anyone that you didn't know on the street and said "Hello,

how are you?" It really made me think about how disconnected to humanity we can become in our day to days. Those words, "hello, how are you" are so simple and easy to ask and yet can make someone's day just as it did to me.

The third act of love and kindness that I saw was the story of Abraham. This story began on our third day of clinic. Annie and I had some free time away from the Pharmacy table so we decided to go an help out on intake. Intake had gotten really crazy with well over 100 people each day crowding, pushing, and trying to be seen. Annie and I stepped outside and we saw a little child lying on the ground. We went to his side and with out interpreter we asked the people beside him where his parents had been. They said he showed up on his own. So when I went to wake him from his sleep, I felt his arms and they were on fire. Annie felt his head and we both knew that we needed to get him into the clinic. We quickly picked him up and rushed him onto the only examining table we had. We got a temperature reading and it read over a 106 degrees. I started to quickly rip of his clothing and yelled for wet towels and water. I don't quite remember who got the water because as I started to take his clothes off, huge ants started coming out of every conner of his clothes.

The team quickly got all the ants off of him and we started to pull the water all over his body. Dr. Usatine, told us to get an 800mg of Ibuprofen to help break the fever. The child was barely responsive, but we got his name "Abraham" and his age, 10. Dr. Usatine quickly talked to the health clinic officials and we rushed him into the only bed available in L&D. The nurses at the clinic put in an IV and Dr. U ordered fluids. Now we played a waiting game. Long story short, he recovered after two days of broad spectrum antibiotics. He told Tsegaye, the owner of Common River, that his father had beat him and ran him out of this town at the age

of 6. He walked 30 km to Aleta Wondo, where he had been working and living on the streets at time for 4 years. When he got seriously sick, his employers fired him and kicked him out. We talked to Tsegaye and he said that if Abraham agreed, Common River, would find him a place to sleep, eat 3 meals a day, and go to school.

After ripping off all his clothes, I gave some of my clothes to him and Annie gave him her tennis shoes and socks. Annie and I went everyday and brought him food in the hospital for breakfast, lunch, and dinner. Everytime we came through the door, it was amazing to see his eyes light up with his big smile and he would give us a hug. He gladly accepted Tsegayes offer and is staying with one of the nicest staff members, Tafasaye. It was truly touching and tough to see Abraham run after the bus as we left the compound.

The hardest part about leaving Ethiopia was leaving this place of love. We all grew attached to people there, but Abraham and some others especially hold a place in my heart. I do not know how one can go on a trip and experienc

e the wonderful people of Ethiopia and not come out a little different and filled with a new sense of love and gratefulness. I look forward to writing Abraham, Mituku, and Z, who are new members of my family.

Thank you Katie Gong for putting this amazing trip together, Josh for all our wonderful talks, Wade and Ed for keeping things lively, Myra for always ready to listen and being a secret assassin, Annie for helping us become "team awesome" and not making me the only "mushy" person on this trip, Nishina for being my "Habiti", and finaly Dr. U for being an amazing mentor and educator, not to mention a suave salsa dancer as well!

Ciao,

Matt -

Back to Life, Back to Reality

It's our 5th day back in San Antonio and I'm having a hard time realizing that we were in Ethiopia less than a week ago! Although it sounds a bit cliche, I truly feel that I've grown from this experience. Never would have imagined that I would have the chance to go to the continent of Africa in my lifetime, let alone with 7 classmates for 3 weeks! Ethiopia is a beautiful country; specifically, the rural area around Aleta Wondo is quite tropical and lush. The capital city Addis Ababa is happening--international restaurants, internet cafes, bars, and clubs surrounded us. Poverty is present, but Ethiopians are a happy bunch regardless of socioeconomic status. Whenever we traveled, we heard shouts of "ferenje" meaning foreigners and "welcome to Ethiopia!" I never felt threatened or unsafe, but we had our reliable tour guide Negusse and a few big fellas on our team to protect us if needed. Working with my classmates allowed me to get a glimpse of being a physician--creating teams working towards a common goal. The eight of us had varying personalities that brought a fresh perspective to the table. Being in Ethiopia for 3 weeks allowed us adequate time to really feel comfortable around the people, language, and environment.

Looking back, I feel the trip has exceeded my expectations and goals; we were able to see healthcare in the capital by visiting Black Lion Hospital, CURE Hospital to watch orthopedic clubbed foot surgeries, ALERT Hospital specializing in leprosy treatment, and Luke Society Clinic serving the poor. In comparison, we saw the limited resources available in Aleta Wondo--there was a health clinic run by nurses and health attendants, but no physician available aside from private clinics.

Most importantly, I have learned much from and admire my teammates. Dr. Usatine did an incredible job of teaching as well as guiding our efforts. Team leader Katie Gong: nicknamed Cumem for spicy, bears the weight of the world on her shoulders, responsible, loving. Myra Liu: nicknamed for her calmness, she is caring, easy to talk to, wonderful roommate. Annie Lu: nicknamed konjito for her beauty (inside and out), she is our superwoman that gets the job done, a spiritual fortress. Josh Essel: nicknamed Joseph (for what reason I forget), great listener, kind and gentle. Wade Murray: nicknamed Demolash (Demolisher) because he looks like he can take you out, fun-loving, caring. Matt Murrell: nicknamed Tasfaye for 'my hope', compassionate, knowledgeable, and great at cheering us up. Edward Shipper: nicknamed Alemayo for 'one who sees the world,' brilliant and our comic relief. As for me, nicknamed Tsahai for 'sun,' I've been told that I have a gentleness that commands respect--not too shabby! =)

Thank you all for your support and prayers. God bless.

Clinic in Aleta Wondo 6/28-7/2

Having spent the first two weeks of our trip familiarizing ourselves with the health care system in Addis Ababa and then trekking south into the Ethiopian countryside, the final week of our trip culminated in the offering of a free health clinic for the people of the rural town of Aleta Wondo. After some logistical cajoling, we were able to host the clinic at the Tena Tabia, Aleta Wondo’s own local health center. In the single room provided for us, our group set up four stations manned by two students each: an intake station, two “sick” stations, and a pharmacy. At the intake station, patients provided their name, age, and chief complaint before being sent to one of the sick stations, at which point the students recorded a patient history and performed any pertinent physical exams in anticipation of our faculty sponsor Dr. Richard Usatine’s final clinical assessment. Patients were then shuttled to the pharmacy to receive deworming pills for intestinal worms, a multivitamin, and any medications prescribed by Dr. Usatine. Throughout the process, we were assisted by a cadre of translators who deftly navigated the language barrier presented not only by Amharic, Ethiopia’s principal language, but also by the various dialects spoken in the countryside. Our thanks go out to all of the translators!

We went into our first day of clinic consumed with the archetypal fear of the unknown. For starters, we did not know how many people would show up. In performing a maternal health survey the previous week, we had informed the almost 200 women interviewed about our clinic, but it was impossible to know how many more people had been alerted by subsequent word of mouth. Perhaps more importantly, although the Tena Tabia itself is a free clinic, it is staffed primarily with nurses and public health workers. As we were told, our clinic would in all likelihood be the first time many of the people from Aleta Wondo would have the opportunity to be seen by a credentialed medical doctor—a fact which might inflate the demand for our services.

While Monday graced us with a manageable assembly of Ethiopians, tidings of our free clinic rapidly spread throughout the week, such that by Friday literally hundreds of people were gathering in mob fashion in front of our doors before we opened at 9 AM. It is difficult to describe in words the surreal experience of sifting through this throng. Men, women, and children of all ages would beg, yell, and even physically grab the poor student running intake tasked with the duty of choosing which patients would be seen by Dr. Usatine that day. Often times, these people would remove their shirts or pants without modesty or reservation to expose a rash or mass that the student might deem worthy of admission. Indeed, Wade and Annie suffered open wounds on their arms due to the clawing of several overly eager Ethiopians.

While the scene outside the building personified the quality of entropy, the setting within the walls of the clinic offered a more controlled sense of chaos. Amidst the constant chatter of patients, translators, students, and doctor, we treated a number of patients afflicted with a wide range of pathologies, many of which typically would not be seen in the United States. One of the most common disease types we saw was a skin infection, usually fungal but also bacterial. Most of these diseases could be cured with some combination of oral and/or topical antibiotics. Trachoma, a bacterial infection of the eye, was another prevalent illness. If left untreated, the disease will ultimately lead to blindness, so being able to cure trachoma with a single dose of antibiotics was particularly gratifying. Unfortunately, whether because of lack of resources or lack of treatment options, not every disease could be cured, but in total, we were able to see over 415 Ethiopians. Our thanks go out to Dr. Usatine who visited with every single one of these patients over the course of the week and never once seemed stressed with the burden of a constant patient flow.

Homeward Bound :)

Dear Friends--


Thank you all for your prayers, kind thoughts, words of encouragement, and constant love and support. Just a quick update -- 23 hours of flight and 12 hours of layovers later -- we are all home and healthy! Unfortunately, the town of Aleta Wondo has not had internet for over a month, so we were unable to post any updates regarding our experiences there. However, as you might notice, we have been posting retroactively! So keep an eye out for our thoughts and reflections on our last week in Aleta Wondo as we hosted clinics for the community of Aleta Wondo, as well as our own personal team reflections! We look forward to sharing with you the remainder of our journey :).


Much love and many blessings,

Katie

Onward to Aleta Wondo! Maternal Health Survey - 6/24-6/26

from the pen of Nishina



Last week we drove the scenic journey from Addis Ababa to Aleta Wondo. The eight hour trip was pleasant—staring out of the window ain’t so bad when there are kilometers (versus miles) of untouched land to admire. We passed the time by belting out lyrics to a variety of jams, a little Strawberry Wine and Aerosmith’s I Don’t Want to Miss a Thing were top hits for us.


The compound at Common River is breathtaking. There’s a beautiful field just outside of our huts where we can find horses and cows grazing. Yesterday morning I skipped team breakfast (being the rebel that I am) to sit outside and enjoy the scenery; soon afterward I see a heifer and its calf galloping together onto the field…California’s a joke, the happiest cows live in Aleta Wondo, Ethiopia!


We conducted a field survey on Maternal Health in order to get an idea of sex education and healthcare available for the residents living near Common River. I had the opportunity to participate in a health census in my previous medical trip to Nicaragua and I remembered this being my favorite part of medical missions abroad. Essentially, you and a teammate walk from house to house with a translator and ask questions while sitting inside someone else’s home. Clinics do allow us to provide a diagnosis and treatment, but they do not allow for us to actually see a patient’s living conditions or family situation. One of the questions we asked was about female circumcision, also known as female genital mutilation. Female circumcision typically entails cutting of the clitoris and sometime the labia minora. When I first asked this question during our trial run and heard her affirmed response that our interviewee had experienced it for herself, I couldn’t help but think of what a terrible, terrible experience that must have been. The responses overall seemed to be that most mothers were circumcised as children, but the government has made it illegal and girls nowadays do not undergo circumcision. Interestingly, the elderly women felt that the government should not interfere with their traditions since it is part of the culture-- the people should be left to do as they please. I can’t say for certain how women under 60 felt since they may have given biased answers to please us as ferengi (the term they use for foreigners). Those women replied that it was a “different time” in the past. It is difficult to ask such personal questions and probe for their opinions for a multitude of reasons which include having to translate questions and answers through a third party after barging into their daily routine. From what I understand, younger mothers seemed to react positively to the change of no longer circumcising young girls.


The women appear to be well educated about HIV/AIDS and family planning, somewhat a surprise for me given such a rural community. The purpose of the survey was to get an idea of what Common River can offer in terms of education for the surrounding community.


Another high point of the trip was our opportunity to watch the World Cup (taking place in South Africa) match between Ghana and the US in an African equivalent of a dive bar within the small city of Aleta Wondo. Our team was a bit torn since Ghana is the only African team to still be in the running; moreover, one of our very own teammates Joshua grew up in Ghana! Most of us still rooted for the US amongst a crowd of at least one hundred Ethiopians, cramped into a small room with the game projected onto a stone wall. The whole experience was amazing—sipping Ethiopian St. George’s beer and exchanging high fives and hugs with the locals…wouldn’t trade it for the world. Still in awe of the fact that I am here.

Salom from Addis Ababa!

from the pen of Katie: 

What a busy week we have had here in the capital of Ethiopia! As you may know, we arrive late on Monday night and were greeted by a tired but happy Negusse! Negusse is our guide and has been extremely helpful to our team during our time in Addis. We spent all of Tuesday running errands (i.e. getting a SIM card, exchanging money, etc.) and getting aquainted with the city (we visited the national museum!).

On Wednesday we visited the Luke Society Clinic which is a clinic established in the Bole City area. It was founded specifically to bring access to health care to the poorer parts of the city. For just 5 burr, anyone in the area can be seen at this very intimate clinic.

On Thursday we shadowed two relatively outstanding physicians at the ALERT hospital. These doctors taught us about Leprosy and a number of other conditions. They PIMPed us on the causes of vasculitis and the criteria for Lupus. Talk about a wake-up call. We wracked our brains as we tried to recall all of our first-year microbiology information! But it was a very nice session. I really do agree with everyone when they say that the problem in Ethiopia isn't so much the quality of doctors, as it is the quantity. All of the physicians we've shadowed are very competent! But there simply aren't enough of them!

On Friday, we visited the Black Lion Hospital which (from what I can tell) is the "University Hospital" for the medical school here. It truly is a very technologically advanced hospital -- and once again, the doctors are very competent. It was nice to hear from the dean of the medical school their plans for increasing the class sizes so that there can be more doctors in Ethiopia. However, he also talked about how currently, the nation needs to find money to sustain that level of health care.

On Saturday, we visited Kingdom Vision International which is an orphanage in Addis Ababa. It was started just two years ago. They are a relatively new NGO. It was really neat to sit down with Eyob and talk about his goals as an NGO for the reunion of children with their families and the impowerment of women in poverty. Nevertheless, Ethiopia has ~5 million orphans primarily caused by AIDS. It makes me a little sad. Our goal at the orphanage was mostly to spend time with the kids. When you live in a home with about 50 other children and only 5-10 adults -- one-on-one attention can get scarce. I think we all had a good time playing soccer and frisbee. I played with a little girl by the name of Mahador which was so lifegiving! She's incredibly bright and sweet. But it broke my heart when one of the caregivers asked me if I could adopt her, as she had no parents. And of course -- I had to explain that as a student, I don't have any means of taking care of another human being.

Sunday was a reflection day -- and our team had some personal time to reflect on our time here and then to meet together to discuss how we are all doing and processing the things we've been seeing. And today, our team spent the day shadowing a US orthopedic surgeon at CURE Hospital.

What a busy week it's been! In addition to all of that, we've found some time to cheer for the US in world cup soccer. We also got some really great time to head to the stadium and cheer for Ghana and Cameroon! The spirit of World Cup soccer in Ethiopia is so alive and it's been fun to get excited!

Tomorrow we head to Aleta Wondo. For the next week we will conduct a women's health survey -- replicating a study that was conducted by our Haiti Team Counterparts in Haiti and on the Haiti/DR border this past winter and spring breaks. Afterwards, God-willingly, we will host medical clinics for the people of Aleta Wondo.

Prayer Requests:

(1) Health -- I've been sick for the past couple days and a number of people on our team have been feeling a little ill. Pray that we would all be well and able to function at 100% capacity.

(2) Safe Travels -- As we travel the 8-ish hour journey to Aleta Wondo -- pray that our vehicles would work well and that we would have a safe and uncomplicated journey.

(3) Medicines -- A number of our medicines are still sitting at the Ethiopian Ministry of Health. It seems that Dr. Usatine has obtained the necessary paperwork. Pray that there would be no further things to offset this necessity and that we would get these medicines soon!

Thank you all for your continued support! We look forward to updating you again!

We are Safe and Happy.

from the pen of Annie:

WE ARE HERE!!!!!!!!!! In Ethiopia. After 38 hours of grueling travel we are finally here. The plane ride was okay - we spent lots of time sleeping. We did not get into Addis Ababa until 7:30 PM, and because of a baggage situation, we did not get out of the airport until 9:30 PM. Although we looked totally lost, we were quickly rescued by our guide, Negusse, who had been waiting for us for 2.5 hours. He helped us get all of our luggage into vans and we were taken to the Holiday Hotel in Ethiopia. Today, we are trying to get some errands done before we start at the hospitals tomorrow. This weekend, we are also going to be able to help out at an orphanage.

Katie had asked us to fill out a predeparture questionnaire before we started our journey here, and one of the questions was "What is your current definition of poverty?" After just one day of looking around the area and even in what is in our hotel rooms, I can tell you what it is like to be pretty well off: Having electricity, having clean water (Hot water is a big plus, which we currently do not have), and having clean clothes. Most of the people here do not have any of these things. Apart of me misses home because I am not use to this, but another part of me is excited about living simply and not taking these basic things for granted.

Our spirits are high and we are all ready to get started though. I hope to update you on more later, but we all wanted to let you know things are okay.

One thing you could really be praying for us for - our baggage!!!! Most of our medicines were taken away at customs to be reviewed by the Minister of Health. It shouldn't be a problem, but we still don't have them in our custody, which makes us a little antsy. We do have all of dental supplies, so if anything, many Ethiopians will still have clean teeth :D

This trip seemed completely surreal to us even a few days before we left, but now that we are here, our entire team is just in awe of this entire journey from beginning to now. It still blows our minds that we are here, and we are so, so thankful. We all want to say "Amaseginalehu" (thank you) for just being here and supporting us.

Ciao! (Bye!)

Ready or not, here we come!

After weeks upon weeks of preparation, countless e-mails, text messages, and phone calls as we worked to coordinate this trip from 4 different cities in Texas (+ Edward who had gone to Rome for a bit) -- we met once again in San Antonio to complete some last minute preparations. After a rather scintillating orientation with the Office of International Services, we all went off to our errands, packlists, inventories, and a sweet goodbye/goodluck party hosted by some dear friends.

Today, after some pre-trip reflection, we dived straight into packing. As I was packing my personal bags the other night, I was slightly intimidated by the piles of team supplies stacked up in my closet. And as my teammates arrived carrying boxes upon boxes of donations, I started to wonder if we would ever get everything to Ethiopia! But a luggage scale, some teamwork and Matt's crazy packing skills can go a long way. By 4PM -- we were sitting in my living room with 18 pieces of luggage packed and ready to go.

After some more last minute errands and some serious blessings from Wayside Chapel, we gathered back at my parent's home for a farewell dinner. What better wraps up a busy week of trip prep than a delicious meal cooked by your mom? Thanks mom and dad for all you've been doing to support our team. Food was delicious!

To say it's been a rough semester would be somewhat of an understatement. Waiting to see if this trip would happen was rough, and pulling everything together in a period of about 6 weeks was not easy. I recall stating that if our project even made it off the ground, it would be nothing short of a miracle. And lo and behold -- I see on every side of me miracle after miracle after miracle. In the past few months I have learned so much about what it means to be a leader and plan a trip, to coordinate people from all different places, to work with peers and superiors. But above all -- I think I've learned a lot about what it means to perservere in the face of adversity.

I'm excited to be leaving tomorrow! I'm sure that our team will have a great time in Ethiopia and that we will learn plenty. And I look forward to the next life lessons that await us as we embark on this portion of the journey. Until next time, au revoir!

Some hard work ahead!

Ethiopia Outreach Slideshow

@ Yahoo! Video

"Hope deferred makes the heart sick.."

A few months earlier we got word that our trip to Ethiopia had been suspended indefinitely. I was distraught. We all were. The travel curriculum of the health science center was getting a major revamping and as a result, the trip was placed on hold till more concrete criteria for travel had been set. Our first meeting as a team, after discovering the news, was, well, quite lugubrious; for lack of a more complex word. These hopes we'd had were now adjourned, arrested, dashed, deferred.

On April 22nd, the team met once again. It was unlike any other meeting we'd had before. Meetings before this one had been to discuss how we could be preparing for our trip to Ethiopia. Meetings before this one had been about new opportunities for service in Ethiopia. This was different. We had met no longer as the Ethiopia Outreach team; but as the soon to be "A-destination-other-than-Ethiopia" Outreach team. We were convening to look at other options for the summer. The drastic length of suspension of the trip had despaired us of hope for Ethiopia. Now, we sought plan B's and C's.

Nonetheless, I sure am glad that there's a second portion to the verse from the book of Proverbs which entitles this post!:

"Hope deferred makes the heart sick,

but a desire fulfilled is a tree of life." Proverbs 13:12

During the meeting on April 22nd, as we conclude discussing our options for travel else where, Katie decides to check her email. Behold, there in her inbox is a letter from the president of UTHSCSA. Katie exclaims her finding. Our eyes widen. We immediately perk up in our seats. I scoot my chair closer to Katie's computer. Annie gets up and is now peering over Katie's shoulder.

Katie begins reading quickly and aloud through the letter to get to the portion that will state the fate of the trip. Soon, it comes: "... I have decided to allow this summer's trip to Ethiopia.."

We get to go! We get to go!!

Though we were exhausted from the wait, we knew now that there was hope again! The desire is still on course to be fulfilled. What now lays ahead of us is immense fundraising and preparation.

Life will bloom from the seeds of service and patient-care that this trip will plant in us. We are eager.

Roots of hope are reaching and establishing in us. We are filled with it.

A disease of poverty

One of the things that’s been on my mind over the past couple months came from our very first training session with Dr. Berggren.  Wade had asked Dr. Berggren what scabies are and Dr. Berggren proceeded to describe the pathology of Sarcoptes sabei and how it is treated with promethrin. However the words she used to describe the disease really caught me off guard: “It’s really a disease of poverty.”

A disease of poverty. I don’t know if I’ve ever heard something described in this way. In microbiology, we’ve been learning about infectious diseases and the risks of giving birth in “unsanitary conditions” but not once have we talked about how sometimes – people have no other choice. In the classroom – we talk about how one should avoid “poor sanitation,” “bad hygiene,” and “stagnant water” nonchalantly like “it’s just common sense.” But never have we addressed the fact that there are places in the world that have very little access to something as simple as clean water. Diseases of poverty are diseases that are more prevalent among the poor than among wealthier people. In many cases poverty is the leading risk factor for such diseases, and in some cases disease can (or allegedly) cause poverty. Why is that?

A few years ago I watched a documentary about a couple who had decided to live incarnationally as Nike factory workers in China. They lived in the same living quarters, worked in the factory, and tried to live off the same wages as their co-workers. At one point, the wife had become extremely sick due to the poor living conditions. Not only was she unable to work, but her husband was forced to choose between using his day’s wages to purchase food for them, or to save up for medicine for his wife. Without food and/or water, she continued to become sicker. Diseases of poverty reflect the dynamic relationship between poverty and poor health; while such diseases result directly from poverty, they also perpetuate and deepen impoverishment by sapping personal and national health and financial resources.

214 out of 228. That’s where Ethiopia ranks in the world in terms of GDP. Definitely not good enough to be on the all-star team of life – at least not in terms of money. What does this mean? This means that the greater majority of Ethiopians are poor. A lack of physicians means that when the people of this nation contract preventable diseases like Scabies or Trachoma, they sometimes can’t find someone to treat them to rid them of these infections. Once they do, the issue of money comes back into play. The more and more I read and learn about Ethiopia, the more I see that the issues are not singular, but systemic. Ethiopia lacks the infrastructure necessary to maintain sanitary conditions for all of its people. What happens when people wash, bathe, and drink from the same water that is used to dump sewage? Or when space requires families to live in huts with their livestock? People become infected with (often preventable) diseases. What happens when there is disease but not enough health care workers? What happens when those health care workers cannot be paid?

While our hope and goal is to go to Ethiopia and bring about some good in the sector of healthcare, the deficit of healthcare is due to problems that run much deeper than they eye can see. And the need for healthcare comes from situations that seem far beyond our reach. Where does the cycle stop? And what is our role as medical students, as future physicians, as fellow citizens of a single planet in bringing this seemingly downward spiral to an end?

The Challenge of Empathizing with Ethiopians

Medicine is often framed in terms of a dichotomy between science and humanism. On one hand, the practice of medicine is rooted in the unwavering principles of science that are applied in a rational and predictable manner. As a first year medical student, I often feel inundated with the teachings of this part of the dichotomy, which I like to think of as the what of medicine—what tests and procedures do I need to perform to diagnose and treat the disease? Less apparent in the first year curriculum is the human aspect of medicine, which testifies to the why question—why do we treat disease? For me, this query is more appropriately answered wearing the patient’s cap. Anyone who has had a broken leg or a horrible case of the flu knows why he or she needs medical treatment; spending eight weeks on crutches or being confined to bed with a debilitating case of nausea is simply not the way human beings are supposed to enjoy life.

This ability to wear the patient’s cap, to understand and share the feelings of another, is more formally canonized in the doctrines of medicine as the quality of “empathy.” To empathize with another is to step out of one’s own shoes and to try to envision life in someone else’s. As I contemplate my upcoming experience in Africa, I find the ability to empathize with Ethiopians particularly challenging because the Ethiopian experience is so different from my own to the point that it seems impossible for me to emulate it in my mind’s eye.

I have never been to Ethiopia (much less Africa), so what little I know about the Ethiopian culture and condition has been gleaned from the impersonal transactions between myself and the information that has appeared in books and presentations about the country. In the context of our medical trip, I have been confronted with sobering statistics about the abysmal state of health care in the country. As I ponder these statistics, I find them compelling, but I think I fail to appreciate fully their significance. As much as I try to empathize with the plight of Ethiopians, I have never felt that truly visceral reaction that I expect will come with the actual experience of living among the Ethiopian people and knowing first-hand what it means to live in one of the poorest nations in the world. I hope my experience abroad will allow me to feel truly for the suffering of those with conditions so difficult for me to imagine right now.

I heart Water.

Over the last few weeks, we have had many training sessions with Dr. Berggren and Dr. Usatine in preparations for our Ethiopia medical trip. Walking out of each session, I have not only learned more about the history, culture, and needs in Ethiopia, but my heart for that country has only grown more and more with every story and every need.

There is no debate that Ethiopia desperately lacks in healthcare, but one fact that I have been thinking about the most the past two months is the lack of clean, drinkable water in the country. Honestly, I have never really thought too much about water and the lack of it in my life - ever. Clean water is something that I always thought was available no matter where you were, and stories that indicated anything different was a vague concept that seemed somewhat unreal. But after seeing several pictures of women filling up water containers with brown, stagnant water and hearing stories about the fact that so many of their medical problems stem for this lack of a basic necessity humbled me in understanding this major issue that faces so many Ethiopians.

Now, everytime I turn on a faucet, take a drink of water, brush my teeth, or do laundry, I think about how easy it is for us to do any of these things, but without clean water, none of these activities would be possible. I have only recently noticed how amazing it is to take a shower with hot, clean water. So many of us are so "rich," and we don't even know it.

Without clean water, we, as first year medical students, will see countless cases of Trachoma, the leading cause of treatable blindness in developing countries. Without clean water, we will see children and adults with scabies because they can't wash their dirty clothes and sheets. And without clean water, we will see gastrointestinal diseases, malaria, and other infectious and water-related illnesses.

Though these sessions, I'm sure, will continue to raise more reflection questions, I am sure I will not be able to comprehend the extent of the issues in Ethiopia unless we are there; and even then, those three weeks wouldn't be near enough time. However, I am excited for our team and for the opportunity to make even a small difference in the lives of Ethiopians.

Thanks for reading!

Common River

When Donna asked Congressman Shamana, from Aleta Wondo, how he knew Tsegaye after a long day together he replied, “Oh, Donna, we come from the same river.”

the namesake of Common River

Common River, an NGO based in Mill Valley, California, that we will be working with in Aleta Wondo, is an organization established by Tsegaye Bekele and Donna Sillan in 2007. Common River’s approach to empowering the people of Aleta Wondo is based on the “positive deviance” approach. This approach is based on the observation that in every community, there are individuals whose unique (“deviant”) behaviors create better (“positive”) results than their neighbor with the exact same resources. Common River seeks to amplify these behaviors to create a naturally sustainable and culturally appropriate community.

The story really begins back in the 1940’s when Tsegaye parents helped found the town of Aleta Wondo and create jobs for the people. The family fled Ethiopia during the Ethiopian Civil War and eventually Tsegaye settled in California. 30 years after he fled Ethiopia, Tsegaye returned to visit his hometown and was shocked by what he saw. While he had moved on with his life, the people of his home community had not. Tsegaye was moved by Aleta Wondo’s great need and was determined to return to help them out. In 2006, Tsegay met Donna Sillan. Donna had decades of experience in international health development and consulting big NGO’s. Together they found a mutual interest in helping the people of Aleta Wondo.

In April 2007, Tsegaye and Donna visited Aleta Wondo and spoke to numerous people on all levels of the community. They established three main areas on which Common River would focus: education, health, and livelihood. As they worked to develop the structure for Common River, Tsegaye also reclaimed some of the land that belonged to his family and donated it to the organization. They began by building a school for orphaned and vulnerable children and supporting the existing school. They then built a health care post that treated patients and taught the community preventative health care practices. The third component, livelihood, focused on creating a sustainable business development program, particularly the coffee-growing enterprise which is the main livelihood of the area.

Last year, the 2009 team was the first group from UTHSCSA to work with Common River. This year we will return there to help out by providing check-ups, teaching preventative measure, and bringing medical supplies. We go to Aleta Wondo representing UTHSCSA, the US, and the medical profession and hope to leave the people there with a positive impression. We also hope to gain a better understanding of how to serve others as well as an appreciation for Ethiopia, its people, and its culture.

For more information about Common River, visit their website, http://www.commonriver.org/.

Training Session #1: Community Service Learning

Friday's meeting with Dr. Berggren brought the eight of us together to hear about our goals in Ethiopia from a physician's perspective. She explained the history of the Ethiopia Outreach program--an endeavor begun by medical students. Dr. Berggren had accompanied UTHSCSA's Ethiopia Outreach team in 2008 and was able to provide us with insight from past trips. She emphasized three goals for our team as part of community service learning: preparation, mentorship, and reflection. Before we leave for Ethiopia, it is important for us to be well educated in the diseases afflicting the area as well as prepared to enter into another culture. Mentorship from Dr. Berggren, Dr. Usatine, and each other will allow us to learn from one another's experiences and hopefully improve methods of treatment. She also suggested that we keep track of a journal to record medical cases and personal/social observations which we will eventually present to our peers in order to gain feedback. Reflection is often the most significant part of community service learning since it is what leaves an impact on how we as medical students view global health.

Dr. Berggren also touched upon the interdependence of health with nutrition and clean water. Due to the vastness of that concern and the limited time and resources we have while in Ethiopia, we will be working with Common River, an NGO, to help alleviate this issue. Primarily, we will focus on providing treatments for diseases and educating the communities about preventative measures to ensure good health. Overall, our meeting with Dr. Berggren helped us to grasp just what it is we can hope to accomplish through Ethiopia Outreach and we left excited about what lies ahead. As for me, our meeting was a reality check about the great responsibility it is for us to head to Ethiopia as med students trying to treat patients. At the same time, it was encouraging to hear Dr. Berggren speak about the treatments for common ailments such as dehydration from diarrhea because we actually understood the physiology and biochem behind oral rehydration therapy! It's all making sense...

For more information on community service learning, see http://texashumanities.org/csl.cfm

Wall to Wall Madness

This past weekend, the team spent Friday evening and the better part of Saturday at Katie's parents' house painting the family room upstairs. Her parents had been kind enough to offer us the job in exchange for making a contribution to trip fundraising efforts, and so began twenty four hours of wall to wall madness!

While our collective array of artisanal acumen might not leave us with any jobs as home contractors, we had a grand old time stripping the wallpaper, priming the wall, and--after much anticipation--actually painting the wall. The amateur craftsmen among the readership will be interested to know that Katie's parents opted for an ecru color scheme with a textured finish-- très magnifique! Whilst painting, the team enjoyed the special talents of Wade's ability to remove entire sheets of wallpaper without tearing them and Nishina's trowel strokes of genius. We learned that Josh has an obsession with moonlight. We even filmed a montage scene where we laughed and flung paint all over one another while the song "Girls Just Wanna Have Fun" played on the radio. OK, that last part was a joke!

For our efforts, Katie's parents contributed a monetary donation to our trip fund--thank you! Special thanks also go out to UTHSCSA Haiti trippers Krista, Tiffany, and Matt, as well as Ethiopia friend Shushan, for their generous donation of time and labor over the three day weekend.