SV2 -- LeAlem and networking

Site Visit Day 2 (Tuesday) -- Short post today. Most of day spent at LeAlem, case study and report writing. Today is a national holiday, Timkat or Epiphany, celebrating Jesus' baptism. This kept clinic volume lower.



Did a lot of writing, conversation with LeAlem partners, coffee fete in courtyard (brewed over embers) with all staff. Case study subject today, imaged above, is pastoral woman presenting with acute gastritis. She lives in one room house, sleeps on ground with two children, sells candles near church. Her husband is deceased. She's proud of her children, her son having completed ninth grade (dropped out to support family) and her daughter continuing at tenth grade level.

A subject explored in today's writing and through email with EHN board is that nutrition is a critical co-factor to medical care success. Some medicine should not be taken without food, and poor nutrition, of course, fosters illness and deficiency. I'll look into network partners who may be available in Addis to help, or mark issue for future research.

Dinner tonight with US Embassy friend and LeAlem colleague (social worker).

LeAlem 2010 Picture Library
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SV1 -- LeAlem and Atetegeb

Site Visit Day 1 (Monday). Walked to LeAlem for first site visit. Met key EHN staff -- Medical Director Dr. Alemayehu, additional doctor, laboratory director, and Gashaw, Abeje, and Almaz, social workers and program staff. Very impressive team. Observed patient intake for seven-year-old Desta (pictured below with mother) and documented case (e.g., income, living conditions, education, nutrition); learned about intake and referral structure; supporting HIV/ART and tuberculosis programs; network partners (churches, mosques, NGOs, local government healthcare organizations); obtained copies of partner relationship agreements and referral templates; learned LeAlem staff backgrounds and capability; toured LeAlem facilities, and more. Very busy day. Alemayehu saw c. 50 patients, clinic saw 100+ patients.



Very striking was afternoon visit to Atetegeb Worku Memorial Childcare Association facility in north Addis (assistant director Temesgen pictured at top, with child). Atetegeb, described by Melissa Faye Greene's There is No Me Without You, was remarkable. Joyous children, primarily AIDS orphans, age 11 months - 15 years. Most in good health, one (11 month old) suffering from failure to thrive (image below, with nurse).



Atetegeb is facing financial pressure due to completion of USAID grant for remote program in Bahir Dar and Debre Tabor (about 500 Km north of Addis, near Lake Tana) and pending completion of term with Hope for Children USA. Atetegeb facility fees are approximately $700 per month (not including salaries). Atetegeb pays for child medical care, including routine pediatric examination and advanced care (e.g., hospitalization, specialist visits). Due to strong mission alignment, EHN preliminarily agreed (subject to agreement by Alemayehu) to assume medical care for Atetegeb children, including pediatric exams, referrals and specialized care. This will reduce Atetegeb cost burden. Additional areas for prospective collaboration were discussed (e.g., Debre Tabor health program) for longer term, as EHN program matures.

Enjoyed traditional Ethiopian coffee with Atetegab Executive Director Sosina Tefarra, assistant director Temesgen, and staff. For me, a somewhat sedate Washingtonian, 30 minute drive from LeAlem to Atetegeb was notably exciting. Very fast driving, pedestrians, animals (donkeys, etc.), cars and buses zigging every-which-way, citizens marching in Epiphany parade ... apparent chaos, but no vehicular fatalities.

Site visit plan has proved very useful, established framework shared by team, and tools and interrogatories for data collection. Given productive day 1, much writing to do. Pictures look pretty good; only a few uploaded here b/c of hotel bandwidth constraints.

LeAlem 2010 Picture Library
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Abyssinian Casbah

That's a good way to describe this weekend, Abyssinian Casbah. I love Ethiopia, the Ethiopian People, the intricate and complicated capital. Many contrasts.

My 24-hour airport-to-airport, Dulles to Bole, excursion left me tapped, but I wanted to synch with East Africa Time, so I took a five-mile walk through central Addis Saturday afternoon. Hot dry dusty diesel fumes, the poor and desolate in every crevice. A man missing his legs. A beautiful infant, about ten months, in her mother's arms, raised to my face. A grandmother folded, parched on the sidewalk, moaning. My self-appointed tour guide, a very smart guy who started as a shoeshine boy by the UN compound and now works as a dishwasher at my hotel for $5 US per month. Ethiopian Birr notes and coins slip from my pockets, given as slim fodder. Billionaire Prime Minister Meles Zenawi’s palace, the opulent Sheraton, and fenced-off enclaves sit opposite tin hovels and open sewers.

Saturday night I reconnect with Mesay, a friend from my 2007 trip and his girlfriend, Ida. I give them photographs and Obama shirts. (East Africans are passionate Obama fans; several Addis restaurants are named “Obama Cafe” or “Obama Coffeehouse.”) We go to an old favorite for supper, Yod Abyssinia, spicy food, tibs and wat in a large pan of injera, live music and hyper-energetic tribal dancing. The crowd joins in, some jumping on stage. A wedding descends on the Yod, about forty people holding sparklers and flaming punks. Singers ululate. It’s wild. Many beautiful Africans, ferenge (tourists) jaws agape holding cameras.

Sunday I wake about 7 AM and meet Dr. Alemayehu, his wife Wolansa and eight-year-old son Eyasu (Joshua) at 9:30 AM. We have coffee and go to Gospel Light Ministries church for 11 AM service. Then we lunch into the afternoon.

Alemayehu and Wolansa met while graduate students in the Ukraine, Alemayehu studied medicine and Wolansa economics. Dr. A. worked for several clinics and hospitals, where he performed a range of practice, including internal medicine, pediatrics, and obstetrics. Among his most intensive education was serving as a military doctor near the front in Asmara, Eritrea, when the Ethiopians were at war. In 2006, he established LeAlem -- “Serving All” –- a private clinic in Addis. The Health Ministry designates LeAlem a “higher clinic,” a level below hospital.

Though our time was informal, our personal interests and EHN vision seemed congruent. Alemayehu described his grueling work schedule, as well as his success compared to other practitioners. Tonight we will have a more business-oriented supper meeting, reviewing the site visit plan, framing questions and anticipated interviews. Tomorrow, Monday, I begin observation and case study development at LeAlem.

Returning to the Casbah theme, Gospel Light service was stunning and joyous. The first hour was gospel music and dancing, with ululation and celebration among several thousand congregants. (Like a few other non-Ethiopians in attendance, I had simultaneous Amharic-to-English translation via radio earphone.) The music was followed by devotions and a sermon of about an hour. I saw and embraced several officers and parishioners I met during the 2007 trip. Remarkably, the young man stricken by juvenile onset polio whose picture I took in 2007 (below) stood in the pew immediately in front of me. The Casbah has almost become familiar.





“Mega churches” in the United States make me anxious, but those in Africa do not. The need for hope, spiritual relief and popular representation is severe in Africa. There, churches are transformative social and charitable engines, for example, helping end Apartheid and supporting AIDS orphans. Gospel Light is a partner with EHN, along with other churches, mosques and Addis Ababa social service organizations. They work together to qualify needful patients and provide treatments that result in improved health and ability to maintain families and attend school.

Details to come.



LeAlem 2010 Picture Library
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Hopeful work in a sad place

Up early today. 2:00 AM Washington, DC, 10:00 AM Addis Ababa. Transitioning to East Africa Time. My plane leaves Dulles at 9:30 AM, arrives in Ethiopia 8:30 AM Saturday. I'm going to a sad place, with beautiful people, to do hopeful work. Received a bunch of nice phone calls and communications. My son at college in Boulder. Our cycling coach; she is going to throw a fundraiser at her shop in Herndon, perhaps, later, a benefit bike race. My mother-in-law. Dad. Friend at the U.S. Embassy in Addis. My driver Mesay, an old friend. Cyclists with material to donate. A gifted writer with Ethiopian children.

Yesterday morning, I spoke to Raj, my friend and Swings barista. He's going to Nepal, his home, Sunday. I mentioned Ethiopia. Alfeau, another barista at Swings, her father is very sick, in Addis; he lives behind the Hotel Concord. I said "Can I do anything?" Her English is not good. Her friend, an Ethiopian at the IMF, came over for an impromptu meeting. (Small world: He knew my good friend who headed IMF press and pubs, an EHN benefactor ...) Alfeau's father has Type 2 diabetes. Could I bring him medicine? But there is not time to fill a prescription. I asked medical questions. He has no money. His medicine costs $30 in Ethiopia, perhaps three month's income. I will take him to the EHN clinic and buy the medicine.

Wednesday at Men's Group, Western Presbyterian Church, we were unusually reverent. A friend spoke of the recent tragedy, the earthquake in Haiti that killed, likely, tens of thousands. How can there be any God? Such cruelty. I believe there is God, but his scale is different, in many ways imperceptible, a thin monolayer. In this ether we are given choice and opportunity to make things better. A reason we die is to make life meaningful, so we do important work. There is an apex where we get little pleasure in climbing higher, material gain, rank or whatnot; and we hopefully, necessarily turn and give back. Whether it is nurturing children, helping youth gain confidence cycling, or cleaning an invalid's spoils. In aggregate, the world becomes a better place. That's my gut.

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Time for bath, final packing. Care is driving me to Dulles. Internet access in Addis is weak. I'll write, take pictures and post when I can.

John Wimberly wrote, "Vaya con Dios." We'll see.



LeAlem 2010 Picture Library
EHN Blogs

LeAlem Progress Report, December 2009

In the third month of Ethiopia Healthcare Network (EHN) grant performance, December 2009, LeAlem exceeded benchmarks, providing healthcare for 168 economically disadvantaged children and women in Addis Ababa, Ethiopia's capital. LeAlem strengthened networks and partnerships with churches, mosques, governmental organizations, non-governmental organizations, and others to recruit beneficiaries and best address needy people. LeAlem Medical Director Alemayheu Dinku Gebrehiwot reports: "All the systems of healthcare service delivery are functioning well and have been strengthened. The binocular microscope [funded by EHN] to enhance the healthcare service by performing different laboratory procedures was purchased."

Patients treated ranged in age from eight months to 80 years; 87.5% were women and 36% children or youth under 20 years of age. 99% of treated patients had income under $100 US per year; two patients (1%) had income between $100-$200 per year. Patient outcome level is based on the diagnosis and treatment given. During December, 29% of the patients were relieved from their pain, 24% were cured, 7% of the patients’ health status is improving, and 6% of the patients’ health status is improved. 3% of the patients are under follow-up, and 14% of the patients are under treatment. In addition, 15% of the patients were referred to hospital for services which are not available in LeAlem Higher Clinic.



Presenting symptoms included: Cough, night sweating, and loss of appetite; burning pain over the legs; dysuria, fever, chills, and back pain; undeveloped language skill; trauma to the right hand 5th finger and abdominal pain; irregular menses; flank pain and epigastric pain; joint pain and amenorrhoea; vomiting, ear pain, and eye pain; joint pain and on ART (anti-retroviral therapy); uterine prolapse; swelling over right foot; itching of the eyes and dysuria; poor vision and swelling over anterior neck; poor appetite and had hepatitis; general weakness and abdominal discomfort; epigastric pain and heart burn; abdominal pain and loss of appetite; fever, weight loss, cough, diarrhea, and vomiting; poor appetite, fever, yellowish eyes, and joint pain; decreased appetite, red urine, fever, and headache; cough, chest pain, fever, decreased appetite, dysuria, and flank pain; leg deformity; poor feeding; poor appetite and weight loss; fever, joint pain, headache, and sore-throat; supra pubic pain and itching over legs; tension, sleeplessness, and weight loss; pain over breast; backache and vaginal bleeding; flank pain, dysuria, and rashes over the loin; pin over operation site with discharge; scalp lesion, skin rashes, and abdominal pain; delayed development; poor vision after cataract operation; poor vision, headache, and scalp lesion; fever, cough, and weight loss; tension, headache, malaise, and sound in the head; diarrhea, vomiting, and grunting; back ache, pain over thighs, and vaginal discharge; vaginal bleeding; ear pain and discharge; pain over leg, headache, backache, and dysuria; joint pain, sweating, and hot flashes; swelling over jaw, epigastric pain and heart burn; cough, chest pain, and flank pain; fever, joint pain, and on ART; chest pain, epigastric pain, and completed anti-TB drugs; backache and trauma; tongue lesion and on ART; double vision and excessive sweating; eye discharge and itching of eyes; unable to walk; chest pain and scar over it; epigastric pain and decreased appetite; eye pain with redness and discharge; pain over leg, palpitation, and dysuria; back pain, flank pain, and swelling over vulva; trauma to the face; failure to thrive and skin rashes; headache, fever, and cough; unable to conceive; polyuria and polydypsia; pain over eyes and poor vision; and accidental falling.

As to lessons learned, LeAlem reports: "We have learnt that the provision of the healthcare service with your kind support has enabled patients to continue their bread winning activities and schooling in the case of students; we have continued enjoying the soul satisfying endeavour; and we have also learnt that the beneficiaries are thankful as usual for the healthcare service they got. The team work as we do it regularly enabled for coordinated effort and synergistic effect."

For further information on EHN and LeAlem, visit our web site http://ethiopiahealth.org or email info@ethiopiahealth.org.

To Addis

Been hectic here. Next Friday I go to Addis. Leave 9:30 AM, arrive 8:30 AM Saturday, refueling in Rome. It's a nice flight, time to sleep and read. I've vaccinated and medicined up -- yellow fever, typhoid, rabies, hepatitis A/B, DPT, anti-malarial, Cipro, lomotil and such. I lost part of my EMT kit this summer at a bike race, so I restocked -- new stethoscope, CPR mask, airways, saline, wound care, PPE, glucose, splints, occlusives, etc. I'm not sure, but I may have some EMT work during the site visit. We will be looking at some unsupported locations, folks who need care. It will be sad in some ways, hopeful in others.

I'm traveling as a volunteer for a 501(c)3 non-profit I helped start in December 2008, Ethiopia Healthcare Network (EHN). When my mother died cruelly from ALS in 2005, my father reflected that while he had personal monuments -- books, stories, a play about his work, -- there was not a memorial that represented Joan, though she did wonderful things. We asked her pastor and he guided us to support a clinic construction project in Dukem, about an hour south of Addis Ababa. Impressed with the mission and church, I signed on, helping to raise and contributing a goodly sum. Fortunately, in a way, before we sank funds into construction, we lost title to the rural land (due to a reportedly corrupt act). I helped refactor the program as a non-profit corporation focused not on real estate construction but on efficiently providing care to needful patients, disadvantaged women and children. In November 2007, we conducted a survey in Addis, including visits to several clinics. I was very impressed by one facility and its medical director, LeAlem Higher Clinic and Dr. Alemayehu Gebrehiwot. After the land problem, we reached out to LeAlem and requested a proposal.

With EHN support, starting in October 2009, LeAlem hired a part-time doctor, social worker and nurse to provide healthcare to disadvantaged women and children. Results have been promising. Here's a summary from November 2009: "LeAlem exceeded numerical benchmarks set by the grant, caring for 103 patients. Ninety-two percent (92%) of the patients had annual income below $100 US per year; the balance had annual income of $100-200 per year. Ninety-seven percent (97%) of post-school age patients were female. Without EHN support, all patients would not have had access to professional healthcare. Patient outcomes were largely positive, alleviating suffering, treating disease, and supporting improved pre-natal and infant health. Patients were treated for a diverse range of diagnoses, including pneumonia, head injury, reproductive complications, pregnancy, diarrhea/intestinal disorder, gangrene, hemiparesis, urinary tract infection, seizure, candidiasis, asthma, metastatic cancer, adverse reaction to anti-retroviral therapy (ART), and Parkinson's disease."

We cared for 168 patients in December and my sense is that patients and service capability will continue to increase, partly owing to this month's trip. Interest and activity is burgeoning. I've several letters and resumes from medical school students who want to work in Addis as summer volunteers. Individuals with high net worth are looking into the program, we're organizing a fundraiser at the Ethiopian Embassy in DC, and more.

The purpose of my trip this month is to review grant progress, develop case study material, understand how we can best help, and develop relationships and ideas for future work. With EHN's Board, I wrote a 30-page site visit plan, providing background, articulating survey questions, and identifying contacts, from US embassy staff, to NGOs, social service providers and other clinics and doctors. The plan will help make the trip productive and facilitate writing an assessment and additional media.



The situation in Ethiopia is grim. Famine is projected by monitoring organizations. [USAID] Four million children are orphans, 500,000 from AIDS. Under-5 mortality rates are high. Less than 6% of women have medical care when they give birth. Average per capita income is $630 US. [WHO]

What EHN and LeAlem are doing is a small initial step. Our vision, though, is broad and resources sound. As noted by the plan, EHN is fortunate to be headquartered in Foggy Bottom, Washington, DC, blocks from the State Department, international development organizations, and a major university and medical school. EHN's Board is an exceptional team of medical doctors, individuals born in Ethiopia, well-connected professionals, and individuals with long-term experience with innovative charities. We envision drawing upon resources in Washington and helping them deliver value, and we envision EHN clinics and projects across Ethiopia networking together and with regional resources, NGOs, government and other organizations to provide care, alleviate suffering and improve outcomes.

The trip will be one positive step followed, I hope, by many.

Camera Choices

I received a pre-Christmas note from a friend on which camera to buy and I thought about it and wrote back. FWIW, I'm sharing my thoughts ...

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On cameras, the brand I've worked with is Canon. It's been good. I went there because I thought the digital color was strong and pro usage is pretty extensive ... though of course there are flame wars between Nikon and Canon. Both brands offer exceptional options. Here's what I've looked at and work with --

Point and Shoot -- the top rated two options are the Canon G10 (now the G11) or the Leica D-Lux 4. I bought the Canon G10 for about $500 and subsequently lusted after the Leica for about $700. (The Leica has some awesome image quality for a small camera and a certain elite appeal.) However, as I got used to the Canon, my lust faded. Leica, while nice, is too "precious" ... not as sturdy as the Canon, no auto lens cover, a little harder to set. The Canon G10 or G11 gives you a lot: Great image quality, the ability to shoot in RAW format (and, subsequently, edit/post-process native image files without loss of quality ... this is really important to me). Plus it has a pretty bomb-proof metal case and feels okay in the hands.

On the digital SLR, there are a lot of options. I started with Canon's Rebel for about $500, and moved up to the 5D (which cost new about $3,000). But, really, many Canon SLR bodies will be just fine, particularly as you get started. The key thing that makes the difference is the quality of the lens. The kit lens I got with the Rebel was pretty weak, about a $100 thing ... the images were never very sharp. My first higher end lens was the Canon 70-200 F4L, about a $600 deal (non-I/S). The damn thing delivers great results, all my shots at bike races (including candids) are from that lens, both on the Rebel and the 5D. Subsequently, I added the 24-70 F2.8L (the wedding "brick") and I'm probably going to get the 135 F2L before my next overseas trip. So, I'd recommend a reasonably inexpensive digital SLR like the Rebel or a used 20D or 30D, and spend more money on good glass -- which you'll keep using if you move the camera body up the food chain.

One advantage of the point and shoot is that it is portable and mostly self-contained -- e.g., it has its own flash, no need (or ability) to change the lens. The SLR is more complicated (and more capable, as you grow ... some pros, though, like Chase Jarvis think the iPhone is the best thing since sliced bread (mostly because it's easily ubiquitous ... if there's good light).)

There are lots of review sites out there. I think Fred Miranda is among the best -- http://www.fredmiranda.com.

So, these are my starting thoughts. Get something you like, that feels right, and shoot a lot. Henri Cartier-Bresson, my favorite photographer, said something like "Your first 50,000 shots will be bad, so get them over with." It's a great art form, and way to remember things you like, your family, the mountains.

The other piece of the equation is what you do after you take the pictures. I discussed this here.

Anyway ... I hope you have a great holiday and that photography brings you as much satisfaction as it does me.

Favorite 2009 Pictures

I probably took fewer bike race pictures this year than in past years, but I took more nature pictures. I think my quality settled down a bit. I had more fun. Here are a few favorites with comments. Originals are posted at http://images.jamesrwilson.com. You can click through pix to download high resolution or order prints.

Nathan at Fitchburg



This is my personal favorite. I like the black and white, the contrast of youth and harsh context. My son Nathan following a national-level road race where he fought to win second, solo, against the powerful Hot Tubes squad. A couple months past his 18th birthday. Nathan is an exhausted but matured warrior here, something I mark as a turning point. Nate continued the 2009 season to set ever higher marks, achieving Category 1, winning big races, besting pros, and riding to a silver at the USA Junior championships.

Chris Kelley at Kelley Acres Cross



I've known Chris over the years and been fortunate to grab some nice images. I like the ethereal lighting and how Chris's beauty and wisdom penetrate. Outdoors on her farm.

Andy Wulfkuhle at Capital Classic Cyclocross



This is "Bad Andy" Wulfkuhle, 2009 Pennsylvania Cyclocross Champion. (Apology -- I had mislabeled him as Wes Schempf in an earlier post.) I like this gritty image.

Joellen and Pam Mauch at Reston Town Center



Mother and daughter in the rain. I like this pairing, generational beauty with a sense of both je ne sais quoi and knowing.

Bobby Phillips at Turkey Day



The Baltimore Bullet is one of the winningest cyclists to grace our region. A friend, one who has given much. This shot is of Bobby as he memorializes his mother and father at the start of the annual race he hosts in Maryland.

Middle Child at Wilmington



This reminds me of a Sally Mann picture. The girl looks defiant and perhaps angry, her brothers watching the bike race, her mother laden with her next sibling.

Young Racer at Tour de FCCC



I like the lighting and color balance with his one, the strand of hair (click through to zoom). I recall that she won her class. Beautiful.

West Side Road, Mount Rainier, Nisqually Bridge







This was an important part of a journey for me, some time off in raw nature. I wrote a blog post on this.

Deschutes River, Mount Bachelor (USAC Nationals)



This was one of those virgin nature shots, refreshing. I grabbed it after an 80 mile loop riding around Mount Bachelor in Oregon. Makes me want to drink the cool water, put on my backpack and head out.

Ethiopia Healthcare Network

My next big round of photography comes in January 2010 when I travel to Ethiopia. I'll be working (volunteering) for the Ethiopia Healthcare Network charity and related programs in Addis Ababa. Below is a favorite shot from my Ethiopia work in 2007. These children in Dukem are yearning for (and need) healthcare.



Have a wonderful New Year! -- Jim

Questions for LeAlem

I'm conducting a site visit to LeAlem Higher Clinic in Addis Ababa, Ethiopia, on January 17-31, 2010. This is a scratchpad of thoughts for that trip, with background and draft vision and questions. Comments or suggestions on this blog, at Facebook, or email to me are welcome.

Background

We founded Ethiopia Healthcare Network (EHN), a 501(c)3 non-profit, in December 2008 and started the LeAlem project in October 2009.

About two years ago, in November 2007, John Wimberly and I visited LeAlem and met its medical director, Dr. Alemayehu (Dinku) Gebrehiwot. When a clinic construction project we were working on -- the "Clinic at Dukem," south of Addis -- became ensnared by local politics early in 2008, we turned to Dr. A. to consider a different approach. We shifted from infrastructure development to healthcare delivery, in order to more immediately provide benefit to needful patients.



Dinku (pictured above) is an amazing individual. He regularly works 12-14 hour days, seeing many tens of patients. He is noble, dedicated, smart and humble. With EHN support, LeAlem serves 100 additional patients each month, patients who cannot afford and would not otherwise receive professional care. EHN's October 2009 grant enabled LeAlem to hire an additional doctor, social worker and nurse.

Our focus is mothers and children who do not have access to professional medical care. We do this because it concentrates resources and will help us achieve excellence, and because we believe children and their mothers are the seed corn and binding force of a community. As EHN grows, we'll likely have projects that support more broadly-based community healthcare, particularly in rural areas.

This is a long-term effort, and we are only at the beginning of the beginning, a couple months into our first project.

Vision

EHN is fortunate to be headquartered in Foggy Bottom, Washington, DC, near the White House and blocks from the State Department, international development organizations, and a major university and medical school. EHN's Board is an exceptional team of experts, individuals who were born in Ethiopia, generous patrons, and well-connected professionals.

We envision the EHN "network" drawing upon resources in the Washington area and helping them to deliver value -- charity, healthcare -- a continent away, in a place orders of magnitude less fortunate. Beyond leveraging DC resources, in the long term we envision EHN clinics and projects across Ethiopia networking, working together and with regional resources, NGOs, government and other organizations to provide care, alleviate suffering and improve outcomes.

So what's next? We have started a project that is delivering meaningful results (see link), at low cost. My focus and line of inquiry for the LeAlem visit will be on how we can help, how we can enable. How can we better serve the great mission of delivering medical care, relieving suffering, and improving outcomes -- while responsibly stewarding EHN resources and talents? What shared vision can we develop and support?

While in Addis, I will meet with Dinku at length and meet with all the staff supported by EHN. I will shadow Dinku and his clinic, open to close, observing activity and interventions, and develop anecdotal case studies describing EHN-supported work and challenges.

In addition, I'm scheduled to meet with NGO and government officials, and tour a few other medical and social work centers, including Biruh Tesfah (Bright Future), which cares for displaced girls and women, many from rural Ethiopia, and helps them develop skills and gain traction in the urban economy.

Questions

Here are draft questions to explore at LeAlem. These will likely change based on research, feedback from partners, and cogitation.

1. What is Dinku's vision for program expansion? How could we help with next steps? What are the limits of LeAlem's current capacity?


2. Could Dinku envision working as a center of the EHN network, with additional clinics in Ethiopia, locations in Addis as well as rural areas? What scenarios are plausible? Would others be willing to take on roles in this area? What resources would be required?


3. How would we identify new projects? Do any new projects come to mind?


4. Considering different time frames -- one year, three years, five years -- how might the LeAlem program evolve? What additional resources make sense? Could a telemedicine program, with specialists from GWU online, be feasible? Would it make sense to rotate med students in with LeAlem, perhaps in combination with the large Black Lion hospital in Addis?


5. Who are we serving? Where do the EHN LeAlem patients come from? Where do they go? Do LeAlem patients need and receive follow-up? What are post-treatment outcomes? What degree of the EHN work is preventative?


6. Are there meaningful, additional community needs to be addressed -- sanitation, hygiene, education, housing, clean water -- needs that severely impact the outcome of LeAlem patient care? Can we make a difference here? How? What partners or coalition?


7. Who are our partners? Are we collaborating with local government agencies, NGOs, family care providers, other health care providers? Should we work to strengthen relationships like these? What are the risks and benefits?


8. Given our focus on women and children, is there more we can do? Gynecological/urological expertise? Neonatal? What are the most significant problems for this population? Can we do better?


9. What vaccine programs are available for children? Pneumococcal vaccine? Could we partner with or help form an immunization program for client children?


10. How does LeAlem handle HIV cases? Is there a referral structure (e.g., PEPFAR) that works? Are we connected to a program to prevent mother-to-child transmission (PMTCT) of HIV?


11. Are there elements that EHN's current LeAlem project is missing? Equipment, medicines, infrastructure, staffing, management? How could we be better? Are there parts that are inefficient?


12. Are we measuring the right things? How is the patient case tracking data valuable? Research, trend analysis, publication, quality assurance, follow-up, grants, government reports, support for fundraising?


13. How can EHN volunteers help? Money, politics, collaboration, clinical or technological expertise, NGO contacts?


14. Does it make senses for Dinku and/or LeAlem staff to come to the US, for advocacy, training or other reasons?

These are a few topical areas, probably all weighty, we look forward to examining. Other logistical matters are well in play -- from lodging to setting up meetings in Addis with NGOs, diplomats and the like. Ideally, I'd like to return to DC with at least one or two pieces for publication, to help grow the charity.

The end goal, the site visit purpose, is to help EHN learn how it can do more to deliver care to underserved patients, efficiently and effectively, and to gain assurance that our resources and talents are being well-applied.

LeAlem Progress Report, November 2009

This is an extract of LeAlem Higher Clinic's November 2009 progress report, furnished under terms of an Ethiopia Healthcare Network (EHN) maternal and child care program grant. Located Addis Ababa, LeAlem is headed by Dr. Alemayehu (Dinku) Gebrehiwot, a specialist in pediatrics, obstetrics and emergency medicine

In summary, during the second month of operation, LeAlem exceeded numerical benchmarks set by the grant, caring for 103 patients. Ninety-two percent (92%) of the patients had annual income below $100 US per year; the balance of patients had annual income of $100-200 per year. Ninety-seven percent (97%) of post-school age patients were female.

Without EHN support, all patients would not have had access to professional healthcare. Patient outcomes were largely positive, alleviating suffering, treating disease, and supporting improved pre-natal and infant health.

Patients were treated for a diverse range of diagnoses, including pneumonia, head injury, reproductive complications, pregnancy, diarrhea/intestinal disorder, gangrene, hemiparesis, urinary tract infection, seizure, candidiasis, asthma, metastatic cancer, adverse reaction to anti-retroviral therapy (ART), and Parkinson's disease.



Ethiopia Healthcare Network (EHN) appears to have effected a highly successful launch of the LeAlem program. A more extensive quarterly report will be provided in January 2010. Additional assessment and case study data will be developed during an upcoming site visit.

Based in Washington, DC, EHN seeks further support and volunteers to enable measured growth in healthcare programs. Volunteer needs include fundraising, administrative, multimedia development and research support. For information, please see the EHN web site or email info@ethiopiahealth.org.

Secure, online donations may be made at this link. EHN is a 501(c)3 charitable organization; donations are tax deductible. Thank you.

Rockburn Cyclocross, 11.22.2009

Lovely fall day at Rockburn, everyone was home. Nate came in from Boulder for Thanksgiving break, and Care returned from a six-day spin through Pine Bluff, Paris and Hannover. I hadn't shot a bike race for a couple months. It was nice to reconnect with the scene, see friends, and watch the boys. Perhaps sad to say, my photographic interests and best pictures vector toward people and nature rather than cycling. At Rockburn, held in a small park near Baltimore, I worked a little to mix the three. In the shot below, the tangled tree is the focus. The blue rider came into it.



Below is elite race leader Wes Schempf. Nice (almost jungle looking) woods detail, Wes looking over his shoulder, black and white moire.

Shot the cyclocross race a little slower than a criterium or road race, because action is a little slower. Also, lower light in the woods made slower shutter speed helpful. Experimented a bit. About half shots were manual focused. This helped in woods; I could make sure an interesting tree or such was sharp, and shoot the rider when s/he came into focus.

Of course, family trumps. Here's a top-bottom of Avery (blue bike) and Nathan. And, as common, dogs.

Full album here. Thank you.

Off the Grid – Mount Rainier

“This greatest of American mountains with its living glaciers and magnificent forests.” -- Floyd Shmoe, A Year in Paradise

Thursday PM, November 5

After near a week of Microsoft SQLServer conferencing in Seattle -- a great conference, PASS, -- I went off grid. Drove down in the rain to Mount Rainier National Park. Renewed my annual Golden Eagle pass and drove straight to the end of the road, the Paradise area, base for climbing expeditions and the Jackson Visitors Center. The road beyond was closed due to snow and ice. My plan was to tramp about Friday and take a lot of pictures. This evening’s aim was framing, to get a feel for where the shots could be, to learn the lay of the land somewhat. It was beautiful. I did about 100 exposures in the half-light of late afternoon, with heavy overcast and light drizzle or wet snow.



I had thought to go down to Mount Saint Helens Saturday, on my way back to Seattle’s airport. But, I don’t know, Rainier is so extensive, so grand, I decided to stay in one place and go a little deeper. To hike and touch a glacier, many thousand-years-old ice, now dissipated due to global warming.

My lodgings were rustic, sort of. The National Park Inn at Mount Rainier (Longmire), an old place that reminds me of the Peruvian at Alta … shared baths, creaky stairs, good, hearty food, smoky fireplaces, red wine, no WiFi or cell.

Sat by the fire reading Tracy Kidder’s Strength in What Remains, about Deo, a survivor of Burundi genocide, medical student, and later Partners In Health acolyte (under Paul Farmer) and clinic founder. Fits with my Ethiopia healthcare work (EHN), inspiring, painful.

Friday

Woke early, about 5 AM. Raining out. Finished Kidder’s read. By breakfast, precipitation turned to snow, then back to rain. High at Longmire predicted at 39 degrees F. Wet, cold. Hiking today will be "manly."

Wake-up hike around Longmire and across Nisqually River. Pretty meadows, tall evergreens. Waiting for main gate up to mountain to open (following snow-clear operations). At ll:00 AM, main gate opened but restrictions set for tire chains, which I didn’t have, so out of luck. Drove instead a few miles up West End Road, caught some nice field/stream/rock images. On way back to Longmire, it appeared that tire chain restrictions were lifted, so I drove on up the mountain. Light drizzle at start, quickly shifted to heavy snow, about 4-6” deep on sides. Halfway to Paradise, I quit. Turned about and low-geared and white knuckled it slowly back to Longmire. Lunch then book-reading by the fire. No big hike.



Reading my book I looked out and saw snow had stopped. I grabbed my gear and ran to the car. Drove up to about 4,000’ and stopped at the “chains required” sign. Shot some nice pix at Nisqually bridge, very cool. Cold depth, glacial moraine, snow and fog. Headed back down to Longmire. On the way, light improved and I saw patch of blue sky. U-turned. This time, drove past chains-required sign, up until ice began to grip. Pulled into Narada Falls overlook and shot some nice pix. Retreated with a few more pix stops to Longmire. Hearty dinner – pasta primavera and white wine -- and off to read and write by fire, then bed. Forecast calls for much snow and cold, snow for next five days. Will work my way back to Seattle airport tomorrow. Awesome.

Saturday

Looked out window, pre-dawn. Elk grazing in front of Inn, one rubbing antlers on tree, stripping bark with teeth. Lumbered down for breakfast. Steady rain. Read a bit more of Schmoe’s A Year in Paradise, about his post-WWI honeymoon over the winter as a snow-bound keeper with his new bride at Paradise Inn. Schmoe’s lifelong conservation efforts did much good, earning many plaudits, including nominations for Nobel Prize. Inspiring. Rain at Longmire meant snow higher up, mountain tops were glazed white, and unlikely success in my coaxing the tiny rental car past the chains-required zone. So I packed, loaded-up and drove towards civilization.

Stopped at an amazing art gallery outside park, Ashford Creek Pottery. Spent an hour talking with proprietor Rick Johnson, also a school teacher. Many interesting stories, shared interests. Famous climbers and artists had passed through, record holders for Everest ascents, survivors of high-altitude horrors, Mount Rainier naturalists, park founding activists, novelist Tom Robbins, poet Theodore Roethke, mountaineer, writer and humanist Greg Mortenson, many more. An intellectual and artistic treasure trove, not larger than my living room, but immense.

After cell phone signal came live, stopped in Starbucks to shuffle travel arrangements, rushed to airport, grabbed non-stop to Washington Dulles. Less than 48 hours at Mount Rainier loomed enormous, edging me closer to increased environmental activism.



Sunday

Home safe Sunday and working pix on big screen Mac Pro. Uploaded original pics here. Facebook cross-posting with additional notes here.

Enjoy! (Christmas card photo below?)

EHN Awards Maternal and Infant Healthcare Grant

Washington, D.C., October 19, 2009 -- Ethiopia Healthcare Network (EHN) announced award of an initial maternal and infant healthcare grant to LeAlem Higher Clinic in Addis Ababa, Ethiopia. The competitive award will enable LeAlem to care for 100 patients each month, patients who would not otherwise be able to afford or have access to professional medical care. Under the grant, LeAlem will hire medical and social work staff and buy medicine and equipment. LeAlem is headed by Dr. Alemayehu (Dinku) Gebrehiwot, Medical Director, a specialist in pediatrics, obstetrics and emergency medicine.



On learning of the award, Dr. Alemayehu said, "[EHN's] support is a godsend. We will now be able to treat more patients among my country's most needful population." Only about 52% of Ethiopians have access to healthcare services; less than 6% of women have access to a health professional while giving birth [1]. Ethiopian women have a 1 in 27 chance of dying during childbirth. Many suffer devastating complications like ruptured uteri or fistula -- complications which, according to the United Nations Population Fund, are preventable [2]. EHN's mission is to alleviate these problems.

Through the EHN grant, according to LeAlem, each day five persons who would not otherwise have access will receive healthcare, 25 persons per week, and 100 persons in a month for six months. Thus, the health of children and women will be kept and these beneficiaries will perform their normal duties and strengthen their bread winning activities. Women will be healthy and take care of their family, children will be healthy, and school dropout will be reduced. The EHN grant provides not just for in-clinic care, but also social worker outreach to identify those most in need and monitor and support post-clinic patient performance – e.g., patient home care, access to and taking medicines.



Washington, DC-based EHN is guided by a board of directors with expertise in obstetric and emergency medicine, information systems and telecommunications, Ethiopia and third-world development, and non-profit organizations. EHN will evaluate LeAlem performance under the initial grant, and work to increase and extend support and practices that prove most beneficial.

EHN President Rev. John W. Wimberly, Jr., notes, "We envision this effort and LeAlem as a highly-efficient model for care delivery and use of EHN resources. Our goal is to extend support based on this model to not just care for 100 people, but hundreds if not thousands of patients each month at LeAlem and similar clinics." In the next 2-5 years, Wimberly notes, "EHN plans to add clinics and extend services and capabilities to rural Ethiopia, where maternal and infant healthcare needs are also dire."

[1] 2005 Ethiopia Demographic and Health Survey (FR179).

[2] Advocates Rally World Support to End Fistula, 6 July 2009, United National Population Fund.

Full press release here or PR Newswire.

LeAlem 2010 Picture Library
EHN Blogs

Fin de Semana ... Parks

Really nice weekend. Mellow Friday off with Care. Rode 80+ miles out to Purcellville and back; Care partnered through to Ashburn. Saturday, last U19 race of season, Juniors' Day Out. Awesome squad swept most categories (overlooking our champion's crash with 100 meters to go). Pic of the big guns below.



Avery (above, far right) built up his new 54 cm team frame (upsize from 48). He's had a good year and next year, racing age 16, will be awesome. Probably national championships, with a number of teammates. Sunday slept in (to 6:30 AM), meandered through WashPost and Times, a few cups of coffee. Dickered with Ethiopia healthcare press release and such. After lunch tuned in Ken Burns' "National Parks: America's Best Idea" on hi-def. Extraordinary!

Burns is a great photographer. The national park (and John Muir) story is compelling. Today's chapter featured Yosemite and Yellowstone, places I could return to again and again (if only I had time). (I remember backpacking through Lamar Valley with my sister when I was 15, and later showing my children and Care.) High mountains, rivers, trees do much for me.

Here's a recent shot of Rocky Mountain National Park; we may visit in a couple weeks when we see Nate.



Stirred by Burns, I hopped on my bike and headed to the national park closest to my house, the C&O towpath (Chesapeake and Ohio Canal National Historic Park), rode out to Great Falls National Park (Maryland), rode back streets home through Potomac Palisades and Arlington. It was raining a little when I left, then the sun came out, so the water and trees had that luxurious warm hue and mist. No camera on the ride.

Saturday, took a few pics of 15-18 year old race and crowd candids, posted here. In Oregon I did a no-no, quickly changing lenses at a wine party. Got some dust and fiber on the CCD (sensor). As a result, many of the subsequent images had to be retouched to clear the junk, slows down post processing and frustrating. A week ago, I dropped my 5D at ProPhoto -- 1902 Eye Street, NW -- for a sensor and lens cleaning. Very pleased with results -- don't have to spend 10 minutes retouching a landscape with a black strand and freckles ruining the sky.

Also this weekend I threw up some old shots from Nate's graduation and Care's recent work trip to Italy. (She took the G10 and it worked pretty well -- middle shot below.) As my technique settles down I'm finding myself trying to find more avant-garde shots and processing. I like the good fellow pictured at bottom.

Busy week ahead. Cheers.

Fitness

I've shifted gears on the fitness front. Usually, this time of year, I've dropped about 15 pounds, the result of riding over spring and summer. No such luck this year, though I've ridden hard. What happened? In March I started Lyrica (pregabalin), a seizure med that is experimentally used to treat central pain syndrome -- from which I increasingly suffer, due to adolescent traumatic brain injury and aging. Lyrica has helped with pain and improved my sleep architecture, but it added pounds and blurred my vision. So I'm weaning myself from the drug and increasing my fitness regimen. I've hired a personal trainer and nutritional consult; bought a high-end Retul bike fit; cleaned-up our home workout room; and am riding as intensely as ever.

Results so far are promising. I do weight training twice a week, ride 100-200 miles/week, and have trimmed my diet. My weight is down a few ticks, and should drop more quickly as my muscle build/burn rate amps. With the weaning, my pain (mostly left peripheral with some spasticity) is increased but tolerable for now. In a couple weeks, I meet with the folks at Georgetown to discuss an intrathecal baclofen pump -- an implanted device to push a low-dose into my spine. Given my current tolerance, I think this may not yet be appropriate, but it's good to understand the option.

Life is good. I feel bad that this pain stuff has taken some engagement off the table -- fewer good days to enjoy with Care and the boys, lost athleticism. The human condition.