English Language Enrichment for Deaf Students in Quetzaltenango

1Our names are Abby MacKnight and Jacquelyn Katuin and we recently returned home from spending seven weeks in Quetzaltenango, or Xela, Guatemala. With the help and support of Dr. David Burt, the UVA Guatemala Initiative, and the Center for Global Health, we were given the opportunity to improve our Spanish, explore Xela, and soak up the city’s culture. We are also so lucky to have been able to make strides in a previously-established collaboration with a local school in the area.

For the past year, the two of us have been teaching English and American Sign Language to a group of deaf Guatemalan students at the Centro Elisa Molina, a school for the deaf and blind in Xela. We 2have been teaching the hour-long classes two mornings a week, via Skype and Jabber. The experience has proven to be just as challenging as one would expect. And probably more.

We used our time in-country to observe at the school, and to specifically observe the online English classes from the Guatemalan classroom. It was eye-opening to be on the other side of the collaboration. We also did our best to collect data and information about the program from students and teachers. Doing so was quite an experience, as we had to work through somewhat of a “double” language barrier. Those that we interviewed used Spanish and Guatemalan Sign Language to communicate.

3Our observations will help us to piece together a more complete picture of the school and how it functions. Our meetings with the students and teachers gave us insight into some of the various perspectives that play into this complicated program. We are currently in the process of writing and translating a comprehensive report of our findings.

4It is our hope that the work that we’ve done this summer can shed light onto the benefits and the drawbacks of this sort of collaborative effort. Improving this program could lead to the implementation of similar efforts in other low-resource educational settings. And doing so could make it easier to reach students in these areas, particularly deaf students, who are typically less likely to receive an adequate education. Our experiences this summer in Xela will be invaluable in deciding how to best move this project forward in a way that is beneficial for all involved.

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Ricky Anjorin: The Sustainability and Impact of Short-Term Medical Clinics in Iquitos, Peru

1During our investigation on the impact of short-term medical clinics in Iquitos, our first objective was to understand the structure of the community. Iquitos is an impoverished city of about 370,000 people located in northern Peru, with no roads leading into the city. This isolation has contributed to the stunted development of certain areas of the city. We researched communities in Punchana, San Juan, and Maynas, all chosen because of their lack of resources.

Through semi-structured interviews with community members, some whom have attended the clinics and others who haven’t, we gain valuable information regarding general thoughts on the clinics, and about the Peruvian health care system. Overwhelmingly of the people who were familiar with clinics, community members were very pleased and grateful for the volunteers. The single consistent criticism we were offered was that the clinics should return to their community more frequently and regularly. This criticism piqued our interest as to why these communities value the clinics so highly. Upon further discussion we learned that the clinics provide better treatments and medications than their own government-funded clinics known as postas. Treatment at the clinics is also free compared to the postas, which is made affordable for people living in extreme poverty through an 2insurance policy known as SIS, or Seguro Integral de Salud. Individuals with SIS are able to visit the postas without charge, but must pay for many essential medications out of pocket. With clinics offering better treatments and free medications, we found people in the community were profusely thankful.

Finally, we experienced the nuances of field research. We faced challenges with co-authorship and how to best represent thoughts and opinions of our research participants in constructing a holistic narrative. In carrying out our investigation in a predominantly Spanish-speaking community, we grappled with issues surrounding language, translation, and interpretation. Still, we learned about the logistics involved in administering a survey in communities with very little structural organization. In short, our investigation was on impact of medical clinics in Iquitos was intellectually riveting and quite productive. With the information we’ve gathered and the stories we’ve heard, we will offer recommendations to our partner NGO in Peru on possible ways to improve the structure of their medical clinic program. We also intend to further pursue other questions that have arisen from this investigation such as how these medical clinics fit within the larger context of the healthcare system in Peru.

Hello from St. Kitts and Nevis!

My name is Deega Omar and I am a rising 4th year majoring in Anthropology. I have the privilege of being a CGH scholar working with the Minority Health and Health Disparities International Research Training (MHIRT) Program in St. Kitts and Nevis. This is my second time coming to St. Kitts and Nevis and I love being back! I have been on the islands for about four weeks and have enjoyed every minute of my experience here. I am working with seven other students, four from St. Kitts and Nevis and three from various universities in the U.S. We also have a graduate assistant and an amazing faculty mentor, Dr. Jeanita Richardson. The research question of the MHIRT study was crafted with the Ministry of Health (MoH) in the Federation. An important aspect of the health system in the Federation is that their primary focus is preventative health care. The MoH recognized Type II Diabetes as a priority due to the fact that it is the leading cause of morbidity and mortality in the Federation. Therefore, our study focuses on Type II Diabetes. There are two research questions in our study: what are the knowledge and perceptions surrounding Type II Diabetes and what is the prevalence and distribution of diabetes in the Federation? The first research question will be carried out with a World Health Organization (WHO) survey instrument about lifestyle, as well as open-ended questions on diabetes to ask the general population in both St. Kitts and Nevis. The second question will be carried out by doing a chart review of records in the health clinics in Nevis.

The first couple weeks in the Federation were great! We had tours of both islands, St. Kitts is only 68 sq mi, while Nevis is only 36. They are both so beautiful and it was really nice to learn about the history of the islands. The locals are very welcoming and friendly as well! We had time to familiarize ourselves with our Kittitian and Nevisian partners who are wonderful. Some of our partners were still in school when we first arrived, so after they had their finished exams, we held a community picnic where we invited all students and faculty who are contributing to this great project. Before starting our research, we had different workshops with Dr. Richardson on various topics pertaining to our research; for example, qualitative research and community based participatory research. We also got familiar with our WHO survey instrument and open-ended questions that we planned to ask the general population. The survey is focused on diet, physical activity, and medical history, all of which relate to diabetes. The open-ended questions ask about knowledge and perceptions of diabetes. We made adjustments to these questions so that they were applicable to our study and St. Kitts and Nevis in particular. For example, the WHO survey comes with show cards to show examples of physical activity; however, the example on these cards shows someone pulling a rickshaw, which is something you would not see in the Federation.

The survey portion of our study was conducted first. We went to public places approved by the MoH such as grocery store parking lots or the port located downtown. I didn’t know what to expect for the first day of survey collection. We went downtown on a weekday afternoon and asked random people between the ges of 18-75 if they had time to participate. The locals were very receptive to us and it made the survey collection easier than expected and enjoyable. It was great to know that the locals were interested in knowing about the study and willing to help. The chart review portion of the study started around the third week in country. We are conducting the chart review at all six of community health clinics in Nevis. We also had training before starting the chart review. We created a procedure for conducting this study, which included our inclusion criteria, confidentiality protocol, how we randomized patients, and what relevant information we would need from the files. We have only completed the chart reviews for one clinic in Nevis so far. The chart review is much different than the survey portion in terms of how we are collecting our data. Rather than talking to people, we are getting our data from doctor records. One challenge that we have noticed is reading the doctor’s handwriting. This may pose a problem for the other clinics as well. However, with the help of nurses on staff and one of our faculty members who is a physician by training, we expect to mitigate the legibility problem. One exciting thing for our research was that we were featured in one of the local newspapers and attended a press conference for our study. The Ministry of Health held a conference to inform the public about the research. This was really great in that many people actually saw the press conference or read about in the newspaper, which helped us have more local help. When collecting surveys, many people actually said they heard about the research and were happy to help.

In my free time, I have had a lot of exposure to the country and it’s culture. On weekends, we go to the Saturdaymorning market where we buy local fruits and vegetables and the “catch of the day” from Kittitian vendors. We have had time to explore the beautiful white sand beaches as well! Everything is amazing here, from the mountains to the strong ocean breeze. Attending local events is also a past time that we enjoy. We went to the Children’s Day Parade where local children marched in costumes through downtown as well as a music festival. We also attended the “Eat local day” held downtown and had some delicious local foods and drinks. Participating in outdoor activities like hiking and attending more local events is something that I look forward to as well! I have about one month left in the Federation and I’m excited to complete our research while enjoying the islands. I have learned so much in this time and I know I have so much more to learn. Our data will be very beneficial to the Ministry of Health and their preventative health care focus. I look forward to the next several weeks as we finish our research and will report back the rest of my experience!

Anisha Hegde: Kigali, Rwanda

I love seeing panoramic views like this one from pretty much any point in Kigali.
I love seeing panoramic views like this one from pretty much any point in Kigali.

Muraho from the land of milles collines! I have been here for a month now, and each day has been the best kind of adventure. After the non-stop intensity of the first year of medical school, I am enjoying reacquainting myself with the world outside the UVa medical education building and with why I chose the medical profession in the first place.

I am interning and doing research in the Rwandan Ministry of Health for two months. I have the privilege of working with the Dr. Agnes Binagwaho, the Honorable Minister of Health, on a chapter that details her efforts to boost vaccination rates in Rwanda.

Exploring Lake Kivu by boat
Exploring Lake Kivu by boat

We are also working on a vaccination advocacy piece, and I am looking into child and infant mortality data retrieved from the country’s 2015 Demographic Health Survey. It is an especially exciting time to be here doing health work since the Ministry just announced that Rwanda has met the health Millennium Development Goals. I love stories, and Rwanda’s narrative is incredibly powerful: filled with learning from a painful past, hopeful rebirth, indomitable grit and rebuilding of a rich culture.

It was an honor to be in attendance at the interagency meeting that celebrated the Day of the African Child.
It was an honor to be in attendance at the interagency meeting that celebrated the Day of the African Child.

All the opportunities that have come my way this summer have resulted from a little bit of intentional searching on my part and a lot of goodwill from perfect strangers-turned-mentors – and that formula did not stop with my arrival here. I was itching for clinical experience, so an infectious disease doctor invited me to round with her at the teaching hospital. I was curious to see how a district hospital functioned, so an internal medicine resident showed me around the Ruhengeri hospital. Between public health research at the Ministry of Health and seeing the practice of medicine in resource-strapped hospitals, the teaching I received in the classroom this past year has come alive and been reinforced.

My work keeps me blissfully busy, but on the weekends I get to explore this amazing country. In Kigali, I enjoy wandering weaving in and out of fabric stalls and fruit stands in city’s many markets,

CHUK: the largest public teaching hospital in Rwanda
CHUK: the largest public teaching hospital in Rwanda

devouring passion fruit and avocados, practicing Kinyarwanda with patient souls, and running long distances uphill because views from the top of all thousand hills are breathtaking. Public transportation to destinations outside Kigali has given me glimpses into rural vistas, dotted by terracing agriculture and children playing soccer against a dramatic mountainous backdrop. The destinations themselves have afforded me opportunities to trek, observe different flavors of Rwandan life and eat my fill of fish and goat brochettes.

Daily I pinch myself to make sure that I am not dreaming. Here’s to another month to learn more about this beautiful country from its beautiful people!

Installing Water Filters in Xejuyu, Solola, Guatemala

Posing with the UVA-GI in-country lake team.  Pictured from left to right: Marcos, Gaby(e), Felipa and Leticia
Posing with the UVA-GI in-country lake team.
Pictured from left to right: Marcos, Gaby(e), Felipa and Leticia

¡Hola! With the mentorship of Dr. David Burt, with sponsorship from the Center for Global Health, and through guidance of countless others such as Dr. Aaron Mills, I have been afforded the opportunity to travel to Guatemala this summer to work on creating a water potability testing system in indigenous communities that have received water filters from the University of Virginia’s Guatemala Initiative.

During my fourth week in-country, after Spanish lessons, cultural immersion, and material delivery, the literal down and dirty work of my project began with filter instillations in Colonia Xejuyu, Sololá, Guatemala. Some people might actually call it unlucky that I arrived at the lake just in time for filter instillations, since they only happen about once per year and involve heavy sand bags and a lot of endless standing in the hot sun, but since I learned so much about the process and the community, I’m very happy I was there.

To give some background, women in the community participate in a 4-month long program in which they attend a weekly class that teaches them about general hygiene, nutrition, bacteria, and filter composition and maintenance. If women fail to attend more than 3 of these classes, they don’t receive a filter. Because the filters are donated and don’t cost any money to the families, the classes aim to provide value to the filters because ultimately the women spend over 16 hours in class time earning their filter.

Marcos and Felipa with the help of local women inserting the 100 lb bags of sand.
Marcos and Felipa with the help of local women inserting the 100 lb bags of sand.

Mornings with the UVA GI in-country lake team, Marcos, Felipa and Leticia, began at 8 am. We averaged about 13 filter installations per day and time spent at each install ranged from 15 minutes to an hour, based on many factors. To prepare for our arrival and speed up the process, the team had asked all participants to prepare a few items. First, a base to hold the filter above floor level; four concrete blocks cemented together are recommended to all of the women but, for some, even the cost of 20 Quetzales, around $3 USD, is too much to bear. The team also requested 9 gallons of chlorinated water at the installation to ensure the gravel and sand added to the filter didn’t contain any unwanted bacteria. The chlorinated water, however, was often not present for two reasons. First, the townspeople’s hesitation to chlorinate their drinking water. In fact, water chlorination would be a simple solution to making the water potable by killing all the bacteria, but most people dislike the smell and taste, and therefore refuse it as a solution to bacterial or fecal contamination. Second, the citizens of Xejuyu can go up to 5 days without receiving tap water and therefore many of them had very little water to spare for the install. This is another reason why the filter will be useful for these families, because even when the water does finally arrive, it only lasts for about a few hours, forcing the women to frantically fill up as many containers of water as possible. Many of these water containers stay uncovered and ultimately become contaminated.

A filter after installation.
A filter after installation.

Between the hot sun, the smoke coming from burning wood, and dragging 100 lb. bags of sand across many rooms, after every day, I needed a long shower. I had some serious lower back pain and my legs still could use a nice massage. However, the whole experience was so rewarding. At every house the residents looked on at the install with amazement and excitement. Often we made a muddy mess all over the floor with the water and sand mixing together but they didn’t care. In fact, at most homes, people offered us fruit, drinks, crackers, and even lunch! It was completely unnecessary but the team explained it was their way of being thankful and that we could not refuse their food. On one of the occasions in which they served us lunch they served frijoles (beans) which I don’t eat, so Marcos, while they weren’t watching, kindly took them off my plate. It was a close call. By the end of the week, I had around 25 cans of juice, 10 packs of crackers and countless bananas, oranges and pitayas.

The biggest take away I’ve had during my time in Guatemala is to learn to value what is important rather than material things. These gifts meant so much more than a snack or a meal. I felt incredibly grateful to the families that provided them and even those who couldn’t, because everyone I met was incredibly welcoming and hospitable. The families have created relationships with Marcos, Felipa and Leticia but many of them couldn’t ever remember my name yet each day they opened their doors and welcomed me in. Overall, I felt very underserving but I’m starting to think the best way to repay them is to return to the U.S. and share what a beautiful country Guatemala is. Its people are amazing and I’m so lucky to be here.

Anna Eisenstein: Local Perspectives on Healing

During my first weeks here in Mbarara, Uganda, I spent much of my time at the hospital. In talking with doctors, nurses, and researchers on the hospital campus, I kept hearing that patients often only come to seek biomedical care when it’s too late. Many locals only think of the hospital as a place of despair – it’s where people go to die. This cycle is a self-fulfilling prophecy: people come to the hospital too late for treatment to be effective, and then rumors of the hospital’s failure circulate, discouraging others from trusting in biomedical care or seeking care until it’s too late for them too. Of course, this isn’t the case for every patient, but the bleak story holds true for far too many.

I began to wonder — if the sick don’t seek care from the hospital, where else are they seeking care? What are they doing in pursuit of wellness? These questions led me beyond the hospital gates and into Mbarara Town to the various herbalists, healers, and Christian churches that provide various types of healing services. These various kinds of practitioners are all part of what “healing” means for the people of Mbarara. And in all of these spheres, healing is not only taken as a matter of physical health, but rather, a more holistic kind of health that entails social relationships and financial needs as well. This way of thinking about healing defies the Cartesian dualism (separation of body and mind) that characterizes so much of Western medicine. I’m not trying to say that Ugandan perceptions of illness/wellness are any more or less legitimate than classic biomedical views – but I am noticing a significant difference.

For many patients here, a biomedical diagnosis answers the question of what is wrong, but it does not address why this sickness is afflicting this person right now. While the search for causes may find some biomedical explanation, it does not go so far as to get at the “underlying” reasons. I’m still working on understanding how these explanations of underlying causes work. From what I can tell thus far, not every sickness requires an explanation at this level, but there are some sicknesses that are “spiritual” in nature and can only be adequately understood/cured by figuring out the reasons behind the affliction – this can be done through seeking Christian healing (there are healing and deliverance services at various churches around town throughout the week, every single week!) or consulting a spirit medium.

As for herbalists, they seem to occupy a space that is neither biomedicine nor “spiritual” in nature, although many herbalists profess religion alongside their herbs. To me they are the most interesting, because they don’t fit neatly into my categories – they’re not squarely “scientific” or “religious”. And they are immensely popular. I haven’t met a Ugandan yet who has not sought the help of an herbalist, or used herbs they themselves have gathered and prepared. And this is true of the most “modern” Ugandans too, the ones running NGOs and collaborations with American medical charities. There are some governmental regulations on herbalists’ practice, and many of the herbalists are involved in “research” trying to develop products for sale on a large(r) scale. And patients’ interactions with herbalists take a variety of forms, depending on which herbalist, and which patient.

As I move forward with my research on patients’ ideas of healing here in Mbarara, I’m so interested to learn more about how all of these various options come together for patients as they navigate health and healing in this lively and quickly growing city.

UVA Nursing in Addis Ababa, Ethiopia

July 9th:

Emily and I arrived safely to Addis on July 8th.  The flight was VERY long, and we were both tired and swollen by the end of it, and when the sun rose and we caught our first glimpse of the hilly, African landscape, we were both very excited to get off the plane.  The customs process was long, and completely disorganized, but we made it through and were relieved to find all of our bags waiting for us on the other side.  In addition to our own packs, we brought two very large suitcases full of medical supplies, toys, and books for the children at the adoption agency.  There was some question as to whether those bags would make it, but they did, and we delivered them to the Transition Home this morning!

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The driver who picked us up from the airport, Johnny, was very helpful, and his reflexes are incredible. Driving in Addis Ababa, there are no lanes, very few sidewalks, pedestrians everywhere, and I’ve seen one traffic light.  The drivers are constantly opening their windows and yelling at each other, and they have to stop on a dime to avoid hitting another van or taxi veering in from a turn.  Pedestrians walk along the roads and cross at will, and children roam through the cars when they are moving slowly to ask for money.

Once we arrived at the guest house, we had just enough time to unpack and take a short nap, and then another driver, Champ, picked us up and took us to lunch at a pizza place with two of the adopting families.  We were told later that the drivers often take families to restaurants for faranjis, better known to all of us as “white people.”  We did enjoy getting some time with the families, because they told us about the process for adopting their children.

We visited the Transition Home after lunch, got a tour, and met the kids with special needs, who we will be working with primarily.  One of the older boys decided that Emily looked particularly appealing and decided to cuddle with her while we waited for our ride back to the guest house.  She was quite pleased about it.

On July 9th, we went straight to the Transition Home and spent much of the morning with the pediatrician, Dr. Nehassie.  She led us through some assessments with the toddlers, who are all precious as can be, and we talked about some of the main health concerns in Ethiopia.  These include infectious diseases, like malaria and tuberculosis, and of course, the dreaded HIV/AIDS.  She was very open and passionate about her Christianity, which is to be expected as America World Adoption Agency is a Christian organization.  All of the children are expected to go to church and are only sent home to America with practicing Christian families.

In the late morning, we spent an hour with the children with special needs, interacting with them and feeding them lunch.  It was very challenging as the nannies who stay with them only speak Amharic, and the children have very limited mobility, so I most of what I did on this day was improvisation.  We hope to do some research to better guide our care and the education we provide the nurses and nannies.  I think we both feel like there is a lot of work to be done while we are here.

In the afternoon, we stirred ourselves out of naps and took a walk down one of the main streets in Addis.  Most of the sidewalks, if they exist at all, are crumbling, and the streets are often dirt roads.  We saw a herd of goats running down the street, and there are stray dogs running around all over the city.  There were a lot of tiny shops on each side of the road, called souks.  There were also people selling food off of grills in the middle of the sidewalk, and it smelled delicious.  Emily and I are excited to try the samosas the next time we venture out.  While we were stared at a lot, we were never harassed, which certainly made me feel more comfortable about more expeditions into the city.

July 13th:

Emily and I really enjoyed our first weekend, here in Addis.  On Saturday, we began our day with a jolt of energy from two delicious Ethiopian macchiatos, courtesy of our driver, Johnny.  He then took us to the National Museum of Ethiopia, where we saw ancient artifacts, clothing, crowns, and thrones of Ethiopian royalty.   Here is a photo of the throne used by Emperor Haile Selassie, the ruler of Ethiopia for fifty years, before the Derg took over in the 1970’s.  I don’t think it really looks all that comfortable, but then my idea of a comfortable chair is couch with a bunch of pillows and a throw blanket.  I guess I would make a terrible empress.

3Also in the museum was an exhibit of the extinct ancestors of many of Africa’s most notable animals, including crocodiles, elephants, giraffes, warthogs, and, of course, humans.  The second photo is of me and our darling great, great, great, great, great, great, great, great…great, great grandmother, Lucy.

We had a delicious lunch of papaya and avocado juice, shiro (ground chickpeas), beg tibs (sauteed lamb), and the staple of Ethiopian cuisine, injera bread. Injera bread also serves as the utensil, which makes the meals more filling.  It’s very flat, rather sticky, has a bit of a sour flavor, and it’s a strange grayish-brown color.  It doesn’t sound terribly appetizing, but you cannot get a traditional meal here without it.  When I asked Emily if she thinks Ethiopians ever get tired of eating injera, she asked, “Do you ever get tired of eating normal bread?”  Point taken.

After our lunch, we went to the Red Terror Martyrs’ Museum, which is a tribute to the half a million Ethiopians killed by the Derg, which means “committee” in English.  The Derg was a military dictatorship, led by Mengistu Mariam.  He called for his followers to participate in a genocide to rid the country of his opposition, which would later form the Ethiopian People’s Revolutionary Party.  Our guide was a victim of the Terror, and during his eight-year imprisonment, he lost many friends and was brutally tortured.  While most of the governmental officials were later sentenced to death, some have been released, because the Ethiopian automatically releases criminals after 20 years, regardless of their sentence.  Our guide told us that this part of Ethiopian history is rarely discussed or taught in schools, so it was very significant to us to become aware of his story and the events that occurred here, not too long ago.

On Sunday, July 12th, Emily and I walked south to more metropolitan area.  We spent some time at an internet cafe (because, oh right, we have SO much work to do), but most of the day was given to roaming around the Edna Mall and the Bole Medhane Alem Cathedral.  The mall is less commerce, more arcade, which was a happy surprise to us.  The top floors of the mall house Ethiopia’s only movie theater with 3 screens, so Emily and I went to see Jurassic World!  The crowd was very enthusiastic and responsive, which made the movie even more fun.  Also, the theater sells doughnuts, which are the size of cakes, and I would love American theaters to consider adding this to the concession stands.

45When we visited the cathedral, we made a friend, Mark, who is a Canadian in town for a big conference.  The three of us walked right into the post-celebrations of three weddings.  The wedding parties were dancing, singing, and clapping, but most importantly, there were men thumping away on huge drums, and I could not have been happier.  Here is a photo of the cathedral and a photo of one of the weddings, just as it erupted into the celebration parade.

We spent all of today, July 13th, at the Transition Home.  This Transition Home is one of several around the world run by America World Adoption Agency, which was founded by a married couple, who have a passion for international adoption within the global Christian community.  This home has been in existence for eight years, and there are about 40 children there right now, ranging from six months to 12 or 13 years of age.  The home houses children who are matched, but still need completed paperwork and children whose paperwork is generally complete, but have yet to match with a family.  Children in the latter category are typically older, or they have developmental disabilities, which makes it more difficult for them to get adopted.

The home is a compound of three buildings, which hold the children’s rooms, the kitchen, the physician’s examination room, and the offices of the nurses and administrators.  The buildings all look like one-story houses, and there are two playgrounds for the older kids.  The children live in different rooms, according to their age, and their primary caregivers are the nannies.  Emily and I are working mainly with the special needs kids, and the nannies have already told us that while working with them contributes great meaning to their lives, it is very challenging work.  We hope to offer some ideas about how to improve the quality of life that these kids experience.

We got a lot of good work done today, visiting with many of the children and talking with the nannies and nurses.  Emily and I have found the toddler’s room to be particularly challenging, because they are particularly hungry for affection, and they are mobile.  For us, this meant that they would literally chase us until we picked them up and showered them with cuddles and kisses.  At one point, I had four children climbing on me, including one little girl who wrapped her entire little body around my face, like a koala.

July 18th:

Happy Saturday, everyone!

Emily and I have been working very hard this week.  We’ve been putting in 7 to 8 hours a day at the Transition Home, and then writing and brainstorming our nights away.  One of our assignments is to assess the care given to the kids with special needs, who all suffer from varying levels of developmental disabilities.  We are then supposed to plan and implement some improvement in their care.  Emily and I decided to focus on feeding techniques.  We are putting together a training session with handouts that we will present to the nannies and nurses at least once this coming week.  We are also both enrolled in a pilot course to augment our cultural experience during our trip, so we’ve been working on some reflective assignments featuring this city and the people we’ve met.

Yesterday, Muslims were celebrating the end of Ramadan, so most of the city was closed.  This includes the oh-so important roads that we use to get to the Transition Home.  At one point, we hit a dead end, and when our driver asked the policeman directing traffic how we were supposed to get to the home, he replied quite frankly that we should walk there.  The Transition Home is 30 minutes away from our guest house.  There was no way we were walking.  Luckily, our driver knew a back way to the home, so we sneaked our way there successfully.  When we arrived, we were informed that all unnecessary staff members would not be coming, because it was a holiday.  None of these people are Muslim, but that didn’t seem to stop them.  Perhaps the lack of road access did.

Regardless, Emily and I took a half day, and we filled our afternoon with an exploratory walk through one corner of the city to find a Japanese restaurant.  The only building that presented itself even slightly like a Japanese restaurant (with two red lanterns and what turned out to be Chinese script over the door) was virtually abandoned on the inside.  We redirected our trip, and we managed to find a very tasty Korean restaurant for lunch.  I couldn’t tell you what it was, but Emily became quite enamored of some strange, black, nut-like things.  Then again, I don’t actually know what I’m eating most of the time, here, so I guess this lunch went right along with the theme.

Today was a day to remember.  We joined one of the adopting families for a day trip to the Muger River Valley Gorge, which we were told is like a miniature Grand Canyon.  The drive was about two hours, but we finally got out of the city, and we saw some of the green parts of Central Ethiopia, so Emily and I were thrilled.   Much of the land we traveled through was devoted to agriculture, and I must say, I’ve never seen so many adorable donkeys in my life.  I must have seen over one hundred donkeys throughout the day.

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We were accompanied by two drivers, Johnny and Champ.  Champ has particularly excellent English, and he clearly has a passion for showing off his country.  He asked Johnny to pull over so we could stretch our legs, but also so that we could get beautiful pictures of the countryside with many of the local children.  Every time we got out of the van, Ethiopian children came running from the fields to get a closer look at our strange white skin, and they shyly allowed us to take photos with them.

8A little further down the road, Champ asked Johnny to stop, turned around in the van, and asked, “Okay, who will ride horses?”  That’s right, people.  I got to ride a horse in the Ethiopian countryside.  Granted, the owner stayed with me the whole time, because this horse was apparently only tame for him, but it happened!

Just before we got to the Gorge, we took a detour into baboon territory, and we saw four different tribes of baboons.  Let me tell you, their shrieks are LOUD.  Right before we left, two of the tribes entered into a skirmish, so Champ swept us back into the van.  No monkey bites for us.

Finally, we made it to the gorge, and it really is beautiful.  I’ve never 9seen the Grand Canyon, but Emily says the description is appropriate, except that this gorge is quite green.  Champ told me later that it is only green during the rainy season, so we went at the best time of year.  During our hike at the gorge, we crossed an old bridge called the Portuguese Bridge, which is made of crushed ostrich shell and limestone, according to my guide, Dedemje.  The bridge spans a rather large waterfall, which dumps dirt-saturated water into a pool that is 15 meters deep and then onto the rocks below.  When I asked Dedemje if he ever swam in the pool, his rather extended response was to climb over to the top of the waterfall and jump into the pool.  It looked incredibly slippery and very dangerous, and he did it with ease.

On our way back from the gorge, Champ asked Johnny to make one more pit-stop.  This pit-stop needs a bit of back story.  Do you all remember that lovely, little girl who koala-bear’ed my face?  It turns out, she had a cold.  And, yes, I caught that 1cold.  Champ picked up a cold this week, as well, and I guess he decided that we both needed some relief.  He got out of the van and ran over to a tall plant growing on the side of the road.  He pulled down a couple of stalks and passed one back to me.  I gave Emily half, and he instructed us to rub it vigorously in our hands and then inhale deeply from our cupped hands.  The first inhalation was startling.  What felt like cool mint shot up into my sinuses, and Emily and I looked at each other with pleased amazement.  Champ told us that the plant is local eucalyptus, and it provided me with the most relief I’ve experienced in the last couple of days.

We are now hunkering down and preparing ourselves for our last week in Addis.  Emily and I cannot believe that we only have three more days to work in the Transition Home and to wrap up our clinical rotation.  We are very excited to move on to Uganda, but we will have a hard time saying goodbye to these kids.