Turning Cancer Struggles into Something Helpful for Other Cancer Patients

I have wanted to write this blog for a while, but it required holiday time away from work and some reflection on what surviving cancer means to me, nearly four years after my diagnosis.

The ending of one year and the beginning of another naturally causes one to ponder where their life has taken them and where it is going.

As I get farther away from my diagnosis, I continue to remind myself that the gift of a second life as a cancer patient is not to be taken for granted. I am more and more grateful for family and friends who continue to love me and surround me despite the ups and downs of a cancer survivor’s life.

According to some medical sources, the form of breast cancer I had is the most rare, has the lowest survival rate of 40-60%, and a life span of four to six years after diagnosis. With the four-year mark coming in March 2014, I feel like my life is taking on a greater sense of urgency if the survival statistics are to be believed.

While fighting to live through cancer, it was hard to imagine life after treatment. It was a struggle to survive numerous treatment complications. I vowed that if I survived, I would one day turn the terror of a cancer diagnosis into something positive. Author Henri Nouwen once said, “I always try to turn my personal struggles into something helpful for others.” I too want this to be my manifesto as a cancer survivor.

Turning personal struggles into something helpful for others sums up my last three years of volunteering for Cancercare Manitoba. The volunteering I do is  not for me, as I hope my cancer never returns. I volunteer, hopefully, to help benefit the more than 6,000 newly diagnosed Manitoba cancer patients who enter the healthcare system annually (over 60,000 undergo testing annually for cancer suspicion).

I started volunteering by raising money for the cancer foundation in its annual fundraising event, walking with a fellow breast cancer survivor and former work supervisor, and my daughter, who both walked alongside me in my own journey.

My volunteering expanded to becoming a speaker for Cancercare MB’s Foundation, and a cancer patient lecturer for first year medical students.

As a cancer patient who received inadequate treatment on several occasions in emergency departments when cancer treatment complications surfaced, my survivorship turned to advocacy in complaining about care to a local hospital and to Cancercare MB. That advocacy resulted in being jointly appointed by Cancercare Manitoba and Manitoba Health as a patient representative to the Manitoba Cancer Patient Journey initiative. http://news.gov.mb.ca/news/?item=11726

In my role with the initiative, along with another cancer survivor, we share Executive Co-Sponsorship of the Patient Participation Advisory Group where we provide the “patient voice” at the steering committee table. As Executive Co-Sponsors, we co-chair a group of six cancer patient advisors who meet regularly to provide feedback to the steering committee and all of its working groups whose aim it is to improve the cancer patient experience.

With the initial appointment to this initiative over two years ago, I have gotten over being intimidated in providing the patient voice in a room full of the province’s brightest minds in health care comprised of CEO’s and senior health administrators from Cancercare MB, Manitoba Health, Regional Health Authorities of Manitoba, and Diagnostic Services Manitoba.

Our patient voices are not only accepted, but also encouraged to provide candid feedback from the patient’s perspective on where to make improvements in cancer patient care in Manitoba. To date, our patient advisory efforts have had several successes in shaping and improving the health care of cancer patients in Manitoba.

Our first achievement was the development of cancer patient communication guidelines, which are now being circulated province wide as reminders to health care providers on how to conduct positive communication with cancer patients.   http://www.cancercare.mb.ca/home/health_care_professionals/cancer_patient_journey/communication_principles_and_guidelines/

We have introduced the use of in-person patient stories to remind steering committee members that we are gathered to help “live” cancer patients when we meet monthly. The patient stories often uncover new areas for improvement that are being addressed in the initiative’s work.

We have been influential in ensuring that neutropenia (fever and infection with chemotherapy treatments) protocols for cancer patients who report to emergency departments with treatment complications are consistently practiced in all Manitoba hospitals.

Our patient advisory group has developed a series of open letters to medical caregivers and providers who work with cancer patients to thank them for their compassionate care. These letters are being circulated in various provincial healthcare institutions as a form of patient appreciation to those who work with cancer patients daily.

Our patient voice at the steering committee table helped lobby for an after hours clinic for cancer patients undergoing treatment who develop complications. Our efforts recently resulted in the opening of this service for cancer patients, enabling them to bypass attending emergency departments for after hours care.

We also recommended after hours care information be updated on Cancercare MB’s website.

 http://news.gov.mb.ca/news/index.html?item=19814

http://www.cancercare.mb.ca/home/patients_and_family/cancer_patient_journey/ucc_helpline/

Currently, our patient advisory group is working with medical professionals at Cancercare MB to adapt a cancer patient passport from one currently being used in Alberta. The passport will serve as a communication vehicle for cancer patients and medical care providers when patients attend appointments, will log medications and test results and assist with visits to their pharmacy. It will also help to provide information on treatment at after-hours care facilities. It is hoped that the passport will be enacted within the next year.

My life as a cancer patient educator continued in late 2013 speaking to medical staff who are running the Urgent Cancer Care Clinic talking about emergency room experiences as a cancer patient, and various post treatment complications requiring after-hours care. As well, I will be featured in upcoming cancer patient videos with my family physician and surgical oncologist, which will be used to provide training for patients, medical caregivers and providers on doctor patient communication.

In the midst of volunteering on the Manitoba Cancer Patient Journey initiative, I was recommended by my breast cancer nurse educator last spring to become a breast cancer support volunteer through Cancercare MB’s Breast Cancer Centre of Hope. http://www.cancercare.mb.ca/home/patients_and_family/patient_and_family_support_services/breast_cancer_centre_of_hope/peer_support/

At the time that I completed training for the peer support program, I was told that I can expect to receive calls from elsewhere in Canada (and possibly beyond) to become a peer supporter for other women who are newly diagnosed with the same rare strain of breast cancer I had.

In 2010 when I was newly diagnosed, there were no peer volunteers with carcinosarcoma of the breast anywhere in North America, as it affects only 0.1% of breast cancer patients worldwide (23 diagnoses in Canada that year). Through this blog, I have already helped at least one other carcinosarcoma of the breast patient in Northern California who found the information through an internet search on the disease.

The more one is exposed to the complexities of cancer patient care in the health care system, the more one realizes there is more work to be done. My cancer Co-Executive Sponsor and I continue to identify areas where services to cancer patients can improve. Our experiences and those of other cancer survivors tell us that there is room for improvement.

As more and more cancer patients survive treatment, employers need to be trained on how to reintegrate them into the work force with their post-treatment limitations. Provincial labor laws need to be enacted similar to those legislated in the United Kingdom, which are very progressive in their approach in protecting patients suffering from cancer and other long-term illnesses.

Pain management of survivors dealing with treatment complications is an ongoing need.

Post-treatment rehabilitation through physiotherapy, occupational therapy, diet, exercise and nutrition need to be part of a patient’s post cancer treatment, similar to what is being done in Denmark.

Some of these ongoing needs have been identified in the province’s cancer health care strategy, based on feedback from our patient advisors. http://www.gov.mb.ca/health/documents/mbcancer_strategy.pdf

People ask me where I find the time and energy to do all cancer care volunteering, while working full time. I have a very understanding employer that supports me in this important work. I see it not a duty, but as a passion to help others. I share this passion with five other cancer patients, who, like me, volunteer and believe in wanting to make the cancer journey easier for others that follow us.

Through this volunteering, my circle of cancer survivors has widened. Each of us knows that any one of us can relapse and become sick again. My patient advisor peers understand the cancer patient journey as well as I do, and are among the most beautiful people I have met in living life as a cancer patient.

In the words of Elizabeth Kubler Ross, who spent her life working with the dying, "The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen." 

It is for cancer patients and their families that I lovingly do this volunteer work. I understand their struggles. I understand their fears. Spending time with other cancer survivors to make lives of other cancer patients better as they journey through the medical system gives me the Strength, Courage, and Determination.

Holiday Season Ushered in With New Health Challenges

The old adage says, “No news is good news”. In almost two months since my last blog, there was no news in my life after cancer, thus nothing to write about. I was living a normal pre-cancer life--busy with work, family and volunteer obligations. It has been nearly four years of living without evidence of disease, so life has been good.

Then two health related events happened one week after another this past month.

During my regular cancer quarterly monitoring appointment, my family doctor checked my blood pressure. For the first time in my life, it was unusually high. She sent me home with instructions to check it regularly for two weeks to see if the pressure would lower. This was not the case.

So, in mid December, I was put on high blood pressure medication. We are not sure if the high blood pressure is hereditary (my father had and sister has high blood pressure), or if it is being caused by my anxious personality. So I have a new health issue to manage, which is not difficult with medication and my continued regime of proper diet, regular exercise, and healthy weight.

But then there were unusual lab results that came after my last quarterly check-up. Another surprise, and one that is more difficult to manage.

I have been diagnosed with hypoparathyroidism--a rare and permanent condition where my body is secreting abnormally low levels of parathyroid hormone, resulting in low levels of calcium and high levels of phosphorus in my body. It can be hereditary, can occur if the thyroid is damaged in surgery, or can arise with an endocrine condition. None of these apply to me, so we are not sure how I acquired it.

My breast cancer nurse educator tells me it is likely a side effect from my chemotherapy and radiation, as the four tiny parathyroid glands lie behind the thyroid gland in the neck. The thyroid gland area is at risk whenever breast cancer patients undergo chemotherapy and radiation. She says that the condition can develop long after active cancer treatment is completed.

I do not know how long I have had hypoparathyroidism. I suspect it has been for a few months. There have been several clues that it may have been developing. I chalked it up to being in my 50’s and living with an aging body.

These last few months, I have had increased low-level chronic pain in my legs, feet, hips, and lower back. There have been terrible charley horses (always at night) in my legs, feet and hands that remind me of when I was calcium deficient when pregnant. (These side effects can also occur while on Tamoxifen, my chemo maintenance medication, so I thought it was the trigger). My doctor put me on anti-inflammatory medication, but I had to go off of it because of my high blood pressure.

My bones ache at times. Some nights I hardly sleep, as pain will wake me up several times. Fatigue is now part of my daily life. I have developed extremely dry and flaky skin and now react to skin care products I have used for some time. My nails are so soft that they snag and tear.

At my last eye appointment, my optometrist was concerned with the results of some of the tests and is monitoring my eyes more carefully. He was perplexed by the test results, which will see me undergo retesting early next month. He has been monitoring my eyes because of the risk of cataracts from chemotherapy, and now will have to monitor my eyes with hypoparathyroidism as it can cause eyesight problems.

If left unchecked additional problems like impaired kidney function, heart issues, and osteoporosis can occur with hypoparathyroidism.

My family doctor is monitoring this condition with quarterly blood tests. I will be monitored for the rest of my life. Generally, hypoparathyroidism can be stabilized with consumption of calcium-laden foods, calcium supplements, and high doses of Vitamin D. If the parathyroid hormone levels continue to be low with my next tests in February, I will then be referred to an endocrinologist for an in-depth assessment and further treatment.

In the meantime, I have to learn how to manage this new health issue. It confuses me, so I will see my breast cancer nutritionist early in the New Year to determine what foods I can eat with this condition. Foods that are high in calcium (particularly dairy) are also high in phosphorus. I do not know how to lower phosphorus levels in my body while boosting my calcium levels. It is further complicated because I’m lactose intolerant and I avoid soy based foods because of their natural estrogens, which can be an issue with an estrogen positive breast cancer history. I am hoping she has some answers.

It is a setback as I work through these new health challenges. At times I feel discouraged, but I refuse to give in. Instead, I shift my thinking and remember to be grateful to have had almost four years added to my life thus far because of cancer treatments. I continue to fight daily with Strength, Courage, and Determination.

Potpourri of Updates Since Spring Blog

It seems like such a long time ago since my last blog on May 28. In some ways, it is.

For those of you who have checked in for blog updates and have persevered in your waiting, there is a lot to share with you.

Life as a surviving cancer patient has me living my “new normal” reality--full, rich, rewarding, and at times busy.

In June, we celebrated my husband’s retirement, my mother’s 80^th birthday, and family visiting from Alberta.

July was filled with finishing re-landscaping of our back yard. In between, there was work, work travel, and new work projects to develop. For a good mixture, there was a couple of family friends’ children’s bridal showers and weddings, spending time with adult kids and hearing stories of their European and San Francisco vacations, and a week’s vacation of our own to end the summer.

Some disconcerting health problems also arose. At my annual oncologist check-up in May, the doctor switched my cancer blocker anti-hormone drug (a form of oral chemotherapy) to another hormone blocker—supposedly it gives a few percentage points increased benefit to prevent cancer from returning.

True to form, as with other cancer drugs of my past, my body did not tolerate the new drug. After battling with allergic side effects and being treated with steroids to eradicate them, I was put back on the original drug. All is now well again with the chemo maintenance drug, except that with the switch, there has been more muscle and joint pain and increased frequency of “charley horses” in my lower limbs and feet.

My sister, the nurse, tells me this occurs because the hormone blocker chemo drug reduces estrogen in my body, which acts as a natural lubricant. So, I’ve been put on an anti-inflammatory to enable easier movement, reduce chronic pain, and improve sleep. Regular exercise helps somewhat to also reduce the pain’s intensity--all the more reason why skipping out from the gym has its consequences.

Then there was a concerned phone call in late summer from my family physician about elevated protein levels in one of my cancer markers blood work tests. The fear of cancer returning was back once again, albeit briefly.

After some scurrying on my doctor’s part with the oncologist and my liver specialist for a consult, it was determined that the elevated markers were not a concern. I will continue to be monitored closely (breast cancer can metastasize to the liver), as has been the case since markings on my liver were found with MRI scans while in treatment three years ago.

I am lucky, and particularly blessed with the care I receive from my family doctor who continues to be vigilant in my health care monitoring and acting on my behalf. I am confident that I am in goods hands with her care. It was a scary few weeks until the specialist consultations on the test results were reviewed and ruled upon.

My volunteer life as a cancer patient advisor continues with the Ministry of Health and CancerCare Manitoba’s five-year appointment to the Manitoba Cancer Partnership Steering Committee. The provincial government’s $40 million+ initiative to improve the waiting times from suspicion to diagnosis to under 60 days has been an interesting volunteerism and learning opportunity.

I share this volunteer role with another cancer survivor as Co-Executive Sponsors on the Steering Committee; Co-Chairs of the Patient Participation Advisory Committee (six cancer patient survivors) associated with the initiative; patient advisors on the cancer patient passport working group; and occasionally deliver a presentation/lecture to health care professionals, medical students, or the public, speaking on the cancer patient experience.

Through the volunteering, I am learning so much about the complexities of health care, the background behind the complicated webs of treatments cancer patients experience, and where improvements can be made in the healthcare system. Halfway through this project, change is starting to be seen. It is rewarding to see how the voice of patients can positively impact health care reform.

To date, our patient input has resulted in the formation of a cancer patient advisory committee; improved communication of healthcare professionals with cancer patients through the development of communication guidelines; cancer patients telling their stories at Steering Committee meetings as reminders about whom we are serving; improved practices in emergency departments requiring after hours care of cancer patients who develop complications including dangerous febrile neutropenia (infection with low blood counts); open letters to various health care providers commending them on their treatment of cancer patients; the beginnings of a cancer patient passport to use as an information guide for medical appointments; and regular feedback to 10 working groups under the Steering Committee umbrella who are addressing various improvement areas to reach the goal of 60 days from diagnosis to first treatment.

A few months ago, upon recommendation of my breast cancer nurse educator, I undertook training to be a breast cancer peer volunteer for other women who are dealing with their diagnosis. Peer volunteers generally are placed on a provincial registry, where they are matched with other breast cancer patients with similar life or diagnosis circumstances.

In my case, because my form of breast cancer is so rare—0.1% of all breast cancer diagnoses in the world (23 out of 23,000 annually in Canada), my name has also been put forward as a peer volunteer on a national breast cancer peer registry.

Within two weeks of completing the peer volunteer training, I was matched with my first client. It is an interesting experience to walk alongside other breast cancer patients, to listen to their stories, and to find ways of supporting them that are meaningful. It is an experience I wish I could have had when I was in active treatment, but unfortunately there was no peer match available for me anywhere in Canada. So, this is important work to ease the burden of others who follow behind me.

And in between all of this, there have been several sessions with a personal trainer! Hard as they have been, I have enjoyed every minute of them. There is a deep satisfaction in knowing that despite how deformed my body became with surgery and radiation, I can make it stronger and rise up to the challenges my trainer poses.

The workouts have been fun, grueling, and have taken me to progressively higher levels of fitness. I am doing workouts I could not imagine before the trainer sessions started. In the not too distant future, after I muster enough courage, I will join the “hard core” gym folks in a TRX boot camp or spin class. Stay tuned.

Life is good. The gift of a second life is a daily blessing. I continue to greet each day with Strength, Courage, and Determination!

Living a Normal Life - - With Reminders - - May 9

It’s been several weeks since my last blog. I’ve been busy travelling in rural Western Canada with work and there have been a multitude of family birthdays in the past few weeks and life kind of feels normal as it did pre-cancer. Almost.

Three years have passed since my cancer diagnosis. It now only feels like a bad dream. Although life and the routine of work have resumed, one lives life differently once you’ve survived cancer.

You just don’t forget that cancer is part of your past. It does get easier the more distant one is from diagnosis and treatment, but it doesn’t leave your memory. As my surgical oncologist said at a conference where we were both presenters, “women who have had breast cancer live with that dark cloud over their heads for the rest of their lives.” I couldn’t state it any better.

So what does living with a dark cloud over my head feel like? Most days I tend not to dwell on it. However, I am reminded that I survived a cancer as I see the scars from my mastectomy and the chemo port’s central line incisions on my neck and upper chest. The three “dot” tattoos on my chest where radiation beams were aimed are permanent markers from treatment.

Perhaps what is most evident to me are the current tell tale signs in my day-to-day activities that I live with a cancer past in that I have less energy than in the past and tire more easily.

The hormone blocking medication that I take, a form of daily chemo that I will be on for 2 1/2 more years, causes pain in my hips and legs while I sleep. My legs and feet also cramp when sleeping. Hot flashes add to the mix for a miserable nightly sleep. My family doctor has me on other medications to counteract these complications and they help, but don’t alleviate the problems.

My arms and upper torso don’t move as well as they once did as I cope with the treatment’s cut muscles and radiated shrunken tissue. The right side where my cancer was is also the side of my dominant hand, so tightness in the upper body and the lack of strength gives me some limitations.

This week was unusual in presenting four reminders that I have been a cancer patient.

With the recommendations of my two treating physiotherapists, I finally hired and met with a personal trainer this week. She specializes in working with breast cancer patients and has had them as clients for several years.

She is consulting with the physiotherapists on areas of concern, which she will consider in developing my program. We are analyzing all of my body issues and are coming up with an exercise plan that will give me strength, flexibility, balance, and improved range of motion. I am looking forward to having a stronger body to help me cope with the complications of life, post-cancer.

My second reminder came yesterday in a story in our daily paper. The provincial health minister announced that the cancer treatment organization and the province have opened a Cancer QuickCare clinic to serve cancer patients in the evenings, on weekends, and during regular business hours. Halleluiah for that!

My hope is that with this clinic no other cancer patients will ever have undergone the terrors of waiting for hours in emergency with treatment complications like I did on several occasions.

                                                                                                           

I would like to think that being one of two cancer patients advocate appointees on a provincial steering committee to improve cancer treatments had something to do with establishing the clinic. As advocates we represent the voices of cancer patients in the province and in this role raised numerous concerns about the poor quality of cancer patient care after hours. The after hours clinic is a positive step for all cancer patients in this province.

Tomorrow presents two more reminders that I survived cancer. I will have my annual monitoring appointment with my surgical oncologist to see if there is any evidence of  the disease.

I will also be meeting with the local breast health centre volunteer coordinator to discuss being a breast cancer patient peer for newly diagnosed cancer patients. I was recommended to her by my breast cancer nurse educator some time ago and will be interviewed to see if I am a suitable breast cancer buddy. If I am, then I will participate in a training workshop this weekend that will equip me with tools to journey with other newly diagnosed women who are undergoing treatment.

As I walk to my bus stop to go to work every morning, I am grateful to have lived through cancer.  I live joyfully with the realization that I am a survivor. It gives me Strength, Courage, and Determination.

Ethiopian Coffee-Flavour to Savour

As I enjoyed my cup of Ethiopian coffee this morning I realized that it has been a month since my last blog post. I spent a week recovering from travel illness, worked for a couple of weeks and then was working out of town again for several days. It’s hard to believe a month has passed since my visit to the African continent.

Ethiopian java is among the best coffee in the world. It also originated in Ethiopia in the Kaffa region. I can buy Ethiopian coffee locally at a coffee-roasting house I frequent, but to experience it in Ethiopia is something special.

Coffee in Ethiopia is equivalent to Italy’s espresso. The Italian influence still remains in Ethiopia where their terms for coffee are used for Ethiopian java.

Ethiopian coffee is rich and robust and is to be enjoyed after every meal. It is often drunk straight like espresso or with steamed milk like macchiato. It can be cut with chai tea, or can be served with either cardamom, butter, salt, and local bitter herbs. It can also be served with freshly popped popcorn.

What is interesting with Ethiopian coffee is that there is often a ceremony that accompanies it. Green beans are roasted in front of guests until they are dark brown. They are then manually ground. The coffee is brewed by hand, poured into demitasse cups, and served with sugar.

As guests of Ethiopian partners, we were educated on the best flavours of coffee to buy from this homeland where exporting of coffee is an important contributor to the local economy. Our hosts told us that the best coffee is Yirga Cheffe, followed by Sidama, Harar (most expensive), Keffa, Wolega, Limu and Bale.

Sharing a cup of coffee with Ethiopian people is not just drinking a beverage. It is an invitation to share in their lives and in their warm hospitality. Food and drink were extended to guests wherever we visited with local people--even in the poorest of the poor families we met with.

In one village they freshly roasted coffee for us, made bread that morning, roasted chickpeas, shared bananas from their farm, and bought apple pop to share with their Canadian guests. In another family’s home we were treated to Injera bread, recently harvested honey, and Ethiopian coffee. Even though language can be a barrier in communicating in other countries, food and drink were universal in being able to bond with others.

Life in Ethiopia is very hard and much different than it is in Canada. The people I spent time with over many cups of coffee taught me much about how to be fully present with others in my life. They live simple and humble lives, but their lives are rich because of how they value people in them.

The people we spent time with in Ethiopia were poor, but they live their lives with much love and hope. They showed me new ways of living my life with renewed Strength, Courage, and Determination.                  

February 18, 13

I am safely home in Canada

Today, I finally feel well enough to write a blog about my travels in Ethiopia.  Like many travellers who go to foreign lands, I’ve been sick since the last week of my trip from something I ate or drank. My doctor has put me on antibiotics to rid my body of what she thinks may be a parasite.

Technology is an intermittent reality in Ethiopia, as is electricity. It was difficult to post blogs from Ethiopia due to a lack of wi-fi access in my travels in rural and remote towns. Amazingly, cell phone access was available in many parts of the country where electricity is yet to be established. A world of contrasts of old vs. new in the world of utilities and technology.

Riding the Roads of Ethiopia

Let me start off by saying that I could not drive in Ethiopia!

Having been behind a Canadian steering wheel for nearly 40 years, driving in Ethiopia is chaos.  Most foreigners elect to hire drivers to go from place to place than risk driving either because of congested traffic or difficult rocky and mountainous roads.

Here, it is the thousands of donkeys, goats, and cattle that are kings of the roads in rural areas, highways, and yes even in places like the capital city, Addis Ababa. Car horns are amongst the most used parts of vehicles maneuvering through traffic.

Sprinkle this mayhem with pedestrians that come at you from all directions—front, sides, behind, and cars that zigzag into your lane from either side and it all adds up to an ever present accident waiting to happen.  Here two lane roadways do become streets for four vehicles!

Miraculously, I saw few accidents, nor stricken pedestrians or animals on the roadsides. On the national highway there is no speed limit; drivers decide what they feel is a safe rate of travel.  The exception is when the highway passes through local towns where a lowered speed limit is posted. One of the NGO’s that we work with has chosen to limit their highway travel to 80 kms per hour. Their motto:  “Reduce Speed, Increase Longevity.”

In the time I spent travelling here, it was always with a driver who was either a work colleague who lives here, or an NGO partner who was native to the land.  With the latter, it felt sometimes like the movie “Driving Miss Daisy,” except that this Miss Daisy was younger than the movie version and the drivers insisted that I sit on the front seat for better picture taking.  They were great at stopping their vehicles to enable me to capture the countless spectacular scenes of Ethiopia with my camera.

Toyota should think about doing a television commercial here.  The majority of  vehicles driven in Ethiopia are Toyota Land Cruisers. Many of them are white, signifying NGO’s who are also given orange license plates identifying them as aid vehicles. This is done so that locals can quickly identify them as assistance vehicles should they be in trouble.

Interestingly, many of the NGO drivers are also fully trained mechanics, as garages are hard to find, and the roads travelled can create problems for vehicles.  One of the drivers I spent several days with noted that he spent seven years learning his trade in how to fix and maintain Toyota Land Cruisers.

The white vehicles are also “magnets” which attract the attention of local people—especially children.  NGO trucks and those who are inside them represent money in one form or another to the locals.

As you pass by them, hands extend for money, while others frantically wave to see a rare sighting of a white person.  Vehicles are swarmed if you stop, and you can expect that some of them will want to shake your hand or have their photo taken as something novel to do. Children wait for vehicles to stop and stand ready to pose for cameras. Others come by wanting to sell you things.

The children will call to vehicles carrying white passengers yelling  “You, you, you”, or “Money, money, money”, or “Firenje” (Ethiopian for French white people who came here many years ago to build the railway).

White people in these parts strike up a lot of curiosity, especially in the countryside. In some of the rural remote mountain villages that we visited, we were the first white people that residents in the community had ever encountered.  One elderly woman said that her mother told her as a child that there were white people in other parts of the world, but our Canadian NGO contingent were the first Caucasians she had ever seen.

Fuel for vehicles comes here either from Libya or Sudan. It will cost you $1.09 (20 Ethiopian Birr) Canadian per litre to fill your tank.  As with other parts of life in Ethiopia, it is not uncommon to see contrasts in modes of transportation.  At one gas bar, the owner of two donkeys sidled up to a gas pump, tied them to the pump, and then went inside the store to get supplies. Old transportation meets new transportation everywhere in Ethiopia.

Motorcycles driven by young men (without helmets) are everywhere in city and rural areas.  Some even use the motorbikes to carry grass for animals on their backs, a chore that would have been done previously by donkeys.

For 20,000-70,000 Birr one can buy a motorbike in one of the larger centres. Cars—mostly Asian imports like Toyota, Nissan, Huyundai, Suzuki, and Isuzu --- can be had for 200,000-300,000 Birr.  North American vehicles are non-existent. Countless thousands move from place to place by foot or public transport, as the price of motorized travel is not affordable for many in Ethiopia.

Addis Ababa, a city of 4 million has few traffic lights. In the many trips made throughout the city I only saw traffic lights four times, and only once were they working. Traffic is managed by street police who stand in the middle of the mayhem and give out driving instructions by blowing whistles and gesturing with their arms.

When travelling the streets of Addis Ababa, you won’t find multinational businesses that dot streets of major cities elsewhere in the world. There are no McDonald’s restaurants, no Starbucks coffee cafes, no Walmarts or Pizza Huts.  These companies have been denied business entry into the country by the government.  You may find signage for Asian electronics companies, but local businesses will sell you their products.  What you will find is a wide assortment of Coca-Cola and Pepsi products, with flavors locally adapted to the African marketplace.

Anywhere one travels in rural Ethiopia, you can expect spectacular sights.   Surrounded by mountains in many areas, the vistas envelop you with beautiful scenery and vegetation not seen in Canada.

Although the African wildlife is better seen in Kenya where there are more forests, in our travels we did manage to see a herd of camels grazing in grasslands, antelope in the distance, congoni (an African animal similar to deer), a vulture, guinea fowl, a baboon on the roadside, and a jackal darting across the road as we approached.

Ethiopia is a land that stimulates all of your senses.  Every day I resolved to experience all of it with Strength, Courage, and Determination.

  

Zeway, Ethiopia; Greenhouses and a National Highway Complicate Life in Zeway --- February 7-13

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This lakeside city of 60,000 is named after nearby Lake Zeway, which wraps around one side of it.  Like other parts of Ethiopia, it presents a life of contrasts.

The area is one where the wealthy vacation as the lake provides local tourism.  Cabins can be rented a couple of kilometers off the highway and people come to relax, swim, and fish. 

Fishing is also an important part of the area’s economy with fishers supplying restaurants and local markets.  As well, some vegetable farmers in this part of Ethiopia can make a reasonable living because of the lake and irrigation.

In some ways Zeway is more prosperous than other parts of Africa. The lake provides income for up to 11,000 local people and others from across Africa, because of an international floral greenhouse operation established here by a private business owner from the Netherlands.  This greenhouse and many others like it are a growing economic sector in Ethiopia.

In Zeway, row upon row of greenhouses go on for many kilometers and greet you as you enter the city from its outskirts.  The greenhouse owner in Zeway established a business here because of the tropical climate and abundant access to water.  It is said to be the largest greenhouse operation in Ethiopia.

Exotic and other flowers grown here are trucked daily to Addis Ababa about three hours away, and are put on planes bound for the Netherlands to be distributed to other worldwide destinations. Chances are that some flowers I have bought in my Canadian city may have been grown here.

The other noteworthy distinction about Zeway is that the national highway that runs through it also becomes its main street. The highway takes travellers into Kenya.

And while there are many who work in the greenhouses to support their families, others in this city face extreme poverty. Ironically, poverty is further complicated here because of the greenhouse and national highway.

A migrant population is the result of these two features, and with them comes social issues locals have to contend with. Trucks bearing the name of the greenhouse move in and out of the city daily to load flowers for sale elsewhere. 

Truckers and people passing through to Kenya who may be HIV/AIDS infected patronize sex trade workers and spread the disease in the community. The locals are then left with lifetime consequences of dealing with the illness and the effects on their families.

Families who are affected by HIV/AIDS encounter poverty, as their loved ones may not be able to work or have to adjust their work hours due to illness. Because of this, many of the NGO’s that work here have AIDS/HIV education and healthcare as part of the outreach they provide to citizens. 

Yet despite these realities and hardships of life, many families here with the assistance of NGO’s are coping and developing better ways of life for their children. Social change is slow, but many of the changes that are occurring are positive. It is inspiring to listen to parental stories of hope and dreams of the future for their children.

These people, in a land so far away from my home, are teaching me many things.  They have a persevering spirit and a willingness to succeed.  Their examples remind me of my cancer battle nearly three years ago.  They give me Strength, Courage, and Determination to live a life that matters.