Pediatric Rounds, Lalibela, Axum
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 pediatricians, they are all considered generalists, but most have interests in specific areas; he is interested in hematology/oncology. Since beginning to offer chemotherapy for a wide array of cancers, pediatric oncology now accounts for approximately 60% of all pediatric admissions.
After coffee, we trudged the 7 flights of stairs up to the peds floor where Dr. Haileyesus introduced me to Sarah, the teaching resident on the ward. I joined the two other residents and four interns on rounds, listening as we visited each patient. A few fractures, a myriad of cancers, a kidney stone, and endocarditis were present among the tiny patients. What struck me most about the rounds however was the socratic method employed by Sarah and her fellow residents, the collegial exchange that occurred, and the group learning process that encouraged participation by all. This was a far cry from the type of Ethiopian physician I have encountered before and hear so often maligned by Rick, Aelaf, Befekadu, and others. Perhaps it was the residents on rounds that day or maybe the phase of the moon, but I was pleasantly surprised, to say the least. I can't fully judge the quality of the care they delivered and the limitations of their setting were painfully obvious (the intern said he has never heard of the lab delivering back a positive blood or CSF culture, even when patients almost certainly have meningitis or septic shock), but the residents were trying their best and most importantly, trying to work as a team to diagnose and care for the patients. My fingers are crossed that the change I saw was systemic and not just a blue moon occurrence.
Lalibela
This town nestled in the jagged mountains of Northern Ethiopia is home to the country's crown jewel(s) - 11 amazing rock-hewn churches. Words are a poor substitute for pictures in this case so I'll try not to perseverate on these impressive feats of construction. To explain in slightly more detail, these 11 churches date from the reign of King Lalibela in the 12th century AD. Each church (some are connected) are cut into and away from the earth so that what is left standing is a sandstone structure the size of a small suburban house made from one continuous stone. The earthen walls surrounding each structure are covered in moss and pockmarked with caves that used to host the resident monks, sarcophagi, and churchly treasures. Most of the churches are connected via damp, pitch-dark tunnels, and the entire complex has the feeling of a huge maze. Kind of like the game with the marble in the maze and the board tilts. Passing through the tunnels and random holes in the rocks, you'd be confronted with this imposing structure that was similar to where you had just come from but you couldn't be sure if you had ever seen this particular one before. I'll try to post some pictures once I get back to Addis. One final highlight of the trip was an excursion I took on Sunday when I arrived to a cave church 45km outside of Lalibela. It was a beautiful 2 hr car ride there and the church is built inside of a large cave. To add to the crazy/creepy factor of the whole place, a quarter of the cave is filled with the skeletons of 10,000+ religious pilgrims who came from far and wide to die at this church. You can walk right up to the edge and see the piles of bones that goes on and on until it recedes into the darkest reaches of the cave.
Axum
As most of the guidebooks say, this town is slightly disappointing given its tremendously important and wealthy history as the capital of the Axumite kingdom from ~200 AD til the late 7th century. The primary remains are a few fields of giant (~85 ft tall) carved granite stelae that stand as tomb markers for some of the kingdom's earliest rulers and nobles. It is tough to imagine how the citizens were able to erect this monuments and tougher still to imagine how this thriving trade civilization essentially melted away in the face of rising Islamic power in the 8th century. The town is now home to 70,000 people (it was revitalized in 1906) and although the main street is wide and separated by a margin filled with short palm trees, the streets are filled with a mixture of cars, bicycles, donkey-pulled carts, and camels. After seeing the stelae I walked around the old city, which holds street upon street of mud walled homes behind rock walls but is eerily empty. According to my guide, the government is making people move out and prohibiting further development because of future archeological excavation plans. One highlight of the walk, other than the cute kids trailing us and the occasional street blocked by a lounging camel, was that we stopped in at a local wedding celebration for five minutes. The wall of the compound was surrounded by kids and adults alike, trying to get a glimpse of the festivities going on within. My guide and I were kindly shepherded to just inside the wall and saw a group of 30+ people doing traditional Tigrayan dances, a bedazzled bride and groom sitting on plush chairs overseeing the festivities, and the nearly universal merriment that accompanies weddings.
Tomorrow I am heading to Debre Damo, an isolated monastery built on a mountain overlooking Eritrea, guarded by sheer cliffs and accessible only via a rope the 80 resident monks dangle below for those willing (males) who wish to climb up. This location has been on my Ethiopian to-do list for my previous two visits and although I'm sure it can't live up to the hype, effort, and money I've poured into getting there, I am looking forward to the experience of visiting a place that most don't even know exists and that even fewer make the effort to visit.
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 pediatricians, they are all considered generalists, but most have interests in specific areas; he is interested in hematology/oncology. Since beginning to offer chemotherapy for a wide array of cancers, pediatric oncology now accounts for approximately 60% of all pediatric admissions.
After coffee, we trudged the 7 flights of stairs up to the peds floor where Dr. Haileyesus introduced me to Sarah, the teaching resident on the ward. I joined the two other residents and four interns on rounds, listening as we visited each patient. A few fractures, a myriad of cancers, a kidney stone, and endocarditis were present among the tiny patients. What struck me most about the rounds however was the socratic method employed by Sarah and her fellow residents, the collegial exchange that occurred, and the group learning process that encouraged participation by all. This was a far cry from the type of Ethiopian physician I have encountered before and hear so often maligned by Rick, Aelaf, Befekadu, and others. Perhaps it was the residents on rounds that day or maybe the phase of the moon, but I was pleasantly surprised, to say the least. I can't fully judge the quality of the care they delivered and the limitations of their setting were painfully obvious (the intern said he has never heard of the lab delivering back a positive blood or CSF culture, even when patients almost certainly have meningitis or septic shock), but the residents were trying their best and most importantly, trying to work as a team to diagnose and care for the patients. My fingers are crossed that the change I saw was systemic and not just a blue moon occurrence.
Lalibela
This town nestled in the jagged mountains of Northern Ethiopia is home to the country's crown jewel(s) - 11 amazing rock-hewn churches. Words are a poor substitute for pictures in this case so I'll try not to perseverate on these impressive feats of construction. To explain in slightly more detail, these 11 churches date from the reign of King Lalibela in the 12th century AD. Each church (some are connected) are cut into and away from the earth so that what is left standing is a sandstone structure the size of a small suburban house made from one continuous stone. The earthen walls surrounding each structure are covered in moss and pockmarked with caves that used to host the resident monks, sarcophagi, and churchly treasures. Most of the churches are connected via damp, pitch-dark tunnels, and the entire complex has the feeling of a huge maze. Kind of like the game with the marble in the maze and the board tilts. Passing through the tunnels and random holes in the rocks, you'd be confronted with this imposing structure that was similar to where you had just come from but you couldn't be sure if you had ever seen this particular one before. I'll try to post some pictures once I get back to Addis. One final highlight of the trip was an excursion I took on Sunday when I arrived to a cave church 45km outside of Lalibela. It was a beautiful 2 hr car ride there and the church is built inside of a large cave. To add to the crazy/creepy factor of the whole place, a quarter of the cave is filled with the skeletons of 10,000+ religious pilgrims who came from far and wide to die at this church. You can walk right up to the edge and see the piles of bones that goes on and on until it recedes into the darkest reaches of the cave.
Axum
As most of the guidebooks say, this town is slightly disappointing given its tremendously important and wealthy history as the capital of the Axumite kingdom from ~200 AD til the late 7th century. The primary remains are a few fields of giant (~85 ft tall) carved granite stelae that stand as tomb markers for some of the kingdom's earliest rulers and nobles. It is tough to imagine how the citizens were able to erect this monuments and tougher still to imagine how this thriving trade civilization essentially melted away in the face of rising Islamic power in the 8th century. The town is now home to 70,000 people (it was revitalized in 1906) and although the main street is wide and separated by a margin filled with short palm trees, the streets are filled with a mixture of cars, bicycles, donkey-pulled carts, and camels. After seeing the stelae I walked around the old city, which holds street upon street of mud walled homes behind rock walls but is eerily empty. According to my guide, the government is making people move out and prohibiting further development because of future archeological excavation plans. One highlight of the walk, other than the cute kids trailing us and the occasional street blocked by a lounging camel, was that we stopped in at a local wedding celebration for five minutes. The wall of the compound was surrounded by kids and adults alike, trying to get a glimpse of the festivities going on within. My guide and I were kindly shepherded to just inside the wall and saw a group of 30+ people doing traditional Tigrayan dances, a bedazzled bride and groom sitting on plush chairs overseeing the festivities, and the nearly universal merriment that accompanies weddings.
Tomorrow I am heading to Debre Damo, an isolated monastery built on a mountain overlooking Eritrea, guarded by sheer cliffs and accessible only via a rope the 80 resident monks dangle below for those willing (males) who wish to climb up. This location has been on my Ethiopian to-do list for my previous two visits and although I'm sure it can't live up to the hype, effort, and money I've poured into getting there, I am looking forward to the experience of visiting a place that most don't even know exists and that even fewer make the effort to visit.
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