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.

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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

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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.

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SV9 -- LeAlem

Site Visit Day 9 (Tuesday) -- Mellow day at the office, administrative/social worker and beneficiary intake area, pictured above ... desk in back is my temporary station. Today, shared draft site visit report with LeAlem partners, identifying areas for clarification, further research, questions, and concepts for discussion.

Followed a couple compelling cases, 7 year-old girl on follow-up for nausea and vomiting, pictured below with Dr. Alemayehu. And 49 year-old war widow with four children, presenting with stomach ache and retroperitoneal burning, complicated by asthma. She lives in one room house with her children, supported by pension income less than $100/year. At bottom, hugging social worker Almaz.

Click through photos for high-resolution.





Tomorrow, home visits for HIV/AIDS patients and orphans and vulnerable children, supported by Organization for Social Services for AIDS patients (OSSA), research postponed from Friday past.

Mid-term thoughts

While first week was rough, the second is proving smooth. (I had been overwhelmed, then a medical got me.) There seems to be a sweep of congruence. Collecting data, making observations, writing, reviewing with partners. Developing patient case studies and making photographs.

Even the hotel seems in rhythm. I initially planned one week in Addis, followed by a week in the Omo Valley (southwest Ethiopia, for ethnographic photography). The day I arrived I asked reception to extend my Addis stay to two weeks, so I could do more work. In a communication error, instead, they cut my reservation short. Last Friday, when I was bad sick, they knocked on my door and insisted I leave. The African Union Summit had filled all remaining bookings, including my mistaken vacancy. Most other hotels were full. I protested and showed my booking confirmation to gain a few day reprieve. Forces came to my rescue. Dr. Alemayehu appealed to the hotel manager, called the owner -- "Jim is helping the Ethiopian people, doing real work." Each day my reservation end date has crept forward. Fingers crossed. I board the plane next Sunday.

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SV7-8 -- Chill Sunday, LeAlem Monday, Learning

Site Visit Day 7-8 (Sunday-Monday) -- Took a restful Sunday, pretty well recovered from medical distress that made for sharp Friday. Walked about five miles around Addis, drinks with leader in Addis Ababa Cycling Federation, Dr. Telaye Wube. Did a good bit of writing and reading, picking-up Abraham Verghase's Cutting for Stone, recommended by EHN board member. Verghase's novel tells of romance and graphic detail of (some extraordinary) medical work at an Addis Ababa missionary hospital, during the early years of Emperor Haile Selassie. Gripping and apropos, intellectually large.

Similarly peaceful if routine Monday, with morning and afternoon case study work at LeAlem. A number of compelling stories captured, images below.







I'm increasingly impressed by the business model we've set for EHN/LeAlem. Here's a clip from my current draft: "LeAlem is performing work efficiently. Several notable factors and measures contribute to this finding, including: The clinic is an established, ongoing commercial operation that is not dependent upon charitable funding for successful performance; economic efficiencies that support successful commercial performance carryover to charitable activity supported by EHN; [and] costs for non-profit, charitable patient care is the same or less than costs for commercial activity. (E.g., some commercial patients request/demand additional tests that are not provided to charitable patients, where medical staff deem these tests non-essential.)" So, it seems we're on the right track.

On another interesting contextual note, the African Union 2010 Summit begins later this week, so the hotel is filled with an extraordinary range of diplomats and interest groups. Adds a definite class and mystique. It's pretty cool to sit in the hotel bar and absorb the culture, watching African soccer championships on big screen, sipping beer or such.

Also today, had a bit of a medical "Whoops!" I'm trained as an Emergency Medical Technician, and I've seen pretty much, from ER/ICU/brain surgery, to nasty bone, blood and shock trauma. I'm trained in scene safety and personal protection. But Africa is different. I probably need to assume many things are contagious, more than I'm used to. Today a very appealing child came in, and I lifted him high in my arms, offering comfort. Well, the little guy was recovering from Typhus, which is fatal (if untreated) 10-60% of the time. The translation was uneven, so I heard Typhoid, for which I'm inoculated. On return to hotel I read about Typhus. I quickly re-upped my Purell (alcohol gel) scrub and hopped in the tub for a thorough wash; I'm already on Cipro ... Well, it's to learn. This trip is definitely stretching my envelope.

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SV6 -- Beneficiaries Home Visit

Site Visit Day 6 (Saturday) -- Visited impoverished homes of beneficiaries, followed by children's event at community center for orphaned and vulnerable children (OVC). Crawled through narrow alleyways, into 1-2 room mud and tin huts; swarms of beautiful children seeking contact and attention. (Glad I had extensive inoculations.) Compelling pictures. Area impacted by poor sanitation and hygiene, malnutrition, disease, economic destitution. First house visited had 2 rooms for 3 or 4 families, other houses similar. Admired craftsman weaving in front room of two room mud/tin house.

OVC event, organized by "Redeem the Generation," was extraordinary cultural dance show, followed by counseling discussion and distribution of free clothing. A licensed Ethiopian non-profit, Redeem the Generation focuses on psychosocial support for HIV/AIDS OVCs, educational support (e.g., tutoring, book clubs), micro-lending for small business start-up, HIV prevention education, and similar individual- and community-empowerment work. The association is led by a skilled staff with over 100 volunteers.

Click through pictures to see high resolution.

















Day off tomorrow (Sunday), kicking back, attending local bike race, lunch with leader of Ethiopian Cycling Federation ... just like home!

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SV5 -- Sick Day

Site Visit Day 5 (Friday) -- Hit stomach problem, epigastric pain and bad bleed. Stayed in hotel room. Had a few email and telephone conferrals with wife, Carolyn, and Medical Duty Officer at US Embassy. MDO was great help, conferring on diagnosis and treatment. Started course of Ciprofloxacin, NSAID etc. Care, of course, was great, the greatest friend ever. Partners have planned ambitious Saturday site visits and events, so I need to steel myself.

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SV4 -- LeAlem

Site Visit Day 4 (Thursday). Better day today, well-rested. Got over-tired Wednesday, stressed, both joy and sadness. LeAlem served 12 EHN beneficiary patients today. Dinner with 8 staff and children tonight; sumptuous Ethiopian meal -- $35 total (including beer). Pictured above is Gashaw, a LeAlem social worker. LeAlem maintains meticulous records.

Below are a few of today's case study pictures and abstracts. (Click through pictures for improved resolution.)



Pastoralist woman age 91, presenting with epigastric pain and disorder. No children; subsists by begging. Sleeps on ground in shed. LeAlem/EHN provided medication and vitamin B supplement.



Seven year-old girl, presenting with nausea and vomiting. 4th grade clever student, poised. Her name translates to "Work of God."



10 year-old boy and 36-year old mother. Boy presented with facial ulcers, and mother with flank pain. Mother previously treated for typhoid. Mother is blind; eight years without sight. Eye injury brought on by laundry work. Subsist by begging near church baptismal spring; live in one room house with 14-16 people.



38 year-old beneficiary with gynecological issues. Sells small merchandise on street. Two children, 10 year-old boy and 14 year-old girl. Children attend government school. Mother and children live together under plastic tarp by street. Treated by EHN/LeAlem (multiple visits).



35 year-old woman, previously cured from malaria. Presenting complaint, flank pain. Works in Addis as housemaid; earns less than $100 US per year. Helps support five children living in southern Ethiopia; her husband is farmer in Wolayta. Two children live in Arba Minch in order to attend better schools.



Tomorrow, home visits with HIV/AIDS social services agency caring for pediatrics with HIV/AIDS or impacted by AIDS (e.g., orphans). Similar work Saturday morning.

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SV3 -- LeAlem, Atetegeb and OSSA

Site visit Day 3 (Wednesday). "Symbol of Hope" (above), stamped on LeAlem patient processing forms. Three or four big events today. Quoted material from notes.

Atetegeb Partnership "I don't believe in an activist God, but sometimes you wonder: I was walking from Jupiter Hotel to LeAlem on busy Tito Street. I hadn’t slept well last night, so I was running late, about 9:30 AM. By Denver Café on Tito, waiting to get in a blue minibus, I saw a familiar face. It was Temesgen, Assistant Director from Atetegeb, who I had met Monday (notes). Of the millions of people in Addis, on the countless dusty corners, here was a man I knew, someone EHN could help. After surprise and greeting, I asked Temesgen if he wanted to come with me to see LeAlem Higher Clinic, about 150 meters down the road. We of course visited. I introduced Temesgen to staff partners, we toured the facilities, and Gashaw (social worker) got on the computer and prepared a referral agreement to enable Atetegeb to send children (and their nurses) to LeAlem for healthcare. A good days work! ... In my insomnia last night, cycling ‘What to do?’ concerns, I had thought through next steps. On waking I scribbled on my to-do notepad, '[Make sure to identify] specific next steps to set Atetegeb relationship.' Today’s encounter seemed Providential."

Patient Care We saw nine EHN-supported patients before I left clinic about 3:30 PM. Subject below is 16 year old boy without income (but in school), presented with dental pain (front teeth), swelling and bleeding. Treated by LeAlem dentist.



Memorial Plaque We installed a plaque in EHN/LeAlem patient reception office (where social workers obtain referral forms, develop patient background, record presenting diagnosis, and direct patients to course of care. The office is about 7x12 feet, with three or four desks, one of which I've taken over for site visit work. Depending on available translator, I interview patient and develop case study information. I may take patient picture.) The plaque honors the EHN-LeAlem relationship and major supporters, including "Joan Gibbons Wilson Memorial," for my mother who died cruelly from ALS.

OSSA Following a recommended line of inquiry, with social worker Gashaw, I visited OSSA -- Organization for Social Services for AIDS patients, not far from LeAlem. Compelling story, heart-breaking. "Had one-two hour meeting with Paulos Kenea, Addis Ababa region manager for OSSA, Organization for Social Services for AIDS. OSSA is supported by USAID, CDC, Catholic Relief Services and others.  Multi-path support for HIV/AIDS patients and impacted persons (e.g., AIDS orphans). Services include prevention counseling, psychosocial support, palliative care, orphan and vulnerable children program, and HIV testing. 120 trained community volunteers; home visit volunteers serve 10-12 households per day. Support for 5,500 children (285 HIV positive) and 1,220 patients on ART (anti-retroviral therapy) in Addis catchment.  Partners with EHN/LeAlem; economically disadvantaged OSSA pediatric clients receive non-ART medical care at LeAlem (up to 5 patient visits per day, no charge), under EHN program."

I'm going on site visits with OSSA Friday, where we will visit homes of indigent children in OSSA care.  OSSA manager Paulos made compelling argument for nutritional support (e.g, necessary for ART medicine intake, opportunistic disease defense). Children died last quarter due to nutritional insufficiency; children on ART with good nutrition often thrive.

Paulos provided me with several reports (which I'll read tonight), and case study of OSSA best practices, including testimonial about OSSA/LeAlem/EHN care model.

Friday will be very challenging.

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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).

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