From Nepal-US to Ethiopia

The beginning

My first ever journey to Ethiopia and the whole continent of Africa, began with an early morning flight from Dulles Airport, Washington DC. I was standing in line to collect my boarding pass and I could already feel the welcoming vibes around me.

Every one- passengers awaiting in the line, fellow seated next to me, or the air hostesses rushing down the aisle- were remarkably very friendly. They were all happy, candid  and eager to talk with each other, often leaning or standing close, close enough to be considered a violation of personal space in the West.  As  soon as the captain turned off the seat belt sign, people started forming small groups at every corner possible and delved into conversations for hours, often breaking into bouts of laughter. An almost 14 hour Ethiopian airlines flight to Addis Ababa, gave me plenty of time to contemplate the quality of days I was about to experience in the upcoming two months.

During my travels, I try to blend in as much as possible and often have a good success rate. However, I wasn’t expecting to blend in on this occasion. I have to admit, I wasn’t even trying. To my surprise, I realized I was going a much better job than I thought when the stewardess started to talk to me in Amharic. She was gentle and kind enough to apologize upon realizing the truth, but it started to grow uncomfortable when her friends started to point towards me and giggle.

My skin tone and build have allowed me to pass as a Puerto Rican, Haitian, Latino and undoubtedly a South Asian (my origin-Nepal). All of this of course, is limited by my ignorance of their languages. Now that I’ve been in Ethiopia for a while, I have realized I can easily get away with being a Habesha (Ethiopian or local- in Amharic ) provided I improve my Amharic skills from just saying “hello” and “how much?”

How did such a chameleon end up on a flight to Ethiopia?  Let me rewind a few years and share my journey to Gondar, Ethiopia.

My decision to embark on a Public Health Degree with a graduate program in Global Health at the University of Washington was a major career shift. I had been working in the role of a Medical Superintendent of Jiri District Hospital  for the Ministry of Health, Nepal for past 4 years- practicing clinical medicine as well as heading the administration.

At one point, I had reached to the conclusion that this hospital of Jiri valley and its wonderful people had grown in me. I was no less of a Jirel (native people of Jiri), than them. I heeded that I would never leave the place or even imagine that I  could.

Soon after the major earthquakes of Nepal, I was faced with new challenges of acute management and care, followed by the long term rehabilitation and rebuilding phase. Now as I see it, the earthquake not only brought destructions but also provided a myriad of opportunities for Nepal and its people.  Through major media attention globally, the lost mystical Himalayan land of Nirvana and Yeti was once again remembered. Friends- known and unknown all gathered for aid.  It definitely brought down our temples and stupas, our Dharaha (a 9 story cylindrical tower, in the heart of Kathmandu, long symbolizing Kathmandu and Nepal), but it strengthened the bond both within and beyond the nation’s boundaries.

Personally, interactions with the relief teams, primary and secondary responders, psychological aid teams and volunteers both national and international, opened a newer perspective to my existing career. I was then provided opportunities to expand my medical care to relief work, figuring out how to deal with disaster situations both natural and man-made. I was inspired to apply to study at the University of Washington and received a Fulbright grant to do just that. All my career and years of working had prepared me and I was ready for this next step. My confidence was as high as my ambitions soared. Once a lone trekker, in the foothills of Himalayas, I set out to embark on a journey into the wide world.  After all “A man should reach beyond his grasp, otherwise what’s heaven for?”

Now that I am in the program at UW, I have been offered the amazing opportunity to work as a SCOPE fellow in Ethiopia. Here are the some quick facts about this great country I am so grateful to be learning from.

Ethiopia:

In numbers (2016)

Population = 107 million

12th most populated nation in the world

Capital city Addis Ababa

Median Age = 18.8 years

Urban Population = 19.7%

Adult Literacy Rate = 39% ( Males – 49.13%, Females- 28.92%)

Maternal and Neonatal Indicators

Maternal mortality rate = 412/100,000 live births

Health facility delivery = 26%

Total Fertility Rate = 4.5

ANC coverage (at least 1 ANC visit- 2011) = 33.9%

Neonatal Mortality Rate (number of neonates dying before reaching 28 days of age) = 27.6 per 1000 live births

Infant Mortality Rate= 59 per 1000 liver births

Source- Ethiopian Demographic and Health survey (EDHS) 2016, World Bank 2011.

I will be working in Faith Leaders Advocating for Maternal Empowerment or FLAME study, which is an interventional study initiated in 2016, to evaluate SCOPE’s model of brining communities together to improve the maternal and neonatal health.  In this model, faith leaders are paired with members of the Health Development Army (HDA) from the community, to engage with new pregnant women and their families and encourage them to access antenatal care and delivery services.

18 government health centers, six intervention and twelve control sites have been identified, where the study team will compare the outcomes in terms of women seeking antenatal and delivery services. This program aims to provide evidence on SCOPE’s model at increasing the number of women seeking reproductive health care and for its future replication.

Being a SCOPE fellow provides me the opportunity to participate in various components of the study. It is an opportunity of realizing the global health concepts of my classroom knowledge in the field.  So far  24 graduate students from University of Washington and six from university of Gondar have received this fellowship.

The FLAME study is being carried out in the Gondar region of Northern Ethiopia. Gondar as a region, is famous for its ancient stone castles and rich heritage of Ethiopian Orthodox Christianity (Tewahedo Church). As rich as its culture heritage is, there is ample opportunity for improvement in terms of general health care of the public and more so of pregnant mother and their newborns.

While I am here to contribute to the program, I am also here to learn. I likely have more to learn than I have to offer, which is why I am so grateful to be here. I truly have been learning since the first day and so far with my 15th day today, have learned to acknowledge a world beyond my horizon.

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