The country
I returned from a second trip to Ethiopia on 19th February 2017. It is a country I am not ashamed to admit that I know very little about. A place I never considered visiting during my twenties when I did the bulk of my globe trotting.
So in an attempt to provide a bit of useful background for this blog, I turned to the two most obvious and reliable sources for research.
1. Social media and 2. Google. I wanted to find out just how little we all know about this beautiful country and its inhabitants.
Good old Facebook provided me with the following in answer to THIS question:
Q: "When YOU (the general public) think of Ethiopia what do YOU picture?"
Not surprisingly I was met with answers like these:
A: "famine, poverty, arc of the covenant, hunger, skinny children, illness, coffee" and one person informs me that "Ethiopia is one of the fastest growing economies in Africa AND in the world" (I did not know that).
WHAT GOOGLE SAYS (so it must be true)
Google says that "Ethiopia is the home of the Ethiopian Orthodox Church - one of the oldest Christian churches". Interesting for those interested in Christianity.
The Omo river is pretty famous too as it is home to some ancient tribes, known for their iconic lip plates which are large discs, made from clay or wood. These discs are inserted into a pierced hole in either the upper or lower lip (or both), thereby stretching it so people with such facial statement-pieces are of great interest to portrait photographers like myself and a source of inspiration to those who are keen to find new ways to mutilate their bodies (of which we seem to have a vastly growing population in the western world).
You'll find plenty of information and photos available of these indigenous people as, sadly, there is a looming threat that one day they will disappear.
Did you know in one place that YOU or I could feed WILD hyenas by hand? I'll move on from these Google-worthy factoids about Ethiopia, pass on hand feeding wild hyenas and facial mutilations and get on with my experience of Ethiopia shall I? After all, you are reading MY blog and NOT searching Google.
So what about the mountains?
I am guessing it would surprise most of you to discover that Southern Ethiopia has mountains as high as 2,800m above sea level and that, during the wet season, they become extremely lush and green. There are forests too. The soil is incredibly fertile in these upland areas and this is where you will discover millions of people subsistence farming, working every hour to provide enough food to sustain their families. This is where I spend time when I am in Ethiopia (nowhere near indigenous tribes or hyenas).
Before inviting you to read on and find out in more detail about my experience I would like to give you a little warning.
Some of the photos I have chosen to include in this blog are not for the fainthearted but I can assure you that they are an essential part of sharing this particular story.
The images that I will expose you to are quite different from the usual that anyone will associate with my business but, thanks to all the people that enable me to have a business, I am able to do things like this (for which I am eternally grateful to you ALL by the way).
You will at some point most likely feel shocked, possibly upset and, if that is the case, then I will not apologise for it. That is really the point. I do not get paid for these trips, I cover all my own expenses and all the time I choose to spend on this particular project with APA is my own.
The way I see it, someone needs to help give these people a voice and those that know me personally know that mine happens to be pretty loud. My motivation comes from a place of genuine compassion and love for the people represented in this blog. Also, if I am honest, I feel that there is very much a spiritual drive behind what I am doing, a higher-purpose calling you might say, so I'm choosing to go with it.
So if you are ready to read on (maybe grab a pack of tissues now) I'd like to introduce you to an exceptional young lady named Damenech. She is now 20 years old and represents millions of people in Ethiopia today, men, women and children included.
It is estimated that as many as three million people in Ethiopia are suffering from the physical and emotional pain of the disease Podoconiosis (podo). Damenech has been living with podo for the past ten years.
Please take a few moments to study her face and if you can, hold on to this image as you scroll down. I am going to share with you her story which is one of heart break, brokenness and dancing.
Damenech aged 18 taken by me during my first trip in 2015.
LIFE IN THE MOUNTAINS
You'll need a bit more background to even begin to develop an idea, perception or small understanding of the reality of life in the mountains which leads me to the main purpose of my most recent trip.
Most rural families in Ethiopia’s southern region live in traditional round or rectangular huts, made of materials readily available in the local environment. Homes typically have walls made of wood and are finished with mud. The roofs are thatched, a fire is kept in the middle of the hut to provide warmth and a place to cook. Homes are without electricity, running water, or toilet facilities. A typical home like this can sleep as many as eight people (adults and children) and also include chickens, goats and a cow or two (if they are really fortunate) and, on average, costs around £160 to build.
Subsistence farming is how most people feed and support their families and, more often than not, there is not enough to sustain them all year round. The primary role of women in these areas is to fetch grass for the animals, water and wood for the fire, as well as farming the land.
Most people have little if any income and can barely afford clothing or shoes so barefoot farming is a very common occurence. Although some roads are now under construction (thanks to the Chinese) they are mainly uneven, rocky and dry and, therefore, not at all easy to walk on. You certainly could not travel without a 4x4 in these regions.
Roads like these are a hive of activity with most people traveling on foot carrying enormous bales of long grass on their heads or multiple large containers of water. Some are lucky enough to own donkeys or mules which they use to transport goods to and fro and they do all this under the blistering African sun. There is nothing easy about life here.
Two elderly women struggle up hill daily on dirt roads, covering long distances to collect grass.
Small family-run businesses include owning small coffee shops which, in appearance, don't look any different to a standard home from the outside but, when you step inside, you will discover a few hand-made wooden tables, stools and plastic chairs. These small huts offer social meeting places just as they do back here in the western world. They are far more basic stripped-back versions without the multiple choice coffees or tempting sweet pastries.
Below are a couple of images from inside one of these coffee shops to give you an idea of just how basic they are.
EDUCATION
Primary-aged children are schooled during half of the day (morning or afternoon) until they reach the age of around 10 or 12, when they are considered old enough to work.
The two children below are both about that age and are working for their family business. The boy pictured on the left is grinding freshly-roasted coffee beans and the young girl serves tea and coffee.
By the time she was this age, Damenech already had Podoconiosis.
SO WHAT IS PODOCONIOSIS?
When traveling to Africa we are made fully aware of the risks of malaria and we know that Africa has an extremely high rate of AIDS and HIV. But... skin health? Podoconiosis? What's that? Most of us have NEVER heard of it.
Podoconiosis is a devastating, disfiguring disease of the lower legs and feet. Nowhere is incidence higher than in these upland areas of Southern Ethiopia. Bare-foot farming and prolonged contact of feet with specific soil types means that millions of people are suffering and few people know about it (funnily enough it is not something that appears in Google when you type in Ethiopia).
As with all diseases, there are various stages of it. Below is an image of a farmer's legs and feet at an advanced stage where full lymphoedema has also taken hold. As a result of podo, his lymphatic system has been severely damaged, which means the fluid in his legs is unable to drain causing swelling and intense pain. He struggles to walk and is unable to work his land or provide food for his family.
Severe cases of podo like this have devastating effects on whole families.
Most people that have podo don't know why and neither do their families or people in their communities. Lack of education is, therefore, a huge problem. Many people treat it as potentially contagious and will avoid contact with someone who has it.
APA are continually meeting patients that have been dis-owned by families and ostracised from communities, making this is as much a social disease as a physical one.
This was sadly the case for Damenech for half her life. Years passed where her feet were left untreated and, inevitably, the disease became worse. In fact, it escalated to such a severe stage that she was rendered unable to walk and had no choice but to crawl on her elbows to the outside toilet (which is traditionally a "long drop", a hole in the ground).
You should also know that podo often has a distinct, offensive smell, especially when it gets infected. Many patients and those around cover their mouths and noses in an attempt to avoid it, so it is no surprise that families struggle to live within the confined spaces of their mud huts with these poor people.
The smell of podo can be very unpleasant and, in extreme cases, unbearable.
As a result of the debilitating affects of podo, Damenech was unable to work or carry out even menial tasks. Her father was so embarrassed and ashamed of her that he treated her very badly, in fact no better than the animals, insisting that she sleep with them and not occupy any of the family space.
For the record, the animals are not toilet-trained either. The inside of the mud huts serves as good a place as any for a toilet for them too. I know this to be absolutely true because I stepped in a fresh cow pat during a home visit on this last trip. Not quite the welcome I am used to receiving when I visit people in their homes.
Damenech was forbidden to appear in front of the family hut in case people saw her, neither was she permitted to join the family at meal times or any special occasions.
Podoconiosis eventually robbed Damenech of all human contact...
...until 2013, when news had spread through her village that some people were coming that knew about this disease. Desperate to receive even a glimmer of hope or better still any help, Damenech overcome her shame, embarrassment and fear of further rejection and set about making the long, painful journey to the treatment site.
She was carried up-hill for approximately two kilometers from her home to the main road by her mother and members of her community. Just to try and get some sort of understanding and perspective of what that journey would have been like for her, I did this same walk and it was tough, REALLY tough for me - and I have no physical limitation.
Not only was I roasting and dripping with sweat once I had reached the top (and I'd consider myself relatively fit) my heart rate went nuts! It is so steep and extremely rugged, the ground is totally uneven and I had to clamber over huge rocks along the way.
There is no way that Damenech would have made it up alone. After she was helped up the steep mountain she was transported by motorbike to the health center. She would have been in incredible pain along the way BUT she made it and was discovered sitting silently at the back of the room full of other people with podo.
The following images were taken during that visit by Dr Paul Matts who met her here for the very first time.
Meredith Somerville meets Damenech with a small group of others for the first time
Paul describes that first experience as an image of hell. The sheer number of people with podo who had somehow walked unacceptably-long distances, their raw feet, the smell, the despair and collective sadness of so many hopeless people left an indelible mark.
He says Damenech's feet were, at that time, the worst he had ever seen. Paul was among a small group of people who cried uncontrollably for Damenech and gave her some of the first warm human contact she had received in years, apart from her mother and grandmother.
Damenech receives the first compassionate human contact she has had in years
Damenech's feet in 2013.
TREATMENT
I am guessing you may be feeling a little shocked right now? I still feel that way every time I look at these photos and I have seen them several times. Do you know the REALLY shocking and most disturbing fact about Podo is that it need not exist at all? It can be completely prevented by simply wearing shoes and taking care of the skin on one's feet. FACT. There is absolutely no need for Damenech or anyone else to end up in this state.
Podoconiosis is NOT contagious, it is NOT infectious, it only exists because there is a distinct lack of education about the cause of the disease (walking barefoot on volcanic soil) and, for most, the cost of shoes excludes these items from a household budget.
Sadly, the people that suffer with podo often believe it is a curse, that they are being punished by God and that they are forgotten, abandoned and that nobody cares. All they have left to turn to is prayer.
SO WHO ARE APA?
Action on Podoconiosis Association (APA) was founded by Zelalem Mathewos and Dr Paul Matts in March 2012. It is a local Ethiopian Non-Governmental Organisation (NGO) ultimately passionate about preventing and treating this devastating and horrific disease.
It would be impossible to run a project like this from outside of Ethiopia and APA needed someone trustworthy and committed to managing the project. To take on a role such as this takes a certain type of extraordinary person, not only someone who can manage people, be prepared to spend most of their time hundreds of miles away from their family but someone with a huge capacity for compassion and as much love for the patients that Paul has. Thankfully such a man did exist and Paul and others persuaded a VERY reluctant Zelalem to accept the obvious calling on his life and co-found APA. What a blessing he is. Zelalem remains at the very centre of the project and patients' hearts today.
As a result of Paul's early fund-raising efforts and with the backing of a very generous and supportive church, enough money was collected to start treating patients like Damenech. The first APA treatment sites were established where patients could be taught how to look after and treat their feet. APA also set up its first shoe workshop which continues to make hundreds of completely custom-made, over-sized boots for large, diseased feet every year!
In 2014, APA received enough funds to buy a much-needed 4x4 so that Zelalem and the team could visit patients, transport supplies and cover the vast distances between sites. How AMAZING is that?
During a return trip in 2014, Paul and his wife Ali met Damenech again and were delighted to discover that, as a result of her ongoing treatment and custom-made boots, her feet were reducing in size dramatically. HOORAY. In this picture you can just about make out her big toe. Proof that this simple, inexpensive treatment REALLY WORKS.
SO WHAT'S HAPPENING NOW?
The past five years have been really tough for everyone involved. I am sure all charities or projects like APA are not without huge challenges financially, geographically, culturally and beaurocratically. The sustainability of the project long-term is the main challenge that APA faces. It cannot depend on donations alone and, in order to reach the huge number of people out there with podo and prevent others from developing it, support from local Government is crucial.
Great efforts have been made to set up meetings and build relationships with local government officials and I am pleased to report that significant changes are happening. I sat in on a couple of meetings with the APA team and was delighted to hear that local officials are extremely keen to partner with APA and are passionate about helping their people. They are offering to support the project by providing rooms with electricity for new shoe workshops for free, and by delegating the care of podo patients to the extensive armies of health workers spread throughout local communities. This will also mean that a majority of patients will no longer have to walk to health centres, but will receive care in their own villages.
Together a shared vision exists to eventually wipe out podo forever!
It is exciting to hear news like this isn't it? It has been an absolute privilege to meet so many patients in person at these sites. I cannot tell you how lovely and how grateful they all are. During my last visit I hand-delivered loads of pairs of socks which I had collected from lots of generous people in the UK. Small gestures like these go a long way when spreading the good news to a group of people who are otherwise living desperate and unhappy lives.
APA SUPPORTS JOBS
The APA team in Ethiopia is growing and there will be an increased demand for health workers like these guys who genuinely want to help and serve their people.
SPREADING THE WORD PREVENTS PODO
It is unnecessary for families like this one to suffer in silence any longer. They live in a tiny remote village where over half of their community members have podo. They have four children and both parents have podo, but now they know why thanks to APA and are able to prevent their children from developing it too. This family were amoung many in their village that gratefully received brand new socks for themselves and their children!
I am hoping that you are starting to feel a little more uplifted now? Carry on reading... the story is about to get even better!
Note that the floor of their home is also mud. The very soil that is doing them so much damage is unavoidable, it is everywhere.
Damenech February 2017
Since their first encounter with Damenech, Paul and Ali admit they couldn't help but take a special interest in this extrodinary young lady and, given her story, who wouldn't?
They have met with her several times in the past five years and she makes a point of walking the extremely long distance to see them when she hears they are visiting, despite the pain she must endure along the way. You may have also noticed that in every photo you will see of her she is wearing the same clothes? Well done if you did - you really ARE paying attention (thank you). Anyway, this is no coincidence and simply reflects just how poor she is, as they are the only clothes she owns.
As her feet have started to improve, Damenech has been able to return to school and takes enormous pride in showing off her school books to Paul and Ali. Her father has since passed away and after his death she and her mother were unable to continue to live in his home. His family took back the home with the land and expressed no interest in supporting either of them, leaving them only one option which was to live with Damenech's grandmother. Sadly, she recently died too. All of this aside, something INCREDIBLE has also happened in Damenech's life.
A couple of years ago, Paul and Ali felt compelled to go a little above and beyond for Damenech. Wanting to help improve her life in some practical way, they asked her what she needed. Damenech replied, "a pair of goats". The goats were procured and, unbeknownst to anyone at the time, the female was already pregnant. This proved to be an almighty blessing. Damenech and her mother do not own any land to farm on and have no money or source of income and, therefore, rely heavily on support from relatives and their community (who themselves aren't really much better off).
The multiplication of these goats (which, for the record, Damenech named "Paul and Ali") meant that she could take some of the offspring to market and exchange them for a nice healthy young cow, which now provides roughly one litre of milk per day for her family. It must also be noted that she did not make this decision lightly, she first checked with Zelalem that this was met with the approval of Paul and Ali, of course.
So, as part of our schedule, we made a point of paying Damenech a visit, especially after receiving news of this new cow! I was really interested to get a first-hand experience of her environment too and gain a better understanding of the challenges of living in such a remote and poor location.
Damenech is now the very proud owner of a healthy young cow
A huge welcome awaited us! It appeared that half the village showed up on the side of the road and, before we knew it, we were descending with escorts down the steep mountain-side and heading to Damenech's home collecting plenty more enthusiastic, inquisitive locals along the way.
Before we reached her home I spotted Damenech heading up towards the large crowd. I recognised immediately her black and white checkered shirt. She must have spotted Paul (he's hardly inconspicuous at the best of times) and she virtually flew up to greet him at a most impressive speed! We were all smothered in kisses and hugs from her mother and other relatives and everyone smiled. It was one of the most joyful experiences of my life.
I cannot tell you just how incredible the transformation of this young lady is. From the girl that was rejected and cast out of her community, couldn't walk, coudn't work and was treated no better than an animal, who once described her life as living in hell, she now states with whole-hearted praise and declaration that she is now living in Heaven.
THIS is what APA is all about! THIS is why I will probably return to this place again and again to share stories like these. I for one would love to witness more of this dancing. Wouldn't YOU?
"You turned my wailing in to dancing;
you removed my sackcloth and clothed me with joy,
that my heart may sing your praises and not be silent.
LORD my God, I will praise you forever"
Psalm 30: 8-12 NIV