Shabbat . . . Special Edition

As many times as I have been to Rick’s house for Shabbat, tonight was yet one more unique experience.

I brought with me one of our neurosurgery residents from The Black Lion. Tsegue is very modest and reserved, but one of our best residents. He is currently doing a rotation to the Korean Hospital. This means he works all night at the Black Lion, gives report there in the morning. goes to the Korean Hospital to make rounds and operate all day, and then returns to the Black Lion at night. There is an American orthopedic surgeon who he has become friendly with at the Korean who is a good friend of Rick’s. Tsegue has heard much about Rick and so I offered to introduce him tonight.

Fifteen Swedish Jews who just arrived in Ethiopia this morning came to Rick’s for Shabbat this evening. One and all, they had heard such wonderful things from 30 Swedes who visited at this same time last year, that they wanted the experience. The organizer, Misha, is a wonderful fellow who speaks Amharic. One of the men in the group, Andualem (ne Andy) was here last year and immediately recognized me as his namesake from last year. He is an Ethiopian Jew (Beit Israel) who emigrated to Sweden from Israel shortly after Operation Solomon. He speaks superb Amharic, Hebrew, English, Swedish. We had a long talk about his experiences.

A number of the Swedes were Holocaust survivors from Poland,. In every case their parents had escaped from Poland only to return to Poland after the war. It was then in the late sixties that most of them eventually emigrated to Sweden, when unable to reconstruct any semblance of their previous lives in Poland. One woman told me the story of her mother who escaped from the Warsaw ghetto after she thought her husband had died there. Several years later, while living in Russia and having again married, she met her first husband who was alive. She lived out her life as an authentic bigamist!

Jennifer Kraft was also here this evening (www.jenkraft.blogspot.com). She works for the JDC in Denver, but has been in Addis for the past three months adopting an Ethiopian girl, who is precious. She thinks the process will take at least another few weeks, but has had the child with her for nearly two months and is loving motherhood. We met her when Rick was giving a talk last March in Vail and both she and Rick stayed with us.

After the brief but emotionally poignant “service” and introductions of the many people present there were the Shabbat prayers, an amazing vegetarian buffet with 12 unique dishes served in a kitchen smaller than your bedroom closet, and all prepared by a cook in this tiny kitchen. The Swedes began singing Hebrew melodies and all were very moved by the experience.

My suspicions have been verified. Turns out the Ethiopian government is in the habit of blocking the blog sites in an attempt to prevent circulation of any adverse political ideology.

New Year's Eve

Saturday, December 31 . . . . Happy New Year

Weekends can sometimes be a little tedious, but not today. Rick said to be at his house at 9:30 this morning. When I arrived, Joann and Sam Silverstein were there. After a while Rick arrived from the gym.

A bit later we set out for Mother Theresa’s mission with Rick’s staff of 3 assistants in a separate cab. Road was closed near the Mission, so we parked and walked more than 1/2 mile to get there.

In a small waiting room were at least 60 people as we passed into the exam room, an 8x10 ft. cubicle. During the next 6 hours we saw 30 or 40 patients, nearly all under the age of 25 and most under 15. Remarkable pathology; a dozen with heart disease including two in serious congestive failure; at least two dozen kids with profound scoliosis. In my field, was a post-op with acromegaly (operated by a neurosurgeon from Norway who left the day I arrived), a new pituitary tumor that I will likely be operating in the next week or two, a patient with serious paraparesis that we are working up, and several other neurosurgical problems.

We were all fascinated by both the interesting cases, and Rick’s very uncommon manner, particularly with the youth. Our only break was at 2:00 for tea. Rick’s lunch is a cup of tea and a cup of coffee. Fortunately one of his aides brought us a banana. Actually he bought several dozen bananas and gave them to everyone still left in the waiting room.

In the course of the day, Rick’s instructions for several of the cardiac patients was to get a passport and return next week. He hands them 300 birr (about $18) to pay for the passport and will be paying about $9,000 for each to fly to India for their heart surgery.

I told him that I could only do the pituitary tumor at the Korean Hospital as we will need special microsurgical instruments for a trans-sphenoidal operation. This is a private for profit hospital (in contrast to the Black Lion where all care is free). He said no problem, he will pay for it (about $7,500).

Quite a remarkable day.

First day in Addis Ababa: 12/28

Arrived yesterday after an uneventful 13 1/2 hr. non-stop trip from
Washington Dulles. The iInitial part of the trip to European mainland
was a chip shot; after that it got a little tedious.

Things often don't go smoothly here and sure enough there was no one
ostensibly waiting for me at the airport. After looking unsuccessfully
thru the throngs for a sign that might have my name, a woman was nice
enough to offer her cell phone. Called Akeza Teame who was supposed
to have a driver waiting for me and got a wrong number. Called his
hospital and no answer. Taking a taxi would have been no problem, but
I did not know the location of the apartment where i was to be
staying. Finally called Rick (Hodes) and he said he could come for
me. He told me to go to parking lot to wait for him and guess who was
at bottom of walkway . . Akeza! He has a new phone number since last
year.

He drove me to the apartment he was going to let me use; no more than
5 minutes from the airport. A large 3 bedroom apartment, 3rd floor
walk up. Fortunately the guard/doorman lifted my 60 lb. instrument
laden duffel onto his shoulders and carried it up for me.

Today I was awakened by the rooster in my neighbor's yard. I paused
for a moment of reflection to thank Akeza for the pleasure of hot
water. If I were in the apartment I was supposed to be in on the
hospital grounds, I would not have had this amenity.

Once outside, it was like morning in Vail; cool, a bright sun, soon to
warm up to 70 degrees. I took a taxi to the hospital. The driver
thought for a moment after giving me a good look up and down and said
the fare would be 100 birr (an obvious farengi, Amharic for foreigner,
fee). After walking away twice we settled on 50 birr, still more than
a local would pay.

I immediately felt at home in the gray, dark, unlighted passageway
leading to the four flights of stairs up to our conference room. I
was delighted to recognize the residents from last year. After a
report of the usual overnight two depressed skull fractures, fall from
scaffolding, etc., I elected to spend the day at the Korean Hospital
(also known as MCM Hospital -- you can google it). This is a private,
very profitable hospital on a large tract of land donated to the
Korean Christian Missionaries who founded it.

I was wonderfully at home in the O.R., today quizzing both the
attending and resident in Socractic fashion regarding the planned two
cases. My training under the tutelage of Bill Collins at Yale was
today passed on to yet another generation. At first gently, and then a
little more forcefully I led them to re-think their surgical plan in
both cases, the first a meningomyelocele (i.e. spina bifida) in a
three month old, and the second a large herniated disk.

After surgery we made rounds on a virtual neurosurgical museum of
post-operative cases. Most of the patients had huge tumors, that
would never have attained that size in the U.S. as the patient's long
ago would have presented to their doctor with symptoms. All patients
seemed to be doing very well. We then went to see three patients who
had been admitted while we were in surgery. Two had huge hypertensive
hemorrhages that were inoperable; the third had a small hemorrhage in
a vital area. I don't expect any of them to survive.

We finally had lunch at 3:00, at a pizza place on the way back to the
Black Lion Hospital. My host ordered a "fasting" pizza. Fasting
occurs twice every week (Wed and Fri) for Ethiopian Christian
Orthodox, in addition to 40 days of "fasting" prior to Easter.
Fasting, however, is not what it means to us. To them it means no
meat or dairy products for the day. Our vegetarian pizza with tuna
was excellent.

Rick is getting some people together for dinner tonite and I will be
joining them. A very memorable day for me, in which I was energized
by the opportunity for some meaningful teaching moments.

Story of the day

I was supposed to be picked up by one of the residents this morning at my apartment. When he did not show, I called him. Turns out he did not have my phone number and was still at the hospital after operating all night.

I decided to take a minibus to hospital. There are hundreds if not thousands of these on the streets. One comes by nearly every minute. For the minuscule cost (15 cents for wherever they go) you get the privilege of riding with 15 others crammed into 12 seats.

I had no idea where the minibus was going so asked "anyone speak English". Fellow in front of me answered "I know where you are going". "What". Turns out he was a medical student in my class two years ago and is now an M.D. and was on his way to his hospital where he is interning.

He told me where to get off and change for a minibus to Black Lion Hospital. That's another story not worth telling.

Bye for now.

1/13:my new Chinese friends in addis

After morning rounds dr. Zenebe picked me up as I was planning to do surgery with him at the newest and largest private hospital in addis. Hospital is owned by a very entrepreneurial gynecologist. It is in a beautiful spot high in the hills in the outskirts of addis. I am told that they would not allow him to buy land in the city because he refused to pay bribes to the officials. Now there is an entirely new suburb spawned by what was previously a remote hospital. We are operating on a fellow who fell off scaffolding on a building site, broke his neck and is quadriplegic. Very efficient operating room personnel in contrast to The Black Lion.

Obligatory tea after surgery and they then serve us lunch in the o.r. Lounge, such as it is. Everyone is devouring their injera, but they were very kind to ask me if I would prefer a European meal. They bring me a huge plate of spaghetti.

After lunch I go with Tadios, the first and for a long time the only neurosurgeon in Ethiopia. He is giving a lecture at the Army Hospital on the history of neurosurgery in Ethioipia. In 2008 their three, there are now 6, and in 5 years, if all current residents finish, there will be 22.

Late in the afternoon I return to my apartment to see a very interesting patient.

I am picked up at 7:00 by Alex, a delightful Chinese fellow,age32, who with his Chinese friend, dr. Wong, owns one of the three MRI scans in addis. They also own the only MRI in Djibouti. They have a Chinese MRI machine which is 1/5 the power of the most common machine in the U.S., but I can tell you that the images are excellent. They charge $90 for a brain MRI that is a minimum of $1200 at home, and usually more. Admittedtly our scans are more complete, but they will supply equivalent scans on request.

After touring their facility we all go to their favorite Chinese restaurant in Addis for a 10 course Chinese feast that is by far the best meal I have had in addis. Not a single dish even remotely resembles anything in a Chinese restaurant at home, but each dish was different and amazing. They selected (and treated us to) the entire meal.

After dinner, it is now 10:00 , Wong wants to take us to his house to meet his lovely wife who is a radiologist. We have tea and some Chinese snacks. A marvelous and unexpected conclusion to my last night in addis.

1/11

After rounds this a.m. , one oftheradiologists who aspires to be a neuroradiologist gave a superb lecture on origin, techniques and interpretation of CT scans. After lecture chief of radiology wanted me to look at an MRI of a friend. Very large midline suprasellar tumor possibly extending into pituitary fossa and with possible minimal duralumin attachment to planum sphenoidal.

Then saw 20 or more patients in clinic. Never thought it would stop. A few routine minimal complaints but admitted four for urgent surgery (that means they will be operated in 2 weeks if we are lucky). Preparations take forever and anesthesiologists don' like to work after 1:00, so we are lucky if we can do 2 cases in a day. There is at least a six month waiting list for even huge benign tumors and other conditions that would be urgent at home.

Met Minalu, one of my guides from the South Omo 3 yrs ago, for tea along with Naomi.


Minalu called his cousin Andualem, my main guide in the Omo, so that I could say hello. I have referred a number of clients to him in the past two years.

Had my daily shoe shine with my favorite shoe shine boy.
Walked to dinner at the Ethiopia hotel, a recently discovered very nice dining room with impossibly huge portions. Walked home to end the day.

1/12:different yet again, and wonderful

I was supposed to operate at Zedetu hospital today on a child with a huge hydatid cyst (a kind of worm that can migrate thru the bloodstream to the brain), virtually unknown in the U.S. As often occurs that was cancelled and they asked me to start a case I have been dreading for two weeks. Anyway i was greeted enthusiastically in the O.R. By two American anesthesiologists. Maroj is an American born indian who is a third year resident at Beth Israel in Boston; Laura is from Virginia and the mother of 5 who been here for 2 1/2 years. Both were thrilled I was involved in the case and taught me a lot about neuroanesthesia. Some other stories from them that will await my return.

I left after 5 hours (this will be at least a 10 HR case) as I made a commitment to see some patients this afternoon at one of the private hospitals. One was an ophthalmologist and one a nurse. All were very lovely people.

At obligatory tea afterwards on Bole rd. I went to the bathroom. Came back to find a 3rd person seated at out table who I thought must be a friend of the doctor I was with. Turns out he just wanted to speak English. A former physics teacher who speaks excellent English as well as Amharic, French and German.

I'm waiting for a patient who is coming to my apartment with one of Rick's assistants and then off to dinner.

1/10: a busy and different kind of day

A sad and frustrating to the start of the day. We operated on a huge tumor last week, probably benign. I thought the surgeon did a wonderful job. Ran into the resident who was assisting on the way to rounds early this morning and learned the patient had died. I was shocked and angry, particularly when I heard the description of events and the management of them. Details are technical and frustrating.

The usual 6 or 8 trauma cases over the weekend are reported. Some make it and some do not. We have our morning tea and I then learned the Norwegians have arrived. We were expecting them tomorrow.

More than 2 hour meeting with the dean, 4 of the six neurosurgeons in the country (80,000,000 people), 3 Norwegians (more about them later) and I.



They are here to determine whether to renew a grant from the norwegian peace corps to our hospital. Most of the funds will go for scholarships for residents and nurses to spend 3 months in Bergen, Norway. Remainder for some equipment. There is an unbelievable amount of construction going on in Addis and the entire country; however health care does not seem to be a priority and the hospital actively seeks help from Norway, turkey, etc. U.S. Does not seem to be much of a participant here at all except in providing AIDS drugs and care .

After much planning and rehearsal, and thanks in no small part to my being here (which really impressed the Norwegians), our proposal seemed to be very well received and my impression is we will get the money ( sounds like more than $100,000).

After the meeting we tour the hospital with them and then go to the other hospital, Zudetu, just 5' away.

The Norwegians then invited us to a lovely old world Ethiopian hotel dining room. I was fortunate to sit next to the recently appointed chief of neurosurgery from Bergen and we had a very informative discussion. The other norwegians were an anesthesiologist and the head nurse/administrator of their 70 bed neurology/neurosurgery unit.

Norway is a country of only 5,000,000 people with purely socialized health. Taxes are high, but essentially all health care is free, except for $25 for every visit to a g.p. the neurosurgeon said he makes a good salary and both he and his patients are grateful for their system. Yes, the doctors periodically wrestle with the government over salaries, but overall he feels their system is far better than ours and he knows our system well.

There is no such thing as malpractice except for egregious acts. Normal complications are expected and accepted, If the patient has a complaint they go to an ombudsman, who seeks a review and opinion from experts in the field. If the patient was injured by other than a known complication and the doctor was at fault, some money may be awarded but it is reasonably related to the injury and very rarely as much as 6 figures. Usually the hospital pays, as the employer of the physician. Egregious demands are never made; documented pain may be compensated but not "suffering" which is the usual huge award in our system.

All in all a wonderful day with very intelligent, highly motivated and caring, blond and bright blue eyed (all three of them) Norwegians. They were very impressed that the King of Norway rented our house in Vail a few years ago.. I had forgotten, but Gabriel, the Norwegian/Ethiopian neurosurgeon reminded them.

1/9: the end of my visit is sadly approaching

It has been an amazing month with the unexpected being the norm. Walked a few miles to dinner tonite, leaving early to allow plenty of time to find the unknown place. Was supposed to meet Naomi and MINALU (one of my guides three years ago in the south Omo. Something came up at the last minute so Naomi brought one of her friends instead of minalu.

I walked past what looked like an architecturally significant building that I have been past several times. Turns out to be the Ethiopian equivalent of the Holocaust museum, with a number of the exhibits clearly influenced by that edifice. The stories depicted in the exhibits were strikingly similar to many from the holocaust. It is called the Red Terror Martyrs Memorial. Hailie Selassie was overthrown (and ultimately murdered) by a rebellious socialist regime that ruled from 1964-1971, in fact I learned at dinner last night that the father of one of my neurosurgical colleagues, Zenebe, was killed by the communists during this reign of terror. This regime also terrorized the Jews leading to operation Solomon.

This will be a very busy week. I have a number of teaching sessions with the residents and am giving a lecture to the neurologists, neurosurgeons and their residents. In addition we have two days of meetings with a contingent coming from the medical school in Bergen, Norway. They have been funding scholarships for several residents each year to spend seven months in Norway. This arrangement is up for review and the staff here is quite nervous about it for several reasons. They really want this renewed as they otherwise have no funding to send residents abroad.

So far I have dinner plans 2 or 3 of my remaining four nights here, plus seeing patients in my apartment two nights. It will be hectic these last few days.

1/6: an impressive day in surgery

Walked nearly five miles to dinner last night. Did not mean to walk quite this far, but missed the restaurant which is set back a bit from the street. Along the way suddenly there appeared out of a side street a few herders with probably 200 sheep. This is on one of the main streets of the city with many new tall buildings. Turns out buying a sheep to kill for the family Xmas feast is a big deal and these poor fellows were probably on their way to be sold. The Ethiopians "fast" for 50 days before Xmas. Fasting means they have a strictly vegan diet--no meat or any meat products including cheese, butter, milk, etc.

When I returned late to my apartment, there was a goat in the hallway


to greet me (there is no front door on the building), probably bought for Xmas feast. For the past 24 hours he has been screeching goat sounds every few minutes.

Today, amazingly, one of the surgeons reluctantly tackled an extremely difficult case. Quite an accomplishment in itself as they much prefer easy cases and I am constantly trying to push them otherwise. You may recall I posted a photo a few days ago of a woman with a huge mass growing out of her head, twice the size of a grapefruit. Dr, Rich had sent a nearly identical case just a few months ago to the university. Of Wisconsin. The surgeon today was impressive and removed the entire tumor, which hopefully may be benign. It takes nearly two weeks for processing and a pathology report so I won't know until after I return home.

I paused half way thru the procedure ( I was coaching and not operating) for lunch and to visit a friend, Lilly, in the coffee shop that she owns 5' from the hospital (walking). Her father owns many businesses and upon her return from 19 years in the US, he gave her two coffee shops/bakeries which she says are very profitable. A wonderful huge cinnamon roll and tea cost only 6 birr (36 cents), but most of the employees make less than 700 birr per month. The shop is full constantly from the time they open at 6 am.

She has invited me to their family feast and "break the fast" tomorrow. Right now I am seeing 3 patients at my apartment.


Standing next to me in the photo above is Berhanu, Rick's wonderful long time assistant. Next to him is Blaine. She is an Ethiopian who is now in her 4th year at univ of maryland med school. She speaks impecable english and amharic and was invaluable in examining these 3 patients. In the background is my apartment (on the right). I am seeing patients at my apartment 3 days in a row and again sunday.

Dinner tonite will be either Italian or Arabian.

Bye for now.

1/5: I'm getting lots of calls

My phone rings more here than at home. A call today from the private hospital where I did surgery yesterday. The emergency room has a sad case of a fellow who fell a few days ago, fractured his neck, and is paralyzed. They have already seen one of the neurosurgeons in town who recommended surgery tomorrow but properly told them it will not help him to recover movement. They are looking for a miracle and want to fly him out of the country but also wanted my opinion.

A call from the doctor who assisted me yesterday to tell me the patient is doing well.

A call from a gal at Ethiopian airlines who was helping me with reservations. We got talking and she told me about her brother who was a professional soccer player but got thrown off the team when he sustained a ruptured disc. Saw them in my apartment today and it turns out they have been seeing one of the neurosurgeons who I was operating with this morning. This has been dragging on for seven months and he is not a moment free of pain. In the US the team would of course be helping him to get the best treatment. Unfortunately here he is simply dropped from the team.

Numerous other calls from several recent acquaintances.

My cook made me lunch today which was quite good. I told her I wanted some vegetables including beets. She did not know what that was and instead bought two pounds of green beans! Anyway green beans, carrots, cabbage, onions was quite good.

Tonite I think I will go to an Indian restaurant and then to hear some African (not Ethiopian) music at a nearby bar.

Ethiopian Christmas is this Friday and very different from elsewhere in the Christian world. NO presents, perhaps an exchange of cards. Mainly a special dinner with family. One of my friends told me they will kill a sheep and have a feast. Most of the shops and restaurants will be open. The holiday is on friday. There is no such thing as Christmas eve and the weekend will be business as usual. In fact I will be spending part of the day, Saturday, at dr. Zenebe's private clinic. Lynn and I were to dinner at his house.

Tomorrow, Rick's assistant, Berhanu is bring three patients to my apartment for me to see. He has been quite helpful tacking me the minibus routes for getting around town. I've actually met some quite interesting people navigating this way.

That's all for now.

1/3:the new year and a new problem

Turns out (from info on the Internet) that there is a bug in the iphone 4 software that prevents proper use of the alarm clock which has been my necessary companion. Sure enough my alarm did not go off this a.m., but fortunately I awakened spontaneously.

Next week there is a review team coming from Bergen, Norway to assess the program and determine if they want to continue funding some scholarships for four residents each year to go to Bergen as well as some visiting neurosurgeons and other expenses. There is a lot of anxiety around this visit because of the money involved and they have spent one or two hours each day beating the subject to death. I have proposed an approach that I think is their best shot, but nearly every discussion of anything reverts to repetitive dialog on this subject.

Today I visited the other nearby government hospital, Zeditu, where I will be doing some surgery. I hope they are going to pay attention to what I said as some proposed surgery is not indicated based upon their incomplete examinations. I have proposed a remedial review of neurological examination for the residents and hope the consultants will attend as well; in lieu of this I am now doing a relevant examination at the bedside on each patient in hopes that they may see how to properly assess the patients. Met two of the neurologists who want me to give a lecture next week on trigeminal neuralgia.


Last night I had the pleasure of spending the evening with Tom Kornberg and his family. In the picture are Tom and sons Ross and Zack


Tom's father and brother have both won the Nobel prize. Tom is a professor at UCSF and his himself doing brilliant work. Thru a contact of theirs we had dinner at the home of a very successful Ethiopian young businessman.


His cook prepared an immense buffet of lasagna, steak, fish, chicken, two other pastas, at least five vegetable dishes. Did not get home till well after midnight.

This afternoon I am going to work on the problem of accommodations for the next surgeon who is to follow me here in 3 weeks. This is his 6th visit, yet somehow they have felt free to give his apartment to someone else. While the people are incredibly nice, they often do strange, unpredictable, and inexplicable things like this.

With all of the chaos here in every aspect of, they have two very civilized rules that yield an immediate ticket if broken: taxi drivers must wear a seat belt (but there are none for passengers) and there is a policeman on many corners to give a ticket to anyone driving and talking on a cell phone.

They have changed the movie at the only English speaking theater so I will probably go to it tonite.

That's all for today

1/2/11: daily life in Addis

It's the weekend which is the most tedious time. I am not working and there is virtually no cultural scene. I have seen the only decent English speaking movie in town. I have not seen or heard a single musical instrument as you would know it. There is plenty of "cultural" music but it becomes annoying after a while. Bars with dancing are popular among the young, and any white person getting involved is welcome and applauded. Otherwise white males are easily tolerated and generally are seeking a stunning Ethiopian hooker as they are ubiquitous in and around the bars.

Last night I went to dinner with Naomi (lynn's guide) and her mother.



Both are handsome, intelligent and lovely women. If you painted them white and planted them in Shawnee mission they would be your friends. We ate at a "Swiss" restaurant. Had Garozzo size portions of veal Parmesan, chicken Marsala, and veal with mushrooms, numerous side dishes, drinks and dessert for 3 people for $21 including 25% tax and tip.

It is very interesting that I have rarely been aware of anyone staring at me as a lone white. Walked more than 8 miles yesterday and never saw another white person, nor felt I was being observed.

Today (Sunday) I was awakened by chanting over a loud speaker probably from a church blocks away. It started at 3:30 am and was non stop till 7:30. I now recall that this was an annoying issue each Sunday in Gondar during my past visits. They take their religion very seriously here. There is not a day that I don't here Jesus Christ invoked in one context or another.

I guess I could have stayed at the Sheraton for $480 per night or the Hilton for $200+ per night. However it is very convenient being on the hospital campus where I practically roll out of bed to rounds in the morning, or where students and residents often stop me with questions or just to talk. However, there is a price for this.

The building I am in seems to have residents with families living in one room "apartments". The building is filthy beyond belief, worse than any abandoned home or crack house. However my four room apartment is clean and has every essential, except . . .

If you flush the toilet it takes 45 min to refill with every drop of water echoing throughout the apartment off the porcelain tank and plaster walls. The shower is a 2 1/2 by 2 1/2 ft shower stall base with no enclosure; by the time I am finished showering the entire bathroom is soaked with the splashing. The choices of water are ice cold and boiling on, and the steel hot water spigot gets so hot you can only handle it with a towel. I am not complaining,but rather grateful for the privilege of being here; just want to be able to remember what life is really like.

The weather in Addis is ideal. 70 and sunny every dat. However when the sun goes down it rapidly cools to 50. Somehow my apartment is always cool, and becomes cold at night. I sometimes shiver getting ready four bed, but once I get under the covers (4 blankets!) all well and somehow it is warmer by morning.

I'm off to get a pedicure, replenish a few groceries, and wander the streets for the day.

An amazing day!

You never know what is going to happen in Addis. Day started out quite normally with morning report. Then degenerated into a discussion that became quite acrimonious over some latent medical political issues. I eventually loudly proclaimed "time out";suddenly there was silence and I proceeded to outline my proposed solution to which they quickly agreed.

On to rounds to see a museum of neurosurgical cases. I hesitate to post this photo but it may be quite historic:



I leave rounds early as I am being picked up by the administrator of ST. Yarod's Hospital. This was founded two years ago by Akeza Teame, an Ethiopian who went to K.U. Med school and did internal medicine and an infectious disease fellowship at Albert Einstein.


He is quite an amazing guy and his vision and his hospital are quite unique. Too long to go into all the fascinating details, but I am going to try to help him set up a sustainable program for elective neurosurgery in Addis. He is of the opinion that of the current 6 or so neurosurgeons in the country there is not one who meets his standards; he is probably correct. We are going to try and change that.

Had a snack on Bole rd and then lunch at the Jupiter Hotel where I caught up on Internet and email for the first time in two days. You would never know it is new year's eve in Ethiopia unless you are at one of the western hotels. Their new years is sept. 1.

Went to Dr. Rick's for Shabbat and it was historic. 60 people in his very small living room, the most he has ever had. His cook, working in a kitchen the size of a small closet made buffet dinner for all. There was a load of 27 fascinating Jews from Sweden who arrived yesterday for a 10 day tour of Jewish Ethiopia. About one third of them were doctors and I had some fascinating talks with them. They were extremely moved by the experience as was I. This is at least my fifth Shabbat at Rick's house, and each is different and very inspirational. Hard to put such a unique experience into words.

Met and had a long talk with Tom Kornberg, a fruit fly researcher at UCSF and son of a Nobel Prize winner. His son Ross is being paid by Johns Hopkins to do research here in Addis for one year; he will then be going to med school. Part of his work is at The Black Lion Hospital where I am working; I plan to meet him for lunch next week to learn more.

Also saw once again two couples from Denver who Lynn met when she was here. They have just returned from 10 days in the south omo. Their experience was not quite like mine; they were quite fascinated with the trek that we did.

Now I look forward to a weekend of leisure and dinner Sunday with Akeza and his wife.

One more funny story from the Mercato, the largest market in Africa and pickpocket capital of Addis. A true story. A friend of mine was there today. Suddenly he saw a woman lifted in the air by her waist and then shaken up and down. The woman's shoes fell off, the fellow grabbed her shoes and ran off. As the Ethiopians would say, "very clever".

Somehow I never know what I will be doing tomorrow, but it always ends up fascinating. I will miss Rick as he leaves for a two week trip to the states. Denver is having a huge fund raiser for him and thus far has raised nearly $400,000. He has a one hour presentation to the Gates Foundation, and is also trying to raise money from Schultz, CEO of Starbucks and one other prominent foundation.

Trek, day 2: Rachel and Safta were incredible

This is advertised as our longest day, 20 Km (12.5 miles). We arise to a table set on the edge of the escarpment looking down upon the vast Ethiopian equivalent of the Grand Canyon. Breakfast of pancakes, scrambled eggs and tea.



We set off for the trek slightly ahead of schedule with a plan to stop every hour. This worked well till the last hour when many aches and pains slowed us down.

We passed thru vast grazing lands where sheep, goats, cattle, oxen and horses are all tended by children in bare feet, aged perhaps three to ten. Huge wheat fields were ready for harvest. Men working with 12" diameter sickles were cutting the wheat, arranging them in large piles. They gathered the piles on their heads and walked long distances where they were set on the ground in a large circle. Two or three horses were then led round and round for hours to thresh the wheat. When the winds come in a few weeks it will blow away the chaff. The wheat will be crushed by hand into flour that will then be used to make the wonderful bread that we ate that was baked without a stove. There is no electricity, running water, plumbing, ect. However they have found a way to provide all the necessities of life.

Lunch is another idyllic spot where there are three tikuls. One is large and open on the sides -- the lunch room. One is the kitchen with a charcoal fire, and the third is the toilet, open on one side to the amazing view.



We meet people from Belgium, Germany, holland and the u.s. Hiking in opposite direction to us. We sign the guest book in which only one or two guests out of every one hundred are from u.s. I cannot help thinking that if people would do this instead of cruises we might make a dent in our obesity problem. Two other obervations; in 30 or 40 pages that I searched I found two 7 year olds and a scattering of 13 and over. To date Rachel is the first 10 year old to do this trip. Lynn and I are the most senior that I can find in dozens of pages. Oh yes, one more item; Brad Pitt has done this trip.



After lunch of, spinach, beets, potatoes and crushed spicy chick peas, we are off for two more hours to our destination on the edge of yet another section of this seemingly endless escarpment. Two other guests are with us here; a couple from France on their honeymoon.



Afternoon snack is Ethiopian pizza ala the bush. Our first "shower" in an enclosure built around a tree in the great outdoors. Dinner around a warm fire is again wonderful, nutritious and vegetarian.

We are off to sleep under a starry sky, the cooling air of nighttime in the mountains, and silence like you have probably never experienced.