The Four Musketeers on safari, Ethiopia

For a fan of the Lord of the Rings trilogy, it is probably sacrilege to steal a chapter title from Tolkein, but I honestly couldn’t think of a more fitting header for this last post about my fellowship.  Fans of the trilogy know that the Many Meetings chapter covers the part of the story just after the fellowship has endured an arduous, stressful, and sometimes dangerous several month journey and arrived in the safe haven of Rivendell, with much rejoicing as old friends and family reunite to tell stories of the events of the recent past while also partaking in formal councils and meetings to plan for the days ahead.  For the characters in the book, it is a time to take a long rest to recover from the physical and emotional “bruises” endured along the trail, looking back on how far they have come and re-energizing before moving on with whatever lay ahead.  As the calendar page flipped to February in Addis Ababa, for the first time in my five months in Ethiopia I could see the end of my assignment and my days of rest and joyful reunions in sight.

After spending several months working to help improve operations at the Carter Center in Ethiopia, my first focus as my fellowship’s end drew nearer was making sure to “finish with finesse” and properly wrap up my ongoing projects so that they would progress after my departure.  To that end, my colleagues and I made final plans to enable the pilot of our Zithromax(R) dosing stickers, printed some research on inflation and exchange rates to aid in the office’s budget preparation, installed IT systems to help prevent viruses and enable file sharing, and printed the final MALTRA report to properly document our unprecedented achievements in the malaria and trachoma control programs.  My boss and new lifelong friend, Dr. Teshome Gebre, took Lorena and me out to a wonderful dinner at The Showroom in Mexico Square and the office threw us a farewell celebration and unexpectedly gave both Lorena and me traditional cotton Ethiopian gowns, blankets, and tablecloths!  It is strange how quickly an office can become like a home away from home, and it was certainly so with my experience at The Carter Center Ethiopia.  I will truly miss working with the team there, who are perhaps the most talented, passionately dedicated people I have ever known.

My in-country assignment came to a close after the first week in February, and Lorena and I celebrated by welcoming our great friends TJ and Nuz to Addis for our planned vacation into the Rift Valley.  Living in San Diego, we have become accustomed to entertaining visitors, but have never witnessed the shock on the faces of travelers like we did when our friends arrived in Addis!  Quickly we realized that many of the things Lo and I had become accustomed to – open sewers, car-sized potholes, sheep/goats/donkeys/cows in the streets, begging children, 40-year-old cars and trucks, smog so thick you can’t see more than a mile – were as shocking to TJ and Nuz as they were to us when we first arrived.  In a way, we had become “Habeshas” ourselves, moving through the streets and taking a “ho hum” attitude to sights to which we had once recoiled in surprise.  After some quick tours of our neighborhood, some local food (kitfo, or raw spiced ground beef), and some shopping trips to Piassa, we were off on our safari into the Rift.  Thankfully, our driver Bereket (from Duka Travel, great honest tour operators if you’re looking) was experienced and safe and never made us recoil in horror on the roads!

For three nights we returned to Awash Falls National Park in the Afar Region of the Rift Valley, enjoying the sights and sounds of the river’s waterfalls, the baboons and vervet monkeys that roamed the trees in the lodge, the five-meter crocodiles in the river below, as well as the many lesser kudu, gazelles, oryx, jackals, and uncountable birds we saw on our game drives.  We hiked to the top of the Fantale Volcano, seeing smoke rise from its dormant dome as we stared down into its crater.  The highlight of the Awash trip was our visit to the “hyena cave”, where these canines have taken up residence in a nook of the several mile volcanic crack in the earth running from Fantale crater to the lake and where, at nightfall, you can watch them emerge from their daytime dens and begin their nighttime hunt.  On our trip, we saw chaos erupt when a hyena took aim at a passing herd of hundreds of sheep and goats, thwarted at the last moment by a shepherd and his loud shouts and the whacks of his cane.

Leaving Awash, we began the 11-hour drive to Arba Minch and the Netch Sar National Park.  From our room at Swaynes Lodge, we could take a few short steps to stand on the cliff face marking the edge of the Rift Valley and look down over a large forested plain with the sediment filled Lake Abaya to our left and the clear, croc and hippo infested Lake Chamo on our right.  Again, baboons frolicked everywhere we looked, whether wandering through the lodge or walking through the town itself.  The trip to Arba Minch was highlighted by a morning game drive into Nech Sar (meaning white grass), braving unthinkable offroading to see the hundreds of Zebra and Greater Kudu.  Later that day, we took a panga boat on Lake Chamo, passing several hippos lounging in the reeds to reach the famed “Crocodile Market”, a mud flat with hundreds of crocodiles and shore birds.  Some of the crocs topped 20 feet, and the guides had no problem poking them with boat oars to create a photo opportunity for a large swirling splash!

Our final leg of the safari took us eight hours north to Bishangari Eco Lodge on the shores of Lake Langano, where we had drinks in a treehouse bar surrounding a massive ficas, drank $1,500/lb coffee, and shared good spirits and great food in toasting our last full night in Ethiopia.  After returning to the city, we finished packing, gave away some last clothes and food to some local “friends” we had made on the streets during our six months (I gave away my hiking boots after four years of use on four continents, hoping that they, like the autos of Addis, will find many years of additional use!), and headed to dinner with our friends the Maxeys and new friends Bereket and Tedy (our taxi driver these many months).  Boarding the van to go to the airport was surreal.  We had waited so long for “our turn” to board that same van, watching uncountable adopting families leave our Guest House for home and feeling like our time would never come.  Finally, mercifully, we were heading home.

Flash forward 24 hours and there we were, sitting in the living room of the home outside of Boston where I grew up.  After six months in Africa, with the sounds of donkeys braying mixed with Amharic music outside our windows, it was beyond surreal to be watching HDTV in the relative quiet of our home.  For the next few days, it seemed a never ending string of reunions and feasts with family and friends, mixing jet lag with excitement and the stomach pains of the “reverse adjustment” back to foods like turkey and brisket and ribs and chinese food and….well, you get the point!

The trip home was coordinated to allow me to attend the Carter Center’s annual trachoma review meeting in Atlanta, which was a smash success.  I was heartened to meet several people from the Carter Center HQ who had read some of my IT proposals (Google Enterprise, digital surveys, etc.) and were considering pilot implementations as I had not realized they had been received so well.  We heard about the great work so many countries are doing with trachoma control – in Ethiopia, Sudan, Nigeria, Niger and more – as well as results from the latest research being conducted in academia and NGOs that will impact trachoma control strategies.  For me, it was a privilege to be in attendance, and a great way to formally wrap up my fellowship at one of the world’s most outstanding organizations.

And then, finally, six months to the day from leaving San Diego, my flight touched down at Lindbergh Field.  While we were greeted by cold rain, it didn’t dampen the mood of the many reunions with friends, family, and coworkers  that took place over the following days.  Whether having breakfast with family or barbecues with our friends, or even putting my boat (acquired while in Ethiopia)  in the water, gradually it felt like we were returning to normal again.  Well, I guess I’d have to say “the new normal”, because in a way, everything has changed.  That’s the thing about returning home, about a place that is constant, is that it makes it obvious when you come back just how much you are changed by what you went through.  An experience like the Global Health Fellows for some is life changing, and for others like me it is at the very least “life amplifying”, in that it may not fundamentally change who you are and what matters to you, but it will turn up the volume on those things and make you realize just how much these things give your life meaning.  In that way, by what you saw and what you accomplished, you do come back a different person than when you left, a better person for what you went through.  And, thanks to the work you did while you were gone, you’ve helped in some small way to make the lives of others better and more hopeful.

Thinking back on my six months in Ethiopia, I feel so lucky to have been afforded the opportunity to see what it is truly like to live in such an impoverished, yet burgeoning, city.  It was undoubtedly the hardest thing I have ever done, testing me (and Lo) on a daily basis and doing its best to wear us down with its “death by a thousand cuts” repertoire of pollution and dysentery and poverty and lack of “fun” diversions that we’re accustomed to in the developed world.  Despite all of these challenges, however, I got to know a city full of people who smiled despite their challenges, who find a reason to be optimistic about their future whether or not common sense tells them they should be.  I saw a city on the grow, with construction in all directions, with exponential improvement in services like electricity and internet and a government with grand development plans to help its citizens move out of poverty once and for all.  The future for Ethiopia truly is very bright, and thanks to the hard work of the Federal Ministry of Heatlth, the Carter Center, the Lions Club, Pfizer, ITI and many more, the people of Ethiopia will be able to see that future with their own eyes and help shape it for generations to come.  To have played some small part in that story is one of the great experiences of my life.

In a way, I suppose that’s what being a Global Health Fellow is all about.

I had just returned from spending the New Year in the remote western Ethiopian region of Gambella, which shares both a desert scrub landscape and regional tribal culture with neighboring South Sudan. Because I had been working almost exclusively on the Carter Center’s Trachoma elimination program which treats millions of people in just one week, my boss here thought I might benefit from being exposed to an entirely different approach to neglected tropical diseases that is relentlessly focused on reducing under two dozen cases in the entire country to zero cases for the rest of time! Gambella is “ground zero” for Guinea Worm in Ethiopia, with all 21 cases in 2010 reported from one small Woreda named “Gog”, confined to an area of three ponds the Center has dubbed “The Great Guinea Worm Triangle”. After seeing the MALTRA program first hand and having just analyzed the results of data that revealed over nine million doses of Zithromax® dispensed and almost 90,000 anti-malarial treatments in one week, 21 Guinea Worm cases seemed so low I wondered what all the fuss was about. However, completely eradicating any disease, I learned, requires the complete absence of cases, year after year, until the disease has no more transmission vectors and ceases to exist. And that requires a tremendous dedication to disease prevention, identification, containment, and treatment along with huge grass roots education campaigns, all of which I saw evidence of as we traveled hours through the countryside by land cruiser and on foot.

While we traversed the region, we had to eat of course. Fortunately, there were plenty of small restaurants (I can’t call them “hole in the wall” since not all of them had walls, exactly). Unfortunately for me, the sanitation left a lot to be desired, and after a day and a half of driving back to Addis through truly spectacular scenery, I returned home and felt a strange rumbling in my stomach. I’ll leave out all that followed for the next three days, but needless to say I didn’t have to worry conceptually about my nightmare any more. I was in it. There is a phenomenon here in Ethiopia that expats call “Addis Belly”. I had become accustomed to its symptoms, which I can only describe as a background, aching pain in the stomach and a feeling that your digestive tract is “just not right”. When it got a bit worse in October, I took a three-day course of Ciprofloxin which helped for a couple of weeks, but it came back. This new bout of illness, however, required something more. Besides the cycle of Cipro, Lorena found me the Ethiopian version of Pepto Bismol (Peptica), as well as an anti-emetic to help keep food down. After about a week of feeling better, the symptoms returned, and I got to go back to a place we are getting to know really well here, St Gebriel Hospital, for a diagnosis. After giving them a “sample” (enough said) to bring to the lab, the doctor told me I didn’t have a parasite and then reprimanded me for taking only three days of Cipro. Rather than defend myself, showing him the Global Health Fellows medical sheet calling for a three day cycle and the same instructions on the bottle from my US pharmacy, I accepted his advice that “our bacteria are stronger here in Africa” and his recommendation (which matched WebMD’s) that I take a full five-day course to knock the bacteria back once and for all. Those who know me won’t be surprised that I took it for seven days For now, the symptoms are gone and Addis Belly has not returned. Fingers crossed that it may remain so!

Despite losing over a week of work to sick days, January was a busy month at the office. I had the task of finalizing the “MALTRA V Report” for the Carter Center and its partners, and the team allowed me to spend some time with my Macbook Pro trying to create a more aesthetically pleasing version for this round that would be a break from the typical “Microsoft Word” factual report and style. Thanks to a lot of photo contributions and repeated analyses of the (often updated) data, the final report is ready for printing in early February. I also pushed ahead on an idea to digitize the creation of “dosing stickers” to guide Zithromax® treatment in the field, purchasing samples from a vendor in the US and having local versions printed for comparison here. So far, it looks like the technique and approach are promising, and could allow the Carter Center here in Ethiopia to avoid a cumbersome and expensive process to repaint the thousands of existing metal sticks that are deployed across the northern reaches of the country. Though we had hoped to spend late January in the Simien Mountains of North Gondar to conduct a height/weight dosing study, due to time constraints and the difficult terrain of the zone, we were forced to postpone the activities until MALTRA VI in May. Some of the villages we were to visit were so remote that even donkeys cannot traverse the routes, so carrying the necessary digital scales and measuring devices would have been unfeasible. Back in Addis, a team of a dozen temporary workers have been furiously entering data into PCs from paper forms with the results of a trachoma prevalence survey that took place in East Amhara in December. The results will tell us how effective the first three years of Mass Drug Administration have been in reducing trachoma burden in the region, so we are anxiously awaiting the outcome! Seeing the effort required to manually enter tens of thousands of pages of data underscores the rationale behind the eSurvey proposal I put together for the Carter Center last month with the goal of digitizing the process of collecting this data in the field using new electronic tablet technologies. There is so much left to do, but so little time left.

As I write this, I have just five full days in the office remaining, and have been busily trying to wrap up my tasks here in Ethiopia, get started on the required activities for my transition back to Pfizer, and of course meeting with newfound friends to start the process of saying farewell. It is amazing how much you can learn about a place in just a few months, and we’ve been trying to pass on some of our experience and knowledge to some newcomers to Addis so that they can have some “free” perspective we had to learn the hard way! Ben Maxey (Global Health Fellow assigned to ITI) and I had the pleasure of taking some of the leaders of the local Lions Clubs out to lunch to express our appreciation, both personally and on behalf of the company; the Lions fund a good deal of the trachoma elimination activities in MALTRA campaigns, and included us in their “Sight First” work related to eliminating Measles as well. Lorena, who did some amazing volunteer work at a local hospital, and I were invited to a traditional dinner and coffee ceremony at the house of one of the midwives and it was one of the most special meals we have ever had in our lives. We also have been able to have S’mores – yes, S’mores – with our friends Jeni and Ray and hang out, and visit the silk spinners and weavers of Sabahar with our friends Dan and Nataly from the embassy. Incidentally, if you haven’t seen the homes of the state department employees on deployment, you’re missing out. It’s the ONLY way to live overseas! We were lucky enough to housesit for them to take care of their gorgeous Rhodesian Ridgeback, Sophie, and avail ourselves of Armed Forces Network, HD/BluRay movies, and (God Bless them) a crock pot to make slow roasted chicken! To prove we care about more than just our human friends, we have also spent some time helping our favorite neighborhood street dog, who gave birth to a litter in late January, raise and cuddle her puppies almost daily. Lorena even rescued the lot of them when they fell into the open sewer and were close to drowning, proving she is a better human being than I am (I’m not saying I would have seen them drowned, but I definitely would have had to think about sticking my hand in there)!

With so much accomplished, thoughts now turn to the future but not before wrapping things up the right way. There was a phrase floating around Pfizer for a while that comes to mind, “Finish with Finesse”. February will be busy, with a frantic week at the office in Addis, a week of vacation in the Rift Valley with friends, a long trip home (if we can get through Cairo, that is!), and a review meeting at the Carter Center headquarters in Atlanta. If you’ll excuse me, I better get back to finessing my way to the finish line!

SJ

I realize I may be in the minority, heck maybe I am the only one out there, but today I feel lucky to be a Boston sports fan. Like others who follow the Patriots, I am still reeling from the unexpected loss to a trash talking, inferior and loathed Jets team. There is no escaping the empty, gut wrenching feeling that hits you when a glance at the game clock and some quick calculations in your head reveal that there is no hope for a comeback and that the end of your team’s season is, as the chief engineer said about the Titanic’s probability of sinking, “a mathematical certainty”. If there is anything worse than waking up with the dreaded “Sports Hangover” the day after a season-ending loss, I have yet to experience it. Like many journalists and Patriots fans, over the past two days I have tried to find comfort by reminding myself that the team’s future is bright, that returning veterans, developing rookies and a stacked 2011 draft bode well for forging a new dynasty, that this team exceeded all expectations set for it before the 2010 season began, and of course that we still have the Celtics and Red Sox (sorry, Bruins).

I confess that the depth of my anguish from sports defeats has been unnerving, leaving me doing some soul searching and looking for intellectual and psychological explanations for, well, what the hell is wrong with me and why I care so much. I know I am not alone in my feelings, and when I started thinking about the historical context surrounding Boston and its love affair with sports, it hit me that I and all of my fellow Boston sports fans are really suffering from the normal range of issues that plague the nouveau riche – those who came from modest backgrounds and have found some modicum of wealth – in everyday society. Just as the members of this newly affluent group develop a world view that affects their expectations and personalities (rarely for the better), so too have the nouveau riche of the Boston sports scene been influenced by the successes of our teams in the past decade to such a degree that, I fear, we have lost our grasp on reality and what a healthy relationship with Boston sports is really all about. Frankly, we are spoiled and have forgotten where we came from, a fact that I only fully realized three years ago when I talked to a younger generation of fans at a Bar Mitzvah in New England.

I was 32 years old at the time, and was attending the entrance into manhood of the son of my own childhood mentor. Before he was even born, I remember sitting in his father’s downstairs game room in High School and on weekends home from the University of Connecticut, especially in the September and October days when the Red Sox would invariably lose to the Yankees in the playoffs and we would be naively hoping that Drew Bledsoe and Bill Parcells would cheer us up with a victory. It had been a decade since Larry Bird’s Celtics had given Bostonians anything to cheer about, and we were getting desperate. A decade and a half later, I found myself talking to a table of 13-year-old Boston sports fans who were exuding confidence not long before the Patriots were to take on the New York Giants in Super Bowl XLII. And who could blame them? They had no idea that the Patriots were once the worst franchise in football, perennial losers whose one Super Bowl memory was a humiliation at the hands of the 1985 Bears. They had probably heard stories about the Red Sox curse, but had just celebrated the second World Series title for the Sox in the decade and could not see what all the fuss was about. The Celtics had signed Ray Allen and Kevin Garnett and the new Big Three boasted the best record in the NBA (and would go on to win the championship that year). My UConn Husky basketball teams – both the men and women – were winning National Championships. For all these budding teenaged fans knew, Boston teams win championships and that is the way it has always been. Seeing the reaction of Boston fans this week after the Patriots loss to the Jets, it is evident that after living through the past decade of success and unbridled sporting avarice, even we seasoned veterans were quick to abandon reason and reality and subscribe to that same naïve philosophy that Boston teams win championships and that is the way it has always been. How soon we forget.

If we had the courage to face the pain and humiliation of decades past – when we cheered and were let down by great athletes like Dwight Evans, Bill Buckner, Antoine Walker, Mosi Tatupu and Drew Bledsoe – it would serve not only to re-educate us on the reality of what it takes to win it all but to also make us appreciate how lucky we have been to see the likes of Manny, Big Papi, The New Big Three and Tom Brady hoist championship trophies. We watched some great teams lose, again and again, decade after decade, before finally getting to celebrate the Red Sox, Celtics, and Patriots reaching the ultimate goal. Their ability to do it repeatedly has spoiled us, making us “rich” beyond our wildest dreams in such a short period of time that we are as careless with our support as teenage first round draft picks are with their signing bonuses. As with all new money folk, being called “winners” is nice but nothing compared to our fear of being called “losers” again and causes us to instinctively react to losing with intolerance and denial and with a total rejection of and distancing from our collective sporting past. For shame. We can learn at lot from the past, if only we are brave enough to face the lessons it teaches us.

First, we would be reminded that the best team doesn’t always win; rather the team that plays the best on a given day will be the victor. Sure, it didn’t feel good to lose to the New York Giants in 2008 or the New York Jets this week knowing we were the better and more talented team. But I’m sure the Rams of 2001 felt the same way, wishing they could play us and beat us nine more times in a row. Lesser teams sometimes outplay better ones, and they only have to do it once to send your team packing.

Second, winning it all takes luck, usually a lot of luck. If you don’t believe me, ask the Giants where they would be without the David Tyree catch and Asante Samuel missed interception. While you’re at it, ask Tom Brady if he would have advanced without the “tuck rule” against the Raiders in 2001.

Third, winning it all requires staying healthy, and injuries have a way of getting in the way of great teams and their goals. The Celtics learned that the hard way when they lost Kendrick Perkins in Game 6 last year and tragically saw how the losses of stars like Len Bias and Reggie Lewis can destroy a dynasty, not just a season.

Finally, and luckily for Boston sports fans, winning championships takes skill. Thankfully, we have people like Bill Belichick, Doc Rivers, and Terry Francona building and maintaining our beloved dynasties, and mercifully we fans are not involved in the process despite offering our opinions and “expertise” daily on talk radio and the blogosphere. I was horrified that we picked McCourty in the first round last year, only to have him make the Pro Bowl in his rookie season. My brother was convinced in 2001 that Drew Bledsoe was our future and that we should trade Tom Brady “while his value is still high”. Sox fans hated the trades of Nomar and Mo Vaughn, and we’ve won two World Series since. We didn’t have managers with the right vision or skill during the dark days of Boston sports, but we do now, and we should feel very good about it, and put our trust in them.

Clearly, that Patriots Sports Hangover we are suffering from can be cured only by the perspective that comes from looking to the past, which shows we have had it pretty darn good. In the modern era (starting in 1980), only three teams have made five Super Bowls in any 15 year span: The 49ers (five wins), the Broncos (2 wins), and the Patriots (3 wins). Since 1996, our team has been in the playoffs 11 times and won 10 AFC Championships. Thanks to the 2010 Patriots and their 14-2 record, we suffered only three Sports Hangovers this season, so we should be thankful that the team gave us 14 good Monday mornings this year. That’s a history to be proud of, and how can we complain when there are 29 less fortunate teams that would give anything to be in our shoes?

If we want to get back to a healthy passion for our teams, we have to accept that our sports wealth has changed who we are, and that only by facing and embracing our past will we truly appreciate our sporting future. It means we should be grateful for our past, even if the current season didn’t live up to expectations. It means that we should not expect perfection, even if we hope and cheer for it. It means that though we would never revel in defeat, we will not wallow in it either. And it means that while we look forward to Draft Days and trades and the building of our teams’ futures, we should never forget the long and emotional road we traveled with our teams that made us who we are today.

Boston fans, it could be a lot worse.

The Blog-Health-o-Meter™ reads This blog is on fire!.

Crunchy numbers

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 1,700 times in 2010. That’s about 4 full 747s.

In 2010, there were 13 new posts, growing the total archive of this blog to 28 posts. There were 73 pictures uploaded, taking up a total of 73mb. That’s about a picture per week.

The busiest day of the year was February 12th with 223 views. The most popular post that day was In Defense of Ray Ray.

Where did they come from?

The top referring sites in 2010 were facebook.com, myespn.go.com, linkedin.com, espn.go.com, and pfollow.pfizer.com.

Some visitors came searching, mostly for magician, i never could sit still, magician pictures, magician picture, and magicians.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

In Defense of Ray Ray February 2010
5 comments

About Me February 2009

Now You See It… February 2009
3 comments

First Impressions September 2010
2 comments

Leaving Well September 2010
5 comments