First few days at site

Exchanging greetings is an important part of Ethiopian culture. All greetings come with at least a hand shake and usually also a shoulder bump. Sometimes a double shoulder bump. As you shake hands you pull each other in to bump shoulders. All of this while saying some variation of Akkam? Naga? Fayaa? (In Oromifa: how are you, do you have peace, do you have health?) So when you meet a young man headed towards you walking down the street with a machete in his hand, what do you do? You greet each other and bump shoulders of course. That machete? No matter. I had to chuckle to myself - yet another 'did that just happen?' moment. 

I have been spending most of my days at the health center, getting to know the staff and just generally making my presence known. I am anxious to meet more people around town, like the teachers and staff at the schools, and people from the nearby villages where the health posts are located - but I have to wait until someone is available to go with me to introduce me and explain why I'm here. With my level of language skills I could sort of do those things by myself but it's valuable to have a respected worker from the health center vouch for me. After a few long, slow days at the HC, I felt invigorated after I was able to pay a visit to one of the neighboring villages. The health post there was hosting a celebration for the community because the village had successfully built enough latrines for the population. I had absolutely no idea what I was in for, I'm learning that I just have to be ready for anything. The head of all the health services in my area showed up and I rode with him to the village. Luckily I had met him at his office located in the main town when I came for site visit last month, so I knew who he was and that he was a VIP. I thought to myself, thank god I am dressed professionally and conservatively enough. It was a beautiful drive out to the village, only 10km away and nestled in the mountains. When we arrived there were about 30-40 men (someday when I have a better understanding of things maybe I'll write about gender roles) seated in front of the health post, waiting on our arrival for the presentation to begin. When I saw this I thought I would just hang back and observe, stay out of the way. Well, no. I was made to sit at the head table with the VIPs. We're on a slightly higher level, facing the audience. All eyes are on me. I can imagine their thought bubbles - who is this lady? where did she come from? what is she doing here? While I'm thinking to myself (again), thank god I am dressed professionally and conservatively enough. I have no choice but to sit there and smile and try to make a good first impression. Thankfully the health admin head introduced me and explained why I was there and that I would be coming back to work with them in the future. While I felt incredibly out of place sitting at the VIP table, it was comforting and validating to be introduced to the community in that way. It made me feel valued and appreciated. Students from the local school marched in singing a song about sanitation and hygiene, some students performed a drama to educate the audience on the importance of institutional delivery (going to the health center to give birth rather than delivering at home), a particularly bright young woman presented a poem about sanitation and hygiene and finally certificates were handed out. There was food and coffee afterwards, everyone was really impressed that I was eating traditional Ethiopian food like marqa (porridge - sometimes served with milk, this time it came with honey - delicious) and braatto (flour and butter pressed together into a bar, there is nothing I can compare it to). Seriously it was a topic of conversation for days at the health center - "when you went to the celebration what did you eat? (even though they already knew the answer) really you ate that? wow!" I am told that another one of the villages will be having a similar celebration soon and I look forward to attending if I can. It's exciting to get to know the communities I'll be working with for the next two years. 

Ethiopian healthcare system as I understand it...

Ethiopia has a very well organized healthcare system. There are health centers and health posts - health centers are in the bigger towns and serve a certain catchment area. The health posts are in smaller villages within that catchment area. For example, at my future site there is a health center because it is the biggest town in its area and it serves 4 other smaller villages that each have health posts. The health center is where everyone in the catchment area comes when they are sick or if they need antenatal, delivery and postnatal care. (Pregnant women are encouraged to travel to their local health center for delivery rather than delivering at home, in an effort to improve maternal and infant mortality.) So the health center is staffed with nurses, midwives, a laboratory, a pharmacist, a cashier, they have a room for health records/registration, and someone doing health information management. Paperwork, record keeping, data collection and reporting is a big deal. (So it turns out there is no escaping it!) People pay for the care/treatment they receive when they receive it with the exception of perinatal care, family planning, vaccinations, etc; those services are free/covered by the govt. The health posts provide some treatment but they are more focused on illness prevention and health promotion. Each health post is ideally staffed with two health extension workers. HEW's complete some health training beyond high school and they are charged with making home visits to provide health teaching and outreach to their communities. So let's say it's a village of just 500 - that's still a lot of ground for 1 or 2 workers to cover! They have very nice educational materials (provided by the govt with international support) that cover a range of topics - nutrition, family planning, sanitation, hygiene, etc. There are families that readily adopt the HEW's health information and begin to practice health promoting behaviors so they become 'model families' - these model families are expected to share their knowledge and have a positive influence on their community as well. Each model family (they are actually part of what's called the 'health development army') is assigned 5 other families. It's a very organized, strategic approach for disseminating health information and encouraging behavior change in the community. 

There are private clinics in the bigger towns as well, so people can pay to go there when they are sick if they want. I presume it's more expensive. And of course there are hospitals in the bigger towns. Anything that the health center can't manage they will refer to the next level of care. 

Although I am a nurse, my role here is not to provide clinical care. There are plenty of qualified individuals who work at the health center and health posts - who know their community, are respected by their community, and will continue to serve their community long after my two years are up. My role is to support the work they are already doing, to assess the needs of the community and motivate the health center and health post staff to work with me on projects targeting the needs identified. I don't know yet what those projects will be! But it is my intention that they be relevant and of value to the community, that they have a long term vision and are sustainable, and that everyone has a voice and is part of the process. My first several months at site will be spent integrating into the community and completing a 'community needs assessment'. When I have enough information to start making plans I'm sure there will be a blog post about it!

This week we practiced building a pit latrine/squat toilet/mana fincanii/shint bet

It started out as just a hole in the ground, here it is almost finished - still needs a roof and wall covering of course. 

Proof that I contributed to the cause!

Our crew! I've spent a lot of time with these guys during training - I'll miss them when I move to site. 

Love from Ethiopia!