Long Live The Sar

Here are few pics from the past week. This cave church in Lalibela predates the rock-hewn churches by nearly 100 years - Yemrehanna Kristos (The skeletons are off the R side of the picture) The entrance to one of the churches in Lalibela One of the largest churches in Lalibela - Bet Medhane Alem (I think) Bet Giyorgis - Lalibela's pride and joy. The picture is a bit misleading b/c it's actually 30m tall The Debre Damo monastery resides on this mountaintop. (Possibly) the oldest church in all of Africa, dating to ~6th century. The view from on top of the mountain. The landscape was very similar to the canyon lands of the American southwest, just with more green. Just climb to the doorway above the kid in yellow. (This picture cuts off the last few feet at the bottom) I'm sure the "safety" rope on the L was up to industry standards. The leather didn't look too worn or twisted... Victorious, post-descent smile.

It has been a few days since I last wrote because it has been an action packed six days. I'm now sitting in an internet cafe 125 km from Eritrea, along the palm tree lined streets of Axum. Rather than give a day-by-day accounting of my past week, I'll focus on the three highlights listed in the title of this post. Pediatric Rounds at Black Lion Last Thursday I spent the morning at Black Lion shadowing the pediatric residents and interns as they did rounds. When trying to set up a study on pediatric Hodgkin's Lymphoma, I emailed with a pediatrician at Black Lion, Dr. Haileyesus Adam. I met him during my previous visit to Black Lion and I was able to finally get him on the phone and finagled an invite to shadow. We started the day with coffee in the hospital's shai bet (which is really just a few tables in the main lobby with waitresses shuttling trays of macchiatos and juice). Dr. Haileyesus explained that there are no "specialists" among the pediatricia

I haven't yet posted an update on my daily life this summer, so here's a brief summary of the past few days. Monday - I woke up Monday and had to move out of the JDC house where I've been staying into a hotel because the house was being fumigated for suspected bedbugs. I don't think we had any, but I wasn't the one getting bit so I can't say for sure. After breakfast, I went to the " Red Terror " Martyr Museum near Meskel Square. This new museum commemorates the 2 million people killed during the regime of the communist Derg (1974-1991) and the 500,000 killed between 1977-1978. The museum has many photos and some interesting points, but is unfortunately a little light on details and doesn't give enough background information. However, it's still relatively new (1 year), so I'll give it a break. My pseudo-tour guide was a nice middle-aged man who had actually been imprisoned for 8 years by the Derg, and he had shared a cell with one

A small collection of some of the funnier things I've seen in the past three weeks. Note the "Customer Name" on our dinner bill from the other night. Apparently they missed the memo about NOT calling your charity a "scheme" The "Complaint Desk" at the Ethiopian Telecommunications office. Obviously customer service is not their highest priority. Toby, the newest addition to the JDC's stable of dogs. This was taken at a "puppy play date" we attended two weeks ago.

Looking back, I realize the tone of my initial post about the epidemic may have seemed a bit alarmist. To clarify, the disease we were dealing with was not ebola, bubonic plague, or malaria (even though a few of the prisoners may have had that too). Administering fluids was sufficient treatment for almost all of the patients; the issue was when the nurses neglected to check the patients' fluid bags, IVs, or other basic vitals. Now back to the story... Thursday morning, Dr. Aelaf stopped by the prisoners' ward before morning rounds. During the night, 3 patients had become unstable and the rest were doing ok, not great. Of course vitals had not been checked in about 5 hours and patients were running low on fluid. The situation got fixed and patients returned to borderline stable condition. We went on morning rounds and then I went back to my hotel for a nap and an extended (but ultimately victorious) battle against slight bout of food poisoning. The highlight of the night

A quick note about the hospital and its response to the outbreak: The Debre Berhan Referral Hospital is a compound of ~30 single-story buildings with nearly 115 beds. There are wards for medicine, pediatrics, surgery, and OB-GYN as well as an emergency department, an outpatient clinic, and an ophthalmology department. There are close to 10 senior physicians on staff and more GPs (General Practitioner – graduated 6 years of university/medical school but no further training) overseeing patient care. Dr. Aelaf and the GPs live on the hospital grounds in 15'x15' single rooms. We visit the hospital's shai bet (tea house) at least 3 times every day. As for the outbreak: Only a handful of people seemed to care about the fact that we were in the midst of dealing with an epidemic or that the patients were at serious risk of death if not managed correctly. The Chief Clinical Officer, a caring, well-intentioned physician, works hard to improve the hospital and often considers

I haven’t written in a few days because there has simply been too much going on this week in Debre Berhan. I arrived on Monday afternoon and met my host, Dr. Aelaf Worku. A former Mt. Sinai student and resident, Aelaf has been working in Debre Berhan since February on a joint project with Dr. Joseph Mascii, head of ID at Elmhurst Hospital in NYC. Although initially a slightly intimidating figure, it became quickly apparent that he is a driven, passionate, and thoughtful person who is burning it at both ends here to affect some of the change he knows is possible. To be sure, there is no shortage of room for improvement. Likewise, there is no shortage of things that I could write about my experience here. However, the true excitement began yesterday (Thursday) around 10 AM… Wednesday night, two prisoners from the town prison had been brought to the hospital for uncontrollable, watery diarrhea. Dr. Aelaf was able to stabilize his patient, giving him 8 bags of fluid in or

One of the most exciting things about this summer is reconnecting with patients that I met either three or four years ago. Some of the patients have undergone successful surgeries in the meantime, regaining use of their hands, backs, and jaws. However, more of the patients I have seen are those who are still suffering from their various maladies that I was first introduced to years ago. On Saturday, a patient came to Rick's clinic who I first met in 2008, briefly described in this post. "Blayne", as we'll call her, was a beautiful 17 year old girl at that time who suffered from a debilitating neuromuscular disorder. She was confined to a wheelchair, had constant tremors and tics in both her hands, arms, and head, and was dutifully cared for by her loving father. I frequently think of Blayne and her father, the pleading in his eyes as he waited during Rick's neurologic exam, the tenderness with which he lifted her in and out of her wheelchair, and the obvious devot

I spent yesterday (Wednesday) at Black Lion Hospital, attending the resident's morning report and a guest lecture by an ENT physician from Phoenix, Arizona. The purpose of his talk was to introduce a neonatal hearing screening program that is being started at Black Lion and to explain its importance. The doctor donated a machine that detects otoacoustic emissions from the inner ear that are absent in people with hearing loss. (For extra credit: Does anyone have any theories as to why such a phenomenon even exists? It seems counterintuitive for the ear to produce its own sound). In the US, children who are identified with hearing loss are enrolled in early intervention programs that educate the parents in various forms of communication, such as sign language, beginning at six months; many children who experience this early intervention end up in normal school classrooms and communicate at a level on par with their normal-hearing peers. In the US, children with very severe hearing l

Friday and Saturday were spent with Rick seeing patients at the Mission. As usual, the days were jam-packed and went from 9:30-4, without any breaks. I still can't figure out how Rick survives most days without eating or drinking. The majority of patients were spine or heart patients, but it is extremely exciting to hear a heart murmur and be able to say something other than "yeah, hmmm, it sounds like water rushing through a pipe." Among the more interesting cases, there is a patient with potential Wilson's disease, a child with Madura head, and a child with Windswept Syndrome. Crazy, crazy stuff. It's odd how normal it seems to see a patient with TB of the spine with a shape like a > or worse. I have been spending a lot of time with Rick's boys, which has been a total blast. They are the warmest, kindest, most fun group of teenagers I have hung out with since the 10th grade. Semegnew, Dejene, and Mesfin are all home for the summer and we have sp

Returning to Addis has been like becoming reacquainted with an old friend, but something has changed and you can't quite put your finger on it. The city still looks the same (minus the rampant construction) and there are still dirt roads, beggars, and muddy sidewalks galore, but the city has an indescribable energy. I have no idea what the countryside is like and think it's an interesting policy move to export energy to Djibouti before providing energy to the country's rural populations, but I'm blindly trusting that Meles and crew thought this one through...) The changes were readily apparent the moment I stepped through immigration, looked at my phone, and found I had high-speed wifi. Whoa. I kind of looked around to make sure I was actually in Addis; in 2008, there was maybe 1 quasi-high speed internet cafe. Turns out there are a smattering of high-speed places that are a significant improvement over the dial-up days of yore. I spent most of my day in the Bole