12/30: a rainy day in Addis

It is not supposed to rain in Addis this time of the year, but we had a thunderstorm last night. Today was dreary, cool, and intermittent sprinkles.

After morning rounds with yet another (now daily) epidural hematoma, and two fascinating (and sad) intracranial infections in young children, I decide to opt out of the first surgical case of hydrocephalus.



Walk up hill one mile to the piazza and wandered around. Tried to use Internet at a cafe but it was impossibly slow. Had a call from Tadios that he was waiting for me for lunch. Turns out the surgery department secretary, who bakes pastry for tea each morning and also serves us tea, had made a spaghetti with spicy meat sauce for us for lunch.

After lunch I go to o.r. Where I will see the Ethiopian version of an anterior cervical fusion. The consultant who is doing the surgery and teaching the resident, asks I'd I would like to scrub and show them how I do it. One big problem . . . There is no additional surgical gown for me. I end up coaching them thru it, albeit with some improvised instrumentation in view of some critical instruments that are missing.

We have a banquet for the finishing surgery residents (and one neurosurgeon) at the Intercontinental Hotel.



Wonderful dinner and very interesting to watch the various eating styles. Something less than half use utensils, even for their European type food. There was a huge buffet (over 100 people) with a mixture of Ethiopian and western food. First desserts I have seen in Ethiopia served after a meal; a large buffet with at least 15 choices. There are lots of bakeries in town, generally with bland tastes, but most ethiopians do not generally seem to eat dessert. Even at this banquet with copious offerings, most seemed either to eat none, take a tiny sample, or a few pieces of fresh fruit.

I did some adventurous shopping today as my cook has offered to make some rice with vegetables for me for the weekend. Adventurous only because I bought directly from the farm (women seated on the pavement with an old sheet on which are offered carrots, cabbage, onions, beets but only one choice per vendor). Pray for me that I don't get sick, but all should be well cooked.

I made contact with Akesa Teame. He is an Ethiopian who went to med school at K.U. And did a residency in infectious disease at Albert Einstein. He and an enterprising friend bought a defunct hospital here and have ambitious plans. He is sending a driver for me tomorrow and I am going to spend a few hours with him.

12/29: a varied day

They want me to go to surgery, but cases are very routine and I am not interested. One of consultants is to meet with medical students to discuss head trauma. I invite myself to join him and suggest a "dog and pony show". He does not seem to understand the idiom, but I go with him. He starts out, but very didactically and I cannot resist kindly offering to add some comments. Of douse I end up engaging the class and they would not let me go for two hours. I was exceedingly impressed with their fund of knowledge and willingness to engage in Socratic dialogue. There were three obviously Muslim women, 10-12 other women and perhaps 15 men. They were totally attentive and taking profuse notes.



After class I go to my apartment to see if Wubi, my housekeeper found all of my laundry from the past week. It was already washed and hung to dry, bed made, and she was making my lunch. She asks that I pay her 100 birr ($6) each friday. She leaves me a note in perfect English accounting for the money she spent at the market and asks me to leave a note each day whether I want Ethiopian or European food.

I return to surgery. There is an emergency and they want me to scrub with the first year resident. However I wait around for nearly three hours and they still have not begun, so I enlist one of the senior residents to help.

After a brief nap I decide to take minibus to one of the hotels where they have wifi. Spend some time catching up and then another minibus to one of the six Tuesdays in addis (2 complexes of 3 each). For $2.15 (plus .40 for popcorn) I see The Tourist.

Return to a wonderful Swiss restaurant near my apartment for dinner and a relaxing evening with a book.

12/28: A hard days' work

Checked out of the quite luxurious Sheraton and was driven to my apartment on the hospital grounds. Steve Friedberg describes it as a crack house but I'm afraid that is a bit generous. It is definitely adequate but I'm sure glad I did not bring Janet and Rachel here. It does come with a lovely cook/laundress/housekeeper who as a bonus even speaks a few words of English.

After morning rounds I go to see patients; probably more than 20 in about 2 hrs. Tadios and I go to lunch and I walk back about a mile just to be outdoors. There is moderate pollution in Addis, but it is a lot better than the odors of the hospital.

We have a meeting at 2:00; they are trying to figure out how to interact with a Norwegian group that is coming to review the residency program to determine if it will continue to fund scholarships for four of the residents ranch year to go to Norway for seven months.

I am abruptly called from the meeting after two hours; they want me to be the consultant (I.e. assist) on an emergency, an epidural hematoma. It takes three hours to wait for anesthesia and get the case started. The first year resident who is doing the case and has done at least 30 of these so far this year ( in k.c. We saw one or two in a year in our busy practice), clearly needs help and guidance and I end up doing most of the case. It is an ordeal with woefully inadequate equipment, but that is the easy part. The O.R. Light is marginal at best and as the sun begins to go down I realize that the only light in the room is the surgical lamp with only three bulbs. When we finally finish the case I need to feel my way along the wall to find my way out of the o.r.

Walk to the market to buy food for breakfast. My housekeeper says she will make me lunch each day and leave additional food for dinner. Tonite, however I walk to a very nice Chinese restaurant.


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12/27: Great work day and a sad goodbye

Work started at 7am with report of 9 cases from the weekend . . All trauma. Two sounded strange so after rounds went to OPD (no hospital beds available .. This is a small room with about 30 beds 2 ft apart) with resident and sure enough my diagnosis and proposed treatment was quite different from theirs.

Next to O.R. They have 6 patients scheduled and waiting for surgery in the holding area. We all know they cannot do more than 2-3 at most and sure enough they propose that we choose two of the easy cases. I veto that idea and choose a huge low grade tumor and they are willing. I propose a position, incision, and approach that they have never done and are anxious to try. I help for a while and then leave it to them preferring to teach five med students who are watching. Teach them to read MRI's and CT and then proceed to some neuroanatomy and pathology. One in particular is a quick study. Tells me she is half ethioian, raised in England and now lives in Germany. I am fascinated and intrigued by the amazing diversity of the people I am meeting.

I leave o.r. After first case as this is last day in addis for Lynn and Rachel. Meet them getting their hair done at the Boston spa and Rachel wants her hair braided in ethiopiano style -- very cute.

Walk to lunch at combination art gallery/Italian restaurant with rachel's companion, Naomi and with one of Rick's kids who has been helping us. Great lunch and we bought a painting.

Few last minute errands and back to Sheraton for L/R to shower and pack for the long trip home. I go to airport to sadly see them off. Tomorrow I move into my apartment near the hospital and begin much more intensive work.

That's all for now.

Sat & Sun, 12/25,12/26

We trek a few km to meet our van waiting for us for the two hour ride back to Lalibela airport. Plane is quite late but we meet an American couple from Charlottesville who have a seven year old Ethiopian child who they adopted at age 2 1/2. They are on the way to reintroduce him to his birth mother and aunt who raised him. Lovely child who immediately engaged in play with Rachel, but with an all too common story. THe child was developing very slowly and after a year or more they realized that he was deaf. There is at least an interim happy solution. He has had a cochlear implant for one ear that has provided him with essentially normally functional hearing; he has had a developmental spurt and is nearly caught up with peers.

We arrive in Addis, get our bags at our original B&B, and proceed to the Sheraton for our first hot water shower in days, a real mattress, a warm room.

Sunday is another novel day. I asked Rick to rent a bus for us as we are going to take all of his kids to Sodero for the day. 2 1/2 hour each way, but a favorite treat for the kids. We have about 30 packed into the bus -- his 17 + some available siblings.

The kids swim for two hours. Rachel teaches one of the gIrls to swim. We watch dozens of monkeys au natural. On the way back we stop for lunch in Nazaret, where they can order whatever they want. They ask if they can order soda (coke, orange soda, 7up,etc) for an extra 6 birr. Total bill for more than 30 of us for a big lunch and a case of sodas is $30. Would be more than double that in Addis and at lest five times that in U.S.



Lynn says a prayer as we proceed back to Addis in our aged rattling bus after dark and prepare for their last night in Abyssinia, in the luxury of the Sheraton.

Trek, day 3: 60 km and counting

Today we are walking with a French couple from Grenoble. They joined us last night and are on their honeymoon.

The day begins with a challenging 200 or 300 ft climb on the ubiquitous rocks. We finally level out, but continue with intermittent rocks thru the day. Rachel has dozens of "silly bands" that she gives to many of the groups of children that we pass along the way.



Age from 1 1/2 to about 12, the ones who are of age attend school half a day and tend the animals the remainder of the day. They carry their English workbooks back and forth to school. Most fascinating yesterday was a boy of perhaps six or seven sitting by himself in the dirt in a field studying his English lesson.

Lunch is at another delightful spot, similar to other days, but always a bit different. Guides from our next destination meet us to transfer our gear to their donkeys and send the previous ones back to our village of last night.



We trek for 2-3 more hours after lunch thru groves of eucalyptus trees, rocky ridges of cacti, view our first baboons, and after a total of more than 14 km arrive at our destination. Another set of tikuls perched on the edge of the escarpment. I have two blisters for the first time; the wonder is that Lynn and Rachel have made it with hardly a peep. We watch them split some wood for the fire tonite, clean up and relax. Rachel discovers lovely scarves that have been hand knitted in the village. There are only a handful but one is just the colors she had been searching for in Addis. One of the local elders plays his melodious flute and teaches Rachel how to make one from a stick of bamboo.



In the smoke filled dining tikul, but warmed by the fire we tell stories before dinner. Mine is the tale of meeting Rachel's Great great grandfather, my grandfather, for the first time. I was 13 and we had sailed to France on the Queen Mary, as my grandparents had escaped the communists in Romania earlier that year.

We had another wonderful vegetarian meal, followed by brief time around the fire and then early to bed.

Tomorrow we will be arising early for breakfast and then a brief 2 km walk to the road for our two hour ride to the Lalibela airport and our flight back to Addis.


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Trek, day 1

We are up at 5:30 to pack, get to airport for our flight to Lalibela. Airport is in a remote spot 25 Km from town. Driver takes us into town which is a holy spot by virtue of it's famous below ground churches. The town redefines primitive.


We drive 2 hrs, and arrive at 1:00 to welcoming children and a delicious lunch of spicy chick peas, spinach and roasted potatoes -all delicious.







We begin our 12 km trek at 2:00. Interesting and varied terrain. An ideal outdoor temp as we rapidly warm up hiking. After 3 hrs we arrive at an amazing setting on the edge of a 1000 ft cliff. Our tikul is lovely. A separate outdoor bathroom with a 50 mile view of rugged mountains. A separate dining tikul with a lovely fire and delightful meal of vegetable soup, chicken stew, spinach and homemade bread. All is grown in our village and the cooks are amazing

Tuesday, a much better day at work

Went to hospital very early for morning report. Fortunately one night's "action" is not as involved as the weekend. As we are having obligatory tea break, the general surgeons file in and one of the fellows looks remarkably familiar. Turns out he is a pediatric surgeon who I Had met and done several operations with in Gondar during my last visit. Just one month ago he moved to Addis to be chief of pediatric surgery here. In great detail he reminded me of the surgeries we had done together.

Next on to rounds with the chief resident and one of the consultants. Memories of many years ago. I am in awe of the the resident keeping track of the names and varied locations of 40 patients. Women's adult ward, then mens, then icu, then pediatrics, then newborn nursery and on and on. Could be easily depressed with 6 new meningomyeloceles


with hydrocephalus,
3 men nearly paralyzed from advanced problems involving the cervical spine (including one age 26), a gymnast who missed a maneuver, landed on his head, fracured his neck and is now paralyzed. 4 huge benign brain tumors being constantly postponed because of priority of others. The smallest of these is larger than the largest tumor I have ever seen. Took more than 2 hours to see everyone.

Next we move on to OPD (outpatient department) where there were at least 40 patients waiting in a small room to be seen by four of us. I was assigned my own room with desk and translator/nurse. She was great. Very efficiently handed me a chart to review, ushered in the patient, translated, then filled in all required demographic if I needed to write a prescription. Incredibly competent help. So goes another day at work.

I walk a mile or two to Ethiopian airlines to pay for tickets to Lalibela tomorrow, then to lunch, walk some more and then catch a minibus to Jupiter hotel, one of the few places in town with wifi. Minibus is 14 people crammed into what we call a minivan. Windows closed, one man with a basket of at least 100 eggs, and plenty of local "perfume" (use your imagination).

A final visit to Rick's for Rachel to teach the kids how to make dolls out of pipe cleaners. We walk home in the dark, pack, and tomorrow we get up at 5:30 to get the plane to Lalibela for our 4 day/3night trek. Lynn is not so excited (but Rachel is) and I have not yet been brave enough to tell her we will be flying a turboprop.

This won't be posted till we get back, when I'll have a full report of our adventure.

That's all for now.

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Monday, Dec 20, work day #1

Dr. Tadios picked me up at 7am for 7:30 meeting; nine trauma cases over the weekend, four of whom died within 6 hrs. Break for tea and then to the O.R. With 8 am case finally starting at 10:15. Helped with 1 1/2 cases; left early to meet Lynn and Rachel. However not before some pretty depressing sights and events that left me wondering whether I really want to be at the Black Lion Hospital for a month. It's probably like Boston City hospital or Bellevue in the 1930's, only worse. No lights anywhere, poorly maintained, often 24 patients to a room, three feet apart . . . And that is the good part.

Meanwhile Rachel and Lynn were having a wonderful time with Naomi, their 19 year old guide, who loves Rachel. I met them for lunch at the Ghion hotel that has huge magnificent gardens with birds every color of the rainbow. We ate outside watching the birds, the palm trees and large trees with red, purple, orange,fushia and other colored flowers

To back up a little . . . Sunday afternoon we met at Rick Hodes' house with two Denver and one Montreal family freshly arrived in Ethiopia.






All of them along with us and Rick's 17 kids introduced ourselves and then an orientation for the newcomers to the work of the JDC in Ethiopia. We treated all of them to pizza and cake and then Rachel taught the kids how to make friendship bracelets while they braided Rachel's hair in Ethiopian style (think fashionable dreadlocks).

For dinner, our Danish friends at the B&B recommended a traditional Abyssinian restaurant with Ethiopian food, music and dancers. Very colorful entertainment and food.


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Saturday, 12/18:pathos and adventure

Went with Rick to Morher Theresa'sMission..impossible describe. Hundreds of children ranging from mentally retarded to crippled to seemingly normal. Some sad, some playful, some in their 14 yr old mothers' arms. An amazingly competent nun brought me one patient after another with lumps on the head , paralysis, muscular dystrophies thought previously to be spinal tunics, etc. Most fascinating to me was poor teenage parents insisting on MRI scan and surgery when clearly not necessary or indicated. Not terribly different from situations I encounter frequently at home. Finally when translated from English to Amharic to their native village language that I was a famous US neurosurgeon ( the nun speaking) they accept that their child was ok.

Meanwhile Rachel got into a wonderful rhythm playing with the children and Lynn learned from the nun who (of the many deposited at their gate each day)is accepted and how the rejections are dealt with; how to deal with beggar children and their desparate mothers.

Went to dinner with Rick. Manlio (from JDC in Rome) and betsy from JDC office in Jerusalem..

1st day: some things never change and moe

Plane was 1 1/2 hrs late into Addis because of head winds after refueling in Rome. By the time we got our visas, got some money, went passport control, stood in line for our bags to be screened and found our driver, it was 11:00. Needless to say we were all tired and a little fussy after 25 hrs of travel.

I was picked up at 7:30 am by dr. Tadios.. We went to the Korean hospital for an unusual international morning. A visiting American neurosurgeon, making his 5th trip this year (he is retired at the age of 47), was doing a hands on workshop for the residents and their attendings. An amazing international crowd . . . Neurosurgeons visiting from Sweden, a fellow from hong kong who is a native Pakistani, the leader, an American of Korean descent, his 79 year old Korean father who is an e.r. Doc, etc. Etc. Lynn and Rachel must be having a good time. They left with their guide, Nuhamin (ne Naomi) at 10 this morning and were due back at 3. It's 5and they are not back yet, hopefully a good sign.

Tonite we will have a very special Shabbat at Rick Hodes' house. Tomorrow night we are invited to dinner with the head of JDC for Africa, in from Rome. Sunday night we have been invited to one of the neurosurgeon's homes for dinner; and so it goes.

So, what never changes?

Went to the bank to change some money. First you go to one counter where they check passport, execute extensive paperwork by hand, calculate Amy. Due, get approval of supervisor. Paperwork is paasedto a teller where island in line. Teller then repeats all of the handwritten paperwork, recalculates, gets the approval of another supervisor, runs my bills thru a counterfeit detection machine, counts and recounts by hand; voila, I now have some money.

Blast off -1

Last minute preparations in progress. Phoned Dr. Shibikom in Addis; very easy on google phone, but India or China is much cheaper. Something to do with the Ethiopian Telecom monopoly. Made tentative arrangements to go to Gondar for a weekend to see old friends. Emailed an Israeli woman I met on a plane 2 years ago. She owns a flower farm outside Addis and it might be a nice afternoon trip.

Rachel arrives from SLC soon and we have annual Research dinner this evening where I will be receiving this year's Distinguished Physician award.

Blast off -1

Last minute preparations in progress. Phoned Dr. Shibikom in Addis; very easy on google phone, but India or China is much cheaper. Something to do with the Ethiopian Telecom monopoly. Made tentative arrangements to go to Gondar for a weekend to see old friends. Emailed an Israeli woman I met on a plane 2 years ago. She owns a flower farm outside Addis and it might be a nice afternoon trip.

Rachel arrives from SLC soon and we have annual Research dinner this evening where I will be receiving the Distinguished Physician award.

Location:Kansas City