This is a snippet from the journal of Michelle Palma’s and Lindsay Bahn’s visit to Ethiopia. I hope you enjoy!
Tuesday, May 31
23.9.03 (Ethiopian Date)
selam: peace, traditional greeting
We arrive in Addis Ababa, obtain visas and clear customs without difficulty. Lindsay comments on the freshness of the air outside of the airport, only to learn that the pollution in Addis is so severe that living here and regularly breathing the smoggy air, thick with diesel exhaust, is equivalent to smoking several cigarettes a day. We go to the home of Hannah and her son Samuel where we are served the traditional welcome foods of popcorn and coffee, which is roasted in the living room and ground fresh. We stay up late chatting and have a slumber party on the floor.
Wednesday, June 1
Stephanie’s family prepared a traditional Ethiopian breakfast including tea and injera (an airy, bitter bread) that is used to scoop spiced ground beef in sauce and scrambled eggs. Families make burberry every year, a combination of spices that gives our breakfast much of its delicious flavor. Stephanie alerts us to a sound and said, “What do you think that is?” Michelle guesses, “Is it a goat?” Steph explains, “No. It’s a man selling mops and brooms.”
Meat markets have whole cows hanging to purchase a cut. After noticing several individuals doing so on the street, Angie informs us that, “You can pick your nose here, it’s fine.”
Silas takes the long drive up the mountain to Entoto, a settlement overlooking the city. Women carrying large loads of firewood on their backs line the sides of the road. They carry this down the hill to sell on a daily basis, making just cents a day for their efforts.
We return to Addis for lunch. After a stop at the grocery store, we begin the six hour ride back to Soddo. The drive is beautiful. Tall mountains serve as the backdrop to rolling hills with lush farm fields, creeks with waterfalls and sporadic cities. Grass and mud huts are scattered throughout the landscape. Although much of the drive is through rural areas, we never see a stretch of road without people (including unattended young children) and animals (goats, cows, donkeys and sheep roam the streets, even in downtown Addis). We see several fields with young people playing soccer, although most “balls” are not true soccer balls, but made of what appears to be cloth covering some unknown substance, perhaps dirt. At one point, the van slowly inches through a large crowd of slowly walking men; it looks as it they are making their way to a gathering place where a funeral is taking place.
Thursday, June 2
la la: relax
One postpartum patient and her newborn are preparing for discharge, which typically occurs six hours after delivery. Next, Ayech is being induced for severe preeclampsia: BPs 180s/110s with HA and epigastric pain. Because they don’t have IV pumps, they perform IM magnesium sulfate therapy. However, the laid back nursing staff has discontinued her IV, her fetal monitor is off and it is unclear whether her MgSO therapy has been completed as directed. Blood pressures seem to be taken only under the immediate instruction of the physician rather than as ordered.
Next is a post-term woman, Meserat, in early labor that is being induced for anencephaly; she is also being treated for malaria.
Clinic with Dr. Karnes begins with a couple here for an infertility workup (HSG and semen analysis). Dr. Karnes explains that conception is a gift from God and we pray before he mentions that there is a large number of orphans in the country (about 6 million) and they may consider caring for an infant without parents. The couple has major argument over this idea, including the mention of divorce.Many patients are unaware of their last menstrual perdiod and simply present to the clinic “nine months after”. This makes determining an due date difficult, but gives Michelle and the nurses a good opportunity to practice their ultrasound skills. While we are seeing patients in the clinic, a student nurses’ ringer goes off: “Baby” by Justin Beiber.
In the OR, Dr. Karnes assists Michelle with a cervical cerclage for Sofia. The woman will stay for 24 hours after the procedure and Dr. Karnes explains to her husband that she must not walk the three hours home. If they are unable to arrange transportation, she must be carried or ride on a horse or donkey.
Shortly after, a nurse appears to report that the preeclamptic patient’s FHTs are in the 70s. Upon our arrival, we find that they were tracing a maternal pulse and that the heart tones are reassuring. The woman is completely dilated and they transfer her to a delivery room. She pushes for some time; the language barrier makes it difficult to properly direct her efforts and coach her pushing. She proceeds to deliver a 2.8kg male infant with a nuchal cord, which is delivered by Lindsay under Michelle’s direction (both wearing flip flops!). He doesn’t have a name yet, as many people here don’t give their children names until they have reached a year old due to the high infant mortality rate.
After lunch, the sun is shining and we head back to the clinic for the afternoon. We see a woman with irregular periods who states that she is 25 years old. Although she is obviously older, Dr. Karnes explains that there is little concept of age here and most people report that they are 25 (maybe 35 if they are remarkably older with grandchildren).
The midwife enters to ask if Lindsay would like to attend for the anencephalic delivery. The woman is weak from malaria and pushes for some time before we start pitocin (her quinine is stopped momentarily). It is evident that the woman has underwent genital mutilation surgery (female circumcision) in the past. Eventually, the top of the infant’s head is visible and the face slowly emerges. For nearly thirty minutes after the face is delivered, Michelle, Lindsay and Addis, the head of the midwifery program, struggle to deliver the baby with the shoulder dystocia under Dr. Karnes’ direction. From the baby’s sloughing skin we estimate that he has been dead for a couple days. The baby is put into a box to eventually be given to the family.
Friday, June 3
Lindsay attempts to make us all oatmeal and Stephanie makes Ethiopian coffee in a French press – most likely the nicest coffee we’ll ever have! Stephanie offers to eat the oatmeal prepared with faucet water that Lindsay accidentally used; she discourages us from drinking it as it is speculated to carry giardia.
We continue to the GYN/OBS department to do rounds. Motivation for the mother and newborn to breastfeed is essential as most mothers cannot afford formula and the baby may likely die due to malnutrition. Infants do not wear diapers.
A woman with a history of eclampsia and stillbirth via vertical cesarean section comes in for some testing. While she is in the room, a nurse and the family of the anencephalic baby come in the place the baby in a coffin. Dr. Karnes also shows us some medical supplies from World War II and an anesthesia machine that was made in Norway for third world countries with limited electricity.
Our last clinic patient for the morning presents with abdominal pain and leaking of urine. The patient is concerned that she’s only had one period in the last seven years. Michelle and Dr. Karnes find a vesicovaginal fistula and, after noting stool in her vagina, also a rectovaginal fistula. Dr. Karnes explains that this is from the pressure of the fetus’ head on the mother’s pelvis, which leads to necrosis of the tissue separating the bladder and/or rectum and vagina. The woman’s condition is not surprising, considering she was in labor for four days. In addition, we notice scarring on her chest, which her husband explains is from when she had pain there in the past. They used fire to “treat” these pains. Lastly, Dr. Karnes explains that there is little chance that she will conceive in the future. In these cases, the Ethiopian man often leaves his barren wife. The woman is sent to the fistula hospital in Addis Ababa, who will pay for her transportation and procedures there.
goal: 10,000 points
1: 100 points
5: 50 points
three of a kind: # 00
3 – 300
4 – 400
5 – 500
6 – 600
four of a kind: add 100 x # on dice (except one, then add 300 per dice)
straight of 5: 500
straight of 6: 1000
first roll: no scoring dice, score 500 (Farkle)
if all dice score, keep rolling until you decide to stop or Farkle
Our night ends with the three of us snuggling in bed, staying awake until 2:15am (8 night time) and telling stories, giggling. In the distance, we can hear hyenas doing the same.
Saturday, June 4
ferenge: white person, foreigner
Kebede arranges for three friends to pick us up on their motorcycles and drive us through the country to the home of Tamarat (translation: miracle). His mother presented to the hospital hemorrhaging at 31 weeks and Stephanie delivered the 1.2kg newborn via c-section. We stop first to get gasoline; because it isn’t available in town, we must buy it “black market” from a roadside shop for nearly $6/gallon. Our chauffeurs drop us off and while we walk to their home the neighborhood children all follow behind us. Tamarat is home with his grandmother and two sisters; the other
children quickly alert his mother (at a neighbor’s home) that the ferenges have arrived. After weighing the now four month old baby with a fish scale and Michelle’s backpack, we find that he is up to almost 12 pounds today, even after peeing all over Michelle. While we chat, his grandmother is busy making yarn from a handful of sheep’s wool; after her spool is completed, it will sell for one birr (six cents). Again, the children enjoy having their picture taken and seeing their faces on the small screen. On the ride home, we pass through villages as the children chase after us, yelling.
We take the bajaj to the market, where we are dropped off near the clothing section. As we pass through the food (butter, cheese, spices) and recyclables (tin cans, bottles, plastic containers) sections, a crowd of children accumulates and follows us. Michelle nearly has a panic attack as both the kids and grown women are poking and prodding at us, touching our hair and asking for “one birr” and “money”. Things escalate when a woman shakes a handful of green leafy vegetables in Michelle’s face, yelling, “WHAT IS YOUR NAME? MY NAME IS.” We leave through the animal section (mostly chickens, some sheep are being unloaded from trucks) and pass a few “coffee shops” – huts with women luring us inside for a cup of coffee. People also gather around large tobacco pipes. As we walk home, some persistent children from the market are still following.
Thankfully, we are able to sleep through the sounds of the Protestant church service over the loudspeakers in the distance (and ignore it for the majority of the day). We walked to the prison. Stephanie had heard that several months ago, a baboon was imprisoned after throwing a rock at a young child and killing him. When we talk with the guards we learn that the baboon is at the city jail, not the prison. He allows us to come into the prison and look at the items the prisoners have made, including picture frames, boxes and knitted decorations. We talk with some of the men and women while their children (most were born at the prison and have lived here since) mill around. The prisoners were all around us, not locked behind bars as one might expect.
Monday, June 6
Today was our first day visiting the government hospital that Stephanie works at, Wolayta Soddo Hospital. The day is immediately off to a great start when Lindsay spots a Green Bay Packers t-shirt on our walk. We arrived by taking two different bajaj, the second of which barely made it up the steep hill to the hospital with seven people inside. People next to us literally seemed to be walking faster than our bajaj could drive! When we arrived, we went into the triage and labor area. A few women had new babies, who we gave knitted hats to. Another woman was early in her labor course, dilated to 4-5cm, and attempting a VBAC after her first child was delivered stillborn by C-section. The laboring noises that fill the room are not typical of American women, and sound much like chanting and animal noises.
Rounding at the hospital here is not very similar to what we are used to. Large groups of people go into each room, kick out the family and friends present, and very quickly discuss and examine the patient. Very little is done, as there are very little resources. We rounded on both postpartum and post-surgical patients today. On the postpartum unit, we enter a room with twins that are undergoing phototherapy. Toilet paper covers the long, low-lying lights because the mother was unable to sleep due to the brightness. The smoke billowing from her room, however, is not due to this fire hazard but rather the incense they are burning. One of the rooms for post-surgical patients is devoted to women who have had prolapse surgery (hysterectomy, sometimes with other repairs done concomitantly). Today, there are fourteen women in this room.
After rounding we went back to the triage area to see a woman (her first child had died at one month of age from an unknown cause) who had come in for bleeding. She said she had been bleeding quite heavily and was about 28-30 weeks along. We immediately took her for an ultrasound, which showed no fluid around the baby and an absent heartbeat. Fetal demise was diagnosed, likely from PPROM and abruption, and the patient was examined. Stephanie found an arm and cord presenting in the vagina. We still wanted to attempt vaginal delivery for this patient, so oxytocin was started.
Dr. A came to examine her and gowns up to attempt to deliver the baby by pulling on his arm. The arm detached, was removed and thrown in the trash bucket. Dr. A then placed his entire hand and lower part of his arm into the patient’s vagina and up into the uterus. Eventually, he was able to bring the baby’s feet down and out of the vagina, followed by the rest of the infant, up to the neck. The cervix was reexamined and not found to be dilated enough to allow the baby’s head to pass. He then took a hemostat-like instrument and performs a craniotomy by puncturing the baby’s skull, followed by using scissors for decompression; portions of the brain run down and out of the vagina and on the baby’s back. After more forceful pulling, the head finally came and the dead infant (minus the right arm) was dropped into the trash bucket. The placenta immediately followed. Although this poor woman was in the room without any familial support, there are 16 “spectator” strangers standing around on tiptoes, all watching this heartbreaking experience. We have now seen more dead babies born than living ones.
On a tour of the hospital we came across a daunting room. It was filled with about 10 children fighting severe malnutrition. The sight was unbelievable, with no bone on these children’s bodies not exposed. Some were so weak they couldn’t hold up their own heads. We all hold back tears as Stephanie lifts the frail children, telling each how beautiful they are and dancing with them.
We examined the surgery book, which is where every procedure performed is written down. Many common procedures fill the book, such as hernia repairs, abscess debridement, fracture repair, and prostate surgery. There are very little accounts of appendectomy or gallbladder surgery. Some interesting ones that stand out are repairs of hyena bites and knife and bullet wounds. Melanoma seems to abound, which several notations on each page. Typhoid perforations with abdominal exploration also seem to be very common.
The VBAC patient was still laboring at this point, and Lindsay went to attend to her and teach the students to listen to her FHT with the wooden fetoscope. Once she was found to be fully dilated, she was brought to the delivery room, where Lindsay encouraged her in her pushing efforts, as well as fended off tons of curious onlookers.
Finally it was time to go home for the day. After two more bajaj rides (and one more Green Bay Packer sweatshirt), we were home.
Tuesday, June 7
We wake up early and Michelle prepares a large breakfast in anticipation of a busy day without lunch.
A woman who was being watched for labor yesterday had recently delivered. Unfortunately, during her labor and baby had died. He looked perfect, laying on the table next to his mother, but had no life in him. There was another woman in the triage area who had come in for bleeding; heart tones could not be found and an ultrasound confirmed IUFD. Yet another dead baby was due to be delivered.
A pregnant mother of four had come in the previous day, also with complaints of vaginal bleeding. Her baby was found to be alive, and an induction was started for her post-dates (42 weeks) status. An ultrasound had confirmed a low-lying placenta, but no other abnormalities. Exam was suspicious for malpresentation, as Stephanie thought perhaps she could feel an eye on cervical exam. During the night, her induction had been stopped for “fetal distress and bleeding”. Nothing else had been done after that time. Because of unknown fetal well-being and increased bleeding, a C-section was performed by Stephanie and a GP resident, demonstrating thick meconium. The baby came out with respiratory effort but quickly deteriorated and Lindsay started resuscitation. The Ethiopian nurses felt all that was necessary was bulb suctioning and hanging the baby upside down by its ankles and aggressively spanking its butt. Although they had a very difficult time accepting and understanding, Lindsay (and Stephanie, shouting while standing at the mother’s abdomen) attempted to instruct them on proper neonatal resuscitation, as the baby required chest compressions and bag-mask ventilation/PPV. Michelle then came to help, and was able to suction some meconium from below the cords. The infant’s heart rate recovered and tone improved somewhat, but breathing status continued to be very worrisome. Eventually, the baby was moved to a smaller room, where blow-by oxygen was continued and a heater was started (only one heater was available, and had to be moved from a room with premie twins). An IV was also started after multiple attempts (nearly a dozen different sticks with only two needles, using a piece of a cardboard box as an arm board) and the baby given IV fluids and antibiotics. When we left the hospital the baby was still alive. That night he died. There was no electricity to continue giving him oxygen and the damage was too great.
Prior to all this excitement, Michelle had attended to some postpartum and post-surgical rounding. The first patient was POD#4 after a c-section for obstructed labor. She had difficulty voiding after her catheter was removed on POD#2, and therefore it had been reinserted on POD#3. Michelle asked how much urine she was making, which is never charted and therefore not known (apparently the family is responsible for emptying the catheter bag), so she lifted the blanket to look at the urine. The bag had been removed and never replaced, so the patient still had a catheter in but was sitting in a pool of her own urine. Michelle ordered for the catheter to be removed, and fortunately the patient was able to resume voiding on her own.
Sadly, many patients usually share rooms, and two of the patients sharing a room today were the two deliveries from yesterday. The woman who delivered a living baby by VBAC, and the woman who had the partial destructive/manual-assisted delivery of the dead baby. It is heartbreaking that a woman grieving death must share a room with another woman celebrating birth and life. The next patient had a living child, but it just died during the night. No explanation.
Another patient presents to labor and delivery with ruptured membranes. FHTs are tachycardic and Stephanie rules out causes: she is not febrile, her abdomen is non-tender and two bags of fluid do not slow the heart rate. She instructs the staff to prepare her for a c-section (there are approximately three nurses and 12-15 students in the small room) and she is ready for surgery nearly an hour and a half later. Again, the procedure is performed under general anesthesia because the anesthesia provider insists it was for fetal distress, though the other surgeons complete two more hysterectomies before prepping the patient for surgery.
When Dr. Harry and Stephne come over to visit at 8:30pm, we are all in bed – Michelle and Lindsay with their books and Stephanie in tears. Stephne, realizing that we’ve had a hard day, comes back with Hershey Kisses and words of encouragement. Lindsay tells Michelle that tomorrow is not only a new day, but a new month…
Wednesday, June 8
Today was exactly what we needed. We wake up with the sun and have a breakfast of bananas, banana and zucchini bread and coffee before rounding with Dr. Karnes. We stop in the ICU to check on a septic patient that had a surgical repair of a ruptured uterus the day prior; the charting and care provided by the nurses here is worlds apart from that of the hospital in Otona. The babies are given hats and blankets and the nurse says a prayer with those being discharged today.
One of our favorite things here has been the abundance of Fanta and Mirinda. Orange soda (in bottles) is not only a restaurant staple, but is on the bedside table of nearly every hospital patient. Yesterday, a child was given it through a nasogastric tube. Michelle noted, regarding the urine in the foley bag, “Mirinda goes in, Mirinda comes out.”
Angie who enters and asks, “Want to see what I bought for 10 birr?” She enters with a bird on her arm that she has named Jailbait; upon further investigation and Googling we find that it is a yellow-breasted chat.
Right away this morning, Michelle wakes up to check on Jailbait. He is gone but, thankfully, not on the ground.
We come home for lunch and walk to the Supper Market to buy cookies, candy bars (post-blood donation treat) and cards to recharge our phones. We muster up the courage to return to the laboratory and give blood. We first are tested for HIV (among other things, we’re not sure) and told to return 20 minutes later. Although we didn’t give our name or any identifying information, when we come back we are simply given a thumbs up and told to sit down. Lindsay goes first and her donation is quick and uneventful. Michelle’s, however, takes some time as the man searches for a vein in her arm. When her donation is nearly complete, she asks him to stop and she lays down on the cot while the lab tech places his cool, wet hands on her and a nurse rushes to take her blood pressure.
Stephanie calls soon after and asks our blood types. She has a surgical patient that needs blood and we arrange to bring Lindsay’s unit up to Otona for her via bajaj. We must first “buy” the unit from the lab here, which costs 271 birr ($16). Very little documentation is required and we are soon on our way there with the blood in a Gatorade cooler. When we get there, Stephanie greets Lindsay and brings her to the lab to have it cross-matched. We wait until the blood is released to be sure that it will reach the patient in a timely manner and then head home for the evening. On the way back, she tells us of the extreme fear the patient had when she returned to surgery and also the gratitude her husband had when we learned of her improving condition.
Friday, June 10
We wake up early to shower, pack and eat breakfast before leaving for Arba Minch for the weekend. We board the bus shortly after 8am but must wait until the bus is full before we can leave. We hit the road shortly after 9:30am but are slightly entertained by beggars (one boy with an extremely winged scapula looking for money for surgery) and entrepaneurs selling cookies, nuts, water and, of course, Mirinda. Of course, an 8-month old child is in front of us, enjoying cookies and orange soda for breakfast. Every seat in the bus is full; in fact, one row of three holds six people – three adults and three children. We pay only 48 birr ($2.85) for the three hour bus ride.
Along the way, the roads are bumpy and the dust and dirt comes in through the (very few) open windows; many Ethiopians believe that infection might enter through the breeze and insist that they remain shut. It is not uncommon to have to stop for herds of cattle walking in the roads. During our frequent stops, women and children come on the bus selling bananas and mangoes. Someone in the front is playing music from a tape recorder and the ferenges feel right at home when they hear Bryan Adams and Chris Brown. We pass through several small villages and near many rivers and streams, one which has several grown men bathing…completely naked.
We must then ride in a bajaj with an unexperienced driver who is getting driving lessons as we are getting it. We say prayers for safety the entire way, as we are concerned it will tip on its side as he navigates the uneven road.
Next, we hire a driver to take us on a boat tour. We take the dusty, bumpy ride past monkeys, warthogs and various birds through the park and board a covered metal boat. Our captain drives us through the muddy water surrounded by rolling green hills to the beds where the crocodiles and hippos lay. We see dozens of enormous crocodiles, one which hits the front of our boat. There are also many birds, primarily storks, in the area. After we’ve seen the animals, we ride back to the “headquarters”, get back in the van and watch the sun set on the ride home.
Upon returning to the hotel the owner insists that, “for the safety of the beds”, we cannot sleep together and must have a room with one bed for each of us. When we finally make a deal for the night, Lindsay sits on the patio to enjoy the view but is quickly eaten by mosquitoes. Because Arba Minch is at a lower altitude the climate is considerably warmer than Soddo but we are also at increased risk for malaria. The air smells sweet from the bee hives around the property.
Saturday, June 11
When we wake up, Stephanie’s leg is hanging out of her small netting – a prime target for a mosquito. We have breakfast at the hotel. The front desk worker then tells Stephanie that he likes her outfit today and she doesn’t look like an old woman, as she apparently had yesterday. She reminds him not to forget that she is fat; he then concludes that today she is a “fat young woman” rather than a “fat old woman”.
We walk toward town and take a mini bus to the bus station. Five of us are originally sitting in the very back row, which, in America, would only fit five people. Unfortunately, the bus attendants want to fit six people in that row and we are all too fat. “Well, of course there isn’t room, they’re all fat,” describes the bus driver (he states this at least two other times). We therefore have to rearrange and switch seats with skinny Ethiopians that can actually squeeze six people in the long bench seat. As usual, beggars board momentarily and ask for money and the bus reeks of body odor. After stopping to load up a cracked, bald tire, we slowly navigate up narrow, twisting gravel roads and pass through Dorse, a village displaying beautiful scarves and gabis along the road. We are both concerned about the possibility of encountering another vehicle, especially when we look over the steep cliffs out the windows. When we arrive in Chencha, a Rastafarian man (among several other women and children) attaches to us and insists on being our tour guide.
Next, the man (and another Rasta that has joined us) leads us to a “shortcut” that will bring us to the waterfall in town. Halfway there, we pass an elephant house constructed
from bamboo and everyone looks inside while we wait. Meanwhile, it starts to rain. We continue to wait outside with our umbrella as the rain gets heavier and heavier. Steph joins us after a while (doing an impressive combination of squatting to pee and holding her umbrella) and, after finding banana leaves to shelter the rest from the rain, we continue.
The walk home is our nightmare. Our sandals are slippery and heavy with mud. The
down-sloping road is very steep, with many ruts that are filled with flowing water. Lindsay falls down twice, much to the amusement of the onlookers. A young boy runs out of his home and lifts Lindsay’s skirt up to expose her muddy thigh and underwear to the crowd that has gathered. She is not happy, to say the least, and makes sure everyone is aware of this. Michelle also is upset at the laughing crowd of creeps, and gives them all the stink eye. We are truly a spectacle and escape the large crowd of gawkers that constantly seem to be near.
When we finally reach the bus station, we learn that buses to Arba Minch are not available and we try desperately to hire a minibus to bring us home as soon as possible. We finally find a man that is willing to drive us. We stop for scarves in Dorse and strike an impressive bargain with the sellers (including goat hair headdresses Stephanie buys that cheer us up immediately. We later learned they mean that you have killed a lion.). Our driver flies down the mountain and gets us home in
record time; we sing along with his American music whether we know the words or not. One hundred km/hour on a bumpy road seems fine when you want nothing more than to get back to a more suitable environment.
Our driver drops us and we immediately take the sidewalk shoe shiners up on their offer to clean our shoes. Lindsay and Stephanie use their sponges to also wash their feet; apparently the boys were only interested in washing shoes, not feet. For his hard work, the man that scrapes the mud from Lindsay’s flip flops is given five birr (30 cents). Lindsay then compares her muddy leg to that of a habasha guard and they look surprisingly similar.
We then have a wonderful dinner at the Tourist Hotel, a popular destination for ferenges. The outdoor atmosphere is great; frankincense is burning, a traditional coffee roasting ceremony is taking place and newly slaughtered goats are hanging to be roasted over an open fire.
Our morning is off to an eventful start when we hear a rustling on the porch and spring out of bed to feed the baboons that have found the bread we left for them (Lindsay, from a dead sleep, asks, “Is that a baboon!?”). Foreigner blares from an adjoining room as we feed them bananas, tomatoes and bread. They run up to us and grab it from our hands; the mother is by far the greediest and most daring, stuffing her cheeks full and continually coming up for more. Again, the father of the bunch is the most aggressive but will not approach us.
We then pack our things and walk to town, where the bajaj picks us up and brings us to the market. The market has long, winding, narrow passageways that we wander through. Our following is not as large as usual but accumulates nonetheless. One boy tells Lindsay, “You are an elephant!” and a mother tries to give her young daughter to us (“Take her with you!” – a sincere request). We feel the little girl’s butter smeared hair and tear stained cheeks as she sobs into Lindsay and Stephanie’s shoulder.
Thankfully, when we get to the bus stop the bus is filled and we leave for Soddo shortly after our arrival. The bus ride is sweltering hot and there is even less circulation than the ride there. There is not room for one more person on the bus; people are sitting (Lindsay on the area between the driver and passenger, which the police officer questions her about) and standing (one man resting his elbow on Michelle’s head) in every possible location.
When we get off at the bus station and head home a young man attempts to steal from Lindsay’s backpack twice. Thankfully, it doesn’t appear that he got anything, most likely due to Michelle’s keen eye and big mouth. Finally, the three adventurers get home. There’s no place we’d rather be!
Monday, June 13
We wake up to the sound of pouring rain, which continues on and off throughout the day. Rounds in the OB ward include a deliver from last night (absolutely adorable little girl – it’s so refreshing to see a healthy, breathing baby!) and two other patients that were admitted over the weekend. We see one antenatal patient, a woman that is approximately seven months pregnant and has AIDS. Michelle does an ultrasound and Dr. Mark stresses the importance of adhering to her AZT regimen.
Due to the rain, we doubt that many more patients will travel to the clinic today. For the rest of the morning, Lindsay, Michelle and Dr. Karnes do an introductory neonatal resuscitation inservice.
Tuesday, June 14
We wake up to birds singing and the sun shining, much different from yesterday’s gloomy rain.
On the way home, we stop to go shoe shopping for Karmyn. The store is small and cluttered and the workers are unable to find the match to the shoe she hoped to buy. She tells them that she will return tomorrow and hopefully they will have it by then.
Stephanie is home when Lindsay returns and, after reviewing her symptoms, Dr. Steph suspects that Lindsay may have giardia. Lindsay goes to the lab to get a “specimen container” (a 2 oz. medicine cup, needle cover and empty plastic wrap from a syringe) for stool. After seeing this, she decided to self-medicate based on her symptoms.
Wednesday, June 15
Dr. Karnes stops by to get Michelle in preparation for surgery this morning. Although they are ready to operate, the patient does not have her supplies, and she has eaten breakfast.
Thursday, June 16
Our last morning in Soddo beings as usual, with pouring rain.
We arrive in Addis around 6:30pm as rain clouds fill the sunset sky. At this time, it is pouring rain (we find later that Michelle’s suitcase and everything it in is soaking wet). We have dinner at Antica before moving into Mr. Martin’s Cozy Place. Our room is huge but we aren’t there long before Lindsay ruins something, ripping down the towel bar in the community bathroom.
Friday, June 17
We have breakfast at Lime Tree. Next, we get a ride from Taxi Teddy to Churchill, where we do some souvenir shopping. The shops all have similar items (the majority of which appear to by imported from Kenya, we are told) and a persistent young man selling toothbrushes sticks nearby for the morning.
On the way to dinner, Stephanie raves about the food here but proceed to tell us that a roach dropped from the ceiling into Dr. Karnes’ wife’s food the last time they were there. We order several dishes to share, our favorites including garlic naan and chicken masale. When we get back, we continue to wrestle with the hot water supply and hunt the grounds for a towel (in the “family room”, the four of us were given one large towel).
Saturday, June 18
We wake up and lounge in our hotel room for the morning. Angie struggles to get bathroom time while Michelle takes a freezing cold shower. Lindsay showers in the bathroom across the property, in a ramshackle room without any lights.
We are entertained by a shirtless man outside who has blood and wounds on his face and what appears to be whiplashes on his chest. He is arguing with others on the street until the police come to diffuse the situation. When Stephanie steps outside, he tells her that he and his brother were in a fight last night and he is concerned that his brother, sick in bed, will die from his injuries; he obviously requests money to bring him to the hospital. Stephanie tells him that she is a doctor and will examine him free of charge. We wait for them on the street corner for some time and leave when we see him up the street, begging others for money.
Angie calls Stephanie to tell her that she had been robbed. She was in a public transportation van when several individuals who seemed to be collaborating put on an elaborate show (seat changes, distractions [i.e. asking the time and “vomiting”], ejecting them from the vehicle) with the intention of stealing her wallet. They are successful and she spends the afternoon not only trying to find a police officer with whom to file a report (the individuals that need to officiate her report are not available until Monday so it will undoubtedly take several days to work things out).
Sunday, June 19
We land in Chicago on time and are, for a change, treated like royalty for being American citizens. We bypass the long “visitor” line and proceed to the short US citizen line, where we quickly pass through customs and wait for our luggage. We are so happy to be back on American soil!
They pimp their vehicles (especially the bajaj) with fur.
The women usually use cloth as “pads” when they menstruate; sanitary napkins are available, but not widely used.
“Boobs mean nothing.” They are commonly flopped out without a thought, and are usually saggy and pendulous.
Same sex affection is widely accepted, while opposite sex PDAs are very rare.
No sense of urgency.
Lack of consequence for actions.
SMELLS. Some better than others: alcohol hand sanitizer, rancid butter, sweat and body odor, burberry, eucalyptus, diesel exhaust…