A Native Ethiopian Grain is Growing in Popularity

Julia Entwistle - School for Environment and Sustainability

The onset of rainy season here in the Ethiopian highlands also means the start of growing season. You can’t step outside without seeing farmers hard at work plowing and planting their fields. Plowing is done manually with a basic plow made from local materials and the help of two oxen. Most families own only enough oxen to get the job done and with the season underway farmers often team up, bringing their plow and pair of oxen to a neighbor’s farm, to help each other out.

Farmers at work preparing fields for planting 

The common crops grown in this region include wheat, barley, beans, and lentils. While most wheat and barley fields are now waist high, farmers are still preparing to plant another grain that is very special to the region. Teff is a grain in the grass family that is only indigenous to Ethiopia and neighboring Eritrea. Seeds are very fine and grow best in soft soil so farmers will plow their fields seven times in preparation for planting teff. With plowing being so labor intensive, this is huge amount of work. But for most Ethiopians, the effort is worthwhile. Teff seeds are ground into flour which comprise the base of the Ethiopian staple food, injera, a fermented, spongey flat bread. Teff, being high in protein, vitamins, and minerals, is also considered nutritionally superior to many other grains. The crop is gaining attention in the western world due to the fact that it is also gluten-free. Imports of teff to the U.S. are on the rise and Ethiopia is encouraging farmers to expand production to keep up with this growing demand.

Oxen with plow attached

Teff is beginning to be cultivated in the U.S., although it is not the easiest crop to adapt to conditions outside of its native range as teff is so well suited to the specific climate of the Ethiopian highlands. The grain grows best at over 6,000 feet, but won’t tolerate frost.

A farm in Woyene, North Showa, Ethiopia

 

 

Teff’s particular growing conditions may be both an advantage and a grievance to Ethiopians. If the crop cannot be easily cultivated elsewhere, then Ethiopia may have cornered the market on what is being called the next superfood. A few Ethiopians have also expressed the concern that rising teff prices may cause this grain to become unaffordable for most Ethiopians to consume, which would be great loss to diets both nutritionally and culturally.

 

My Internship Reflections

Nana Asare - Ford School of Public Policy
       

Yours truly explaining the first exercises 

August 12^th marked the conclusion of my summer internship at The Ihangane Project (TIP). During my 12-weeks in Ruli, I was able to observe and participate in the continuous development of the Ruli District Hospital (RDH) through multiple perspectives. Completing the retreat and setting up the next steps for the Health Systems Management (HSM) program at TIP was my biggest accomplishment. The next steps will feed into the work of the Ross Team to visit Rwanda next year and further continue the development of both TIP and RDH from an emerging markets standpoint. Nevertheless, the relationships I was able to develop with the hospital and TIP staff are also part of my personal accomplishments as I’ve always known that I belonged in the company of those dedicated to making a change in the world.

Quality healthcare provision is undoubtedly a costly endeavor and innovators are constantly working to find ways to deliver care effectively at lower cost while improving access and quality. My work with TIP and RDH was no different. I was really excited and proud of how the retreat outcomes mirrored and addressed the innovation needed in healthcare emerging markets. While brainstorming goals for the 5-year plan, costs and monetary issues were reoccurring themes but the retreat participants didn’t lose focus that the end goal was improving their service delivery. Even better, the participants made sure to bring forth the seemingly non-monetary issues that when unaddressed, eventually ended up affecting the annual budget. For instance, the participants wanted to strengthen the internal verification system which has enabled the hospital to recoup significant revenue which would have been lost due to petty mistakes and lack of professional consciousness.

            

The RDH head of Lab and Tech offering her suggestions

One factor that stood out to me during this summer was how the innovations within the HSM at the RDH was uniquely based on necessity. In my experience traveling and working in developing countries, it is common to see organizations flock to Western models as the way forward. However, at RDH, I realized that the innovations they wanted and suggested were informed by their “lived realities” and thus they wanted to forge solutions inspired by the highest standards, which are both within Rwanda and the developing world. I believe their ability to take these measures is largely influenced by the effective but less strict oversight from the Rwandan Ministry of Health. Thus, with fewer constraints, they can develop innovations specific to their catchment areas as a district hospital. Some of these innovations we discussed during the retreat included, standardized operations, workforce skills development and establishing revenue streams.

Post-retreat smiles

After the retreat was completed, I spent the following 3 weeks putting together my deliverables and ushering in the new B.A Liaison. I feel very accomplished and I am ready for the last year of my MPP program and post-grad career which will be influenced by the many lessons I’ve learned this summer. Now I’m off to enjoy a little vacation time in Zanzibar before I return for the last bit of Ann Arbor summer until I can say “Winter is here” :)

Gathering information at 9000 feet above sea level

Julia Entwistle - School for Environment and Sustainability

The rainy season is in full force here in North Showa, Ethiopia. The area, which had not seen a drop of rain in several weeks, now experiences daily storms. The dry arid landscape has been transformed into lush green meadows in a matter of days. With the rain comes colder temperatures, overcast skies, and mud, lots and lots of mud. In a place where the closest paved road is 25 km away and walking is the primary form of transportation, this makes getting around more challenging. 

Our household surveys of local farmers are well underway, but with the sudden onset of rainy season, I decided it would be wise to try to complete data collection in the most distant area that we needed to access by road, a region called Metkoriya. Metkoriya is a very remote area only accessible by a single lane dirt road that winds alongside cliffs, up and down steep mountain passes, and sharp switchbacks. Here in the highlands of Ethiopia, most plateaus are over 9000 feet above sea level and getting to Metkoriya involved descending from the plateau I live on and then climbing back up to the neighboring plateau. 

A survey in progress at 9000 feet above sea level

So as soon as I could secure a vehicle to rent, three translators and I set out on the road to Metkoriya one morning. After a few minutes of travel I realized we may already be too late to access this area. After only a week or so of rain, the road had been transformed into sloppy mud with deep puddles. The van we were in was not equipped to handle the steep inclines and declines and the spinning tires so close to the edge of a cliff were making me nervous. Several times we all got out to push the van out of a deep puddle. The driver was not too happy with the situation and after 2-3 slow miles of travel down the mountain side and into the valley, he said he wouldn't be able to take us any further. With about 2-3 uphill miles left until we reached Metkoriya, I asked my translator what we should do now. "We walk" he said, "into the cloud." He pointed up the steep muddy slope that after 20 feet was obscured by thick fog. 

So we set off on foot on the uphill hike into the clouds. The mud clumped around our shoes and added a few pounds of weight to each step. The inside of a cloud is unsurprisingly very wet and we were all soaked by the time we reached Metkoriya. As we summited the top of the plateau where Metkoriya sits we were rewarded by the spectacular view of looking down at the cloud covered valley below. 

View from Metkoriya

We have since found a large truck to rent that is better equipped to handle the terrain and are making progress towards our goal of 80 household surveys in Metkoriya. This remote region may be the most beautiful I have seen in Ethiopia and its people are extremely welcoming, but I have to confess that I will be relieved once we are finished skidding along the sharp turns on the edge of the mountain. 

A Metkoriya farmer showing off one of his barley plants

Brief Summary of the RDH Retreat



Sorting out pre-retreat logistics with Alice, my co-planner 

Nana Asare - Ford School of Public Policy

Due to an unplanned ministry of health evaluation at the Ruli District Hospital, the 2017 RDH retreat was almost pushed back. This would have been the second time the retreat was delayed, putting my summer of hard work in jeopardy. However, with the stellar help of my co-planner (Alice) and the TIP country director (Delphine), we were able to negotiate and keep the retreat going as planned. The planning process largely focused on building on and tailoring the work of the University of Michigan's Ross School BA 685 team's work to the expectations of the RDH hospital. Since the majority of the hospital staff aren’t fluent in English, Alice and I put in a lot of effort to developing a teamwork approach in delivering our retreat exercises. Specifically, I’ll start and explain each section in English and she’ll follow up with the French or Kinyarwanda translation when necessary.

The retreat was structured in three phases and scheduled for 3-days with each day dedicated to a different aspect of the strategic plan. Below is a summary of the three phases;

•       Phase one of the retreat was dedicated to a recap of the 2016 Ruli District Hospital retreat, reports of 5 pilot projects developed during that retreat and a visioning exercise for the 2017 retreat.
•       Phase two was a SWOT Analysis segment conducted with the WHO’s health systems framework guidelines (Building Blocks). The six building blocks were connected to the main departments of the RDH in efforts to turn the negatives affecting quality health service delivery into positives to promote health.
•       Phase three was a Stakeholder Analysis and S.M.A.R.T Goal Setting workshop structured to develop goals to be achieved through the RDH’s 5-year Strategic Plan.

RDH staff and Admins brainstorming S.M.A.R.T Goals

The retreat was attended by the Administration members and department heads of the hospital. The key purpose of the retreat was to focus on a 5-year strategic plan regarding the processes, skills, and the hospital’s future goals. Furthermore, the retreat served as a platform for a successful dialogue between the administrators and department heads.

During the retreat, we didn’t encounter many issues besides occasional participant lateness and delays. The retreat as whole was a huge success for the hospital as everyone finally felt that they were on the same page in the next steps for the hospital. The hospital employees felt at ease and were able to specifically voice out their opinions which was great because “critiques” of leadership isn’t really part of the work culture at the RDH. Additionally, the outcomes of the retreat set the tone for the next steps of the strategic plan, which involves action planning and implementation.

Jotting down notes during our S.W.O.T Analysis exercise

On a personal note, I was very satisfied with the retreat. There were several times when I didn’t feel confident that it was going to go as planned because the hospital wasn’t as forthcoming and involved as I hoped. However, during the retreat, everyone was thoroughly engaged in the exercises and offered feedback to make the event fruitful. Moreover, my co-planner was excellent to work with and although her time at TIP has ended, she helped me transition in the new B.A Liaison in following up with the retreat and setting up the necessary steps for TIP’s health systems management program.