Community Therapeutic Care

Spending two weeks in the much smaller village of Alaba over four hours South of Addis Ababa does wonders for the novelty of white person status. Instead of being called ‘ferenge’ we are now called by the local general name ‘Aba’ (sister, Mom), and have yet to see any other ferenges nearby. Although frustrating at times, it is nice to be entertaining to people without having to do anything but exist. An attempted trip to the market, however, on market day proved to be impossible as so many people crowded around us that we couldn’t move. We thus escaped to the car and let the Habeshas finish the food shopping for dinner.

Alaba is a base for the community-based therapeutic care sites that are set up for the management of Severe Acute Malnutrition, and are a model used by many different NGOs. Each day an emergency team heads to the different outpatient sites to provide weekly rations of plumpynut to the children admitted into the program and to screen for new children. A brief health message is also provided and nurses are on-hand to check on the status of the children after their progress is measured (weight and arm circumference). My favorite aspect of visiting the sites, however, is the infamous playstation – a mat with some toys including balls that make loud squeaking noises. The stations are provided to engage the children in play while they are waiting, but I have found it unusually hard to get the children interested in the toys, as they are unfamiliar to them. The hand-washing station with soap and a steady stream of water from a faucet as well as the shiny silver packaging of the plumpynut both seem to be more entertaining options.

Where am I?

There are a number of English mis-translations around Ethiopia, our current favorite being “Tackey Fashion.” I thought of informing them that their name was not a wise marketing choice, in addition to being spelled wrong, but decided to give it some time. Karen unsuccessfully went in search of sweatpants there yesterday, and ended up with a purple sweatsuit from a nearby store (you can’t just buy pants). We are now fully equipped to continue going to ex-pat heavy power yoga class at the Bole Rock Gym, taught by an American. Turns out Ethiopians aren’t very familiar with yoga…everyone thought we were either going to meditate or going to eat yogurt.

Knock-offs also seem to be a popular business scheme in the Addis area. The chain coffee store, Kaldi’s Coffee, resembles Starbucks in every way, from the matching paint colors, the green aprons worn by the employees, the tables, and the drink choices (frappucinos, macchiatos, etc.) The only difference is you have to sit down and order, and next to their pastry display is an ice cream counter (Get up to speed, Starbucks). So far we have also noticed a Pizza Hut, an OliveS Garden, an EHOP (Ethiopian House of Pancakes), Burger Queen, and the Mariot Hotel (with one R).

Learning to navigate the infamous mini-buses around this city has also proved more time-consuming than I imagined. I always prefer riding with the masses over taking taxis, especially because it costs around $0.20 USD per ride, but the cushioned vinyl seats that limit the number of passengers and seat everyone facing the same way just does not compare to the thrill of packing a carved-out bus around a circular wooden bench like in Mali. In Mali they at least have signs on the front that say where they are going also. Karen and I took a total of 8 minibuses yesterday: 3 to get to the orphanage, 2 to get back to Piazza, and then 3 more to get to the supermarket. The last leg should have taken only 1, but the guys who run the minibuses are always so excited about having ferenges (white people) on their buses that they are prone to lying about where they are going. Yes, I speak enough Amharic to know that Meskal Square and the Merkato are not the same place. Luckily the man next to me informed me we were going in the wrong direction as we ended up in the busy streets of the Merkato (the largest market in all of Africa.) After 2 more minibuses to head back, we gave in and took a taxi home after buying groceries.

Rapid Nutrition Assessment

Last week we conducted a Rapid Nutrition Assessment of a woreda (a district comprised of kebeles, the smallest village administration level). A Rapid Assessment (RA) consists of four activities, starting with key informant interviews with the woreda administration. From those kebeles identified as the most severely affected by food shortages, three were randomly selected to be further assessed. Splitting into three teams, the next day we set out to our respective villages to complete the other three steps of RA: focus group discussion with the village leaders, transect walks to observe the layout and health practices of the village, and MUAC (mid to upper arm circumference of children under 5) to test for the presence of malnutrition in the most vulnerable population group.

After driving up and down cliffs and through two rivers in a land cruiser, my team reached our village. I thought I had seen a village before from being in Mali, but after driving through the first river I realized I had no idea what I was getting into. Having listened to a sermon on the Matthew 6 “Do not worry” passage just the night before, I tried to maintain an attitude of trust as I held on tightly to the car door. After miles of not seeing anything but green countryside and rocky roads, we finally saw huts in the distance and were greeted with many curious eyes. Within minutes there were a couple dozen villagers gathered around the car to find out why we were there. Taking benches from the central church building, we met with the village chief, elders, and other leaders to discuss the main health problems prevalent in their village and to explain why we were conducting the assessment.

The transect walk revealed maize, maize, and maize. Besides the occasional beans and mangoes, the village inhabitants pretty much eat corn. Although they have a church, there is no school nearby so drop-outs are common with no money to buy supplies, and limited energy as a result of the food shortages. Thankfully there was no severe acute malnutrition found in the sample of children we measured, and the majority of the population remains just at-risk for malnutrition while they wait for the harvest production to improve from the delayed rains.

After the nutrition advisor telling me multiple times that we would have to stay overnight if the rains came and made the roads inaccessible, we made it out in time to head back to the main woreda health clinic to gather health statistics and view the facilities. The assessment ended with presenting the results at a Child Survival NGO coordination meeting the next morning, a forum where different NGO representatives meet weekly to share ideas and coordinate their projects to reduce overlap.

After wandering through a national park, feeding some monkeys, and taking a boat ride on Lake Awassa, we are safely back in Addis for awhile before the next trip! It is great to feel like we have returned home, and although that comes with being able to cook our own food and relax, it also means we are back to the daily cycle of sheep being slaughtered in the office compound. My favorite time of day.