Exciting news!

Stay tuned to hear more about EthiOT's collaboration with People to People Ethiopia on the nation's first home health agency! We are honored to be invited to help develop this innovative endeavor. Proceeds will support a boarding school for girls and the agency will improve access to rehabilitation & nursing care as well as develop educational opportunities for occupational therapists, occupational therapy assistants, and rehab aides. Check out the good work People to People Ethiopia is already doing.

Children's play

As an occupational therapist, I know that culture affects occupation, but what are specific ways and specific occupations relevant to the Ethiopian context?

One song I am fascinated with illustrates the impact of how changing cultural norms affects child’s play.

Watch a video of this song, sung by a 6 year old boy in Ethiopia. (if the embedded video doesn't work, click here)

A 2 year old girl singing

What was your initial response to this song? When I heard it in Amharic, I heard only the lovely tune and sweet voices. I saw only the beautiful physical and emotional connection to one another as they simultaneously sang and gestured.  

The English meaning of the words are as follows:

My sister, my mother, you taste like lemons

Tonight, what did that man say?

He said only one thing, that he wants to marry me and get divorced

He will never divorce, but he will marry you by force

(There are several versions of this part)

A raven nested on top of my roof

Flew away thinking that I wasn’t home

Oh, poor raven! I feel bad it flew away

May I will be cursed to drink Elephant’s bile

Elephant’s bile is bitter!

A brave man’s heart is as big as a mountain

When I came back after a mountain trekking

I saw a hyena crying for a dead donkey

I saw a flea standing there and praying

I saw too a snake getting tattooed its neck

50 chickens were slaughtered

One chicken survived

And ran away to the backyard!

When I heard the translation, I was reflexively horrified to realize that young children were casually singing about child brides. I realized I needed to learn more about the origin, history, and context of this song.

I could not find any published research so I asked many adults from the community as many questions as I could think of. What people said is they hope the themes of this song (connection to female friends, family members, and role models, enjoying childhood, eschewing marriage while still a child) can shape a child’s thinking about childhood and marriage and hopefully contribute to the decrease in the rate of child marriage.

This song is sung by many children nowadays, but in the beginning it was intended in particular for girls. While some in the West shun the idea that activities should be assigned a particular gender category, the history of this song was an answer generated by the community to address a particular need in the community. The fact that it is now sung by all children, regardless of gender, can be seen as a cultural evolution in several ways. It may empower girls who will grow to be young women and later women possibly raising children of their own, to make safer choices on their own behalf. It may prepare boys who will grow to be men to see the world in a way they may not have previously which may impact their decisions regarding marriage and their own daughters when they become men. Parents who teach this song to their children or hear their children sing it will hopefully also be impacted by it's message.

Although the Ethiopian government has committed to eliminating child marriage by 2025 and child marriage rates have declined by around 20%, in the period from 2000-2011, 41% of girls in Ethiopia under age 18 were married or in a union.

For more information regarding child marriage and efforts to end this practice in Ethiopia, visit these places:

United Nations in Ethiopia

Population Council

Unicef

United Nations Foundation

Ubuntu

Ubuntu is a concept, known throughout Africa by various names, which means, “a person is a person through other people.” With a Western focus on independence, this complete dependence, even for one’s own definition of oneself, can be bewildering as a concept, and as a practice, daunting. As an occupational therapist, the implications for daily life are many. It encompasses one’s identity, the roles one fulfills, the daily responsibilities, and time management. It affects whether one fulfills one’s dreams, and what those dreams are. Westerners tend to strongly self identify as individuals and to see their role as distinct within the context of the snippet of history they are on this earth. Not so for many Africans, as Breyten Breytenbach so eloquently describes in his novel Memory of Snow and of Dust:

An African doesn’t normally experience the need to explain. He simply is the way he is, though he may well pretend to be different, or someone else, in an attempt to fool you. Why is this so? Maybe it is because the African even now still grows up secure in a larger family context where sharing is a matter-of-fact, everyday practice, in that there’s an absence of having to fight those closest to you for survival, of having to claw your way to the top, maybe because there still is an open-ended communication with the environment, animals and natural phenomena have histories and characteristics and personalities too, even when the surroundings are hostile you fit in, you are not isolated, you are not the master, maybe because there is an unbroken chain linking past to future, the dead are standing with wise eyes just beyond the glow of the fire, maybe because rationality has not been isolated and favoured the way it has been elsewhere in the world, there is an easier and more complete flow of sentiments too, less watertight dykes between heart and mind and liver; maybe because there is simply not such an insurmountable demarcation between ‘reality’ and ‘illusion’ and ‘magic.’ (p. 103)

After a 40 kilometer trek down a dirt road filled with potholes and arriving in a small village of single room mud huts without electricity or running water, I had a budding migraine, however my guide to Blue Nile Falls beamed with pride in his tradition and community as he told me, “We are not rich, but we have no stress. We have our community and that is everything to us.”

Here are some photos from the environment including people, animals, and natural phenomena which shape this particular community:

Returning from market. Near Bahir Dar, Ethiopia

 3 day old donkey with his mother. Near Bahir Dar, Ethiopia

 Crocodile. Blue Nile, Ethiopia

Crossing the Blue Nile, on the way home from school. Near Bahir Dar, Ethiopia

Returning from market. Blue Nile Falls, Ethiopia

Blue Nile Falls, Ethiopia

A family at home. Near Bahir Dar, Ethiopia

Assumptions

A conversation I had with a gentleman (waiter at a restaurant) accented an important assumption regarding children experiencing disability and their families in this cultural context. The conversation went like this:

Waiter: What do you do for a living?

Me: I am a therapist.

Waiter: Oh! That is wonderful. So you help people.

Me: I try to. I work with children with conditions such as Autism and Down Syndrome.

Waiter: Oh, yes, orphans.

Me: What?

Waiter: Orphans.

Me: Oh, in Ethiopia, yes, many of the children live in orphanages but in other countries they live with their families.

Waiter: Really? So they can take care of them?

Me: Yes.

Waiter: Families here must learn to take care of these children.

Values

If you haven’t yet read Memory of Snow and of Dust by Breyten Breytenbach and you have any interest in Ethiopia, I strongly encourage you to. The literary structure is similar to Don Quixote in that characters introduce themselves into the novel, and the format shifts between dialogue, plays, poems, and prose, however the subject matter is quite different!

It is difficult to step outside oneself to see how others view you. This novel helps do just that and this is an important skill for an occupational therapist, particularly if you are working with people from a culture not your own. It has important things to say about the value system of Ethiopia from a native and about the Western value system from the perspective of non-Westerners (Ethiopian and South African).

The author states:

Could it not be argued that subsistence economies, when assumed consciously, allow for a dignity based on self-sufficiency, that there can be a transformation of basic realities-with earth materials and native intelligence- without the utopist folly of top heavy and foreign relying superstructures? Could there not be the valorization of non-Western traditions and types of    learning allied to the most modern techniques the north has to offer? Surely they put up examples of modesty, integrity, sincerity? They have shown a suppleness of adaptation to harsh of environmental conditions, they are resilient, they have developed survival methods and yet maintain a thrust toward metamorphosis. (p. 122) 

I shot the photos below on a 30 km poorly maintained dirt road near Bahir Dar, Ethiopia on the way to Blue Nile Falls. There are several communities and a lot of farmland along. To me, these photos illustrate the the harsh environmental conditions, resiliency, and survival methods Breytenbach speaks of. For this alone, the people in these images and their compatriots, deserve all the respect I can fathom.

 Boy with his herd

Man walking on dirt road

 Woman resting under a tree

Something From Nothing

My favorite project in OT school was called "Something From Nothing." Professors gave us a box of assorted junk like a piece of string, a screw, a scrap of cloth, and a knub of a pencil, and our assignment was to make something useful using only the items from the box.

I am embarrassed to admit that I don't remember exactly what I made, but I do remember the inspiration I felt when I saw the box. It gave validation to the quirky ideas I always had for repurposing discarded items. This has become quite a trend lately in the Global North for purposes of ecology and design, and it is a very valuable skill when working in areas with few material resources.

While Ethiopia is rich in human capital, the financial and material resources to obtain specialized adaptive equipment can be beyond reach for most people. The World Bank reports that in 2013 (latest data available at time of this writing) the per capita income in Ethiopia was $505 per year. To give context to this number, here are a few estimates of daily costs:

• Bus rides within the capital city cost $.10-$.20 each way (many people must transfer and take more than 1 bus each way to work)
• Meals in an average restaurant with a soft drink or bottled water cost approximately $3.00
• An out of town round trip bus ticket costs approximately $40.00-$60.00, depending on the distance
• A flight between cities within the country costs approximately $300 round trip
• Cellular phones cost between $20 for a simple phone to around $150 for a (non iPhone) smartphone
• Cellular phone service is prepaid and costs approximately $.04 per minute. (landlines are rare in private homes)

One of the requests we had while working with at a local school for children on the autism spectrum, was for strategies to help them eat more independently. The first child demonstrated a high motivation toward self feeding but decreased hand coordination and strength. Because the standard spoons in Ethiopia tend to have long and thin handles like this:

We decided that a built up handle might do the trick. The challenge was how to obtain one.

One alternative might be to order specialized utensils, such as these available from Good Grips:

for anywhere from around $8.50-$31.00 (plus shipping cost) which would 3%-8% of the average Ethiopian annual salary. Percentage-wise, this would be equivalent to an American spending $1591-$4243 on this spoon. (World Bank reports $53, 042 as 2013 per capita income in the United States) It was not a viable alternative.

A less expensive (but also less durable) alternative might have been to add a piece of foam to the handle of the child's spoon for around $2.00 (plus shipping). This was more affordable, but in this context, still not attainable locally or sustainable (meaning even if we obtained funding, it still wasn't a reasonable alternative because the child would always be dependent on external funding).

Our challenge was to find a material which was locally available for a reasonable price and was durable. I thought the circumference of a garden hose might fit well, so I asked a staff member if they had a hose. It turns out that although they use jerry cans to water their plants, they did have discarded "tubo" (clear plastic tubing) in a pile in the courtyard. After cutting a length, thoroughly washing it, and trying it on the child's spoon, there was only one more problem to solve. The spoon handle was so thin that it slid around and the tube was too wide. We toyed with the idea of taping, plugging it, and stuffing it but decided that those ideas were less hygienic and too labor intensive for daily maintenance/cleaning.

Luckily, in the classroom they had some plastic spoons with thicker handles (which they use for matching with photographs and words in preparation for using the PECs communication system) and the school was kind enough to allow us to use them for this purpose. The (free) result is below:

The 8 year old child learned to self feed within a few minutes, his smile was ear to ear, and the staff are able to duplicate this tool (free) for anyone who needs it in the future.