Reunited in Gondar!

I arrived in Gondar on Saturday and was reunited with Gelane who has been living here for the last year.  Her cousin was graduating from nursing school at the University of Gondar and so her cousin's parents, sister, uncle, neighbor, etc were visiting from Addis for the occasion.  They immediately welcomed me into the festivities!  First we went to extended family's house in Gondar for graduation lunch.  "Fasting" is very common in Ethiopia especially among Ethiopian Orthodox Christians when praying for a certain outcome.  I was initially confused when seeing "fasting foods" or "Beyanatu" on menus in restaurants, but quickly learned that "fasting" means no meal until midday and then when eating - no meat or diary products.  Perfect for my vegetarianism, because Beyanatu is on most menus in Ethiopian restaurants and is an easy way to explain I don't eat meat.  So we had a delicious lunch with Beyanatu for those fasting and meat for the others....

We then went up to Goha Hotel on the mountain overlooking Gondar (the pic at start of blog is from there) for pictures and tea.  Like Lalibella and Aksum it rains here most afternoons and when it rains it is pretty cold but during the mornings it is usually pretty warm and sunny.  So the Ethiopian tourism commission likes to use the slogan "13 months of sunshine" since Ethiopia follows the Julian Calendar there are 13 months - though i am not sure that slogan works when over half of the day during this season it is overcast and rainy.....Also it is actually 2004 here!  And time is different with sunrise (or our 6 am) being 1 am and then the time going from there.  Most official tourism things (like flights, store openings, etc) use the Western dates and times but it is still a bit confusing in places like the hospital where sometimes both systems are used.

Interesting spellings are very common

On Sunday we walked around town, going to the market for some Ethiopian scarves, rather than live chickens which were also for sale....

We also went to a traditional Ethiopian restaurant for dinner where several traditional dances were performed. Here is a video of the traditional Gondar dance....

On Monday I went to see Gelane in action at the hospital.  She taught medical students on the malnutrition ward.  Several of the patients were very severely malnourished - one was 2 years old but was the size, weight, and developmental age of a 6 month old.  Medical care is not free here.  For malnourished patients formula, plumpy nut nutritional supplements and some other care is provided but when diagnostic tests (blood tests, chest xrays etc) have to be done the patients' families have to pay first.  The prices are quite low, but for poor families with nothing, even the slightest fee can be too much.  There is some free care for very poor families, but they have to provide documentation from their  village leaders of the fact that they are destitute and if they are traveling a far distance to come to the hospital this can often be quite hard to get.  Often the resident doctors who are very poorly compensated (3500 Birr or about $200 USD a month) end up paying for tests out of their own pockets!

Today I went to the tourist attractions in Gondar.  The castle compound is the main attraction.  The first castle (above) was built by Fasildas  when he was Emperor of Gondar from 1632-1667.  It apparently took ten years to build.  The subsequent kings built other castles on the compound because they each wanted to have their own.  There was also a house for lions which were kept on the compound, steam baths and a "music hall".  I then went to Debre Birhan Selassie church which is famous for the incredible paintings inside.  There are more than 100 angels on the ceiling and they were painted 300+ years ago and have not been retouched but remain very vibrant for the most part.  Some more photos....

A place of mystery - Aksum

I flew from Lalibella to Aksum, a 30 min flight where I could choose my own seat and the boarding pass looked like this

No worries they had a hard core metal detector, all (checked and carry-on) bags went through a scanner, and I had a serious pat down from the female security officer. 

Aksum is a town with a lot of mystery.  The Ark of the Covenant is said to be here (my guide told me God had said for it to be brought to Ethiopia because he knew that Israel would be too unsafe).  It is housed in this building

It is guarded by a monk.  The monk never leaves the building’s grounds and is the only one to see the Ark of the Covenant.  I asked what happens when he dies and I was told that when he is about to die he tells those who supply him with food etc the name and where to find the next monk to stay with the Ark.  Only he has not left the area for numerous years (the current one is 50+ years) so he does not really know any other people and hence his choice is actually from God.  The are other stories on how the guard is picked – including that all the monks sit and select one.  Regardless once selected that person is the only one to see the Ark and never leaves until he dies.  Fascinating!

There are two churches on the complex with the Ark, one is the “old church” of St. Mary of Zion women are not allowed in here “because it is a monastery.”  I asked what would happen if a woman went in and was told that it would bring very bad luck to that woman – “she might walk in and then completely lose her eyesight!” Yikes, I didn’t want to tempt it so took the picture above from over the wall (the last point where women are allowed).  The new church of St. Mary of Zion was built by Hallie Selassie in the 1960s and doesn’t exactly fit in with the surrounds…..

The town is also said to have been home to the Queen of Sheba.  This was apparently her palace....

Aksum is also known for its stelae, which are incredible.  They were apparently built as tombstones and range in size from 1 meter to 33 meter (though that one is broken on the ground) some are quite plain will others super intricate.  A true engineering feat considering that the quarry where the stone comes from is 4 km away and granite is super hard.  Each one is a single piece of granite and it remains unclear how they were transported and carved and raised hundreds of years ago. 

People are incredibly friendly here which is nice, but makes it hard to go anywhere without being asked for something: "ferenji (which means foreigner or white person) money?", "Ferenji, candy?", "ferenji, pencil?", etc, offered a guide, asked if I want my shoes cleaned, etc. 

In Lalibela a typical conversation with a school age child went like this:

Child: Hello

Me: Hi

Child: Welcome

Me: Ames a ganalu (thank you in Amharic)

Child: Where are you from?

Me: America

Child (with huge smile): OH, Obama we love him!

Me: me too

Child: You live in Washington, DC?

Me: no, New Jersey

And then they would tell me about their football team, which needed uniforms (showing me a crumpled piece of paper requesting money).  Or about how it was their sister’s birthday and could I give them a shirt to give her, etc. 

After having this conversation numerous times I decided to change it up a bit and said I was from South Africa

“Oh Pretoria?”

No, Cape Town

“Oh Mr. Mandela, great man!”

Clearly education of world capitals and famous “good” leaders is working in Ethiopia (interestingly there was no mention of Bush or Zuma…..) 

All over Ethiopia, students graduated from University yesterday.  So on Thursday and Friday they dressed in their graduation gowns and walked around the town taking pictures.  As I passed a group of them I said "congratulations."  We had a short conversation about what each of them had studied and then they requested that I take pictures with them.  I agreed, figuring it was the least I could do after spending all this time taking pictures of their town and its inhabitants.  I thought we would take one group shot but then they each wanted a private one. After they took many with their cameras, I had them take one with mine.

There are also ping pong tables and foosball tables all over town, on the side of the road.  These guys asked me to play with them as I passed by.  Unfortunately I only got a pic of them playing.

Lastly, anyone who has ever seen me eat Oreos knows that I really only like the cream filling and often only eat that part, or at least scrap the filling off and save it for last.  This monkey was a pet of the cafe in one of the local parks, I had some "biscuits" with cream filling which I had bought as a snack and my guide suggested that we give the money a few.  The monkey gladly took them and proceeded to lick the cream filling off and leave the cookie part to the side!  

Where have I been? Where I am going?

Last Sunset over Camps Bay

I realize it has been WAY too long since I have updated this blog, so probably no one is reading it anymore ;)  The "why" is multi-factorial.  For one, there is facebook which makes it easy to just post a quick update and some photos and not feel like I have to write a whole story, but I realize not everyone is on FB.  Secondly, I have been having a rough couple of months from a work prospective and I like to keep the blog relatively positive so haven't felt like there is so much to write.  Lastly, I have decided to move back to the United States (for now ;) and planning that transition has been consuming a lot of time.

One of my last trainings at the "African Cave Lodge" in NW province South Africa, it is really cave like. 

We taught the nurses and lay counsellors to calculate the adherence of patients taking ARV medications

We also taught them a color coding system useful for patients who cannot read and write to make drawing up medications easier

After spending the last year doing mentoring and training of local nurses, doctors, and lay counsellors on pediatric HIV, I have realized how much I miss clinical work.  I do enjoy teaching and training, but I need more of a balance.  I miss having patients.  I also feel that while "capacity building" should be the gold standard of global health work, building true capacity is quite hard when many of the barriers are secondary to mismanagement of resources, lack of infrastructure, and shortage of health care workers.  It is also really hard to show that all this training and mentoring is making a difference.  Ask me about this next year and I may be able to give you a different perspective ;)  Regardless I have decided to return to St. Christopher's Hospital for Children in Philadelphia (where I did my residency) and work as a general pediatrician.  That patient population served by St. Chris is quite diverse and I am excited to serve those patients again and to be able to put my Spanish (which is now quite rusty) to good use.

Before going back to the US, I decided to take advantage of the fact that I was already in Africa.  For the next month, I will be traveling around and attempting to see more of this incredibly diverse continent.  I started in Ethiopia.  After a day in Addis Ababa, I traveled to Lalibela which is known for its rock hewn churches.  In the 12th and 13th century King Lalibela wanted to create a "new Jerusalem" in Ethiopia and apparently instructed workers on the construction of 11 churches.  The churches were carved from the rock with hammer and chisel - an incredible feat.  In the Ethiopian orthodox tradition, coming to Lalibela is just as holy as going to Jerusalem and during holy days thousands flock to the town to pray. All of the churches are incredibly crafted especially when you consider the tools that they would have had at their disposal.  Of course pictures are worth a thousand words so here are 50 or so of them....



Tomorrow I head to Axum for 2 days and then Saturday on to Gondar where I get to see Gelane for a few days (unfortunately my work permit ended and I had to leave South Africa during her already planned trip to the US) but we still get 5 days to see each other. Then I will fly to Tanzania where I hopefully get to see Tecla (my anatomy lab partner from first year of medical school!) and then Zanzibar for a weekend.  Finally I am joining a Nomad Adventure tour which will be an overland trip from Dar to Victoria Falls - 11 days of camping across Tanzania, Malawi, Zambia, and Zimbabwe.  Finally on 28 July I will fly back to the US and begin my transition back into life "that side."