Getting into a routine.

I've settled into the routine of my visit.  My roommate, Korosh, a radiologist from Toronto, returned yesterday. It's nice having someone else in the apartment.

 This photo was taken on rounds this morning.  If you look closely you will see three 28 week premies sharing a single isolette.

I'm beginning to struggle with just how I can be most helpful.  I spend a part of my day rounding with the pediatric interns, residents, and the neonatal fellows.  I'm able to make suggestions about care but I'm looking for ways to make more lasting improvements.

Even though resources are severely limited, the challenge is to identify changes which can improve care without significant cost.

One of the most important and lasting recent improvements addressed infant nutrition.  Using minimal additional supplies, the nutritional content of breast milk and formula has been dramatically improved. Babies who previously weren't growing are now showing steady weight gain.  This is huge! 

This little guy wandered into my office a few days ago.  To me, he signifies the major reason I've made this trip. In Ethiopia and other countries in Sub-Saharan Africa, 1 in 8 children dies before age 5. This is more than 20 times the average for industrialized countries (1 in 167).

I had an opportunity to visit a pediatric ward this morning with Goitom, one of the neonatal fellows.

Here I saw six to eight children with their families living together in one room. In every corner there were stacks of food, bedding, and clothes.

On a lighter note, I have come to enjoy Ethiopian coffee.  My drink of choice is macchioto.  It is available everywhere including in establishments which have a strong resemblance to Starbucks.  There is, however, one major difference.  Decaffeinated coffee does not exist in Ethiopia, at least in all the places I've looked.  I've learned to skip coffee at dinner if I want to sleep.