After 2.5 hours driving north of Mekele, in the Tigray province of northern Ethiopia, I reached my home for the next six months. Hawzen is the main district village for the Millenium Villages Project (MVP), Koraro cluster. I am a volunteer, placed by my company GlaxoSmithKline(GSK) as part of its PULSE Volunteer Partnership. PULSE provides GSK employees an opportunity to use their professional skills and knowledge during a three or six month immersion experience within a non-profit or non-governmental organization (NGO). My R&D and laboratory skill set partnered me with MVP and its Tropical Laboratory Initiative in Ethiopia.
Library books and YouTube had prepared me in part for what I could expect -- a poor rural area lacking infrastructure and basic necessities like health, education, water, agriculture -- areas the MVP is addressing. In addition I was excited to be immersed in a culture with a history pre-dating Christ mixed with strong Christian and Muslim beliefs.
My first project was to review the functioning and systems of three Health Centre laboratories associated within the MVP area of the district – there are two more laboratories outside the MVP villages. Recommendations and implementation with minimal budget were completed. Sustainability is a challenge, so the passion of the laboratory staff was important to implementing their training and maintaining the changes.
Alongside this, I started to assess the Tuberculosis situation in the MVP Koraro cluster to propose and plan for an enhanced TB surveillance program that would reach Village Health Posts and ultimately homes to assess people with the key five TB symptoms. In the future a Rapid Diagnostic Test for TB may become available that would be faster, more accurate and enable treatment intervention sooner, but for now this enhanced surveillance program would mobilize awareness among the people about TB.
I was here to train the first two health extension workers for the TB Surveillance program that would initially be conducted from two village Health Posts, Siluh and Salem. They have gathered on Market Day in Hawzen Health Centre along with Takar, the Hawzen lab technician, Centre Head Dr Atsbaha, MVP Health Sector worker Hafti and Hawzen woreda TB focal person Anelem. All four will contribute to explaining in Tigrinya what I am delivering in English about the planned surveillance program. I go through the basics of TB, symptoms and then how the program will work and how the sputum will be collected from patients and transported to the Health Centre Laboratory.
The discussions were excellent with many questions, in particular the detailed organizational aspect of the sputum collection and in mobilizing the villagers to attend the Health Posts. The momentum, enthusiasm and the opinion of these Health Extension Workers was welcoming but limitations on our language skills still left something missing from the discussion. If I can bring that involvement and enthusiasm to my colleagues back home, this will have been a successful trip.
Work aside, I started to build a connection with my new home. People, food, amenities, that I took for granted were not readily available. Phone, internet and power were lacking for long periods throughout the day. But then again people did not communicate by these means like the way we do back home. Often I was called with a single ring with a general understanding that I would call back the caller, as I was the firenje, the foreigner or white person who could afford the pre-paid cards.
The culture and friendliness was overwhelming, but at the same time people were naturally reserved about what they would share. Children shouting “firenje, firenje”, and running up and asking 3 simple questions Money? What is your name?, or Pen? I learned that 1 birr, less than 5 cents was a huge amount for people. Walking across the countryside on Sunday afternoons someone would almost always invited us into their home. Most were made of stone with metal or earthen roofs and floors with a single door, cleanly arranged inside. We were usually offered coffee, food or my favorite local honey. Inevitably a small fire would be burning in an oven for making injerra, the tef grain based flat bread.
However, part of my role here was to see what I could take back to my life and work in Australia. Maybe the following story illustrates one thing I learned:
Its Friday afternoon, about 5.20pm, I am walking back the 2 km to my lodging outside the village of Hawzen. I notice a young girl with a baby on her back who is following me from the village along the road to Megab, about 9 km away. Nothing unusual, as many folks leaving the town 1-2 hrs before sunset to walk distances of 5-10 or more, km back to their home or villages (local rush hour I think). It will be dark by 6:30pm and although a full moon will rise by about 9pm, those walking long distances will do so in the dark under starlight. I talk with the girl who speaks some English and combined with my limited Tigrinya we manage to converse. She is 19 years old, dressed in “city clothes” unlike the rural clothes worn here, carrying her 4 year old sister on her back supporting her with her left hand and carrying a heavy plastic bag in her right. She works in the local district office as a typist and stays in Hawzen during the week. I ask her where she is going – Dugum she answers – a village about 16 km by road, maybe 12 km if she takes shortcuts through the fields. It will probably be 8 pm before she reaches home, unless a car stops to pick her up, which is unlikely as very few cars travel this road, especially at night. This is life here, long distances walking, carrying heavy loads, perhaps some danger from hyenas at night, deep holes that she could fall down in the dark. She looks around as she hears a car long before I do. A possible ride, but unfortunately the car turns into my lodging, as we part ways.