January 2, 2013 in Kenya

We are in Jomo Kenyatta airport (Nairobi) after several sensational days in Kenya.  Stayed at a resort on Lake Naivasha.  Grounds the size of a golf course with amazing colorful birds, hippos, giraffes, waterbuck, colobus and vervet monkeys and others as friends and neighbors.  The animals wander freely, as did we.  Meals were a large buffet for all meals in a lovely rustic lodge type main building.  Our room was huge with 2 king beds, a large sitting area on a separate level, our own outdoor patio.

A harem of gazelles; the guy in front is the stud

First day we took matatu (a Kenyan minibus) a few miles down the road to Hell's Gate national park, the only park in Kenya where you can walk/ride bikes.  We rented well used mountain bikes and cycled 10 miles over a rugged, pitted,  dirt road, stopping frequently to see (up close and personal) hundreds, if not thousands of animals in their natural habitat.  Our destination was "the gorge" which was the site of filming of an Angelina Jolie movie.  

The gorge involves a descent of perhaps 200 ft and then a nearly 2 hr. walk; at times spooky, frankly terrifying, and otherwise a casual stroll.  The difficult part is 15 ft descents down vertical rocks with tiny notches for your feet, nothing to hold except the hand, shoulder or head of our already descended guide, Jeremy.  Rachel (12 yr old granddaughter) scampered like a monkey while I was at times sweating with fear.  Jeremy is a Masai who looks 15, but is 24, weighs at most 120#, and supports us in our descent.  He is a fabulous guy who invites us to his village at the end of our hike.  180 men, women, and children living in mud huts with no electricity, running water or toilets.  This was a fascinating cultural experience that words cannot describe.  After a half hour in the village, we walk 2 km back to our bikes and then cycle 10 miles back thru the park, partly in a light drizzle.

This all takes place in the Great Rift Valley, an area where perhaps the most extensive earthquake in history took place 700 years ago.  The top of the dirt/stone tower you see in the distance was where the earth was before the earthquake; foreground is where it is now.

Lunch after a rough ride; in background is height of land before the great earthquake 700 years ago

Next day we our picked up at our hotel by Philip our driver and guide for the day.  We drive 40 miles or so, nearly two hrs to Nakuru, where we stop to pay Susan for the day.  Unfortunately she tells us the price is not as we had previously agreed.  After negotiation and some tense moments, I agreed to a slightly higher price.  The highlight was clearly the "birds".  Thousands of greater and lesser flamingos, herons, multiple varieties of ibis, storks, cormorants, and too many others to mention, most of which I had never seen.

Can you do this?

Today we were waiting for a matatu to come by to take us up the road to visit a women's weaving collective.  Two lovely British girls stopped and offered us a ride.  Later our driver will be coming from Nairobi, to take us back to the Nairobi airport for our flight back to Addis

The last two days at work have been the usual mix of head and spine trauma, mixed with neurosurgical museum materials . . . Problems of a scope not seen at home.  In the ultimate irony, the very first case presented to me was a young man who was removing a tree and was down to its roots.  In trying to extract them from the ground by hand, one of the root cracked, snapped up striking him in the back, and he fell to the ground paralyzed.  He needs an operation with the new instruments that I brought and that customs had threatened to confiscate.

Rounds with the residents

Yesterday, Janet and Rachel came to morning report with me.  Rachel then waited in the surgeon's lounge enjoying the attention she was receiving from the surgeons.  Janet went on rounds with me and the residents as we cycled thru a large ward with perhaps 16 patients in varying degrees of distress.

We left early as I have not been feeling well.

Last night was an experience Janet has been waiting six years to see, Shabbat at Rick's house.  Rick, unfortunately is in the States this week, but we nevertheless welcomed Shabbat precisely as we would have done with Rick.  His assistant this year is a wonderful fellow, Menachem Stein from Cleveland.  In a remarkable twist of fate, Janet had an email a few days ago from a lifelong friend in Cleveland.  After emailing back that she was in Addis, David replied that one of his best friends was in Addis working with Dr. Rick.  Menachem stein!  There was another woman there who had just arrived to spend 2 months as a volunteer with JDC.  turns out her father is a neurosurgeon in NYC.  The world Really is a very small place.

Lynne (a Burmese Jew), Rick, Sali (wife of Omar), one of Rick's kids with corrected TB of the spine), Omar and ?

Some photos that should have been in the last post, but I did not yet have my act together:

Rachels corn rows at the Boston Spa

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.