Thursday, December 27, 2012

Another year and yet more new experiences

Trip on Ethiopian Airlines was uneventful, but a lesson learned.  It is not a good idea to take a 13 hour flight that leaves the U.S. in the morning.  Very little sleep during what are your normal daylight hours, and you arrive early morning local time (in Ethiopia) with no sleep and a full day ahead.

Having arrived, we were in store for newly invented delays, in spite of first class treatment by Ethiopian as business class passengers.  They let us off the plane first, so at our first stop (obtain entry visa) there were only 9 people in front of us (and 200+ behind).  It took the local Ethiopian authorities 1 hour to get to us and hand us our visas.  Pity the poor 200 people behind us.

Next to the line for the bank.  Again exactly 9 people in front of me, but took me only 45 minutes to get through this process.  Many sheets of useless duplicative handwritten forms for each customer,

Ethiopian Airlines had specially marked our business class luggage and had it in a cart waiting for us, a new and delightful experience.

Now there is only one more obstacle to leaving the airport 2 hours after entering the terminal.  Our bags need to pass thru an x-ray machine.  I was slightly anxious as my new friend from Toronto, Dr. Mark Bernstein had a large box of surgical equipment confiscated upon his arrival 3 weeks ago.  We passed thru the x-ray machine with flying colors, loaded our luggage back onto a trolley and began to leave when we were approached by a customs agent who asked what was in the large duffel.  Surgical equipment of course, so that I could do surgery on his fellow countrymen.  I explained this was my fifth visit to teach and train more neurosurgeons for his country. He proceeded to inspect each item and summarily throw aside numerous items ("they are outdated") and request an explanation of others.  Finally with a dour look he uncovered my 45# trove of lumbar spinal instrumentation, worth somewhere between $50K and $100K.  I explained to him that I would be using it to operate on the Ethiopian people unfortunate enough to sustain traumatic injuries to the spine.  I used a spine model to attempt to illustrate to him and his supervisor how this could be accomplished.

After much dialog they had a few different proposals: 1) confiscate the equipment; 2) pay duty; 3) leave a large financial deposit at the airport and upon leaving the country with the equipment the deposit would be returned (would you trust them?); 4) produce a letter from the hospital inviting me to come and do the surgery (or course I did not have that); 5) you can't practice surgery in our country without  license.

After interminable and unfruitful discussions during which daughter Janet was also attempting to help, I  finally convinced them to call one of the local neurosurgeons with whom I was working to verify that I was legit.  After 10 minutes on the phone with Mersha, he indicated that I was verified but there was still the issue of the equipment.  I thanked him profusely for trying to help and asked if I might offer him
some tender for his efforts.  I tried to hand him some money but he backed off while leading me back to the baggage area.  He told his supervisor that it might be all right for me to proceed with the equipment, but he needed to talk with me further.

He led me back to his unadorned (i.e. primitive) office, and proceeded to lecture me about precautions and preparations that I should take when I return next year.  He then extended his hand and said I could reward him if I wished.  You will need to use your imagination as to what transpired next.

Finally after nearly three hours we exited the terminal to a lovely bright new day with all our bags intact to me met my a driver from our guest house.

Clever Rachel (12 year old granddaughter who was also with me) has come up with a wonderful idea for our left over food.  We hugely over-ordered for our first evening feast, and had much left over.  She asked for take-out containers and they obliged.  As we walked home at night in the darkness, accosted every few feet by beggars, she rewarded a select few with a food package, that brought instant smiles and gratitude.

Finally, at my first day on the job, yet another of the intriguing encounters that continues to draw me back to this interesting and remote country.  Some of you may recall from my posts in past years, the many unpredictable calls and encounters that I have had from strangers asking for help with an infirm relative.

One of the residents picked me up on a street corner this morning to drive me to the hospital.  I typically take a present of equipment each day with me to the hospital.  On this first day I had in hand a large model of the spine.  As I emerged from the car with spine in hand, a caucasian fellow, who looked like he might be a visiting physician, emerged from his adjacent chauffeur driven car.  He came over to me, handed me his card  and we introduced ourselves.  He was not a doctor, said he had a spine problem, and asked if I could help him.

Many more stories from just day one, but they will need to wait until later.

Regards to all.


Saturday, January 21, 2012

Sadly, my last post for this year



This was quite a day. My friend Sisay got me a VIP pass to the main Timket ceremony. Google or even see on YouTube if you are interested. This is by far the largest (religious) ceremony of the year for Ethiopian Christians. There is no comparable event that I have ever heard of anywhere else in the world. The Ethiopians believe that they are in possession of the original tablets of the Ten Commandments and that they are stored in the bowels of a church in historic Axum. A designated monk spends his entire life guarding the door, and the lock on it, that leads to the room where the Ten Commandments are stored. This holiday, the Epiphany, celebrates the baptism of Christ. In an extraordinarily colorful ceremony, replicas of the tablet are taken from each church to a body of water; the priests stay with them and pray all night; in the morning there is further ceremony and then water is splashed on the worshippers to symbolize the baptist. This is an abbreviated version of what takes place over many hours and 2 days. There are then parades and celebrations thought each city.

On my way back to the car, I encountered a man lying on the ground having a grand mal seizure, with a dozen folks hovering over him. They were sprinkling water on his forehead. I turned him on his side and held him there. One of the natives started to light a match. I stopped him. Turns out they believe the sulfur and smoke will drive away the evil spirits. When I turned my back for a moment, he tried once again; at this point the rest of the people had confidence in me and told him not to continue.

I was awaiting a ride when a huge and colorful parade came down Bole Rd (the 5th avenue of Addis). I tried to call my ride to warn him, but the phone circuits were overloaded due to the holiday and I could not reach him. An hour later he could finally get through. We were on our way to an outlying hospital where I was supposed to do a procedure on two patients with trigeminal neuralgia. To make a very long story very short: 1) it took us one hour to get there as we detoured down dirt alleys to avoid several more parades; 2) the procedure requires a spinal fluid compatible dye and they handed me a dye that would be toxic to the brain; 3) one of the patients did not actually have trigeminal neuralgia (he had cluster headache). That is the short story.

Went to dinner this evening with two of the volunteers that hang out a lot with me, and a professor from Middlebury College.

Tomorrow I will play golf at Addis Ababa Golf Club. This will be followed by lunch in the clubhouse. My host called tonite to tell me he wants to take me out of Addis for the afternoon to see some of the villages and other sites. Regrettably, I have agreed to meet with the Chief of Neurosurgery tomorrow afternoon (he is one year out of his residency; I was present at his diploma ceremony last year). He wants to buy my MacBook Air that I bought literally the day before I came here. He has no idea what is involved in switching from a PC to a Mac. I plan to spend two hours with him and then I have two patients (and a few of the volunteers planning to go to medical school) coming to my apartment.

Hopefully, for my last dinner tomorrow night I will be going out with a 11 of my good friends here ( volunteers, adopting parents, and colleagues) to a Chinese restaurant. I was there last year and it is about the most memorable Chinese food I have had anywhere. I cannot tell you what I was eating, but it was wonderful.

That's all for this year.

Tuesday, January 17, 2012

Touching lives

Monday, January 16: Touching lives


I have been tempting fate for four years here, and finally succeeded. I succumbed to some wonderful looking ice cream yesterday in Harrar, tasted wonderful, and within hours it was having a disruptive relationship with my digestive system. Fortunately mild and gone within 24 hours.


Another exhilarating day in surgery. Residents wanted me to scrub with them on a seemingly routine case billed by the consulting neurosurgeon as a cyst in the spinal cord that needed to be drained; no big deal. I asked to see the x-rays, and it was actually an extensive tumor within the spinal cord itself. Another 6 hour case, but fortunately I was able to leave once the residents were ready to close. The 4th year resident who I was assisting did an outstanding job without the $200,000 set of instruments he would have had at his disposal anywhere in the US.


Just I was leaving, had a call from Jen and Jennifer who wanted me to meet them at the only Thai restaurant in Addis. No one except me, including Rick and his kids, seems to know where it is. We had a wonderful time and also treated Fitsim (one of Rick’s older live-ins) to his first taste of Thai food, which he loved.


Quickly had my internet fix at the Harmony Hotel, and then walked to Rick’s to see a patient in his yard. A 36 year old woman whose only ostensible symptom has been incontinence for one year. However, even without speaking a word of English it was clear she was mentally dull. She has a benign tumor larger than a baseball, which I probably won’t be able to get to before I leave. In any event I had three aspiring doctors with me (taking a year between college and med school) and they were fascinated by the experience. I spent a lot of time and we really connected. They are more excited than ever to move to their next stage. Incidentally, all three are here for a full year, 2 teaching English at the only high school in Gondar and one who has been here for 11 months as Rick’s assistant. Wonderful fellow, born in South Africa, raised in Australia, Israel and U.S.


Was invited to a dinner tonite at the Sheraton with probably the 50 most impressive and influential medical people in Ethiopia. The head of the UN Medical Clinic; chief medical officer of the American Embassy; probably the most prominent expert in the world in Tropical Medicine (here from Oxford); head of 5 of the most prominent hospitals in the country -- fabulous men and women with unending interesting conversation.


Friday is the largest religious holiday of the year, Timket, which far eclipses Xmas or Easter. I have a VIP pass so may go and watch the celebration. I’m operating at one of the private hospitals tomorrow, going to another on Wednesday and Carter from Minneapolis is going to shadow me Wednesday.


Have an invitation Friday or Saturday to play the only golf course in this country of 87 million people, the Addis Country Club; 9 holes with a great restaurant and another different view of Addis. (9 more holes under construction). This is apparently the retreat of the ubiquitous ambassadors to Ethiopia from nearly every country in the world.


That’s it for now.