The Elephant Cloud


The Elephant Cloud header image 1

Market Day

January 29th, 2011 by · Africa, Ethiopia

IMG_0255It is market day and the streets are full of donkey carts and barefoot pilgrims wrapped in their white gabi’s, driving their wares to the square. We buy potatoes, cabbage, beets, kale, onions, garlic, eggs and a chicken. Darlene named her Doro Wat, which is the national dish of Ethiopia, a spicy chicken stew. Philippa declared him a rooster and Joni sat on our patio and entertained the hospital staff with her arsenal of barnyard animal calls, drawing not only the rooster, but the sheep grazing in our yard. Yamatan prepared the bird for us, after I crawled into a shrub to retrieve the hobbling fowl as he made his break for it. We added pasta and spices and stewed him up in a pot we also bought from the market for just such an occasion.

The Imam's house...On the way home we took my favorite street, past the mosque and imams house, and like a child I peered thru the slotted wooden fence to the large golden wheat fields that makes up the eucalyptus lined yard. The men in the field across from ourhouse sift teff from hay and drive their cattle in circles to mix it up. Donkeys bray from somewhere out of sight and children run the dirt packed avenues with homemade pinwheels spinning in the wind. The hospital was quiet with two new births, the sun was present and ready as always.

IMG_0403Darlene spreads across the chairs in the yard, dark glasses on, reading a novel as the heat of the afternoon soaks her clothes with warmth. Our pails are full of water, as today is a water day. At the stadium, the hospital futbol team tied in a tough match and Manchester United, the town favorite, won on the tele. It seems the perfect day.



Ethiopia’s Daughters: Chapter II

January 25th, 2011 by · Africa, Ethiopia

… continued from Chapter One of Ethiopia’s Daughters

Chapter Two

Operating TheaterWithout running water, sterility is difficult and conservation is everything, even during surgery. Faded green gowns and drapes, homesewn lap sponges, recycled tubing, everything in the operating room is used again and again. We enter building 24, the operating theater. A clear plastic apron, battered from use, is placed over our heads and tide in the back. I run my hands under trickling water from a bucket, passing the soap to Dr. Philippa, we scrub for surgery. A sweet smelling purple alcohol dries our fingers.

Putting patients under general anesthesia at our Hospital is an amazing feat undertaken only by one, a recent graduate of the nurse anesthetist school. Without the ability to monitor blood pressure, oxygenation, blood count or really anything else during our case, he does an exceptional job of keeping our patient stable. I’m in awe of what little maintenance will keep a patient alive. I feel this is what surgery must have been before technology or electricity.

Fingers across her taught belly, a lateral incision is made. It is now obvious the uterus has ruptured just as the midwife Abraham had predicted. We pull gently, dislodging the lifeless baby from her torn womb and pass it to the nurse. A quietness overcomes us all.
There is little time to be sad as we shift our focus to the mother, Samanesh. Working quickly, Dr. Philippa’s nimble fingers stop the bleeding as she removes the uterus and repairs the vaginal wall. Dr. Frantilal, a young local General Practitioner, his dark eyes concerned behind the mask, ponders our decision to save her right ovary, ‘I have never seen this done before.What is the use of this?’
‘Wouldn’t you prefer I save a testicle if I could?’ asks Philippa.

In remote rural areas, there are no roads, only narrow foot paths. Sometimes a six hour walk is required to reach a bus stop. And then they wait, wait for an overcrowded bus to transport them to the district hospital. During the rainy season, foot bridges are washed away, roads eroded, making the journey even more arduous. Often without shoes, these women labor on route.

Samanesh’s forehead perspired, she was familiar with birth, this was her fifth pregnancy. Her ‘pushing down pains’ began at home, surrounded by family, far from the hospital. Hours passed as the baby’s head wedged high in the birth canal, unable to slip into position for delivery. Labor stalled. A sense of urgency, something was wrong, her life was now in danger. Her family began the long procession to the hospital. Hours later, Samanesh arrived exhausted, bleeding and the baby no longer kicking in her belly.

Morning RoundsPoverty, lack of education,  malnourishment and the devaluation of women are obstacles in developing nations for a safe delivery. Once these are rectified, one issue remains at hand- access. While numerous health centers are within hours from each other, the hospitals are few and far between, once you reach a hospital there may be no physicians on staff,  not to mention no operating room or surgeon. The WHO reports there are more Ethiopian doctors in Chicago then there are in Ethiopia. Lack of transportation and lack of roads are a standing problem for these women.image by Joni Kabana

Early mornings we walk through the rusted blue hospital gate to make rounds, the maternity ward, building 28, is just waking, newborns crying out to suckle, birds chirping, staff yawning. We check our patient’s vital signs, looking for infection, any signs of decompensation. Samanesh’s devoted family remains at her side, they feed her injera and chai, change bed sheets and sponge her tired body clean. Days later her fever resolves and we stop the intravenous antibiotics. A week passes, her incision heals, she is able to return home with her husband. She returns a sister, a mother, a wife, a daughter.


to be continued…


Ethiopia’s Daughters: Chapter I

January 19th, 2011 by · Africa, Ethiopia

Chapter One

‘You want a picture?’ he asked as we drove to the edge of the desolate canyon.

‘How about now? You don’t have camera?’

‘Later,’ I told him, ‘When we come back, when we return home.’

‘You sure? You sure you return home?’ he laughed.

That was a good question since I was wondering how this rusted jalopy, bouncing and speeding through curves, almost colliding with buses, was going to get us to Mota at all. Knuckles white, seizing a broken door handle, I watch as the broken speedometer oscillates anywhere from 0-120km while the gas gauge hoovers over empty.

‘We make the hospital in no time, maybe three hours.’

Image from Joni KabanaThe only two story hotel in town is painted pink, Hotel Wubit, and sits midway along the dirt highway stretch of 240km, the original eastern through-way connecting Addis Ababa with the North. Asphalt has yet to see this part of the world.
‘We are here, this is Mota!’ he smiles, pulling into the hotel parking lot, ‘Now we should have food.’ Inviting the driver to lunch, we collapse into wollen couches and share beyainatu, small portions of vegetarian food dumped over injera. We scoop potato, shiro, cold french fries, lentils and cabbage into our hungry mouths.

Road signs adorned in blue Amharic script line the road, we turn off towards the Hospital in search of our new home.

Blue and white paint coat the walls, colors of hospital and government. Only open for ten years, age prevails over the compound- a building has fallen, walls cracked, overgrown weeds and trash decorate the compound. An aluminum latrine sits downwind, but meandering the paths, one must be mindful of human scat.

Only in the last year has the hospital come alive- a water tank, the opening of an operating theater and a mini medical library. Water is pumped from the ground four mornings a week into the tank and keeps the plastic buckets in each ward filled. The small library houses a surprisingly large assortment of medical textbooks with two wooden desks filling the room and one dial-up computer with a lineup of staff waiting to check Facebook accounts.

Episodes of MASH come to mind passing through the aluminum doors into the operating ward. One room for minor procedures stays busy removing lumps and draining wounds. The main OR, reserved for gynecological emergencies, is open 1-2 times weekly. My visa and papers are stamped with such purpose, Dr. Philippa and I will become quite familiar with these quarters.

Patient TransportThe morning of our first day, a daughter recovering from childbirth is carried home by her family, she rests atop a wooden bed strung with goat skin. At the same time, another daughter arrives, supported by the arms of her father and husband. Her pregnancy is full term, but her labor has stalled. Abraham*, a quiet, unassuming midwife, his second year working at the hospital quickly recognizes her distress- a ruptured uterus, the baby has lost its heart beat.

To the untrained eye, her stomach bulges on top and bottom, a valley between- twins, a mass, a fibroid tumor? Instead, Abraham teaches us, it is the sign of a ruptured uterus bulging atop and the dead baby bulging below. ‘The mother will die if she is not operated on immediately.‘

This is why we have come, this is the purpose of the Foundation, to train local medical doctors to perform emergency obstetrical services.

We are here to teach, but we have much to learn.

CostsThe story is complex, these young women are often malnourished and under developed. Their pelvis is small, creating a problem for childbirth. The nurse midwives, three females and four males, are incredible talented at using their hearts and hands delivering even the most difficult of births. But their magic ends once a baby becomes stuck in the birth canal, the mother’s survival precedes the baby’s. A Cesarean Section vs. removal of the fetus through the vagina. There are no perfect solutions.

*Names have been changed.


to be continued…


Hamlin Fistula Hospital

January 17th, 2011 by · Africa, Ethiopia

In her gardenDr. Catherine Hamlin is eighty seven years old and still performing surgeries. Her work has been included in multiple award winning documentary films, including A Walk to Beautiful and Lighting the Candle. We hadn’t received confirmation on our request meet, so when an interview was granted, we had to race back to the hotel to grab our equipment.

Along the way I hooked the lavalier microphone to Philippa and tested the audio levels, an excellent sample given the bump and jolt of the old minivan and the chaos of horns and street commerce. Joni configured her cameras for video and together we honed our questions to respect Dr. Hamlin’s time.

Dr Hamlin’s presence is graceful and enchanting. She fills a tall, composed space in her hospital whites surrounded by a backdrop of large window panes framing the extensive flora on the hospital grounds. As we prepare to film, a group of tourists come in to greet her. They are at once speechless and giddy with respect before this humble, grandmotherly presence.

The interviewI hoped to ask five questions in about ten minutes, but the tape started rolling as she talked about her gardens, how there were only two trees on the property when they purchased it, and how she personally planted each and every plant and tree. She spoke in long, thorough narratives and my five questions became a dialogue on women’s health and access issues that lasted for almost of forty minutes.

After our interview she gave us a more personal tour of the plants and trees that document her tenure here. Amid the chaos of Addis Ababa she has cultivated a garden, a hospital, and a system of support where rural women can begin finding peace and building a new life after the horrific, isolating trauma of fistulas so common in rural Ethiopia.


Photos by Joni Kabana

NOTE: Two duffel bags of KEEN shoes were delivered to Dr. Catherine Hamlin, who couldn’t have been more sincerely appreciative. Darlene and Philippa delivered two additional duffels to their clinic in Mota. The shoes are a big success and we’re working with Dr. Hamlin to transport more to her clinic, but there are so many more to deliver and we continue to look for delivery options.


Returning to African soil- Addis Ababa, old friends and roosters

January 15th, 2011 by · Africa, Ethiopia

Windows down, hot air plastering dust over smiles, the traffic is chaos with horns blaring as we pull into the city of Addis Ababa. We have returned to Ethiopia. Danny, our taxi driver, shouts over the mix of local hip-hop and Michael Jackson, inviting us to a bunna bet or coffee ceremony at his sisters café.

Soaking in the bustle of morning, a chaotic paradise surrounded by mountains and high risers. Goats awaiting fate with their brethren chickens anchored by the side of the road. Christian and Muslim families alike make their way through the city. So begins our journey.

Stumbling over broken Amharic, laughter erupts from all sides as we try to assimilate our ferengi smiles into warm and welcoming crowds. The faces seem familiar as we return to our old hotel.

Last night in Addis, dinner was shared with old and new friends from Gimbi. Jay was excited to hear about the Street Boys he spent so much time with. The Podoconiosis project he filmed lives on and many of the first patients now have normal size legs, ankles and feet.  We spent hours talking about medicine, Africa, the pros and cons of humanitarian efforts and the realities of poverty. I am exhilarated to be back, where my passion for medicine and Africa fuse, this is where I belong.

The roosters have been crowing, waking before the sun, bringing the city slowly to life. Our Ethiopian coffee sludge awaits, I must remember to ask for bunna weuteut, coffee with milk.

Nine months ago we left Gimbi Hospital in Western Ethiopia with a desire to return and further our volunteer efforts. Since then we have joined forces with Joni Kabana and Dr. Philippa Ribbink in FootSteps to Healing. Our purpose is multiple, including volunteering for four weeks in Northern Ethiopia with the Mota Governmental Hospital teaching Emergency Obstetrical Services to local doctors, health officers and mid wives. Jay and Joni area heading south to the Omo Valley to document the tribal medical facilities and services, as well working on a film project for Merci Corps.

We are thankful to everyone who has donated to FootSteps to Healing, Darcelle’s raised over $5000 and combined with other efforts we now have over $ 11,000, nearing our goal.