Ethiopia

So, it's sort of embarrassing that I've been back for over two weeks and haven't taken a minute or two to post about my trip on my blog. But things have literally been so crazy. Sometimes when I take a step back from my life I have no idea how I manage to do it all. I don't mean that in a sort of, "Oh wow, look how awesome I am" kind of way, it just really seems almost comical sometimes.

Anyways, a few weeks ago I got to go to Gondar, Ethiopia for a week. The plan was to go with all of these surgical supplies and they were going to teach us how to do small incision extracaps, and we were going to teach them how to use the phaco machine they have. I spent weeks before hand applying for supplies and getting everything ready. We got it all in the nick of time and packed it all up. Then we got to Ethiopia... and they confiscated it all. Every last bit of it, including the phaco handpieces and the surgical instruments that we had gotten. It became a week long battle, and in the end we ended up leaving our stuff there in the hopes that eventually they might get the supplies. The government was just being ridiculous. Their people are starving to death, blind from cataracts, and they want us, or the University of Gondar, to pay almost $40,000 to get the stuff out of customs. Stuff that we did not pay a dime for. Insanity.

So, we never got our stuff. But our hosts were very gracious, and I, as the resident, did learn a lot about how they practice medicine and the struggles they face. Truely, it is humbling. The work they do makes what I do on a daily basis seem meaningless. 1.5% of adults in Ethiopia are blind, and of that 1.5%, 50% of them are blind due to bilateral cataracts. We're talking you-can-count-my-fingers-in-front-of-your-face-but-you-can't-read-the-chart blind.

First stop was Addis Ababa, the capital of Ethiopia. We stayed at the Harmony Hotel, which was pretty nice and near the airport. They had massages there, for about 200birr. With 1birr = $0.05, it was quite the deal. Since we ended up staying a day longer than we thought we would, I went ahead and splurged on one. I don't know if you can see or not, but the scaffolding is made out of wooden sticks. Not exactly as sturdy as i would want it to be to climb up there...

Taxi's in Addis

They had some museums - this is where Lucy, the oldest known human or whatever is from. The museums were about what I guess you would expect in Africa, but they were really some of the worst I've ever been to. Even in Peru and Brazil, which are poorer countries (especially Peru) they were nicer. But they also have a more robust tourist economy. Being in the horn of Africa does not help them much. So I didn't really take any pictures of the museums. The picture above, however, is the cathedral in Addis.

Ethiopia is actually mostly Christian. On the order of about 80%. And they've been Christian for a really, really long time (like as far back as the apostles some people think). They are orthodox Christian though, so though it has some similarities to Catholicism, it is not at all the same. It has a very arabic flare to it as well.

One thing I thought was really interesting (read comical) is how Ethiopians really think that most every significant event in history is related to Ethiopia in some way. For example, they think that Queen Sheba (aka the Queen of Sheba) went to Jerusalem to visit with King Solomon. While there she fell pregnant and had a son, who later became Emperor Menelik I. Menelik decided he wanted to meet his father, so he went to Jerusalem, and, as Ethiopian legend has it, he came back with the Arc of the Covenant. So they think the Arc is somewhere in Ethiopia. They also state that when Jesus, Mary and Joseph were fleeing King Herod, they took a little breather in Ethiopia before returning home. And that Jesus came after he died to Ethiopia for a bit.

In every Orthodox Christian church in Ethiopia (and maybe everywhere, I don't know) they have the holy of holys which is supposed to be a replica of the Arc of the Covenant that Menelik took from Jerusalem in the time of Solomon.

Truthfully though, they do have a very rich culture and history. Apart from some Italian occupation right before and during WWII, Ethiopia was never colonized by any European country. One of the oldest languages in the world, Ge'ez was developed in Ethiopia in about 2000 BC. From it came Arabic and Amharic (what is largely spoken in Ethiopia now), but the priests and monks in Ethiopia still read, write and speak Ge'ez.

Next stop was Gondar, the Camelot of Africa...

This is the airport in Gondar. It get maybe two flights per day from Addis, and that is just about it. Sort of reminds me of the airport in North Platte...

 So, this is why people come to Gondar. In the 1600's, Emperor Fasiladas decided he wanted to establish a new, permanent capital. And he chose Gondar. It really is beautiful, so you can sort of see why. So, he got to building. He built and built. This castle below was the largest, and the one he lived in. Emperors who came after him each built their own castles as well, but this is still the biggest.

It's sad, because they do not have the money to keep these buildings up. So many of them are falling into disrepair. UNESCO and others donate money to help, but it's really not enough, and they don't generate enough money from tourism to really help out at all.

One thing I thought was funny is they have saunas all over the place. Our guide finally explained why Ethiopians are so traditionally excited about saunas. It was the only way to keep the scabies away. The hot steam was the best thing they had to kill them. Yum.

That was all very impressive, and our guide was extremely loquacious as well as proud to be Ethiopian, so it was sort of exhausting. However, next he took us to this church. I have been to churches all over the globe, on several different continents, and never in my entire life have I ever seen a church this beautifully breathtaking. The entire inside is plastered with mud that was put up in the 18th century and then painted. Gondar used to have a lot of churches, but in the 19th century dervishes (yes, like a whirling dervish) came through from Somalia (they were Muslim) and burnt almost every church to the ground. The story goes that there was a swarm of bees that attacked them when they got to Debra Berhan Selassie Church and it was spared.

 It is really a pretty small church. And very dark inside. But absolutely amazing.

the ceiling

 The last part of our tour of the historical sights of Gondar was Fasiladas' Bath. This was sort of his summer home. If they want to, they let the river come in and fill the whole thing up like a swimming pool. Pretty impressive. These days they only do it for the Epiphany in January.

Believe it or not, we did actually do some surgery. Cataract surgery there costs about 500birr, or about $30. They do all of their surgery by extracap, which makes sense for them. The supplies are not that expensive, there isn't nearly the disposables, and it is a safer way to deal with hard lenses. The thing is, if someone has a complication from cataract surgery, that is it. They have no money to go to Addis and have surgery by a retina specialist or glaucoma specialist. If you mess up the surgery, that is it. The person is going to stay blind forever. Yikes. Pretty high stakes.

This was the front of the eye clinic. Right across the street from our hotel.

Every day they would get out all the supplies they needed and put them on this table. They they had little sterile grabbers they would use to grab things. They scrubbed once per day. They they would just keep their gloves on until it was time to start the next case, and then change gloves. They did not change gowns in between patients at all.

Despite their seemingly careless sterile techniques, they were very strict about their no-street-shoes-in-the-OR policy. And they did not have shoe covers. Well, they found 3 shoe covers that had been used by someone else. So Dr. Tandon got 2, and I got one. I got to wrap my other foot in a rag for the entire week. This was me, looking forlorn about my shoe rag.

This is the clinic waiting area. That guy on the end looks unexcited to be in the picture...

This is the operating microscope (one of the three). I don't think I saw them change the sheets on the beds once while we were there...

This is where the patients waited for surgery. They are all dressed and ready to go.

After they get their eyes numbed up, they lay here and wait for their turn

See, I did operate. That is one of the Ethiopian attendings by my shoulder, watching what I'm doing. They were way faster and better at extra caps than I was...

The obligatory O-H-I-O picture:)

Lastly, I've got some pictures from around Gondar. I'll try to explain each as I go. It was really like being in a different world all together. It was pretty safe though, I never really felt threatened, though I was also not doing a ton of wandering around.

The Goha Hotel. On the top of a mountain. By far the nicest place to stay in town.

View of Gondar from the Goha Hotel

Dr. Tandon, one of our hosts, and me, at the Goha Hotel.

Kids walking home from school

There were lots of random animals around - a lot of donkeys, goats, chickens, horses etc..

Herd of sheep on the street

Note the satellite dish...

Me, in the airport in Addis, eating injera one last time before we leave. Injera is the flat bread. It's kind of spongy and sour, but goes really well with the spicy meat they serve with it.

Our hotel in Gondar, pretty nice digs...

My room. Only two roaches found and a mosquito net since there are no screens on the windows, the window would not shut, and there is a lot of malaria...

Bathroom - only had hot water one day.

Pretty balcony at our hotel

Our coutyard. There was a restaurant too, which was nice because getting a taxi or a rickshaw was no easy feat...

Overall, it was a great time. I would love to go back, if we can find a way to more securely get our supplies in:)