the tao of what's really going on
Disclaimer: I wrote this and then felt like a bit of a knob. But I'm posting it anyway. Ho hum.
So! Hello! I hope you are all well. I went to Ethiopia for ten weeks!1 It was very interesting. Now I am back and having slight culture shock. I was not expecting that. F was all "oh my god, I don't understand England, I'm scared of going back" and I said "mmmm" and internally rolled my eyes because for god's sake, it's not like we have been EXILED TO THE ANTARCTIC FOR MANY YEARS, but yet here we are. Anyway. Yes. Ethiopia! It is very poor and there is not much there. Oh, I don't know how to talk about this. Perhaps some illustrative anecdotes.
1. I should clarify what I was doing: I've spent this last academic year intercalating in International Health. Second term you get to do a research project abroad. I intercalated almost entirely for the opportunity to travel, and to get away from medicine for a year before I cracked up, and my research project was conceived at the last minute and generally shoddily executed - I just want to clarify this in case anyone is tempted to give me karma points. Anyway, the research involved interviewing the urban poor, hence why I got to go to people's houses and talk to them. When I wasn't doing that I was having an extremely nice time laughing and eating cake.
1) Woman in a mud hut off the side of an asphalt road. Occasionally big lorries go past and we can't hear ourselves talk. There are two rooms in the hut, with no door between them. I would estimate that the total area of the house is about 4m by 3m. In the room we are in, at the front, there's a mud pallet built into the wall with a single blanket over it, and several low stools made of wood with strips of hide woven from the frame to make the seat. In the back room there's another pallet, a plastic bucket and a few cups and other things, the little charcoal stove everyone has here to cook injera, the cups for the coffee ceremony. The roof is corrugated iron and doesn't seem to have any chinks, which is quite an improvement over quite a lot of people's.
The woman - call her Tigist - is thirty five years old. She has a second grade education, an income of less than one dollar a day, and three children: a twelve-year-old, who is at school, a ten year old, who is here at home, and a four-year-old, also here. The four-year-old had a twin, but he died. The ten-year-old - let's call her Mariam - is not at school, because she is blind.
Here is what happened to Mariam: when she was five, her mother gave birth to the twins. She wasn't married to the father, and he cleared off before the birth. I'm not quite sure if he paid her for the sex or not, and don't want to ask. Either way, Tigist was alone with two young daughters and a pair of newborns. During their first month of life, Mariam began getting headaches. They got worse and worse. Then her head started swelling up. "Do you mean the flesh of her head?" I ask, but no, Tigist says, her whole head actually swelled up. Then after a few days she went blind. At that point Tigist took her to the hospital.
At the hospital the doctors didn't explain what was happening, although it was clear from the way they talked among themselves that they were worried. They checked on Mariam every hour. She continued to deteriorate. She went deaf. Tigist stayed at the hospital. She was certain Mariam was going to die. Her face and voice, when she tells me this part, are awful. It took them a week to diagnose the child with cerebral TB. The treatment worked and she recovered and regained her hearing. She never regained her sight. It's clear, from the way Tigist talks, that no doctor has ever sat her down and told her that she never will, and although she is a sensible woman I can tell that she still has a shred of hope. She asks me I I know anything that will help Mariam regain her sight. I am inexplicably struck with the feeling that it's not my place to tell her things, especially when I'm not certain of them - after all, I'm not her doctor. I just say that I'm sorry, I don't know of anything. Afterwards I wish that I'd said right out that Mariam will not get better, because the woman doesn't have a doctor, and she might keep on painfully hoping and being confused for years.
"Why didn't you go to the hospital sooner?" I ask, and I already know the answer but my fists still clench when she says "I couldn't afford it". She doesn't just mean money. She was alone and destitute and she had no-one to look after her newborns, and it was not physically possible to walk to the clinic carrying three children. Hence the child is blind. This is what happens. This is how it works.
Watching Mariam she's obviously not quite right. She's more animated than anyone else I've met here, adult or child, and slightly mal-coordinated. Tigist and my translator keep telling her to sit down as she wanders around the hut, occasionally bumping into things. She laughs a lot and says things that don't quite make sense. My translator draws her down to lie with her head in her lap and she gradually quietens, lies there drowsily murmuring to herself. She still gets headaches a lot. I can't think what's going to happen to her.
I don't ask Tigist about the twin who died.
2) A man living in the real slums. The ones that are worse than mud and corrugated iron, I mean; the ones that are self-built out of sticks and plastic bags out in the wasteland beyond the market. He hurt his leg in an accident at the building site he was labouring on. He's still got the metal stuck in his leg. It stops him from working. He can't afford to get it sorted out, because the hospital is charging him 100 birr for the operation. 100 birr is £5.31.
3) The wife of 2). A few months ago, she went for an HIV test. This is a big deal for Ethiopia, because the stigma is still pretty major - we know one seven-year-old child who's HIV positive, but her mother won't take her for antiretrovirals, because everyone in the community will find out about it. The average time between infection and onset of AIDS in untreated people in Ethiopia is about six or seven years, and it's the same for children as for adults. The child we know is starting to show. The last time I saw her she was wearing a scarf over her head, and when she moved it to show me the sores behind her ears she lifted it and beckoned me under it to see. So her mother is training her to try and hide it, but of course she's not going to be able to; of course people can spot AIDS round here.
Anyway. This woman, Mrs 2. Despite this stigma, she went for a test a few months ago, because the kebele organised an educational programme and sent out a representative to tell people to get tested. So she went along, and to her great relief tested negative, and then went home and got her husband to go for a test as well. And another time, the kebele promoted birth control, so what she did is, she went along to the family planning clinic and went on the pill, and then later that didn't suit her anymore so she went on the depot. They have little education sessions in the waiting room at the clinic, and she told me about all the forms of birth control there are, and how to use them.
This story is more impressive if you understand what a huge gap there is between implementing public health measures and people actually doing anything about them, what an immense leap of will and effort it takes, the effort to trust some completely abstract information and then to do something completely contrary to the normal flow of your life. Even if you're well-off; unimaginably more so if you're poor. This woman's got nothing. She can't read or write. She lives in a hut made of sticks and plastic bags and sweeps the streets for 180 birr a month. But when someone gives her a scrap of an opportunity, she finds the will and the energy to take it. She always takes her kids to the doctors, as soon as they're ill, no matter who she has to borrow the money from. She's trying so hard and no-one's giving her a fucking inch and she's got nothing.
4) Similarly to 3), I spoke to a beautiful girl in her mid-twenties who'd obviously managed to move her family up a notch in the world, because they have an actual bed with a mattress in their house, and an armchair and a table. She was a hairdresser and supported her three younger siblings, who were twelve, eight and five. The eight-year-old girl was, as the translator put it, "slow in her mind". It was twenty minutes into the interview when she mentioned this, and I'd been idly watching the girl and thinking what a beautiful child she was: braids, pink skirt, pink sweater slipping off one shoulder, otherworldly expression, sitting on a stool and staring at the sunlight on an opposite wall. Talking to the older sister, it sounded like she had what dawned on me was phenylketonuria. The story of her experience with the healthcare services was instructive: the kid had an accident when she was one year old and had to go to the hospital. Her sister heard the doctors talking among themselves, saying that they thought the younger sis - call her Getachew, although it's a boy's name - had something wrong with her. They didn't say any of this to the family. Older sis went away, thought about this. Over a couple of years it became apparent that indeed there was something wrong with the girl. Their mother had a friend who knew a specialist at the hospital, so when the child was three sis managed to get her an appointment - she told me, matter-of-factly, that she'd never have been able to get one without having a contact.
Anyway, she had one appointment with the specialist. The specialist looked at the girl and diagnosed her. He told sis that she needed to cut down the protein content in girl's diet and told her which foods to avoid. With regards to the mental retardation he told her, okay, you just need to teach her. You'll need to show her what to do over and over again. Show her how to feed herself and dress herself. Talk to her and explain things. Never get angry or impatient with her, always be kind. You can get another appointment if you need to talk to me again. Sis never got another appointment. She went away and followed his advice to the letter and the girl got much much better, lost all the weight and started to make progress and learn to walk and talk and dress herself.
I just - I think of all the medical support you'd get in this country, all the places you could go, the patient support groups, the helpbooks, the internet sites, the access to information and skilled care. This girl got one fifteen minute interview with a specialist. He didn't prescribe anything, he didn't offer any follow-up. He told her what she needed to know, once, and she went away and did it, and four years later the girl is enjoying a quality of life possibly better than she might expect in the UK - discounting, of course, that in the UK she'd never have to get to the point of disability, because they'd have picked her up with the pinprick test at birth - because she's fully integrated with her community, and with her family, and she'll never ever have to go in a home.
The other thing Older Sis does is, in her free time she helps people in her village when they need to go to the hospital. She goes with them to the hospital, and stays with them, and helps them work out what's happening and where they need to go. She doesn't do it as part of an organisation, just off her own bat. She says that the poor people find it difficult to get healthcare, because they're poor and easily intimidated and it's confusing and takes too much time and whatnot, so when she has time she goes with them and helps. And when she has free time when she's waiting there with them she goes and finds people who've come from the rural areas and don't know where to register and stuff, and shows them. This stuff was exactly what I was doing my project on, and I'd just spent a couple of weeks going GRRR ARGH I CAN'T BELIEVE HOW DIFFICULT THIS IS FOR PEOPLE I CAN'T BELIEVE HOW CRAP IT IS DAMN YOU HEALTHCARE PROFESSIONALS DAMN YOU GOVERNMENT YOU MUST REFORM. And there she was, not professional or trained or getting any money for it, and with more than enough of her own to worry about, just realising there was a problem and doing something about it. I just- I've never been floored and humbled as often as I have been over the last ten weeks; I can't believe people are this amazing.
The other thing. At the end of the interview, my translator pointed to the younger boy, who is five, and said casually "He is also ill."
"Oh, right, what with?" I said.
"We cannot say in front of the children," said my translator. I was a bit bewildered, but thought maybe it had something to do with sex or genitalia or something. The kids went outside, and my translator said quietly "He is positive." It took me a minute to realise what she meant.
*
That's just a few of them. We kept on hearing and seeing stories the whole time we were there, lots of them. I'm having a Reality Shock thing. I think the reason I've been more affected this time than other times I've been to developing countries is partly the repeated exposure effect - the first time you go somewhere poor you go oh, how awful, poor people, and you cry and freak out a bit, and give excessively to beggars, then you go home and forget about it; then the next time you go back all those poor people are still there, and you are very embarrassed - and partly because I wasn't meeting people in a medical context. I spent three months (sort of) in an exceedingly unpleasant hospital in Mongolia during my gap year, and a couple of weeks in a rather nice one in India last year. And, you know, there was an eighteen-year-old in India who was dying of leukaemia which he'd have been able to get the chemotherapy for in England, and a twelve-year-old with TB everywhere who had to have fluid taken off his lungs every day, and who would sit on a woollen blanket in the emergency room every afternoon with a large-bore needle in his chest wall and tears running silently down his face, and a little boy who'd fallen in a cooking fire and had second-degree burns over his entire leg and who was pretty much getting nothing but wound care, and oh yeah, the Indian government grants licences for the use of opioid painkillers and this hospital didn't have one yet, so they were performing pretty much every major operation except for neurosurgery with only ketamine and NSAIDs available for pain relief. But you're pretty much expecting horrible things to happen to people in hospital, you've got people filed under "patient" from the beginning, when you meet them you know what to expect. Whereas in Ethiopia we just met people in a way that felt social, and said hello and smiled shyly and laughed at nothing in particular the way you do, because you know you want to tell jokes but you don't have the language but you both have goodwill, and you smile a lot and try hard to say it all with that, and then they invite you to their houses, and their houses are made of mud, or sometimes sticks with mud blocking the chinks, or sometimes just sticks and plastic bags, and they don't have running water or mattresses or healthcare or education or shoes or clean clothes or power or a future or knowledge or anything, but they're just like you, and you realise that this is allowed to happen to people who are sitting right in front of you. The people I interviewed were randomly selected; I wasn't looking for people with horrible lifestories. But every single person I spoke to had had something terrible happen to them: bereavement, illness. Because that's what happens when you're poor.
I was cross that I couldn't show pictures because of confidentiality, then I remembered that I have pictures that aren't of the specific people I've mentioned here, so it should be alright to show them.
Here are some houses in the slum-of-slums out beyond the market:
Here are some more:
And more:
Here is someone's roof:
Here is one of the children living under that roof:
Here is a little boy who lives in that neighbourhood:
Here is a woman making injera:
Here are her kids:
Here is a beggar woman and her child who said hello to me every day when I went to work for two months, and who I eventually had to take a picture of. Mostly their faces break me:
I don't have that many photos of dreadful things because I felt invasive taking them. I very much wish I could show the pictures of the little girl we befriended, and spent two months playing with and being irritated by and avoiding-the-clinging-of and all the ordinary things, and then found out that she was HIV positive. I wish I could show the pictures of everyone I mentioned above. But, you know, not so much. They're good photos, though.
The thing I can't get over is how little new factual information this is to me. I cannot, I just cannot get over the fact that in theory I have known about all this stuff for years. The way I keep finding myself thinking about this is the difference between facts which can be known and a reality that has to be appreciated. While I was away I was reading Karen Armstrong's History of God, and she keeps going on about how most religions are basically saying the same things, and most of the trappings of religions - prayers, scriptures, rituals, meditation, avatars and idols etc - were originally conceived, or considered by smart people, as just aids to helping you perceive a reality that was completely outside your sphere of existence. I kept on thinking about it, how it's sort of exactly the same process, trying to feel the reality of something you can't see, and that is so far away it essentially leaves no traces on you at all. Just thinking about how long it took me to develop basic reflex empathy for the human beings around me makes me tired; of course nothing ever gets changed. How are you supposed to believe in an invisible world full of people who are completely different from you, suffering in ways which, by and large, you can't imagine? The only evidence you have is pictures and stories, just like in the old days when you were supposed to believe in crucifixions and virgin births and heaven and hell. Pretty much no-one has that ability at all; I can only think of one person I have ever met who had the sense, genuinely and painfully, that all the people she couldn't see were also real, and it informed everything she did, to the point where she gave away literally half of what she earned, and never wore new shoes, and couldn't sleep at night. Most other activists/vaguely political people that I've met jimmy themselves into virtuous behaviour by study and will and knowledge and occasional welcome flashes of deep feeling, the way most theologically-minded types who aren't actually prophets always have. It is such hard work to keep yourself convinced, and still a little bit akin to belonging to some sort of minority sect; it's not like it's even the broadly socially acceptable thing to do. It would be good if people acknowledged that of course we don't really believe in the rest of the world, and then set about making some support structures that help us cultivate a sense of what's really going on. There should be something you can do, somewhere you can go to help yourself really know it; there should be an actual programme, it should be an acknowledged discipline, it should be a recognised faith.
I'm unhappy that after a week for me the feeling of tears and vertigo has pretty much worn off completely, and I can once again go into the supermarket or watch the telly without a visceral reaction of what the fuck what the fuck WHAT THE FUCK? If we were in the least bit trained to be aware of reality it would be impossible to do this stuff, it would be impossible to live this way; it should be as impossible to buy sweatshop trainers as it is to push your own grandmother down the stairs. I cannot believe how dysfunctional human brains are; I cannot believe how much training we have to do to remotely understand the wider world, I cannot believe that my default mode is one of being incapable of grasping reality on an emotional level. I am particularly not happy that having attained, for a few days, a genuine sense of how strange and unbelievably awful the world I grew up in is, how very much it is built on lies, it has disappeared again and everything around me feels more-or-less normal. It's not. It's not normal at all.
So! Hello! I hope you are all well. I went to Ethiopia for ten weeks!1 It was very interesting. Now I am back and having slight culture shock. I was not expecting that. F was all "oh my god, I don't understand England, I'm scared of going back" and I said "mmmm" and internally rolled my eyes because for god's sake, it's not like we have been EXILED TO THE ANTARCTIC FOR MANY YEARS, but yet here we are. Anyway. Yes. Ethiopia! It is very poor and there is not much there. Oh, I don't know how to talk about this. Perhaps some illustrative anecdotes.
1. I should clarify what I was doing: I've spent this last academic year intercalating in International Health. Second term you get to do a research project abroad. I intercalated almost entirely for the opportunity to travel, and to get away from medicine for a year before I cracked up, and my research project was conceived at the last minute and generally shoddily executed - I just want to clarify this in case anyone is tempted to give me karma points. Anyway, the research involved interviewing the urban poor, hence why I got to go to people's houses and talk to them. When I wasn't doing that I was having an extremely nice time laughing and eating cake.
1) Woman in a mud hut off the side of an asphalt road. Occasionally big lorries go past and we can't hear ourselves talk. There are two rooms in the hut, with no door between them. I would estimate that the total area of the house is about 4m by 3m. In the room we are in, at the front, there's a mud pallet built into the wall with a single blanket over it, and several low stools made of wood with strips of hide woven from the frame to make the seat. In the back room there's another pallet, a plastic bucket and a few cups and other things, the little charcoal stove everyone has here to cook injera, the cups for the coffee ceremony. The roof is corrugated iron and doesn't seem to have any chinks, which is quite an improvement over quite a lot of people's.
The woman - call her Tigist - is thirty five years old. She has a second grade education, an income of less than one dollar a day, and three children: a twelve-year-old, who is at school, a ten year old, who is here at home, and a four-year-old, also here. The four-year-old had a twin, but he died. The ten-year-old - let's call her Mariam - is not at school, because she is blind.
Here is what happened to Mariam: when she was five, her mother gave birth to the twins. She wasn't married to the father, and he cleared off before the birth. I'm not quite sure if he paid her for the sex or not, and don't want to ask. Either way, Tigist was alone with two young daughters and a pair of newborns. During their first month of life, Mariam began getting headaches. They got worse and worse. Then her head started swelling up. "Do you mean the flesh of her head?" I ask, but no, Tigist says, her whole head actually swelled up. Then after a few days she went blind. At that point Tigist took her to the hospital.
At the hospital the doctors didn't explain what was happening, although it was clear from the way they talked among themselves that they were worried. They checked on Mariam every hour. She continued to deteriorate. She went deaf. Tigist stayed at the hospital. She was certain Mariam was going to die. Her face and voice, when she tells me this part, are awful. It took them a week to diagnose the child with cerebral TB. The treatment worked and she recovered and regained her hearing. She never regained her sight. It's clear, from the way Tigist talks, that no doctor has ever sat her down and told her that she never will, and although she is a sensible woman I can tell that she still has a shred of hope. She asks me I I know anything that will help Mariam regain her sight. I am inexplicably struck with the feeling that it's not my place to tell her things, especially when I'm not certain of them - after all, I'm not her doctor. I just say that I'm sorry, I don't know of anything. Afterwards I wish that I'd said right out that Mariam will not get better, because the woman doesn't have a doctor, and she might keep on painfully hoping and being confused for years.
"Why didn't you go to the hospital sooner?" I ask, and I already know the answer but my fists still clench when she says "I couldn't afford it". She doesn't just mean money. She was alone and destitute and she had no-one to look after her newborns, and it was not physically possible to walk to the clinic carrying three children. Hence the child is blind. This is what happens. This is how it works.
Watching Mariam she's obviously not quite right. She's more animated than anyone else I've met here, adult or child, and slightly mal-coordinated. Tigist and my translator keep telling her to sit down as she wanders around the hut, occasionally bumping into things. She laughs a lot and says things that don't quite make sense. My translator draws her down to lie with her head in her lap and she gradually quietens, lies there drowsily murmuring to herself. She still gets headaches a lot. I can't think what's going to happen to her.
I don't ask Tigist about the twin who died.
2) A man living in the real slums. The ones that are worse than mud and corrugated iron, I mean; the ones that are self-built out of sticks and plastic bags out in the wasteland beyond the market. He hurt his leg in an accident at the building site he was labouring on. He's still got the metal stuck in his leg. It stops him from working. He can't afford to get it sorted out, because the hospital is charging him 100 birr for the operation. 100 birr is £5.31.
3) The wife of 2). A few months ago, she went for an HIV test. This is a big deal for Ethiopia, because the stigma is still pretty major - we know one seven-year-old child who's HIV positive, but her mother won't take her for antiretrovirals, because everyone in the community will find out about it. The average time between infection and onset of AIDS in untreated people in Ethiopia is about six or seven years, and it's the same for children as for adults. The child we know is starting to show. The last time I saw her she was wearing a scarf over her head, and when she moved it to show me the sores behind her ears she lifted it and beckoned me under it to see. So her mother is training her to try and hide it, but of course she's not going to be able to; of course people can spot AIDS round here.
Anyway. This woman, Mrs 2. Despite this stigma, she went for a test a few months ago, because the kebele organised an educational programme and sent out a representative to tell people to get tested. So she went along, and to her great relief tested negative, and then went home and got her husband to go for a test as well. And another time, the kebele promoted birth control, so what she did is, she went along to the family planning clinic and went on the pill, and then later that didn't suit her anymore so she went on the depot. They have little education sessions in the waiting room at the clinic, and she told me about all the forms of birth control there are, and how to use them.
This story is more impressive if you understand what a huge gap there is between implementing public health measures and people actually doing anything about them, what an immense leap of will and effort it takes, the effort to trust some completely abstract information and then to do something completely contrary to the normal flow of your life. Even if you're well-off; unimaginably more so if you're poor. This woman's got nothing. She can't read or write. She lives in a hut made of sticks and plastic bags and sweeps the streets for 180 birr a month. But when someone gives her a scrap of an opportunity, she finds the will and the energy to take it. She always takes her kids to the doctors, as soon as they're ill, no matter who she has to borrow the money from. She's trying so hard and no-one's giving her a fucking inch and she's got nothing.
4) Similarly to 3), I spoke to a beautiful girl in her mid-twenties who'd obviously managed to move her family up a notch in the world, because they have an actual bed with a mattress in their house, and an armchair and a table. She was a hairdresser and supported her three younger siblings, who were twelve, eight and five. The eight-year-old girl was, as the translator put it, "slow in her mind". It was twenty minutes into the interview when she mentioned this, and I'd been idly watching the girl and thinking what a beautiful child she was: braids, pink skirt, pink sweater slipping off one shoulder, otherworldly expression, sitting on a stool and staring at the sunlight on an opposite wall. Talking to the older sister, it sounded like she had what dawned on me was phenylketonuria. The story of her experience with the healthcare services was instructive: the kid had an accident when she was one year old and had to go to the hospital. Her sister heard the doctors talking among themselves, saying that they thought the younger sis - call her Getachew, although it's a boy's name - had something wrong with her. They didn't say any of this to the family. Older sis went away, thought about this. Over a couple of years it became apparent that indeed there was something wrong with the girl. Their mother had a friend who knew a specialist at the hospital, so when the child was three sis managed to get her an appointment - she told me, matter-of-factly, that she'd never have been able to get one without having a contact.
Anyway, she had one appointment with the specialist. The specialist looked at the girl and diagnosed her. He told sis that she needed to cut down the protein content in girl's diet and told her which foods to avoid. With regards to the mental retardation he told her, okay, you just need to teach her. You'll need to show her what to do over and over again. Show her how to feed herself and dress herself. Talk to her and explain things. Never get angry or impatient with her, always be kind. You can get another appointment if you need to talk to me again. Sis never got another appointment. She went away and followed his advice to the letter and the girl got much much better, lost all the weight and started to make progress and learn to walk and talk and dress herself.
I just - I think of all the medical support you'd get in this country, all the places you could go, the patient support groups, the helpbooks, the internet sites, the access to information and skilled care. This girl got one fifteen minute interview with a specialist. He didn't prescribe anything, he didn't offer any follow-up. He told her what she needed to know, once, and she went away and did it, and four years later the girl is enjoying a quality of life possibly better than she might expect in the UK - discounting, of course, that in the UK she'd never have to get to the point of disability, because they'd have picked her up with the pinprick test at birth - because she's fully integrated with her community, and with her family, and she'll never ever have to go in a home.
The other thing Older Sis does is, in her free time she helps people in her village when they need to go to the hospital. She goes with them to the hospital, and stays with them, and helps them work out what's happening and where they need to go. She doesn't do it as part of an organisation, just off her own bat. She says that the poor people find it difficult to get healthcare, because they're poor and easily intimidated and it's confusing and takes too much time and whatnot, so when she has time she goes with them and helps. And when she has free time when she's waiting there with them she goes and finds people who've come from the rural areas and don't know where to register and stuff, and shows them. This stuff was exactly what I was doing my project on, and I'd just spent a couple of weeks going GRRR ARGH I CAN'T BELIEVE HOW DIFFICULT THIS IS FOR PEOPLE I CAN'T BELIEVE HOW CRAP IT IS DAMN YOU HEALTHCARE PROFESSIONALS DAMN YOU GOVERNMENT YOU MUST REFORM. And there she was, not professional or trained or getting any money for it, and with more than enough of her own to worry about, just realising there was a problem and doing something about it. I just- I've never been floored and humbled as often as I have been over the last ten weeks; I can't believe people are this amazing.
The other thing. At the end of the interview, my translator pointed to the younger boy, who is five, and said casually "He is also ill."
"Oh, right, what with?" I said.
"We cannot say in front of the children," said my translator. I was a bit bewildered, but thought maybe it had something to do with sex or genitalia or something. The kids went outside, and my translator said quietly "He is positive." It took me a minute to realise what she meant.
*
That's just a few of them. We kept on hearing and seeing stories the whole time we were there, lots of them. I'm having a Reality Shock thing. I think the reason I've been more affected this time than other times I've been to developing countries is partly the repeated exposure effect - the first time you go somewhere poor you go oh, how awful, poor people, and you cry and freak out a bit, and give excessively to beggars, then you go home and forget about it; then the next time you go back all those poor people are still there, and you are very embarrassed - and partly because I wasn't meeting people in a medical context. I spent three months (sort of) in an exceedingly unpleasant hospital in Mongolia during my gap year, and a couple of weeks in a rather nice one in India last year. And, you know, there was an eighteen-year-old in India who was dying of leukaemia which he'd have been able to get the chemotherapy for in England, and a twelve-year-old with TB everywhere who had to have fluid taken off his lungs every day, and who would sit on a woollen blanket in the emergency room every afternoon with a large-bore needle in his chest wall and tears running silently down his face, and a little boy who'd fallen in a cooking fire and had second-degree burns over his entire leg and who was pretty much getting nothing but wound care, and oh yeah, the Indian government grants licences for the use of opioid painkillers and this hospital didn't have one yet, so they were performing pretty much every major operation except for neurosurgery with only ketamine and NSAIDs available for pain relief. But you're pretty much expecting horrible things to happen to people in hospital, you've got people filed under "patient" from the beginning, when you meet them you know what to expect. Whereas in Ethiopia we just met people in a way that felt social, and said hello and smiled shyly and laughed at nothing in particular the way you do, because you know you want to tell jokes but you don't have the language but you both have goodwill, and you smile a lot and try hard to say it all with that, and then they invite you to their houses, and their houses are made of mud, or sometimes sticks with mud blocking the chinks, or sometimes just sticks and plastic bags, and they don't have running water or mattresses or healthcare or education or shoes or clean clothes or power or a future or knowledge or anything, but they're just like you, and you realise that this is allowed to happen to people who are sitting right in front of you. The people I interviewed were randomly selected; I wasn't looking for people with horrible lifestories. But every single person I spoke to had had something terrible happen to them: bereavement, illness. Because that's what happens when you're poor.
I was cross that I couldn't show pictures because of confidentiality, then I remembered that I have pictures that aren't of the specific people I've mentioned here, so it should be alright to show them.
Here are some houses in the slum-of-slums out beyond the market:
Here are some more:
And more:
Here is someone's roof:
Here is one of the children living under that roof:
Here is a little boy who lives in that neighbourhood:
Here is a woman making injera:
Here are her kids:
Here is a beggar woman and her child who said hello to me every day when I went to work for two months, and who I eventually had to take a picture of. Mostly their faces break me:
I don't have that many photos of dreadful things because I felt invasive taking them. I very much wish I could show the pictures of the little girl we befriended, and spent two months playing with and being irritated by and avoiding-the-clinging-of and all the ordinary things, and then found out that she was HIV positive. I wish I could show the pictures of everyone I mentioned above. But, you know, not so much. They're good photos, though.
The thing I can't get over is how little new factual information this is to me. I cannot, I just cannot get over the fact that in theory I have known about all this stuff for years. The way I keep finding myself thinking about this is the difference between facts which can be known and a reality that has to be appreciated. While I was away I was reading Karen Armstrong's History of God, and she keeps going on about how most religions are basically saying the same things, and most of the trappings of religions - prayers, scriptures, rituals, meditation, avatars and idols etc - were originally conceived, or considered by smart people, as just aids to helping you perceive a reality that was completely outside your sphere of existence. I kept on thinking about it, how it's sort of exactly the same process, trying to feel the reality of something you can't see, and that is so far away it essentially leaves no traces on you at all. Just thinking about how long it took me to develop basic reflex empathy for the human beings around me makes me tired; of course nothing ever gets changed. How are you supposed to believe in an invisible world full of people who are completely different from you, suffering in ways which, by and large, you can't imagine? The only evidence you have is pictures and stories, just like in the old days when you were supposed to believe in crucifixions and virgin births and heaven and hell. Pretty much no-one has that ability at all; I can only think of one person I have ever met who had the sense, genuinely and painfully, that all the people she couldn't see were also real, and it informed everything she did, to the point where she gave away literally half of what she earned, and never wore new shoes, and couldn't sleep at night. Most other activists/vaguely political people that I've met jimmy themselves into virtuous behaviour by study and will and knowledge and occasional welcome flashes of deep feeling, the way most theologically-minded types who aren't actually prophets always have. It is such hard work to keep yourself convinced, and still a little bit akin to belonging to some sort of minority sect; it's not like it's even the broadly socially acceptable thing to do. It would be good if people acknowledged that of course we don't really believe in the rest of the world, and then set about making some support structures that help us cultivate a sense of what's really going on. There should be something you can do, somewhere you can go to help yourself really know it; there should be an actual programme, it should be an acknowledged discipline, it should be a recognised faith.
I'm unhappy that after a week for me the feeling of tears and vertigo has pretty much worn off completely, and I can once again go into the supermarket or watch the telly without a visceral reaction of what the fuck what the fuck WHAT THE FUCK? If we were in the least bit trained to be aware of reality it would be impossible to do this stuff, it would be impossible to live this way; it should be as impossible to buy sweatshop trainers as it is to push your own grandmother down the stairs. I cannot believe how dysfunctional human brains are; I cannot believe how much training we have to do to remotely understand the wider world, I cannot believe that my default mode is one of being incapable of grasping reality on an emotional level. I am particularly not happy that having attained, for a few days, a genuine sense of how strange and unbelievably awful the world I grew up in is, how very much it is built on lies, it has disappeared again and everything around me feels more-or-less normal. It's not. It's not normal at all.