Day 2: Chama to Ojo Calienta: 94 miles

Well this was a day to dread. Have not done a day like this since Vietnam, and that was totally flat, this was not.

A subtitle for this day would be "simultaneous events and the intervention of mother nature"

Instead of boring you with prose, I'll just set out the good,

the bad, and the ugly (in reverse order).

The ugly

How about a violent wind, hailstorm, and driving rain that left huge puddles of water and threw our bikes 10 ft into the mud from where we had placed them while we went for lunch.

What do you think is the range and velocity of a puddle of water on the road when a semi-trailer drives thru it (and you are biking on a 2 ft shoulder)?

The bad

A lot of ups and downs on a very long day

The last 16 miles is a gradual uphill, into the wind, and with our third rain of the day

A flat tire and the first rain of the day beginning at precisely the same moment

A fair amount of traffic from 7:30 to 8:30 in the morning

The good

My flat tire is only 1 1/2 miles from lunch (after 56 miles of riding) and the rain only lasts 5 minutes

Our support vehicle pulls up one minute later and they help me repair the flat

As I start off at 7 am I see many dear leaping the road, but they don't have good depth or distance perception. One comes silently from behind me and leaps one foot in front of my bike miraculously avoiding death by deer.

The weather is perfect (except for the rain)

The scenery is spectacular (immediately below is Echo Canyon National Park where some of our group stopped for lunch... and thereby missed the hail storm)

The ride is actually only 89 miles (not 94)

We arrive at Ojo Calienta, a delightful unpretentious mineral spa resort with 7 different pools (mud, soda, arsenic, iron, sulfur, etc etc)

The company is great

I feel great after the long ride

We have two nights at this delightful place

A mirage:

Everything is up to date in New Mexico; have you ever seen floor tiles on the side of the road?

(How about rumble strips filled with water from the rain)

Cumbres and Toltec Railroad, 6/23/09

Today was the first day of a 300 mile bicycle excursion thru the mountains of northern New Mexico. After a lovely, scenic four hour drive thru the central valley of Colorado, thru small one street towns and with mountain ranges of each side we finally arrived in the town of Antonito, one of the hubs of the Cumbres and Toltec narrow gauge railroad (http://www.cumbrestoltec.com/).

We saw the railroad arrive at 4:45 pm steaming, whistling and hooting after hauling three carloads of people up what would be our first days' ride. (see movie below)

Finally at 7:30 am on Wednesday we are off on a 49 mile ride to Chama, NM, over two 10,000 foot passes. The first is a 2400' climb over five miles.

After a long downhill to an abandoned restaurant where we had sandwiches on the porch, we did another 750' climb to the second pass.

This could be one of the most lovely bike rides I have ever done. Rare cars on a road that winds thru lush forest, high above remote wild valleys, at times along the railroad tracks of the narrow gauge, and all the while with the songs of birds cheering us along. The climb was tough, but the scenery helped it to pass without a complaint. The final 16 mile downhill to Chama was a delight.

From Gondar to Bahar Dar

I’m trying something different today after three days in a row of inability to post to the blog site after typing a long missive. Today I am typing into Microsoft Word and then will try to cut and paste into the blog.

Today I traveled from Gondar to Bahar Dar, a town on the largest lake in Ethiopia. Distance of 200 km and we made it in 2 ½ hrs. A little scary as we had to cross 3 mountain passes with winding roads to and from and the driver preferred to drive on the left 2/3’s of the road. After some pantomine for the first 1 hr to please keep to the left on any curves, he finally got the message . . . for 10 minutes. Only three overturned trucks on the road.

But first, a lesson in Ethiopian economics. Only way to get here is by minibus which is cheap but involves sitting with no windows open, 12-14 other people none of whom have bathed in the last 30 days. For 700-1000 birr you can get a “private” minibus, but did not want to spend that much. Found someone who asked my “best price” (usually the beginning of bargaining) and I said 350. He said o.k. if he can bring some locals at the local price. I said no more than 3-4 locals and we had a deal. He arrived promptly at the appointed time, introduced me to his driver and we were off (with 7 locals, but I had my own row behind driver in the minibus.

The drive was lovely. Magnificent and different scenery. Passed thru 3 or 4 villages where I know the annual income of the country ($250 per person) is spawned. People walking on the hot asphalt road along most of the way (with bare feet). Carrying huge packages, bales of hay, and whatever on their heads. Herding goats, sheep and cattle. All in the heat of the midday equatorial sun.

Finally arrived in Bahar Dar where the driver (who speaks 10 words of English) pulls into the bus station (a huge dirt and stone parking lot with at least 20 buses and 150 minibuses and hundreds of people milling around. We take a tuk tuk a short distance to the hotel (turns out minibuses are not allowed on the boulevard where hotel is located). Room is very nice, with a terrace overlooking Lake Tana, the largest lake inEthiopia and the attraction of the town. There are 20 or more monasteries on islands in the lake, the origins of the Nile river and several other attractions.

I am negotiating with the driver (who will pick me up tomorrow after driving back to Gondar today and returning tomorrow) to hopefully stop at what sounds like a very interesting weaving cooperative in the hills along the way.

Cheers! I made it.

Safari (simply a vacation to the locals)

As my birthday is approaching my memory has geared down yet another notch. That combined with just returning from the bush and negotiating crazy downtown Nairobi, and this post may or may not make sense.

To catch up, last Thursday night I had an Indian feast at the home of Jetinder Singh's parents in Nairobi before departing on Friday am. Wonderful, intelligent and hospitable people and a true local experience.

Friday am took my first walk venturing into neighborhoods and finally felt like I had seen at least a corner of town. Taxi drove me 2hrs to Lake Naivasha where I stayed in a lovely "cottage" onthe lake with hippos in my back yard at night. Amazing birds, like none I have ever seen and not one true, flowering bush, plant, giant cactus that Ihave ever seen anywhere in the world.

On Saturday I took alocal minibus (mutata) 10 miles down the road. By law only 14 peopl allowed, but in fact >20. Tried to hold my breath for 10 miles since they don't seem to take showers here, but it didn't quite work. Hiked 2 km down the road to Hell's Gate National Park, the only one in Kenya that allows you to walk. Saw ostrich, zebra, wildebeest, watrbuk, giraffe, buffalo and many others as I waalked5 miles to the "lower gorge". Met up with Minister of Commere frm the Czech embassy and hiked (with guide) 4 km down and thru an amazing gorge (18'wide at its narrowest), the site of several movies. Steaming water coming from the bowels of the earth, so hot you can boil an egg!. Then walked another 7 miles back before hitching onthe back of a motorcycle.

Met 3 American med student from BeerSheba medical school in Israel on a two month elective in Eldoret,Kenya. Had a picnic lunch with the Czecks. Delightful food, hiking and accomodations.

Sunday am my taxi driver returned as scheduled from Nairobi, drove me back to nairobi where I took a twin engine Otter to theMasai mara. An adventure in third world avionics. The pilot, flight attendant, baggage handler, check inagent are all one person.

Was met at the dirt air strip in the middle of nowhere and drove 1 1/2 hrs (15 miles) over horrendous road, rocks, thru a river to nirvana, the Royal Mara situated on a peninsula jutting into the mara river. A heavenly place -- not a "tent camp", not a "rich American safari tent", but an architecturally fascinating place. Feels like you are sleeping in the bush, while actually in a rustic (huge) safari cottage.

Did a total of three game drives and saw more animals than you can imagine. Two most interesting sitings were a Cheetah and a mal lion having breakfast, lunch and dinner(all inone) -- a gnu. Monkeys, baboons, hippos, crocodile and more in my back yards. A deranged elephant visitor at 1:30 am

Need to meet my taxi to go to airportfor flight to Addis tonite.

Regards to all.

An emotional goodbye

We started off the morning with neuroradiology rounds and visiting Professor Kaufman. What a kick! Actually three great cases with animated discussion.

Then went to Aga Khan Hospital to see postop patients. Truly a joyous experience with all three cured of their pain and gratitude like I am not sure I have ever experienced, both from the patients and doctors to whom I taught the procedure. Have a great photo of the first lady we treated but ridiculous internet service will not permit it to be uploaded. Suffice it to say this poor country woman had not been able to eat, smile, talk, wash her face, brush her teeth for weeks. This morning she smiled widely and handed me a gift. It was similar with the other two.

Teekra, our anesthesia/pain management specialist insisted I come see her office and treatment facilities. We really hit it off. A lovely, very bright woman from Jordan. At some point I told her she looked Jewish. Her grandparents are Muslim, Palestinian, and . . . . Jewish!

Went for first come of tea and a lovely goodbye to Moody. His last words were "you have made a difference in our country".

Took a cab back to my hotel to try to wind up travel arrangements. You can never imagine the havoc over such a simple affair. Everything from airline unwilling to fly their schedule because not enough passengers, an essential road closed, and beware of drunken rangers when you land at the airport who will have AK-47's and threaten you with jail until you pay them a phony "entrance fee" with which they will then buy more whisky so they can repeat the procedure all over again.

After hours of rearranging, replanning and haggling I have hired a taxi to drive me 2 hrs to Lake Navaisha where I will stay two nights. I will then take taxi back to Nairobi airport to fly to Masai Mara to a distant air strip so as to avoid the extortionists.

This afternoon I lectured to surgical grand rounds in a very large packed amphitheater on Spinal Cord Injury. Great questions and afterward one of the neurosurgeons who I had not met asked if I would be willing to come see some x-rays and problem patients that he had.

Back to hotel to do ironing (laundries are rare to non-existent and laundry service at the hotel is more expensive than the Waldorf Astoria ($8 for a shirt). This computer goes to its rightful owner tonite when I go to dinner at the home of Jetinder Singh's parents. No more news till at least next Wednesday when I get to Gondar.

Love to all. Wish you could see a few of today's pictures, but the internet is misbehaving.

a good day

Moody (Mahmood Qureshi) picked me up early am to travel to Aga Khan Hospital for our surgery. I found it fascinating to work with anesthesiologists from Rwanda and Jordan, neurosurgeons from Kenya and Uganda, all gathered to learn the procedure for trigeminal neuralgia that I have been didactically teaching the last several days. They were very excited as was I. They all wanted at least some hands on time. We treated all three patients successfully. For those non-neurosurgeons among you this is a procedure that for various reasons cannot always be completed. Today all were successful. It was handing the neurosurgeons a new toy only much more. Statistically there ought to be 1500 new cases of trigeminal neuralgia in Kenya each year, and yet hardly any are being treated. They all wanted copies of my lecture from yesterday and have already arranged CEU meetings for the neurologists and dentists in Nairobi and Mombasa to try and get the word out.

Below are concrete barriers in the road to be negotiated after passing security check at the Israeli embassy.

After the first of three cups of tea I was finally returned to my hotel for a welcome afternoon off. Worked my my talk for grand rounds tomorrow on spinal cord injury (thanks to JDC for the core, but he won't recognize the finished product) and then finally ventured out for a walk after the front desk assured me it was safe as long as I was back by 5:00. Incidentally my lovely country hotel is across the street from the Israeli Embassy; you cannot imagine the guards, concrete barriers, concrete walls etc. Each time we ascend the street to the hotel the car must stoop for a security check of the trunk and back seat of the car.

I walked two miles or so, stopped in a neighborhood place for lunch and returned for more work on my talk and to await being picked up by Moody for dinner.

Moody is of Pakistani descent (from the days when it was part of India). He is Muslim. His father came to Kenya with his brother to work on the railroad in early 20th century. The brother returned to India. Moody's father stayed here, ultimately returned to India to marry a woman his parents had chosen, then returned to Kenya where Moody was born. He has three children, all physicians. He and one other felllow are the best trained of the 12 neurosurgeons in Kenya (2 retired). Moody is very polished and proper and has organized a multi-country residency program in East Africa with tentacles that reach around the world. His residents have been to Turkey, Japan, South Africa and the U.S. There was a team from Johns Hopkins here just a few weeks ago (actually working in Eldoret in northern Kenya). In the past year that has also been a team from Duke.

Paul Young, a neurosurgeon in St. Louis who has been here 10 times, has invited (and 10-12 have accepted) the guys from Rwanda, Uganda, Tanzania, Ethiopia and Kenya to gather in St. Louis the first week in March. He is paying for all hotels and foods. Each of the locals are paying their own way, though in most cases they have obtained the funds from their governments.

Moody and I had a superb and very unusual Indian dinner at a fine place in the Intercontinental Hotel downtown.

Tomorrow is my last day of work. I will go to neuroradiiology rounds in the am at the Kenyatta Hospital, then out to Aga Khan to see my post op patients. In the afternoon I am giving grands rounds to all the surgery departments at the University of Nairobi.

I'm still trying to tie together loose ends for a trip this weekend. Transportation is the problem. A car and driver will give me more flexibility, but ends up being quite expensive and leaves a 6 hr drive back to Nairobi next Tuesday. I can fly everywhere by puddle jumper but then need taxis/drivers to get to various places and apparently that is not always reliable (car break down, there can be bandits on the road, etc.).

Bye for now.

Obama day in Nairobi

Walked to the hospital this morning, about 20’, carrying computer for my lectures, my backpack with Obama pins, ties and hats for presents. Today is Obama day in Kenya and the excitement is palpable. Everyone, everywhere is talking about him.
Day started with a lecture on diagnosis of coma to about 20 surgery residents, neurosurgery residents and attendings. Went better than I expected as these were my poorest slides. Then rushed over to the Aga Khan hospital to see the three patients on whom I will be operating tomorrow. Mahmood Qureshi ushered me into his office, insisted that I sit at his desk and we began seeing the patients. Three excellent candidates. The first two were charming and lovely women who considered it a blessing that they had found their way to Moody and he had brought the American professor to operate on them. The third woman spoke only Swahili, but had with her three very articulate and attractive daughters who translated for me. Moody speaks Swahili, but I wanted the daughters to be engaged in the process which pleased them very much.
A major difference from American medicine . . . The doctor discusses with the patients, at his initiative, all of the costs involved. He explained that there would be a charge from the hospital for the bed, all supplies, the use of the operating theater, anesthesia, etc. He explained that there would be a small charge for a donation to the Kenyan neurosurgery Foundation since I would be donating my time and services and not charging them. Further, the cost of the kits (which I brought from the US is $2000, and I would be donating them. The total cost that he estimated to the patients was 65,000-80,000 Kenyan shillings which is something less than $1000. In the US the hospital bill alone would be something over $10-15,000, not counting the anesthesiologist and physician fees. This hospital is the nicest and most prestigious private hospital in Nairobi.
After seeing the patients I went to the radiology department to meet a friend of Jetinder Singh (from Kansas City -- Dr. Vinayak). He is a very impressive fellow. Extremely bright and articulate and hugely involved in all kinds of Kenyan and international activities in his field (diagnostic and therapeutic ultrasound). He represents all of Africa in the International Federation of Ultrasound and in this capacity is often lecturing in Morocco, Libya, South Africa and Europe. As if that were not enough he and his brother own what is reputed to be one of the finest Indian restaurants in Nairobi, where Moody and I are going for dinner tomorrow night.
Went to present Grand Rounds at the University of Nairobi at 12:30, where there were more than 200 people filling the lecture hall. It was actually pretty exciting and I did not see a single head bobbing. They asked superb questions and thanked me profusely, following which I presented the moderator (chief of Medicine) an Obama pin, which thrilled her and the audience. There was then a large buffet lunch outdoors for all attendees to honor the “visiting professor”.
Was quite tired after all this, when Moody asks if I will go and help at the neurosurgery clinic and see a consult for him. Good thing I was in the clinic. Both attendings and residents had a few issues with which I was able to be quite helpful. Saw the consult, advertised to be trigeminal neuralgia, but actually a woman just as goofy as some encountered in the US. My host in the clinic and the afternoon was a delightful, loose as a goose, smart and articulate neurosurgeon from Obama’s village. Exactly the personality I wrote about a few days ago characteristic of the Luo tribe from which Obama’s father came.
Vinayak gave me the name of his travel agent who he highly recommended -- a very knowledgeable and helpful woman. She is the first one who understood what I am looking for in my adventure trip. If all works out I will probably hire a private car and driver and visit an area not frequently visited by American tourists. Will be able to do some hiking, mountain biking, walking safaris, game drive, and canoeing with the hippos. It’s still in the planning stages, but may finally be what I am looking for.
Let me tell you what I have learned about the Somali pirates. First, the Somalis are in general the bad guys of East Africa. I won’t go into all the details, but they are in general lawless, corrupt, untrustworthy, secretive and insular. There are undoubtedly some good people among them, but they are avoided by the Kenyans and in general they are secretive with a low profile. There are many who have left their country and have settled in Kenya. Among the latter are the employers of the pirates. The operation goes something like this: (1) rich Somalis in Kenya hire mercenary pirates and agree to pay them to hijack ships; (2) ransom is demanded; (3) eventually ransom is paid, general in the range of $1M to $3.5M; (4) the “employers” obtain the money from the pirates, give them their pay and return with their money to Kenya; (5) the Somalis are using their money to buy up land and buildings in Nairobi. So there you have it. All of this is speculative but as the dots of evidence are connected by the Kenyans this is the picture that emerges.
I’m going to stay out of town tonite as it is Obama insanity. Fireworks, singing, dancing in the streets.
Surgery tomorrow a.m. Hope it all works out. I’m not sure what I am going to encounter in the O.R., but if it is equipped as well as the rest of the hospital I have no concern.
Love to all.

Just wind me up and push the button!

I have had many occasions to give lectures over the years, participate in seminars, teach classes, etc but have not really done bedside teaching since my residency . . . until today.

The day started with neurosurgery rounds at the Kenyatta National Hospital, 2000 beds and 3000 patients (you get the picture). First rounds with the neurosurgery residents and attendings on 40 patients on the neurosurgery ward. A virtual neurosurgical museum. Then just the residents and I went to see 15-20 patients (new and old consults) ,on medical, pediatric, ob/gyn, general surgery, orthopedic services, plus one trauma patient in the E.R. I was observant at first, then interjecting subtle comments and suggestions (and alternative diagnoses). Finally on the non-neurosurgical wards I was greeted by superb presenting residents and their coterie of medical students. Here I took advantage of the opportunity to discuss subjects I have not confronted for decades. My reward was students sneaking from the group to follow me the remainder of the morning.

Rounds last 5 hours. One of the residents then took me cross town through horrendous typical Nairobi traffic (Los Angelinos have nothing to complain about) to the private Aga Khan Hospital. There I conducted a workshop (in the morgue) for several of the neurosurgical attendings, residents, an anesthesiologist and pain management specialist on the balloon compression treatment of trigeminal neuralgia.

I later had a lovely evening with Jaininder Singh (brother of internist Jetinder Singh in Kansas City) and his wife at a local Indian restaurant.

Let me give you some idea of the security issues for a tourist (or even a local Kenyan who may not look the same as those of tribal origin) in Nairobi (not true in the countryside). Jaininder took me on a brief auto tour of some the newer buildings in the downtown central business district (CBT). This is the only part of town (not much larger than downtown Kansas City) with stop lights. As we approached the first light, he warned me that he would not stop for the red light, nor did he stop for the next 5 or 10 that were red. The potential "tip" to pay off a cop who might stop him is much less than the risk of a mugging or carjacking while stopped at a red light.

Tomorrow I am giving two major lectures and will be seeing three patients with trigeminal neuralgia on whom I will be operating on Wednesday.

Good night to all.

Sensory overload

The previous post which is dated Sunday, is actually from Saturday. This is today's post (I still haven't completely figured out composing these posts).

I awakened to blazing sunlight (we are 25 mi south of the equator) and magnificent very large birds of every color on my porch. Buffet breakfast outdoors was lovely with every imagineable offering. I toured the extensive gardens and grounds and then we started off on what was planned to be a road trip to see and countryside and Mt. Kenya (which is quite spectacular).

We pulled into a tiny town with a dirt road and street lined with shops and many people wandering about. Peter said he was going to try to find his "uncle". I wandered the streets shaking hands with everyone and taking photos.

Michael, the uncle is 10 years younger than Peter, the product of Peter's father's second wife. He is a conservationist/environmentalist which all sounded quite like featherbedding to me; I sure was wrong on this one!

He took us to his place of employment, http://www.whwf.org/index.htm, and the excitement began. First he gave us a 2 hour tour of the most innovative, exciting sustainable project you can imagine. The place is not open to the public. 40 Kenyan students at a time can be accomodated for a 3 day stay during which they learn, thru very exciting hands on projects and demonstrations, how to cook with homemade methane gas, how the earth was formed and what it will look like in 5o million years, how to dispose of sewage and household waste without septic tanks, odor, sewer lines, etc. They learn how to farm fish, grow their own food, plant trees, reduce CO2 in the atmosphere, live in the outdoors, care for sick and orphaned animals and much more. Each group that comes plants a different specie of tree and does other projects. The grounds are magnificently kept and this is a truly exciting project funded by many movie star peers of William Holden, and is longtime girl friend Stephanie Powers. There is probably much more about this in Wikipedia.

We then went on a game drive on 1400 acres of land owned by the Foundation. We saw warthog, wildebeest, waterbuck, impala, reedback, crowned crane (one of the most magnificent birds you can imagine), regular zebras, albino zebras, greve zebras, Mt. Kenya hartebeest (there are only three remaining in the world and I saw all three of them), rhinocerous, elaud, bongo and bushbuck. I have never heard of most of these; they can likely be googled if you would like to see them (try google images).

We then went to the Foundation animal orphanage. So what is animal orphanage? It is a place where they gather animals abandoned by their mothers or whose mothers were killed. This orphanage raises them and then releases them into the wild. We saw ostrich, colobus monkey, four other species of monkey, cheetah, 4 species of gigantic tortoise (5 feet long), wild pigs, mt. kenya porcupine and many others.

Stopped a country "hotel" where you would not want to spend the night. We had a huge kikuyu lunch at 4:30, before dropping off Michael, visiting his wife and kids once again, and then driving nearly 3 hours back to Nairobi.

An amazing and completely unexpected day seeing and visiting sites not available to tourists in an area on no tourist destinations. My kind of thing.

Tomorrow I make rounds at the Kenyatta National Hospital, see patients in the outpatient clinic, and in the afternoon will run a cadaver workshop on the balloon compression procedure for trigeminal neuralgia at the Aga Khan Hospital.

This is a mere fraction of my experiences on a sensational day. I wanted to post a few pictures but somehow that part of the blog is not working for me at this moment

A depressing day

It all started well enough. Peter Wanyoike, one of the neurosurgeons in Nairobi, offered to take me with him to the regional hospital in Nyeri where he does voluntary outreach once a month.

We arrive after a two hour drive and immediately settle into our "clinic". A very small room with Peter and I sitting across a desk from a local G.P. who is presenting cases to us in rapid fire fashion (one patient is still putting on their coat as the second famiily is seated -- all in a less than 80 sq foot area.

Only five or so adults with everything from headache to a ruptured cervical disk. The latter is misdiagnosed by Peter (I believe) after a brief examination. I then examine him and offer what I think is the correct diagnosis. Then at least 10 children with meningoceles, encephaloceles, malfunctioning shunts for hydrocephalus, untreated hydrocephalus and two pediatric brain tumors. Very sad in terms of incomplete treatment, dellayed diagnosis, etc. Most will be treated after MRI's, etc. in one month when Peter returns.

We then make rounds in the superheated newborn nursery on a newborn with a meningomyelocele (google it if interested). Finally off to a private hospital to see a patient Peter operated one month ago who presented with abrupt onset of paraplegia. She turned out to have Pott's disease (TB) of the spine and remains paralyzed though with a flicker of function suggesting at least some possibility that she may walk.

I then had a hospital lunch of typical kikuyu food (picture below if it works). Actually quite good and I did not get sick.

The greenish stuff is a mixture of potatoes, palm leaves, banana, beans and corn and is actually very tasty

After extensive shmoozing with doctors, nurses, etc. we then return to the regional center to do three operations starting at 4:00 pm. Actually residents did all the surgery and Peter and I supervised and helped them along.

Well after dark we checked into Treetops, a place that Queen Elizabeth I visited after death of her husband. Not much done to the physical plant since then (at least 50 years ago), but the food was suberb and thank goodness there was a working fireplace in the room as it was quite cold.

Report for Saturday, January 17

Arrival in Nairobi: it's not Ethiopia

Another inauspicious beginning. Moody (Mahmood Qureshi, an eminent neurosurgeon here) had said he would meet me at the airport and accordingly I cancelled the arrangements for a hotel cab to pick me up. Unfortunately Moody was no where to be found. Again someone was nice enough to let me use their cell phone and I reached him in the middle of hospital activities.

The ride from the airport, 4 or 5 miles, to the Fairview Hotel took 2 hours -- apparently typical for Nairobi, but quite a nuisance. Fortunately I am reading a good book (Biography of Benjamin Franklin) and aside from the fact that I had by now been up for 30 hours, I survived.
The hotel is an oasis. High on a hill, no more than two miles or so from the gleaming skyscrapers of downtown Nairobi, I feel like I am in a park in some British protectorate in colonial times. One or two story buildings spread through a park with magnificent gardens; if it were not for the architecture you might think you were in Hawaii.

After locating essential items hidden beneath medical paraphenalia, I met Moody and his colleague Peter for a drink by the pool. They outlined the week for me . . . I hope I survive. This is total immersion in a life I had left behind. I'll be making rounds, seeing patients in the clinic, assisting the residents and attendings in surgery, running a cadaver workshop on a procedure for trigeminal neuralgia, giving grand rounds at the University of Nairobi, two other lectures to neurosurgeons, general surgeons, neurologists and orthopods, and doing three trigeminal neuralgia procedures. On top of all this tomorrow at 7 am I am driving with Peter to assist him in surgery at an outreach hospital two hours from here in Nyeri. We will stay overnite and then tour some game reserves and villages in the foothills of Mt. Kenya (2nd only to Kilimanjaro in Africa).

I have made contact with Jetinder Singh's brother here and he sound like a wonderful fellow. I'm going to have dinner with him Sunday night when I return from Mt. Kenya and he wants me to come to dinner at his parent's house sometime this week.
Nairobi is positively not third world, though you step into a different country no more than 100 yds from the hotel. More on that as the week goes on.

Love to all.

In flight medicine

On the flight from Atlanta to Tel Aviv, at precisely 3 am, there is a call for a doctor. I dash to back of plane -- a man had fainted and had a pulse of 40. Probable vasovagal episode. Stayed with him for a while, returned to my seat; a non-event.
Tel Aviv to Addis (en route to Nairobi) a bit of a problem. First I have 150 lb of luggage and I eventually negotiated them down to 22 lb of overweight. Had to go to other end of airport to a small office to pay and their computer was down; fortunately had the cash. Returned to check in . . . the very last person to do so. They wanted to give me a middle seat in the last row of the plane (you know how I love that). Fortunately they yield to the fact that there was one other seat on the plane in an exit row.
Sat next to an enterprising Israeli woman who with her husband lives in Addis and has a “flower farm” 15 mi outside of Addis. They employ 400 people and export flowers 3x weekly to Europe and the U.K. They also have a farm in Israel but poblem there is: (1) no water this year; (2) impossible to find workers. For now Ethiopia is the place to be. Turns out she lives across the street from Dr. Rick in Addis. She invited me to spend a day with her when I am back in Addis.
If I can get my surgery done I would like to do this. In any event, left Tel Aviv at midnight. Precisely at 3 a.m. a lot of rustling, people yelling help and I was sure we were being hijacked. Fortunately just another fainting. I was the only doctor on board and tended to the woman. I did not sleep a wink.
Arrived in Addis 30 min early and Rick’s assistant who was supposed to meet me was no where to be found. Waited one hour and still no appearance. An Obama pin saved the day as a fellow stayed with me while we called Rick’s house for 30’, getting either a repeated busy signal or no answer. When I give him an Obama pin it was to him like a pot of gold. Finally reached Rich. He had dates mixed up and was planning to meet me tomorrow!. If that is the worse that happens to me I am all set. Gave Rick my baggage that I will pick up in 2 wks on my way to Gondar.
I am writing this as I await the plane to Nairobi. Addis and particularly Israel hold a very fond place in my heart and so far the incidents are a small price to pay for the privilege of being here.

It's Wednesday, night and I am confortably at my cousin Florence's home in Zichron Ya-acov in northern Israel. The only visible sign of a war going on is that our plane from Atlanta was not full, as might usually be the case.

The airport was bustling with the usual throngs of people from all over the world. The lights of the night, the traffic on the roads and the bouyant people all mask the anxiety of a war in progress.

Everyone has children or relatives involved. One of Florence's sons-in-law as flown numerous missions in his F-16 into Gaza. The other son-in-law was called up for two weeks as a captain in his artillary battalion. He was stationed near the border with Egypt but in a non-combat role. The mission of his group was to coordinate between the artillary, ground forces, and air force to attempt to prevent "friendly fire", the primary source of nearly half of all Israeli injuries thus far.

While Israelis seem overwhelmingly supportive of the war, the people I met are distraught that the world seems so overwhelmingly in opposition to and not understanding of their situation. There is of course extreme anxiety among the Israelis about where this will all lead.

Had dinner tonite with Yael, now 7 months pregnant with her first child, while attending school working for her master's degree and holding a full time job. Ofer is flying for the Air Force several times a week, attending the university full-time and holding a nearly full-time job. Dana is also full time in school and working at night. Seems like everyone (at least in my family) is multi-tasking; don't know how they all do it.

Tomorrow night (12:20 am flight) I fly from Tel Aviv to Addis; after a four hour stop I will be on to Nairobi where Mahmood Qureshi will be meeting me at the airport. Turns out that one of Florence's friends here in Zichron will be on my plane with an Israeli tourist group going to Ethiopia. I am hoping to meet her for lunch tomorrow.