This week is my first week as primary author, shying away from my editorial role. The reason? I am glad you asked, is that James needs to be bragged about ‘a bit’. This week was a hallmark week for Bahir Dar University. The first PhD student ‘Solomon’, from Construction Engineering defended his PhD proposal, and successfully passed heading now into the final ‘burning hoops to jump through’ for his earned degree. This accomplishment for Solomon has come about from 4 years of administrative work envisioning this partnership for education, brought to fruition by James and his Ethiopian colleague Asre Woldensenbat. Asre once worked with James at the University of Nebraska and he is now Chairman of Construction Engineering at Addis Ababa University. James, I’m sure wouldn’t talk of this success, but it needs to be claimed as a hallmark for Ethiopia.
Tomorrow, the second PhD defends his proposal and is expected to have a favorable outcome too. One of the PhD projects is dealing with ‘safety-improvement’ for the scaffolding used during construction. You have seen James’ photos of the current methods of creating 5 stories or more of scaffolding. On our walks around town, James is always lecturing me on the dangerous scaffolds, proven time and again to cause Ethiopian death and disability. The women and men are climbing rung by rung, standing on 16-foot lengths of eucalyptus timber, several stories in the air. Literally hanging by a woody thread, they complete their masonry work, mudding concrete walls, or whatever is the daily chore. Bahir Dar University’s main building “Wisdom Tower” had 26 deaths when the scaffolding collapsed during construction. So, this PhD project, curing bamboo to use with stable steel joints for attaching expanses and crossbars is important ‘implementation science’ research, as we call this in academia. Creating solutions within Ethiopia, using available resources, combining ingenious student ideas with faculty guidance and support is life changing. Think about the young deaths that can be prevented and the number of children (average family size 4 or 5) who will have parents living when this new construction safety idea takes hold.
I have several personal beefs to air now. One is that my students show that they agree with what I have said by a ‘disturbing gasp’, during my lectures. Especially when I am doing hands-on teaching with resuscitation, I hear a room full of gasps and think that half of the class is having respiratory distress (no, not a viral epidemic, cultural). It is a challenge teaching in English when this is the second language for all the students. As you know, as Americans we are generally ‘unilingual’, so at great disadvantage for ‘getting the gist’ of most of the conversation, except the gasps. 😊
My second beef is about a ‘small revolution’ I am trying to create within the OB/GYN community to convince the faculty of the importance of cervical cancer screening. Ninety-nine percent of Ethiopian women have had no screening for this second leading cause of death in the country. Finally, and a bit desperate, I asked the medical grand round’s audience to raise their hand if they knew of someone close to them who had died from cervical cancer. Ahha! Now we are talking, there was a universal show of hands. This week we will plan together, across, a major campaign in the regional and national hospitals to screen all women who come for care. The nurse midwifery students and faculty, along with the OB/GYN students and residents will be 100% supportive; they are the workforce. They are also the reason I ‘show’ up to the rounds and wards to work. They unconditionally understand their privilege of being educated and their responsibility to care for the most vulnerable. Our screening will be ‘leap-frogging’ across traditional screening, because the traditional technologies (Pap and HPV virus screening) are too expensive or non-existent in the area. The testing that will funnel down those with pre-cancer or cancer (picks up 99% accurately) is a genetic test from Silicon Valley. It is anticipated that our first round will reach about 2,000 women, and then out of that group that is expected to be 3% positive tests. From that group, we will have the traditional Visual Inspection with Acetic Acid and triage to determine the treatment, all doable with this motivated workforce. I feel lucky to be here, to have the resources and the workforce behind this. Perhaps I will talk more on what has been done to create this global effort to address cervical cancer, there are many partnerships and professionals to credit!
My third beef, is why do trucks and buses honk their horns at donkey carts loaded down with hay? Apparently, the vehicles think that the carts are not moving at the speed of the traffic. One thing I know, is that the carts CAN move at the speed of a truck, but only on the way back home! So, the honking seems to be in the similar vein as drivers trying to get around combines or planters, in such a hurry to get somewhere.
Medical knowledge doubles every 73 days, so the job of a teacher is to understand how people learn, to engage the audience in meaningful and significant life-long learning. This is the ‘pedagogy’; all teachers know this and seamlessly appear to coach students, to motivate and mostly to accompany them in this learning that creates the best outcomes. Sure, technology advances are important, but they are just a platform from which we launch this important work of students and teachers as partners. James has done this with the engineering group with important and time-intensive work of creating the next generation of Ethiopian leaders and scholars. “Better a guide at the side than a sage on the stage.”
Beef 4 is the sick babies who are separated from their mothers. The NICU is now my primary place of work, with labor ward second priority. The babies are mostly septic with preventable infections, have birth defects (enormous numbers of neural tube and craniofacial defects), or have had untoward tough deliveries with anoxia or obstructed labors. These little ones would be better off wrapped kangaroo with their mothers or fathers, and have the medications delivered to the bedside versus the mothers coming with expressed milk to the nursery. The mothers are unable to touch, talk to or to nurture their newborns. I hear the collective sigh from the readership, I know, I know! Slowly I am trying, with the help of a little Midwestern humor and some of my singing to win over the providers. Mostly I just work in the one little room, with 18 cribs and bed-sharing of the 1 isolette, positioning, massaging, wrapping, and feeding babies by example. I also know that bribes work! Into providers’ pockets are dropped hand sanitizers (there is no running water in the unit) and candy. Candy is part of a universal language, ‘sweet’. All around the world people believe what we do more than what we say.So, let’s see if a NICU team will arrive to help teach and accompany from Illinois. These professionals were from an impressive ministry called Adventures in Truth. The medical and nursing team from this NGO were introduced to us 3 weeks ago and we found them impressively culturally competent and incredibly experienced. They brought with them an understanding of the global south challenges and basic medications that really are useful here, along with an idea of encouragement and accompaniment. They left medications that have been used in the NICU and at a visit I made with Dr. Wende to a monastery known for curing diseases, including leprosy. Last Sunday on the visit, I kept pulling out medications from what is called the ‘fishes and loaves’ suitcase. You cannot imagine the bounty that generosity has created for people who have ‘nothing’, now to be treated. HyVee at 132nd has a young pharmacist who helps me with Haiti meds and who has been an enormous support for the ‘medication bag’. I cannot adequately tell you how much this networking means. It is just a joy to be able to say, ‘yes, wait, I do have that medication’. Unbelievable what connections reach across the Atlantic to touch Ethiopians at the place of their need.
There are major celebrations we enjoy here too. We have a lovely Sunday mission group that moves from home to home, and shares the presentation topics for separate groups, kids and adults. Last Sunday James and I oversaw the kids’ service. While inside there was a more peaceful discussion. The pictures tell it all!
We miss you; I am homesick for my kids, especially when they have the flu and could use my help. There have been birthdays missed and Peter learning to crawl! James seems to be his usual happy productive self. This week he made me ‘screens’ for the windows to avoid having to listen to my distress about mosquitoes. His mother told me he could do anything!
In closing, I would like to share one of my favorite books Mary Pipher’s Women Rowing North. She writes, “recognizing our own contentment is an undervalued skill. Intense passion and excitement grab our attention, but contentment whispers in ways we may not notice”. This way of proceeding is very like an Ethiopian whisper. On our walks we have children just delighted with kisses thrown their way and with exchanging greetings. The tradition ‘handshake and bow’ to elders shows that we understand that they have lived long lives, and that if we had more language, we would honor knowing the wisdom they might share’. We slow our pace, see the life that goes on with families, across generations, ever mindful that we really are universally just one people, wanting to be content and make some small difference in our world.
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