Travels through Ethiopia

Lexy Adams

2012 GHLI Fellow

Our Fellows’ program luckily coincided perfectly with the Over the last four weeks, I  have been visited eight of the 15 LEAD hospitals as part of the Ethiopian Hospital Alliance for Quality (EHAQ) -- traveling all four directions out of Addis Ababa to visit different parts of this country.

Each of the hospitals and regions has have unique differences – some are located in the thick of the city, overflowing with patients and their families in tall institutional buildings; others are tucked high into the mountain peaks, many kilometers away from the closest town, and attract rural patients that trek barefoot for hours across the countryside to receive their care. Regardless of  location or patient base, each hospital has been identified as a leader in patient satisfaction. Our site visit teams spent a several  days investigating the secrets to each hospital’s  exemplary service, collecting data, interviewing patients, taking countless pictures, and asking question after question of all relevant staff members.

We have collected a wealth of information – illustrated by the  huge stack of documents and full “inbox” on my desk. Somewhere in this huge mass of paperwork there lies key best practices that can be shared across the country to help improve the quality of care. These practices are simple, effective, sustainable and reproducible across all facilities. Our job now is to  identify and disperse them through our next Ethiopian specific change package.

These site visits provided me with many opportunities to travel outside of Addis and see the major sights in the country. I was fortunate enough to see the stellae and obelisks of Axum, the castles of Gondar, Lake Tana of Bahirdar, the churches of Lalibela, and I even fed some hyenas in Harar. Through all of this travel and work in the hospitals, I have effectively fallen in love with Ethiopia: the people, the countryside, the cuisine, the strong community feeling. As my time winds down I dread my departure, and know I will undoubtedly return. 

Update from Ghana

Micah Johnson

2012 GHLI Fellow

Much of my work this summer centered around Ghana’s newly passed Mental Health Act. I was honored to be invited to give a presentation on the law at the University of Ghana Medical School, Department of Psychiatry, which provided a great opportunity for me to step back and reflect on the piece of legislation that forms the core of the mental health reform effort in Ghana. In addition to distilling the law into its main themes, I attempted to spark a realistic discussion of the challenges that remain in implementing the law. For instance, the question of funding for mental health is still largely unresolved. The law establishes a Mental Health Fund, but it is up to Parliament and other bodies to identify and secure ongoing sources of money that can be paid into the fund. Without these and other crucial next steps, the law may largely remain an empty promise.

The most interesting part of the presentation for me was a follow-up discussion with the master’s students in clinical psychology. They had an especially sharp eye toward the challenges of implementation. For instance, one provision in the law states that involuntary admission of a person for a mental health issue requires approval by court order before taking the person to a hospital. But a student from the Northern Region of Ghana made a simple observation—his district doesn’t even have a court or a hospital! This point and the rest of our discussion reinforced an important theme from the summer: passing the law was a great victory for mental health in Ghana, but it really only lays the groundwork for further efforts that will be necessary to truly effect change.

It’s a privilege to have been involved in this work, and I hope the progress that has been made so far will only be the beginning of a true transformation of mental health care in Ghana.

Visit to Margibi County

Janeen Drakes,

2012 GHLI Fellow

I have spent the past two weeks in Kakata, a rural area of Margibi County in Liberia. The change of pace is refreshing and the overall atmosphere is much more relaxed. While there, I visited numerous facilities and attended community meetings. Driving through the county to the different sites is breathtaking. The area is filled with small villages and farms, rubber plantations and vast areas of untouched land.

My last day in Kakata proved to be the most rewarding thus far. I assisted with a clinical outreach and awareness campaign being held in the village of Worhn. When we arrived, the community center was filled with hundreds of patients, many of whom had walked for hours to reach the site. While patients waited to receive care they made construction paper hats featuring health messages and listened to radio campaigns while children danced to the latest hits being played.

We took advantage of the gathering, to have a meeting with trained traditional midwives (TTMs) from the Gibi district. Despite having travelled many hours to reach the meeting and then having to wait due to our late arrival, the women were welcoming and excited to meet me. I was greeted with traditional songs and dances and hugs and handshakes to welcome me to the district. During the meeting, I explained, how maternal waiting homes were being utilized in other countries and some of the best practices. Then the floor was turned over to the women. It was great to see the ownership and pride which they took in their jobs and to hear the roles they would be willing to take to make the project successful.

It was especially great to meet Ma Teneh, one of the TTMs and a source of inspiration for this project. Before the county health team embarked on the maternal waiting home project, she had been hosting and caring for pregnant women in her home until they were ready to deliver. She and the other women will continue to play a crucial role in the project as it moves forward.

National Day of Service

With Fikile Ndlovu -- a member of the 
delegation -- at a township school. 

Heather Fosburgh,
2012 GHLI Fellow

On July 16, I had the privilege of participating in South Africa’s National Day of Service in commemoration of Nelson Mandela’s 94th birthday. I joined an event with the Premier’s office at a township school outside of Durban. The day included various projects such as painting, planting trees, setting up a library and cleaning the school grounds. The event was joined by the Premier who reminded the students that they were the first generation born out of apartheid. It must be truly heartening for people to know that that there is a new generation that never had to endure that horror.

While this was only a daylong event, countless hours went into preparing for this project. The night before we did not leave the school grounds until midnight and many of the same people returned at 6 a.m. It was amazing to see so many people work so hard not only for their appreciation of Mandela but also, their own engagement in improving their country. And, the school and the community will continue to improve their facility and educational outcomes.

After being here six weeks, I am continually impressed with the passion and dedication people have for their community. For me, this is most noticeable in the provincial and district government offices.

Most importantly, the National Community Service day is also a humbling reminder of the dedication, innovation and passion it takes to build a nation. South Africa’s democracy is only 18 years old and its constitution, while a strong foundation, is still a working document. This is a nation still in its infancy. They have been forced to tackle enormous challenges that other democratic institutions have been struggling with for centuries.

Chilling in Shashamane

Sudhakar Nuti, 

2012 GHLI Fellow

Shashamane, fondly known as “the Shash,” is a city to the south east of Addis. We traveled there for a site visit for Shashamane Hospital, one of Ethiopia’s LEAD Hospitals within the Ethiopian Hospital Alliance for Quality (EHAQ). However, the experience we had was much different than expected.

I will forever remember Shashamane as the “Little Jamaica” of Ethiopia – a large billboard of Bob Marley greets you as you enter the town. The town had a tropical feel, with palm trees lining the roads, and the hospital seemed more like the grounds of a small jungle than a medical facility. The facility did not look top class from the outside – buildings were dispersed among the grass and trees, connected by rocky dirt roads. But physical appearance was definitely not the best way to judge this center.

In fact, the hospital was amazing. The CEO Hedato and his Medical Director demonstrated that they were well prepared and very proud of all the work done to make this a high quality hospital. The department heads were all helpful and quite informed on their areas of expertise, which allowed us to collect valuable “best practices,” our primary objective on the trip. We left the hospital pleasantly surprised by the excellent work that was done and with the satisfaction of accomplishing our task.

Yet, even more enjoyable than the hospital was the Jamaican restaurant that Zahirah (GHLI program director) and I frequented in our time there. There we met Brother Desai, a Jamaican emigrant who told us stories about how his family arrived in Ethiopia more than 30 years ago, quoting Bob Marley lyrics to make his points. We also spoke to his son, who described how they used to fight off hyenas and how hard they worked to build their restaurant. Later, we bartered with Brother Desai’s wife for some hand-woven Jamaican items. When thinking of Ethiopia, Shahamane is one place I will never forget.

Why We Do What We Do: Kaveh Khoshnood

Kaveh entered Loyola College on a premed track, but his father, a doctor in Iran, noticed his son’s interest in social sciences and encouraged him to explore a career in public health. Kaveh began his M.P.H. at Yale in 1987 when the AIDS epidemic was news around the world. After volunteering for AIDS Project New Haven, Kaveh teamed up with Jon Parker, a former drug user, who led many radical AIDS prevention efforts in New Haven – including distributing clean needle to drug users - at that time considered an act of civil disobedience. Parker later became a Yale School of Public Health graduate. “Parker connected with people at a human level. It was an unorthodox approach that was very different than what I was learning in school,” explains Kaveh.

When asked to relay a moment in which he felt his work had made a difference, Kaveh recalls a talk he gave a few years ago. “A man came up to me after a speaking engagement and asked if I remembered him -- he said he was "Bugs Bunny.’” This was a pseudonym used by one of the drug users to whom Kaveh gave clean needles more than 20 years ago. “Then I remembered him clearly because after he picked up new needles and got back in his car he always buckled his seatbelt. I was always told that drug users were careless with their lives and it was hopeless to help them, so this act of caution always stuck with me.” The man had come up to Kaveh to thank him for all he had done and told him that the needle exchange program had saved his life.

In July, Kaveh enthusiastically attended the first International AIDS conference held in the U.S. since 1990. He reflected on the meeting as monumental as it is a response to President Obama repealing the policy that banned people with HIV from entering the U.S. Along with numerous positions in AIDS organizations, Kaveh is a professor at the Yale School of Public Health, where he encourages students to examine current approaches to the prevention and control of infectious diseases.


Nina Gumkowski, GHLI Staff