05-AUG-B-3

 

ARRIVAL IN HIGH ELEVATION ASMARA, ERITREA

IN COOL CENTER CITY OF A NEW NATION

“UNDER RECONSTRUCTION” USING MY “NAFKA”

 AND SETTLING IN FOR TWO WEEKS OF ANOTHER KIND

 OF ADVENTURE WITH MY TEAM

 

August 7, 2005

 

            When we left Jeddah and almost all passengers on the plane who were arriving in Saudi Arabia for their Umrah in a religious pilgrimage to Mecca, the doors were open letting in the desert dry heat of 43* C.  We took off for the one hour hop with a very much lighter Airbus 330 to cross the Red Sea in a bit less time than the Israelites needed, and we did not even have to dry it out first to create a tunnel with walls of water on either side. We entered African air space at the Red Sea Coast, which presumably was just as hot on the African coast as it was at sea level on the Arabian Peninsula, and headed inland for the Eritrean capital of Eritrea, Asmara.  I was watching the altimeter on the plane with the shorter estimated time to arrival when suddenly there was a bump.  “That cannot be the landing gear yet making contact with the ground, since the altimeter still reads that we are at 2350 meters” I thought to myself.  We then bounced twice more, a rather sporty landing for an airliner, but then I realized that he is using the thin air of this altitude to set the plane down well above any Denver International Airport level.  The altitude is 7,400 feet at Asmara International Airport and it is at ASMA 15* 17.40N, 039* 54.10E—or, if you want to orient yourself to the closest point you could get to Washington DC at Reagan National Airport, DCAA is  6007 miles at bearing 315* “over the top.”  And, it is cool.

 

            The people meeting us at baggage reclaim were wearing jackets.  We traded in US fifty dollar bills for 300 “Nafka” making the exchange rate for $1.00 US= 15 Nafka.  We trundled through the dark city “under renovation” passing the Eritrean national Festival whose last day is tomorrow, and checked in at the Hotel Center Eritrea in center city.  It is a clean hotel with shared bath down the hall, and it is a simple hotel that can accommodate all of us.  It does have either an advantage or a drawback—it is in the heart of the city’s bar and disco district, so there is loud music far into the night.  I had reclaimed my bag from the Azerbaijan check-in as well as the new one with extra clothes and the surgical supplies  that Amy Fielder had checked in from Dulles, so I could begin by sorting out what I would leave and what goes along with me. I am now going to poke around a bit and explore on my orientation day, with my first set of laundered clothes from the Derwood resupply.  Welcome to one of Africa’s newest nations, from which my first act may be to try to send a stack of postcards I have written enroute so as to transmit to you the transition from one very different kind of extreme adventure travel to another sort of mission altogether as this “pilgrim in transition“ between continents, cultures, commitments and missions is setting up shop in Asmara Eritrea!.

 

FIRST DAY’S SCREENING CLINC IN PICKING

BIG AND COMPLEX CASES TO OPERATE THIS WEEK

 

            I began the clinical activity by going to the hospital compound and seeing two dozen patients that had been set up for me to see, and booking half of them for operations.  There was little about it that was trivial since the diseases were long in waiting and advanced in the terms of their pathology.  I saw a dozen goiters, many of which were recurrent or hyperthyroid.  Some of these ere under treatment and could be safely done as Grave’s Disease and would be scattered through the coming week.  A number were simple hypothyroid goiters and a couple of patients had nodules.  I talked some out of operation and others were booked.  I saw a young woman with a six months size gravid uterus which was a complex mass, most likely uterine fibroids for a chief complaint of infertility.  She was advised that I would be willing to operate on heir but she should know that her infertility might not be resolved but would become permanent if we had to take out here uterus.  She understood that and wanted it to be removed, since having a six months gravid uterus pressing on her bladder continuously was getting to her.  I saw a couple of breast cancers, one a tragic young women with a nipple discharge of bloody fluid for three years, now with  a messy infiltrative inflammatory carcinoma which had eroded the skin and broken down the area all around it, which would need a skin graft as part of a clean up mastectomy.  This patient got to my student Sherri since she was the same age and their futures seem remarkably different.

 

  Another was a woman with a right breast mass, which was much more like the kind of breast cancer I could see anywhere else, but we had here go for a needle aspiration following which we would book here urgently or electively for biopsy.  A young man had a large sarcoma of the leg which will need an extensive bloody excision.  A very big problem presented with a man who had achalasia of the esophagus, who has been losing weight and cannot swallow, regurgitating undigested food, and a swallow showed a very dilated distal esophagus just before a unrelaxed stenotic are.  He needs a Haller myotomy and perhaps a Thal patch—a big thoracic procedure which will be the first tine I have seen or encountered anything like this in three decades. But there is no one else I can refer him to, so he is on the schedule for a thoracotomy.  I also saw a woman who had cholecystitis that had resolved and had a sonogram that showed gall stones. So, we will do here cholecystectomy.  We received her abundant thanks along with the salute, “May you live forever.”  Maybe not but the thought is what counts.

 

            So, already we have a full day’s operating list of several cases each day for the entire time we will be here, and I know we will have to push others into this already full schedule.  So, we will be busy.  I came back after meeting the rest of the team at the sorting out of the equipment we had brought and learned that many are form the Diaspora of the Eritreans unaccountably clustered in Seattle Washington area, Washington DC and in California.  So, a number of these have come back to help, a few of whom were born here, but moved out around their fifth birthday to the US and can still use the language so are helping as our nurses or translators. My students are all ears and eyes, as very junior students for a surgical safari but will be helpful and learn a lot more as they get going in the week. We came back to have a spaghetti lunch at the hotel, and then took a walk on a mission in search to the “bayas” highly recommended as our desert course.

 

“BAYAS” IN THE RAIN,

AS I WALK AROUND THE CLOSED MARKET AND SEE THE

ASSORTMENT OF CHURCHES AND MOSQUES

 

            We were taking a walk under a darkening sky as the clouds rolled in over us.  The central city streets are as safe as anywhere to be walking in Africa and cleaner than most.  We skirted around the big Roman Catholic Cathedral and heard the prayer call form the muezzin in the minaret of the mosque.  Next I saw the Eastern Orthodox Greek church and the Coptic Church close by.  There is also a synagogue near by, so here seems to be one nation where it is possible to have the mixture of faiths working. It turns out that Asmara is a majority Christian area, and the countryside evenly split between Christina and Moslem, with all of the Islam practiced being Sunni.  It is 49% Moslem overall.  We could not find the usual street curbside vendors of the one product we sought—the “bayas” or as they say in Mexico or Chile “Tuna” or in South African the “Turk’s Pei” or Turkish Pear.  This is the thorny fruit of the cactus, which grows wild around but is difficult to harvest because of the spiny thorns that can inflict painful stabs and require tweezering out the spines.  We passed around the closed open central market with much of the goods wrapped under tarps for tomorrow morning’s opening of the market

 

            Finally a young girl was located who ran to us with a bucket full of the “Bayas” and with a knife, cut both ends off and peeled the skin for us to eat the Bayas, with a charge that came to us on the basis of how many skins were left on the street after we had dined.  It was sweet, but with a gritty collection of seeds in the soft sweet pulp.  We were distracted at the time by being pushed back against the side of a building near the market by a downpour that hit abruptly.  Fortunately, I had the light jacket that I had packed up in the bag I had brought that had been in the extra bag checked in from Derwood with the surgical supplies I had carried here by leaving them with Amy who checked them in.  I am going to be going to a special dinner tonight, with an interval rained out opportunity to see the last day of the Festival, which we may stop to see after the dinner.  It was once begun as a way to raise money for the war effort, and with peace and independence on May 24 1993, there was great enthusiasm for prosperity.  These hopes were dashed with resumption of the fighting in 1998, and things have been somewhat stymied since then by economic drain of ten percent of the Eritrean population staked out along the border with Ethiopia to defend against incursion and occasional sniping and cross border disputes.  The other border is with Sudan which is also unstable.

 

 But, Eritrea seems to be trying to muddle through these pains of getting to be an independent nation in the process of reconstruction, and we seen to be an overall part of this process by encouraging and teaching the care of surgical and medical problems starting with the list of two dozen patients I had just screened this morning.  We will be busy during my stay here!