MPH | Tigray, Ethiopia | May-July 2012
“…Water was so scarce that one of her responsibilities…was to regulate when her troops could sip from their flasks…”
Global health fieldwork is often challenging. There are the inevitable language barriers and cultural differences – which become all the more important to consider when dealing with sensitive topics like reproductive health. Compounding the communication difficulties, poor infrastructure can sometimes make it difficult to accomplish even routine tasks. I often find these challenges exciting, but at times they can be discouraging.
And midway through my summer internship with the Bixby Center in Ethiopia, I was a bit discouraged. My fellow intern Kristina and I were spending three months in Tigray, a region in Northern Ethiopia, to support the same program of community-based distribution of the injectable contraceptive DMPA that Karen wrote about last month. Our tasks were to collect GPS points for the houses of the project’s community-based reproductive health agents (CBRHAs), refresh CBRHAs on the data collection protocols, and assess whether they had any needs that the program wasn’t meeting. We had postponed our work due to scheduling conflicts with local partners; we were falling behind.
After a week of waiting, we were able to hold an educational meeting with the CBRHAs in one of the project areas. The meetings were well attended and were useful for the participants, a heartening success.
Another treat came that afternoon, when we attended a traditional Ethiopian coffee ceremony at the house of a public health nurse who was involved with the project. The coffee ceremony is a true feast for the senses: the wafting smoke from roasting coffee beans, the dull thud of the mortar and pestle as the beans are ground, then the taste of the strong black coffee, the smell of tree-bark incense, and the crunch of popcorn and sweetness of orange slices that are served with the drink.
During the coffee ceremony we looked through our colleague’s old photographs, black and white images of people with big Afros and somber eyes. She told us that she had been a commander in the Tigrayan People’s Liberation Front, when the region was fighting against the Derg – the communist regime that ruled over Ethiopia in the 1970s and 80s. Her troops were stationed in a nearby desert. Water was so scarce that one of her responsibilities as a commander was to regulate when her troops could sip from their flasks, and when they had to wait, thirsty.
Kristina and I were floored, while our Ethiopian colleagues simply listened calmly. As the coffee ceremony continued, we heard many more stories about the sacrifices this nurse and her colleagues had made during the years of fighting. Her stories put all the challenges we had been experiencing into sharp perspective. The colleagues we were sitting with had all found the strength and the spirit to fight for a worthy cause in circumstances far more extreme than our current situation.
Once we were more attuned to this recent history of resistance, we began seeing it everywhere. One of the project villages is called Guroro, which means “Throat”, because of the many who were hanged there during the years of fighting. Now the village wears that past like a mantle, or perhaps a defiant warning to any who would try to threaten it. At one of our meetings, a CBRHA said she tells women that if they have concerns about using contraception, they should draw upon their strength as fighters and do what is best for their families. And – my favorite – one of the project villages is called Ayin Birkaken, which means “Never Give Up”.
I could end by saying that Kristina and I learned to “never give up” in global health work, and we redoubled our efforts as interns for the rest of the summer. While that’s true, it’s not the whole picture. The stories renewed my passion for global health work, in spite of the challenges. But even more, they gave me a new level of respect and admiration for the strength of my colleagues who live the reality of these challenges in ways that I can only begin to imagine. Poor roads might make it annoying for me to get to sites for monitoring and evaluation, but they also mean that women in that region may be less likely to travel to a health clinic for health care. Bureaucratic inefficiencies put us a few days behind schedule, but they can make it hard for people working in the public sector to retain their optimism and their passion. I may be outraged by the high mortality rates in developing countries, but they mean that the loved ones of our colleagues in these countries are more likely to die early. Our colleague’s experience as a resistance fighter is an extreme example of a broad phenomenon – the courage and the ability to rise up to the challenges that exist. I have an incredible respect for these colleagues. I simply bear witness to their strength.
I thank the Bixby center for providing me with this opportunity to contribute to a project I believe in, and to learn so much from the people involved. And I thank our colleagues for the coffee, the photographs and the stories.