Makin' do with watcha got

  It’s an early rise for David. No water, so no shower. We use our pre-filled hot pot to boil water for AM care. David meets his fellow neurosurgeon Mersha in the hospital café that offers a simple roll, tea or coffee. This is the only place where any food is available for hospital people and only tea, coffee and a simple sweet roll is available for purchase, unless you can can get fed M-F in your own dept.David and Mersha  head to the OR to prepare for surgery. Ready to go? It appears not. The autoclave machine (sterilizer) broke down, and without back up equipment, all surgery is cancelled for the day. I join David and the residents on their hospital rounds. They have about 25 patients to see, including some pediatric.

  Although here are some small rooms with 4 beds, the majority are large wards with 8-12 beds and there are no curtains between patients for privacy. The beds are old, without side rails, and are not electrical. The Black Lion is a public hospital serving the poor and often illiterate. It is quiet here; there are no TV’s on the wall, and no one has a radio or a computer, not even any reading material at the bedside. Patients wait to get better, often waiting weeks to months for surgery, or if necessary surgical supplies are unavailable, they simply wait for the body to heal itself. At this time the hospital has no pedicle screws (used to stabilize spine fractures) and hospital management has no money to buy them. There is nothing to be done until some country or company donates supplies. These items are frequently available at the nearby private hospitals but if the patient does not have ready cash, there is nothing to be done. Those in need of radiation for tumor treatment are sent home and advised the wait will be at least a year or two before an appointment becomes available (by which time their tumor frequently grows back).

   Patients are required to bring their own hospital supplies at admission, including necessary medications, IV bottles, catheters, linens and food. If they have an ID card that certifies them as “poor” (which, according to American standards, would cover 98%of this population!), the hospital will provide the items needed. However, since many cannot read or write, they do not know how to sign up for assistance.

   Except for the open veranda areas, this large 400 bed hospital is quite dark. Perhaps one out of 3 hallway lights is functional day or night, and that is at low wattage. The hospital wards have windows for natural light. These open veranda areas have internet connection, but it is very spotty, and already the server has been down for the past 2 days. Several verandas have 2 or 3 long hard wooden benches, and we try to eke out a fanny spot among the medical students studying on their computers. There is no lighting here, so computer use is for reading not writing. The several electrical outlets on each veranda are always in use and not near the benches, so if a plug-in is needed, one just sits on the concrete floor. The medical library is a long and dark area, with no more than 15-20 computer hookups for Ethernet but not Wi-Fi. Again, there are only several electrical plugs in the entire library and they are never near the Ethernet outlets, so it is a constant game of finding a seat, getting connectivity and then trying to get some computer work done before you run out of juice. An inordinate amount of time is spent (honestly, HOURS!) just trying to get “set up” before you even start getting something done. The frustration is beyond comprehension and just sheer crazy-making. These are the only areas of connectivity on the hospital campus and there are no computers available for general use, you must own one.

   Yesterday we walked toward town and saw a very large crowd of perhaps 1,000 people, gathered around an enormous building with “Immigration Office”  written on it. The lines snaked from the left and the right for probably close to ½ mile each way and meeting in the middle at an office area. Everyone stood with some documents in hand as they slowly inched forward. I have since learned that the Saudi government, and probably other wealthy Arab countries are advertising heavily to encourage Ethiopians (and probably other African nationals) to come and work, offering free airfare and a multitude of benefits. Conditions are so poor here that Ethiopians are anxious to find a better life. I am told that often the conditions are sometimes even more intolerable there, where they may find themselves as “indentured servants”. David and I were in Saudi in 1990 and found the country to have a sub-minimal work ethic; that is, their main job was to find people to work for them, since working was something they had no interest in doing. Sounds like not much has changed.

   On this same stroll I bought a very large and colorful plasticized folding map of Africa from a young street-seller for $1.50. I unfolded it longitudinally, showing the entire east half of the continent.  “Where is Ethiopia?” I asked my 20-something salesman. “Open, open”, he said, trying to nudge the other half of the map open. I showed him again the eastern half and asked him to show me Addis. He never knew where either his city or his country was until I showed him...a most miniscule teaching moment…

   The weather has been unusual. Though the rainy season does not start until end of April, we have had a light warm rain almost every evening but delightful sunshine and 70-75’’ during the day.




A dead end study cornerat the medical library for ethernet, only about 20 of these for the whole medical school and hospital. you must bring your own computer,

     On our walk I noticed a sign for Tikur Ambessa Secondary School wit h students pouring out of its gates. I asked a young girl to take me to the headmaster’s office where I introduced myself to Mr. Abera. I have arranged to attend several classes tomorrow. It should be a very interesting experience-

  PS/  I have been trying to attach pictures for over an hour but the connection is very, very slow. I will try again tomorrow. David and I are at the Ethiopian Hotel because the server at the hospital is down, therefore, no ethernet; and the wifi hook up box has been removed, presu



 

A side courtyard at our public hospital.

9th grade class, they did not appear to take their education seriously, spending most of the classtime in constant,very noisy chatter, seat-changing and with little interest in the subject matter.

A very good biology teacher who enjoyed his subject and seemed to have better control of his classroom.

The hospital has 3 veranda areas with 2 benches each where wi-fi is available (sometimes). This area is filled 24/7 with students trying to get on-line. Often I have sat on the floor.

The only place visitors or general hospital staff  can buy food in the entire hospital. This cafe offer only coffee, tea, and 3 kinds of sweet rolls.If you are a doctor, then sometimes the dept. secretary cooks lunch. We are lucky that our surgery secretary, Elaine, is a great cook and offers Ethiopian injera for lunch.This is where we meet the residents at 7:45 and then go for AM rounds of patients.

 mably for repair and perhaps will be fixed some time next week. That means, there is no connectivity in any form at the hospital...unimaginable- As David and I remind ourselves when frustration mounts: "This is Africa"., and it has a long way to go, tech-wise. The people, however, are kind, gentle, intelligent and quite charming.They deserve success. I hope their government comes thru for them.

Lines at the immigration office. Ethiopians are being offered free airfare by Saudi and other Arab countries in exchange for work. Those unable to obtain legal papers often resort to illegal methods of emigration which frequently lead to disaster: forced into the sex trade, walking across the Somalie desert and dying of starvation or being kidnapped and having a kidney or eye removed as a "living donor".

Settling in...

It’s been a long day, or rather long day and night and day, with an 11 hour time change from the west coast. The flight from the states to London is about 10 hours, then 4 hours of hanging out, then another 8 hours to Addis ( here they say only “Addis”, sort of like “Frisco” for San Francisco). We were disappointed that the Boeing 787’s were grounded, that would have been our airplane. But we made ourselves comfortable in an older 767 model that even still had ugly, stinky ashtrays in the console.

   Our big worry was customs. We had heard from 2 American doctors who had recently been here in Addis, that often the only way to get medical supplies cleared was by a little cash passed under the table, and this, only after much wrangling and phone calls to the hospital people who would then call friends in the government. Our last option was to just leave everything and let the hospital figure out how to retrieve it, though this concerned us greatly for fear it would be rifled through or stolen.  And we had lots of supplies to worry about (about $80,000 worth!)... boxes of cranial reconstruction tools and materials, bone wax, and gigli saws (yes, as in “giggle” but nothing to laugh at. A gigli saw is a braided wire about 16” long, with hard metal “teeth”. It has a loop at each end to which handles can be attached. When passed under the cranium via burr holes, it needs only some muscle plus see-saw action to make a clean and quick cut). Gigli saws are dinosaurs in American hospitals, but precious and essential in countries that lack funding for any ultra-modern equipment. Our game plan was to declare nothing and just head through the gates, as we had done successfully last year in Kenya. However, Ethiopia is unique in that after baggage is claimed, it is put through a scanner, and that’s when the “Secrets of the Suitcase” are revealed. I saw 2 large scanner ahead of us 2 large scanners, one with a man staring at the screen in deep concentration, the other with a young woman with… what? A BOOK? Was she really HOLDING A BOOK IN HER LAP, and engrossed in a novel she had positioned below the monitor desk??? We quickly loaded our baggage to her conveyor belt, and it spilled off on the other end as she seemed to turn the page. We loaded up our trolleys and headed out the large doors. Time for high-5’s!!!

We were met at the airport by one of the neurosurgery residents (they have a moderately new and certainly ambitious program, with 20 residents) and then delivered to our apartment, certainly basic but manageable. Wubi, a lovely young Ethiopian lady will attend to us for all our needs for the next 2 weeks, as well as wash our clothes and cook any meals we may wish. All this for about $1.15 a day!

   Our next stop was to meet Dr. Mersha, head of the neurosurgery department and a delightful young doctor who manages his life via cell-phone. Since he was about to start surgery at the Black Lion Hospital, he invited us to make rounds with 6 of the residents currently on his service. The residents were sharp and well-learned, they knew the correct answer to almost every question David posed to them, and they explained some very challenging cases. The heartbreak is that most of these patients had already spent a long time in the hospital, but due to lack of equipment, such as pedicle screws to stabilize vertebrae, they must lay flat in bed for perhaps several months, waiting to fuse “naturally”.

   We had eaten little on the plane, trying instead to sleep on the overnight flight, so we asked about a cafeteria. It seems there isn’t any, just a small pastry shop. Patient’s families bring all the food, beverages, linen, clothing, and whatever else is needed for comfort. Mersha invited us to join him and a dozen fellow physicians to the doctor’s lounge where the secretary, Elaine whips up a daily lunch for the surgical staff (each department feeds its own). Today she offered an international spaghetti dish (which we immediately declined) and we were overjoyed to share a platter of the Ethiopian Grand-slam Special: a blanket of injera bread, covered with portions of beans, hummus, salad, lentils, slaw, spinach and “wot”, a hot and deliciously spicey side dish. This is a daily banquet of food and friendship. In typical Ethiopian style, no silverware was offered. The soft and billowy injera is used  in a scoop manner by the right hand, to bring morsel to mouth.

   Wouldn’t that be one less worry for American hospitals…if they didn’t have to serve food???!!!

View from our apartment. Black Lion entrance is on other side of Dumpster



Our very basic shower. one towel provided, no soap, no TP, shower is only source of hot water, and that's when water is avbl. Since our arrival we havealready lost all water and electricity for 4-6 hours 3 times.



Daily lunch at the doctors lounge, much spirited discussion in Amharic, less English spoken than we had expected. Surgical secretary, Elaine, cooks daily and with great finesse!



We were invited to Elaines small apartment where she makes anjera every evening for the surgical staff and brings it to the office. An anjera grill is about 30" across and a thin yeast batter is poured on. It is covered, cooks quickly and is served with various side accompaniments, all delicious! (electrical connections tend to be dicey)



Our bedroom, and suitcases with supplies.

       

Our little kitchen. Wubi, our room servant, offers to cook but this area is not so clean, refrigerator works but needs  frequent unplugging so as not to freeze everything. We use the hot kettle for boiling water for AM coffee.There are many Ethiopian restaurants near by, average cost of meal is $3.