Long Live The Sar

So leaving Ethiopia is never easy. Saying goodbye to friends, favorite places, and such exotic experiences is never easy, but who knew it would be so difficult for me to escape this year.... My initial flight from Addis to Beirut was delayed by an hour. As a result, I was bumped from my Beirut-Istanbul flight (even though they seated me on the plane, then pulled me off and let 30 other ppl take my seat). At 3:30 AM, I am not a happy person, and I am a very unhappy person when I'm kicked off a flight I should be on. I argued with the Turkish Air manager for an hour, demanding some form of compensation (miles, flights, lounge pass, food, heads to roll) to no avail. They offered to put me in a hotel for the night but without any guarantee of flying out within the next 3 days...I don't think so. Instead, I brilliantly took their offer of taking a cab to Damascus (which is in Syria as I conveniently forgot at the moment of truth) and flying from Damascus-Istanbul. At this point it&#

It is always difficult leaving this place I have come to love so much and so today, while sitting in a cafe, I sat down to make a list of the things that I will miss.  This was not as easy as it sounds because the first things that come to mind are all things that I will miss simply because they remind me of how nice life in the US is (i.e. cheap massages).  Instead, I wanted a list of things that I will miss about Ethiopia, not things that I will miss just because they are better/cheaper here than America.  Here is what I came up with: ~I will miss the omnipresent Ethiopia shirts, hats, and scarves that illustrate the ubiquitous nationalist pride in spite of the country's problems; ~I will miss the random conversations with people on minibuses who are genuinely interested in you (or at least your "whiteness") but interested nonetheless, ~I will miss desperation and danger of everyday life in Addis, ~I will miss the mundaneness of seeing polio, elephantiasis, and terrible

As every Thursday morning should start, Stuart, Berhanu, and I began the day with a tour of the St. George brewery here in Addis.  For those of you keeping up, this is my second brewery tour in Ethiopia; Ari Dia and I did Dashen in Gonder.  So St. George is the largest beer company in Ethiopia (70% owned by some French dude) and controls ~60% of the market share (vs. the 45% quoted to us @ Dashen).  The facility was not as impressive as the Dashen factory, but everything was made up for when we got ice-cold beer fresh from the fermentation tanks for breakfast and then our guide Robel loaded us up with free gear (4 t-shirts, a hat, 2 aprons, 3 mugs, a St. George Jersey, and coasters).  Basically I am know the biggest fan/walking advertisement for their product and can't wait to hit up the company bar @ 4 (after visiting the Fistula Hospital and indulging in ice cream and steam bath @ Addis Ababa Golf Club).  Should be a good day.... :-)

The last few days before leaving are always the busiest but I know my loyal readers deserve better...so here is a recounting of events from the last few days.   Golf - Stu and I went to the Addis Ababa Golf Club on Sunday.  Ridiculously awesome is one way to describe it.  We started our adventure on the driving range.  With 200 balls, a 5/7 iron, and two caddies, we were ready to work on our game (correction: Stu was ready to learn the game and I was ready to smack a few).  The club consists of a nice clubhouse, stables for the Addis Ababa Equestrian Society, a 9-hole course, driving range, gym, and spa.  The driving range is quasi-mowed; probably cut by hand with a scythe...like every other lawn in this country; there are markers for 50, 100, 150, and 200 meters and the tee-off area is great practice for hitting out of PGA-style deep rough (knee-high in places).  The highlight of the driving range however is that we each got a personal caddy.  The caddy's responsibilities inclu

It's hard to believe another summer in Africa is coming to a close.  My days are packed as I try to fit in everything I've put off and then some...  Yesterday was an especially busy (learning) day as I started the morning with ~Grand Rounds @ Black Lion Hospital - a 20 yr old female patient, known Type 1 Diabetes, with very short stature and discussed possible reasons for her short build ~Hip Hop class with Tesh - the whole classed learned a combination, almost 10 8-counts, I'll post video when I get back to the states - and then ~nursing class with Abebe at night - we learned about Trichuriasis and Strongyloidiasis (two intestinal worms endemic in Ethiopia)   So I learned a lot and stayed very busy. Because this is my second summer here, much of the day-to-day craziness ceases to strike me the way it did last year and for whatever reason, my stay has been essentially bereft of any deep "Africa revelations" like I had weekly last year.  Luckily such malaise

As we sit on the 33rd floor of our 5-star hotel in Dubai and log on to a free high speed Internet connection, our minds drift back to the wonderfully bizarre land that Sar has chosen to call "home" for a second summer in a row.  Ethiopia, where the water runs like diarreah and the people flock to Faranjis (foreigners) saying things like "My name is Money.  Can I have some Money?"    First off, Long Live the Sar!!!  He orders macchiatos and egg sandwiches in Amharic like a Habasha (Ethiopian), smells remarkably decent for showering once a week whether he needs it or not, navigates the labryinth that is Addis Ababa better than Diana does the grid that is Manhattan, and is making a HUGE difference to patients at the Mission.  If we had to choose one highlight for the week, it would be visiting Hanouk, Sar's patient/friend who had his leg amputated in an attempt to prevent cancer from spreading -- see previous blog posts.  Watching Hanouk's face light up wh

I apologize for not writing in the last week but Ari and Diana were in the house and to say that we experienced everything this country has to offer would not be an exaggeration.  To give you an appreciation for the craziness that was last week, I will go through the events of the past seven days.    Tuesday (7/22) -  Ari and Diana arrived at 12:50 AM.  According to Rick, only Ethiopian Air flights arrive on time/early, so Tesh and I assumed we had time to stop @ Cocoon Burger on the way to the airport @ 12:15.  One delicious beef patty later, Tesh and I walked to the airport, arriving at 1:30 only to find Ari and Dia preparing to call the Sheraton.  Whoops.  But all's well that ends well and I brought them to their cozy, albeit smelly and not too comfortable, room at the Taitu.  In the morning we had a great breakfast of scrambled eggs and then off to the mission.  I showed them wound care and gave them a tour of the compound.  Rick came for an hour or so and we watched him do

Yesterday I had two random, fortuitous encounters with street boys.   1) After a morning at the mission, lunch, and a visit with our patient at Black Lion, Katie and I were walking down to Rick's when we encountered a street boy laying in the middle of the sidewalk having trouble breathing and his body wracked by spasms.  One lady was standing by watching but no one had yet stopped to help.  Realizing that he was not having a seizure, I got down and rolled the boy onto his side.  This didn't help his symptoms but at least he wasn't in danger of choking on his own vomit.  By this time a small group had gathered to watch and some of his street boy friends were busy lighting matches, blowing them out, and sticking the still-smoking match under his nose to try and wake him up from his "seizure."  Other people in the crow tried to get the boy to drink some water but when he was unable to swallow Katie and I hailed a cab and took him to Bethzatha Hospital, a nearby p

After yesterday morning, ideally I would have had a relaxing afternoon sitting poolside at the Sheraton sipping on a daquiri with an umbrella in it, but it was not to be.  Stu and I had an all-american lunch of grilled cheese/hamburger, fries, and a coke, and I treated myself to a Snickers bar.  We shot off a quick email to Rick and then headed to the mission where we were set to give a tour to a group of HS students from the states.  It was a good tour and we were led around the compound by one of the workers who took us into the TB/HIV isolation ward, which was my first time up there.   After the tour, Stu and I went next door to pick up Zack and Katie, our friends who work for the Cherokee foundation.  Zack still had work to finish, but Katie joined us for a delicious chemaki and then we went to Addis Ababa University's Yared School of Music senior concert.  On tuesday, Zack and I were having a macchiato when we struck up a conversation with the guy sitting next to us.  Turn

Hanouk got his leg amputated yesterday!  Despite his 5-yr survival chance of 55%, at least now he has a fighting chance.  WARNING: If you don't want to hear all the details of the surgery, DO NOT read on. For those of you with strong stomachs, the world of Ethiopian surgery awaits.... Stu and I arrived @ Black Lion hospital at 7:30 yesterday, but of course couldn't find anyone to talk to until 8:30.  At that time, Dr. Biruk's assistant brought us up to Floor 4 - The OR.  We waited outside for an hour until we finally asked a passing doctor and found that Dr. Biruk was already in his first surgery of the day, a "hip angle plating" (basically the patient snapped his femur right below the pelvis and they were putting in a few angled plates and screws to help it grow back together - as Resident Ray calls Orthopaedic Surgery, "glorified construction").  Instead of bothering him right then, Stu and I went to hear a presentation on the "Management of a

So I wrote about Hanouk's aggressive cancer and pending amputation two days ago. The post I would have written yesterday would have gone something like this: Hanouk visited Black Lion this morning and his doctor again told him that "bone grafting" is an option as opposed to amputation. I spent 2+ hrs trying to convince him that it is not a real option and that amputation is the only possibility for saving his life but to no avail. The remote ("10-15%") hope of saving his leg is enough for Hanouk to ignore the experts' advice and sign his own death warrant. I am meeting him tomorrow morning @ Black Lion to talk with this Dr. Biruk and show him Rick's letter from the experts. On a side note: Of course as I ran to print out copies of the letter and 50+ pages of uptodate information, the power cut off in all of Sidist Kilo and Piazza. Maybe this was punishment for having 3+ days of electricity in a row? Power came back on an hour later, but too late

Two things note have happened in the last two days: 1) Rick emailed and asked me to convince Hanouk , a patient with malignant fibrous mistiocytoma in his left femur, to get his leg amputated. Hanouk's x-rays and biopsy results were sent to experts at Sloane-Kettering, St. Jude's, and MD Anderson, and all agreed amputation asap was necessary. After nearly ninety minutes I was able to convince him that this was the only option, and Dr. Solomon agreed to amputate on this coming Friday (hopefully). There is still time for some hurdles to emerge, but so far so good. Interesting note: Hanouk is currently in a hip cast because of a broken femur he sustained while playing soccer a few months ago, and he was/is convinced that he got the tumor because he played soccer. He believed that because he broke his femur playing soccer, it got infected, and that's what caused the cancer...interesting stuff. Should make for an interesting survey with Stuart, who is about to start his

Let the epic Awassa saga continue… After we checked out of the hotel, the four of us jumped into a motorcycle/tricycle taxi and went to the bus station.   We caused a shoved match by getting on the wrong bus (it wasn't that driver's turn to take faranjis) but eventually reached Legehar 45 km away (not the 6 km Tesh had told us).   There we met Tesh's sister, neice, and two brothers.   We macchiatoed and then got on a minibus we contracted to drive us to their father's farm.   This is a crucial point of the story – we negotiated to pay them 300 birrh to drive us to the farm (35 minutes on a dirt road), wait for us to visit, and then drive us back to Awassa, NOT Legehar where they picked us up. We drove to the farm, picking up a few passengers on the way but nothing ridiculous.   The countryside was gorgeous but I was surprised by the population density.   Even though we were far in the countryside, we were never out of site of at least one house.   Tesh's house wa

5 Things My Mother Told Me Never to Do : 1) Go fishing 20 yards away from an angry hippo 2) Eat raw fish in Africa 3) Drink "fresh" milk (basically straight from the teat) 4) Hitchhike 5) Hitchhike at night in Africa To call Awassa an adventure would be the understatement of the year.   Stu, Ray, Tesh and I left for Awassa on Wednesday.   We got very lucky and were able to hitch in some NGO's Land Rover that was headed south.   Compared to everything else that was to come, this was like riding in a limousine.   The 4-hr car ride cost us $4/person and we got to our hotel on the shores of Lake Awassa in time to watch the monkeys play in a gorgeous sunset over the lake.   We went for a walk along the lake, ending up at a lakefront bar and then finding a restaurant with fish goulash (on injera) and fried fish for dinner.   The experience was enhanced by the lack of power throughout the town and the awesome cloud-to-cloud lightning that lit up the night sky.      Thursday

I am too lazy to consolidate all of my thoughts on the day into a lucid post, so I will instead just list my impressions on the day: Just because something sold at the Sheraton looks like delicious mint fudge, it may still taste like crap. Hermaphrodite – Rick has 3 new patients.   All brothers, all hermaphrodites.   Born with both male and female genitalia, they have elevated testosterone levels but also elevated LH (LH surge in females causes ovulation) and Estradiol.   Very interesting that all 3 brothers have the same congenital defect. Everything in Ethiopia takes a while – Internet is slow, public transportation is spotty at best and the hills make for long, difficult, but fun walks Awassa is gonna be fun (we are leaving tomorrow, returning Thursday night) – I am bringing my fly-fishing gear and hope to catch a tilapia for dinner…we'll see how that goes. Tonight is abebe's birthday and I am taking him to Blue Tops – they have some of the best Italian fo

Have had a nice Sunday - slept in, waffles for breakfast, and then chilling Bole (Stuart and Ray are getting $12.50 massages!).  Really looking forward to the upcoming week: Monday - Regular work @ the mission Tuesday - Work in mission in AM, pediatric oncology clinic with Dr. Khalid in the afternoon, Abebe's birthday at night (Dinner @ Blue Tops - best lasagna. ever.) Wednesday - Morning oncology clinic with Dr. Amaha then going to Awassa with Tesh, Ray, and Stuart.  Hopefully get to use my fly-fishing equipment and planning to meet Tesh's family - they live 6 km from Awassa + an hour walk to the farm.   Rick and Tom are leaving for 10 days in India! Thursday - Hang out in Awassa and return to Addis late in the evening Friday-Saturday - Work @ the mission Sunday - Debre Zeit maybe? - Beautiful crater lakes an hour south of Addis.  Should be a great week and of course, will keep everyone updated.

It's been a few days since my last real update and though I have a few stories, it has been a great few days of typical Addis life. Thursday - Stu and I worked at the mission until Rick arrived, and after seeing his patients, Stu and I took Workinah (Olliere's Disease) and Firtuna (a beautiful 7 year old girl with Hodgkins) + family to a private clinic for blood tests. The tests were uneventful until we got in a taxi to go back to the mission. Right away I should have realized that the tire-size car part sitting at my feet in the cab was probably important, but off we "sped" (in 2nd gear...always). Everything was going swimmingly until we reached the big hill in front of the Hilton, that leads up to the Prime Minister's mansion; then the engine sputtered and died, and our cab driver skillfully manuevered us across 2 lanes of traffic back to the curb as we slowly rolled back down the hill. He pulled on the emergency brake, said "one minute," popped the t

Mosquito Kill Count last night: 40+   Everything is going well, lots to tell, but no internet as of late.  Sitting at Sheraton right now while Rick swims, about to indulge in some delicious cheese bread and the NY Times digest.  Consider a 4th of July treat....Happy 4th of July to everyone!   more to come soon....

Nothing too crazy has happened as of late, but a few small incidences are certainly noteworthy. On Monday night, Stuart and I went out for a few drinks with Bella and Naomi - Both are from Scotland, Bella is finishing her gap year before starting medical university, Naomi is visiting Bella. We started at a hotel bar beside the Taitu, the only people in the restaurant/bar. After a few drinks we moved to a literal hole in the wall I had found last year (for those who were reading last summer, this was the bar where i met the taxi driver who spent an hour trying to convince me he was jewish). This bar should be called the diamond in the rough (except for their expensive beers! 6 birrh/beer~60 cents). It was the most "authentic" ethiopian experience I've had thus far. By that I mean, it was the first time I was able to mingle with the local people in their haunts, simply as another bar-goer and not some strange faranji. This bar is about 30' X 60' with ~50 local

Today was a great day in Addis and one thing I had forgotten is how great life is here (at least for the visitor).  We worked from 9:00-11:30, and I found one patient that I will be paying close attention to over the next few weeks because I think he is a perfect candidate for special bandaging that should cut his recovery time significantly.  After work was juice, then lunch, then macchiato, then a great exploration walk around the mission area, then macchiato, then tea, then rounds with Rick. And I almost forgot, not electricity today in Sidist Kilo (the area of the mission), so we couldn't look at pathology slides with Bozuna...maybe tomorrow.      The subject of today's post is an interview Rick did with one of his patient's father.  Workinah is the 10 year-old male patient with severe Olliere's disease, or enchondromas all over his hands (particularly affecting his right hand).  He has recently been accepted for surgery at a hospital in LA and Rick is in the pro

Tired but content.  It has been a busy, busy few days here in Addis getting things set for the next few weeks.  Saturday, Stuart and I went to work the wound dressing clinic at the mission, slightly frustrated by the 1 hr of travel time required to get from Rick's to the mission via public minibus taxis.  It was a relatively quiet Saturday morning b/c there was a holiday in honor of some Christian saint, which Ethiopian Orthodox take very seriously (major crowds at every church).  It was business as usual - examining, cleaning, and wrapping - with a few surprising incidences.  2 patients of note: 1) a 50+ year old man from Harar who I treated last year, notable for the reason that he has an infected open wound covering more than half of his face, he is one of the most dignified patients we have and truly courageous in the face of what he deals with every day with his unspeakable injury, it is amazing that he is still alive; 2) a 2-3 year old girl that was missing an eye, it had bee

To start off with the most important news: it rained this morning and so the soccer game was cancelled.  Addisu, Mesfene and I awoke @ 4:30 AM, walked outside, and when we were told the game was off, went back to catch some shut eye.  Oh well, soon enough this jewish pele will be unleashed on an unexpecting Addis.   After a quick breakfast, Rick, Tom, Stuart, and I went to the mission.  As usual, things were hectic/unorganized, but for some reason this really fazed Rick today.  We spent 30 minutes looking for Sister Bridgitta and one of Rick's new Hodkins patients, a beautiful seven year old girl.  Overall things were moving pretty slowly but Rick saw ~10 patients, telling those needing any serious consideration to return tomorrow for his big clinic.  A group of 15 students/teachers from Georgetown Day School visited and Rick gave them a tour of the mission and introduced them to some of his patients.    I finally reunited with Abebe, and we had time to catch up, look over th

It's a great feeling to walk into a place and feel like you never left. Flying yesterday went very smoothly overall and I arrived in Addis @ 4:00 AM. Rick's son Duke, Mount Sinai first-year med student Stuart, and rising Middlebury sophomore Tom were waiting to take me back to Rick's. It was such a great feeling to walk into Rick's dark home, open the door to the living room and see 12-15 sleeping children scattered on the furniture, on mattresses, and on the floor; I felt like I had never left. I couldn't sleep so I stayed awake listening to everyone's breathing and then watched Donnie Darko on my ipod. The house came alive around 7:00 AM when all the children got up to go to school, our bedroom suddenly transformed into Grand Central. I joined everyone for breakfast and received very warm greetings from Bewoket, Zewdie, Dirige, Tesh, Dejene, Mohammed and all of Rick's boys. Around 9, Stuart and I went for a walk to find a bank and some coffee/pastrie