Sunday, 13 May 2012

No longer a Ferenji

Been back in Toronto for a week now, more or less over the jet lag, and trying to put things in perspective.

I was quite relieved in a way to study the UN Human Development Index (a measure of wealth, education and health) and find that Ethiopia was 174th out of 187 countries listed.So what I saw was fairly close to the bottom of the barrel, almost as bad as things get anywhere in the world. One way to look at is that in Ethiopia they only have two phones for every 100 people (including both cell and land-line phones!).

There is some money in the country - a lot of stuff is getting built in Addis and in Gondar, and there are some nice restaurants, hotels and shopping malls, but overall its still a very poor country with little money. GDP is $848 per person, of which 2.2% or $19 is spent on health care.

This explains why everything in the hospital was pretty much as cheap and nasty as you could imagine, from the IV tubing which always kinked to the IV bags which had no injection port, the re-used endotracheal tubes and spinal needles and to the paper in the charts which was thin, grey and friable.

Medical education does seem to be a priority, and there are lots of smart students at all stages getting quite a thorough book knowledge of how to provide medical care. I cannot imagine that, despite the best efforts of TAAC and similar groups, they will choose to stay in the country. As we talk about dining in Ethiopian restaurants in Toronto, we make it obvious that they could emigrate and yet preserve much of their cultural life overseas. As we talk about how we care for our patients in Canada, it shows how much better medical care they could provide for their patients if they practised in a developed country. When we fly to Lalibela for one weekend and Gondar the next, we display mind-boggling disposable income to people who have lived all their lives in Ethiopia but only sees a few of the sites of their own country. Why stay and work in a hospital with an intermittent supply of running water in the operating rooms and only one ventilator and no ABG machine in the ICU when you have heard of what else is possible? I don't think you can build a modern health care system on the money currently available in Ethiopia. Maybe if these residents go to work overseas and send money back to develop the Ethiopian economy, that's the best thing they can do.

On a more personal note, Addis is just not my kind of City. It is too new, too big, too polluted, too lacking an natural or man-made beauty. If it was in Europe or North America, there  would be no reason I would ever go there. Also, maybe teaching residents is not what I do best. I found the university atmosphere , where everyone watches and assesses everyone else, rather constricting., and our mandate, to do what we are asked to do and only teach the residents, without looking at the broader system in which they work, too limiting.

Friday, 4 May 2012

Strange things inFrankfurt

Arrived a little early at Frankfurt. Could not figure how to pay for WiFi so using a kiosk.
Tried to check my email but could not log on. Went to this site and was logged in automatically. Weird.

(Don't know what the issue was , maybe I was just jet-lagged and confused by the European keyboard and a slow connection)

Fistula Hospital

There are lots of hospitals in Addis, but probably the most famous is the Hamlin Fistula Hospital, which is where Dr D and I spent our last afternoon in Addis.

The basic story is that many years ago the Hamlins came to Addis intending to improve the care of pregnant women. They found women with fistulae who no-one else was caring for and devoted the rest of their lives to trying to fix this problem.

The basic issue is that many Ethiopian women are under-nourished and then have children when they are too young. The babies get stuck, and without any access to obstetric care, after several days the baby dies and the mother suffers injuries to her bladder and bowel, which leave her leaking urine and/or faeces. This makes her a smelly outcast, rejected by her husband and family, left alone in a basic shelter with nothing to do but wait for death.

Thanks to the fistula hospital many of these women can be fixed, and return to their families in good health. The hospital provides comprehensive care, including preoperative nutrition and physiotherapy for those who are too undernourished and deformed to be ready for surgery. They can do urodynamics to assess patients, and if necessary they will do a urinary diversion and create an ostomy if no other solution is possible. Women who do not wish to return to their families are considered for positions as nurses aides.

The enterprise has been wildly successful, with supporters from around the world, notably including Oprah Winfrey who built a new wing. They have now developed smaller hospitals to do the simpler cases in cities across Ethiopia, have set up some small businesses for their ex-patients, and have just now graduated their first class of midwives. Fistula is a preventable problem, which hardly exists in developed countries. If women have decent care in childbirth and can be referred to a hospital early for a CSection, the problem can be avoided.

We were shown around the beautiful grounds, and the spotlessly clean wards, where we met Catherine Hamlin, who was a very gracious host and spent quite some time talking to us about the hospital.

Photographs are not allowed, but you can learn more about the hospital and make a donation at

Djibouti Fini

What to do with my last night in Djibouti-ville?
A band called Danakil were playing at the Salines Theatre, so I went to see what that was about. Half an hour before show time the only people there were riot police. Scratch that idea! I wandered around the market area, which felt safe even after dark. A few touts want to show you stuff, but if you look at a few things and say “Non, merci” they leave you alone.

What to do for dinner? The boring thing would be to go back to the pizza place I went the first night, the more adventurous thing would be to search out some “poisson Yemenite”, the local baked fish specialty. I found a place on the Rue d’Ethiopie which had a name similar to the one which Lonely Planet recommended, but which has gone out of business. They had no menu but seemed to be doing good business, so I asked if they served poisson Yemenite and they were pleased to be asked, and insisted I go back into the kitchen to pick my fish out of the fridge. They all seemed rather large, but the deal was they cost “deux milles” – about $ 12 – with all the fixings. The waiter was arranging a chair and table for me, so I seemed to be committed. He quickly bought a bottle of water and a glass, which was welcome as the place was hot even at 8 pm. This was followed with some limes, a pink frothy dish which turned out to be made of tomatoes, cream cheese and milk, a galette (which was a huge naan-like bread but with a big central cavity) and the piece de resistance, a whole fish, cut up the middle, with a splash of hot red sauce in the centre, and baked till dry and crisp on the outside.  My medical colleagues would say I was well into the “Cipro chaser” category here. (Ciprofloxacin is an antibiotic used to treat severe cases of traveller’s diarrhoea.)

The galette was delicious, the tomato cheese dip pretty good, (but I felt that was the most dubious item to eat) and the fish was tasty but had lots of bones. I managed about half of everything. I was not very hungry and I was aware that the more I ate the more likely I was to get any bug that was going around. The waiter was very friendly and apologised that this day’s catch had not included any smaller fish. So far, no ill-effects!

Today I packed up slowly and reluctantly, enjoying the facilities of the hotel right up to check out time of noon. Wandered to the almost abandoned station of the decrepit Djibouti-Ethiopia railway, then decided it was time to make like a real tourist and head to the Kempinski Hotel to use their beautiful infinity pool. It was full of American soldiers, making it just about the only place in Djibouti where you hear English.

I got the worst taxi driver back to my Hotel. He kept on calling me “my friend” and wanting to arrange to take me other places, while driving too fast and playing explicit English-language rap loudly on his iPhone. He then claimed not to have any change so I just sat in his cab till he found some.

Got a Fanta at the kiosk at the airport. After the shopkeeper had opened the bottle, I found out she did not have change for a 5,000 DjF (about $30) note. I drank the drink slowly, then returned to try to pay again, but she just waved me off, saying it was a gift!

That would have been such a cool last encounter in Djibouti, but I still had to change my residual money into dollars. The airport is pretty basic (no A/c, no WiFi) so I was doubtful there would be an official bank after going through security. This lleft me changing money with the rather shady guys at the convenience store, who stiffed me out of about $8! But I had guessed right, if I had not changed it then I would have been stuck with the money in Djibouti Francs, which are not exchangeable outside the country.

No ill-effects from the fish so far…

Wednesday, 2 May 2012

Lake Assal

Just back from the lowest point in Africa, and the saltiest lake in the world!
Lake Assal is a dead sea of salty water, 150m below sea level, and the third lowest point in the world.

The start of the drive was depressing as we passed through acres of dusty yards with dozens of trucks and tankers which take stuff by road from Djibouti to thee land-locked Ethiopia.
The I saw three camels wandering down the middle of a four lane paved highway!

Gradually we moved out of the city into a bleak landscape, dry dusty and rocky.The local Afar people live in "bungalows" made of twigs and course fabric:

They depend on the government to refill blue drums of water by the roadside, as there is so little rain:

The lake looks rather like a Canadian lake in winter, with white stuff collecting along the shoreline, but its almost 40 degrees above freezing, not below!

I bought a small packet of salt spheres, about 4mm across. This is a rare form of salt, and the subject of an article on the salt news website (link below). I paid 200 DjF, just over $1. My driver paid 500DjF for a similar packet of regular salt, which I was offered for 100 DjF! Am I better at haggling or am I just mean?

Its hard to imagine how impossibly tough life must be for the Afar nomads, its almost like the Inuit surviving in the Canadian Arctic. The article below suggests that all they want is to continue in their traditional life, but with a little more water. I think I would be walking the hour or two to the few small schools available in the hope that one day I would get a job in an air-conditioned office!


Tuesday, 1 May 2012

Chillin’ to the max on Isle Moucha

Took a cab to the stunning Djibouti Palace Kempinski Hotel and admired the infinity pool and swim-up bar beside the Red Sea. Walked down the pier to a small (maybe 20-seater) boat with two 200 HP engines which shot off like we were running drugs for the 20 minute ride to Isle Moucha. We stopped just short of the island to watch dolphins swimming alongside our boat.

Stopped at Blue Lagoon, a small beach with a bar, dive school and a few thatched beach umbrellas and beech chairs. Arrived at 8:30, left at 5 pm, the only excitement was a buffet lunch.

Swam several times in the warm clear water, had a couple of drinks, finished two books, listened to my iPod. That was it for the day.

Came back and took a cab directly to Sept Freres, a highly recommended restaurant for the local specialty, baked fish. It looked a bit run down, and it turned out that it was out of business. I walked back to my hotel for a shower and change, I am now thinking about a plan “B”.

Monday, 30 April 2012

Djibouti 2

This is more my kind of Africa.

Well, apart from the heat. I would be exaggerating if I said that as I walked sweat dripped from each of my fingers, but it is pretty close to that!

View from bedroom window

Got up at 7:30, had a shower, had breakfast – fresh juice, omelette, baguette with jam and Lurpak butter, coffee – and headed out. By 10:30 I was back in the Hotel for a shower. Now it is noon and I am back for my third shower and I think I will hang out in the airconditioning for a couple of hours to avoid the mid-day sun.

Pretty much done the town. Went to the bank and changed some more money, as tomorrow is a holiday. Went to a tour shop and booked a one day trip to Moucha Island  for tomorrow. Bought a couple of postcards and stamps.  Found a nice French restaurant – Le Poirier – for dinner.  Went to the supermarket and bought about 4 litres of various liquids. They sell meat the way it should be, shrink wrapped on polystyrene trays, European brands of jam, Lays French Fries with Arabic labels, and Activia yoghourt at $10 for four.

Bought a wallet to replace the one that was stolen and a pair of flip-flops to replace a pair that are falling apart.

Went to the main market, which was amazing! Incredibly picturesque, but they did not like me taking photos so I stopped and just looked. Its dirty and packed enough to feel African, but not so decrepit or congested to feel threatening, especially when you only bring $30 in cash with you!  It covers maybe five or six city blocks and is sorted of organized. Electronics in one area, restaurants in another, sarongs here, shoes there. I was looking at sarongs, but 75% of them, including all the nicest ones, are made in Indonesia and I would prefer to buy one made in Djibouti.

 I  cant find the adapter to connect my camera to my computer so I cant see or post my pictures. If it does not turn up after my siesta I am sure I can find someone to sell me a replacement. (I found it!)