It is now day 5 of my Ethiopian adventure.  (so far not much adventurous has happened).  

I am staying in a hotel, that if it had fleas would be considered a fleabag hotel.  Fortunately, it does not have fleas (or bedbugs, or any other undesirable insects).  They achieve this by spraying insecticide around the room every day.  It would not pass as a one star in Toronto.  The bed is comfortable, the room is tiny, lighting is poor.  I will manage.  

The hospital is about 10 minutes walk away.  It is quite similar to the hospital I trained in in Johannesburg, old, in need of repair and a coat of paint.  The elevator does not work.  The GI offices and teaching rooms are on the 8th floor.  So each day I will have to climb the 8 flights of stairs twice.  There is a saying in Afrikaans that translated means "that which does not kill you makes you strong".  I hope that's true for the hospital stairs.  I should be able to kick an elephant to death by the time I am done here

I have not yet been in the wards, so I can't comment on those.  However, I have been in the clinic.  Many patients, some looking quite sick.  We were shown a patient who was a problem case.  If she was a Torontonian she would have been quite outraged and embarrassed by the goings on.  There were three Ethiopian trainees and three Canadians.  The poor woman had to bare her middle for us to examine.  We then had a "bedside" discussion"  while she sat, understanding nothing, waiting for us to finish.  I used to work like that back in the old days in Johannesburg, but women (or men) with any degree of sophistication would not put up with this behaviour.  

Of course, since people with any medical condition tend to present late in the course of their illness the presentation is often extreme, and there are signs and symptoms that we never see in Toronto.  

The residents here are quite knowledgable and clinically adept.  However, they lack sophistication, and for example, to day presented a case that can be characterized as "not seeing the woods for the trees".  They made the diagnosis with out biopsy, but did not offer the appropriate treatment because they did not have biopsy proof.  

The city is a typical poor African city, dusty, in a state of disrepair, but with some gleaming modern buildings.  Traffic is chaotic, but apparently as a pedestrian you are unlikely to be hit, since the driver would get an automatic jail term.  Most cars have scratches and dents, a function of trying to squeeze your way into traffic in a intersection without traffic lights.  The taxis are literally from the last century, Lada's old Datsuns, old Fiats, etc., held together with wire and a prayer.   

The city is full of birds.  In the short distance between the hotel and the hospital I have identified a dozen or so species, and there are more that I could not identify.  I am looking forward to going birding next weekend.  

This weekend I am off to Lalibella, one of the must-see  sights in Ethiopia.  The next instalment will be after I return form Lalibella