My last weekend

Returned to the hospital Saturday morning.  The residents at the hospital were outstanding in arranging for an “emergency” redo of the Dawit’s trigeminal surgery (this is the radiologist from out of town).  It was difficult the first time, and the same this time around.  However, I talked to him later in the day and his problem is now cured with numbness in his face just where we want it (it will gradually recede over the next 6 weeks).

I met Corey at the best spot in Addis for buying “souvenirs”.  Two blocks of shacks with all kinds of shirts, religious symbols, jewelry, replica antiques, etc. where we both did some shopping.  Then walked uphill a mile or more to the Piazza.  Sounds like Rome, but no resemblance whatsoever.  We had lunch and I changed into my Timket outfit. 

Getting ready for Timket

We were told there would be a big pre-Timket event at St. George Cathedral, but turns out our information was off by a day.

Sadly, Corey is leaving tonight to return to Brown Medical School where she is in the department of pulmonary medicine.  Rest for the afternoon and then I treated her to dinner at La Mandoline, a lovely French restaurant a 10 minute walk from our hotel.

My home for the past 2 weeks

Road is under construction

, so it was a little dicey in the dark, but we made it out and back uneventfully.

On Sunday, Alexa (has a 3 month gig with the BBC here) and Nuhamin came to my hotel and I walked with them, once again, to La Mandoline.  Alexa had a meeting with her boss who had flown in from London, and Nuhamin and i had lunch.  At one point I went over to meet Alexa’s people from the BBC.  We chatted for quite a while.  They were very interested in my work with the neurosurgery program at the Black Lion Hospital, and want to consider returning next year when I am here to do a documentary of my work.  That would be exciting.

Spent the afternoon walking miles around town and buying some more gifts.  Had dinner at one of the Chinese restaurants nearby.  Within close walking distance of my hotel are Sudanese, Chinese, Korean, Yemeni, French, Canadian, “traditional” restaurants and a great pizza place.  Mama’s kitchen and others are a little further.

Will go to the massive Timket parade tomorrow, and then a big wedding tomorrow night.  My flight is at 3 a.m. after the wedding so this is probably my last post for this year. 

Friday, Jan 16: Shabbat and much more

I dreaded the day.  Colleagues were still at the retreat so there was no hospital work today.  Cory, a pulmonologist from Brown staying at my hotel was a regular breakfast companion, but left at the regular time for the hospital.  I lingered trying to invent activities to take up the time of day.  No hot water (and the room is always about 50 deg in the morning), so I bundled up, skipped my morning shower and caught up on internet and paper work.  Finally decided that I would return to the Ethnological Museum that I had not visited for 8 years.

Some students outside Ethnological Museum

This is on the main campus of the Addis Ababa University, the largest in the country.  It is the former estate/palace of Haile Selassie and previously his emperor father, Ras Mekonnen.  It is quite lovely (for Ethiopia).  The museum while clearly up to third world standards (!), has exhibits that are well annotated in Amharic and English and tell some fascinating stories.  For example, there is an exhibit of Muslim artifacts from the town of Harar.  I visited there a few years ago, an historically all Muslim town.  The story accompanying it described the myriad uses of baskets in the daily life, and of the jewelry abundantly worn by the women.  In the mid 19th century Jewish goldsmiths from Yemen came to ply their craft, knowing of the desires of the Muslim women for their jewelry and knowing the primitive nature of it.

The day only got more interesting.  I had a call from the doctor who I had operated on Wednesday for trigeminal neuralgia.  He was concerned that he had the desired numbness of the face, but was not numb in his “trigger” area.  We decided that he would be driven to where I was at the university  and I would talk with him and examine him.  I was not completely pleased with the result, and after many phone calls to the O.R., the sole resident at the hospital, etc we arranged that I would declare an emergency on Saturday and repeat the procedure.  It remains to be seen if we can pull it off.

After meeting with him and his family, having tea, and talking for quite a while, they directed me to the largest and loveliest cathedral in Addis, St. George. 

St. George Cathedral

It is quite a wonderful setting and fascinating to see the remarkable devotion of the people to the structure.

Devotion

  Makes one think of the Western Wall in Jerusalem as a metaphor to try to understand what I witnessed.

Incredible traffic jam as I sat in a hot, crowded minibus for what should have been a 15 minute ride back to my hotel, that extended to nearly an hour.

Fortunately hot water had been fixed when I returned.  Barely had time for a shower and then Cory and I walked 1 1/2 miles to meet Alexa and then walk back another mile to Rick’s house. 

Alexa and Cory

Alexa was a childhood friend of my sister-in-law,  Sharon Kaufman in San Francisco.  She lives in Berlin, is a free lance journalist, and arrived in Addis 3 days ago.     She has a 3 month gig with the BBC to be executive editor of a series of radio programs that they want to produce in Addis around the subject of maternal health, a serious issue in this country.

Shabbat at Rick’s house

Some of the kids at Rick's house

was again an extraordinary treat.  Alexa and Cory were thrilled to be there with the kids and Rick.  Also there was Adam, a general surgery resident from UCSF who is trying to bring some semblance of sanity to the completely disorganized E.R. at the Black Lion Hospital.  Also Robel, who Lynn and I met here last year.  Born in Ethiopia, but living in the U.S. for many years and now a graduate student at the school of International Studies at Columbia in New York.

There are many frightening barriers to safely walking at night here (not the people, but the sidewalks and streets), but Cory and I and my trusted flashlight ended an exhilarating day.

Thursday, Jan 15: our retreat

The neurosurgeons requested that I accompany them on a two day retreat out of town, in Nazaret, 50 miles, but a 2 hour ride from here.  Said I should be at the hospital to get on the bus at 6:30 am.  I guess I should have been suspicious when they told one of the residents to pick me up at my hotel at 6:30.  I had on 3 layers but was still very chilly/cold standing outside at the hospital with no bus in site.  Slowly residents began to appear, and by 7:15 a bus pulled up; 40 year old very long Mercedes bus that could barely get up the hill to the hospital but was going to take us to Nazaret.  Finally, thankfully we were out of the cold on the unheated bus and on our way at 7:45.  That’s about right for “Ethiopian time”.  This was a retreat for the entire department of surgery, but only the neurosurgery residents, not any of the others.

Nazaret is in the Rift Valley, one of the most potentially violent earthquake zones in the world.  Within an hour it was quite hot.  There was air conditioning in the seminar room, unfortunately emanating a bone chilling cold that thankfully went off after 2 or 3 hours.  I was prepared to be totally bored, and was through some of the formal presentations. However, the panel discussion at the end, which lasted quite a while, was surprisingly constructive and thoughtful, and meaningful comments and recommendations that I did not think was within their capability.  Not because they do not have the intelligence, they are very smart; however, their discussions with each other at the hospital tend to be bland, safe, polite .... and meaningless.  This was different.

I was finally given an agenda for the retreat and shuddered to learn that the entire second day was general surgery, which for me would be quite a bore.  Thankfully, one of my resident friends was driving back at the end of the day and I was able to return with him. 

We had very good and plentiful food for lunch and at breaks, so I just went to a pizza place up the street for a late dinner.

Tuesday, January 13: Best day yet

Yordanis

Today was all about neurosurgery (and friends tonight).  Started the day with the usual morning summary of trauma from the night before and follow up on patients operated yesterday.   Yordanis, our only female resident (there is actually one more in the first year, but they rotate on other specialties) was presenting.

Next was my weekly clinic that ranges from hectic to even more hectic.  I have a room which is shared with a resident off in a corner at a very small desk.  We were each seeing patients when it became apparent that he wanted me to see his patients with him.  Turned out to be a wonderful bonding experience with one of the more junior residents who I had not known previously.  He clearly wanted to hear my approach to things and devoured every word out of my mouth.  We saw many fascinating patients together, and in the middle of this Jonathan, one of Rick’s two assistants for the year appeared with a computer full of x-rays and patient summaries he wanted me to review and one patient.  The patient is a young man with either a craniopharyngioma or giant aneursym.  The most interesting of the other patients was a weird anomaly of the cervical spine with a tumor (oval structure near the top of the linear S-curved spinal cord (no, that is not the normal configuration).

oval tumor in front of top of s-shaped spinal cord

radiologist with tic

Next I saw a radiologist who came from Awassa, a town 275 km from here.  He has been suffering with trigeminal neuralgia (tic douloureux) for >15 years and heard that I could cure it.  His case is unusual in that he has had it since his late teens, so I insisted upon an MRI to be sure he did not have some weird cause for it; MRI was normal so we will do surgery in the morning. Another patient with tic had five teeth removed before it occurred to someone that it might not be a tooth problem.

another patient with tic to be operated tomorrow

After much more teaching

some of the residents with me today

and an exhausting number of patients I was through.  Took two minibuses back to my hotel, caught up on email and paperwork and found another great place for lunch.

There have been several plumbing and electrical issues in my room, and the manager has been great about having things fixed.  Everything is now whole.

As I was resting before dinner I had a call from Azarius, a resident who just completed his residency 2 weeks ago (they are allowed 6 months paid vacation after completing a 5 year residency), and is getting married next Monday.  I have been invited to the wedding at the Sheraton (the Addis equivalent of the St. Regis in New York) and a personal invitation is required for admittance.  He was here to personally deliver it to me.

Tonight I am going to dinner with Dan Combs, one of Rick’s assistants from last year who liked it enough to return for several months to work on some special projects on his own.  Jonathan, one of his assistants this year, will also be joining us.  One of my favorite (French) restaurants, La Mandoline, has moved since last year and I no longer know where it is, so these friends are coming to the hotel and we will walk there, perhaps a mile or two from here.  

A good time to mention one of the unique characteristics of Addis.  There are no addresses in Addis, and street names are meaningless and never used.  Hence when you inquire about directions,  reference is made to a known building or landmark nearby, but it could be anywhere within a half mile!

Saturday, January 10: Lunch with Tadios

My friend Tadios,who I call #1 (since he was the first neurosurgeon in Ethiopia, and for many years the only one), invited me to come to lunch at 1:00 today.

Tadios and his wife

  One of the other neurosurgeons was to pick me up.  With horrendous traffic, and quite a long distance, it took nearly one hour to get to his house.

In the seven years I have known him, and we are good friends, I have never been invited to his house.  Ostensibly it was to meet three of his daughters who are doctors and students in the U.S. who are visiting.  

We entered through an imposing gate to the yard of a very large home with white tents and perhaps 150 chairs around festive white tables. 

All except 2nd from left are daughters; 1 and 3 are twins

Turns out his only son was married a few months ago.  With his daughters home, he wanted to have a large reception for family and friends.  A buffet of typical Ethiopian celebratory food, wine and other drinks and lots of people.  Not a routine lunch.

I had an email from one of the residents who just finished the program on Dec 31.  He is  on vacation for two months (typical after they finish the program) and heard I was in town.  I arranged to meet him for dinner tonite, and he arrived with another of his colleagues who also just finished.  These are two wonderful doctors who Lynn also met in China when we were on a bicycle trip there in April;  they were in China for one month to attend a conference and numerous other neurosurgical related activities.  It was great to see them once again and we talked for quite a while.  In Ethiopian restaurants they will never bring the bill until you ask for it and it is quite typical to linger for several hours after dinner.

Friday, January 9: Shabbat

Friday is teaching day in our neurosurgery program.  There were two excellent presentations by two different residents; one on stereotactic neurosurgery and the second on brachial plexus injuries.  They are capable of neither of these procedures, and I am always amazed at the quality and depth of their presentations, in spite of their lack of hands on experience.  Actually these presentations provided an opportunity for me to discuss with them several practical, and reasonably inexpensive strategies for adding these capabilities to their repertoire.

I took two minibuses from the hospital to the Ethiopia Telecom office for a problem with my phone.  I can receive phone calls, but not initiate them.  I have an Ethiopian SIM card and you buy cards on the street that have codes you punch into the phone to load money onto the phone.  I bought three different cards and none were working.  I had Ethiopian friends try and still no luck, hence my long trip to the Telecom office.  The lady greeted me with a smile and laughingly told me I have the same problem as everyone else.  The system has not been working for two days.  When will it be working? “sometime”.  How soon?  “I don’t know; keep trying”.  What do I do to make calls? “ buy a new phone and sign up for recurring monthly phone service!”

In addition to no functioning outgoing phone, the wifi at my hotel (and in numerous spots throughout the city) has not been working for two days, but suddenly was functioning again in the evening.

Walked 1 or 2 miles from Telecom to my hotel to greet Paula and Joan, from Rochester,

Joan and Paula

who have been working with deaf children in Bahir Dar for the past 2 weeks.  They left their group a day early to come to Addis so that they could experience Shabbat at Rick’s house. It was the usual spiritual, moving experience with wonderful opportunities to interact with the many children living in his house and his current volunteers, Jeremy and Jonathan.  He gets outstanding recent college graduates who come for a year, volunteering through .. the JDC (the Joint).  Also there for several months is Dan Combs, one of his volunteers from last year who is doing amazing work extending the capabilities of Rick’s various activities.

Walked probably four miles with Paula and Joan, stopped for lunch, when to an Ethiopian supermarket where they bought food related gifts to take home.  Finally back to the hotel for a rest before walking to Rick’s house, just 10 minutes from here for a glorious Shabbat

Jet lag day, Thursday, January 8

Barely slept and was picked up a few hours later by one of the residents for morning report.  The usual 5 trauma cases overnight.

On to the surgeon’s lounge where a post-Christmas (Xmas in Ethiopia was yesterday) morning feast was in progress. 

Two festively attired aides were serving a huge plate of Ethiopian food (which is the same whether for breakfast, lunch or dinner . . . the meat and spices may vary but it all looks the same). Eaten with fingers of ocurse and no napkins.

Hagos, who had visited us in Kansas City 2 months ago, reminded me that he had eaten everything served to him and I should do the same.  I was still stuffed from the airline and lounge feasts so finessed this a bit.

Surgery today was a transsphenoidal removal of a large pituitary tumor which went surprisingly well with a new fluoroscope machine since last year and a microscope that finally was working properly.

tumor is bright white near the center

P.S. Wifi in the hotel was remarkable (compared to experience in years past).  However, as I write this, WiFi, T.V. and phone network are all not working.

This is what oil money can buy: MCI-ORD-DOH-ADD

Tues/Wed/Thu , Jan 6-8,, 27 hours door to door

Flight from O’hare to Doha, Qatar on Qatar Airways was very pleasant.  I had terrible guilt about flying this airline, but have had enough with the Ethiopian Airlines non-stop from Dulles which is vastly overpriced and quite ordinary even in business class, aside from the sleeping comfort of the seat.

Qatar was entirely different.  I was disappointed when boarding with the “plain Jane” appearance of the business seats.  However they were wide and comfortable.  Movie selection was excellent and the service was remarkable.  In addition to the usual amenities, I was offered pajamas (which I refused) and “turn down service” where a sheet and mattress pad were placed over the lay flat seat for sleeping. The menu was amazing; a la carte with more than 25 selections from soup to salad to entrees to dessert.  Each was irresistable and outstanding.

The Doha airport is a sight to behold.

  Undoubtedly new within the last year or two. Amazing in every respect and the business class lounge was indescribable.  Main lounge is the length of a football field and perhaps 2/3’s as wide and that is just the first floor. 

There is a wide winding staircase to a second level perhaps 1/3 the size of the first.  There is an incredible restaurant on each floor and all the food is free!.  Bars galore, vast buffet tables, prepared to order small plates, separate dessert buffet and on and on.

Arrived in Addis 1/2 hour late and the adventure begins.  Apparently only Ethiopian Airlines is allowed to use the main terminal, which itself is clearly third world.  Qatar was required to pull into the “local” terminal for all domestic flights.  This terminal is spartan/primitive third world.  There was not the usual table for “on arrival” visa.  Only after passengers started arriving (I was first off the plane) did they call for a visa agent from the main terminal which is a 10 minute walk away. Finally got out of the airport at 2am and had to bargain for a cab to drive me 1 1/2 miles, 4 min,  to my hotel (they initially wanted $20).

A reception person was sleeping on a cot in the lobby of this 15 room hotel, gave me the key to my somewhat chilly room.  Addis is sunny and warm during the day, and cools to 45 at night.  There is no heating or air conditioning in all but the newest buildings (where it often does not work anyway).

Barely slept and was picked up a few hours later by one of the residents for morning report.  The usual 5 trauma cases overnight.

On to the surgeon’s lounge where a post-Christmas (Xmas in Ethiopia was yesterday) morning feast was in progress.  Two festively attired aides were serving a huge plate of Ethiopian food (which is the same whether for breakfast, lunch or dinner . . . the meat and spices may vary but it all looks the same). Eaten with fingers of ocurse and no napkins. Hagos, who had visited us in Kansas City 2 months ago, reminded me that he had eaten everything served to him and I should do the same.  I was still stuffed from the airline and lounge feasts, so finessed this a bit.

Surgery today was transsphenoidal removal of a large pituitary tumor which went surprisingly well with a new fluoroscope machine since last year and a microscope that finally was working properly. They had never had the equipment or skill to do this surgery in the past, but have obviously done a lot of planning to be able to pull this off.

P.S. Wifi in the hotel was remarkable (compared to experience in years past).  However, as I write this, WiFi, T.V. and phone network are all not working.