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.