FEB-C-4

THE DAY BEGINS WITH A TOUR OF THE LIBRAY AND THE

OPERATING THEATRE, THEN INCLUDES A MEETING WITH

THE DEAN ON SUBJECTS OF COLLABORATION AND AFFILIATION BETWEEN OUR INSTITUTIONS;

IN THE EVENING AT THE GOHA I MEET A CYCLING TOUR GROUP “TOUR AFRIQUE,” AND RICK HODES WHO ARRIVED

FROM ADDIS

February 18, 2004

This was a day lightened up to be my tourist day, but I did not do any of those activities, and instead made rounds in the library, ward and theatre, picking up a few things along the way about the history of this area and the Gondar College as it relates to how I heard about it. I went first to the Library, a relatively recent building addition to the campus here and was led around by one of the surgery faculty who will be the pediatric surgeon when they get to that specialty stage. He pointed out the shelf full of very well used surgery text books, and I saw what he said, that they were about fifteen years out of date. I recognize that, since a number of them had my chapters in them! They have essentially no journals, since there is no currency of that and the surgery journals I had brought in with me were coveted for the library reserve use,

We went from the library to the Theatre, and there I had seen two gastrectomies and one cholecystectomy, with an additional prostatectomy and a urethroplasty—the first in a series of repairs by Dr. Gatechow, freshly returned from a course he took at Addis on how to repair urethral strictures. He is being groomed as the future Urologist here, and Dr. Muhammad is being groomed as the Orthopedist, and Dr, Mensur will be the endoscopist GI Tract surgeon. Each of these latter three had made two trips to Leicester UK to study for a short two month period. Muhammad learned about the bones, and Gatechow learned about urology, and Mensur learned first about laparoscopy and second about organizing a residency. Each of these young fellows are at the top end of the curve in the new affiliations, and the Leicester UK team was one such, now fading., Before that, there was an affiliation with Leipzig in the old East Germany, where the Dean went to school to learn Physiology and there Muhammad studied surgery. That was in the era before unification of the two Germanys and that alliance fell apart after the reunification.

It was in that era of Mengistu’s presidency and his communist state that the parade grounds were built here that then had three large tableaux built behind a review stand, the first for Lenin the second for Marx and the third for Stalin. Those same large tablets are now inscribed with local booster slogans, since the communist dictatorship of Mengistu’s state is gone. But, the memory of that era lingers on such that a number of the Ethiopian doctors were able to spring out as economic betterment under the title of political refugees. One surgeon from Egypt managed to found a political party and was jailed. He was aiming to be Ethiopia’s nelson Mandela, but he got sick and looked like he would die imminently so he was released to America where he died. The idea that the government is repressing the doctors might have held up as a claim in the Mengistu regime, but it is silly now, and has as much validity as saying that a democrat in the US can seek refuge from entrapment in a Bush Administration.

That is just exactly what 16 of 24 physicians from Gondar did four years ago in all taking up the opportunity of going to a Harvard conference on AIDS. Once in Boston, 16 of them defected, denouncing the government saying they were oppressed refugees. They are all still in the US, of course, and one of them may be Hailu Emiru who met me in the nebulous position of an attendant at the Howard University Surgery Rounds when he was an auditor there, and was seeking a residency—any residency—from me when I suggested to him the MPH. He joined that program and that gave him the leg up he needed to remain as a US resident and got him a job in the Fairfax County Public health Department. The denouncing of the government played well in Eritrea which put the Gondar doctor’s statements on their web page and milked it for the publicity value it had. This infuriated the government and decimated Gondar Medical College, and made the US consulate very leery of issuing any visas of anyone going from Ethiopia to America for any visits. That number of physician was 1% of the total of 1600 in Ethiopia and much more of a percentage of Gondar’s faculty. Nonetheless, the public here regards them as a resource that made good in the land of milk and honey and can send back bank drafts from the Diaspora, the single leading source of Eritrea’s “foreign aid” (called “remittances”) and a substantial part of Ethiopia’s income, as my Derwood neighbors would attest.

As I had driven down from the Goha Hotel this morning I passed again the sign that advertises that “Early Marriage is a Source of Many Economic and Health Hazards” not the least of which is a burgeoning birth rate. I had found other such “Public health social marketing” signs. But, the capitalist mode seems to be working overtime in the bustle of the Gondar Community where the people are busily commuting on foot through the market and chasing donkeys out of their way as they share the road with the quadrupeds. It is a colorful procession and they mill around the former Communist parade grounds which is now ironically turned into the staging area for the great capitalist process of the moving of great quantities of fuel from the refineries of the Sudan oil fields to the consumers of Ethiopia. Mengistu should be turning over in his grave, and even his three tableaux advertise the local chamber of commerce!

MEETING WITH THE DEAN TO GO OVER THE POSSIBILITIES

OF AN AFFILAITON WITH GWU

AND COOPERATIVE PROGRAMS LIKE “OP SMILE”

In going over the kinds of diseases prevalent here that would be good for a study by the extra facilities of a first-world connection; I had singled out some of the pediatric surgical problems. Like the kinds of ano-rectal malformations, the bladder extrophy, the many cleft lips and palates, I suggested we assemble a team that would be equipped to take on such a group opf patients, that can be stored up for a several months’ intake period, and then done electively, with the hand-picked pediatric surgical specialist Amezere Tardesse who will be trying to learn how to repair them. We can then get Operation Smile interested by my contacting Bill Magee and Skip Williams for an “Op Smile” mission to Gondar and to Somaliland and repair these defects I had listed to be called in. That way, we would have Skip Williams already here, and any Memorandum of Understanding or formal affiliations agreement might be signed in place during his visit.

I went over all the options for different forms of assistance to the African developing nations in their institution-building and I suggested a visit by Mensur at the time of the October ACS meeting being held this year in October in new Orleans, whereby he might meet with the organizations interested in supporting growing indigenous institutions abroad. I am interested in getting to know more about the Sudan medical school that Tim Harrison had told me about some many years ago, which was interdicted by some of the civil war there, but is now operational. My next visit then might be to the Horn of Africa to go through Somaliland Ethiopia and Sudan for an extended attempt at formalizing some East Africa programs for affiliation as I had the Southern African programs. The Dean was very excited about the large number of potentials, and I pointed out that it was unlikely and even undesirable to have each one of these potential leads “pan out”: but, if a few of them did, it would be a very good start to the development they have already planned, and fit well with the attempt to specialize that they had expressed, which was congruent with the specialty interests that would come from the US side of such an affiliation.

On return to the Goha Hotel, I met Rick Hodes who had come up to see his refugee group in the clinic he visits here every two weeks. He was eager to see Dr. Mensur and to talk with him about surgical service for a number of his refugees, and he also was going to see a few of them n follow-up, particularly one woman who had had an enormous retro-orbital tumor protrude from her face. The pathology was a Schwannoma, and a group of plastic surgeons from Detroit had come to do her in a one stage operation two years ago. In those two years she had been at Addis, and had remarkably improved. She came wearing a head cover draped over the right side of her face, so she was obscuring the graft site. But, she looked remarkably different than her grotesque photo pre-operatively. She had a very impressive CT scan of the pre-op appearance and I would not have predicted that she would have done as well as she has done.

I also met a very interesting group calling itself Tour Afrique. They are a group of 36 people from 11 nationalities who are bicycling from Cairo to Capetown. The long dimension of Africa. The leader introduced himself having done this trek the first time last year. There was a woman who was a MD from Huntsville Alabama who with her husband quit their jobs, sold their house and took off on a “wunderjahr” and are biking along at 115 km each day followed by a van with all their kit. It is a great adventure and one I would like to do. At this rate it will be 100 days for their arrival in Capetown and they had timed it so that they would not be in the northern part here in the hottest part of the year in the desert. We compared notes, and also learned that they have a website. I am eager to hear from groups that have organized travels around and in Ethiopia, and saw a tour van come up to the Hotel named Ethio-Fauna, with other kinds of ecotourism groups as well which have come through the hotel as I am one of the stable guests here in my allegedly scholarly leadership pursuits at the Gondar University-to-be, yearning meanwhile for the adventure tours that these groups are enjoying. They are all speaking French, German or Japanese, since I saw no Americans except incidentally tagging long in other groups’ tours. One or two of the 36 bikers is serious about biking, one being an Olympian, but the woman MD said “You don’t have to be really into biking to enjoy this; it is simply neat way to watch the African scene go by.”

That may be what I am doing here to—watching the African Scene go by—using a different vehicle than a bicycle, and not an Olympian competitor for the sake of checking my time-in-transit each day as two of the bikers were doing, just living into the experience and extracting whatever I can from it to report to you through these photojournalistic means. I hope you are enjoying it, which possible through this technology without even breaking a sweat!

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