The Seeds

Just in case if readers ponder why I titled my last blog “Wearing My Other Hat”, I am a person with many hats of trades. Besides being a medical doctor, I am also a counselor and art therapist. It all dated  back more than 10 years ago when I was working in Hong Kong with many underprivileged patients in a government housing estate. Numerous of them were suffering from mental or emotional problems, but due to financial reasons and insufficient services provided by the government, they had limited access to counseling /psychotherapy. In order to care for my patients in a more holistic fashion, I undertook a Master Degree in Counseling. As time went by, I realized that there were some blind spots with verbal psychotherapy or counseling, especially for children, people with language barriers, speech problems or simply those who do not express themselves well with words. Art therapy seemed to be another helpful treatment modality for me to put into my armarium. Consequently, I went to do a postgraduate diploma course (Master degree equivalent) at the  Toronto Art Therapy Institute in Canada. Therefore, working in the mental health field is wearing my other hat in  addition to my regular obstetric-related job.

In a community where it feels like everyone knows everyone, or knows someone that knows someone, I understand why one would have concerns about seeking professional help for mental or emotional issues, especially from an Ethiopian counselor. There are also myths about mental illness being the curse of  devils. Seeking help is  a sign of weakness. All these deter patients from obtaining help.

It cannot be more obvious that the actual demand for mental health services in Ethiopia is enormous while supply is limited. Similar to the medical health care with shortage of trained doctors and nurses, primary care is usually provided by health workers with some training. Counseling is usually done by community counselors (paraprofessionals) who will try to help with simple problems and more complex issues will be referred to psychosocial counselors.

It is now coming into recognition the importance of mental well being and the Ethiopian universities have started psychology as a new subject. They just had their first batch of new graduates in 2011. There are additional  increase in job postings in the newspaper from NGOs hiring psychologists, counselors and social  workers, especially for projects working with with  women and children from violence, physical and sexual abuse, and HIV.

Likewise with all other “new” professions in developing countries, the challenges these fresh graduates face are: lack of supervision and guidance from experienced seniors. They have to explore their own way.  The students were taught all the theories in the classroom but had not gained the actual working experience through practicums. Often they are overwhelmed and intimidated by the heavy workload and complex case scenarios in the workplace. On top they have the extra pressure of being “seniors” to teach  their juniors in 2-3 years time. Lack of access to textbooks and training materials is another major obstacle for continuing further education to advance in the field.

One other frustration for the psychologists and counselors are misconceptions of their job nature and scope of work by the uneducated public. They were often mistaken as “social workers” who can help solve issues about money, food and housing which are of extreme importance to satisfy the basic human needs. Clients will turn down appointments once they discover they cannot be assisted in those arenas.

In order for any foreign aid assistance program to be sustainable in the long run, it is of utmost importance to educate and train the local staff to deliver the services to their  own people. Besides conducting individual art therapy sessions, I also teach students and educate related staff about mental health and art therapy. (Ironically, art therapy is often interpreted by the locals as ART therapy-the antiretroviral therapy for HIV)

I am very surprised to find 3 young psychologists in Bahir Dar, one is working at Grace Centre for Children and Families, one for Alem Children Support Organization (ACSO), and one sadly (like many Ethiopian university graduates) is still unemployed. I am very happy to share with them my knowledge and skills and give them support and supervision with their work. Hence I started up a weekly 3-hour training program in art therapy and counseling with both didactic and practical components.

Topics that were covered include the theories and principles of counselling and art therapy, developmental stages of children- Erik Erikson’s stages of psychosocial development,; motor cognitive theory; Viktor Lowenfeld’s artistic developmetal stages etc., psychoanalytical theories of Freud, …to very practical, work related subjects such as aggression in children , stealing behavior, practical tips in setting up for an art therapy session.

The experiential practical portion of the training session gave the students hands-on experience using the different art materials, experience of using artwork for expression and exploration, learning the different art therapy techniques and mastering some directives such as those used in projective art therapy assessments.

Here are my 3 psychologist students (left to right): Hiwot Yared, Ateneh Abun, Tadesse Haile (future pioneers  in Psychology field in Ethiopia!)

Here are my 3 psychologist students (left to right): Hiwot Yared, Anteneh Abun, Tadesse Haile (future pioneers in the Psychology field in Ethiopia!)

These three young brilliant people are a delight to teach. They are very enthusiastic and keen to learn. They actively engage in  discussions and ask plenty of astute questions. They make full use of their experiential sessions and are very willing to share their reflections on their artwork. Tuesday evenings usually pass by without being aware of time. The three of them are encouraged to form a peer support  alliance for themselves to share and discuss their work experiences and hopefully will expand their network to other parts of Ethiopia and globally to the rest of the world.

Performing the Ulman's manouvre.

Performing the Ulman’s maneuver.

  Just to close this blog with a fancy note. My students were so proud and happy that they were told to be great- great grand students of Sigmund Freud.  Freud is considered by many to be the Father of Psychology. Dr Martin Fischer, the founder of both Toronto Art Therapy Institute and Vancouver Art Therapy Institute, was a student of Freud. All my teachers and supervisors from TATI were taught and trained by Dr Martin Fischer. Thus my students can rightfully claim to be  Freud’s students of the 4th generation down the line. I hope I had sown some seeds of art therapy and counseling in Ethiopia, Africa. I do have faith these brilliant and passionate young people will make the profession  bloom in their country.


Wearing My Other Hat

After my first visit to Grace Centre, I was so touched by the work of these missionary volunteers to the children and families in need that I really wanted to help out in one way or another.  Thus, besides my regular weekday work with  the Amhara Regional Health Bureau on BEMONC training, I  volunteer weekends at Grace Centre.

The premises are jam packed with kids, most of them are from broken homes, single parent families, if not  being abandoned. For some, parents may be suffering from diseases such as HIV rendering them disabled to work or may even have died. Facing poverty and many difficulties in life, many of these children have emotional and behavioral problems.

Basic medical care is limited in Ethiopia, not to say mental health care. Awareness of holistic care and mental well being is on the rise and Ethiopia’s universities had produced their first batch of psychology graduates in 2011. Grace Centre was very  lucky to have hired one of the fresh graduates to provide counseling services and emotional support to their children. Obviously demand is much greater than supply and the list of children requiring counseling and therapy is long. I decided to put on my other hat and wrote a proposal to start a weekend art therapy and counseling program for the children. In order for the program to be sustainable in the long run, it is important to start training the local staff as well.

Art therapy is definitely a very new entity to Ethiopia. So far as I know, this is the first art therapy program in Bahir Dar even though this is not the first in Ethiopia. From my limited google search, Artists for Charity is operating a children’s home in Addis Ababa.  Deb Paskind and her 2 students from the Adler School of  Professional Psychology in Chicago had established an art therapy program in Awassa in partnership with Heartland Alliance for Human Needs and Human Rights in summer of 2011.

It is a lovely experience working with the Ethiopian children and a great learning  opportunity for  myself  doing therapy in a completely different cultural setting.


There are some significant challenges:

Language is  a major issue. With my limited Amharic, I am conducting individual art therapy and counseling sessions with the help of  a translator. Not many local staff can speak English, hence I have to pull them out of their busy routine duties to assist my sessions.

This is Hiwot Yared, Grace Centre's psychologist. She is a great help in assisting me with the translation as well as offering me background information about the children.

This is Hiwot Yared, Grace Centre’s psychologist. She is a great help in assisting me with the translation as well as offering me background information about the children.

Understanding the children and their issues in their cultural context is another challenge. The children are overall shy. It is their cultural way to show respect not to have direct eye contact nor to speak loudly, not to say in front of a ferengi (foreigner). Ethiopian children are strictly disciplined, sometimes even by physical punishment. They are not very open verbally to express their  emotions. (Art therapy just comes in handy as pictures is a universal language for communication and children can express themselves freely through their  artwork)

Under normal circumstances in Ethiopia, art materials and supplies would be an issue. The local stationery stores do carry some color pencils and crayons. The only paper they have available is the A4 white paper for printing. I did attempt to search for paint in Addis Ababa, the capital, but the only paint I could find was for the walls. I discovered myself pretty spoiled  working at Grace Centre. With volunteers bringing in donations from abroad, I was surprised they even had the luxury of different colour markers, chalk,  and even foams for craft making. I did bring along some water colour, paint and brushes myself, so we are well equipped to have fun in art making. The only thing I miss is clay which is an excellent medium to use in art therapy.

Getasew 5 (4)

Power outage is not a problem. We can always go for an outdoor session for more fresh air and sunlight. One day I was caught off guard as we were happily doing finger painting when the water supply suddenly went out. How could I clean up the kid with his face and fingers all covered with paint? OMG, the cleaning staff would be cursing me making all the mess without cleaning up the room after. The next week I was a bit more prepared saving up a small bottle of water and rationed it amongst the kids.

Dawit 7 (3)

Last but not the least is the challenge of my own reactions as a therapist in witnessing the social problems that came along with poverty in the developing world. The most fundamental physiological needs in the Maslow’s hierarchy of human needs are not met. Food and other material supplies are scarce. These children are aggressive hitting their siblings fighting for a banana because they are hungry. They steal a loaf of bread as their family cannot afford. Common themes in their drawings include mostly food, house ( a strong  desire to satisfy their basic physiological needs  for food, shelter and protection) and cars. Food in Freudian psychoanalytical terms can also represent the oral needs for love and nurture.

This is a drawing from a 7 year old boy from a single parent family. The  following are items which he would like to have: a car to take him to see his dad, a book to learn, an apple to taste ( he had learnt about apple from school), an orange to eat and a TV with  remote control. (I think kids in our developed countries should find themselves very lucky having all these things possessed  for granted)

This is a drawing from a 7 year old boy from a single parent family. The following are items which he would like to have: a car to take him to see his dad, a book to learn, an apple to taste ( he had learnt about apple from school), an orange to eat and a TV with remote control. (I think kids in our developed countries should find themselves very lucky having all these things possessed for granted)

This picture speaks it all. This is a drawing by a mentally retarded child. He said this was the hero (mother) with super powers to protect the 2 children.

This picture speaks it all. This is a drawing by a mentally retarded child. He said this was the hero (mother) with super powers to protect the 2 children.

Later he drew the father of the children on a separate piece of paper.He indicated he would like to stick the two pieces of drawings together.

Later he drew the father of the children on a separate piece of paper.
He indicated he would like to stick the two pieces of drawings together.

With the language and cultural barriers, I am not quite sure about therapeutic  benefits of my therapy on these children. However, I am glad that at least I  can provide a safe and nurturing setting for them to express themselves and receive some one-to-one attention amongst a big crowd of kids (They usually have large classes of at least 40 children taught by one teacher) I am so happy to see these children so engaged in doing their artwork and their self confidence and esteem improving over the weeks.  Some of them are even out of their “shyness” running up to give me hugs and high fives when they see me down the street.

Totally Absorbed

Totally Absorbed

A Real Life Miracle

My dear blog readers and followers,

Interestingly enough, I have procrastinated for a while before I pick up the pen to write this blog. To be  very honest, I have never written a Christian testimony before, nor have I even thought about writing one. But truly God has worked miracle  through this woman’s work and definitely her amazing story needs to be shared. I feel so blessed to become a witness of His grace  and also have the opportunity to work with her and become a small part of this miracle.

This woman’s name is Marcie Erickson, the founder of Grace Centre for Children and Families (which include an orphanage, day care centre and medical clinic) in Bahir Dar. Since August 2012, besides my regular weekday volunteer work on BEMONC (Basic  Emergency Obstetric and Newborn Care) at the Amhara Regional Health Bureau, I work with the children at Grace Centre during the weekends.

This is how I came to know about Marcie and the Grace Centre. It all happened one day after work walking home from the hospital. I was following two women, one Caucasian and one local, both in uniform. They had just finished donating blood (which is a precious scarcity in Ethiopia). Upon casual chatting, they told me about their work and even proudly led the way to show me their workplace – Grace Centre.

Marcie is a US missionary in her 30’s. Just out of high school at the age of 18, she headed off to Guatemala to volunteer in a children’s home and then at 19 went to Ethiopia for the first time. She spent 9 months in Ethiopia teaching English and was overwhelmed by the conditions people lived and children dying from starvation. Upon return to US, she studied music therapy at Florida State University and then transferred to Florida A&M University to study photography. She waited for God to send her for another international mission.  Although she did not graduate, she had used her photography all the time as a voice for Africa. At age 24, she volunteered under the Catholic Church in Kenya, Uganda, Rwanda, and Congo. Later she returned to Ethiopia and made Bahir Dar her home. She felt the calling of God for her to adopt children and raise them in Ethiopia.

Marcie Erickson, 26, adopted three Ethiopian children on July 25: Tariku, 3, left, James, 10.5 months, middle, and Amanuel,1, right. Erickson, a 1999 graduate of Barron Collier High School, currently lives in Ethiopia but was visiting family in Naples. She has started a project in Ethiopia to open a center which will include an orphanage, day care center, and clinic, called the Grace Center for Children and Families.

In May 2006, she quickly became the adopted mother of three Ethiopian boys, aged 13 days, 3 months and 2 years and 9 months respectively. At that time, the frail 13-day old baby was hanging on for his dear life. While waiting for the processing of the adoptions, she had to stay in the orphanage with her children. She found it hard to see the way these babies were cared for with  three laying to a crib, bottles propped in their mouths and their cries seemed to go unheard. She then had a vision from God in her head, a wonderful safe loving place for women and children. According to Marcie’s article “Blessed through Service”, she said a prayer, “Lord, if this is coming from you, then you give me the people that will help me run it.”

She then phoned to her closest friends Deanne and Andrew Knife who are Australian missionaries, residing in Addis Ababa at that time. They immediately agreed to move from the capital to Bahir Dar to help Marcie run the project. (Deanne was the Caucasian lady I met at the hospital that day) Together, with God in the forefront,  they formed what is known today as Grace Center for Children and Families. Their goal is to see families remain together and not come to the point where mothers feel like they have no choice but to abandon their children. They began by taking in foster children in the fall of 2006 with five foster children. Two were reunited with their birth mothers and the other three are now living with their adoptive families in Australia.

It didn’t take long before the Grace Center was busy and fully operating with the:

Day Care Center: Offers single women another option other than to abandon their children.

After School Program: Provides tutoring for children.

Feeding Program: Providing nourishment for the malnourished.

Medical Clinic: Offers free medical care to those in desperate need.

Women’s Empowerment- Jobs and Training: Assists women in becoming self-sufficient through childcare, basket weaving, jewelry making and other skills, training and employment.

Children’s Home: A home for abandoned and orphaned children.

Temporary Care: Provides the opportunity for families undergoing severe trials to have  temporary accomodation for their children.

Child Sponsorship: Provides the opportunity for impoverished families with the ability to stay together as a family.

Within the Grace Center alone they serve 850 women and children, hundreds of these women have conceived children through rape. Many of the women are HIV positive and have other diseases. The children are homeless, begging with their mothers on the streets. At Grace Center they strive to allow these families to grow and become self sufficient, having a full life.

Come and have a tour of the Grace Centre with the youtube clip below. You will see the amazing service Marcie and her friends have provided to the women and children in Bahir Dar. Grace Centre is the first to provide such kind of services in Ethiopia. It now has over 140 local staff with 6 compounds on 12 acres of  land donated by the government.  The facilities are well equipped with donated supplies which are often flown in from overseas by missionaries and volunteers. The premises are jam packed with children in need. It is serving at least 800 free meals a day. Volunteers have come to serve  from many different countries.

You can also read more on Grace Centre’s website:  Grace Centre, Bahir Dar

Marcie is now married to a local Ethiopian, Sefinew Birhan, and has 3 biological children of her own (6 in total plus the numerous children in Grace Centre who love hugging her as their own mommy) To raise money for Grace Centre, Marcie is traveling to speak to local organizations and soliciting donations, as well as speaking to youth groups and children to raise awareness. She also is producing music CDs of hymns, and all of the proceeds will go to the mission. In addition, she’s looking into ways to auction or sell her photographs of Africa as an additional means of income. “I know God will provide, ” she said.

Isn’t Marcie’s story a real life miracle? With faith in God, there is no dream too big. This young woman is living her dreams, helping countless  impoverished families and orphaned and underprivileged children in Ethiopia. There is no sign on Grace Centre’s door telling people who they are, but God brings the ones He needs them to help.

Melkam Enkutatash! (Happy New Year!)

Ethiopian New Year Card (1)

Melkam Enkutatash! (Happy New Year!)

Today it’s New Year Day in Ethiopia. It is the year of 2005. Yes, 2005. Coming to Ethiopia, I have gone down the time machine and gained 8 years ( a lot to be done/re-done if I were really given eight more years in my life!) The Ethiopian calendar is a unique form of the Coptic calendar, derived from the earlier Egyptian calendar. It has 12 months of 30 days and then a small month of 5 days at the end, making a total of 365 days a year.

Enkutatash is the name for the Ethiopian New Year, and means “gift of jewels” in the Amharic language. It is an important time for family gathering or reunion for the Ethiopians. Most people have gone back to their hometown or village for this festival.

The celebration is both religious and secular with the day beginning with church services followed by the family meal. Usually they will kill a sheep or goat for this occasion.  Young children will receive small gifts of money or bread after the girls gather flowers and sing and boys paint pictures of saints. Families visit friends and adults drink Ethiopian beer (Tej/Tella). When asked of their new year’s wish, most Ethiopians will tell me they want to find a good job and earn a good living. Many people (men, women and kids) today wear their traditional costume, the white woven cotton with colored embroidered borders or scarfs/shawls.

I have received two new year’s card too. Let me share with you the good will and  greetings from Ethiopia.

Melkam Enkutatash! (Happy New Year!)

Ethiopian New Year Card (2)

All Work and No Play Makes Jack a Dull Boy

As I have settled down into my daily routines and found adaptive ways to live the African life, I have more time and energy to explore my surroundings. I feel obliged to write this blog to promote tourism in Ethiopia as a part of my contribution to aide its economy and long term development. Ethiopia has a rich culture, long standing history and beautiful sceneries which may not have been known to many outsiders in other parts of the world.

Tourism is now a favorite career subject for young Ethiopians as they see huge potential in this field, be it training in hotel management, the food industry or becoming a tour guide or translator. Often ferengis will be grabbed for a chat while walking down the road by enthusiastic tourism students to practice their English.

Lalibela, famed for its rock hewn churches, is arguably one place in Ethiopia that no tourist should miss. It is a town perched at an altitude of 2630m among mountains and rocky escarpments. It is the Holy City of Ethiopia, like Jerusalem, many pilgrims come from afar to visit. It is a UNESCO site, but is still an active Christian spiritual centre, exactly just like what it had been 800 years ago.

The famous Biet Giyorgis, one of the stone churches, as seen in the postcards.

Side view of Biet Giyorgis, one of the most majestic churches in Lalibela. It is an isolated monolith, carved in the shape of a cruciform tower. It is excavated below ground level in a sunken courtyard enclosed by precipitous walls.

Faithfuls travelling long distance by foot to the holy city

Little Faithfuls

95% of the Ethiopian population are Orthodox Christians. They still practice fasting.

Priest reading the Bible quietly in the corner

As for my leaking roof, some of you have suggested putting some kind of canvas on top. Here is what the European Union has done to protect the UNESCO rock hewn churches from water seepage damage.

You are welcome to throw in your thoughts or give them better suggestions about these modern umbrellas over the ancient structures.

“The Umbrella” for protection

Biet Giyorgis is the only church without an “umbrella” as it will obscure the view of it’s characteristic cruciform roof top. How about a transparent one???

Since Bahir Dar, the small city where I volunteer, is situated on the southern tip of Lake Tana, the largest lake in Ethiopia, how can I not spend a day to have a boat trip to see its famous monasteries and visit the hippos?

Besides hippos and  crocodiles, Lake Tana harbours at least 26 species of fishes, some of which are endemic to the lake. Tana is also renowned for its varied birdlife. Flotillas of white pelicans are particularly common.
Lake Tana is about 65km in diameter and averaging 14m in depth. It is set at an altitude of 1830m. It was formed at least 20 million years ago by an ancient lava extrusion functioning as a natural dam. At the backdrop, you can see the skyline of Bahir Dar city.

Monastery hopping on Lake Tana is quite an expensive activity (due to fuel cost). I took this boat with several other tourists to the closest monastery on the Zege Peninsula. The boat ride took about 45 minutes.

You would be surprised to see the existence of this papyrus tankwa, which resembles greatly the ancient Egyptian boat, sailing across Lake Tana. It`s no more than a kayak made of papyrus. The locals are using it as a means of transportation. It takes them 6 hours of hard paddling to go to the other shore!! Obviously no life vests are available.
Not all monasteries allow women and animals to enter. We visited this medieval church, Ura Kidane Mihret, which was founded in the 14th century. This circular church`s walls were covered by jumbo murals, painted between 100-250 years ago. Here are some interesting looking ones just for the readers to have a glimpse. (Wish to upload more pictures, but have to apologize the limitations of the internet line.)

Corridor of the circular Ura Kidane Mihret Monastery, Zege, Bahir Dar
I sincerely hope that today`s blog has given you another perspective about Ethiopia, at least a glimpse of its beauty and some part of its long standing culture.

The Rhythms of Life


I guess I have settled down and  really got used to my volunteer life and its routines: getting up at 5am (no later than 6am when the day starts with chanting of the mosque, crowing of the roosters, barking of the neighborhood dogs as well as pecking of the numerous birds of vivid colours on my window. My alarm clock has thus lost its role and function. Breakfast usually is dabbo (the local Ethiopian loaf  bread, ) or ambessha (local round flatbread, more common in northern Ethiopia) with some fruit jam (We are lucky to have some imported jam in the ferengi’s (meaning foreigner in Amharic) “supermarket”, the size of which is no bigger than a small grocery shop. The imports are usually from the nearby countries like Egypt or Saudi Arabia. Of course these condiments are considered to be luxuries according to the local standards.)

It takes about 20 minutes to walk from my house to the  Regional Health Bureau Office, treading muddy paths as well as crossing streams and dug trenches. My hiking boots have been badly beaten and worn by the uneven gravel roads after 3 months. The short journey is slowed down further by saying hellos and waving to the numerous friendly children on the way. Now and then,  I’ll even stop to join in a game of ping pong (table tennis) with the local boys. Dont really know where the table  and the half squashed ping pong ball came from, but this is one of the favorite activies of the  teenagers, besides playing pool (snooker). Everybody is lining up for their turns, but I have got the special treatment of ferengi to jump the queue being the invited guest. One has to be extremely cautious not to trip over while hitting the ball as the game is played in the open on uneven grounds.

Weather watch is the most important activity one has to do every day. Time off work is determined by the degree of overcast in the sky. With the slightest sign of sky turning dark, I have to start packing up and rushing across the fields to hit home before the downpour of the afternoon storms. It’s no kidding. When it pours, it seriously pours with thunder and lightning. Even with a full length rainjacket, I can get soaked all over. Umbrellas here are basically for shading out the sun. Chances of power out increase with the rain. Once I arrive home, I’ll try to beat the time to prepare supper and boil hot water for my sponge bath before power goes out. Sorry, no dinner  if you are too slow! It is part of my daily conditioning like the Parlov’s dog.

Usually when the power it’s out, there is total darkness except the lightning litting up the sky like an artillery.  The wimpy light of my torch is of no comparison. What other good things can you do in the evening  besides going to bed early and sleeping through the roaring of the thunder??

Two other routines that I dont really fancy are 1. mopping the flooded floor from my leaking roof (yes, due to lack of  proper maintanence , my charming house is leaking everywhere when it rains) With the cool mist of raindrops hitting my bed, it feels as if I am camping out in the wilderness. Sometimes I wonder if the thatched roof grass hut is better water-proof that the modern metal tin roof.  2. constant extermination of bugs/fleas/ticks or whatever that is biting me. This biting nusaince is definitely a huge annoyance. Sometimes it’s not just bites with wheals but small blisters. The highest number of bites I had one time all over my body is 40! Also  I am really worried that there is DDT resistance causing the ineffective eradication. Another major obstacle is during the rainy season, there is no hot sun to kill the bugs or eggs. The clothes and furniture wont dry fast enough despite washing with hot boiling water. Even though my house is very clean, there is no way I can avoid bringing biting insects in from outside such as from public transportation or sitting on sofas/chairs in public places. I am desperate to experiment and  try any methods any friends would suggest.

It is a very simple, quiet and routine life governed by the rhythm of the powerful Mother Nature.

My “prestigious” neighborhood

Creatures in co-existence, just to name a few…

The dog that is leisurely enjoying itself in front of his shop

Africa is a heaven for bird watchers. It is renown for its exotic birds of vibrant colours endogenous only to this continent. I wish I had a faster camera with zoom to capture a few more.

Life in Action

To make this post more fun, there will be some quizes for the readers.

I have got some of the pictures of my BEMONC (Basic Emergency Obstetrical and Newborn Care) students/trainees in action.

Students attending lectures. The training is really intensive-8:30am to 5:30/6:30pm for 18 days, First 8 days of lectures, skills demonstration and role play, then 10 days of practical on labour ward, antenatal clinic and post natal care.

Role playing.

Quiz: What are they doing here?

They are doing an “Energizer”! Since the training program is developed by JHPIEGHO (Johns Hopkins Program for International Education in Gynecology and Obstetrics), it follows very closely a western model including doing energizers- but in a very Ethiopian way. Sometimes a student will tell a funny joke or the instructor will lead everybody to perform some of their traditional synchronous moves which I find very interesting to copy myself.

Infection prevention and sterile technique are definitely something they need to work on. But how can you do a good job if this is all the gear of protection available? Some students said in their health centres, there were no sterile gloves, not to say sterile drapes and autoclaves…Not much is offered for the health workers to protect them from blood transmitted infection like hepatitis or HIV.

Much emphasis is put on disinfection of equipment with 0.5% chlorine solution, washing in soapy water in a bucket and scrubbing with a toothbrush, then rinse in clean water (but often tap water here is very muddy) and air dry.

Quiz: What do you think this is?

An innovative sponge anatomical model to practice suturing of perineal lacerations! Now you see all the female genital parts??

Quiz: What anatomical structure is this?

Come on, isn’t that obvious? With some imagination, you will see a uterus and it’s a model for practicing repair of cervical tears. See the line of stitches.

Newborn resuscitation- you can tell easily some of these health workers have never seen or laid their hands on an ambu bag!

Quiz: What are we doing in the dark?

In order to simulate close to real life situation, the power was out during class time as usual. So a good buddy spontaneously took out her mobile phone to act as a light source in order for her classmate to finish manual vacuum aspiration of retained products of gestation.

Quiz: Time for mid-term exam. How many students do you think make a pass on first attempt? (BTW 85% or above is their passing score. The reason why they set the passing mark so high is  these health workers  are out there by themselves saving lives, so they want to ensure all the BEMONC trainees  are competent and up to standard)

7 out of 14 passed (ie 50%) To my surprise, the instructors were very pleased saying this was amongst the best batch they had ever taught. Usually less than 25% passed on first attempt. Nobody passed on pre-course evaluation which was using the same questionnaire. I am happy to see everyone passed on the re-sit examination 10 days after.

More to follow .