Christmas Letter 2010

Christmas letter. I'm not religious. I've been disappointed by religion. I have a lot of faith, but those who try to organize faith, too often, mess things up, undermine natural, in-born talents for sensitivity, growth, love, what's right. Ask the mothers of kids who are sent on violent jihad, or the boys servicing a priest ... measure the richly jeweled who cry 'hosanna' ... messy stuff ... keep the faith, but hold your own mind.



2010. This was a great year, dramatic. I don't think I've had such a year since 1977, when they opened my skull and cut the dura, saving my life, throwing me down a deep crevasse. This year, with partners, but principally my design, I launched and structured a health care program in Addis Ababa. We treat 200-300 indigent women and children each month, folks who subsist on $100 US per year or less. I worked there in January, and bonded. The program in Addis is excellent. Painfully, I found the collateral effort in DC misshapen, and stepped away.



A friend said I'm an enabler. But not like a supporter of negative addiction. I take pride in enabling folks to hit their goals. My friend opened a shop to support a healthy lifestyle, kids and adults bicycling. It's going great. In turn, she, Sue Hefler, helped my boys hit high marks, we established the dominant junior bike team in the mid-Atlantic ... my old boy (19!) Nate rode for Kelly elite amateur and Team USA ... did Vuelta a Guatemala in October, will tour Europe with Team USA this spring ... 16 year-old Avery raced across the country, from Battenkill, NY, to Bend, OR, to Bunny Hop about DC. Avery's nailing his senior year, diploma in three years, sharp, then he's onto an incredible gap year, Machu Picchu, bike races around the US and maybe across the pond.







I had fun biking, started mountain biking on a single-speed 29er, 'Sparky' (below). Epic rides in the Cascade, Olympic and Appalachian mountains, the C&O Canal, full length, up and back ... I find the mix of biking in wilderness and photography relaxing and energizing.





At year-end, work is interesting. I'm helping with the merger of two agencies, reshaped by Dodd-Frank. Good work, smart people, building something new -- systems integration, data, large complex stuff. First time in years I've slept well.

My incredible wife, Carolyn. September 2010, 25 years ere we wed. Wonderful! She's achieved much, professionally and personally, and been my lift, a rope out of the crevasse. Beyond top scientist, Care is a great fitness acolyte, stronger now than any other time ... dropping me on the climb up Mount Bachelor.

A new, wonderful dog, Soot, completes our team ... so many good things ... On we go.



Neighbor, friend, beloved. It's been a wonderful year. You've been a part. Thank you. Now we look to 2011. 2011 is a prime number. Let's work to make it great, a prime year, marking what we do, making the world a better place.

Much love -- Jim and family

Seattle/Olympic Peninsula

Great week attending database conference in Seattle. Well-focused sessions and, a good benchmark for any conference, developed more than ten ideas for things to consider back at work. My agency is merging with a larger agency (good news), so it's a good time to reflect.



Professional matters aside, I very much like Seattle, a town of interesting architecture, culture, waterfronts, and restaurants. I brought my mountain bike in a travel bag, so I could take in pre- and post-conference rides. Logged about 75 miles, sometimes rising before dawn to hit the mountain bike park or ride around Lake Washington. After the conference, I took the ferry to the Olympic Peninsula where I grabbed more rides and walkabouts. The trip also afforded the opportunity to break in my new pocket camera, a Leica D-Lux 5. While the camera is more fragile than my Canon G10 (which I sold), the Leica image quality is very, very good.







Had a little difficulty on Miller Peninsula, off Sequim Bay / Puget Sound (bottom picture). Got lost and spent a couple hours re-tracing my path, without much success. Finally bushwhacked over towards the bay as dark approached, and made my way back to car. A bit of adventure, lucky no harm ...

Additional pictures here.

Concerned Photography, Active Photography

"You might think I live in some kind of rarefied atmosphere, but I've got all the same concerns as you. When you spend time in the Third World, the gap between an ordinary life there and a life in the West is enormous, almost unimaginable. But the gap between where you are and where I am is microscopic. It's just degrees of luxury." U2 lead singer Bono speaking to his friend Neil McCormick, in Killing Bono, pp. 345-346.

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In January 2010, I visited and photographed these HIV-positive orphans in Addis. We set-up a healthcare program for very poor women and children, including these children and their caretaker.

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Here's a thought: "Concerned photography" (Cartier-Bresson, Magnum, et al.) is to take the picture, inspire a difference. "Active photography" is to make a difference, take the picture, put down your camera, put on the blue gloves, and stanch the wound ... We need more wound stanching ... Jim Wilson

Crazy Bucket List

Not in priority order ...

1. Landscape back yard ... add low (e.g., 6-8 inches) natural stone wall (flattish arc/ogee curve) to match front wall, level/improve soil behind, lush grass (thyme/lavender flowing over wall, steps ...), improve/repair drainage.
2. Update bedroom #2 ... evolve it towards AppleTV/reading room, upstairs den, guest room, crib for pro from Boulder.
3. Ride Colorado Trail -- in segments -- Denver to Durango, c. 2011-2013.
4. Buy/split lightweight (29er) mountain bike with Nate ... he gets it fall for racing, I drive it rest of year ... (Can't do Colorado Trail on single speed ...)
5. Buy undervalued (town)house in Tucson (Sabino Canyon) ... make it training site for friends/family, perhaps rent same ... (helps with taxes ...) ... snowbird getaway during (oncoming) dotage, ice age ...
6. Expand vegetable garden out front (more of same ... lots more ...)
7. (Carolyn) Usher Avery to Australia or exotic locale during gap year ...
8. Return to Mallorca ... visit Girona ... 25th anniversary?
9. New windows/argon double/triple pane throughout house ... seal house to make very energy efficient.
10. Reorganize electrical/components to eliminate/reduce vampire systems (easy).
11. 27" LED cinema display for MacPro (old cinema display goes to BR #2 w/Apple TV) ...
12. Bicycle Cairo to Khartoum with Tour de Afrique (2012?), later Khartoum to Addis ... Capetown? Maybe Ave would want to join segment(s) for gap year project ...
13. Link LeAlem with Partners in Health (Paul Farmer).
14. Work with Greg Mortenson and/or Farmer ... do photo documentary, fundraising book.
15. Get back to Alta this winter ... or perhaps Sugarloaf/Sunday River (Jean).
16. Build a product for iPad.
17. As prep or alternate to Colorado Trail, ride Great Allegheny Passage, Cumberland to Pittsburgh. Better ride Shenandoah Mountain 100 (in segments). Better, do them all ...
18. Migrate, update photo collection, e.g., canvasses in LR.

Overall, be the best father and partner possible. Help folks reach their highest star!

Week in Bend (and other places)

June 19-29, 2010 -- "Vacation" seems to mean other things. I'm working on a photography book with Kevin Dillard, tentative title Urban Cycling 2010, which will portray not just the grit and massive hard work of competitive athletes riding bikes, but also the surrounding urban culture. A couple weeks ago I traveled to Philadelphia to photograph the Philadelphia International Championship, a pro race. That turned out pretty well (preliminary selections here). Subsequently, Kevin and I covered a pro-am race in Arlington, Virginia. On Saturday, June 19, I drove to New York City to cover the Harlem Skyscraper Classic, an astonishing event and locale. As in Philadelphia, the day before, I walked the course area and captured some of the scene. I was taken by a drum circle in Marcus Garvey Park, children cavorting and extraordinary body builders.

After the prelim work Saturday, I wrestled with about two hours' traffic across George Washington Bridge and to South Orange, New Jersey, where my cousin Stony recently opened a restaurant -- "Stony's" -- across from the train station. About ten family members and friends forgathered and had a great dinner on Stony's beach-themed patio, rollicking to live music, downing cold beer, tuna, little neck clams and such -- all great. I overnighted with cousins in their old farmhouse in South Plainfield.

Sunday, I woke early and drove to Maplewood, home of James Ricalton, my great grandfather who was a distinguished photographer, schoolmaster and world traveler. (Ricalton walked from Capetown to Cairo three times, was Thomas Edison's first cinematographer and world-traveling research assistant on the light bulb project ....) I breakfasted there with the head of an NGO that is doing important work in maternal and child healthcare. We may work together on a project in Africa. I then made my way from Maplewood to Harlem for a day of picture-taking -- great stuff. Sunday evening I traveled home, but found the New Jersey Turnpike frustratingly clogged, so I overnighted in Princeton, and drove the rest of the way Monday morning. We caught a 5 PM flight from Dulles to Portland, Oregon, and drove to Bend, arriving about midnight (3 AM eastern time).

About 20 folks (riders, coaches, parents and alum) from the National Capital Velo Club U19 squad I direct are in Bend. We had a great time, supporting some very strong riders, dining and partying about the vacation town. On Wednesday, Carolyn and I rode most of the way up Mount Bachelor from our house, an 18-mile climb. Carolyn has become very strong and I'm a bit thickened (she was riding better than me on Bachelor) ... so I'm energized to work a bit harder over the rest of the summer to regain my form and endurance.

Our fourteen year-old star Shane Scoggin crashed out in the tight, one kilometer criterium Wednesday. Pulling away from the lead chase group on the last lap, he overcooked a corner and went down, a chaser ran over him; he was pretty banged-up and blotched with road rash, nothing too lasting (except the desire to win next year!). Thursday, we did time trials. We had some good results and an even better dinner party on our house deck. Friday, our older cohort rode criteriums in downtown Bend, and Saturday/Sunday long road races for the national championship. My 16 year-old son Avery raced 40 miles and my 19-year-old son Nathan raced 96 miles on the rolling Awbrey Butte course. We fed and cheered our boys and teammates each lap. Nathan and his teammate Kevin Gottlieb both got away at times during the long race, earning plaudits and a write-up in VeloNews.

Working with beginning to top elite athletes is remarkable. These kids press so hard, undauntingly over many years to reach -- or to reach for -- the top. Thousands of miles training, grueling races like New Mexico's Tour of the Gila, Oregon's Cascade Classic or Massachusetts' Fitchburg/Longsjo Memorial. The kids focus on cycling and abstain from many adolescent engagements not conducive to top performance. Often the greatest reward is just a brief run off the front of the pack followed by a bunch finish, day after day, faces caked with salt, cheeks drawn thin. Then breakthroughs happen, and racers climb the ladder to yet greater competition. It's a virtuous cycle. We're getting there.

Sunday and Monday we'll do some exploring and relaxed bike riding in the mountains. We return to Portland for an early morning flight home Tuesday.

Bend is very beautiful. In late June, the mountains remain covered with snow above about 6,500 feet. There are many crystal lakes in the hills, and the beautiful Deschutes River tumbling down from Bachelor and through town. Lovely parks and many tens of restaurants -- taco shacks to haute cuisine. The sounds and stresses of a major bike race -- time trial countdown clocks, slapping chains and cogs, tympanic wheels, chaotic feed zones, cheering crowds -- mesh well.

Above and here are some pictures from last year's trip, using my big camera, a Canon 5D. Below are some snapshots I took with my pocket camera, a Canon G10. (Not too bad.)

Allbest -- Jim

Philadelphia International Championships (June 5-6, 2010)

I haven't blogged for a while, except the Dillard/Wilson book preso. I did a lot of connecting when I was in Africa, writing about the poor women and children, AIDS patients, suffering -- a reach across a large ocean, to stay in touch, proportion emotions, and float some pics (Aduare slideshow). That went pretty well; we're helping a few hundred indigent children each month. Now, I'm looking to do a non-profit survey in Haiti this fall, maybe Darfur in spring.

I used to write compulsively about photo technique, learning and stuff (e.g., '1/1250 @ F8 x ISO 400' ...). Now I am in Philadelphia, to cover the International Cycling Championship, gather material (I hope) for our book. Let me start by saying a number of things: Philadelphia is an awesome city, great architecture and public art. DC, where I was born, is nice, but my informal measure puts Philly over the top. My good friend, JudyB, a child of Philadelphia, should know, she wins! What a beautiful city. My ancestor, James Wilson, sits perpetually on a podium at UPenn, and I collect shallow heriditary remittances. But look at this art and architecture (front of museum, 'Rocky's steps' ...), awesome!

I'm shooting tomorrow's bike race with a high end portrait lens, a 135 mm F2L atop my full-frame Canon 5D. Not a sport lens, my zoom. Why? Well, to me it's about the people, yes the cyclists are awesome, churning massive watts up Manayunk Wall (a horrendous pitch), but it's getting the people that marks me as worthwhile. Look at this fellow, sitting in Love Park. Says a lot to me about the world and society.

Alas, we will see. Oh another thing to say, I'm so proud of my cycling family. All raced today at Church Creek time trial (near Cambridge, MD). Ave pulled down a silver for Juniors, and Care (W4) and Nathan (Cat 1) hit personal marks for their distances. I ride recreationally, but am off the back compared to these horses (challenges!). Anyway, Venga to team W! We're off to Bend in a couple weeks for national road championships and healthful riding for the rec-level rents.

More later.

Dillard and Wilson partner for Urban Cycling

May 18, 2010, Washington, DC – Kevin Dillard and Jim Wilson today announced their partnership to produce an exceptional book and photography products portraying urban cycling, focused on athletes and people of all backgrounds. "We love cycling, the dynamism of riders in competition but also, more importantly, the people, the pathos, inner beauty and passion we see at bike races."

Wilson and Dillard are well-regarded local cycling photographers, fans and hobbyists – with some professional credits, published by PBS, Washington Post, DCist and national and regional cycling mags. Proceeds from this year's collaboration will be donated to charity, one yet to be determined, but one that "makes the world a better place for kids in our area." (Suggestions welcome.) At minimum, products will be self-published, though Wilson who has published under Prentice-Hall hopes to land a larger press.

Dillard and Wilson's current plans for venues to cover are:

• Wilmington Grand Prix (NRC), May 22, Wilmington, DE
• BikeJam, May 23, Baltimore, MD
• Philadelphia International, June 6, Philadelphia, PA
• Clarendon Cup, June 12, Arlington, VA
• Skyscraper Harlem Cycling Classic, June 20, New York City, NY
• Capital Criterium, July 11, Washington, DC

Dillard will have an ‘against the wall’ studio set at this weekend’s BikeJam in Baltimore, while Wilson will mix it up about the course and crowds.

For information or suggestions, please feel free to drop Jim and Kevin a note at mercImage@gmail.com.



Dillard and Wilson are working under the brand mercImage -- a conjugation of merc (speed), merci (thank you), mercy (care), Image and mage (magician). Look forward to an opening of the http://mercImage.com web site in the near future. Jim and Kevin’s individual web sites are http://images.jamesrwilson.com and http://www.demoncats.com.

SV 13-14 Closing Up and Logistical Notes

Site Visit Day 13-14 (Saturday-Sunday) -- Magical Saturday finish to January 16-31 EHN/LeAlem site visit. Several morning patients, including aged pastoral woman requiring two levels of translation -- from Oromifa to Amharic, from Amharic to English. A beneficiary mother and child, both receiving treatment. Met Alemayehu's 84 year-old father, Dinku, who lives 185 Km north of Addis (he still herds a few cows). A grateful patient whose daughter I know in Washington sent several gifts -- goat skin sandals, an ethnic shirt, and a copy of the Quoran. Most amazing and generous, social worker Almaz threw a party at her compound in north Addis. We had extraordinary foods, a traditional coffee ceremony (bean roasting on eucalyptus fire, then grinding and brewing), followed by an exhilarating dance party with about ten children -- LeAlem family members and friends -- going wild. Also, many fine gifts from Alemayehu and colleagues. I reciprocated with a lot of gifts I'd brought from DC. I was overwhelmed, nonetheless.















The town is partly shut-down due to the African Union summit. The zone between the Hilton, Sheraton and Africa Center (ECA) is chock-a-block with machine gun wielding security personnel. Cars are not allowed to pass and much traffic is at a standstill.

Sunday, I got up early and packed. Great breakfast at "Parisienne Cafe." Later, Alemayehu and I drove to the top of Entoto mountain, at 10,000', site of King Menelik II's palace before his wife Queen Taitu led him to establish the present capital 2,000' lower, Addis Ababa (new flower). After our hike and tour of the old palace and 700 year-old church and sepulchre nearby, we lunched and returned to Allemayehu's house to spend a comfortable afternoon with his wife Wolansa and son Joshua. Of course, I was sated by more great food, coffee, bread and honey. At the aiport at 7:30 PM for 10:15 PM departure. Scheduled arrival Monday morning.

Logistical Notes

On the logistical front, many things about the trip went well. I'm a bit compulsive when taking big trips -- they're once-in-a-lifetime experiences and one missing part could be pretty disruptive, particularly on the technical front (e.g., forgetting a camera battery charger.) Also I carry a lot of technical stuff -- cameras, lenses, and computers, -- and this trip had unusual heathcare issues, such as visiting HIV/AIDS patients.

Not to be too exhaustive, but here are a few tips that made a difference for me.

• Expect communication failures In Africa, where English is usually a weak second language to native tongues, communications get jumbled and folks you are speaking to often say "Yes. Yes." when they don't understand. This trip, for example, when I checked-into my hotel I asked to extend my reservation to January 31. The clerk said "Yes" but he heard "21" and, as a result, I had a guy knocking on my door asking me to leave way too early. Luckily, I carried copies of my confirmation letter from the hotel and battled to stay longer ... then downshifted to a cheap guest house when I could extend my stay no more.
• Bring lots of documents Related to the above, I brought lots of documents, full copies of my vaccination records, business visa letter, print outs of Google maps for the Addis area, lists of phone numbers for contacts, country maps, the mix. It is very hard to get good printed information once on the ground. For Ethiopia, the best guidebooks I found I bought on Amazon in the US.
• Know the US Embassy 24x7 phone number When I got bad sick, this was invalauble. The emergency number -- embassy "Post One" -- connected me with a medic who talked me through symptoms and course of treatment. Really helpful in an unfamiliar place, when faced with a complex problem.
• Photographically, be excruciatingly clean Addis and probably most north African countries are dust bins. Two minutes out of the hotel and you have a thin layer of dust on your clothes and camera. So, try to keep everything sealed-up. Don't pull your camera from the bag until you need to take a picture, bring a couple canisters of compressed air to clean-up at night. I used a damp washcloth every night to wipe down the exterior surface of gear bags. I never changed a camera lens except in my hotel room, after I'd taken a shower or bath. (The bump in humidity keeps the dust down.) Also, I kept lots of back-ups on multiple media: on computer copies, external USB back-up, CF cards (never re-used cards while on travel), internet photo site, burned CDs/DVDs ... as noted, this type thing is a once-in-a-lifetime deal, and I don't want to chance data loss.
• Clothing I'd traveled in Ethiopia, Egypt and similar places before, so I had a pretty good idea of what to expect, including visiting slums and interacting with sick people. I pretty consistenly wore an L.L. Bean safari jacket, sort of like a canvas sport coat with extra pockets. It was a good barrier against the dust; I'd shake it off at the end of the day -- $59 at post-Christmas sale (I wish I had brought two!). I generally wore light, long sleeve shirts, including the "Buzz Off" anti-insect variety. Seemed to work well. For pants I'm a devotee of Columbia khaki trousers with a zipper pocket inside the right-hand pocket. Put my wallet and stuff I didn't want pick-pocketed there. $49 on sale at REI; I think I own six pairs, traveled with four. I wore trail sneakers and cushy socks most of the time. I brought a sport coat and ties for fancy meetings.
• Healthcare and personal protection For health protection I always carry blue EMT gloves (even when home) in case I need to get involved with someone else's body fluids. I took my EMT kit when visiting slums. I avoid letting children touch my face, and I brought six bottles of Purell alcohol gel cleanser to sterilize my hands quite often. I made a mistake picking-up one child with Typhus, but I scrubbed down afterwards. I put on SPF 30 sunscreen before heading out each day. Addis is above 8,000' so I drank lots of water -- and I only drank bottled water, not tap. I had an episode of food poisoning; Alemayehu speculates it was some uncooked cheese. I'm uncertain. I had many vaccinations, a few more than usual due to my healthcare work -- Typhoid, Yellow Fever, Hepatitis A/B, Rabies, Diphtheria, Pertussis, Tetanus (DPT), H1N1, Meningococcus -- and I brought Ciprofloxacin, Malarone for malaria (didn't take it), various pediatric and adult analagesics, Lomotil, Pepto Bismal and such. One thing the embassy medic suggested was carrying packs of moist baby wipes; I didn't, but I carried TP in my bag.
• Drivers You probably don't want to drive in Addis -- it's a very complicated place without good maps and most drivers negotiate every intersection, rather than paying attention to signals. Pedestrians (and goats, cows, sheep, donkeys ...) walk randomly on the road and, by law, they have the right-of-way. Ethiopia liability laws are heavily weighted against drivers. I had drivers from LeAlem, took a few taxis or often walked to get around.
• Lodgings I did very well with lodgings, at both ends of the spectrum. At $100 US per night, the Jupiter International Hotel (Kazanches) proved ideal. A short walk from LeAlem, clean, good restaurant, free breakfast and -- key for me -- free Wifi. This compares to the Hilton, about a kilometer distant, at about $200 discount rate (no free Internet), and the closer Intercontinental, also about $200. Pictured below is the Jupiter lobby/bar, where I spent time watching soccer, lunching, listening to jazz, and working on my laptop. At the other end of the spectrum, at $25/night, was La Source Guest House, in the Meskal Flower district. It was cheap but very clean and safe, endearing native art work on display. (I had to stay there when my Jupiter reservation lapsed).

All in all, a great trip, enjoyable, and, I think, good for people I care deeply about.

LeAlem 2010 Picture Library
EHN Blogs

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Post -- Home safe in Arlington Monday morning 11:00 AM. Good flight. Time for hot bath, laundry, dog walk ... back to my real job tomorrow!

SV11-12 -- LeAlem, St. Yared and OSSA

Site Visit Days 11-12 (Thursday-Friday) -- Relaxed Thursday. Highlight was morning move from Jupiter Hotel to La Source Guest House, an inexpensive ($25/day) pension off Gambia Street, in Meskal Flower district, a few kilometers from LeAlem. Several EHN beneficiary patients treated on Thursday, with illness ranging from ear infection (follow-up exam and irrigation), psychiatric treatment, to hypertension. Several Thursday-Friday case study pix below.







Arose early Friday. Productive, but mildly exhausting day. Pension breakfast, followed by macchiato at Kazanchez plaza, near LeAlem. 35 cent macchiatos are stunning, tasty. This trends from birth of coffee in Ethiopia and five-year Italian occupation during Mussolini reign. Fairly busy beneficiary intake Friday, about 15 total. Mid-morning travel with Dr. Aleymayehu to St. Yared Hospital near Bole to meet its director, Dr. Akeza Teame. We visited St. Yared in 2007, when it was a Higher Clinic.

I was interested to learn about St. Yared's evolution to hospital status, which entails an increase in facility size, patient volume, and broadening of departments. Expanding LeAlem to a hospital is a long-term option Alemayehu is considering. Our visit found St. Yared a very impressive facility, with 4-bay emergency department, CAT scan, ICU, NICU, two inpatient floors and much more, in a 6-story building. Unfortunately, St. Yared is underutilized and expensive. In its first year of operation, 2008, St. Yared treated 5,000 patients. By comparison, in 2008 LeAlem treated about 15,000 patients, although LeAlem is about 10% the size of St. Yared.

I reconnected with a doctor who I'd met at St. Yared HC in 2007 and Alemayehu connected with the director and doctors he knew on staff. While mixing EHN's beneficial care model with St. Yared's high-cost model may not make sense, we did establish that St. Yared could be a partner for rotation of medical students and residents from George Washington and other schools. The hospital currently has student rotation programs with New York's Albert Einstein Medical School and University of Kansas. My thought is, for the longer term, EHN/LeAlem might collaborate with St. Yared to provide an Africa community health internship or residency opportunity.



After St. Yared, I lunched with Organization for Social Services for AIDS (OSSA) Addis Ababa manager Paulos Kenea. I'm interested in partnering with OSSA. OSSA has HIV/AIDS operations in 11 of 12 Ethiopia regions, including multiple locations in the capital. Broadly stated, EHN's mission is to provide healthcare where there is none. Our program with LeAlem in Addis focuses on indigent women and children. As this is successful, we anticipate moving to establish needed healthcare in additional Addis locations and in rural areas, where there is no healthcare.

-- Almost all rural children are born without professional medical assistance, and there is not antenatal care. Many infants die. --

Partnering with OSSA, which reaches into rural areas through its HIV Voluntary Counseling and Testing (VCT) programs (mobile unit pictured above), may prove an efficient vector for EHN. Along these lines, after lunch, Paulos and I toured OSSA's VCT, palliative care and HIV/AIDS support facility inside Merkato, the sprawling marketplace (Africa's largest) at the heart of Addis. The facility is a fixed compound, a building with reception and about 12 patient rooms, and several outbuildings.

A concept is that LeAlem could rotate doctors through the OSSA Merkato facility, meeting indigent persons' healthcare needs, expanding EHN's program (without incurring huge overhead). This partnership and care delivery model might be replicated in rural areas.



Correspondingly, OSSA is interested in EHN support -- advocacy, at minimum -- for a nutrition program. OSSA patients, many of whom are on anti-retroviral therapy (ART), most often fail due to nutritional insufficiency. ART drugs need to be taken with food. Two OSSA ART children died last quarter due to poor nutrition; pediatrics on ART with good nutrition typically thrive. (HIV-positive twins, under OSSA care, are pictured above.) In response to a site visit interrogatory, Dr. Alemayehu identified nutrition as the most important collateral issue impacting the success of LeAlem beneficiary care.

On receiving a nutritional support grant (funding) request from Paulos, I told him that EHN's mission is focused on the current healthcare model, but that I would work to identify patrons and support to answer his request. I suspect that $100,000 per year is required to provide nutritional support for the 5,500+ households under OSSA care. Perhaps this is something to consider with the Clinton or another foundation.

Having dinner tonight with a referral partner from large Addis evangelical church. Partner is interested in EHN funding a dental clinic. Clearly this is an unmet need; dental hygiene is noticeably poor in the indigent population. My concern, however, is whether providing dental care is the best use for EHN resources and our intent to provide the highest-value, most beneficial healthcare for patients. I'll present our partner's suggestion to EHN's board for review.

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While in Addis for two weeks, my (volunteer) job has been to conduct a formative review of LeAlem performance under EHN grant, develop case studies (including pictures) of beneficiary patients, and meet with current and prospective EHN partners. The subject matter is extraordinary, at times heart-rending. It is in situ -- and sometimes on-the-fly -- public policy and program development, made vital by the context, our proven results at LeAlem, and opportunities to make a bigger difference. As a going-in product, I developed a 29-page site visit plan, with introduction, conceputal framework, interrogatories, data collection tools, resources and such. My evolving product, which I hope to finalize by February 28, will be a report presenting findings, recommendations, anecdotal case studies, and additional material. EHN will use the report to shape program direction; produce material for media, fundraising and extramural support; report to donors, and for similar purposes.

Tomorrow, Saturday, I'll spend the morning at LeAlem in wrap-up mode, followed by a party at social worker Almaz's house. Sunday, I'll probably take a last long walk in central Addis, perhaps visit a museum and hit a few shops. Then, it's the airport at 7 PM, fly home, arriving at Dulles Monday mid-morning.

Thanks all. Very warmly, Jim

LeAlem 2010 Picture Library
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SV10 -- LeAlem ER and Home Visits

Site Visit Day 10 (Wednesday) -- Big day today, from several perspectives. Walked five miles from hotel (Kazanches), up around Black Lion Hospital (picture 1) to Piazza, through Churchill Road shops, and back. Arrived at LeAlem about noon. While I was waiting outside Alemayehu's office, a 21 year-old beneficiary, Tewodros, was carried into the clinic by friends, screaming. He was lifted onto a gurney. Tewodros writhed and beat his stomach. Dr. Yilkal attended to the patient, auscultating, palpating abdomen, and providing chest x-ray. LeAlem laboratory provided white blood cell count and blood sugar tests. All were normal (and paid by EHN). Patient had taken meds without food, which may have caused abdominal pain leading to, diagnosed, severe anxiety episode. Dr. Yilkal put patient on placebo IV drip, which settled his condition. Tewodros slept (picture 2).

Met with church official who is a referral partner for EHN/LeAlem. Subsequently, traveled with Organization for Social Services for AIDS (OSSA) to mobile Voluntary Counseling and Testing (VCT) center, a truck with three counseling rooms in first segment, and test lab in second segment (pictures 3-5). Test lab produces results in 30 minutes. OSSA VCTs operate all over Ethiopia, serving tens of thousands, an integral component of the country's HIV/AIDS strategy.











After VCT visit, proceeded to home visits of OSSA HIV/AIDS patients and affected children (pictures 6-10), Aduare neighborhood, Addis Ababa. Met two young HIV-postive twins, AIDS orphans (picture 6), their aunt and two cousins, all living in one-room, one-bed home. Visited several other homes in destitute slum, photographed swarming children, patients and impacted community. Black and white, at bottom, is end-stage patient.

We are so lucky.











Returned to LeAlem for report follow-up, discussion with colleagues (they met 'til 10 PM last night, working on report). Having lunch with OSSA director Friday (OSSA is a referral partner for EHN/LeAlem). Wrestled with logistical challenge of finding new hotel in town filled by African Union congress; ultimately successful, a $25/night guest house, but I think I'll have reduced Internet access. My Lonely Planet guidebook gives it a good mark.

Estimate that Thursday will be a long day, hotel move, patient case study work, and working late with partners to craft next report draft. Friday will be busy closing sprint, meetings (if possible) with US Embassy personnel and Addis hospital director, lunch with OSSA director, and dinner with referral partner.

LeAlem 2010 Picture Library
EHN Blogs