When the French organization Medecins du Monde asked Tzu Chi for help in rebuilding a hospital in Ethiopia, Liu King-pong and Douglas Shaw went to evaluate the situation.

From the window of our Ethiopian Airlines jet, the country around Addis Ababa looked lushly green. I had expected the land to be more of a parched brown color. I did indeed see wide, brown gashes across the green that I took to be dry riverbeds. As the plane descended, though, I discovered that the rivers were in full flood, washing down tons of brown silt from the mountains. It was the end of an unusually wet rainy season, following a couple of years of drought.

Liu King-pong, editor-in-chief of the Tzu Chi Quarterly, and I went to Ethiopia at the end of August to check out another joint project with the Medecins du Monde. Tzu Chi and MDM had cooperated before in a three-year plan to rebuild clinics and develop safe water sources in the Ethiopian highlands, as well as in medical aid to war refugees in Rwanda and Chechnya [see reports in the Summer 1996 and Summer 1997 editions of the Quarterly]. Now, the MDM want to help rebuild an old hospital in Debre Birhan, the capital of the North Shoa region. They asked Tzu Chi for help, and Mr. Liu and I flew there to see what kind of help the foundation could offer.

We were picked up at Bole International Airport and driven to the MDM Ethiopia headquarters, which are conveniently located just a couple of blocks from the gate of the airport. Outside and inside, the building is decorated with the stickers and banners of MDM's main patrons: Tzu Chi, Ming Daw (another Taiwanese charity organization), and the European Union.

Jose-Emile Fernandes, the head of MDM Ethiopia, is an amiable Frenchman whose name is courtesy of a Portuguese grandfather. He had just returned from France himself and he met us that evening. His Ethiopian wife, Amarech, who speaks several languages fluently, serves as the assistant director of MDM Ethiopia. Their two sons reminded me very much of my own children and made me so horribly homesick!

Medecins du Monde is an international humanitarian organization whose aim is to provide medical assistance for the world's most vulnerable populations. Since its creation in France in 1980, MDM has relied upon the volunteer involvement of health-care professionals who treat victims of poverty and violence regardless of race, creed, social status or political beliefs. They have developed particular expertise in the areas of mother and child health care, AIDS prevention and treatment of complications, psychological therapy (for victims of war, torture, etc.), and community care (especially with threatened ethnic minorities). Their projects range from mobilizing immediate (24 to 72 hours after the alert) and concrete aid in emergency situations to long-term (at least three years) projects to provide concrete and sustainable solutions to medical problems, including illness prevention, public health-care education, renovation of hospital structures and medical training.

The next day, Jose drove us to Debre Birhan, the capital of the North Shoa region. It is about 130 kilometers [80 miles] from Addis Ababa, and Jose figured we would do that distance in an hour and a half. Before he came to Africa, he was a professional bicycle racer. The style still showed as he barreled down the highway at up to 120 kilometers per hour [75 mph], adroitly dodging potholes, the hundreds of people walking on the road, slow-moving taxis and trucks, herds of cows and sheep tended by small children, donkeys laden with bags of cargo, women carrying firewood or jugs of water, and the occasional camel.

Ethiopia is a proud country that has fallen on hard times. It has an incredibly rich cultural history, dating back four million years to our famous ancestor "Lucy." It is the oldest independent nation in the world, and the only country in Africa that was never colonized by a European power. It is also the only African country that ever won against a European armyn 1896, it decisively defeated invading Italians. However, in the 1970s and 1980s, the country was afflicted with major droughts and the ravages of secessionist movements in Eritrea and Ogaden. Worldwide efforts to provide food and medical aid were hampered by the Marxist government's distrust of the West. During the relative political stability of the past few years, efforts have been made to strengthen the development of the country, but recent renewed aggression by Eritrea threatens this progress.

Ethiopia is supposedly one of the poorest countries in the world with an average per capita income of about US$110 a year. With my own experiences in other parts of the world, I have come to be suspicious of financial definitions of poverty, since people may not count their wealth in terms of money. When I asked a native MDM staff member if Ethiopians themselves considered themselves to be poor, he shrugged his shoulders and said, "We get along all right." Nevertheless, it is a fact that in the last decade, millions of people have been exposed to famine and starvation. There are shoe-shine boys on almost every street corner and a fair number of beggars, especially in the tourist areas. And while in America there is one physician for every 400 people, in Ethiopia there is an average of only one physician for more than 36,000 people. Ten doctors serve at the Debre Birhan hospital, which serves an area with a population of almost two million!

We arrived at the hospital in a light rain. On what was left of the original veranda of the main building, outpatients huddled closely together to get out of the rain. The veranda had originally run the entire length of the front of the building, but most of it had been walled in to gain a little more precious space for examination rooms.

We were met by the handsome, young (26!) medical director, Dr. Ayanaw Admassu, and the head of planning of the North Shoa health department, Ghidey Teklu. They promptly took us on a tour of the facilities.

The hospital was built in 1935 by the Italian military for their invading forces. It was never intended to be the only hospital serving the entire population of the North Shoa region. As we walked along, Jose and Dr. Ayanaw emphasized that the current Ethiopian government has been doing a relatively good job of running the national health system. There is relatively little corruption compared to most other countries in Africa. With the end of the Eritrean war of secession in 1991, the army was demobilizednother rarity on this continentnd the savings from the military budget were allocated for increased development of the health and education systems. With a recent resurgence in Eritrean aggression, it is feared that the army will have to be built up again and that funds and resources for national development will not be available. The government is very much committed to keeping hospitals and clinics running on a daily basis, but funds for building construction and maintenance have always been very tight. What funds there are go to construction of clinics and health centers in more remote regions, which have no access to more advanced health care, especially that available in Addis Ababa. Since Debre Birhan is "only" 130 kilometers from the capital, it was decided that it was possible for seriously ill people to go to one of the hospitals there. However, three or four hours (if anyone other than Jose is driving) across a bumpy gravel highway would be no joyride for a seriously ill patient. Although medicines and personnel continue to be provided by the government, there is no money to rehabilitate the buildings themselves. This is what MDM and Tzu Chi are now hoping to do.

As we talked with the staff there, I could feel their sincere desire to do their jobs well with good equipment and adequate facilities. They would have to be committed souls to even consent to work here. Debre Birhan is a boring little country town compared to the glamour of the big city 130 kilometers away. Most doctors open their own clinics in Addis Ababa, where they earn much more than they can at government-assigned posts in the country.

The first room, partitioned from the original veranda of the main building, would normally have been a very small private office for one person. We squeezed in through the narrow door to find three doctors who barely had room to turn around as they treated their patients. A tiny window and a small fluorescent light high in the ceiling afforded light that was barely adequate to read by (although to be fair, I noticed that few buildings in Ethiopia wasted much electricity on lighting). There was no sink for the doctors to wash their hands. An ancient faucet protruded from the wall in one corner, and underneath it was an elderly plastic bucket on a chair.

This scene was repeated in the pediatrics office and the internal medicine office: tiny, dark, overcrowded rooms with minimal equipment and sanitation facilities.

There were two ward buildings, one for general patients and one for TB patients (we were told that respiratory problems of all kinds are common in the Ethiopian highlands). There was a total of perhaps fifty beds. Again, the North Shoa region has a population of 1.67 million! The wards were relatively clean, but again the sinks and faucets were in poor condition. The few toilets at the end of the hall were all out of order. Patients had to walk some three hundred feet along an open-air path of mud, grass and stones to rustic outhouses behind the ward blocks. We thought that this long trek must be a serious hardship for patients with limited mobility or carrying IV bottles, especially at night or in the rain. Staff members would carry those patients who could not walk at all, but I figured that the staff had better things to do.

In the x-ray department, a low brick wall in front of the operator's station provided no protection against radiation from the antiquated x-ray machine (when it was running at all). The walls of the room also contained no shielding for the rest of the building. A new machine had been provided by Japanese donors, but there was no place to put it and it was sitting in a storage room. The storage room was already filled with medicines and supplies that could not be put on the shelves in the well-supplied but undersized pharmacy.

In the operating room, the surgeon pointed out the autoclave for sterilizing instruments, and he laughed that it "sometimes" worked. The operating room had only two sets of surgical instruments, thus only two operations could be performed each day.

We opened the door to the dentist's office and found only a simple table and wood chair. We were told that even though there was absolutely no equipment, a dentist was kept on the hospital payroll. They were afraid that if they did not keep him, they would never be able to find another one willing to work in this area. It is hoped that dental equipment will be available soon.

For lunch, Dr. Ayanaw invited us to his own residence in the staff quarters. We waded through the grass and mud to the long building at the edge of the hospital property. Dr. Ayanaw admitted with some embarrassment that as director, he was privileged to have a two-room apartment. Grass had been spread on the floor in honor of the guests, and the best food we had tasted in this country was spread out on the table.

I believe that injara must be the national dish of Ethiopia, since it is available everywhere, and I did not often see people eating anything else. On a large round platter, there is a layer of tef, a kind of flatbread made from the grain of the same name. It is similar to wheat, but its cultivation is very labor-intensive because it cannot be harvested by machine. The grain is ground and mixed into a dough which is then fermented for two or three days before being cooked on a flat griddle. Three or four heaps of beef and mutton and perhaps some rice are piled on the tef. Diners tear off some of the bread and use it to scoop up a mouthful of the meat. I had been told that Ethiopian food was extremely spicy. In fact, one of the dishes might be quite hot, but the rest are just very strongly flavored.

I have no idea what vegetables there are in Ethiopia. In the Coptic Christian church, there are several fasting periods each year, during which Christians eat no meat or animal products. The day we arrived in Ethiopia was the last day of the Nehase Tsome fast (in honor of Saint Mary), which lasts two weeks in August. Thus, during the week we were there, the butcheries were doing great business and everyone was busy feasting on meat. No one was interested in more veggies.

After our meal, we were treated to a traditional Ethiopian coffee ceremony. It is generally held that this beverage was invented here (the word comes via the Arabic pronunciation for the Kaffa region of Ethiopia), and the coffee here is certainly the best I have ever tasted, thick but not bitter. Ghidey's wife officiated, her head covered in traditional style. The ritual included roasting the beans over a small fire, grinding them, and a great deal of ceremonious pouring back and forth between urn and cups, all complemented by the fragrance of incense and the rhythms of Ethiopian music. The women served us and then sat back down. We asked if women were also allowed to partake of the coffee. Dr. Ayanaw laughed. "After we leave, they'll probably spend the rest of the afternoon drinking coffee and chatting." The women smiled in anticipation.

For the next couple of days, we toured other clinics and health centers that had been built during Tzu Chi's previous cooperation with MDM. It was apparent that the government and the local people sincerely appreciated these facilities. We were quite impressed with the general cleanliness and good maintenance of the clinics. Each of them had clean running water, solar electricity, and incinerators for proper disposal of clinic garbage. We were especially impressed with the maternity wards at each of the clinics.

We also stopped at one of the water supply stations that had been built as part of our previous plan. A locked fence around the station kept villagers out until the appointed time for water collection. One thing that MDM has insisted on in any of its projects here is that the local people or organizations must commit themselves to maintaining and operating the projects after MDM has handed them over. Here, a water committee collected a very small fee from the local villagers, and the funds were then used for maintenance and repair of the water station. To ensure that the water was used responsibly, the committee only opened the station at a certain time each day. The system worked very well for them, and Jose remarked that the village had even grown larger as people moved in to be closer to the clean, safe water supply.