Hypothetical Michael

This post is not from Emily or Michael. It is from Michael's brothers and sisters left behind in the U.S., who have been looking at pictures of Michael in Ethiopia, and noticing how excited and pleased he seems in every one, and who are beginning to worry just a little bit that he won't come back, and if that happened, how terribly they would miss him. In fact, they already miss him, and because things don't seem quite right around the supper table, they created a temporary stand-in, whom they have dubbed 'Hypothetical Michael.'

I wasn't there during the creation of HyM, so I can't really speak to the strange fact that his "face" has a picture of both Michael and his younger brother. However--and this is pure speculation on my part--it might have had something to do with Yabsera being jealous that Michael's face was being stuck to a soccer ball and not his.

Anyway, this is what his sibling stare at, longingly, during breakfast, lunch and supper.

Come home soon, Michael Michael Motorcycle!

Visiting the Fistula Hospital in Addis

This morning we visited the Fistula Hospital (http://www.hamlinfistula.org/). This is the same one from “A Walk to Beautiful” (http://www.walktobeautiful.com/; http://www.pbs.org/wgbh/nova/beautiful/) and the one Oprah Winfrey has supported (http://www.oprah.com/spirit/Inside-the-Fistula-Hospital_1). I can honestly say it’s one of the most impressive organizations I have ever seen. It is so comprehensive it’s amazing. They support women who have developed fistulas from birth and other traumatic experiences. All of their care costs nothing to these women—they come from all over Ethiopia after being shunned by there communities and their families, often after having lived in small huts, alone, due to the odor because of the incontinence. They develop foot drop and contractures from lying in curled up positions on dirt floors for months or years. They are malnourished due to the fact that they eat and drink very little because of the incontinence.

They come here and they are given nourishment, physical therapy, surgery, post-operative care, and education. They learn to make handicrafts, which are then sold and the profits go back to the women. And one of the most important things is they receive counseling and education about their condition. The emotional toll of losing a baby after 5 days of horrible labor and then the months or years of pain and discrimination takes a great emotional toll on these women—many who are very young, but really they are all ages. The woman I spoke with said the emotional counseling is often more important than the physical therapy.

The PT room had the birthing balls and exercise bike and heat lamps for contractures. It was amazing, and they had ‘before and after’ photos of women which would just blow your mind.

We saw the post-operative ward and the pre-operative ward. The other incredible aspect of the hospital is that they only require two things of these women in return for the weeks or months of care (it’s different for everyone, but the average stay is 34 days). First, is that they go back to their village (they provide the transportation) and tell everyone they know about this place because usually the referrals come from the women who got care. Second, is that when they become pregnant they must return by the time they are 6 months along. They will get nutrition and care and education and will deliver their baby by C-section at a hospital here in Addis so they do not damage their repairs. We also saw the maternity ward, where there were pregnant women and women with young newborns as well.

They also have a midwifery school, and this is on another campus where some of the women whose repairs were not fully successful live and work a trade and run a cafe. We may visit there later this week. Midwives require 4 years of training, and through this institute it is free if they are willing to work in a rural area for 2 years after graduation. They have 4 satellite centers in various regions of Ethiopia.

The hospital has a 95% success rate, and the other 5% are able to stay and live on that satellite campus. Those women may have ongoing ostomy care needs (http://www.ostomy.org/ostomy_info/whatis.shtml) that would be difficult to provide in a rural village.

The school room, counseling offices, and various wards were all so impressive, and all of the women were so well cared for and it really warmed my heart to see how one couple could reach out to a group of some of the most marginalized populations in the world and TRULY make a profound difference in their lives.

We will also be visiting AHOPE later today. I look forward tp sharing about that trip soon.

Love, Emily

What A Day We Had

Again on someone's laptop which costs them money and so I can’t type as nearly as much as i would like So, very briefly—what a day we had!

One thing I neglected to mention in my last message was that we were NOT able to meet Michael's brother. That was a shame, because we came all that way, and if we had one more day, and a little more stamina, we might have been able to make it happen. But we just couldn’t swing it.

Today was so precious. Our first visit was to family who are cousins of Yabsera—but really the direct relatives of the Daubenmeir’s little girl: her father, her family. We were there a long time, so I have many photos and stories for them. I spent the day with Fitsum’s father (handsome guy—and with two daughters and a son, younger than Fitsum . . . all so beautiful).

Then we went to Yabsera's home. When we walked into the home of his grandmother, they all started chirping, "Lululululululu" . . . kind of a high—pitched song of excitement. I can report that his Ethiopian family is "so Yabsera.” His grandma kept kissing me and was so sweet and looked just like him. Not kidding. His grandfather has passed away (I just realized I never asked what his name was). But wait till you see her—so sweet, so amazed at seeing his pictures. I also met his uncles and some aunts.

Mulu (Yabsera’s first mother) recently moved to Khartoum, only about two weeks ago. I just missed her, which made me very sad, and when I heard the news my heart sank a bit. But then we were outside the round mud home taking some pictures and I was getting "Mulu's family" together and they pulled this little boy into the picture and I said, “who is he?” And they said, “he is Mulu's son.” So, yes, I met Yabsera's brother! Mulu’s first son. He is just a little older. They first said he was 6 and later said 10. He can’t be much taller than Yabsera . . . very handsome and very shy. I did get him to smile and showed him pictures of his younger brother, and I have photos of Michael with him. So, a little surprise that apparently Tshay didn’t even know about. I asked what he was like and they said, "he likes football, riding a bike (never saw a bike in Sodo, so not sure if the interpretation was right) and he likes to eat food and drink milk. Sound familiar? Before we headed back, they all sang for us and I can’t wait for Yabsera to hear and watch this—he would have joined right in singing and dancing.

When we got back to Sodo, we went to a home-visit and saw the baby, Tamrat (from the Miracle Baby series on Sophie’s blog that I link to in one of my early posts on my blog). The experience was just amazing, and I can’t wait to write more about what they do here at the hospital and in the clinic. It’s very exciting and quite amazing and frankly hard to even believe. This baby should not be alive but is thriving and I will show you pictures.

So Michael has had a few days of full exposure, up close and personal, to what his life might have been like. On the way home, we bought mangos and bananas. He was eating a mango (his 3rd) and he just said, "I am so lucky." I said, "because you have a mango?" And he said, “yes, I am lucky for three things: that I have this mango, then the 2nd reason is because I was adopted, and the 3rd reason is because I have you and daddy." I think all of what might have been sunk in. I was quick to tell him that in fact Mark and I were lucky, and he asked why and I said, “because we have you and Yabsera and that makes us so incredibly lucky.” (We also like Maddie, Cal and Phoebe, so blessed all around!) But I do feel so lucky for these boys that we brought home 5 years ago. Michael has been so good with so many hugs and kisses from strangers, and just having to be hot and be around a lot of flies and be really, really patient.

We leave for Addis in the morning. I will see a bit more of the hospital here and then in Addis I have some orphanages yet to visit and may visit again with Dr. Sophie if I can. It has been so interesting to learn about HIV care here in Sodo and I look forward to sharing all about that with my friends at CHIP and HIV To Home.

Michael and I miss you all.

Love,

Emily

Our Family in Wolaita Sodo

Typing from a cafe at the hotel in Sodo on Sophie’s little laptop. I won’t be able to type long, however. In short: we arrived Thursday and met with Dr. Ruth, Sophie and Dr. Stephanie. Just hung out for a bit and gave them many donations which they were very, very excited about.

On Friday we set out in the AM and I was kind of on a mission to connect with the woman we knew about who was related to Mulu—Yabsera's birthmom. We had some phone numbers, and I’ll write the whole, long story later, but at one point we were at this bank where Ruth told us to go which was supposed to have a cafe but did not (turns out the new Dashan bank has no cafe). At that point we called the man who was the father of the Daubenmeier’s kids and he answered and came down. He took us to see this woman at Tsheay's house, and we went there. This is the home where Yabsera was born. This made Michael a bit jealous—because he would like to see the home where he was born.

This woman was very gracious: she gave us shiro and injera and Fanta and coffee with milk. She was happy to see the photos of Fitsum Grace. We all talked a lot—well they all talked a lot and I just tried to listen. So, at some point she said, "I have a photo of Mulu." I was like 'Ummmm . . . can you please show me?” I was trying to contain my excitement. She pulls out a huge album and a photo of not just Mulu . . . but of baby Yabsera, too . . . and, yes, it was so clearly Yabsera . . . his eyes . . . his big ears and the extra little dangling finger. He is maybe 3-4 months in the picture? But so cute, and his mom is beautiful and tall! I can’t wait to show you. I took pictures of this and many other pictures on my camera (many for Fitsum). There was also another photo . . . a baby from many years ago . . . he looked so much like Yabsera that Michael actually said "that’s Yabsera!" However, it was actually the daughter of Teshay. I have a photo of her all grown up. Tomorrow we will actually go and visit with Mulu's parents (Yabsera’s grandparents). His grandfather is a church elder and Mulu sang in the choir (of course!). So excited.

I have so much more to write than I probably have time for. I may get a chance later to write more. Michael has been so excited, and yes, in my exhaustion I have had to say things like, "I know how excited you are, honey, but you have to realize how exhausted I am and please just be quiet for a bit," and he does, God bless him!

We left with Kebede and Dr. Stephanie and went to the market which was so much fun—and a bit scary. We bought fruit and veggies and lentils and a chicken! Michael picked out the chicken, and was very concerned on the bumpy road to his grandfather’s about the chicken’s well being, saying "Ummmm, you know we have a chicken in here right?" as we bumped along. There are many details which I will skip for now, due to time, but Ato Ashango was so happy—when he saw Michael he could hardly contain his joy, and scooped him up, saying, "Maren! Oh Maren!" We were mobbed . . . many people kissing and grabbing Michael. I was admittedly very nervous that Michael was going to freak out, but he handled it all with such grace.

I have so much more to tell, but for now I’ll just tell this story. Later in the day, towards the end we realized there was a cow in Michael’s home and so he wanted to see it so we went into the house and while in there we heard they had just lost their beloved cow . . . yes, this was “Maren’s favorite cow" which we heard about from Heidi, and that we have a photo of. And then someone taps on my shoulder and they gesture down and sure enough there is the hide of "Maren’s favorite cow" spread out on the floor. Stephanie and I could NOT stop laughing . . . I can’t tell you how funny it was . . . for us . . . but not for Michael—this was his favorite cow after all!

One last sweet thing before I have to go—they all told him he looks just like his father. And his mother looked like Ashango. Last night, Michael drew a few pictures of his Ethiopian parents—wanting so badly for the photo that Yabsera now will have and he never will.

I gotta run. Much love to everybody.

Sister's Of Charity

I do not have much time to write because in a few minutes Michael and I will be heading to Sodo to see Dr. Ruth and Sophie and to see his birth family. This is the same drive we took about 8 years ago in search of some answers and to see where M and Y came from. We have been looking forward to this all week. Yesterday we spent with the Sisters of Charity which was a long and rough road out towards the far reaches of north west Addis. In the car was an NP who is here studying some natural pathic remedies and an Ethiopian Pediatrician who does a lot of teaching on HIV in the outskirts of Addis, Bekah, the nurse I am staying with who is working on a TB/HIV project. There used to be a nun who gave the kids a mixture of Aloe and Honey before ARVs were available and she swore by its ability to slow the progression of HIV. That nun is no longer there- but the ghost of the once lively Aloe field shadows over the new clinic where they will only give ARVs and do not believe in alternative or complimentary therapies. The complex where these kids live is absolutely beautiful. They grow their own food. Have a state of the art school on the compound where all 361 kids with HIV who live in the orphanage attend along with uninfected children from the community. Early on they tried to send the kids out to schools which created a stigma- clearly someone very smart and very wealthy said- "hey if we build the best school you can find in Ethiopia - those kids will WANT to come to school here no matter what." and it worked- not kidding the school might as well be DSST its so nice.

The clinic is also state of the art and they have started caring for women ad children from the community. Most of the cases were TB cases. On 16 year old who looked about 5 at the most- no body fat who had horrible disseminated TB. She was left to die for a year before her father brought her in. When she whispered that she was 16 my heart sunk. A baby with congenital cataracts which looked possibly like something secondary in my inexperienced opinion who was waiting to get fat so she could have surgery. She kept kicking her leg as if to say "Would one of you people please do your job and pick me up!" She was darling and as we got close- she knew- because she beamed at us with a toothy grin.

The orphanage itself has a few dorms, some nice play grounds, soccer field and basketball fields. The actual dorms are packed with bunk bends flush to one another. So a long room with 15 bunks right next to each other along each wall- 60 kids in that room...then the next room the same...the next room the same...it never seemed to end. It was meticulous. The laundry system was amazing, the dining halls were all clean, the kids uniforms were like brand new, the kids seemed happy and playing as they left school. It appears that they have taken a horrible situation of having too many HIV+ children without parents and have built the best physical complex they could. But I couldn't help but think as I saw the rows of bed and rows of table that there cannot possibly enough adults in these kids lives to provide them with the love they will need to really make it in the world. All the HIV medicines in the world just wont do the trick if you don't have someone who loves you enough to see you through the tough times and to laugh with you during the good times.

In some was- even though it was beautiful- like the best summer camp you can imagine...it really made me feel sad...because these kids will not get on a bus in August and find a mom and dad and big sister and Brother waiting to pick them up and take them home. They are doing the best they can with what they have. My advise would be to break up those big rooms into smaller family unites with consistent caregivers. They have the land and ability to do this. They have a transition house for the 18 years olds and so far it has not been successful...as you can imagine...but if they started early with a family unit- and those kids grew like family they could all transition together. Better yet- these kids need real families. So I would look into which agencies have started pairing with this agency and go from there- if you are ever so inclined to adopt a child living with HIV that is.

Children's Heaven

I have so many wonderful photos from visiting the girls at Children's Heaven. I can't wait to share them. One of the organizations I am involved in, Ethiopian Orphan Relief, helps support Hanna Fanta and Children's Heaven. You can read a little bit More about them if you go to my previous blog post. They are renting a new facility and it was wonderful to see in person. they have a large area which has a canopy to keep the sun and rain out where they do aerobics and general teaching and play games like basketball. There is a tent (kind of like an army tent) where the girls eat meals and a nice indoor space for teaching and gathering. The purpose of Children's Heaven is to provide a place for girls from age 8-18 to come after school and on Saturdays. If they attend school close by they come for their lunch. If their school is father away- lunch is brought to them. For many of the girls this is their only meal of the day. They provide the uniforms and books needed to attend and stay in school. They provide tutors and scheduled activities. For instance on a Saturday they arrive and are fed breakfast. They then do aerobics, play games, help with certain crafts and some health programs used in the community. They eat lunch and then some are part of a soccer or basketball program. And certain girls are part of a program where they are able to shower and bath and do each other's hair for the week. These girls often have an HIV+ mother or their mother has passed away and they are being cared for by an Auntie or grandma. They are at HIGH risk for ending up on the street, ending up pregnant at a young age, dropping out of school...you name it. Hanna's goal is to help each girl succeed at what they want- and I can tell you after the introductions 9 out of 10 of them want to be a doctor. I believe that many of them will go on to do wonderful things because they have this one woman in their lives who just believes in them, loves them, cares about them, feeds them and tells them that they are important.

Hanna used to live and work in the US. She worked for the United Nations. Later for a bank...one day when her children were grown she felt called to return to Ethiopia to help one girl. Her goal was to help just one young girl. She was sharing this story with us while sitting in front of about 75 girls...it was one of those amazing stories where you know God has a hand in her life. He new goal? 100 girls by 2013. She is at 81 now.

You can imagine the tragedy that each child sitting there has suffered. Not one of them is spared. I asked Hanna what kinds of needs they have and she said "A Counselor" as the girls are aging up they have more and more need for counseling and therapy. She has had girls loose their moms, one girl even took her own life not long ago, and there have been a few pregnancies. It is the ugly stuff that is hard to share - because you want to share the beautiful smiles on these girls faces and the joy they have when singing to us- but it would not be truth if you did not understand why there is even a need for Children's Heaven. We talked about sex education. They provide this- but admittedly she does not feel they are skilled at it. She would like someone to come and train their staff to provide more of this in a more effective way. At one point she leaned over and whispered to Bekah and I "I think some of these girls may have HIV but their moms are refusing to get them tested- is there any way we can test them without them knowing?" Of course coming from an HIV clinic in the US my initial reaction was "Are you (swear word) kidding me?" But instead I explained how that would not work on a variety of levels. The very first one is "What if you did that and found someone to be positive? how do you tell them that they are HIV positive and you test them without their consent?" So we discussed how she could go about providing education to the families as to what kind of help the girls can get who may test positive for HIV. I thought of the World Wide Orphans Clinic. That might be a perfect match because of their experience in pediatrics and with families. I will make the connection as soon as I can. As Hanna said, "We need someone who is skilled at talking about HIV testing and treatment to come and provide the education so the families change their minds."

So what does Children's Heaven need aside from families to sponsor the girls? a landlord who wont raise the rent in 9 months? They need a counselor to provide therapy for the girls ad the staff - who as Hanna says- are exposed to the tragedies every day of helping kids who lead difficult lives and that tragedy builds inside and takes enormous tolls on health and emotional well being. And they need someone to come and do some teaching around safer sex and HIV testing and treatment. These are not pie in the sky goals. These are achievable. Doable and necessary.

The girls sang and dances for us and Michael had a great time- eating the popcorn and enjoying the smells of the coffee ceremony. Hanna has always loved Michael and he has such an affinity to her. (He cuddled with her shortly after they met- at a time when I was lucky to steal a smooch from him) and she gave him an awesome Ethiopian shirt the girls made which I will have to post pictures of- he LOVEd it. I am bringing back some of the crafts the girls and their moms have made for the Lights of Hope event in Portland in May!

Also the DSA Theatre Students will be coming to Children's Heaven in May to meet the girls- I am hoping the girls will teach the DSA kids some of their songs and vice versa. If you want to support the DSA Theatre students travelling to Ethiopia in May- I would encourage you to do so. They are working hard to make a meaningful trip and to really give back. Maybe they can help provide some education on the form of theatre when they come. If you want to help the get here email Shawn Hann at Shawn_Hann@dpsk12.org

Finally- and then its my bed time - If I was able I would post the cutest picture of Michael with two giggling little girls from Children's Heaven- your heart will melt.

World Wide Orphans Clinic

Today we started out visiting the World Wide Orphans Clinic. We got a little lost getting there as Bekah had never been to that part of the city before. I found it funny that we stopped and asked a couple of police men and they couldn't give us any directions. Bekah explained they really only know the small neighborhood they are assigned to and they are all on foot. We arrived and we met by Dr. Sophie Mengistu. We had a wonderful time talking to her about the care her clinic provides families with HIV. They started with just caring for a group of kids with HIV and their program has grown by leaps and bounds. They care for kids at most of the major orphanages which are home to HIV + orphans. They have a care center attached to their program with about 40 kids with HIV which is not associated with the other orphanages. They have patients from the community and have started providing care to the adults in those children's lives. They have an outreach program with a few locations because as she said "Most people will not come to this clinic for testing due to the stigma so we bring the testing to them." They provided 16,000 HIV tests last year alone. She showed me the VCT (Voluntary Counseling and Testing) logs and every page has about 50 names and on EVERY page in the column where you indicate the HIV test was positive there were at least 3-4 + tests. It made me think of our own CHIP clinic in Denver and how much our outreach program has grown and how many tests we provide each year- and how few we actually get as positive. They have a soccer team for the children, a summer camp program (where they work with the

Hole in the Wall Gang Camps- just like we partner with in Colorado for our New Round Up River Camp near Vail Colorado!) they also have drinkable water from a spigot outside their clinic which anyone can access. That was really cool. I also saw boxes of plumpynut and other nutritious lentil based food for families and the orphanages. (I took a photo of the plumpynut and might make a tee-shirt for Jennifer Dunn!)

The highlights of the day spent with her were reviewing case studies of HIV+ kids who have come home and what type of care and testing we provide them in the US and how what happens to them here in ET before arriving has an effect on their long term care. She was very interested in seing genotypes and looking at viral loads on medication and what changes we made to medication after kids come home. We talked about PK (medication level testing) and how the HIV medication levels can really cary by child and also when used in combination of other medications. We talked about how they make decisions based on symptoms and CD4 count. They actually do have the ability to get HIV RNA PCR testing (viral load testing which measures the amount of HIV virus in the blood- this is a test we use liberally here in the US which is not available in many parts of the world- particularly those countries where HIV is very much an epidemic) but because it is so expensive - it is not used often. I would love to see this test become more widely available because they would know much sooner if a child is failing a treatment regimen and that would help a child long term.

I was able to look at their new electronic database and even offer some suggestions based on the database we have at CHIP. I met the Phil Ferrero of WWO. She is a nice and as smart as our Phil. I was able to look at a few charts and found

the record keeping to be meticulous and very very comprehensive. I wished I had brought with me a copy of the medical records we receive on ours kids- because I got the impression she thinks we may have more information than we are actually getting. I have to say- these records would hold up to any site monitor visit- including one from Patrick Tshumper! We talked about TB treatment and the standard protocols as well as immunizations. She was curious how many kids come home showing that they had Hep A in the past (I think its almost all of them.) (She figured). It was a lot of medical stuff which is probably pretty dull for many of you reading this- but some of what I was impressed with was the connections they have made in the community and the other support programs they have in place. I met with the pharmacist who not only dispenses the HIV meds but provides adherence counseling..on average this can take about 45 minutes. (I asked if they are having issues with their teens not taking meds- the answer- no- kids in Ethiopia have to listen to their parents until they are 18). (It made me wonder how many kids from like 15-18 they had in their program still living with a parent because I think not wanting to listen to your parent when you are that age is pretty universal...it was implied that is not the case and may not be...I am a little cynical...certain developmental stages can't just be skipped!) :)