I'm home.

I'm home.  The trip from Addis to Seattle was a long one.  I left my apartment at 7 p.m. Saturday  (Addis time) and I walked into my house in Seattle, late Sunday afternoon, more than 24 hours later.  Time, of course, does not begin to measure the length of the journey.

It will be some time before I can begin to understand the impact this month has had.  In Addis we will need to wait in order to learn whether our efforts to make sustainable change bear fruit.  For me, however,  the changes are already real.

This was my first immersion into a developing country.  This was my first trip to Africa.  This was my first attempt to practice medicine with severely limited resources.  And this was my first real experience where I could never escape being "ferengi" the foreigner.  

Although I had previously traveled through Europe, the Middle East, Central America, and Asia,  in those places I some how found ways to blend in.  This was not possible walking or even driving through a small village in Ethiopia or, for that matter through downtown Addis.  I could be spotted a mile off.  I wonder if this is what it is like for a person of color walking through my neighborhood in Madison Park.

This blog, as well, has been a new experience.  I have never kept a journal which required me to reflect on my journey.  It has been a good experience for me.

On they way home, I read the last pages of Abraham Verghese's "Cutting for Stone."  It is a beautiful narrative of a medical family caught up in the changing fabric of Ethiopia.  For me, it was richer because the places and people described are so alive in my mind.

This will be my last post.  I can't resist including a few last photos.

 

  

On to Aksum

The early history of Aksum goes back to 400 BC.  It has been described as "the last of the great civilizations of Antiquity to be revealed to modern knowledge."  According to Ethiopian legend, Aksum was the Queen of Sheba's capitol in the 10th century.

We arrived mid morning and hired a three wheeled bajaj to go out and explore on our own.

Our first stop was Queen of Sheba's castle.

Kids were everywhere selling all kinds of souvenirs.

Next we headed off to the stelae fields.  Stelaes are ancient stone obelisks which are thought to mark burial sites.  The largest tower a hundred feet in the air and are ornately decorated.  Some date back to the 4th century.  

Lucas and Andrew went off in search of a camel ride while Dominick and I visited the St. Mary of Zion churches.  The old church was built in 1665 and a newer one was built by Haile Selassie in the 1960's.

In between the two churches is a tiny carefully guarded chapel which Ethiopians believe contains the Ark of the Covenant.

No one but a single monk who remains inside is allowed to view the ark.  Conflicting stories exist as to how the ark moved from Sinai to Jerusalem and finally the Aksum.  Some legends suggest that Menelik, the son of Sheba and Solomon brought the ark here.  Regardless, Ethiopian Christians believe the ark is here.

We headed back to our hotel and along the way sampled an ancient Ethiopian refreshment.

North to Lalibella

This past weekend my three Canadian colleagues and I took off Friday morning and flew an hour north to Lalibella.

We took a bumpy 20 minute ride up the mountain from the airport and arrived at the spectacular Mountainside Hotel which looked out to the valley below and the distant mountains.

We got settled in and then picked up our guide and headed further up the mountain through the city of Lalibella which was the capitol of the region in the 12th century.  It is here that King Lalibella built a series of 11 stone churches which were carved out of the volcanic rock. 

The workers dug down into the rock until they had created a solid rectangle.  The then proceeded to carve the structure from the outside in eventually forming windows and doors on the outside and rooms with columns within.

Here you see me with Lucas, Andrew, and Dominic who are all emergency room physicians from Toronto and are also teaching at Tikur Anbessa.

We were fortunate to be at the churches during the beginning of the Lenten season and many people were gathering for daily mass.

We returned to the hotel and then walked to a nearby restaurant which was perched on a nearby hill side.

We arrived just as the sun was setting.

 

The temperature dropped and the wind picked up during the meal and our hosts provided us with blankets.

We then walked back to the hotel in the dark to get ready for an early flight to Aksum in the morning.

Entering my last week

Today begins my last week at Tikur Anbessa.  My major focus is to finish orienting the fellows to the online database which we have created.  Our goal is to be able to look at demographics, treatment, and outcome data on all of the infants admitted to the neonatal unit.  The fellows and I are already excited about the insights we are gaining by just looking at the data from the first 50 patients which we have entered.  At this point the data will just be available to the staff at Tikur Anbessa. Once IRB (Institutional Review Board) approvals have been obtained both here and at the University of Vermont the institutions will be able to share this data and measure impact of specific changes which are implemented in the nursery.

I've thoroughly enjoyed working with the pediatric interns and residents.  They are bright and hard working.  The challenge is to help them to develop practical patient care skills to go with their considerable basic store of factual information.

The fellows and I are in a groove.  They are pleased about the database and also anxious to complete our second project which is the development an algorithm to aid in decision making regarding use of antibiotics.  We all agree too many infants are receiving antibiotics.  The database will help us see if antibiotic usage and outcome changes with implementation of the new algorithm.

The fellows are equally interested in my excursions out of Addis.  After rounds we take a break in the cafeteria.  

The want to know about each place I have visited and to fill me in on the rich history of their country.  The mug I'm holding contains a smoothy of mango and strawberry.  Sometimes it also contains avocado which then gives it all of the colors of the Ethiopian flag!

Visiting the Jewish community of Addis

Today I went with Shana Miles on a  five hour exploration of Addis looking for communities of Jews living in the city.  Shana had gotten some clues regarding places to explore.  We hired a taxi for the day for 400 bir (about $24) and first sent out looking for a community near the Israeli embassy.

After several failed attempts we ended outside a locked gate.  When it was opened for us, we were told we needed to get a permit from the Israeli embassy in order to enter. 

We got back in the cab and drove to the heavily fortified embassy.  We were first met by a guard with a sub-machine gun who then summoned another security person who checked our identification.  After many questions about our intentions we were advised to return Monday morning when the embassy opened.

Next we went in search of another community, Bet Abraham.  Again, we had many false starts and finally ended up outside another gate.

 This time we were greeted by a very friendly Ethiopian woman who welcomed us in and soon was speaking Hebrew with Shana. 

We were told this was a messianic Jewish community.  A service was underway and we were ushered to the front row where we quickly realized we had found our selves in an evangelical service.  There were two menorahs on the pulpit and the two preachers were auctioning a framed drawing of the city of Jerusalem.

We slipped out of the service and took time to look at the Judaica crafts in the courtyard.

There were CD's of some of the ministers sermons

We asked our hosts if they knew of any non messianic Jewish communities.  They clearly wanted us to identify them as practicing Jews.  They seemed comfortable combining Judaism with Christianity but realized we were searching for something different. Two of them got in our cab and took us to an area of Addis know as Kedene.

We finally connected with two members of the local Jewish community.  They took us to their synagogue.  We had finally found what we were looking for.

We sat and talked with Belayneh and Abebe.  They told us of the persecution their families had experienced and how until very recently, it was necessary for them to practice their religion in secret.  They said the airlifts which took Jews to Israel more than nine years ago had focused on the communities near Gondor and had ignored the communities near Addis.  They had conducted what sounded like an elaborate census and had identified 30,000 Jews in Addis and another 20,000 north of the city.  They were anxious to connect with Jewish communities outside of Ethiopia.

Belayneh introduced us to the oldest member of his community

We were each given a copy of their siddur or prayer book which they had translated into Amharic.  We exchanged email addresses and told them we would try to stay in contact.  We reluctantly said good bye.

Exploring Bahir Dar

Bahir Dar is a city in north western Ethiopia situated on the south shore of Lake Tana.  The Blue Nile flows south out of the lake and then west and north through Ethiopia and Sudan to join the White Nile to form the Nile River.

We got up early Sunday morning and hired a small boat to explore the lake.

Our guide took us to two monasteries, one of which was located on a small island in the middle of the lake.

 

 

This monk who spoke only Amharic was able to let us know that he was showing us a painting of St. Stephens.  When I told him my name was Stephen, we had a good laugh.

At the second monastery we looked in on a Sunday mass.  The priest then moved the service outside and continued to chant the liturgy.

Our guide then took us to the beginning of the Blue Nile.  We were fortunate to see a few hippos feeding close to shore.

Photo courtesy of Korash Khalili

Later in the morning we hooked up with three US Army officers who were spending the year getting immersed in culture of several African nations.  There assignment is to advise the US ambassador on local issues.  Following this they will return to the US to get masters degrees in international studies.  Ultimately they will return to Africa as military attaches in one of the embassies.

They shared the Toyota Land Cruiser and driver and we drove out of Bahir Dar where we hiked to the Blue Nile Falls.

The water over the falls is much diminished at this time of year because the river is low and 90% of its flow is diverted thru two nearby hydroelectric sites.  We continued our hike and first crossed the Blue Nile gorge on the 600 year old Portuguese Bridge and later crossed back across the gorge on a modern pedestrian suspension bridge.

Finally we took a small boat across the diversion channel then hiked back to our vehicle for a ride to the airport and back to Addis.