05-AUG-B-9

 

AN UNUSUAL WEEKEND DAY BEGINS WITH SOME EXTRA ADD-ON SURGICAL CASES, AND “OR DOOR CONSULTS”,

THEN MY FIRST TOURISM DAY WITH A SPECIAL EXCURSION AS THE REST OF THE TEAMS GO TO THE RED SEA

COAST WHILE WE MALES (ONLY) MAKE A PILGRIMAGE,

TO NEFASET AND CLIMB TO DEBRE ESSIM TO THE

COPTIC MONASTERY

 

August 13, 2005

 

            Today is a day for a change of scene for some of the participants of the program since they are taking an excursion to Karen, a town about sixty kilometers from here.  They are going there, whereas Nicole Lang is taking Huda Ayas to Masawa, the Red Sea port about 12 kilometers away.  The others are not doing that, since that was their brief weekend excursion last year, and all it achieved for them besides a view of the Red Sea is that they found it very hot.  Karen is about three thousand feet lower, so it will be hot also, and it is a village with a market and not much more, but it has a hotel that is comfortable so that the group will probably overnight there.  That will include my two female medical students since they cannot do what I had planned to do and went out of my way to achieve the special permits to enter—climb the mountain from Nefaset to the Coptic Monastery at Debre Issem—a “males only “ privilege.

 

            So, I wore my hiking boots and the special stuff I had packed, including everything from the hunting camo hat and umbrella to the jacket for a potential change of weather, and, of course, the cameras, film, tape recorder and GPS—so, as all such pre-planned experiences, it should be well-recorded!   As I changed into my OR scrubs, I had brought this time a special “camo-colored” US Army scrub labeled “Army health care team”—so the scrub nurses call me “Military Man Doctor.”  Everyone here is labeled by their first name “Doctor Glenn” and I found out why—there are no surnames here!  I could here the chanting as at the Coptic Church next door a service was going on with the Greek-type orthodox priests were swinging the censors and chanting the prayers in a language neither I nor any o f the nurses I asked could understand.  I learned that Dr. Haregu was speaking to the nurses in Amharic with imperfect Eritrean—the same status as Tzion in our recovery Room, which is why they were in a little stand-offish mode with them an very warm with me, since I do not have any “Ethiopian taint” about me, having worked there in both Gondar and Addis where Dr. Haregu had gone to medical school and residency respectively. 

 

They have certainly been very deferential to me and respect American expertise and professionalism. I had seen a series of patients in the “OR Door Consults” and added some to the schedule including an elderly white haired woman with a large rodent ulcer behind her ear with a malignant heaped up and ulcerated tumor.  It could represent one kind of tumor called a basal cell, but it rarely metastasizes, and this woman has large firm and non-tender nodes through her neck on that side—so this is squamous cell carcinoma.  This fulfills one more prophecy I had made—as on every trip, when I first project for the students the kinds of advanced diseases they can expect to encounter in an African setting, within a matter of hours to days thereafter, a similar lesion will pop up and be recognized by them before the echoes of that first recognition can fade away.  Here –big and bold as life—is this trip’s “Marjolin Ulcer.”

 

We undertook tow major operations today, a recurrent goiter eight years post thyroidectomy done at Halibet Hospital and now with a Multinodular recurrence twice as large as the original.  We found it was possible to shell out the recurrent gland, which, of course, does not have any of the regular features of the thyroid gland since they were all taken down and ligated in the original operation.  So, we were removing remnants that had regrown under the stimulation of this woman’s hypothyroidism impetus of TSH to make hypertrophic nodules of the remnants, however small they may have been left eight years before.  The operation was smooth and swift and thorough, so we have scored another first for the team—recurrent re-do repeat thyroidectomy.

 

The next case was one that is familiar to Dr. \Haregu, but the students who had seen it once before and were not quite sure when it happened before their eyes just earlier this week got a closer better look this time—a suprapubic trans-vesical prostatectomy.  With these two operations done, we could wait for the bus to pick us up and carry us back to the hotel.  We could not see the bus, so we were told the ambulance would take us back.  It turned out that we popped out of the OR and hopped into a Toyota Land Cruiser when the driver came along and said “do you remember me?”  It was hard to place him, but he identified himself as one of our hosts on the first dinner of our stay since he was Amoisette’s brother, and “Do you know whose vehicle this is?”  We thought it was the ambulance; “It is mine.”  We were embarrassed by the familiarity we had exhibited in essentially thinking all Eritreans look alike, and now even the vehicles were interchangeable.  We only later learned that he was in this setting, while we had met him in a social setting, because his 11-year-old son had been admitted here at Hazhaz Hospital as our own Diasporan Amoiseette had told me later.

 

We made it back to the Central Hotel for a somewhat late start on the part of the women who all expressed severe envy for those of us who were going to be climbing the mountain to visit the monastery, while they piled into the bus to later ride passing by camels carrying fire-wood and visiting Miriam pilgrimage site a five hundred year old Baobab Tree which is hollowed out to be a shrine site where pilgrims come to chant their prayers and make offerings.  The group went shopping in a smaller village setting and got a few souvenirs, whereas I worked my way into a chartered taxi whom we engaged for the next two half days.  It is not a small deal to take a long drive in Eritrea, since the benzina (regular gasoline) is 32 Nafka per liter= $8.00 US per gallon.  So, I engaged Nicosia, (the name of the Abyssinian Emperor whose palace I had visited in Gondar) and his bright yellow KIA Korean taxi labeled “Best Driver” for this afternoon and tomorrow for about one thousand Nafka each day. ($75 twice)  Moreover, besides the three permits I had got for one charge of 260 N and 180 N (=440 N) for Steve the photographer, and David the Walter Reed junior anesthesia resident, John Sampson, junior attending anesthesiologist at Hopkins had joined in even if no permit had been issued for him up the mountain.  Later, I performed a little flim-flam of my own by handing the monk at the monastery door the three permits along with a photocopy of my passport and indicating with a broad sweep of my hand the foursome with the two “guides” we picked up, and the monk did not differentiate further as to the number and permits papers.

 

 

THE COPTIC MONASTERY AT EBRE ISSEM

AND THE CHURCH FROM THE HAILE SELASSIE ERA,

WITH ANCIENT “GEISS” AFRICAN SCRIPT—

FOILED BY AUTOFOCUS IN THE AGE OF

“FULLY AUTOMATED PHTOGRAPHY”

 

            As soon as we had arrived and been waved through at the monastery gate by the camera-shy monk, we were brought to a guest house and sat down to wait.  For what were we waiting?  Outside, I saw an interesting parade of livestock entering the same narrow gate we had passed through.  I could not run out to follow it, since we had taken off our shoes, and in my case, the hiking/climbing boots.   A colorful scene followed in which a group of camels wandered in.  I had taken the last of the color prints on the Fuji camera, so I elected to do something artsy/craftsy, and took out the sole roll of black and white film I had carried.  It has been a long time since I have used the gold standard of photography that had people working in dark rooms, such as the one I had just had dismantled in the Derwood basement as the new era of digital photography had come in to supplant even the rapid processing of color print film—formerly a premium item when I was first making this kind of trip as a medical student.  Now, to have a roll of B&W film processed requires a special fee and several more days to work it through.  I then tried to shoot the camels, and the automated machine, which insists on autofocusing, could not do so since it did not “see” enough vertical lines to match up.  Since the pocket cameras are  ”point and shoot”  I cannot over-ride them, to take the picture I want to take manually—and more importantly—when I want it.  It seems that the camera has “a mind of its own” and a rather stubborn one at that, so that if it finally agrees to shoot, the photogenic moment has passed—I guess that is the reason for the delete button, to overcome the camera’s willfulness.

 

            We sat under portraits of the various clerics and early leaders of the monastery which were purported to be 14^th century, although the new church, built of solid stone on the precipitous cliffs came form the Haile Selassie era.  I looked out on the “ship of the desert” emblem of Eritrea and called the “soldier’s tank.”  Apparently, the Eritreans are a match for any mechanized motor division of the invading armies they have repelled, using their ungainly allies, the spitting camels.  We had “chai” a reminiscence I have form sitting in any number of Buddhist monasteries as the monk goes through the ritual of pouring one teapot of hot water into a series of handleless teacups and then pouring it back and forth in a compulsive ritual that is accompanied by the sounds of gongs blaring horns and the chanting of the mantra.  This time all I needed was the passage of time to get the scalding hot tea down to the temperature it was able to be drunk—and welcome it, since I had used up most all of my water in the longer than anticipated climb to the summit.

 

            I went out after re-gaining my hiking boots, and walked the cliff edge to see the soaring birds below us, and the steep façade of the monastery walls falling off into deep gulches filled with cactus on the steeply upthrust sedimentary rock layers.  We had pause don the way up to see the boys with us harvest the “bellas”—the cactus fruit called “tuna” in South America as in Chile, or the fermented parts of this cactus fruit called Tequilla in Mexico.  The South African Afrikanse term is “Turk’s Pei” or “Turkish Pear.”  We watched as the boys who were setting out to harvest lots of them had gauntleted gloves, and a tin can on a long stick to avoid contact with the filamentous spines, which sting like sea nettles.   In the case of our own “guides” they gingerly picked the fruit that appeared to be ripening by the appearance of a reddish golden tint, and then got ordinary vegetation and leaves to be swirled around the fruit to get rid of the “stinging hairs.”  It was then possible to make two vertical cuts in the tough outer skin, and to pop the pulp cylinder out to the waiting guest who could eat the sweet pulp, and swallow or spit out the myriad seeds within the juicy center.

 

            The “bellas” were as welcome as the tea at the monastery, since we were all a bit short of water.  It is odd that this very juicy fruit is parked there within reach on the steep slopes loaded with the sugary water we might need in this arid and barren vertical land—a miracle to contemplate while sitting alone in the monastery.  One should surely not be distracted by female companionship, and all animals seen on these slopes and surely within the gates were male—or used to be.  The large Zebu cattle are castrated bulls, and the camels are all neutered males—that may also include those of us in the monastery after the long hot climb.

 

            We shot a few photos and saw a few young boys curiously peering at us trying to see us but stay out of camera range.  WE walked over to the other church—much newere than the rest of the monastery, with a Coptic cross on it and a script on the side which is in what they claim to be the first African language ever written down  called “Geiss.”   It would take a monk to read it since it seems that it is a dead language no one knows except by studying it, and there was no “Rosetta stone” for interpretation.

 

            I had my tape recorder out for what I had hoped to hear after the gong struck several times indicating the hour of prayer around six o’clock PM.  I saw a few monks file slowly toward the prayer hall, and waited, and heard finally a few brief chanted mantras, but did not hear the eerie call of the long Buddhist prayer ceremony.  It was now about to start getting dark, and we thought it a better idea to start our way down and off the mountain.  This seemed familiar to me, since sliding off steep scree slopes loaded with lubricating bearings is what I had done in too much already last week.  Now I would be repeating it in the dark.

 

            I stumbled down the slopes, with Steve having a somewhat more difficult time in keeping up.  He was wearing “boat shoes” and I also heard later that he had some form of aortic valvular heart disease.  This might be IHSS, and I asked if he had heard those initials or been diagnosed with that problem, since that can give a serous cardiac arrest  We had a chance to talk about this and many other things later since when we had finally returned to the town of Nefaset (“Place of Winds”) where we bought could drink and got back with our retained taxi driver Nicosia   I had marked the NEFA 15* 19.42 N, 039* 04.01 E which makes it 6,864 miles from HOME at bearing 314* just west of the north pole on the Great Circle.   The town of 300+ is lower than the capital Asmara, as, indeed, Asmara is almost level with the top of the mountain on which the Monastery sits at just 7,635 feet.  We had climbed about 2,500 feet in the two and a half hours which had exhausted several of my younger friends, who had considered this an Everest experience, until I had said to them that they were probably sleeping at Asmara at the same elevation as the mountaintop.  DEBR= 15* 19.39 N, 039* 04.57 E.  The similarity of this GPS marking to the NEFA, shows we were close under the steep mountain switchbacks as we sipped our “Mai Gaz”—fizzed water, on return in the dark down the steep slopes covered with roller bearing rocks—a “déjà vu all over again” from a recent experience of uncontrolled descent I did not feel it was necessary to repeat.

 

            As we got in the taxi with a great deal of stuff about “stiff and sore knees and hips” from those half my age, I smiled and watched as we crawled up the switchbacks to return to Asmara and the Central Hotel.  As we made one switchback, I saw a small antelope dodge away from our headlights—a dik dik or an oraby in the highlands. 

 

            I had the fish dinner at the Central Hotel with Steve in the dining room.  He had ordered the beef.  “There is no beef.” came the reply.  “What do you recommend?”  “The lamb is very good.”  OK, “I will try that.”  “There is no lamb.”  So, I resolved the dilemma by saying, “If we are to be eating here tonight, just what is it that we would be having?”  “The grilled fish.”   “OK, send us two of those.”  I am getting used to the six-page menus of African restaurants, and know how to take the maitre-di’s “suggestions” to mean that—“If you have any intention of eating here, you will have what we have and not get too demanding about what it is that you would like instead.”

 

            I had hoped to get up early and make a run in the town at about the time all the people would be gathering at the Coptic and Catholic churches, and would be making a run passed an inner city filed I had heard about that contains the vestiges of a long and constant series of events in the Eritrean recent history.  Come on along and we will discover it together.