Epidemic Contained and Debre Berhan Shenanigans

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 was an impromptu kirar performer in my hotel's restaurant while I kept Aelaf company for dinner. Apparently it was some kind of Ethiopian Orthodox holiday so the streets of the city were filled. The kirar player was joined by 6 middle-aged men at the bar who laughed, drank, and danced while the music played. Once I get back home, I'll try to post some of the awesome video I took of these guys doing some traditional dances.

Friday morning began with morning report in the Chief Clinical Officer's office - the epidemic was still ongoing but seemed to be better controlled than the previous day. After seeing the patients and making sure that vitals got checked and fluid delivered, Dr. Aelaf, Dr. Keflegn (the head of medicine), and I got into a white pickup truck. Five minutes later, we turned off the main street and passed through the gates of the prison. The walls were not topped with barbed wire, there were no guard towers, and but for the large number of federal policemen with AK-47s, there was nothing that shouted "prison." The area just in the gate was a large courtyard with a cement compound off to the left, an open-air shack with rows of benches to the right, and another gate 50 yards directly in front. I surmise that the "real" prison must be behind that second gate because any prisoner worth their salt could easily slip through a crack in the haphazard corrugated tin sheets that comprised the walls of the courtyard.

There were 25 patients who were exhibiting symptoms similar to those at the hospital. They had been placed in two dark rooms about the size of a college dorm common room. We saw mattresses on the ground and huddled forms in fetal position or sitting slumped against the wall with a far-off, pleading look in their eyes. The three of us (Aelaf, Keflegn, me) set to work getting patient histories and vitals. I was in charge of blood pressure. A prison nurse promptly handed me a green rectangular metal box that upon opening, held a BP cuff, the hand pump, and a dial on the underside of the box's lid. I went from patient to patient, watching the mercury rise and fall, and then reporting back to the nurse recording the data. Both at the hospital and the prison, I was surprised by how young most of the prisoners were. Nearly all were between the age of 20-30 and looked like normal Ethiopians I meet every day.

Luckily none of the patients in the two rooms were too unstable, so we had the prison nurses start IVs while we went outside to talk with representatives from the regional health bureau. They were planning to take some samples for testing that should be done within the next few days (read: 3+ days). We returned to the hospital, made sure patients were stable, then spent the afternoon researching possible bacteria/viruses that could be causing the symptoms. The problem was that there was minimal consistency between various patients' cases. Some had a cough, others didn't; some had a rash, others didn't. So we came up with some ideas but no homerun.

Saturday, again, patients were still stable and some seem to be on the road to recovery. Again, we don't know what exactly is going on but giving fluid seems to be working and it's now a battle of attrition, us vs. the bug. Aelaf and I took a great 2 hr walk, heading north from Debre Berhan and then making a long loop back to wear we started once we veered off the road in pursuit of a passing herd of sheep. We were searching for the Saturday market and although ultimately unsuccessful, we discovered seemingly an entire city comprised of dirt/mud roads, horse-drawn taxis, and never-ending herds of animals.

The rest of Saturday passed without much further excitement and I returned to Addis that evening. I don't know if it's just me or the system, but travel in Ethiopia is rarely smooth. Among other things, this trip included: a scheming street kid who was trying (for a fee) to find us a bus, 5 federal police who were hot on our trail when we tried to take a gypsy bus, a legit minivan filled with 18 people, a policeman who held us for 30 minutes because we were at least 4 people over capacity, and 3 minivans once I finally got back to Addis.

Here are a few other highlights from the trip to Debre Berhan:

1. Dr. Aelaf shares a bathroom with one of the GPs. The GP had his whole family from the countryside visiting. In the countryside, people use leaves and rocks instead of toilet paper. The GPs family tried putting this improv TP down the toilet - hilarity did not ensue.

2. The town built a roundabout on the main road to slow down traffic. But there are no signs, markings, or anything else to make it stand out, so it's treacherous at night. On Wednesday night, a tractor trailer ran over the roundabout at full speed and proceeded to flip on its side. It was hauling cattle, which is the sad part of the story. The cows didn't die at the scene but I think their legs were broken because for ALL of Thursday, there was a crowd of at least 100 people just standing around these two cows munching on hay, laying by the crash. I'd guess the town's productivity on Thursday was net negative.

3. Before getting on the right bus to Addis, I got on the wrong bus. Somehow I mistook "University" for "Addis Ababa." Don't ask how. But we got 10 minutes outside of town, I tried handing in 50 birrh for my fare to Addis, and the kid taking money looked at me incredulously/confused. I nodded and said, "Addis Ababa." When he shook his head, I raised the pitch of my voice and turned it into a question, "Addis Ababa?" At which point, he and the rest of the van burst out into peals of laughter. Luckily the van just drove to the university on the edge of town (another 10 minutes) and then circled back to the bus station. D'oh.