05-AUG-B-11

 

AN UNUSUAL DAY BEGINS AS I MAIL OUT THE TRIP LOG AND GO TO HAZHAZ FOR OPERATIONS,

RETURNING EARLY WITH AMY AND SHERRY,

 FOR LUNCH AND THE CONFIRMATION OF LUFTHANSA RETURN TICKETS, AS AMY LEAVES TONIGHT WITH MY FILM PACKED FOR PROCESSING;

 I THEN WALK TO OROTTA HOSPITAL VISIT AND AN INCIDENTAL VISIT TO ST. MICHAEL’S CHURCH, FINDING MYSELF IN THE MIDDLE OF A MASSIVE FUNERAL CEREMONIAL PROCESSION CAUGHT ON FILM

 

August 15, 2005

 

            Since I had been unsuccessful in accessing internet servers for my communicating with you, I had been writing out long hand (you remember the art?—with ball point pen and paper?) reflections on my experience here.  Both for the experience of getting it transmitted and for the pretty postage stamps it will carry, I handed it to the desk clerk at the Central hotel.  Each time I had come by earlier to see the postcards I had given them stacked up where I had left them and I had asked when they would be posted out?  “When you carry them to the Central Post Office” was the reply.  OK—how about if I give you the funds to send them all since I cannot get out at the tie the Post Office would be open.  With that agreement, I later learned they had carefully taken each of the postcards I had written, put each in an envelope, copied over the address I had printed on them onto an envelope marked also by hand “Central Hotel Asmara” and added three colorful postage stamps licked and applied to each to send them out, since they had not seen or recognized postcards before, and only understood letters.  So, my twelve page letter should be more readily understood as a subject of proper mailing.  In either event, you should receive not only the card and information but also the colorful collection of Eritrean stamps—at least half the reason for sending you notes form Azerbaijan and Eritrea for your interest.

 

            Since Amy Fiedler is departing tonight to return in time for beginning orientation in the incoming freshman medical class of GWU class of 2009 (what an “orientation” to medicine she has already had!) I thought I might get a jump on the “show and tell” planned for Sherry, Amy and I, by submitting my film to the processing at GWU for prints and at Photo works by the prepaid mailer, so I had packed up the film to be dropped by Amy in mailbox and AVS drop box, which should all be ready upon return.  Amy has agreed to do this and will have a fast start on the collection as it returns.  It is for that reason that I had carried the pre-packaging film mailers and order forms, so she has them all neatly bundled up for the drop.

 

            We began the day with the older woman who had the tragic story of the breast lump five months ago with a recommended treatment at that time which would have resulted in a much better chance for cure.  She had elected to try “local healers” and was treated with herbs.  During those five months the breast lump with one node in the axilla (Stage II) progressed to a large ulcerative lesion fixed to the chest wall and filling the axilla as well as eroding in a messy smelly lesion spread into her neck.  Her son presented her “at the OR door” to allow re-socialization so she could be brought into the house without causing gagging by those around her.  This is a “toilet mastectomy” a cleanup operation to remove the offensive mass and get local control even though the horse has long since escaped the confines of the barn.  It will require an extensive skin graft for closure because of the extensive mess to be excised.  That should be familiar to my team of now-expert assistants, since they had participated in the similar operation for Dinah, in which they were actually suturing for the first times in their lives, to tack down the skin graft in Dinah—the first time they had ever seen the wonder of skin grafting, and now—the next!

 

            It was done well, and I believe we have accomplished something of a salvage operation in a patient already elderly so life extension was not the design of the operation.  But, it is awful to have such a disease, and then to be alone on top of that because no one can come near you is the ultimate loss.

 

            “At the OR door” came another such patient—an elderly woman all swathed in white muslin, but with a foul odor surrounding her.  When the gauzes were unwrapped, she had a large “rodent ulcer” behind her ear on the scalp.  The heaped up edges showed that it was a malignant tumor of the kind that might be assumed to be a basal cell carcinoma, but those almost never metastasize, and she had large fixed lymph nodes in her right neck.  Therefore, I judged that this is a squamous cell carcinoma (epidermoid) of the kind I had told the two students after our first day’s extensive tutorial would be found before we left.  Once seen, a Marjolin ulcer is easily recognized, and this woman now reported she had had a scalp burn so many decades ago she had forgotten.  On every occasion I have shown the series of slides I had taken as a medical student in Africa for the first time, it is inevitable that the next generation of medical students I am teaching will encounter the similar pathology within the trip we are on!

 

            In the next operation we did not only the still photos, but the students with their newly purchased digital cameras—purpose bought for this trip—experimented with video streaming clips.  They then used my own Olympus camera and shot multiple video clips as well while I was resecting a large goiter.  They also got some interview clips while speaking with Johannes who is up and about and doing well.

 

            One of the horrible vices that cripples the economies, productivity and the whole culture of the Horn of Africa is remarkably absent here in Eritrea.  All through Somaliland and Somalia as well as part so Kenya and Ethiopia, most men, and lots of women lie around much of the day in a stuporous cloud they might consider and addictive “high” from “Chat” as it is called here, or “Khat” as it is in the Horn of Africa.  The habit almost completely immobilizes the entire workforce of Djibouti, where no business can be conducted after the “Khat break.”  (It is called Pan in some parts of the subcontinent such as Pakistan.)  This barely legal narcotic addiction is sapping the Horn of Africa and is ILLEGAL in Eritrea—so remarkably enough, one mind-altering substance is off limits here, whereas it is the staple centerpiece of every market in Somaliland.

 

            Another distinction from the other parts of the Horn of Africa—plastic bags are every where plastered ion the cactus thorns of the bushes around Somaliland.  There are work crews that daily clean up the streets, even the biodegradable “Bellas” peelings from the cactus fruit.

 

TAKEOFF FROM LUNCH TO AN ERRAND IN TOWN

WHICH HAS US BUMPNG IN TO FURTHER EXPERIENCES

AS WE SERENDIPTIOUSLY MAKE OUR WAY TO

ST MICHAEL’S COPTIC CHURCH AND GET

SWEPT UP IN A VAST COPTIC FUNERAL PROCESSION

 

            Since Amy is leaving tonight and Sherry and I are leaving together on Wednesday evening, we need to confirm our Lufthansa flight tickets for departure.  I gathered up the tickets as we went to Hazhaz Hospital, but our driver did not quite understand as we left Hazhaz after operating, and delivered us instead to Central Hotel.  So, we had lunch and I pocketed the digital camera and a roll of film in a print camera as we set off on foot after lunch I had treated the young women to as the first of our farewell dinners.  Somehow, I flawlessly walked cross town through a few of the side streets we had not been on before except with a vague familiarity form my Sunday run through the city, and without so much as a wiggle out of the way, arrived at the Lufthansa office in the same building as the German embassy to Eritrea.  It too a while to process each of our tickets by hand to confirm our departures, but everything was in order, and at least they had a water cooler for the long and warm afternoon hike.  Since the Lufthansa office was not far from the direction in which we had passed the Orotta Hospital, we decided to walk there and see what was going on in the new, as yet not fully opened “flag ship” hospital of the new medical school I will be discussing with the Minister of Health later this week.

 

            We threaded our way through the maze of the wards at Orotta and found our way to the OR where the team that is stationed here was finishing a few urology cases.  I did not want to tell them I had done a prostatectomy earlier and would be doing a pyelithotomy tomorrow—but in mission medicine everyone does what everyone can and there is no possessive “ownership” of any specialty “claims.”  The Howard University Ghanaian Urologist whom I had met at Haile Mezghebe’s home in Washington chuckled saying he should send all his extra cases over to Hazhaz since we were doing them more quickly than they.  Orotta Hospital has nice new facilities and looks a lot more like what is usual in the developed world—if for that reason alone, I felt a bit superfluous.

 

            We walked by the new Medical School administrative building and were thinking of getting a cab back when I suggested we climb the hill behind Orotta and visit St Michael’s cathedral—a large and colorful Coptic Church on the top of the hill.  As we approached it, I saw white robed women kissing the blocks at the corners and circled around so as not to intrude on their pious grief.  I posed with fellow Coptic Sherry on the steps in front of the church and looked across the street along a very broad intersection square in front of the church.  I saw a large number of women in white all clustered as though they were waiting for a bus.  I suspected that something big was afoot and waited with a few photos of the congregating women.  As I stood on the steps, some distinguished men came to stand next to me, and then a few Coptic robed priests one swinging a sensor came along side.  I could hear a distant murmuring and could “feel “ a wave of humanity coming toward us to engulf us.  I moved to the side of the square to look down the broad street as a crowd emerged in a slow funereal procession as far as the eye could see.  There were thousands of people all segregated as men on one side and white robed women on the other.  I knew that white was the color of mourning, and could see that there was a cemetery in the distance form which the crowd had emerged.  They came to circle twice in front of me, as a large swirling wave passing the church twice and pausing in front of the priests standing in front of the church.

 

            I had alternating views of thousands of white robed women and men in processional cadence, and was respectfully silent as I stepped to one side but shot many exposures as I was incorporated in the funeral procession.  The figure being commemorated must have been a very prominent citizen to draw this much of a crowd, but the young men who came to ask us what we were doing here did not give the name other than to say we were in a funeral and gave recognition and respect to Sherry’s Coptic cross necklace.  It was a photographic feast as was a similar ceremony in Ethiopia near Gondar.  This all happened from being at the right place without a clue as to the right timing which was perfect.

 

            We retreated slowly in the direction I thought would be the Hotel, and was right, pausing at the Orotta Medical School gate and sign, having to erase a couple of digital pictures to have a couple of young men take the portrait of the three of us on the last exposures still left on my photo card.

 

AN ALL-GWU DINNER AT THE PIZZA PLACE BRIAN MCGRATH AND I HAD DISCOVERED LEADS TO THE SERENDIPITOUS DISCOVERY OF THE REST OF OUR TEAM AT OUR FAREWLL AT AMY’S DEPARTURE BACK TO GWUMC

 

            We had planned to rendezvous with Huda Ayas and Brain McGrath after Amy had packed up for departure, so that we could go out for dinner as we packed her in a taxi for the trip to the airport to begin the return to DC.  We walked along the main street again almost randomly and Brain and I suggested the pizza place we had dropped in on his first night here.  We did so to encounter a waiting queue.  We were asked if we wished to wait until they had a table for the five of us and we agreed to do so, until we were ushered into the front room and found out why there was a wait.  There, with four tables pushed together, was every other member of our large team of all those operating in other places such as Halibet and Orotta, and Haile and all his team.  So, we introduced Brian and Huda to the larger group and we all wished Amy well as she would be taking off, Our team, plus Steven Katz our Norfolk Pilot photographer who is covering the Physicians for Peace DVD and doing separate interviews of me on tape for later publicity purposes for their group sat at a separate table and recounted some of the experiences of the trip as Amy packs back to start a medical school of which she has already experienced the last three years!

 

 I took a picture as Huda waved farewell as Amy popped ion the taxi packing her bags and my film in her carryon.  Sherry said to me: “I was eager to come on this trip to get away after the first year of medical school.  But, now I have never been so ready to get back and study since I think I see now all that I must learn, and more importantly, the reason I must know it to be able to do what you do to fix people’s problems.  I can’t wait!”