philadelphia-airport

photocred: Corey Perrine/AP found on http://www.npr.org/sections/ed/2017/01/30/512431112/students-stranded-worldwide-by-trump-orderF

I have been weighed down during the past few days with a sense of ‘survivor guilt’.  I had lived 17 years of my life safely under the F-1 visa – what I held to be an unbreakable promise to permit me to lawfully complete my education in this country.  Thanks to this visa, I was able to travel home when my parents were sick, take a break in the middle of sophomore year to explore Costa Rica with my friends (one of whom is now my husband), and volunteer at a clinic in Ethiopia – an experience that helped me dream of a future career in medicine and global health. This F-1 visa allowed me study at the Woodrow Wilson School at Princeton University about things like ethics in policy making, safety net programs for underrepresented populations, and rights of immigrants.

Now, as I wait for the approval of my permanent residency status, I am sickened by the thought of how narrowly I missed Trump’s revocation of F-1 visas – even knowing that I am not from the targeted 7 countries. How easily he, upon the stroke of his pen, trashed the dreams and rights of students trailing behind me.  How some of those sophomores can no longer take that spring vacation they had planned… How some of those bright minds can no longer explore careers in global service in third world countries…  How they now have to choose between completing the studies that they had worked so hard to start, that their parents had worked so hard to fund — and returning home to see their families this summer.

The U.S. Customs and Border Protection website has unsurprisingly been underplaying the effects of the Muslim Ban.  The website states that individuals may qualify for an ‘exemption’ that allows them to enter as long as they are deemed by senior officers to “not pose a national security threat.” They state that only two lawful permanent residents have not been allowed to enter pursuant to the exception to the executive order.  But the hidden truth is in 17,000 international students who are left suddenly, overnight, without a legal means of international travel.  That they are DETAINED here with the threat of being unable to return for their degrees – for the crime of paying out of pocket for an education that they worked hard for.

My shoulders are heavy with this ‘survivor guilt’ as I pursue a career in Internal Medicine – maybe Cardiology – all of which seem so petty compared to the career I could have (maybe should have) pursued in policy and international affairs. I write this post to help process for my own sake – but hopefully for the sake of others like me.  Maybe I don’t have the right to do so – being not of Muslim origin, being not from those 7 countries, being no longer dependent on my F-1 visa…  But still for me – the sacred promise of F-1 visa thanks to which I have my lifetime’s worth of experiences, hopes, and dreams has also been shattered overnight.

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After my second day at my new job at the hospital, I am returning home, exhausted but more aware of my position and the issues that bog down this hospital’s administration.

My main job is in credentialing – the verification of the licensure and qualifications of physicians and other health workers currently employed at the hospital, as well as applicants. As the definition may suggest, there is a lot of filing, phone-calling, and handling paperwork in this division. No doubt, as my boss explained clearly, this is a crucial aspect service quality maintenance and improvement. Although I had hoped to be involved in a job that entails more creativity and innovation, I am starting to feel more comfortable in this new role. In my previous office jobs at Princeton and other internships, I found that such busy work does help me develop meticulous attention to detail and, more importantly, patience – which I often lack in such chores. I also hope to learn how to look past the small tasks that are under my responsibility and see the value in the long-term goal of this project.

The overall project is multi-faceted and quite impressive. The eventual outcome is gathering all the necessary paperwork (potentially the most time-consuming task) and entering all of this data into an electronic system called “Morsey System Online” (MSO). MSO will allow the hospital to go paperless in many aspects of its administration – collecting and processing applications, as well as maintaining updated record of all health workers’ licenses and privileges. As a system available to everyone on the Trinitas network, MSO will also ease communication of crucial information regarding the health workers – among division directors, as well as between administrators and health workers. Friendly to the environment and to the people. 🙂

Today I received several return calls and voice of frustration from nurses whom I have been repeatedly calling about missing documents. Many of these nurses claimed that they had already sent these documents and demanded to know why they were not in file. Using my short time in office as an excuse, I explained that I did not know and politely asked them for these documents. Some responded that this is always the excuse they receive – with quick staff turnover rate and little carryover of knowledge and expertise to the new hires.

I am excited about the prospect of eliminating such miscommunication and frustration once MSO is up and running. After all, these health care providers have more important responsibilities in the hospital than sending paperwork multiple times. I’m starting to better understand the importance of effective administration in a hospital – and most of all, adequate funding to hire and maintain an effective and efficient staff.

Yesterday, I was approached by one of the parents whom I had interviewed before. Because I had changed my questionnaire, I asked him if I could interview him and his child again. He seemed very eager to talk to us again, and promised us that he will bring his child to the clinic today. I was a little puzzled by such eagerness to participate in the interview, but I just assumed that he simply wanted to talk to us.

Today, this father came to my office upstairs – actively came looking for us – which never happens. When we asked him the questions about disclosure of HIV and the mental health impact on the child, he kept talking about the stress the child gets from lack of enough food. At the end of the interview with the father and before we could bring in his child, he spoke for five minutes, clearly showing that he was agitated or distressed by something.

After this long spiel, when the translator finally translated all that the father said, I was in shock. The father said that all these foreigners (like myself) come and ask him questions, but nothing changes. They are still hungry – the child still has no food in his stomach when the child takes the medication… It was clear that he expected that in return for participating in such studies, he expected to get something in return. My translator helped me explain that this study is mainly about helping children with the psychosocial stress and cannot help them with their food insecurity.

While the translator was gone, I further explained that I am only a student, but I will try my best to communicate his frustration with the international aid and research…

This interview made my day very difficult. I think my biggest worry is becoming like one of the international organizations or researchers that this father spoke of – that was unable to make changes in the lives of the participants, who took the time and energy to share personal and emotionally challenging stories with me. I had promised him that I will try my best to communicate his frustration with such international aid organizations, but what good will this do? Could I even accomplish what I promised – to improve the mental health services provided to children at the clinic?

Earlier this day, I spoke with one of the cleaning ladies. She asked me that when I finish my schooling and have a job of my own, to provide an opportunity for her daughter to study in the U.S. too. Caught in the moment and excited about this idea, I immediately made this promise. Now, I wonder if it is okay to make such promises. Another cleaning lady at the clinic has asked me to find her a husband. I couldn’t say ‘no’ to such request. But in retrospect, I wonder if I have made some false promises I cannot fulfill… It seems to me that I could devote my life to all of these promises and still be unable to fulfill them all. I am so grateful that they have taken me in so graciously, keep inviting me to their house, and have made me feel so much at home here. But I wonder now if I am taking so much that I can’t return all of these favors… As my sixth week (out of 8 weeks in Ethiopia) wind down, I am beginning to worry more about how to say goodbye and how to keep in touch with everyone. Is there actually a right way to do this?  Could I find a better way to respond to such requests that I am not sure if I can fulfill?

After the meeting with Dr. Jane Aaronson last week, I began to think more carefully about my research, and how it can contribute to the work of WWO.  Both nurses that work with the pediatrician have told me that they are interested in creating a mental health work group for children and that the information that I collect will help them with creating a mental health group.  Today, the VCT counselors told me that a guide for disclosing the status to older adolescents and children would be very helpful.  However, the more I shared my findings with the staff, the more I realized that the results of my research will merely confirm what they already know.  The responsibility and emotional burden I had felt when I finished interviewing crying mothers turned into a sense of guilt for failing to bring results that could really make a difference in the WWO clinic’s psychosocial services offered to children.

Wondering how I could improve my study, I revisited the scholarly article on the impact of the disclosure of HIV on the mental health of children and found a new article on the policy on disclosure of HIV status set out by the American Academy of Pediatrics.  Reading these articles, I was struck by the similarity of challenges in disclosure of HIV found in the states and the stories that I have heard in the first twenty interviews with the child-guardian dyads.  I could match up the faces of the children and their guardians who shared with me the challenges they experienced with the findings I read from the American Academy of Pediatrics policy paper.  However, I also realized that there was one major difference: the cultural perceptions on the rights of children.  Having had worked at the Office of Child Support Enforcement in Washington D.C. earlier this summer, I was well aware of the importance placed on children’s rights in the U.S.  On the other hand, the interviews with child-guardian dyads and the WWO clinic staff have informed me that children are not given such independence in Ethiopia.  Such cultural difference makes it more difficult to advocate for children’s right to know their status.  Although the American Academy of Pediatrics policy paper clearly states that medical personnel have an important say in the disclosure of HIV status to children – especially those who have reached school-age – the WWO clinic staff does not have such influence.  Despite the staff’s recognition of the importance in disclosing the HIV status to the children, their influence is limited to encouraging parents to tell their children.

Today, I did some research on the WHO website on VCT counseling.  I was disappointed to find that there was no guidance on how to disclose the status to the children.  What I did learn was the importance of keeping with ethical standards and cultural sensitivity in implementing VCT counseling particularly in developing countries.  In relation to the children, the guides referred mostly to the importance of preventing mother-to-child transmission, but little on the counseling after mother-to-child transmission.  How can counselors help fathers and mothers cope with the fact that the child now has a life-long disease, potentially due to their decision?  How can adults respond to children who start questioning reason for taking pills twice a day as early as six years old?

From the first twenty interviews and the anecdotes that I have collected from the WWO clinic staff, a guide for disclosing the status to children could reduce the stress for both the parents and the children, as well as help the counselors provide effective advice consistently.  The first twenty interviews also allowed me to see what types of factors could be associated with a successful and least stressful disclosure to the children.  Compared to children in orphanages, children in the community tend to have more difficult time finding a support network or receive effective advice and counseling.   Moreover, the reason for disclosure may impact the children’s ability to cope with this new knowledge of their status – children who find out as a result of the death of their parent(s), for example, must deal with several sources of psychosocial stress at once without the necessary support.  For some children, having support from their peers, other relatives, or religious leaders can truly improve their ability to cope with the shock and stress of knowing about this status.

These preliminary findings, however, are merely anecdotal – stories that are well-known and familiar to the WWO clinic staff.  With this realization, I have decided to change my study in order to obtain more standardized results from the interviews that can be analyzed in a more sensible and uniform manner.  For example, based on the anecdotal data, I have chosen several reasons for disclosure and changed the open-ended questions to choice-based questions.  I have also expanded the section on disclosure to allow each guardian to speak about every essential element of the disclosure: the age of the child at the point of disclosure, the person who disclosed the status to the child, the emotional state at the point of disclosure and at the present concerning his/her HIV status, etc.  Although I now have less than four weeks to use this revised questionnaire, I believe that the results of this study can be more useful to the WWO clinic staff, and even be used for statistical analysis.

I have so far shown this questionnaire to the nurses, the VCT counselors, and the medical project director, in order to receive feedback.  This was another opportunity for me to see that the WWO clinic staff members have so much knowledge about the psychosocial needs of their parents, are innovative thinkers, and already do so much for their clients.  Even on days like today, when I did not have anyone to interview, I could never be bored or simply sitting in my office – the nurses and doctors call me to their offices to engage in another great conversation and learn from one another.  Although I often worry about the small number of interviews ted with the revised questionnaire and the little time I have left, the diligence, great compassion, and encouragement from the staff inspire me to maintain the confidence and faith in my research project.

I just returned from a trip to the northern part of Ethiopia – a place called Lalibela, which in Amharic means the one who eats honey.  This place is famous for the 11 churches that King Lalibela (who apparently was born with many bees around his mouth, hence his name) had 10,000 people carve out of a single rock.  This rock is some basalt rock that has this gorgeous reddish tint.  UNESCO has recognized this place as a pretty special place, so now the town thrives on tourism (there is actually an association of tour guides).

The town center is filled with souvenir shops and hotels.  I managed to stay in this beautiful hotel called “Mountain View Hotel” aptly named as you seen in this picture.  The view from the balcony was just breathtaking – so much green everywhere with a small winding road disappearing behind the hills.  I could not believe what I saw was real – it’s that feeling you get when you see a beautiful landscape on the National Geographic channel.  Is this real?  Maybe it’s unfortunate that this town has been overrun by tourists.  But after staying at this ritzy hotel – with the walls made of windows and a rooftop terrace, where you could stargaze all night – it was hard to complain about the whole industry and the development.

Even more fantastic was the drive to and from the airport.  Away from the bustling, westernized scenery of the city, Lalibela’s peaceful countryside lifestyle was refreshing and a new wonder to admire.  Donkeys, sheep, goats, and oxen overran the streets.  Children ran next to our van, bare feet and without pants, waving and saying “Hello!  How are you?”  From the mud-thatched houses with roofs made from tightly woven hay rose thin wisps of smoke probably from the cooking coals or the incense burning at coffee ceremonies.

When we first arrived, the churches had closed, so we visited the local market.  Children walked along, and I practiced my Amharic with them – telling them patiently, no I’m not Chinese, I am Korean, I study in America, yes I am happy to meet you too.  This one man allowed me to take a picture of him (the locals do not like having their pictures taken) knitting a beautiful hat.  Even without shoes and a toothless smile, he seemed so content, deftly working away with his fingers.  I was struck again the pride and contentment people have for this simple way of life.

Later, we visited the famous churches.  I want to let the pictures do the talking for me, because the wonders and magnificence of the churches is just impossible to put into words.  All of the 11 churches were built around 12th century, during the rule of the four kings, one of whom was Lalibela – the chief architect of the churches.  He ordered 10,000 men to excavate these churches from one stone using a small chisel – the great technology during this time.  One church – my favorite – was the church of St. Mary, where King Lalibela used to pray (it was his favorite too, apparently).  As you see here, the inside was decorated with so many murals and pictures that we were not allowed to take pictures with flash.

The next morning, I saw a beautiful sunrise.  The kind you can’t capture in a photo.  The sun shone brightly over the mountains onto the little village nestled between the valleys.  And once again I felt this feeling of being so fortunate – grateful for this opportunity to experience something so incredible but somehow guilty as an observer who will leave with her expensive camera on an expensive airplane back to her beautiful hotel room.  Is it okay to sympathize for someone who is in a worse situation than you are when they themselves are living happily in their own lifestyles?  This man who was so proud of his green hat, his work of art, keeps me wondering about this question.

I must go to work in a few minutes, but I just wanted to write a quickie about my thing for languages. The local people tell me that I have been a quick learner at Amharic, and are so amused at my parrot-like-imitations that I do for fun. During my morning runs, I bring my handy-dandy notebook, which I read to keep my mind off of how terrible the gymnasium smells or how much I hate running on treadmills. Anyway, through these methods, I think I have come far in learning this language in the past 3 and a half weeks (can’t believe it’s been so long!) and can better communicate with the locals – whether they are the guardians and children that I interview, the WWO staff, the hotel managers, or the random taxi drivers I bargain with (now in Amharic!)

Anyway, the point of this post is not to brag about my abilities but just to say how amazing it is to see the difference that knowing the local language can make in connecting with people. In my interviews, just by being able to say “I like soccer too!” to children whom I interview, they visibly relax a little more, put on a smile, and open up to me.  When I walk by other offices at the clinic, people come in and tell me to sit down, and open up to me – through Amharic and broken English (my Amharic is not yet sufficient unfortunately but I’m getting there!) – about the challenges in everyday life and work.  Even the cleaning ladies and the reception desk personnel recognize me and are eager to find out what new words I learned today and open up to me.

Sometimes, when I am walking around the clinic, bored at waiting in my little office for my next interviewee, and looking for someone to teach me Amharic, I question myself – ‘What am I doing here? Why am I spending so much time learning this language that is spoken only in Ethiopia? Am I wasting my time – being negligent to my research project and my time here in Ethiopia?’ I think that I have been blessed to be born in Korea, to be a child of a daring mother who stayed in the U.S. without her husband for 8 years so that her children could learn English, and just to have a thing for languages. I think I am discovering more and more that just by learning their language, I am taking part in a big chunk of their culture, and contributing in a way that I have yet to completely understand.

My birthday yesterday was one of the most precious experiences in Ethiopia. Traditionally, Ethiopians do not celebrate their birthdays after their seventh or eighth birthday. But yesterday, the WWO clinic staff made an exception – they gave me the most memorable haya-hulett (22 in Amharic) birthday celebration.

With the help of the two other WWO interns, who bought a beautiful card for everyone to sign and a birthday cake (my favorites – vanilla cake and milifone – a delicious Italian pastry), the clinic staff prepared this surprise party – all in a few hours of the morning! At one point, I went around the clinic doing my usual good morning greetings to everyone. I found Brook talking to Allie, who was holding a coffee pot – a traditional one that they use for a coffee ceremony. The excitement that they wore so plainly on their faces immediately told me something was going on that they did not want me to find out. I truly treasure this innocence and openness of the people here that I have found in so many of my interviews with Ethiopians. Of course, I played along and pretended I had no idea what was going on.

The other two interns took me out to a nice lunch to a café. After a rushed lunch in order to make it back on time for “you-know-what,” I walked into the clinic to a warm inviting scent of freshly popped popcorn. And as soon as I walked into the kitchen – “Surprise!” Almost every single person from the clinic was surrounding me in the kitchen with a beautiful cake and milifone in the middle on a tabletop. Sister Tena made me wear a pink birthday hat, and Brook handed to me a giant pop-up birthday card (so my style!) with everyone’s signature and birthday wishes – to my great pleasure some in Amharic! On my right was a setting for a coffee ceremony – with the now familiar traditional coffee pot on charcoals, the basket of popcorn, leaves scattered on the floor. Just as I was taking in all this, Allie walked in the door wearing a traditional outfit to – transformed into a “bunna” (coffee) lady! I jumped in joy and ran toward her as she gracefully embraced me.

When I experienced all the excitement I could handle, Brook told me that I must wait for my gifts. Then he presented me with a beautiful scarf, carefully wrapped in bright pink “Happy Birthday” wrapper, beautiful earrings, and what I had always dreamt of having – a chart with all of the Amharic letters and simple words! Then Brook told me – “There is more. But this is not like the others – it is not a material gift… It is an Amharic name that this clinic is giving to you.” While I held my breath, he told me the name – “Your name will be ‘Tewodage.’ This means ‘beloved.’ ”

I’m sure Brook had something more to say, but I could not hold it much longer. I broke down, my birthday hat falling down, my beautiful scarf soaking up the tears, while everyone else crowded around me to get a good picture of this scene. I just could not handle it all. The connection that I have made with the people at the clinic was more than what I could ask for on my birthday. To know that they went through all this trouble and gathered the funding (despite the difficult financial circumstances for some of them) to make this surprise party happen within half a day was so overwhelming. I took many pictures to savor these moments, and I am leaving a record on this blog about these special moments. But these words – and not even the pictures and the videos – can capture the many unspoken blessings from the staff and my immense gratitude. I think that this memory that I now carry is what many people may call evidence of His blessings, or karma – the evidence of some sincere, deep, and perhaps a spiritual connection among many lives.

My interviews and informal discussions with the staff at the WWO clinic have been absolutely invaluable to investigating ways to reduce psychosocial stress experienced by children with HIV/AIDS. At the beginning of this week, I was unsure how the results of the interviews with children and their guardians could contribute to the clinic’s services and benefit the interviewees. Every time a guardian opened up to me and shared such incredible stories even through the tears, I felt uncomfortable with my inability to explain how their participation will lead to concrete results and help for their children. I wanted to be able to say comforting words, but without any experience in counseling, I could only continually thank in my broken Amharic for sharing such painful memories to a foreigner like me.

Two days ago, I interviewed a single-mother and a son, who were the first among my interviewees using a public water source (instead of pipe water) and living in government housing for people in extreme poverty. The child was one of the youngest I have interviewed – 12 years old. And yet, their stories, the close connection between the mother and the child, and their ability to engage in positive living left an impression unlike any others. The mother told me two very distressing stories. On one New Year’s Day, she had invited many neighbors to have a modest celebration. One girl in the neighborhood, who somehow found out the HIV positive status of her son, told everyone at this party that the boy was HIV positive. Soon after, all of the neighbors left, refusing to eat with someone who is HIV positive, leaving the mother and the son to spend their New Year’s Day alone… The second story was of how the child had found out about his status. When he was younger, he helped out his mother by running errands for his neighbors for some modest tips. Although his mother kept telling him to stay home, afraid that her son may hurt himself, the boy continued to work while the mother was gone during the day. One day, she found that the boy had fallen down, got a deep gash on his arm, and went to the hospital by himself to get stitches. Her worst fear had come true, and she could not keep this information from him any longer. The mother told us that when she disclosed his HIV status, she was surprised the boy was not angry at her, and just asked why she did not tell him earlier. These stories clearly showed the love and constant worry the mother had for the son and the son had for the mother. When the son was invited to the interview, he saw that the mother had been crying. He was one of the first children to tell me that one of his three favorite things to do is to spend time with his mother. Surprisingly, he also willingly shared with us that he came to the clinic because he had ‘the virus.’ Such willingness is really significant, because many children who know are unable to openly talk about their status, because they are not used to talking about such things even with their parents.

This story left me with a strange mix of complex emotions – awe at this amazing bond between the son and the mother, helplessness from my inability to help them or say comforting words, and disappointment at my own project that seemed to have no focus or concrete hypothesis. However, Yayehirad and Antena – the pharmacists – whom I interviewed later that afternoon, gave me a new sense of purpose. Despite my inability to completely understand mental health norms of children in Ethiopia as I described in my last blog post, they were curious how I could contribute with my outsider’s knowledge. How do the American parents disclose the HIV positive status to children? What are some coping mechanisms available to children in the U.S.? What sorts of support networks are effective in helping children deal with the psychosocial stress in societies with strong stigma against HIV/AIDS patients? Even though the cultural barrier will prevent me from fully understanding mental well-being of children in Ethiopia, I can identify ways to improve the current support networks and guidelines for disclosing the HIV/AIDS status to children. I was so grateful to find that the WWO staff were so highly concerned about the children’s emotional well-being and interested in helping me find concrete results of my project.
Worknash, the nurse who currently leads adults counseling groups and helps with HIV/AIDS status disclosure to adults, has also been incredibly helpful. In addition to providing a private space for me to cope with some of the difficult stories that I have heard, she has taught me the value in sharing one’s own experiences and learning from other’s experiences. She says that the Ethiopian society is very conservative – the children are dependent on their parents until marriage, and people do not openly share their problems with their neighbors or even the relatives. In such a society, it is difficult for parents to disclose the status, because they are afraid that the children may spill this secret to their neighbors. Moreover, as the children are dependent on the parents, the children do not have ‘rights’ as they do in the U.S., and cannot know their status without the parent’s consent, let alone get a test to find out their status. Such cultural values and the parents’ sense of guilt for the HIV positive status of their children present many barriers to disclosure of the HIV/AIDS status to the children.

Through my everyday encounters with the parents and the WWO staff, I am learning that these cultural boundaries are crucial for the stability of their family and social life. However, I believe that there may be ways to help the parents with this disclosure process. Worknash told me that in the adult counseling groups, some parents shared with the others in the group the benefits of disclosing to the children and getting them tested for the status. Even though this is a very emotionally difficult process, many others in the group took this experience as a lesson and brought their children and their spouses to the clinic to get tested. From the stories that I have heard from the children and their guardians, I believe that support groups for disclosing the HIV status to the children in their adolescence can be helpful. The story of the mother and the son explained above is one example of how disclosing the status brought the child and the mother closer together. This is one example of a family that can show others how disclosure can help both the child and the guardian better cope with the life-long stress of being HIV positive.

Other stories have shown that many children come to know their status years before the parents decide to disclose the status, because of the daily dose of medication and the posters they see on the walls of the WWO clinic. As a result, it is clear that not disclosing the status only blocks the communication and emotional support that both the child and the mother could provide for one another. Thus, I believe that support groups composed of the children and their guardians could also provide a network for the children to discuss their own issues. Although there are official guidelines to help adults identify sources of emotional support, there are no such guidelines for children. This is especially detrimental in the Ethiopian society, where children do not have the same emotional support from parents, who must expend all of their time and energy to financially supporting their children. I hope that by creating a support network among child-guardian dyads, the children and the parents can learn from each other ways in which the families can cope with the psychosocial stress associated with HIV/AIDS. More importantly, children in the community – who do not have the communal atmosphere of orphanages – can also find peers with whom they can speak to about their HIV status without being discriminated against.

I think I have hit a point, when I start feeling overwhelmed with the stories that I have collected. I am overwhelmed, because the more stories I collect, the more I feel the need to organize them in some fashion to make sense of them. For instance, one scholarly article that I have read on children’s mental health in Ethiopia categorized families into four types depending on the degree of fragility of their circumstances. Although such categorization would help me process the large amount of information, I feel a greater responsibility to preserve the unique quality of each experience. Even the minute details of each circumstance – whether the child has lost the parent one year ago or a few months ago, whether the child has lost both parents or just one, which relative the child is now living with – all seem so important to how the child copes with the psychosocial stresses of HIV/AIDS. Comparing and contrasting these stories I collect and trying to draw parallels between some of them have kept me up late at nights. Even after being able to process the interviews in a haphazard manner, I am constantly reminded of the western (or perhaps eastern) bias that I bring to this foreign world that I have only begun to experience. Some people at the clinic have begun to say that I must have some Ethiopian blood in me (perhaps from the soldiers that fought in Korean War?) and sometimes I sincerely wish I were.

Studying mental health in a foreign country is a funny thing – I want to know what causes stress without the children having to share these stories. But implicit in this goal is that the children are experiencing stress – stress that they should not be experiencing. During a conversation with one of WWO staff, I was reminded that some of the stress that children experience is normal – they are supposed to experience stress as children as they learn through making mistakes or being chastised by parents. Moreover, in certain cultures or different financial circumstances, the relationship between the parents and children are not one of open communication or emotional support. In Ethiopia, where an average woman works 16 hours a day just to get regular meals on the table, the core concern cannot be the emotional well-being of the children. And often times, these children grow up to be extremely resilient adults, who are able to deal with even more difficult circumstances and set great examples for other poor children to follow.

With such new knowledge accumulating from my interviews and casual discussions with WWO personnel, it is increasingly difficult for me to understand what I can say about the stories I have collected from my interviews. On the one hand I acknowledge that there are things that I will never understand – what it really means to be HIV positive, what it means to live in a society with such strong stigma against people with HIV/AIDS, and what it means to live with such condition from which one can never be cured completely. I will also never understand what it feels like to live in a culture where the normal relationship between the parent and the child does not include emotional support. And without this understanding, I feel as though I can never “improve” the situation, because any attempt at doing so will impose some judgment of what is good and what is better.

As a result, I am beginning to wonder if I am going about this whole idea of mental health the wrong way. Why not talk about the same thing but in different terms – like treatment adherence? Or coping mechanisms for dealing with the stigma against HIV/AIDS? But does this defeat the purpose of my study – to increase awareness of mental health needs of children with HIV/AIDS? Am I lowering my expectations and standards too soon? Or am I simply being sensitive to the cultural difference and the obvious cultural gap?

Just a side note, I must say that I am extremely grateful to the staff at the WWO clinic, who have treated me like a part of their family since Day 1. They have taught me so much Amharic, informed me about the Ethiopian culture, and are rapidly adopting me to their way of life and way of thinking. Without being presumptuous, I wonder if these informal conversations and connections I build can help me better understand mental health ‘norms’ in this society. I truly hope so. Because with such stories that the children and their guardians have shared with me, I feel a great weight and responsibility to turn them into something more. Some way to not only improve the children’s adherence to medication, but open channels of communication among children with HIV/AIDS, and among children and their guardians, to deal with the daily stress of taking the treatment every day, feeling sick so often, and facing their worst fear – being shunned by others for a mishap that was completely out of their control.

Last Sunday was one of the most fascinating days I’ve spent here. For the entire day, my two friends from the U.S. and I were habeshas (locals). We were fortunate enough to be invited to the home of Kalkidan – one of the translators at WWO – and experience what true Ethiopian life is like.
When we got off the taxis at her residential neighborhood, the frantic boom of the city was nowhere to be found. Few children playing on the streets and a small kiosk where a woman gave us a warm, toothless smile quickly loosened the tension in my body. Kalkidan first showed us the modest salon, where she gets her hair done, then directed us toward her home. I exclaimed with joy at the sight of the dirt roads lined with pebbles and sheep sitting peacefully on the side chewing away at last night’s dinner, making Kalkidan laugh at me (again). The eucalyptus and large trees of flowers waved at us with the gentle breeze, welcoming us to this wonderfully quaint neighborhood.
As soon as we stepped in through Kalkidan’s front gate, her mother came to greet us with a shake and wonderful three pecks on the cheek. We met her sister – nicknamed “Belly” – a genuine comedian in the family – and the two dogs and a beautiful puppy named Tina. Their home was absolutely beautiful – living room, one bedroom, and a beautiful kitchen with a well-kept garden. Sitting in the living room, decorated with real ivy branches that wrapped around the ceiling, I felt as if I had finally found what I was missing in my wonderful luxurious hotel room – a real home.

Soon after we arrived, we immediately went to work – mixing the ingredients for the banana-chocolate- chip-pancake that my two American friends had brilliantly thought to make for the family, chopping up potatoes for “chips” (Belly’s favorite food), learning how to make schirro (delicious Ethiopian dish), and cutting up injero. With the radio turned on loud, Belly’s wonderful singing voice, and enticing aromas filling the air, I was on cloud nine. We danced to the beats, took one too many pictures, tickled them with our terrible Amharic, and just had one jolly old time. It was truly one quality family time on a Sunday morning.

To describe the incredible tastes I experienced at this brunch, this blog would be a mile long. Of course, this was not the first time trying the great traditional dishes of Ethiopia. But the way that the injero melted in my mouth, the doro wot tingled my taste buds, and schirro spread its warmth… This was the first. I heaped my plates not just one time, or twice – but three times. (This does not include the extra injera that Kalkidan’s mother graciously offered to me.) I should have thought of Kalkidan, who had pent all day yesterday making my favorite spicy chicken dish – doro wot – and how her mother, who woke up at 4 a.m. just to finish it, but this wonderful experience in my mouth shut off my brain for a while. The wonderful chattering of Belly about everything from the Ethiopian cultural channel, her desire to be a singer, and her large belly (no pun intended) somehow gave my stomach the energy to digest all this food. Wow, what a meal!
Later, we walked around the neighborhood. We met many of Kalkidan’s friends, walked past a wedding and a funeral, and of course, graciously welcomed the now-familiar-booty-call “China!” We also were invited into the home of Kalkidan’s best friend from high school. Such hospitality just amazes me to the discomfort for imposing on these people’s lives, but I am fast learning that this is part of their culture. After I whipped out my barely understandable Amharic to say “I’m from Korea,” the hosts switched the channel to KBS – Korean Broadcasting Station. Kalkidan’s best friend even tested out the one phrase she learned from these shows – “Ahn-nyoung-hi-ge-se-yo” – in perfect accent! I was so shocked and at loss for words. On my way out, the best friend’s brother did a Korean bow to me. This little visit made my day.
Of course, until we all came back and had coffee ceremony together. The housemaid who had worked for Kalkidan’s family for twenty years was visiting at the same time we were, and made delicious coffee for us. This process is just absolutely fascinating. They cover the ground with leaves and make a small fire with the Ethiopian version of a Bunsen burner. Then, they roast the green coffee beans on a frying pan until darkened, and allow them to cool. With the heated charcoals, they popped pop corn in a large pan, sprinkled sugar, and offered it for munching while water was brought to boil. Then, in a beautiful jar specially made for the coffee ceremony, they pour the water, then the coffee beans directly, and allow it to simmer over the charcoals. This careful process produces about three small espresso-sized coffees that is so rich, smooth, and dark that it melts your heart as you drink it. The whole time, I sat next to the woman and watched her prepare this coffee – her peaceful expressions, the slow sweep of her hands, and careful – almost sacred – pouring of the coffee from the jar to the small cups. I was entranced, until Belly caught me and – once again – got a good laugh at my expression of absolute awe.
If the back-to-back encounters of the wedding and funeral weren’t enough, we were invited to the birthday party of a boy next door, who turned two today. I was so fortunate to sit with all of the little kids, one of whom gave me a “you’re a star!” sticker on my forehead. With the permission of a little girl, I got to take a picture of her. She, in return, gave me a little peck on the cheek on my way out.
At the end of the day, I am left with a strange mix of satisfaction with my new treasures and bewilderment at such hospitality. I hope that somehow we gave something in return – that perhaps our appreciation for their hospitality and genuine desire to exchange stories and laughter also left valuable memories. I also hope that I can turn this spirit of generosity into something more – a renewed energy to bring many laughs, new knowledge, and contributions to the WWO clinic.