The MERKATO!

The commercial part of Addis Ababa has two central areas- Merkato and Piassa. Piassa has a more Italian feel with European-style buildings, cobblestone streets, and fashionable clothing, shoes and jewelry. Both areas are bargain-friendly, as are most shopping spots in the city. Most of our shopping has taken place in shops near the Black Lion Hospital.
Yesterday I was carrying a bag with my Asics running shoes in it and many of the vendors swarmed around them offering to buy my (gross,dirty used)shoes for 500 birr (about 45 dollars!) I neglected to take the offers as I suspect I will need a pair of shoes for the next few weeks!
We went to a few stores in the Piassa area this week in search of orthotic-appropriate shoes for one of my patients. Today we ventured out for some shopping at the Merkato in the center of the city. The Merkato area has historically been known for its higher level of crime, pickpockets and prostitution. Currently, the biggest threat seems to be pickpocketing and we were very cautious- I would not recommend bringing a purse or backpack. There were many armed men walking the streets and standing around but fortunately we saw no signs of violence.
However, the entire experience was sensory overload and mass chaos- people navigating potholes and manure shoulder to shoulder, donkeys with loads running up the street, cars and trucks and taxis zooming in and out of the crowd, people carrying live chickens and goats/crates/other food on their heads, children following us begging, words in Amharic coming out of loudspeakers, vendors waving their handicrafts in our path. A massive afternoon rainstorm added to the colorful scene and one of our drivers, Fantu, led us for about 20 minutes through the crowd until we reached an area that sold handmade baskets and musical instruments. Taxis here are the blue and white buses that are generally overloaded with 20+ people and one person literally hangs out of the window shouting out the destination to people on the street. It’s difficult to discretely go anywhere in public here… We are now used to the stares and have seen few other “ferenjis” (foreigners) here – aside from some hospital staff and other Americans at our hotel. Apparently most tourists don’t spend much time in the capital city and instead head to the other tourist areas in Ethiopia. I always love to try blending in to countries but unfortunately for me I am a) WHITE and b) with a group of 10 other white people. Needless to say, we get a lot of unwanted attention!

I hate goodbyes!

Today was our last day in clinic due to the holiday starting tommorrow. It was sad- I really do hate goodbyes! All of my patients wanted my contact information- questionable whether for VISA opportunities or really just to keep in touch. It was also difficult to say goodbye to the staff at the hospital. They have all been so welcoming and hospitable. Over the course of the two weeks it’s been a great growth into collaboration across cultures. The first few days were difficult- we learned that we were the first American PT students to ever come to the hospital. But, as we got to know eachother it turned into a fantastic learning experience for both sides. We took turns doing inservices in the afternoons- the Ethiopian PT’s taught us about unhealed fracture management that is so common here and we did inservices on low back pain and spinal manipulations. There was a clear difference between our schooling background and theirs and we noticed many discrepancies in information. We had many great discussions about evidence-based practice and the future of PT in Ethiopia. Currently, the only PT school is in the town of Gonder, but it looks like in the next year there will be a PT school at Addis Ababa University- ran out of Black Lion Hospital. Even more exciting- there are some passionate individuals who are aiming to make it a DPT program! My professors had many meetings while we were here in order to build on partnerships and we are hopeful that this country will make great strides in the advancement of the field in upcoming months. Regis University, a PT school in Switzerland and the Ethiopians will be working together to get this program going. There are many obstacles unique to this country – the government, financial resources, technological resources, educational resources, etc. – but we are hopeful that the future will be bright when it comes to PT. As the Ethiopians always say, “We will hope.”

Easter Traditions

Easter is this weekend! Holidays in general seem to be a much bigger deal here and Easter is no exception. The entire week the city streets have been an even busier flourish of activity than normal. Tents are set up on the sidewalks selling items for holiday preparation. No plastic eggs and chocolate here- just food products for the big meal! Live goats and chickens are everywhere- strapped to the top of cars, carried by hand, clustered for sale next to the road.
The entire city is shut down from Thurs. night-Sun. night. The Orthodox Christian celebrations involve an 8 hour church worship on Good Friday, and 3 hours of church on Sunday. Saturday night at midnight marks the end of the fasting period and the celebrations begin. We’ve been told that every family that can afford it buys a live chicken. The traditional Easter meal is chicken “wot”- chicken in a sauce with injera. It’s very spicy! Each family will also make teuj- a strong honey wine. Others may also slaughter a goat for Easter meals. We have been invited by the PT’s at Black Lion to join them in a dancing celebration on Saturday night! More updates on this holiday to come…
Happy Easter!

More Airport Fun...

Our return flight from Gonder-Addis was on one of those small prop planes. Once we’d all boarded, the captain came into the aisle and said,
“We have problem. Plane broken. Both batteries will no start. Everyone must get off plane. We try to fix. We hope for the best.”
We proceeded to spend 7 hours in the tiny Gonder airport (there were no other planes there, so they had to fly the part in). A little bit of food, cards, and hackey sack helped pass the time. Met some very interesting people. One guy named Andrew was returning to Portland,Oregon after his non-profit organization (www.ethiopiaproject.com) put on a series of running races in Ethiopia. Very cool! After a long day we finally made it back in one piece.
But the whole day embraced to me what I love about this culture. If that had happened in the US, people would have been pretty upset and wanted vouchers or some kind of compensation- and surely there would have been a lot of complaining. The Ethiopian culture is so laid back, “no worries”! I love it! America has a lot to learn…

Weekend in Gonder

Gonder is located in a beautiful valley on the edge of the Simien mountains. The outskirts of town are dotted with cattle, farmers, tukuls (straw-thatched circular huts), and dirt roads with people carrying loads on their heads and shuttling herds of goats or a few donkeys along. The town is much smaller than Addis but with similar scenery- small homes made of cement or mud blocks covered with tin roofs, people selling agriculture and other goods along the roadside, and erratic drivers swerving around the mix. Seatbelts are uncommon and driving rules are pretty much non-existant but with the road conditions fast speeds are not possible which offers some comfort. As we entered the city for the first time we came upon a funeral procession. It was eerily quiet aside from Muslim prayer chantings. Several men carried a coffin at the front and at least 100 people all dressed in black walked behind.
We were staying at a hotel in the heart of Gonder with a nice rooftop café. Our first task was “business”- we headed to the PT school where we met with faculty and students and toured the facilities at Gonder University. The facilities were quite the contrast from Regis and all of the people we met were very friendly. The site has an outpatient clinic and an inpatient ward so students regularly were able to practice in these areas during their 2nd and 3rd years.
Later in the day we hit up the “ferenji” tourist spots in the area. Gonder is so rich with interesting history. If I had more time I would go into details- but for now I will refer you to the Gonder Wikipedia page which probably has a more accurate representation. We toured the castles, bath area, and Haile Sellassie church with a local guide. I’m not the biggest fan about history details but I was very intrigued the entire time! And the views were beautiful.
Our second day we drove toward the Simien mountains for a hike. We stopped about an hour outside of town and began our hike with one guide... after about ten minutes we had about 10 children from nearby villages joining us! Their English was pretty good and they got a kick out of our attempts at Amharic. We stopped to watch packs of baboons, birds, and breathtaking views. It was one of my most memorable experiences so far. I spoke with one of the locals for a long time as we walked. He was 26 years old and worked as a teff farmer (the grain used to make injera- one of the most common agricultural products here). At the end of the hike he told me that he was looking for his wife – would I be interested?! (Don’t worry- no lemons were thrown; I politefully said no!)
On our way back to Gonder we stopped at Falasha village, a Jewish community that houses a women’s agricultural training organization. We watched women make pottery, weave baskets, and had our first official coffee ceremony. The coffee here is fantastic. It is much less acidic than what I am used to. They roast the beans right in front of you and serve it in small cups.
We finished off the afternoon by stopping at the local Dashen Brewery and then went out on the town to practice some shoulder dancing!

Airport Adventure!

This weekend we had a 3 day trip to the town of Gonder which is north of Addis near Lake Tana. The whole experience was quite the adventure, I will do my best to provide a short concise summary…
We arrived at the Addis Airport at 5am for a 6:30 flight which was our first mistake. It was the only flight to Gonder from Addis that day. Just to get into the building to check into the flight you had to go through one slow-operating security checkpoint that had a large mob outside of it. As we neared 6am and the funnel had moved a few feet, people began to yell at eachother and ram their luggage carts into their neighbors. People would cut in line near the door which created more chaos. Luckily our group literally grabbed eachother and elbowed the cutters out until we all made it through the door at about 6:20am. The check-in process was a lot quicker and they held the plane for us. We ran through the airport to the next security checkpoint. I was almost through when the guy in front of me was caught with a huge knife in his carry-on. He proceeded to argue for a good ten minutes about bringing his knife while the line was stalled behind him. Finally I got through but my professor (ahem..Tim!) forgot to remove his scissors from his toiletry bag so that was another ten minute delay. By that point the rest of our group was already on the plane. We were sent to a door which led you down two flights of stairs and out to the tarmac. There were 6 planes scattered around the tarmac and I panicked and started running toward the nearest one. Apparently that plane was headed to Lalibella.. not Gonder. Eventually I was shuttled to the correct plane and we somehow all made it to our destination!

Hospital Acute Care

This reflection is by no means intended to incriminate the hospital system in Ethiopia, but I wanted to paint a true picture of my experiences here. Today I got to experience the acute care area of the hospital- specifically the medical ward. It was an extremely overwhelming experience. It was particularly eye-opening to see the conditions the patients are living in as well as the conditions that plague them- many of the hospitalizations could have been prevented had vaccinations, screening processes or other medical care been provided earlier.
For a cost of 2.5 birr/day (less than 20 cents), patients are placed in the general rooms that may have 12 patients per room. Patients may also opt to stay in a less crowded room (2-4 patients per room) for a slightly higher fee. Imagine this: as previously mentioned, the halls are fairly dark due to frequent power outages. The patients that I treated were in rooms with 12 patient beds in a space the equivalent of maybe two patient rooms put together at Spring Valley Medical Center in Las Vegas (my last clinical experience). There were 1-2 nurses for the 12 patients and there did not seem to be much interdisciplinary (ie-PT/nurse/MD) communication, aside from the rounds that occur once per week. One toilet/shower was available per floor unit and patients had no privacy/dividers, and were lucky if their soiled sheets were changed in the duration of their stay because everything is hand washed. It was common to see pots on the floor catching the water dripping down from the ceiling, and there was an overpowering scent of sweat, urine, feces and bleach mixed together in the air. Patient family members and friends were gathered around the patients beds and pots of lentils and injera crowded the windowsills.
My first patient was previously a world class distance runner who had a rusty nail break through his shoe a few months ago. He proceeded to get tetanus and was so atrophied and weak by the time we saw him that sitting up was an immense effort. He was in the ICU for 5 weeks and on a ventilator for several weeks, during which time he was literally bedridden and immobile. His therapy had up to that point consisted mostly of passive range of motion and efforts to improve his elbow joint contractures. PT here has proven to be fairly conservative in general which has been a challenge. After some coaxing, everyone agreed to let him try walking with me. We walked about ten feet before he succumbed to extreme fatigue but the smile on his face was priceless when we left. It was so frustrating to hear his story knowing that in the US he would have received immediate treatment upon initially injury and never would have gotten to such a near-death state requiring such a lengthy recovery.

We saw a number of other patients. The patients stories are heartbreaking to say the least. One of the PT’s, Nigatu, has told me that the only way he can do his job is by not truly “hearing” the stories. It is easier to put up a wall and not get attached to patients he has said. I’ve had a really hard time with this factor. Other conditions I treated have included cancers, spinal fractures, bacterial meningitis/hydrocephaly, and Brown-Sequard Syndrome. Fractures are so very common and I think it is definitely tied to widespread nutritional deficits here.
My classmates have also worked with very interesting cases- for example, one patient had an affair with another man and her husband beat her and buried her alive. Miraculously, some nearby children heard her screams and came to her rescue. Another story- a 12 year old boy was beaten so severely by his teacher that he needed skin grafts, developed contractures and is now months later just attempting to stand up again. While outpatient care has been very culturally educating, the inpatient side of things here even more greatly outlines the vast cultural differences between the US and Ethiopia. It’s incredibly humbling yet frustrating.