I wrapped up a block course for the Masters of Construction Engineering and Management which is a semester long course smashed into two and a half weeks. There were thousands of students protesting the morning of the final, so I delayed the testing until the demonstration was completed. The protest was on Martha’s birthday; she said it was a fitting for the day! The story is that several Amhara women students were kidnapped in the Oromia Region and have not been rescued to date. This is part of the ethnic tensions that plague the country, but that day the Bahir Dar march was peaceful, “Bring Back Our Girls” was the cry and the marchers were vocal about the government being mute on the issue.
https://www.nytimes.com/2020/01/30/world/africa/ethiopia-students-kidnapped.html Delaying the final, for this march seemed like a fitting action, as it would have been impossible for students or professors to make it through the mass of marchers.
Martha goes to the new Tibebe Ghion National Specialty Hospital nearly every day. She is alternating her days between labor and delivery and the NICU, trying to get the neonatal intensive care unit to be more concerned about sepsis. Every day babies die from this condition that is preventable if providers would recognize sepsis early, begin treatment, practice proper hygiene and keep babies isolated who are brought in from the villages with late onset sepsis. There is no running water in the NICU. And equally concerning is the practice of ‘bed-sharing’ when the two warming beds must accommodate multiple sick babies next to each other. This is often the case all over the global south. The stillbirth rate at the hospital is 3%, and the sepsis deaths after babies are liveborn is causing Martha distress. Currently she is working with Global Partners in Hope and MATTER, a Minneapolis, Minnesota NGO to ship a container with durable goods and life-saving supplies. Sometimes she feels like she is plugging one hole in the dike, while two others are freely dripping. The goodwill that even small gestures build in the NICU and labor and deliveries units cannot be over-estimated. The newborn hats (shiferos’) provided by Mercy Hospital, Council Bluffs bring amazing joy. Colors don’t matter, mothers are thrilled and the nurses say, “Bless Joanna Smith”, the manager who keeps this supply coming from the hands of Iowa knitters. There is one very positive statistic that Martha is reporting, that of no maternal deaths in the first year of the new hospital’s opening. Martha did advanced emergency training with all the new staff before the first mother was admitted to the hospital last year. “Those ‘old’ nurses, although at that time just recently graduated, are now leading the unit; the Ethiopian plan to change the climate and culture of care has worked!”
Dr. Coleen left on Thursday but not until making quite an impression at the hospital and in the community. She has been doing surgeries at the Tibebe Ghion National Specialty Hospital alongside the Bahir Dar University surgeons. She said that they are quite good at their jobs, so she did cases that were extraordinary and relied on a few tricks to teach flaps and reconstruction learned during her over 40 years of experience. One case was a young man who had a neurofibromatosis tumor growing on the left side of his face. Five years prior he presented to a different regional hospital but was turned away. The tumor had grown to a point that his ear was at shoulder level. His left eye and the involved skull had been destroyed by the tumor, however, when Dr. Coleen and team, including Dr. Melesse, had finished, this man woke to a new life and a slightly swollen face where once the neurofibromatosis ravaged the structures. Although the disease will continue to progress, it can be controlled. The surgery will change this patient’s life; he will be able to work and along with removing the tumor has been a significant reduction in stigma. After the hospital recovery period, he will go to the Grace Center, a place many of you may remember from last year when we worked with the teenager Wubet and his elephantiasis treatment and recovery. Most of all, Stice and her resident Andy Yang give surgical teams support for realizing what is ‘possible’. Hope is a mighty powerful part of healing, for both the provider and the patient.
Dr. Stice has worked all over the world and has seen too many burn injuries for one lifetime. Burns are typical on children who fall into the 3-stone cooking fire while ‘helping’ their mothers with chores. The palms of their hands are often affected, and mothers can get flash burns on their chest and neck from explosions. Scar tissue doesn’t grow and is not elastic so as the child’s scars prevents the proper development with adhesions that impact both form and function. It requires multiple surgeries if the scar tissue is to be removed and fingers freed for some semblance of normal flexion and grip. Flash burns in women also cause severe adhesions that prevent the normal range of motion of the neck. Although plastic surgery has been restorative for many patients through work of Stice’s International Medical Exchange, Inc missions, she is tired of ‘fixing’ when ‘preventing’ is possible. Now her up-stream work includes promoting Salama Stoves (www.salamastoves.com) to bring an energy efficient and smoke inhalation reducing safe alternative to cooking with an open fire. There are any number of other health complications, both short term and long, resulting from living most of the day in smoke and carbon pollution. These are also eliminated by a properly vented stove.
Salama Stoves has a factory in Kenya and Namibia and Dr. Stice came with us to Haiti where we built just a few stoves using locally available materials. She was hoping to start a factory in Ethiopia to add to the nearly 350 stoves already distributed throughout Africa. Sunday afternoon I introduced her to Mr. Getu, an instructor of sustainable engineering from Bahir Dar University who specializes in energy efficient stoves. He was a very impressive scholar, scientist and technician who built some of the factory equipment himself as needed to manufacture his stoves. He scientifically determines the best configuration for optimal heat distribution and the best designs for various fuels that are available.
Jetlie Esubalew is our good friend who is working on his MBA. The day before Stice’s departure, we traveled to Jetlie’s home village to see local cooking practices and to talk with villagers about stove use, manufacturing and distribution. The women were estastic! And from the picture of children peeking to check out the ‘firinges’ (foreigners), so were the kids. Foreigners are quite a novelty in this rural area and the entire school followed us around the town, through the classrooms where Dr. Coleen encouraged them to work hard on their education and follow their dreams. And although there was ‘no room’ inside the students crowded to hear the message.
Universally, women use three stone fires and a pot for cooking throughout the global south. The pot or the platter sits on top of three stones with a wood or charcoal fire built beneath the pot. The carbon buildup on the wall is obvious put villagers are not aware of the impact on lungs, the long-term neurological damage, the associations with cancer and the environmental pollution caused by the indoor smoke exposures.
Together, Stice, Jetlie, Melesse (our bijaj driver) and I have made inroads with those who are able to produce stoves, market a business for distribution and possibly develop a franchise to expand use throughout the country. The villagers will drive the demand as the project continues. Global Partners in Hope are advising, with Ian Vicker’s experience, into franchise ideas. The goals of us all are to expand the health and environmental impact of Salama Stoves, while promoting jobs for Ethiopians and preventing disabling burns and smoke inhalation. We are all hopeful; Ethiopians are fast adopters when they see the need for a product. With all of these initiatives we still insist that our loving presence is the most important part of our working, our waking, and our walking in this Ethiopian neighborhood. One of Martha’s favorite poems is:
He drew a circle that shut me out –
Heretic, rebel, a thing to flout.
But Love and I had the wit to win:
We drew a circle that took him in!
– Edwin Markham
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