Saturday

I could write a long chapter in a book about each of our days in Harar. This, our first full day begins with breakfast at the guest house of coffee or tea, and a unique “pancake” for lack of an adequate description and with fresh honey to put on it.  Actually very good.

I want to go to an ancient Muslim cemetery which is somewhat outside the old city, but first, after wandering a little we stop for a large glass of fresh papaya juice which Daniel and Sierra have grown to like.  Sitting next to us are two men, probably in their thirties actively communicating in sign language.  

We finish and walk perhaps a half mile in the presumed direction of the cemetary and one of the  deaf men comes upon us.  Daniel communicates with him by gestures and typing on his phone and he begins leading us to the cemetery.  It is quite a long walk and very hot.  We finally see the cemetery and some men in the distance.  Turns out they are building a gravestone.

We watch them for a while and then begin to ascend a steep hill through a very large field of recent gravestones, then somewhat older, and then very old and deteriorated stones.  All the while Daniel continues to communicate as I have no interest in this otherwise very nice fellow.  I assume he will want to be paid at the end and I am thinking 100 birr.

We walk quite a distance, climb over a 5 foot stone fence and jump down 7 feet to a road. Take  a Bijaj to the market with its essence of spices and coffee,

and ultimately I head back to the guest house for a nap.  I give Daniel some money because our companion stuck to us like glue, obviously wanting to obtain a fee for guiding us, even though we neither engaged him nor wanted him.  Sure enough as I am nodding off to sleep i hear him in the courtyard arguing with Daniel. He wants 500 birr (a ridiculous amount for an unwanted companion). Daniel ultimately gave him 250.

Went for a long walk and ultimately to dinner.  I lingered by myself for a while and encountered a group of 5 young people from Italy with whom I compared travel notes.  End of another wonderful day.

Friday

Today is a travel day. but first we go to the hospital for morning report.  This is followed by a “seminar”.  One of the residents gave an excellent presentation on neuroanesthesia.  This was followed by another superb presentation on trigeminal neuralgia.  By prior arrangement I supplemented this with some intra-operative photos of the treatment of this condition, as well as a review of all the available treatments.

In early afternoon we fly from Addis to Dire Dawa.  Took a minibus from Dire Dawa to Harar (45 miles in 1 hour for 22 birr = 75 cents). Harar is an ancient Muslim town with an old walled city, and the "new" city outside the old city walls.

  Bijaj (3 wheeled vehicle) to near our guest house and walked the rest of the way.  Primitive old traditional Muslim house on a narrow alley. 

They have only one twin bed room for Daniel and I, and a room up some very steep stairs for Sierra.  There is a bathroom across the small courtyard which is clean but primitive.  Today there is no running water whatever, apparently a common problem in Harar.

We have not eaten in many hours so we head to Fresh Touch, the primary recommendation in town.  Nothing fancy, but good food.  At dusk we head to see the hyena man.  This is a unique experience in all the world.  We hire a Bijaj to take us there for 40 birr.  I witnessed this several years ago and it is clear that the vehicle is not taking us to the place I had been.  Furthermore a native jumps in the vehicle with us and we are soon to learn that he is a “guide” to get his cut of an outrageous fee that is asked of us.  We are the only ones there and I am thinking this is a sham; the guide is asking 200 birr from each of us.  I am now convinced that this is  sham, but try to bargain (unsuccessfully) for 100 birr each.  We direct the driver to take us back at which point they agree to 100 birr, and many other people begin to arrive.  Turns out this is hyena man 2.  It is very dark, and the hyena man motions for some of the other tour cars to turn on their lights.  He begins calling the hyenas by name, and one by one they slowly emerge from the surrounding forest until there are 14 in all.  He begins throwing meat into the air and they move quickly to eat it.  He throws the meat closer and closer until one of the hyenas is eating from a stick he is holding and finally from his hand.  Sierra is one of those brave enough to take a seat on a rock next to the hyena man, hold a short stick and proceed to feed a hyena.

When all is done, we take our waiting Bijaj back to the main town square where there is a chat market in progress under the dark of night.. 

Thursday

Morning report as usual and amazingly only one trauma case last night.  This gave me an opportunity to ask questions regarding how all of our operated patients were doing and amazingly some very difficult surgeries thus far are all doing well.

After rounds I demonstrated the use of a lot of the surgical equipment that I brought this year.  One of the items is an electric drill with many bits for drilling burr holes, turning a skull flap, and carrying out spinal surgery.  It currently takes an hour or two to open the skull and finally get to the brain problem.  This should shorten this to 15-30 minutes.  Actually the chief asked if I would scrub next week and show them how to, in essence, get to the meat of the case much quicker.

Our surgical case this morning was a three year old with an enormous tumor, probably a low grade and potentially curable cystic astrocytoma.





They have asked me to give two lectures to medical students next Tuesday and Wednesday, which I always enjoy.

We left a little early this morning to have an early lunch before a very special afternoon.  Dr. Medoff, his wife Debi, and their son Sar from Greensboro, NC picked us up and we all went to the world famous Hamlin Fistula Hospital.  Their son Sar is in the last year of an Emergency Medicine residency at Emory in Atlanta, and has a one month elective rotation in the emergency room at The Black Lion where i am working.

The Fistula Hospital is a remarkable place.  Google it, or read "The Hospital by the River" by Cathrine Hamlin, or go to YouTube and search for "Oprah and Hamlin".


On the way back to our guest house they dropped me at the Telecom office.  I am running low on data on my cell phone and could not figure out how to add more.

Tomorrow I will be giving a conference, along with one of the residents,  to neurologists and neurosurgeons on trigeminal neuralgia, after our morning conference.  We are then leaving early to fly to Harar for the weekend.