FEB-C-7

A FULL DAY IN ADDIS ABABA,

WITH A REVIEW OF THE WORK BY RICK HODES

AND A VISIT TO MOTHER TERESA CLINIC

AND TOUR OF THE TOWN IN PREPARATION FOR DEPARTURE FROM ADDIS, FROM ETHIOPIA, FROM THE HORN OF AFRICA, AND FROM THE CONTINENT AFTER AN EVENTFUL THREE WEEK MEDICAL MISSION IN SOMALILAND AND ETHIOPIA

February 21, 2004

I am awakening in the cold and somewhat barren house that formerly housed the entire ten male menagerie of Rick Hodes and Sons until October of this past fall. A Jewish woman who married an Ethiopian who was a classmate at Brandeis in Boston had a larger house about ten minutes walk away, and the whole entourage moved over there where twelve people are now living, leaving this house for the one-year term that Rick’s Jewish NGO provides to someone who is spending a year between college and graduate school, as Adam is now doing.

I had remarked to Kevin Bergman, whose father had worried about his son, a Jew, going into a potentially hostile Islamic population, “Here I began with you taking you to Buddhist Ladakh through a Hindu nation led by a Sikh outfitter, then we went on to a protestant mission station in Embangweni founded by missionary extraordinaire David Livingstone and run by the Church of Central Africa Presbyterian where you could read the New Testament for the first time, then we work two weeks in a very Islamic Sunni environment in the Middle Eastern communities in the Horn of Africa----and, now, when we are finally among your brethren among the righteous and orthodox, you take off with Safari Dudes on a tourist tour of Kenya!

At least, I have a wide spectrum of persuasions for placement of any student who seeks to carry out missionary work based in religious fervor, which is a good and a strong motivation that often carries them through the experience better than a humanitarian theme, which can often dissolve under the more extreme approaches to deprivation of the creature comforts to which they may have become accustomed in the softer living of the developed world. This latter statement defines Addis, which is a large city that looks for all the world like it should have all the amenities. The appearances can be deceiving, I am sure, and as I know from the experience I had in Maputo Mozambique, where I had a Faculty Apartment in the Eduardo Mondelane University campus as well as a high rise apartment downtown to enjoy as part of my Fulbright experience. The appearance of modernity is then abruptly countered with the realization that I called “Urban Indoor Camping” and the roughing of it made for a bit of an adventure at the outset, a major annoyance when one could not rely on some of the conveniences and facilities that make for an easier life to carry out some activity directed at a goal other than subsistence, and finally an accommodation is reached with whatever is missing—like hot water, or running water at all as represented by a toilet that flushes, or the consistency of electricity, a rather good desideratum if you happen to be upon the “lift” at the time when it goes out which is the majority of the time, or plumbing systems that carry most effluvia out of intimate association with their producers, rather than concentrating it where people are spending most of their time. Addis is a good Maputo mimic.

If one has been around for a while in such an environment and learns where the handles are to move cargo and accommodate the activities of daily living and even enables the reaching gout beyond simple subsistence into accomplishing something in the direction of the goals set for such work as one may have imagined from the convenience-rich setting of the first world planning environment, then the little items that one can skirt around without noticing are not even worthy of attention. But to start up in such an environment, one must get help from someone already so seasoned. Rick Hodes has been here in Ethiopia for sixteen years and is well-initiated and accommodated. So, it is a pleasure to follow his lead around Addis and to see what he has been able to do in this setting, and from this base to reach out and to assist other refugee sites as well.

TO AN X-RAY CLINIC FOR A GIBBUS SPINAL DEFORMITY,

THEN TO THE BLUE NILE CLINIC,

THEN, “MOTERH TERESA’S HOME FOR THE SICK, DYING AND DESITITUTE” FOR AN INSPIRING ROUND OF THE PATIENTS,

BEFORE GOING THROUGH THE BLACK LION HOSPITAL OF AAU

What an inspiring day of rapid rounds through the capital city! We began by taking a neighbor of Rick Hodes' from his former neighborhood who had a severe gibbous deformity of the spine. This was nearly exclusively kyphosis with no scoliosis and we thought it might be a good example of a reparable lesion that might be one to refer for correction. It would require a significant donation from services in my area of the world since the family has no money, and the patient would need to be cared for dung the spinal reconstructive surgery, but I had just received the notices of the three man Spinal Surgery Center in Northern Virginia which has three yo0ung men, from orthopedics, neurosurgery and sports medicine, and they might be able to recognize the advertising value of caring for a very special patient with the attendant publicity sure to come their way. I also have seen three other patients of the six that are here that might benefit from such an operation and perhaps I could induce interest enough that they might be able to arrange a special trip here to do and instruct the similar kind of procedure that this young man needs. I had taken his picture and now we went to the clinic to buy the x-ray of his spine—a bargain at Washington rates. He had a T-9 through T-11 lesion that would be relatively simple to straighten out. Rick Hodes had adopted two of his sons because each had severe Pott’s Disease, and once the spinal column Tuberculosis was resolved the deformity needed correction and they were each brought to Dallas Texas at the time of the September 11 US attack. They are now living at home with Rick and doing well in school, a giant leap forward from the peasant bush surrounding s of their youth. It took special attention to get coverage for them, including the full legal adoption to get them covered under Rick’s Health Insurance to get the job done, but they are success stories combined with two others of his “kids” who have heart defects, each operated in Atlanta Georgia.

We went on to the primary clinic supported by Rick Hode’s NGO the American Federation of the Jewish Distribution Center. Since no foreign NGO’s or missions are allowed to run clinics here in Ethiopia, the local name for this indigenously run group is called the Blue Nile Clinic, and Rick supervises a team of local doctors and the nurses who care for these patients in about six thousand registered “covered lives”. The come for their preventive care, and I took pictures of a homemade child measurement device that does the Growth Charting as well as a few of the posters produced in Israel which are used for the Ethiopian immigrants to Israel as well. The population of this Diaspora going back to Israel has a very special list of needs, being the largest of all of Israel’s HIV population and the one group that has a high incidence of Kala Azar, TB, and a number of other sexually transmitted diseases and tropical diseases that Rick has reported on as well as the traditional health system beliefs and the local practitioners who are called upon to treat them.

I went around on the Saturday’s intake of patients and saw a variety of patients, one with a recovering typhoid. Relapsing fever is a very common problem here and is louse borne. They also have a good deal of nutritional disease and have a NRC (Nutritional Rehabilitation Center) that covers the needs of these kids as well as the primary care “GOBI”. Growth Charting , Breast Feeding, Oral Rehydration and Expanded Program in Immunization are the keynote features of all primary care programs, and Rick serves as the internal medicine consultant in his “day job.” We saw the distribution of condoms, the health education sessions and talked with two of the local doctors about their day’s intake.

PIECE DE REISSITATNCE

I KNEW IN ADVANCE THAT IT WOULD BE INSPIRING:

MOTHER TERESA’S HOME—IT IS A BEATIFIC VISION TO SHARE IN THE FATE OF THE POOREST OF THE WORLD’S LEAST FORTUNATE

Wonderful!

I reveled in my visit to Mother Teresa’s Home “for the Sick, Dying and Destitute” as the unabashed sign says on the gate out in front. The number of beds crammed into wards are all full and probably number around two hundred fifty with about 600 patients staying here. Each bed has more than one patient and when I came through on a Saturday morning, one of the two days in which the line up is of the wound care clinics seen on Tuesday and Saturday morning, the corridors and walkways are littered with patients lying or standing in long queues. I walked through the crowd as many patients reached up and touched my hand or arm, more in thanks than in supplication. The obvious presence of a calm and collected white man with a beard in the middle of all this misery meant that I was one of the healers and from the look of me I must be one of the senior doctors. I was, and with Rick, I was the only other doctor in the center which was busily humming along at its regular full speed ahead pace.

There Sisters of Charity, Mother Teresa’s Order, are scurrying about all from various backgrounds but looking remarkably alike—well-scrubbed plain faces wrapped in the blue-bordered white cotton head dresses and habits of the order. Their faces can only be described as beatific. The more flawed they are, the less they are strangers to any make-up or any thought of self styling that ever saw a mirror, the prettier they become. The Head Nurse is a Leipzig Germany Graduated Dentist, named Sister Benedicto, named after a woman who was a Jew converted to Christianity, Edith Stein, who has just gone through posthumous beatification in the Catholic Church, as she converted from Judaism as Eva Stain to Sister Benedicto in the Sisters of Charity order. The Nazis did not consider her religion valid and killed her as a Jew. Sister Benedicto and I got to know each other later that night as we rallied at the Black Lion Hospital of the AAU (Addis Ababa University) where she had referred several patients, each one sicker and more desperately mortal than the next.

I walked amid the wards, and could spot classic and far advanced disease at every turn. I was carrying a camera, but the patients and especially the sisters were camera shy, and I was encouraged NOT to take pictures except of individual patients who had already been treated such as the post-operative patients who had severe head and neck tumors.

I came upon one young man who had a massive spleen and a Hematocrit of 11%, showing hypersplenism, with only a modest reduction in platelets. I examined his large spleen and thought that he had no evidence of malaria, and was too old to have malaria-induced splenomegaly at his age, an age at which a malarial spleen should be coming down in size toward infarction. Besides, he had been treated for malaria. He had no evidence of Kala Azar, endemic in Sudan where a young woman doctor named Jill Seaman from Moscow Idaho has been carrying on treatment for the Kala Azar (“visceral leishmaniasis”) in a population in her village of 1000 people of whom only 4 are survivors of this epidemic. It is obvious I will be writing to her and possible visiting her in the future, and Rick will introduce me to her. I saw here Time Magazine website portrait as a :”Hero of Medicine,” a photo taken as she was wading across a river in the Sudan during the rainy season carrying medicines to people in her area of the target zone of this devastating disease.

I have enough background in tropical splenomegaly to say that this almost surely what this young man has, and a splenectomy that I could safely do in a half hour with very few resources would not only treat the disease, but would be a large biopsy for the diagnosis they had suggested of Chronic Myelogenous Leukemia, which he currently carries but for which I believe there is very little evidence. He would be a quick fix, but there are no operative facilities here and I would have to take him to some clinic elsewhere with an operating theatre to do the splenectomy. I said I would mark him among others, and surely pick him out for a potential return visit to treat, possible for complete relief.

I saw a number of orthopedic conditions, many congenital, and infectious with a few traumatic injuries that led to the amputations of potentially salvageable limbs. They were getting antibiotics but really needed sequestrectomies, and that is another operation I teach in these settings. I tried to refer a few of them over to the Black Lion Hospital of AAU, but they have their own overwhelming burden of illness to treat, so a lot of the patients I treated were being warehoused in a loving and caring environment as they were slowly getting worse or dying. A whole ward looked gaunt an emaciated, and it was a nearly sure thing that the majority had TB and all of them were due to HIV. I saw a surprising number of orbital tumors, including one that had been fixed by Ricks’ intervention in calling the attention of a visiting Detroit facial surgeon to this fellow’s condition at the time of a volunteer visit. I saw two new ones, including a woman with an eye pushed up to the side that still had vision, the tumor being probably from a large retro orbital neurofibroma or neurolemmoma. If I were here twenty four more hours, I would do her too, but she is also on my return list. I saw a severe burn that should have a contracture release. I saw a man in advanced florid heart failure. I saw a fellow with a large liver with a palpable mass, probably a hepatoma. The kind of care he needs is the kind the Sisters of Charity best provide, tender loving care and hospice attention. We heard one roaring cardiac murmur in failure and started medical therapy for this failure with a diuretic increase and digitalization, but an evaluation should be done, since the patient was of operable sage.

I walked through one ward after the other, looking at the poor people at my feet who stared up at me less in hope that in comfort of just being inside and fed in an environment where they had some dignity. I went to the front gate where the intake is taking place, where wounds are dressed and primary care is given. One man had a stretch injury to the sciatic nerve and had sustained clonus and spasticity of his right foot drop.

If my wandering in these wards through this museum of untreated pathology were not enough of an experience, I then went over to the orphanage, and the place were small kids are lined up and are fed by attendants who spoon food into their mouths. A whole ward on the upper level is of retarded kids with various reasons therefore, although I saw no Down’s Syndrome kids—possibly because there are not that many senior pregnancies here. I then went to the children's ward and saw a museum of genetic abnormalities, as I had seen only a few times in my life, such as the Coldwater facility in Michigan when I was a medical student, and then serially when I was a Boston Children’s’ hospital surgical resident. From a distance I could identify craniofacial abnormalities like Cruzan’s Syndrome or Alpert’s Syndrome (I had written a paper on this subject published in SG&O with the junior lead author Mutaz Habal, and the senior author being my advisor who went on to win the Nobel Prize, Joseph Murray, from Harvard. I saw Treacher Collins Syndrome. Rick had taken a close-up picture of the eye of a patient, the first ever to be diagnosed in Ethiopia with a copper metabolism abnormality—the Kaiser Fleischer Rings around the iris showed the diagnosis of Wilson’s Syndrome.

Now, in a tiny wheel chair came a child that should be of interest to my family history—a small boy with “Blue Sclera”. This is the pathognomonic feature of “Osteogeneis Imperfecta” a disease that is present in my distant Geelhoed cousins that results in early and frequent fractures and deformities of the bones. This small tyke had had multiple fractures already and was getting into the age where they became fewer in number and that from this point on the lethal condition could be tolerated more easily. In fact, in my own family there is such a patient who has come to the age of reproducing when they can pass the mutation along.

I met a woman from Malta named Monica. She was a woman of “a certain age” as she said of someone else she had met that morning whom she wanted me to meet and encourage. She had made the tour of Mother Teresa's almost a year ago, and canceled her trip home, selling her house and everything else she had to stay to help as a volunteer. A man had appeared under the same circumstances as she had who had hoped to go to college but went into the Navy instead and got wealthy on the North Slope oil rigs, and had just made a stop here after a visit to Malawi. He is hoping to recompense for a life of sixty years he had considered wasted after he met a few AIDS orphans last year in Malawi and returned to set up an orphanage of some sort at Inkata Bay on Lake Malawi. He had just arrived at Mother Teresa’s and had called his family saying whatever obligations he had at home in the UK would just have to be sloughed off in comparison to the rewarding work he was doing her as an untrained assistant volunteer applying dressings in the wound clinic, and he was giving his money to this cause after an exposure that he labeled life changing.

I tried to encourage him, and joked about with “Monica of Malta” who is also an addicted clinic volunteer. It is a heavy tip for such people without any formal caring education and another life in acquisition who suddenly are found forced into the professional role that is a rush. The Mother Teresa Home has room for such helping hands, and a number of them have been my students this last year. Adam Goldstein, son of the Biochemistry Professor at GWU, has been in touch with me and had an interest in anything except science. His mother Linda and his father had asked me to encourage him, and he worked with Rick and also volunteered at the Mother Teresa clinic and he switched his major, now coming on line as a pre-med student for which his parents are effusively grateful to both Rick and to me. But I have two GWU students who had just met with me, one named Jeremy Berman and the other my GWU resident colleague Bill Steinberg’s son. Bill Steinberg was a GI fellow when I was a beginning surgical faculty and had once sent me a patient with a hydatid cyst saying he did not know if anyone around knew of such diseases conditions. I assured him that if any did, he was talking to him now, and took care of that patient. That was in the era when, as Rick soon found out, I had started off hoping to set up a tropical surgery program. As we had gone around in the Blue Nile Clinic he showed me the “finest library of any private clinic in Addis Ababa.” There were medical textbooks and tropical medicine texts, with what he said was the single most valuable book, the Merck Manual. He then pulled off the shelf the Hunter’s Tropical Medicine textbook edited by Strickland of Walter Reed. I opened it up as he was saying that it might be a bit dated, but that it was still a very good reference. “How can you say that about me?” I asked, opening the chapter on “Tropical Surgery” with all my pictures which I had just shown to the group at GCMS!

We had a simple lunch at the Mother Teresa Staff Dining Room of Bread and soup, and a group of volunteers came in who were from Spain. They were delighted that Rick and I could both speak to them in Spanish, which Monica of Malta also understood, so our own little UN in this oasis in a world of African misery had a convivial lunch. We saw a few more children, including the “pet” of Monica named Frances, who has a hydrocephalic head that is about one half of her body mass at around age four. She has had a shunt from cerebral to peritoneal cavities, and now Monica insists that Frances seems ready to be trying to talk. She does relate to those around her and follows with her eyes. She might benefit from a “Queen Anne’s color” a four poster padded plastic column that could support the head if she were to be brought up right and the skin care carefully attended to so that she does not break down at any of the pressure points. Monica was delighted with this information and went running off downtown in search of the materials with which someone could improvise a Queen Anne's collar for Frances.

We saw the queue of outpatient returning visitors who were completed at noon for the wound dressings, and then we adjourned to go to the AAU. There we saw a patient Rick had referred over for Chemotherapy after he developed a mid-femur pathologic fracture of a Ewing’s’ Sarcoma. He is somewhat hairless now, indicating that he did get the multiple drug chemotherapy Rick had bought with his discretionary funds, and I would recommend he get relief of the nonfunctional left lower extremity which has a large recurrent tumor about to break down in ulceration as long as he is already on chemotherapy systemically. It would not increase his chance of longevity, but it would improve the quality of life considerably and get him out of a hospital environment. Rick had addressed his quality of life issue more directly: he sent his helper out into the market to buy a battery operated AM/FM radio, which had just been delivered that morning. The boy was happily listening to it, when Rick came up and asked where he got the radio. He told Rick that his helper had brought it that morning. Rick said “No, you stole it from that patient”—pointing to a similar bone tumor young man next bed over. They all laughed at this little joke, and we left them smiling. Add another one to my “easy do” list.

I have got a lot of work to do here in the Horn of Africa on my next pass through—in at least the four venues I have initiated on this trip—Two in Somaliland, in Hargeisa and Berbera and Two in Ethiopia, in Gondar and in Addis—and that still does not add my inevitable voyage to the Sudan, one that has been postponed too long. I had spoken with Tim Harrison about the contribution he had planed to the new medial school being planned a decade or more ago for the Sudan, and both the civil war and his increasing years had interdicted his going there to help. The war is not over but it is not the top problem they have, as Jill Seaman can attest and others working there. When I had spoken with Andrew Sisson, head of USAID from the Nairobi office, he had also suggested that I try to open a Sudan clinic attempt, and mentioned in passing that Bill First had been operating there last year with Samaritan’s Purse. I knew that from the inside, having worked a long time with the World Medical mission, the medical arm of Samaritans’ Purse, and I had watched their single engine big plane taking off from Wilson Field toward Sudan, saying “next time” in that venue as well as a number of other already listed in this series as you have already detected.

I went back with Rick to his home and wrote my final postcards, including one to Tim Harrison and others about the possibilities for future work in this area. I also interacted with his kids, all of whom are real individuals and superb learners, each speaking English, with three of them not knowing any of this language only a few months ago.

We got a call from Sister Benedicto about a former num who had worked with the Sisters of Charity here at the Blessed Mother Teresa’s clinic, who was desperately ill and admitted to the AAU. So, we went to make our second calls in the University’s Black Lion Hospital

The former nun had got married and had a child who died of diarrhea soon after birth. She had come from India, and her husband was not around, but another attendant had been with her and gave a garbled story. She was in extremis. I walked around to watch her agonal breathing and noted she did not arouse to clavicle pinch pain. However, I probed her belly and found that she had no reaction, so she did not have an acute abdomen as a source of her fever and obtundation. She had a few crackly sounds in her chest, but a chest X-ray showed no evidence of TB of any advanced stage of pneumonia. I thought her problem was CNS, and guessed meningitis. Now why would someone who is seven months after the birth of a child who died of diarrhea shortly after birth have meningitis? I suggested and Rick agreed that she had a primary CNS encephalitis from the HIV or an organism like TB in the spinal fluid. With a record that was retrieved and further pieces of the story we got that she had a negative HIV test four months back, but a positive one on this admission. Also, she had a CSF fluid from a spinal tap that showed 282 WBC’s of which 87%were lymphocytes. This is a fungal meningitis. We started the appropriate treatment without much hope of any success. Then the Sisters of Charity gathered around their fallen comrade and did what they do best. With a clear-eyed concern, they held her hand and wet her forehead with a towel and commiserated with her in this helpless human condition—not alone. It was touching and inspiring. I even had to turn away, perhaps more affected by this scene than I would have expected. I had a chance to see it all over again a few minutes later.

SHARING IN THE MISERIES OF THE POOR:

A LONG GLIMPSE INTO THE SISTERS OF CHARITY

AT THE BEDSIDE IN MOTHER TERESA’S

“HOME FOR THE SICK, DYING, AND DESTITUTE”

AND AT THE BLACK LION HOSPITAL

The Sisters moved on to one of their number, a hard working woman who was a cleaner in the laundry where she works diligently for more love than money. She fell over with a pain in her side. She is now in the AAU, and I came over to see her, as they held her hand and soothed her brow. She looked gaunt and emaciated as only two or three diseases can appear—one the ubiquitous viral problem, and the other later stage malignancy. She was sunken cheeked, dry mouthed, white mucosa and had a hard mass in her right abdomen. Again, I had no information but only my first impression. I thought she had a mass that was a malignancy and it could be determined if it were hepatic or something more simple like an ovarian cyst, which should be easily fixable but would not give her the look of impending death. Then came the realist Sister Bendicto, leading her almost clone-looking white faced, well-scrubbed and infinitely patient long-suffering habited nuns. She told me everything necessary to know, as one of the nuns rummaged around and found a lab slip. Sister Bendicto said that the worker fell over striking her side, and she had an eleven point hematocrit drop since admission two days before when they sent her over from the Mother Teresa laundry. She no doubt had internal bleeding. She was HIV negative. She then no doubt had a tumor that had bled when she bumped her belly. The lab slip the nun found came back as adenocarcinoma of the ovary—she had ruptured an ovarian mucinous cystadenocarcinoma and there was no therapy.

Again the Sisters of Charity took this information and gathered around her and squeezed her hand blessing her. What a beatific way to die! They had done it all so many times before, yet this one was, as all the rest, an individualized experience. It was moving. I am a curative clinical therapist, even if I had once written an article about sharing the fleeting time that each mortal hangs on to by such a tenuous grasp. We do what is possible to be done to return a patient back to the kind of three score and ten that might be their lot under the ideal circumstances of the wear and tear of a quite ordinary environment. This is an extraordinaire environment, and these sisters are not passing through, but living in, the valley of the shadow. After we have done whatever we can as curative or even palliative therapists, they move in when nothing more can be done and do it, wonderfully well. I enjoyed the inspiration of their help for the hopeless. As in the whole of this mission and in most in which I participate, there is not a lot of time nor need for a lot of preaching going on. They are just here, sharing in the miseries of mortality—a very powerful object lesson. It is not just my students who should be exposed to this kind of care. Even if one comes in off the street, fed up with the trivial in Malta or off the North Sea oil rigs can pitch in and do something to make a difference to someone who would otherwise just utter a silent, and ignored, groan of protest against the life that is both unfortunate and unfair.

I am a committed orthodox, Christian, Protestant, Calvinist on my own time; but here, I am admiring the work of the Catholic Sisters of Charity and the efforts of the Jewish Distribution Center’s unusual physician, and distributing the drugs of the evangelical MAP through a population of Moslem patients on this trip with some of the leftovers what were destined for the Hindu and Buddhist populations of my last missions. I admire the Embangweni Hospital and the Church of Central Africa, Presbyterian—but not less for the admiration of my own kind than these efforts for the hurting and helpless as I have seen and collaborated with through this humanitarian mission.

Mother Teresa deserves—and got—its own mark on my GPS as TERE 09* 02.28 N and 38* 45. 54 E.

As we had left the AAU and the Black Lion hospital, we saw a legendary figure in Ethiopian surgery—Professor Johnson, a Swede who has been here in Addis for decades and has trained most of the surgeons I had seen in the first or second generations, I Addis or Gondar. We passed the “Great Socialist Peoples Bureau of Libya” (yes, that is its precise name, thank you) and went though the emergency room of the AAU intake into the Black Lion Hospital. There were shelves around a pediatric intake area where about thirty kids were sitting with mothers holding them as scalp vein IV’s were dripping fluids into them—it must be a good day for diarrhea here. I also saw about twenty acutely ill kids in an intake holding area, which is overflowing at the time of meningitis outbreaks. When we had walked thought he wards, there was plaster falling down and the whole of it was being remodeled, even as the patients; beds were pushed to one side of the room to continue their care as the hospital was being rebuilt around them. We also went into the library where they had a lot of books filed according to the Library of Congress familiar system as the scaffolding was put up around them in a much needed overhaul. But the basic facilities looked quite adequate, and AAU seems to have a good training program site with an overflow of good patient material for students and residents. In contrast the minimalist facilities of the other clinics I had seen seemed to have put most of their investment in the caring personnel that were working there.

RETURN WITH RICK TO PREPARE FOR A TOATLLY DIFFERENT WORLD IN THE MIDDLE OF THE ONE WITH WHICH I AM FAMILIAR HERE IN ADDIS

When I got back to the house that Rick runs with the ten fellows who are his “family” coming and going, I got to know them a bit better. When Dejena had been in Dallas to have his spinal surgery for Pott’s Disease, the newspaper interviewed him and asked what were his impressions of America. He answered: “Before I came to America I had only seen two fat people in my life; now, here in America, almost everyone is fat! I have never seen so many fat people in my life!” This statement is true, true, and related.

After a repeat round at the Black Lion, Rick went to the Sheraton in Addis Ababa where he has a membership in the Spa where he swims. The Sheraton is another world, sumptuous beyond my needs or even most demanding first-world usual standards, let alone where I have been for the past month. It has terraced gardens with fountains that dance to music and the plush accommodations that the other world inhabitants would like to have for their conferences on the poor, in rooms that cost twice the annual income of the best off average urban Ethiopian per night. As I arrived a wedding was in progress at poolside, and I though t I should see how the other half lives. I carried this disc all day, and as Rick swam with a Middlebury College student named Britton Keeshan (remember the name, to be explained later) I went to the elegant Business Center, where I logged on and sent the emails of the Ethiopian experience at a cost greater than my accommodation thus far in Ethiopia. I may have sent a scrambled pre-Spell-checked version but it was what I could do while staggering around in the luxury of the surroundings.

Britton is a student at Ricks’ alma mater in Middlebury College Vermont, where he heard Rick give a talk and he has taken a year off to train to climb mountains and see the clinics here. Britton is Captain Kangaroo’s grandson—that is the name recently in the news at the occasion of his death. Britton is on his way to become the youngest person to climb the seven summits and has only Everest to go, so he is in training for that now, before the attempt in May. We could compare notes on the mission as well as the mountains, since I could tell him about the Everest approach and the other moutain climbing experiences we have already shared—like Kilimanjaro, Aconcagua, and the others. He had returned from Antarctic Mount Vinson and is sponsored by AT&T. He will be one to watch in his summit bid for Everest to achieve the summit slam.

We went to dinner at the Armenian Sporting Club and then I went home with Rick to join his kids as they –and I—took a short sleep on his couch before I would have to get up and out at four o’clock AM. So, my experience in Ethiopia and Addis ended on a very good fast paced and thoroughly inspiring note, a successful conclusion of my “Horn of Africa Medical Mission—2004” I should hope that it will be followed in the not too distant future by further missions in this needy area of the world.

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