Oct 11

Today is the day for birding.  We had hired a guide.  He arrived promptly at 7.00 am and we were on our way.  Our destination was only 100 km from Addis, so we went slowly and stopped several times to look for birds.  Pretty country, but not spectacular.  However, we then arrived at our destination, a mountain lodge perched on the edge of a deep, wide gorge.  The river at the bottom of the gorge empties into the White Nile. , which is about 200 km from here.  Here the scenery is spectacular.  

Every possible inch of the country we have seen so far is under cultivation.  Fields reach high up the mountain sides.  The patchwork of different greens because of different crops adds to the beauty of the place.    

It's also impressive for some birds, vultures in particular, but also something called an Auger Buzzard.  This is an attractive bird, possibly a cousin of our red tailed hawk, judging by the buzzard's red tail.  It has the amazing capability of hovering at great height, almost motionless in the wind.  Other birds hover, but have to flap their wings to remain motionless.  Not this guy.  It's very impressive.

The place we are staying at is very rudimentary.  My room has a single bare bulb for illumination.  There is a bedside candle and matches.  Maybe that's for a possible power failure.  We'll find out.  As mentioned, the lodge on the edge of the cliff. looking down into the gorge.  It's cold now in the evening as I write this, but this afternoon when we arrived it was hot and it was very pleasant to eat outside.  

I had forgotten that we are close to the equator.  The sun is fierce.  I forgot my hat in Addis.  Bad move.  I got quite burned on the top of my scalp within a short period of time.  

Birding was quite good.  We totalled 57 different species, with about 20 that were new to me, including several that are found nowhere else, but Ethiopia and Somalia.  Since I am unlikely to ever travel to Somalia I was pleased to see those birds here.  I am getting to be really good at spotting birds in the bush and at a distance.  It's about time that I got this good.  I am still totally unable to bird by ear and I envy those who can.  Our guide found several birds by recognizing the call and going looking for the bird.  I can tell the difference between the call of a crow and a Blue Jay, but little else.  My next step, to get to know some of the calls! 

Oct 12.  We started out the day by driving to a nearby monastery and church which was the home base of one of the most important saints in the Ethiopian pantheon.  not tats e were going to see the church, but the birding nearby was good.  We found several specialties of the area.  The place is lousy with beggars, by the hundreds.  They rely on the fact that donating to the poor is supposed to ensure that your prayers will be answered.  (Despite probably substantial evidence to the contrary).  It really makes the place quite depressing.  Since the monastery is a destination for pilgrims and church-goers the approaches are crowed with people. One of the approaches was down a mountain path.  Like India, every bush was a toilet.  I had the misfortune to step in doodoo.  Human shit is a lot more unpleasant than either dog turds or cow pats on your shoe!!

Monday Oct 13

Back at the hospital today.  More impressions:  If you ever wanted to see the face of suffering humanity, come here.  Hundreds of patients are already lined up before 8.00 am.  They sit patiently, waiting for admission or for clinic.  I have seldom seem so many malnourished people, whether from illness or diet I don't know, but it's pitiful.  

Family members attend all inpatients, but they are not allowed onto the wards when doctors and nurses are doing the rounds or at night.  So they wait outside the wards.  There are few chairs or seating of other kind.  They sit on the floor and sleep on the floor.  It's difficult to grasp how poor these people are and this country is.  There are cockroaches (or a similar African variety) in the hospital.  Infection control is virtually non-existent.  Patients with TB are iafford even the low prices they ask here.  solated to the extent that they only share a room with one other person rather than the 7 bed ward.  The hospital's CT scan does not work.  So if patients are to get a CT they have to pay at a private facility.  Many cannot, so the CT does not get sone.  They also have to pay for some medicines, again the poor cannot afford this and so don't get treated.  

I have mixed feelings about what we are doing.  I initially refused to participate in this project because I reasoned that Ethiopia did not really need gastroenterologists, but needed the local equivalent of China's barefoot doctors, specially trained personnel who ensure that vaccinations are given, water is clean and sanitation is available, and that's where efforts should be directed.  This would mean that those who developed illnesses would not get specialist treatment, or at least not sub specialist treatment. However, the biggest gain in health for the healthcare dollar is going to come from preventative medicine, not specialist care.  More would die of diseases such stroke, heart disease, cancer, but fewer would die of TB, and other infectious diseases, particularly youngsters.  On the other hand, this is a rapidly developing country, and soon they will need specialists, so specialist training is also necessary.  I am not sure that we are contributing much to the country as a whole at present, although we are contributing to the education of a small number of physicians.  We saw a young women on rounds last week with acute leukaemia.  She had been given some chemotherapy (not the most up to date regimen) and had the expected reaction of failure of her bone marrow to produce enough cells to fight off infection.  This is a necessary part of the treatment.  In Canada however, they are able to treat any infections that arise (usually), but here they can't, and according to one of the doctors, all these patients die.  So I ask myself, why bother with chemotherapy.  This is an example of Western medicine gone wrong.  Even in the bad old days in Cape Town, we knew that this was a hopeless situation.  If someone came in with acute leukaemia and infection we did not treat.  So, I have reservations about our work here, in that it is not the what the country needs, but on the other hand I am probably doing some good.  

On a lighter note, I made acquaintance with an old African friend of the last few days, musca domestica, the common housefly, of which there are an abundance here.  I had forgotten how pesky they can be.

Love to all

Morris