A heart breaker

This is my last full day here.  After rounds we travel to the Korean Hospital where one of the attendings has two private patients with trigeminal neuralgia he wants to treat.  When we get there he asks me to do them as he wants to be sure there is no problem.  Very slick and quick, except the resident operating the x-ray (C-arm) was not quite adept, but all went well.

As I am preparing to go the O.R., I get a phone call from an english speaking person who says he is the consul general at the American Embassy.  It seems there is a 19 year old girl who was the victim of a bombing and is in the Korean Hospital. She wants to go back to the U.S. for the necessary surgery, but no airline is willing to fly her with her injuries.

Luckily, I am at the Korean Hospital.  After surgery, I go to meet Nimco Mohammad Omar.  She is a lovely and frightened 19 year old native Ethiopian.  Has been living in St. Paul, MN for 6 years where she is to graduate from community college this year.  Her mother is deceased.  She was here to visit her father who lives in a town near the Somali border.  She was a right front seat passenger in the car driving down the road when a bomb went off under the car.  She was thrown through the air, the car was demolished.  She was having terrible back pain.  Tried to get up but there were gunshots, and in any event she could not get up.  She was taken to a hospital and treated for severe burns on her face, arms and legs.  She was then transferred here.  I have not yet asked about her father, who I fear may have been the driver.

I examined her and her only problem is moderate weakness in her legs which she says is much improved.  She has  a bad fracture of L1.  I leave tomorrow night, but I could hardly hold back the tears as I listened to her whispered, frightened story and cancelled all plans for tomorrow afternoon so I can help with her surgery.  I have some more trigeminal procedures to do earlier in the day at another hospital.

When I return to the Black Lion, a man approaches me and says I met you in Gondar (six years ago) and you are a neurosurgeon.  “I am also a doctor”.  Frequently people come up to me on the street with a similar story (without the neurosurgeon part) and the end of a long story is always they want money.  This fellow starts telling me in detail about the case I operated on 6 years ago (it is accurate), then tells me about his jobs since then, his wife and 19 month old child.  Then it takes a turn toward the usual.  He holds my hand as we walk, tells me his wife and child are living in a small village and he is living with his mother and is destitute.  You can guess the rest.  A different story, but with the usual ending.

Tonight I take 15 or more residents and attendings to dinner, and will have a drawing for a few “door prizes”.  Tomorrow, surgery as mentioned above, and then a late plane, 17 hours to Dulles, 8 hour layover, and then a flight to Kansas City.

I’ll see you soon.

Since writing the above, I have had a call from Lucy, an American infectious disease doctor who is working for the CDC (Communicable disease center) in Addis and saw Nimco on her arrival here.  She is concerned that no one has looked at the burns in the past four days.

Nimco from St. Paul, MD

Some more resident who want to learn
the procedure for trigeminal neuralgia

Man on left was sent to my apartment
by a neurosurgeon in Norway!  On right is a G.P. who was
translating for us

Through the remarkable networking that goes on here I was able to locate a Norwegian plastic surgeon who specializes in burns and happens to be at the Korean Hospital where Nimco is.  He was great and is going to see her tonite to be sure it is safe for us to proceed with surgery tomorrow.

Utopia in Ethiopia

Debra Zeit (or Bishoftu) is a town, fifth largest in Ethiopia, just 45 km from Addis.  However the drive takes anywhere from 45’ to 3 hr; It took us about two hours with horrendous traffic.  Once we passed thru Debra Zeit, we drove 12 km through farms and countryside to arrive at Adulala (an Oromo word meaning worship the sun).  It is on a steep hill/small mountain on the shores of Lake Babagoya, one of several “crater”lakes in the area, the site of an extinct volcano.

My "cottage"

Two days ago in surgery.  Men are commonly with
arms around each other

The gari

After two days here, I can now forget the incredibly inefficient check-in process and instead attempt to describe perhaps the loveliest place I have ever visited.  This is not an over the top, lap of luxury , latest and greatest modernistic feat of a world famous architect.  It is environmentally and esthetically sensitive to the magnificence of the natural surroundings.  From most vantage points you would hardly know you were anywhere but in a semi-tropical forest.  Yet distributed up and down a very steep hillside are very large thatch roofed cottages, each with fireplace, living room, large bedroom and very large bathroom; each cottage has a spacious terrace overlooking lake and mountains in front and at least 40 or 50 feet of steps and walks leading to each cottage built into the hillside.  The pool, spa, “topview” recreation room, outdoor bonfire area, clay tennis courts, etc are all equally sensitive to the surroundings.  If they could reproduce this in the Caribbean or Hawaii it would be far more than $1000 per night, but it cannot be reproduced. There is a winding, switch back native stone walk to a “beach” far below with hundreds of yards of retaining walls built of native stone and seeming to be part of the natural hillside.  I have no idea how they could have designed and built this place based upon the resources I have seen even in Addis.  

Yesterday I walked 12 km to town through farms, tiny villages, and gradually into the city spreading out from the Addis road that runs through the center.  Had lunch overlooking another crater lake and talked with the first American tourists I have met in one month here.  There were 5, only two of whom had know each other previously, spending 3 weeks and hitting all the high points in the country.  Then walked half way back and took a gari (horse drawn cart) the rest of the way.

I have spoken to several people here (as far as I can tell I am the only non-Ethiopian) and learned a lot about the culture, sociology and economics of the country that has helped to bring together thoughts and ideas that I have had but for which I have lacked evidence. Just a tiny vignette: the government has enormous taxes on all imported goods, but some of this still does not make sense.  For example, liquor is taxed at 200% of the highest retail price that it can find on the internet; however, a glass of scotch is $3.50.  Cars are taxed at 200%; a Toyota Highlander that might retail for $40,000 in U.S. is $120,000 dollars here, and there are many.  Medical equipment is only taxed at 50% (of the highest price they can find).  Income tax is a flat 35%, but tax evasion is a national sport.

Shortly I will be off to the spa for a one hour manicure, 56 birr or $3.10.  I will then take a kayak (i.e. an inflatable raft) and row around the lake.  My driver arrives after lunch to take me back to Addis.

One last inexplicable vignette.  Almost all hotels, but not much else, take Visa.  I arrived here with cash for meals, etc. and my Visa card.  During my 45’ at ‘reception” (I was the only one there) among other issues they said they did not take Visa.  I inquired about an ATM (they are all over in Addis), and he said the only ATM is in town (12 km away) and is broken.  “You can  see one in Dukum”, a town that is perhaps 30 km (and a Bijaj or TikTuk is the only way to get there).  i eventually spoke with the manager who told me i could pay by Visa in Addis; they will come to my guest house for this.  Go figure.  The cashier can’t figure out how I can pay, and the manager looks at me and says I can pay in Addis (on my honor).

Can’t believe what happened after writing the above.  I hiked down to the lake front where they have a lovely shaded area with bar and reclining chairs.  Read on my ipad for a while before lunch.  Someone approached me and it is an Ethiopian friend of mine from Pennsylvania, Sisay.  Sisay has numerous business interests here and is with the family of a childhood friend of his.  He explained to his friend who I was and of course the friend send “I need you”.  He just came back from seeking a neurosurgery consultation in Bangkok where they could not help him.  Just has back pain, but he is going to bring his x-rays to my apartment when I get back tonite.

I'm off for the weekend

After morning rounds, quite sad because of the unexpected and likely unnecessary death of a 17 month old who was the victim of a stone falling from a building under construction, there were two excellent talks given by two different residents on: 1) brain tumors; and 2) anterior approaches to the cervical spine.

I was able to get a very spirited discussion going on both topics and offer a number of hints and pearls in the management of both.

At 11:30, my driver arrived to take me to Debra Zeit (also knowns as Bishoftu) to a new resort, Adulala.  It takes us nearly two hours to drive 50 km (about 32 miles) as the traffic is horrendous.  We drive 10 km off the main road thru magnificent unspoiled country side, bordered by mountains, to arrive at this incredible place.

But first, my experience with “reception”.  I was the only arriving person with two people in reception.  They have no record of my reservation (made by my friend Million in his name).  After interminable viewing of the same computer screen over and over, and several phone calls, they finally determine that my reservation was made in the Addis Ababa office; so what is wrong with that?  Apparently their main office in Addis does not communicate with the on-site computer at the facility.  They determine that they have a room for me tonite, but not tomorrow.  After much wrangling, attempts to contact the manager, then the owner, they will see what they can do.  Do I sleep in a tent in the wilderness tomorrow night?

In the meantime this place is amazing.  I have my own room that is huge, the size of a small house.  Fireplace, large bathroom with every amenity you can imagine, king size bed, couch, chairs, large fireplace and 25 ft cone shaped ceiling with a thatched room outdoors.  I have a large patio with several pieces of furniture under flower trees and palm trees, all high on a hillside overlooking Lake Bishoftu.  This is easily the most beautifully designed, respectful of the natural environment resort I have ever seen.  None of the artificiality of Hawaiian resorts or huts on stilts in the Indian Ocean.  All materials are Ethiopian (fixtures are Chinese) and exquisite.  The dining room is unpretentious but magnificent in its subtlety and creative design.  Food is excellent.

My home for the weekend

Just one corner of my suite

I’m off to dinner, about 100 meters away down a natural volcanic stone walk to be serenaded by all kinds of small insect and other wildlife sounds.

Very gratifying

Today after morning rounds we set out for the MCM (Korean) hospital to teach residents, hands on, how to do a balloon compression procedure/operation for trigeminal neuralgia.  We are to treat three of the patients I saw last week.  These are private patients who are paying substantially to the hospital for the procedure, as compared to patients at the Black Lion who are treated free.

I describe to the residents (14 of them) how to do the procedure, and demonstrate the equipment.  I then perform the procedure on the first patient, which went flawlessly.

For the second case, Abenezer, one of the fourth year residents who has helped me interview all of the patients, is anxious to try it.  We immediately identify a problem.  Whereas I am ambidextrous and easily perform the procedure standing on either side of the patient, Abenezer is right handed and this patient’s pain is on the left side creating substantial awkwardness, as his (left index) finger must be inside the patient’s mouth (the procedure is carried out under general anesthesia) as he inserts a needle through the cheek and through a tiny hole (foramen ovale) in the base of the skull with his right hand.  He had some difficulty, but with some help from me the procedure was successfully executed.

The third patient was a little easier for another of the residents, Azarius.  They were all thrilled to learn this new skill and tripping over each other to hopefully have their turn to try next week.

In the afternoon I went to visit my friend, Akeza Teame, at his new outpatient facility, The American Medical Center, that opened to great acclaim and publicity two months ago.  It  is a sight to see in this (trying to emerge) third world country.  It must be at least 40,000 sq ft and probably more.  It is spiffy clean, very attractive, furnished beautifully and equipped to hand all of the outpatient medical and pediatric needs of a wealthy Ethiopian population.  The charge for a medical visit is 300 birr (about $16.50).  Charge for a comprehensive annual physical with a 10-15 page printout of all results and numerous other amenities is $300.  This clinic is definitely the leading edge of medical care in Ethiopia.  He is hoping to halt the exodus of wealthy Ethiopians to India and the middle east for their medical care.

Akeza's American Medical Center

Interior courtyard of American Medical Center

Teaching procedure for trigeminal neuralgia

A day in the life of neurosurgery in Ethiopa

tion

We have had a great improvement in morning report, thanks to the effort of Steve Friedberg from the Lahey Clinic in Boston.  We have the usual 3-5 cases each morning of trauma during the night.  Now, however, there is also a report of any complications in the past 24 hours as well as some impromptu brief reports by residents on some subject of interest the day before.

Pre-op.  Note deformity of spinal cord just
below the brain

Excellent alignment after wiring and fusion of C1 to C2

15 y/o with a huge tumor; need to
abort surgery because of excessive
bleeding and no means to control it.

Miniature plums; my favorite snack

Today there was good and bad news.  The very large pituitary tumor that we operated on last Saturday developed paralysis on his right side 48 hours following the surgery.  Thus far there is no improvement, but a CT scan yesterday suggests that improvement is possible if not likely in view of his young age (25).  The good news relates to a case of a fracture of the odontoid (high cervical spine) from last Friday.  There was very substantial displacement of the fractured fragments and we were having great difficulty manipulating him into alignment; in fact both  before and during surgery we were never able to get good alignment.  As a last ditch effort, one of the residents had an idea during surgery, that was quite dangerous, but there seemed no viable alternative.  He pressed with great force on the C2 spinous process as we wired a bone graft into place and the C1 to the C2 vertebra.  Today, first of all the patient has no neurological impairment;  furthermore, an x-ray shows absolutely perfect alignment of the fractured fragments.  We were all shocked and thrilled by the result.  If you wonder why they fall so frequently from construction sites look at this:

The source of many of our spine fractures

We had a meeting today with the head purchasing officer of the hospital as well as an outside consultant who seemed to know the ins and outs of the government/hospital procurement system.  Who knows if they can deliver, but they asked us to give them name, stock numbers and sources for all of the consumables that we would be needing each six months.  They seemed serious about this; we will see what comes of it.  I will be supplying them with all the information they need and supposedly they will find sources for all of this.  We will see what happens.

I’m going to take all of the attendings and residents (total of probably 20 or so) to dinner my last night here next week.  Spent a few hours trying to find a suitable place that would also accept Visa, and finally settled on one of the two Jupiter International Hotels that has a lovely, though small dining room.  They assured me that we could have half of their room.

Went back of Mama’s Kitchen, one of my new favorite dining spots and had a wonderful chicken shish kebab.  Wonderful unique flavor and with soup, salad, dessert, tea included.

There is a wonderful miniature plum that is harvested annually only in January, while I am usually here.  Of course you should not eat fruits and vegetables that are not peeled.  I have developed a formula that seems to work.  Was the fruit well with soap and water (from the tap and likely not potable), let it air dry, and eat the succulent fruit.  Thus far (keep your fingers crossed) I have had no problem.

Tuesday, my clinic day

Clinic, January 15

One of two lesions in the
young girl; probably T.B. or toxoplasmosis

The waiting room outside
my "office"

18 yr old girl with
headache and blurred vision

After review of emergency cases from last night, then the first cup of tea, I am off to my weekly outpatient clinic.  There is a mixture of cases just like I would see at home . . . headache, back pain, ruptured disc in neck or back.  Then there is the medical museum quality patients.  This morning there was an 18 year old girl with 2 weeks of headache and blurred vision.

There was a 54 year old man who walked into the office smiling and with no complaints.

Sister of the dean with
trigeminal neuralgia

I saw the sister of the dean with trigeminal neuralgia, who will be added to my growing list for surgery in the next few days.

I had three general surgery residents, who are on a neurosurgery rotation.  This fellows translated for me.  They have kind of latched onto me and appear in my clinic each week.  They seem very excited to learn about the neurological examination and happily tell me this is the best rotation they have had in four years of general surgery.

Your diagnosis?

This afternoon I am going to take a long walk to a major minibus stop and then hop on a bus to a corner about a half mile from Rick’s house.  He is in Gondar for two days, but send one of his assistants to my apartment this afternoon with two patients.  I have some gifts for his kids that I keep forgetting to take, but this is the day.

This Sunday is the start of a huge annual Christian festival, Tinket.  This day of massive parades, outdoor religious ceremonies, festive dress, etc. is far beyond any religious event in the U.S.  I have seen it three times in the past, so am going to try to go out of town for the weekend.  There is a new resort, Adulala, about 1 hour from here and I am trying to make arrangement to go.  Lots of surgery between now and then, so I will be ready for a break.

Not for the faint of heart

Friendship International Hotel

I was unable to get a plane to Gondar, as I had hoped today, after spending the weekend in the brand new Friendship International Hotel.  I remembered that Guetahoun had said if I did not go to Gondar we could play golf, so I phoned him and arranged for him to pick me up at 10:00.  5 min. later he phoned to say his wife wanted to go trekking, so maybe we can play golf next week.

the best part of the road

our trekking group

on the cliff's edge

He and his lovely French wife, Francine picked me up and drove to a lovely house where we picked up their French friends, Florence and Roberto (Italian).  They all teach at the French school here.  We were headed to the Entoto mountains, 15 miles out of town, and a different world.  Quiet, remote and magnificent scenery.  Once at the top, we drove perhaps several miles down a deeply rutted road with stones and rocks as obstacles and in a very remote area there was another car waiting with three more French friends of theirs.  We hiked perhaps 3 miles, then down a treacherous stretch to the edge of a cliff, not for the faint of heart.  There was a precipitous 300 ft vertical drop that was very scary.  They would not let me back off as 300 ft below we were watching hyenas stalking some grazing cows.  Had a magnificent view of at least 25-30 miiles with numerous remote Oromo villages dotting the vast valley below.  Finally I backed off a little as I had repeated visions of tumbling to my death.

my new Oromo friend

Oromo girls

woman carrying firewood

We spend at least an hour watching wildlife with occasional Oromo (they speak a different language from the national Amharic) youths appearing to warily socialize with us.  Roberto then led us back by a different route, with an extremely vigorous climb that left me very winded (we were probably at close to 3500 meters) and the others wondering if he knew where he was going through eucalyptus forest, open fields and territory very different from whence we had come.  Passed some women and donkeys carting huge loads of firewood and ultimately other donkeys with enormous loads of some grain that was not teff and not wheat, but is used in making bread and also beer.

"State of Palestine" embassy & chancery

lunch with Guetahoun and Francine

We then drove 30 minutes over the same virtually impassable road back to civilization and back down to Addis.  Guetahoun dropped off his friends and insisted I come to his house for lunch.  His home is across the street from the Embassy of the “State of Palestine”.  I warily took some photos, concerned if they should see me.  Guetahoun beeped his horn and his lovely maid/servant/cook/housekeeper/gardener opened the gate and we entered into his typical old Ethiopian house with lovely very private gardens and a gazebo covered with grape vines.  We sat outdoors in the gazebo where there was waiting a table and an adjacent tray with a lovely prepared meal of baked spiced chicken, rice with vegetable, french fries and salad (everywhere with everything they serve both french fries and rice).  Guetahoun is a native Ethiopian who went to school in France, is a French trained Orthopedic Surgeon and worked for 20 years in the French foreign service in many French colonies and former colonies in Africa.  He and his French wife returned to Addis 3 years ago.  They still maintain a lovely home in Bordeaux.  How do I know it is lovely?  Google is incredible.  On his computer with an EVDO USB dongle we viewed street views of our homes in Kansas City and Vail, and his in Bordeaux.  They then served tea along with Godiva chocolates brought from France.

After a while he drove me back to my apartment at the hospital, I took a nap, and wandered over to Jupiter Hotel to use their wifi (no access at the hospital on Sunday).

Tomorrow begins a very busy work week with the usual load, plus somehow we need to find a way to operate on what are now 17 patients with trigeminal neuralgia.  

Caio for now.

and the beat goes on

Resident presenting on neural tube defects

Today was going to be an easy day.  Friday morning is just for teaching . . . morning review, two presentations by residents and rounds.  Planned to be out of there by 11:00, and as I was getting ready to leave they tell me there are 9 patients with trigeminal neuralgia (also known as tic douloureux) waiting to see me.

A few of the tic patients

As some of you know this has been a specialty of mine for many years.  For the past five years I have been lecturing on the subject in Nairobi and here, and trying to teach them a simple, sustainable, percutaneous technique requiring very little equipment and seemingly ideal for this environment.

One of the 4th year residents, Abenezer, was assigned as my aide and translator.  I think I may have identified the future of tic in this country.  He was great.  After the first or second patient he took a thorough history by himself and was intelligently and thoroughly discussing the patients with me.  He would then meticulous explain to each patient their therapeutic options.  All were reaching near the end of their rope and chose to proceed to have this surgery next week.

Zenebe with his daughter in 10th grade who is going to
school in Lexington, KY next year

The full menu at Zenebe's 10 bed hospital

As I was finishing this, Zenebe (the only privately practicing neurosurgeon in the country with his own 10 bed hospital and "ICU", called to tell me that he had a patient with tic who he wanted me to operate on this afternoon.  So much for my free afternoon.  He sent a driver for me, we had a light lunch together and successfully treated his patient.

Finally I was free to spend the weekend at a hotel in a more active part of town.  Over the past several days I have been speaking to a general surgeon friend from Gondar who helped me during my first trip here six years ago.  At the time he was a first year resident.  Shibikom is now one year out of his residency and a general surgeon at the medical school in Gondar.  If he can get a group of my friends together, I will fly to Gondar Sunday morning to have dinner with all of them Sunday evening and then return to Addis on Monday.

Tonite I went to the very moving and inspirational shabbat at Rick's house.  There were 30 students from the University of Maryland and elsewhere, many pre-med.  A number of them were anxious to speak with me during dinner and I had some wonderful conversations with some delightful young men and women.  They are all flying to Gondar Sunday morning, and I will likely fly with them if I go.

Large grey/white mass in the center is the large pituitary tumor

Tomorrow (Saturday) was supposed to be another free day.  However, Hagos, one of the attendings called and asked if I would help him do a large pituitary tumor tomorrow.  Goodbye to my free Saturday morning.  

Never a dull moment

Today I will go chronologically backward since I have been so busy I am not sure I will remember everything.

It is Thursday and a very active day.  As I was awaiting the start of our first surgical case, a spine fusion in a man struck in the back resulting in an L3 spine fracture, one of the attendings said there is a visiting neurosurgeon who wants to see me.  Turns out there is a brother team of orthopodic surgeon/neurosurgeon who have a spine surgery practice at Cedars-Sinai in Los Angeles.  They have visited several countries in Africa (including their native Gabon) as they wish to set up a first class, western standard spine operating room to do scoliosis and other complex spine surgery.  They have their own charitable spine foundation and claim to have access to sufficient money to do this as well as set up a residency exchange program between Cedars-Sinai and their chosen site.

I spent considerable time with them to suggest that they have found the ideal place.  Our teaching hospital in a large peaceful African country with 18 neurosurgery residents and appropriate desire.  Icing on the cake is Dr. Rick with his huge reservoir of scoliosis patients needing surgery.  Currently he pays $18,000 per child to send them to Ghana for surgery.  Wouldn’t it be wonderful if they could be done at the university hospital in Addis for free!

I phoned Rick immediately and we are trying to locate them (all we know is they are staying at the Sheraton + their email addresses) to try to arrange a meeting of them with Rick.

Second case today turned out to be a tuberculoma in the brain.  Resident who did the case says that is his 7th case; I had none in 38 years of practice.  

In the center of this brain exposure is the tuberculoma

A disappointing episode this morning.  The neurosurgeons told me that they have a new Stryker drill, that lacks a handset.  Also have an ultrasonic aspirator that lacks a foot pedal.  I decided to investigate.  I got in touch with the neurosurgeon in Norway who donated (and paid for) what is probably $80K or more in equipment.  He claims that all of the parts were there when the equipment arrived.  The doctors/nurses here were supposed to contact the supplier who, as part of the sales price, agreed to come to Addis to properly install the equipment and instruct in its use.  Unfortunately none of this was done and now the indispensable parts are missing.  I am hoping I can obtain the missing drill parts once I return to the U.S.  We are going to try and contact the European reps for the ultrasound and see if they are still willing to come here.  This is a tragedy, caused by negligence and disinterest and unfortunately is typical of what often happens here.  These two pieces of equipment would dramatically enhance their capabilities if we can finally get them working (and maintained) properly.

Yesterday, Omar Jiminez, the neurosurgeon with an Ethiopian wife from Scotts Bluff, Nebraska, wanted to spend the day with me at the Black Lion Hospital.  He is a wonderful fellow, smart and motivated, who immediately got the picture and actively participated in our teaching process as well as at surgery.  He did a spine fracture with one of the 5th year residents and was very instructive with some finer points of the surgery that are often discounted and/or overlooked by the residents.

Two of Rick's assistants, Menachem (applying to medical school) and Rebecca (daughter of a neurosurgeon in NYC) wanted to see some surgery.  They came to the hospital yesterday and while they were here one of the nurse anesthetists approached me with her problem of facial pain.  Turns out she has trigeminal neuralgia and presented a wonderful teaching opportunity with the students as well as the residents.

Day before yesterday brought an unexpected opportunity.  I had a call from my orthopedic friend, Guetahoun.  Two weeks ago he was operating for a week in a small town 150 miles from here with a medical mission (Global Medical Foundation) of surgeons/nurses from several countries combined with some Ethiopians.  They did nearly 80 cases in one week. Horrendous cases of burns, congenital anomalies, untreated deforming injuries and much more in  a marginal surgical setting.  Guetahoun said they were having a final “reception” and Today I will go chronologically backward since I have been so busy I am not sure I will remember everything.

It is Thursday and a very active day.  As I was awaiting the start of our first surgical case, a spine fusion in a man struck in the back resulting in an L3 spine fracture, one of the attending said there is a visiting neurosurgeon who wants to see me.  Turns out there is a brother team of orthopodic surgeon/neurosurgeon who have a spine surgery practice at Cedars-Sinai in Los Angeles.  They have visited several countries in Africa (including their native Gabon) as they wish to set up a first class, western standard spine operating room to do scoliosis and other complex spine surgery.  They have their own charitable spine foundation and claim to have access to sufficient money to do this as well as set up a residency exchange program between Cedars-Sinai and their chosen site.

I spent considerable time with them to suggest that they have found the ideal place.  Our teaching hospital in a large peaceful African country with 18 neurosurgery residents and appropriate desire.  Icing on the cake is Dr. Rick with his huge reservoir of scoliosis patients needing surgery.  Currently he pays $18,000 per child to send them to Ghana for surgery.  Wouldn’t it be wonderful if they could be done at the university hospital in Addis for free!

I phoned Rick immediately and we are trying to locate them (all we know is they are staying at the Sheraton + their email addresses) to try to arrange a meeting of them with Rick.

Second case today turned out to be a tuberculoma in the brain.  Resident who did the case says that is his 7th case; I had none in 38 years of practice.

A disappointing episode this morning.  The neurosurgeons told me that they have a new Stryker drill, that lacks a handset.  Also have an ultrasonic aspirator that lacks a foot pedal.  I decided to investigate.  I got in touch with the neurosurgeon in Norway who donated (and paid for) what is probably $80K or more in equipment.  He claims that all of the parts were there when the equipment arrived.  The doctors/nurses here were supposed to contact the supplier who, as part of the sales price, agreed to come to Addis to properly install the equipment and instruct in its use.  Unfortunately none of this is done and now the indispensable parts are missing.  I am hoping I can obtain the missing drill parts once I return to the U.S.  We are going to try and contact the European reps for the ultrasound and see if they are still willing to come here.  This is a tragedy, caused by negligence and disinterest and unfortunately is typical of what often happens here.  These two pieces of equipment would dramatically enhance their capabilities if we can finally get them working (and maintained) properly.

Yesterday, Omar Jiminez, the neurosurgeon with an Ethiopian wife from Scotts Bluff, Nebraska, wanted to spend the day with me at the Black Lion Hospital.  He is a wonderful fellow, smart and motivated, who immediately got the picture and actively participated in our teaching process as well as at surgery.  He did a spine fracture with one of the 5th year residents and was very instructive with some finer points of the surgery that are often discounted and/or overlooked by the residents.

Two of Ricks assistants, Menachem (applying to medical school) and Rebecca (daughter of a neurosurgeon in NYC) wanted to see some surgery.  They came to the hospital yesterday and while they were here one of the nurse anesthetists approached me with her problem of facial pain.  Turns out she has trigeminal neuralgia and presented a wonderful teaching opportunity with the students as well as the residents.

Cooking the lamb

The movie above shows part of the garden before the guests arrived.  Man in the center is my friend Dr. Guetahoun

Day before yesterday brought an unexpected opportunity.  I had a call from my orthopedic friend, Guetahoun.  Two weeks ago he was operating for a week in a small town 150 miles from here with a medical mission (Global Medical Foundation) of surgeons/nurses from several countries combined with some Ethiopians.  They did nearly 80 cases in one week of horrendous problems in a marginal surgical setting.  Guetahoun said they were have a final “reception” and asked if I would like to join him.  We drove quite a way west of town, then onto a cobblestone road, then a rutted dirt road, then a road with stones and even boulders to finally arrive at a home with a 10’ concrete wall.  We entered through the gate into a tropical paradise.  Hundreds of flower bushes and trees, palm trees, eucalyptus and many others.  It was rather cool but our host started a wonderful bonfire.  Turns out the host, Tseguy, is the brother of Dr. Amati from Chicago who put the group together.  Tseguy is a former diplomat and judge and now a lawyer.  There were more than 40 people in the garden, around the bonfire, with bountiful liquor, wine and brandy accompanying an Ethiopian feast;  best food I have ever had here.  Prepared by two lovely cooks, probably no more than 20 years old.  The climax was a freshly sacrificed lamb.  Fortunately I was not invited to watch.  They put a huge (36” wide) metal plate on a rack over the bonfire and proceeded to grill the lamb throwing on many different spices and bottles of wine.  It was unique and wonderful.

I ended up talking most of the evening with a lawyer friend of the host.  We talked for two hours and I learned much about the legal and judicial system here, as well as about taxes, the real estate boom, methods of financing, etc.

Tonite I am trying to arrange dinner with the group of neurosurgeons from South Florida that I met several nights ago.  I believe their potential plan, if they have one, could conflict with our development plans here at the university, so I would like to learn more about their intentions.

Today would have been my father’s 110th birthday!  That’s all for now. if I would like to join him.  We drove quite a way west of town, then onto a cobblestone road, then a rutted dirt road, then a road with stones and even boulders to finally arrive at a home with a 10’ concrete wall.  We entered through the gate into a tropical paradise.  Hundreds of flower bushes and trees, palm trees, eucalyptus and many others.  It was rather cool but our host started a wonderful bonfire.  Turns out the host, Tseguy, is the brother of Dr. Amati from Chicago who put the group together.  Tseguy is a former diplomat and judge and now a lawyer.  There were more than 40 people in the garden, around the bonfire, with bountiful liquor, wine and brandy accompanying an Ethiopian feast;  best food I have ever had here.  Prepared by two lovely cooks, probably no more than 20 years old.  The climax was a freshly sacrificed lamb.  Fortunately I was not invited to watch.  They put a huge (36” wide) metal plate on a rack over the bonfire and proceeded to grill the lamb throwing on many different spices and bottles of wine.  It was unique and wonderful.

I ended up talking most of the evening with a lawyer friend of the host.  We talked for two hours and I learned much about the legal and judicial system here, as well as about taxes, the real estate boom, methods of financing, etc.

Tonite I am trying to arrange dinner with the group of neurosurgeons from South Florida that I met several nights ago.  I believe their potential plan, if they have one, could conflict with our development plans here at the university, so I would like to learn more about their intentions.

Today would have been my father’s 110th birthday!  That’s all for now.

Ethiopian Christmas, January 7

Today is Ethiopian Christmas, which I have been dreading as most shops are closed, no hospital work, etc; turned out to be best day so far.

Let’s start with yesterday, Xmas eve. There are goats and sheep all over the streets.  Gifts are not a part of this holiday.  Family is.  It is traditional for the family to all get together.  They buy a goat or sheep.  The father slaughters it as everyone watches.  He prepares it and then the mother cooks it.  At Rick’s house, the boys will buy a goat, take it to the house he rents for the older boys (his house is kosher), slaughter it, and the cook will prepare it.

I wandered the town yesterday.  Rick called and wanted me to come hiking in the Entoto Hills with he and his son, Adisu, but I was too tired by late afternoon.  Took a nap and then two minibus’ to the Edna Mall where there is a theater that shows current run American movies (for $2.75 + .40 for popcorn).  Saw Life of Pi; remarkable photography and direction.  Forgot to take my flashlight, so it was a little dicey walking a mile to a new restaurant afterwards.  

Speaking of food, I went for the second time to Mama’s Kitchen, and discovered that next door is a place that sells Italian gelato in 10 flavors; it was really good and I did not get sick (as I did after trying ice cream in Harrar last year).

Late last night when I returned to the hospital campus and my “guest house” there was typical Ethiopian church choir music in the distance.  A recognizable chant with a lot of drumming and middle eastern whoops and hollars.  I walked over to find what must be a typical Xmas eve celebration.  Women bearing candles, perilously close in the packed crowd.  Typical Christian holiday dress, dancing, chanting, huge drums .. quite a scene.

St Yared: Akeza's Hospital

This a.m. shortly after awakening my phone rang the first of many times.  It was Akeza.  He is the Ethiopian doctor who coincidentally went to K.U. med school, though I did not know him when he was in Kansas City.  Trained at Albert Einstein and is an excellent physician.  He owns a small hospital here which is quite nice and where I see patients and occasionally operate.  He had a patient with spine injury, paralyzed, and one of my neurosurgeon friends who he called wanted him transferred to the Black Lion.  I said I would come to the hospital to see the patient.  My orthopedic friend, Guetahou picked me up and we went to see this sad case.  A lovely man with a very nice family.  Was driving his car when a goat started across the road.  He swerved to avoid the goat, the car rolled several times, he had no seat belt and is now paralyzed.  I put him in skeletal tongs to reduce the fracture, and will talk to the family about where we go from here.

Rick and I

Talked to Rick and we decided to go hiking this afternoon in the Entoto hills, with Rick and one of his sons.  Rick’s car sputtered up the mountain with ultimately steam coming from the engine, which was badly overheated.  We arrived near the top and ultimately hiked five miles through magnificent eucalyptus forest to an overlook with a village below and mountains in the distance.

Dinner with neurosurgeons/nurses

In the meantime I had a call from my neurosurgical friend, Zenebe, who invited me to a chinese dinner with “six neurosurgeons”.  There are only five in the entire country so I was not sure what lay ahead.  To make a long story short there are four neurosurgeons and a nurse visiting from Florida, and another American neurosurgeon and a North Korean (who I met last year) from one of the private hospitals here.  The North Korean is a superb surgeon and is anxious to learn my technique for balloon compression of the trigeminal nerve for tic douloureux.

A potentially boring day ended up with non-stop and varied activity.  I failed to mention that the surprise on arriving home from the hike, covered in dust, and with 1/2 hour before my driver was arriving for dinner.  No running water!  This has been almost a daily occurrence.  My apartment as about 15, two liter bottles of water under the kitchen sink.  All bottles have been opened but are filled to the brim.  This was a puzzle but now I know what they are for.  They are the only source of water, when there is no running water as has been the case for at least the past 5 hours.

Let’s hope there is water for a shower in the morning.  Good night.