Ethiopia Highlands, Summer 2011

Letter from Ethiopia: Highlands , Homes and Churches

I was in Ethiopia for a week in July 2011- almost 17 years since my first visit in Nov 1994. The government which overthrew the revolutionary Derg regime has just celebrated 20 years in power with huge roadside posters in Addis.  Living standards have visibly improved.  Democracy is not yet well developed in Ethiopia, the opposition fared badly in last year’s elections. I wondered whether this was because the governing regime is protecting its power but people said that the opposition was very feeble and had offered few new ideas and deserved the rejection that they received at the polls.

I was there to visit my research fellow S and monitor progress on a trial of ciclosporin that we have been trying to set up for the last 3 years. Ethiopian bureaucracy is slow and obdurate; S has had the patience of a saint to negotiate it. We had been waiting for the drugs to arrive from India for months. Finally they arrived a few days before me. But although they had arrived they were then untraceable at the airport. It took endless phone calls to track down the container with our drug consignment. Then we had to negotiate Customs, finally we were presented with a bill for storage costs for the time that the container had been “lost”. Since the container people still had the drugs we didn’t have much choice over paying.  I followed S taking the calls. Her fluent Amharic enables her to negotiate with Ethiopian skill.

S is a quarter Ethiopian , quarter Italian and half German and she seems to be blessed with the strengths of each nationality. She is phenomenally well organised, just the person to be running a trial, she has the warmth of Italians welcoming one with food and love and she has the determination and nationalism of an Ethiopian. She is married to G, an engineer who is half Ethiopian, half Italian who is based in Kenya building roads and bridges.  S has set up a household of three servants and a baby in a quiet, residential part of Addis.   Baby L is 10 months old and is the happiest baby I’ve ever seen. He crawl s around contentedly gazing at the world with his big Ethiopian brown eyes. He has fair skin and so his eyes are very noticeable, he looks like one of the Ethiopian icons. There are three servants, a twenty two year old nanny looks after L devotedly, and she hopes that her next job will be in The Gulf. Now she is too young- Ethiopia does not allow women to go and work in The Gulf until they are over twenty five, in an attempt to protect them. The cook is older, more serious and lost her husband years ago. She has a very bright son who although he comes from a poor background has done well in school and is just about to sit the entrance exams for Addis University.  She makes lovely food, highly spiced Ethiopian dishes alternating with Italian pastas and all accompanied by beautiful salads topped with concentric circles of chopped veggies that I was reluctant to disturb by eating. She is a diligent woman who works to high standards and I suspect that her son also her ability to work successfully. The cleaner is poor woman, with a cross tattooed on her face; she has epilepsy and only just manages in the household as a rather hopeless cleaner. S took her in out of kindness a few years ago and she is now part of the household but she has trying bouts of extreme religiosity and superstition.  I could see that the other two women were looking out for her; ameliorating her  outbursts. 

No sooner had I arrived in Addis than S took me away for a night to Debre Libanos, the site of an ancient monastery.  The highlands were beautiful with green grass everywhere, above were clouds and shafts of sunlight broke through into the rural scene.  There were clusters of huts for each family and clumps of eucalyptus trees.  There small herds of cows were tended by black blanketed herdsmen.  The lodge at Debre Libanos is perched on the edge of a deep natural gorge The ground just falls away from one for hundreds of feet  with a few little shoulders of land left were small fields have been created. Deep down in the valley a river flowed and there were small villages across the valley. I felt as though I was on the edge of the world.  We slept in stone floored mud huts, cold at night. In the morning I smelt the rosemary that was growing in the cracks between the stones on the terrace and watched gelada baboons roam through the scrub and small bushes below us. Eagles and vultures soared on the thermals waiting for breakfast.  Last a huge solitary eagle soared, perhaps one of the lammergeyer eagles found in Ethiopia who break open bones by dropping them on the rocks.  The monastery at Debre Libanos is famous and if one dies there one goes straight to heaven, so the monks have exploited this by selling exclusive sites in the cemetery, family plots for £ 2000. So donors believe they have a fast track ticket for the future and the monastery finances are boosted, surely a win/win! The monastery has about 300 monks saying prayers around the clock. We were shown around by a tall handsome blue robed monk who was very keen to tell us all the details of the saints there. Inside a few people prayed before the effigies.  Unusually for Ethiopia the church has modern stained glass and has very attractive scenes from the Old Testament, Jonah perching on a huge toothed whale mouth. Outside the church the beggars line the road for about a mile, all hoping for some alms from the visitors. We also had a request from home women to bring some holy water back to Addis for them. Holy water is very popular in Ethiopia; all the patients try holy water as the first remedy for any illness. We also bought some holy charcoal; if one cannot carry water then crumbling the charcoal into water later on will make it holy. Travel friendly holy water. I was struck by the contrast between the richness of the church and the poverty of both the beggars and the surrounding town.  The church did not appear to feel responsible for their neighbours. We had more church encounters back in Addis. L’s devout grandparents have insisted that he take his first communion, which happens at eight months of age. Now the poor chap has to take another five communions in the next x months because e it is especially important that children who are sin free take communion. He also had to take communion on his saint’s day and was taken off by his nanny and grandfather to the church, initially he was supposed to be fasting but this was relaxed after S protested. I was also glad that the communion on his saint’s day was also going to protect his against leprosy- who could deny him that particular benefit.

ALERT hospital was taken into the government service from NGOs several years ago and went through a ghastly period of restructuring when many people left, partly because their salaries were savagely cut. The hospital has now stabilised again and seems to have better interactions with the Addis University dermatologists. New buildings have also sprung up but it was heartbreaking to walk through the dermatology out-patients, packed with people waiting for a diagnosis. The leprosy clinic is now in a separate hut away from the main out-patients. The advantage of the separation is that the doctors have a lot more time to talk to the patients. There are two young Ethiopian dermatologists working there, Dr X and Dr Y. Dr X is full bearded and is touched by the plight of the leprosy patients. He has also travelled down to South Africa and was amazed by the wealth he saw there. Dr Y is a debonair young man wearing a suit and elegant tie. Both of them finished their dermatology post grad training in Addis. The trio seem to work together well and I hope they will form a leprosy nucleus. And the trial? Well it is certainly well prepared, S and I picked up the proformas that had been printed locally and were just being bound into booklets. She walked me around the hospital so that I met everyone who was involved in the trial and I saw them in their natural habitats, the pharmacist in his drug store, the biochemist in the lab. The next day everyone contributed to a presentation about the drug trial. So now all we need are willing patients.

It was a fine visit to Addis, staying with S opened up many aspects of Ethiopian life to me as well as being fun and nourishing.

Korea travels, Spring 2011

Beauty- natural or acquired?

During twelve days in Korea I experienced some amazing contrasts between the commercial strength of the beauty industry and the remoteness of the old leprosy colonies on remote peninsulas in the far South.

The World Congress of Dermatology was held in a 21st century conference building and was impeccably organised with teams of polite Korean students keen to help and every detail of the conference planned , from daily conference newspapers for the 9.000 attendees to giving us prepaid travel cards for the metro. Dermatology conferences have been completely hijacked by the beauty industry and the L’Oreal stand dominated the exhibition hall advertising attainment of beauty, there were two floors of exhibits 95% of which were stands advertising botox injections or laser treatments to magic away aging skin. Vast photos of Asian women with impossibly flawless spot free skin hung over the stands, all advertising an unattainable ideal. Delegates flocked to the sessions on cosmetic dermatology but just a few brave souls came to the 8 am leprosy and leishmania sessions where we discussed real skin problems. From the advertising and sponsorship one would have no idea that skin disease is unpleasant and that treating itch is the daily challenge of dermatologists. I also had my skin assessed by a computer programme that mapped out wrinkles, spots and blemishes. One could see a vision of one’s younger skin, so I was contrary and asked to see my older skin, so that I can prepare for those deep wrinkles The girl running the programme must have liked my approach because she then reassured me that I did not need treatment when of course she should have been emphasising how much improvement I could gain from botox. I also learnt that one cannot smile if one has had repeated botox injections and so the botox recipients have to relearn smiling. One of my colleagues Terence Ryan is fighting a rearguard action against cosmetic dermatology and is promoting the concept of community dermatology, so that the focus on skin disease or poor people is not completely lost. He shared the leprosy platform but should have been somewhere with higher visibility. The other pleasure was meeting leprosy friends from India, Brazil and Sri Lanka.

I then flew south to visit two leprosaria. The first leprosarium I visited was a former mission-run hospital located on a rocky tree-covered peninsula. It had been founded by missionaries in 1926 when Korean leprosy patients were cast out of society and stoned if they were on the roads. The missionaries were the only people who would care for them. The hospital has now evolved into a modern orthopaedic and dermatology hospital. There was also an excellent museum created around pictures of patients and missionaries. The different phases of leprosy treatment were well shown, from shelter through early drug treatments, to rehabilitation. The old missionaries were also remembered with statues and a Korean carved stone memorial. About 70 very old patients still live in the hospital and are e cared for in an old people’s home. I looked in on one old lady with severe deformities. She was lying on her tatami mat with a bowl of cherries nearby and light was flooding in through the window, a peaceful scene. The hospital was run by a very energetic surgeon who took me and some other visitors out on a walk in the evening. We walked though a huge flat reed bed and up a small mountain with an observatory atop it. Cranes and herons flew around the reeds and crabs scrabbling around in the mud. There were beautiful views and also notices telling one precisely where to take the best photos. In the evening after a Chinese meal at which all the docs had been very deferential to their boss, I was driven back to the hospital by a young doctor doing his national service who poured out his woes to me about his remote posting and how he could not travel overseas because of his service status. So he was a typical conscript in hating his posting, even though it had interesting possibilities for research. The next day Ii travelled to the government hospital on an island. As I was waiting in a car park a hospital bus pulled up and I thought this was my transfer but instead 12 staff got out to welcome me. We then went to a restaurant and sat on the floor and had a Korean feast with a least 12 different types of fish to be picked at with chopsticks. I was then driven over the hospital by a local dermatologist in his Mercedes. I had been expecting a dingy building but instead found a new modern hospital with a high airy atrium and art pieces in the lobby. They had made a large sign saying “Welcome to Dr Lockwood and her special lecture on leprosy”. I then talked about leprosy on London. The director was passionate about providing a good service to the remaining leprosy patients in Korea. There are about 20 000 patients altogether in Korea but now only 20 new patients per year. I was then taken around the island where there were villages that ex-patients had settled in. There was also a small prison for misbehaving patients. The most poignant remnant was a mortuary, preserved with an autopsy table still inside and a notice saying that here patients had autopsies without consent and married patients were sterilised. It was like seeing something from Nazi Germany and was a very forceful reminder of the human rights abuses that leprosy patients have suffered. In the mission hospital I had met some anthropology students from Seoul who were interviewing patients about their past injustices. Patients had been forcibly relocated and also had to work as forced labour. All occurred mainly during the Japanese colonization from 1920-1945. The Korean government has acknowledged the damage done to former patents and when the president came to open the new hospital he apologised to the old patients. I had known of the abuses that leprosy patients had suffered in Japan but I had not realised that this also occurred in Korea. I was very touched by seeing the mortuary and although it is historical there is still much to do to demystify and moralise leprosy.

I was also a regular tourist and was bussed out to the Demilitarised Zone about 50 km from Seoul. It was a murky day so I barely saw over the barbed wire to an N Korean exhibition village that is close to the border but no inhabitants. . We were also taken deep underground to one of three tunnels that the South Koreans found were being burrowed towards the border. These were discovered in the 1970s and 80s and the S Koreans claimed that 60.00 soldiers could pass through the tunnel in 6 hours. I’m not sure that the North Koreans have the ability or the energy to attack the south now. Being in Korea I could feel how far apart the two countries are and how suspicious the South Koreans are. An N. Korean collapse like the collapse of E Germany in 1989 seems very unlikely. It is a very surreal place to be, especially as the DMZ is now a haven for wild life because it has had 40 years of complete wilderness.

Koreans work insanely hard, one sees school students on the street at 10pm, having just finished their post-school academy work and heading home for home work. Their fathers will also have worked 10pm and will be eating with their work colleagues before returning home to sleep and then starting again. I spent a day with Heyjon, a Korean scientist who had done a PhD at LSHTM and she confirmed that she only eats with her husband at the weekend. Suicide is the biggest medical problem facing Korea ; this happens at all ages, school kids, young people, middle aged people because they are all under huge pressure to achieve good grades or earn good salaries. When a celebrity commits suicide then people agree that something should be done but then nothing happens. I guess it requires such a deep change that it is too difficult to contemplate. Most families have one child only by choice and I can understand the huge pressures that are then put on these children and how resentments can develop.

Seoul feels like a huge American city with endless blocks of high rises and four lane highways criss-crossing the city, but when one explores it the individual districts are interesting and have their own flavour. I stayed in the Yonsei university guest house and that district was very lively at night with cafes and bars. Yonsei university was founded in the 1980’s and has an Ivy league feel with ivy clad 19th century buildings, but has continued building since then and has a beautiful outdoor Greek style auditorium to seat 3000 spectators. The women’s’ university was also as old and had an amazing piece of modern architecture that looked like a deep canyon cut out of the hill with glass sides. As I explored it I found that classrooms had been set into hill behind the glass. New graduates in miniskirts and high heels were posing with their friends for graduation photos. The straplines of the two made an interesting comparison, Yonsei was “First and Best”, the women’s, “Where Change begins” In the Bukkon area old Korean house built around courtyards with blue tiled roofs had been preserved and are now used by artists. There is also a very vibrant modern art and photography scene in Seoul and I wandered around small studios with interesting installations and maxed out on contemporary art. This was such a contrast to the public sector and corporate scene that I wonder whether Korea’s artists are doing a collective dissent for the nation. Certainly in other spheres dissent is not encouraged.

I also met a young English architect who has worked on the renovation plans for my house in Islington and is now doing a project in Seoul designing student accommodation. We spent a day biking around central Seoul and then an evening walking around the downtown area. She was both excited by being there and to be doing a project that she would not have done at home, but she also found the working conditions difficult. The long hours were killing her and she was surprised to find that there is little team work in Korean offices so people do not share information about the projects they are working on or help people with ways of improving computer programmes.

So my trip to Korea was full of contrasts, first the contrast between beauty and real world dermatology, then being in the leprosy hospital and feeling that I was touching a very recent past which involved exiling leprosy patients and abusing them. Then meeting Korean people and getting a glimpse into their work –oriented and dissent-averse society. But also being able to enjoy the sculpture and art in public spaces.