Ethiopia's new flowers

ADDIS ABADA, Ethiopia- The Lonely Planet overview of Ethiopia begins, "Once an icon of misery, Ethiopia is coming out of the shadows." But at least in the country's most populous city, shadows are still deep: Although Addis Ababa means "new flower," wilt is common-yet so is grace.

At the gated and well-guarded entrances to the Hilton and Sheraton hotels, beggars lie like Lazarus. It's a 10-minute walk across dirt paths from one hotel to the other, with lush gardens giving way to corrugated metal and cardboard shacks and open sewers before the walker returns to posh. Concierges urge Americans to taxi from one hotel to the other: That advice suggests the existence of two Ethiopias, one of which is generally ignored by diplomats, international organization executives, and tourists. It's easy to go to conferences, travel by taxi, and shop at shiny malls on the road to the airport without seeing abject poverty. But those following the affluent agenda also miss seeing how some Christians are giving up Western comforts for the opportunity to save and change lives.

Those Christians have an exceptionally difficult task. Ethiopia has a population of about 77 million (43 percent under age 15) in an area twice the size of Texas, so it's not a country like India where residents elbow each other for space. But life expectancy in Ethiopia is only 48 years for men and 50 for women: Since the typical Ethiopian woman has five children, the average age of Ethiopians is 18, and only 3 percent are over 50 years old. Most cannot read or write.

Ethiopia has a per capita annual income of perhaps $700, according to the CIA Fact Book's analysis of purchasing power, and one of the highest rates of malnutrition in sub-Saharan Africa: Almost half of children under 5 years of age don't get enough to eat. Micronutrient problems such as Iodine Deficiency Disorders-which irreversibly reduce children's IQ levels-are common.

Estimates of religious adherence vary, but roughly half of Ethiopians may have some connection with Christianity, and half with Islam. Most of those loosely designated as Christian have some connection with the Ethiopian Orthodox Church, which claims to go back to the Ethiopian eunuch schooled by Philip in chapter 8 of Acts. Evangelicals make up perhaps 10 percent of the population.

How can U.S. evangelicals be helpful to their brethren in Ethiopia (and other African countries), as well as to the millions who don't know their right hand from their left?

Press releases late last month shouted one answer: "world bank launches new assistance strategy for ethiopia . . . world bank provides funds to address nutrition needs of vulnerable groups in ethiopia . . . world bank/global environment facility trust fund support efforts to reverse land degradation in ethiopia."

The stories emphasized the World Bank's support for the Ethiopian government's Plan for Accelerated and Sustained Development to End Poverty: "The Bank will support the country's macro-fiscal stability as well as key sectors such as agriculture and . . . large-scale infrastructure. A particular emphasis will be placed on strengthening supply responsiveness of the economy . . . greater economic engagement of women and youth . . . protecting and restoring ecosystem functions and diversity in agricultural landscapes . . . institutional strengthening and capacity building."

All of that could be very useful, but Ethiopia has long been one of the largest beneficiaries of the World Bank and other transnational organizations. The Bank's International Development Association (IDA) had 24 active projects in Ethiopia-valued at $2.3 billion-at the end of last year. Two years ago the World Bank canceled 100 percent of Ethiopia's IDA debt. Ethiopia never was under European control, except for a four-year incursion by Mussolini's Italy that ended in 1941, so imperialism cannot reasonably be blamed for the country's problems.

Ethiopia was one of the 51 original members of the United Nations, and Addis Ababa hosts the headquarters of the UN Economic Commission for Africa (UNECA) and of the African Union-formerly the Organization of African Unity, of which Ethiopia was the principal founder. But when Mercer Human Resources Consulting last year ranked 215 cities worldwide based on their levels of air pollution, waste management, water potability, infectious diseases, hospital services, and medical supplies, Addis Ababa was the sixth worst.

To check such critiques by getting some sense of hospital services and medical supplies, one morning last month I visited Addis Ababa's top governmental hospital, Black Lion. Its waiting rooms were packed with patients, including a child with a fractured arm who had waited for days without receiving medical attention. Potential patients in the waiting rooms were better off than those in a dim corridor where beds lined one wall. Those in the corridor were better off than the multitudes waiting outside.

Disorder was evident even in clocks on the wall, each of which showed a different time. Doctors acknowledged that a lack of sterility leads to many infections. Limited budgets lead some nurses who drop an IV to use it anyway, even though the three-second rule for food dropped on floors-move fast and eat-should not be applied to IVs.

Ethiopians say that Black Lion was a better place when it opened four decades ago, but governmental priorities have changed in recent years. When officials from the president on down (or their family members) need operations, they regularly fly to other countries. The Ethiopian government pays its doctors only about $260 per month, so many graduates of Ethiopian medical schools leave the country, often heading to the United States.

What remains is the love of parents for their children. On that morning last month a baby was lying on a table in one ward. A botched spinal surgery had left him unable to move his legs. A visiting American put his hand on the baby's head and prayed for him. Then he asked the mother for the baby's name. "Exodus," she said. "I've been praying that Jesus would heal him." The American and the Ethiopian woman then prayed together.

Do Ethiopian hospitals have to be as bad as Black Lion? No. At the non-governmental Addis Ababa Fistula Hospital across town, young women come by the hundreds with a problem not seen in the United States: Each has a fistula, a hole between her birth passage and bladder or rectum. The hole develops over many days of obstructed labor, when the baby's head pushes against the mother's pelvis and cuts off the blood supply to delicate tissues, which then fall away. One common cause: pregnancy among very young mothers-sometimes at the time of their first ovulation.

With no doctor present to perform a C-section, the laboring mothers are left with a dead baby and a fistula, which leads to the leakage of urine and feces. By the time the women reach the Fistula Hospital, they've often been shunned by their families and communities. Sometimes they've lain on their sides so long, in a desperate attempt to control the leaking, that their muscles have atrophied.

But when the women arrive at the Fistula Hospital, they are surrounded by lush gardens. Clean wards house them, and nurse aides who are ex-patients themselves comfort them. The hospital maintains a farm outside of town for those it doesn't have room to admit right away. The hospital demonstrates the value it places on each patient in small ways as well: Each patient receives a colorful crocheted wrap made by volunteers from around the world.

Each patient also has access to Bible studies and a Walkman, for listening to Bible stories in any of 24 tribal languages. Each can learn about women such as Samuel's mom Hannah who wept about her barrenness and received God's comfort. And it's all because Christian doctors Reginald and Catherine Hamlin not only sympathized with the young women but showed true compassion by operating on hundreds and opening their hospital in 1974.

Ethiopia does not have a governmental versus Christian program dichotomy as sharp as that which the Bush faith-based initiative in the United States has opposed. Some programs combine government-provided commodities with love from dedicated non-governmental organizations, including Christian ones. For example, a joint program of SIM (Serving in Mission) and Mission to the World (part of the Presbyterian Church in America) distributes the anti-retroviral drugs provided for free by PEPFAR, the President's Emergency Plan for AIDS Relief.

The SIM/MTW program also provides food, rent subsidies, and school expenses to 400 beleaguered families. One of the HIV-positive recipients, Gebeyanesh Shigute, 42, welcomed visitors to the two-room house near the top of a muddy hill where she and her 2-year-old granddaughter live: Her husband is dead and her daughter is "away," a term suggesting spiritual as well as physical distance. There's no toilet, and outside the house sits a yellow bucket of water for washing and a blue bucket for drinking water.

Another recipient, Lemelem Gereyoharisa, 40, lives just down the hill behind pieces of metal welded together to make up the first story of the home, which displays a portrait of Jesus and Mary; mud, cardboard, and metal on the sides make up the second story, accessible through a rope ladder. That upstairs room is a bedroom for her two sons and two daughters, who without the SIM/MTW program would be orphans, probably homeless ones.

They don't have much but they share, particularly during the coffee ceremony, a daily social ritual that includes popcorn and allows full participation by women who roast the coffee in the living room while others sit and converse with them. Ethiopia's largest evangelical denomination, the Kale Haywet Church, has adapted the coffee ceremony to its HIV/AIDS prevention work: Health issues become part of the conversation. When the church outreach workers show that it's safe to drink coffee with an infected person, they are helping to restore that person to community life.

Ethiopian Christians also touch those they help: They are showing love tangibly and conferring dignity on those often rejected by neighbors and families. When children see home workers hugging their parents or sharing coffee with them, it helps relieve the shame they feel about their parents' illness. Lives change: One woman, forced as a child to wed husband No. 1, and then helped to escape by HIV-positive husband No. 2, was bedridden and demented four years ago, until the SIM/MTW program saved her life and gave her new hope.

Compassionate Christian medical workers are also active elsewhere in Addis Ababa. A CURE International surgeon will soon be operating on children with cleft palates or clubfoot, disabilities that local healers (aka witch doctors) say are spiritual curses. Another Christian charity, Selam Children's Village, educates 350 orphans who live in its shady village, plus more than 3,000 poor students from the surrounding community.

The village operates alongside Selam Technical and Vocational College, which trains older orphans and other poor students in auto mechanics, metal and woodworking, building construction, machine technology, and electricity. Students build new facilities for the Children's Village and also manufacture items that they adapt for use in poor areas of Africa: Last year the school made and sold more than $2 million worth of threshers, pumps, windows, concrete blocks, ductwork, steel boats, and solar cookers.

Outside of Addis Ababa, other ministries save and change hundreds of lives. A three-hour drive southwest of the capital runs past donkeys, goats, scrawny cattle, and many buzzards, to an area in the Gurage mountains that is 95 percent Muslim. There sits Project Mercy, which offers Christian and vocational education to 1,500 children and also provides a medical clinic and a variety of economic development and agricultural training projects.

Marta Gabre-Tsadick, a 75-year-old former member of the Ethiopian senate, created Project Mercy in the early 1990s by asking local villagers what they most needed and then setting up the school they requested-but "when the children of the school started accepting Christ, they no longer wanted us," said Gabre-Tsadick. "They threw stones at us. For a year and a half we could not go outside the compound at night."

Gabre-Tsadick and Project Mercy survived, in part because her extended family has deep roots in the area and in part because the school and clinic were meeting deep needs. She applies her experience to the training of her students, telling those who only want to evangelize that they should develop a skill that will make people come to them: "Go to nursing school and become a public health person. Learn medicine, engineering, business management, law."

Now the school, with help from the United States, has 12 donated Dell computers; students built the computer tables. American veterinarians are running a cattle-breeding program; students are making bricks and crafting cabinets, benches, and doors. Agricultural experts are introducing to the area tomatoes, cabbage, carrots, and other nutritious vegetables; students are constructing new Project Mercy buildings.

And all is done with unabashed evangelism. Clinic patients pay 60 cents for a consultation, $1 for lab work, and $3 for X-rays, Gabre-Tsadick says, but nothing for an added benefit: "We ask them, 'Could we pray for you before we start? Jesus is the great physician.' We've had 11,000 patients, and no one has said no." The clinic and school still upset some Muslim leaders, one of whom complained about "brainwashing students with the Bible"-but Gabre-Tsadick recounts that he also admitted, "There's no use getting rid of you. You have sunk your roots so deep."

That Muslim's response may suggest the answer to our initial question: How can U.S. evangelicals be helpful to their brethren in Ethiopia? Find and help Christian individuals and groups who are sinking deep roots. World Bank programs and others that work off grants from massive organizations seem to come and go, but the Fistula Hospital, Selam, and Project Mercy have shown staying power.

A second answer for Ethiopian society might be: Emphasize compassion, not politics. The ruling Ethiopian People's Revolutionary Democratic Front (EPRDF) uses its television and radio monopoly, along with fraud, to win elections, with violence as a backup: Government forces killed close to 200 protesters and imprisoned thousands following the 2005 elections.

Those who criticize Ethiopia's government may face treason charges, as 131 journalists, politicians, and leaders of civil society did in 2005. But the quality of mercy produces fewer strains.

A final answer may be: Help Christian institutions survive the likely onslaught of Islam. In recent years in Ethiopia the competition has generally been peaceful, with one sheik financing construction of a park alongside Menelik II Avenue in Addis Ababa. (Menelik was the son of Solomon and, according to Ethiopian tradition, the Queen of Sheba.) But evidence of past aggression remains: About 40 miles south of Addis Ababa sits Adadi Mariam, an underground church carved out of stone some 600 years ago, with marks left by a 17th-century Muslim attack still apparent.

If Muslims now constitute half of Ethiopia's population, many observers forecast a more aggressive Islam, with radicals attempting to institute Shariah, or Islamic, law. Craig Hammon of CURE emphasizes the importance of humanitarian care, but he also refers to "the struggle going on between Islam and Christianity. . . . This is a strategic, pivotal country in which to serve Christ."

Fistula epidemic

The World Health Organization (WHO) says that over 2 million girls and women in sub-Saharan Africa and Asia suffer from fistula. One reason is that many are forced as adolescent girls into arranged marriages, with the expectation that they bear children well before their birth canals are fully developed. Another is the second-class citizenship of girls and women, who receive less than their share of even the small amount of medical care their societies can provide. Female genital mutilation, a custom in some cultures, also plays a role; WHO suggests the practice may increase the likelihood of fistula sevenfold.

Fistula is an unnecessary tragedy. Emergency obstetric care can prevent it, and simple surgery costing no more than $500 per woman can repair the condition over 90 percent of the time. The Hudson Institute's Michael Horowitz has proposed an anti-fistula campaign involving a consortium of U.S. medical schools that would involve the training of African physicians, nurses, and health educators; the rotation of U.S. surgeons and surgical residents to Africa; and the development of U.S.-African hospital collaborations.