12/30: a rainy day in Addis

It is not supposed to rain in Addis this time of the year, but we had a thunderstorm last night. Today was dreary, cool, and intermittent sprinkles.

After morning rounds with yet another (now daily) epidural hematoma, and two fascinating (and sad) intracranial infections in young children, I decide to opt out of the first surgical case of hydrocephalus.



Walk up hill one mile to the piazza and wandered around. Tried to use Internet at a cafe but it was impossibly slow. Had a call from Tadios that he was waiting for me for lunch. Turns out the surgery department secretary, who bakes pastry for tea each morning and also serves us tea, had made a spaghetti with spicy meat sauce for us for lunch.

After lunch I go to o.r. Where I will see the Ethiopian version of an anterior cervical fusion. The consultant who is doing the surgery and teaching the resident, asks I'd I would like to scrub and show them how I do it. One big problem . . . There is no additional surgical gown for me. I end up coaching them thru it, albeit with some improvised instrumentation in view of some critical instruments that are missing.

We have a banquet for the finishing surgery residents (and one neurosurgeon) at the Intercontinental Hotel.



Wonderful dinner and very interesting to watch the various eating styles. Something less than half use utensils, even for their European type food. There was a huge buffet (over 100 people) with a mixture of Ethiopian and western food. First desserts I have seen in Ethiopia served after a meal; a large buffet with at least 15 choices. There are lots of bakeries in town, generally with bland tastes, but most ethiopians do not generally seem to eat dessert. Even at this banquet with copious offerings, most seemed either to eat none, take a tiny sample, or a few pieces of fresh fruit.

I did some adventurous shopping today as my cook has offered to make some rice with vegetables for me for the weekend. Adventurous only because I bought directly from the farm (women seated on the pavement with an old sheet on which are offered carrots, cabbage, onions, beets but only one choice per vendor). Pray for me that I don't get sick, but all should be well cooked.

I made contact with Akesa Teame. He is an Ethiopian who went to med school at K.U. And did a residency in infectious disease at Albert Einstein. He and an enterprising friend bought a defunct hospital here and have ambitious plans. He is sending a driver for me tomorrow and I am going to spend a few hours with him.

12/29: a varied day

They want me to go to surgery, but cases are very routine and I am not interested. One of consultants is to meet with medical students to discuss head trauma. I invite myself to join him and suggest a "dog and pony show". He does not seem to understand the idiom, but I go with him. He starts out, but very didactically and I cannot resist kindly offering to add some comments. Of douse I end up engaging the class and they would not let me go for two hours. I was exceedingly impressed with their fund of knowledge and willingness to engage in Socratic dialogue. There were three obviously Muslim women, 10-12 other women and perhaps 15 men. They were totally attentive and taking profuse notes.



After class I go to my apartment to see if Wubi, my housekeeper found all of my laundry from the past week. It was already washed and hung to dry, bed made, and she was making my lunch. She asks that I pay her 100 birr ($6) each friday. She leaves me a note in perfect English accounting for the money she spent at the market and asks me to leave a note each day whether I want Ethiopian or European food.

I return to surgery. There is an emergency and they want me to scrub with the first year resident. However I wait around for nearly three hours and they still have not begun, so I enlist one of the senior residents to help.

After a brief nap I decide to take minibus to one of the hotels where they have wifi. Spend some time catching up and then another minibus to one of the six Tuesdays in addis (2 complexes of 3 each). For $2.15 (plus .40 for popcorn) I see The Tourist.

Return to a wonderful Swiss restaurant near my apartment for dinner and a relaxing evening with a book.

12/28: A hard days' work

Checked out of the quite luxurious Sheraton and was driven to my apartment on the hospital grounds. Steve Friedberg describes it as a crack house but I'm afraid that is a bit generous. It is definitely adequate but I'm sure glad I did not bring Janet and Rachel here. It does come with a lovely cook/laundress/housekeeper who as a bonus even speaks a few words of English.

After morning rounds I go to see patients; probably more than 20 in about 2 hrs. Tadios and I go to lunch and I walk back about a mile just to be outdoors. There is moderate pollution in Addis, but it is a lot better than the odors of the hospital.

We have a meeting at 2:00; they are trying to figure out how to interact with a Norwegian group that is coming to review the residency program to determine if it will continue to fund scholarships for four of the residents ranch year to go to Norway for seven months.

I am abruptly called from the meeting after two hours; they want me to be the consultant (I.e. assist) on an emergency, an epidural hematoma. It takes three hours to wait for anesthesia and get the case started. The first year resident who is doing the case and has done at least 30 of these so far this year ( in k.c. We saw one or two in a year in our busy practice), clearly needs help and guidance and I end up doing most of the case. It is an ordeal with woefully inadequate equipment, but that is the easy part. The O.R. Light is marginal at best and as the sun begins to go down I realize that the only light in the room is the surgical lamp with only three bulbs. When we finally finish the case I need to feel my way along the wall to find my way out of the o.r.

Walk to the market to buy food for breakfast. My housekeeper says she will make me lunch each day and leave additional food for dinner. Tonite, however I walk to a very nice Chinese restaurant.


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