Sunday, July 25, 2010
Climbing new mountains
Our deworming work in Mekele has officially come to an end. I still find it hard to believe that I spent only about a week on this project and that it has already come to a close. However, thats how life is at times; you can never expect the curveballs that are thrown at you, but when they come you can either choose to take them in stride or let them overcome you. My original Duke Engage approved plan was to stay in Mekele for the entirety of two months helping out solely with the deworming effort. However, since the school-kids are now leaving school for summer break, we cannot continue with the drug-distribution phase until September, which is well after the time I leave. Regardless, an intial anlaysis of the data from the follow-up surveys of the stool samples are already showing a 50 percent reduction in schistosome prevalence in the school-kids. Once Jemal had finished paying off the lab technicians and our van driver, I bid him good-bye as he departed for Gondar to administer final exams to his students.
For the remainder of the week, I spend time rotating through the different units of Ayder Referral Hospital. Ayder is one of the five teaching hospitals in Ethiopia and has by far the best maintained facility here in Mekele. There is so much I've learned and experienced this past week about the medical world, its culture, and its players that I don't think I can put all of them adequately into words. From day 1 itself, the doctors ranging from the clinical year students, to the final year interns to the senior physicians took me right under their wing and I faithfully followed them for their routine bedside teachings, rounds, history-reporting sessions and surgeries. I spent the the first two days at the Internal Medicine Ward, where there were many patients that were infected with the routine infectious diseases largely prevalent in Sub-Saharan Africa like HIV, TB, malnutrition and anemia, as well as NTDs like Schistosomiasis and hookworm infection. All of the patients (most were female) I saw these first two days in the wards were severely weak and many were anemic. Many of the female patients were pregnant or were about to deliver and this made their existing illness even more complicated to treat. One especially tough case was a female patient who was pregnant and had a rare form of a infectious rheumatic fever, which led to a ethical dilemma for the doctors as to whether they should prioritize the health of the mother or the baby since the drugs taken by the mother would impact the infant's health. Dr. Senay, the senior Internal Medicine physician wisely pointed out to us that without prioritizing the health of the mother at this point, there would be no child. I also spent a good amount of time during these first two day with my Internal Medicine GP, Dr. Lulu, in the OPD as he checked in various patients that had been referred from other rural health centers and private clinics. The most surprising thing I observed here was the fact that there were a large and growing number of patients, who came in and were admitted with common chronic illnesses such as Diabetes Mellitus, chronic hypertension and other cardiac problems commonly found in the West. Dr. Lulu told me that that lifestyle changes were occurring all around Ethiopia as development continued, which in turn impacted and added onto the already existing pattern of infectious health burden present here.
During the weekend, the city became alive with graduation spirit as many college students and school children were celebrating educational milestones in their lives. People from all over the country and even from abroad flooded into the city and suddenly the hotel I was staying at was constantly bustling with family friends and relatives who had arrived for the graduation ceremonies. Moges' brother had just graduated from veterinary school and I attended his graduation party at his home. When I first entered the living room, I thought I was entering a green pasture as the floor was completely covered with grass. Tadele, the friend who had accompanied me, told me that this was a sign of celebration and of good-times. I could indeed see this on the faces of the family members, who were all thrilled to have a doctor in their family. I was received warmly by Moges' mother and his family, who immediately began to set plates of food and sweet drinks before me. When Moges' brother finally arrived in his graduation attire along with Moges, the whole family jumped to their feet and ran to give him hugs and to congratulate him. He looked very much like Moges and he told me that he was so happy to have me at his graduation party. Later that day, as Tadele and I walked back to my hotel, I realized that there was so much similarity between the U.S. and Ethiopian culture, yet also so much difference. Often times, people in U.S and other developed Western cultures celebrate milestones with large parties and expensive gifts. Here, while people also celebrate, the emphasis is more on people and less on material gifts.
On Sunday, Mohammad, Tadele and I set out to summit Mt. Chomaa the tallest mountain that could be climbed here in Mekele. Ever since I arrived here in Mekele, I have seen the mountain loom above the city from my hotel room. Since I was also reading Mortenson's Three cups of tea, an odyssey of an ex-mountaineer who turned his climbing life into summiting harder mountains by building schools for children in some of the most rural ares in northwest Pakistan, I had an added desire to try on some novice mountaineering myself. As we began our journey up the mountain's base, we came across tiny villages edged between patches of small forests and sights of horses feeding on pastures built against the mountain wall. Kids in the village were either calling out to me in my new official name, ferengi, or even "China," since the city was always never short of Chinese visitors in charge of road development and construction. The climb was challenging; although there were narrow dirt roads built around the mountain in steep curves that made it easier for climbers, we took some harder and more challenging shortcuts directly up the mountain face to save some time. My walking shoes were not adequately built for this type of activity and I constantly found myself on the verge of either twisting my leg or loosing my hold on some big rock or ledge. Mohammad and Tadele were there to help me out and with some brief stops, we finally made it to the top. We could see the entire city from up there and even the desert stretching further along from the city that contained the industrial factory of Mekele. It was perhaps the best view I've ever had from a summit and I thought about how small each of us looked in that city from that perspective. The descend was even more harder, as now I found myself constantly slipping on the mountain's steep mud and rock slate and I had to constantly hold onto Mohammad and Tadele, who seemed to have adapted mountain goat type feet despite wearing shoes that were clearly not meant for climbing. I gained two valuable things from climbing that day. Not only did it give me some much needed exercise since I landed in Mekele, but it gave me a renewed sense of purpose and energy for why I had come here: to climb new mountains that will challenge me and that will help me to learn new things about the world and myself.