Amanda

Amanda passed away this past Friday night with her family by her side. She fought a long hard battle against her burn injuries after an airshow accident back in March. My love and prayers go out to her family including her loving husband, Kyle, her mother, Jeanie, her brother, Matt, and her sister-in-law, Michelle. Amanda will be sorely missed by the airshow world and, of course, by her family.

I have to say that since I learned of her death, it hasn't seemed real. It is absolutely tragic and unfair that someone so young and beautiful would be taken from this earth so prematurely. She will be remembered by all of us. I hope that now she is happy to be reunited with her dad and Jackson.

The Way Home

Hannah and I wrapped up our trip to Eritrea yesterday with a driving tour around Asmara with Tsige, Melles' wife. She showed us one of the three dams that is responsible for collecting the water supply for the entire city. The water at this time of year in the very small "lake" formed by the dam was extremely low, which indicated to me just how dependent upon the rainy season the people are. She took showed us one of the engineering colleges that reminded me of the food science campus at the University of Arkansas with basically a high fence around a field containing many small buildings that served as the classrooms. The drive from the city to the college is quite long and not practical on a daily basis, so the 2000+ students that go there live in the dorms on the campus, which are radically different from what we think of as dorms. All of these things she showed us were down the path of a dirt road and lead to many small villages that comprised the population of Asmara.

Tsige was very excited to take us out for some reason. I felt sorry that we had not been able to spend more time with her while we were there, but the time just got away from us. Talking with her, she explained much more to us about the culture and the battle for independence. She explained how the guerilla fighters were finally able to capture the city of Massawa which served as a major port for northern Ethiopia in 1990 after fighting since 1961. Then gradually some time later the Ethiopian fighters left the city of Asmara and independence was declared in 1991. She also explained, however, that Eritrea was not recognized as a country by the United Nations until 1993. Hearing her story about the country and how there was virtually no support from the western world gave me a better understanding of why Eritrea is the way it is now, limiting the outside world in an effort to do things on its own (though I still don't think this is the best for them).

We said our goodbyes to the hotel staff and gave our last tips to the restaurant personnel and the doorman (who was at the door literally all day long every day with a smile on his face). We had our last meal of shiro, addis, injera, and a spinach dish I still can't remember the name of. We ordered our last B.P.W. or big plastic water and finally our trip came to an end with Melles and his daughter picking us up to make our trek to the airport. We were sad to go but were thankful to be finally heading home after a month. After a good 20 checks of our passports by nearly ever person we ran into at the airport, we made it to our gate and eventually onto the plane that took us from Asmara then to Jeddah then to Frankfurt. Hannah and I both got our long-awaited coke zeros on the plane, which we found weren't as good as we had hoped. In the Frankfurt airport I went a little nuts and bought a good $60 worth of German and Belgian chocolates. I do plan on giving some of it away though--at least that is what I keep telling myself to feel better about the ridiculous amount of money I spent (the weakness of the dollar over her really inhibited my chocolate buying abilities).

Hannah and I are planning our last 2 days of freedom before heading back to the ICU and the every third night call schedule requiring a good 90+ hours a week out of us. I'm afraid it will be a bit of a shock after the relatively relaxed schedule in Eritrea that gave us the weekends off and 2 hour lunch breaks. But it will be bittersweet--the ICU is a lot fun and I am very much welcoming back the practice and plentiful resources that make American medicine possible.

One last coffee ceremony

Yesterday Hannah and I were greeted by new interns at the usual resident report. Our old interns moved on to their surgical rotations and these new interns will be on service for the next month, which means Danielle (a fellow resident) will get to work with this group when she gets here next week. I made rounds with my intern, Victoria, and my goal was to make sure that we got as many people out of the hospital as possible and to make sure that every patient we rounded on had a good solid plan for discharge. I could tell that she might have been a little bit overwhelmed, particularly since she had been on call the night before. We also rounded with another sort of sub-attending who was an intern last year and has been assigned to the medical ward as part of his national service after medical school. He will act somewhat like a resident over the intern and the attending will continue to oversee both of them. I am glad that he is there since our attending is not there consistently for the intern.

After rounds and finishing up discharge paperwork yesterday, the nurses had planned a coffee ceremony in the hospital for us. Hannah and I are now very well educated about the process of a coffee ceremony since this was our fifth one. The head nurses from both sides came--Sister Fegadu on my side and Akbaret on Hannah's side. The other nurses including the nursing assistants also attended as well as our interns from the month. I had 2 cups of the coffee and Hannah had one. I think she has about had her fill of coffee ceremonies (as have I). The coffee ceremony included the usual popcorn, which seems to be a must during these events, as well as candy and some crackers. One of the nurses on my side also brought injera and shiro for the group, all of which was consumed by the end.

After our 5th and hopefully final coffee ceremony, Hannah and I took off to a nearby restaurant where we read for about and hour before we returned to the hospital for admissions. In the afternoon we had another thoracentesis (there are a lot of those here!) to do on a patient with a unilateral pleural effusion for symptom control. I have been impressed with the number of patients with pleural effusions here. At times it seems like everyone has one.

After work, we made it to one of the souvenir shops to pick up some last minute gifts for people before having dinner at the hotel. My intern, Luam, and her boyfriend came to our hotel and had dinner with us at the hotel restaurant. They were very cute together and I found him to be very up on his American culture. For some reason, we started talking about geography, so I proceeded to draw a map of the US in my notebook and Hannah and I started to label and name all of the 50 states. Then we started talking about African geography, and he impressed us all with a drawing of Africa in which he labelled all 54 countries. Did you know there is a country called Seashell? Its true! I had no idea. I hope to stay in touch with Luam to know where her life takes her in the future. And to have another contact in Eritrea should I come back to visit.

Hannah and I are now counting down to coming home. We have plans for each leg of our trip back--coke zero on the flight to Germany, then breakfast in Frankfurt, then family phone calls in Chicago, and finally home. We are looking forward to heading out tomorrow, but I admit that some part of me will miss this place and the time that I have had here and particularly the people.

Keren trip

Hannah and I were able to take a short day-trip to Keren, which is a town to the north east of Asmara yesterday. We took this trip simply because our travel permits were delayed the other two weekends we were in Asmara, and we really wanted to make the most of our time here while we were here. We decided to sort of "rough-it" on our Keren trip and did so by taking the public bus. The trip cost a total of $23 Nakfa (or about $1.50 USD). We showed up via cab at the bus station yesterday morning, and our cab driver made sure someone was there to help us. There were very long lines of people waiting for various buses, but somehow we were ushered on to one before it filled. We didn't leave right away, so I decided to get off the bus and use the bathroom before we left. This turned out to be an bad decision because the bathroom I ended up using was the grossest I have been in since the start of our visit (there was a lot of gagging involved), and because I also nearly missed the bus. Luckily, Hannah had the bus driver hold the bus while I emptied my bladder, and I did make it.

We made the 3 hour journey to Keren without any difficulty both of us reading our books on the way there. The bus itself was very old and worn out of course without air conditioning and the road was quite bumpy and curvy on the way there. Despite this, we did ok with the trip and enjoyed the undivided reading time that we had. I do have to add that I am reading Cutting for Stone by Abraham Verghese (almost done now), which is such an amazing book although I don't think I would have appreciated it as much if I wasn't a doctor or if I wasn't in Eritrea.

On arrival on the city of Keren, we were guided by a young guy that we met on the bus. He was actually looking over Hannah's shoulder during the bus ride, reading her book along with her, page by page. He showed us the old and the new markets. The "old" market was really the reason we came to Keren in the first place. It was a Monday-only market with plenty of items including scarves, soap, and coffee, but also included the very large Camel market. We spent quite a lot of time taking photos of the camels, posing with them, and petting them until we were yelled at by one of the camel market men. I love camels--they are soooooooo cool.

After the camel market, we just made our way through the new market, which was an area with more enclosed shops containing very bright colored clothing. The overall appearance of Keren was very very different from that of Asmara. The people were all wearing more traditional clothing with the men wearing white gowns and the women dressed in bright colored gowns. There were many more women were burqas and the population was definitely much more Muslim in their faith compared to that of Asmara. The architecture of the city was clearly not as influenced by the Italians with most of the houses and businesses in the very plain plaster boxy look. Not sure how else to describe it. The city was quite a bit smaller than Asmara obviously and most of the roads that we walked on were unpaved made up of sand. The primary thing that I took away from the city was the colorfulness of the people's wardrobe, which differed quite a lot from the people of Asmara. I was very glad that we made it because it was so culturally different from Asmara. It was clear that the people don't get visitors hardly EVER because Hannah and I were the only white people we saw when we were there and we were a spectacle among the young school-aged children.

After a coke break (which we later learned was Sudanese coke) and a rest from the very hot sun in Keren, Hannah and I found an old Italian cemetery behind the grain market in the city. Behind the Italian cemetery was a hill on top of which we were able to see the whole of the small city. We then took a taxi to a sacred Baobab tree that was believed to be a tree of fertility by the locals around which a church had been built. Hannah and I made a point to touch the tree and to climb around hits huge base before taking the bus back to Asmara. On the ride back, we found that throughout the way, the bus would stop at random small villages along the way and just pick random people up that it would drop off after a short drive. I guess it allows people from these small villages to really hitch a ride to other nearby villages. We made it back to Asmara via the bus extremely hot, sweaty and tired, but very satisfied with our outing that allowed us to see a very different, and pleasant side of the country.

Massawa

The rest of the story of Massawa…after experiencing the sand storm, we quickly opted to wait inside our hotel for the taxi driver to return. An hour and fifteen minutes after our planned meeting time, he came and took us to the Massawa beach. On the beach, the air was much cooler than in the city and the Red Sea was a very welcome site. The wind was still quite strong and that made pretty large waves that Hannah and I both took advantage of. Throughout our trip, Hannah decided that one of her goals was to see and ride a camel on the beach. She asked around, and found that the camels had been put up for the day because the beach was nearly completely devoid of people. But, with some luck, the camel man got one of his camels out specially for us. Hannah finally got to ride the camel, and I took a spin for myself. We got a myriad of pictures of her, myself, and then the two of us together riding the camel on the beach, through the water. They are very gentle animals, always chewing, and will talk with some provoking. They sort of remind me of cats, only bigger, and useful.

After we'd had enough of the beach, we went back to our hotel where we had quick showers and then we were off to dinner and to see the city. We were taken to the port area where presumably the city center was or had been. As I said before, to describe the city of Massawa, I would use the word Bizarre. On the surface the city looked impressive from afar with large, majestic-looking buildings, many of which were probably built by the Italians. The creepy part came in realizing that basically all of these huge buildings were essentially vacant. And around them within the town, the roads were dirt and people lived in the sides of buildings with very, very little. We wandered around finding a "new" hotel that was apparently the place to be. This place was huge with a nearly olympic-sized outdoor pool at the center. It looked like the perfect place that had been constructed for tourists. That was all on the surface. The hotel itself looked already run-down and was completely empty. There wasn't a soul in the pool and it seemed almost like we were trespassing into some secret hideaway when we went exploring. It was like it was built for something that never quite materialized.

There was a bar there and since the restaurant we planned to eat dinner at didn't open until 7pm, we opted to get an appetizer at this hotel. We ordered fried shrimp because we thought that would be safe and two glasses of red wine. What we got instead was two glasses of red-label whiskey further driving home the concept that you never really know what you are going to get when you order anything in this country. We tried our best to give the whiskey away, asking nearby people if they wanted it, but no one did. Unfortunately, we did end up paying for it in the end despite the mistake. I would like to add that at dinner the topic of our conversation centered around the absolute bizarreness of the city and its apparent vacantness.

When 7pm finally rolled around, we made our way to our dinner restaurant, a place called Selam Restaurant, which was recommended by everyone who has ever been to Massawa. Not for the food so much as the experience. The restaurant is literally a hole in the wall place that even the local people of Massawa didn't seem to know much about. They serve fish--medium or large--and bread, which is made of only flour, salt, and water. You get to go in the back of the kitchen and pick your fish--no specific species, presumably just whatever they caught that day. The fish and the bread are both cooked in a hole, which is essentially just a fire pit. The fish are first cut in half and rubbed with Berber (my favorite Eritrean spice) and then are put in the fire pit to cook. The bread is smashed on the wall of the fire pit flat and is much like Indian naan. The restaurant seating is all outside and there were swarms of cats around the tables begging for fish and having the occasional fight underneath some lucky person's chair. We ate our fish and bread, which really wasn't too bad and then spent the rest of the time feeding our left overs to the crazy cats underneath our table. At the most, we counted I think 9 cats under our table. All of which were skin and bone.

We both crashed that night at our hotel with our air conditioner blasting. The following morning, we headed back to the beach bright and early before 9am where we stayed for a good 2-3 hours reading and wave riding. We had lunch at the beach restaurant and then took showers before heading back to our safe-haven of Asmara around noon. As I mentioned, on the way back, we had to stop to air up the front passenger-side tire as it was going flat. It was the second leg of the trip that I noticed a wire sticking out of the drivers side dash board that was smoking and the taxi driver would periodically play with it. Not sure what it was. I'm very thankful we made it home.

We stopped at a small village on the way back so that our driver could buy some road-side watermelon. There, three little girls were selling peanuts and some other grain and were very intent on selling some to us. One thing I have observed is that the people will take any opportunity to sell something if possible or to beg for money or whatever we have. Luckily for these three little girls, I had some extra granola bars--nature valley fruit and nut variety--that I passed out. The girls were extremely eager to grab at these bars, but of course they kept on begging for more, more, more. To get them to stop, we made a game out of making funny faces at each other, which included smashing my face up against the cab window, which they all found hilarious.

Hannah and I were ecstatic to make it back to Asmara and the safety and comfort of our hotel rooms after our weekend trip. Massawa gave us a new perspective on the country as a whole, and it wasn't all pleasant. The large empty buildings, which reminded us of a vacant movie set, was eerie, but the people were still just has friendly and welcoming.

Sand storm

If I had to use one word to describe our trip to Massawa, it would be HOT. If I had to use one word to describe Massawa, it would be Bizarre.

Our adventure to Massawa started a little later than planned at 8:30 Saturday morning. When our taxi driver got there, we entered the cab with initial feelings that this cab was quite a bit better than those we had driven in through the city. It took us to the end of the trip to realize this may not have been true. The cab, which had over 500,000 miles on it had a cracked windshield, no speedometer, of course no AC which was not surprising, but it also had a near-flat tire towards the end of the trip, some raw wires sticking out of the drivers side panel that were smoking (and which our driver played with on the ride home), some serious exhaust fumes, and, my favorite, a pack of roaches that graced us with their presence when we made it to Massawa. I have realized that I have sort of a phobia when it comes to roaches, and Hannah can vouch for my fear of them. Luckily though we only saw them the once, and on our trip back to Asmara I doused myself, my stuff, Hannah, Hannah's stuff, and the interior of the cab in a plume of OFF. Our taxi driver did not really speak English, but he did enough for us to communicate on a very basic level.

So, we set out for Massawa, but not before we clarified that we wanted to go through Filfil on the way there, which is supposed to be the country's one and only opportunity to see forest and animals. With that, he made a U turn and then we were off. The drive to Filfil was very curvy. Actually, to say it is curvy by American standards is somewhat of an understatement. If I can describe, you go 100 yards in one direction on the edge/top of a mountain, and then you make a U turn and you go 100 yards in another direction. With Asmara being at over 7,000 feet, we had a long, long way to go to get down to sea level where we were going. There is no direct way to do that, so it is a series of U-turns back and forth gradually taking you down the mountain. The roads make the back roads of Arkansas look like a major interstate. Dramamine was an absolute must for me on this driving adventure, and I'm happy to say there was no carsickness.

We did stop for a photo-op at the top of the mountain where the view was quite incredible. The mountains are covered in a thin layer of trees, spaced apart so that you can see the dry rock beneath. We also stopped for a hot coke break at a place in the literal middle of nowhere that had a sitting area and apparently a hotel. How this place had electricity, running water, or really anything, I have absolutely NO idea being that it was situated half way up a mountain, a good hour and a half drive from Asmara.

As we travelled down the mountain, the temperature gradually increased so that the last 2 hours of our 4 hour trip was almost unbearable. I can't describe the heat with words. The best I can do is to say that when we had reached sea level and everything turned to dessert, the heat coming through the windows, which were open to help us keep breathing, was nauseating. I kept repeatedly checking my feet because they felt like they were getting burned in the sun, and each time that it turned out that the sun was not shining on them, I had to reassure myself that they were just burning from the heat in the cab. I have never, ever been that hot in my entire life. It was the sort of hot that absolutely sucked the life out of you. I can now understand more why the business model is to close during the hottest hours of the day. I would also like to comment and say that the Danakil area of Eritrea is apparently one of the hottest places on earth. And we were pretty far away from it. Why or how anyone could every go there is beyond me.

On our drive through the dessert, we passed people and animals living in places that I never would have thought possible. There were herds of goats, the occasional cow, and camels on the trip. Then there were villages made up of shacks constructed from pieces of metal where people obviously lived. Throughout the drive through the villages, people were herding goats and cattle. What struck me the most about this area we passed was that there was no water anywhere. Everywhere we saw what looked like a river or stream bed, it was completely bone dry. The only thing I could come up with was that they must have a well dug and that is why their villages are placed where they are because there is no obvious source of water that I could see.

Being in this heat, I was, of course, sweating profusely as I always do. I had to keep reminding myself to keep my mouth closed because even opening it for a few seconds caused it to dry out and I worried it would help make me even more dehydrated. Hannah and I failed to bring gadorade with us, so we we hydrating with only water. I'm sure we became hyponatremic (low sodium) on this short trip.

After having driven for nearly 4 hours, we finally made it into an area that appeared to be populated and looked sort of like a town and we found our hotel. This was lucky because right about the time we were driving up to our hotel, a pack of roaches came out from nowhere and started crawling all over our stuff and on the taxi driver. Although I was wearing a dress, I stood on my tip-toes in the back seat of the cab, waiting for it to stop so that I could get out. I had not yet taken note of the scenery of the city.

Inside the hotel felt like a sauna as we got checked in and made it to the third floor of the hotel where our room was. Thankfully, our room was cool and had an air conditioner. We took a moment to cool off before we got ready for the beach and made our way to the hotel lobby for lunch--the granola bars we brought, a cold coke, and a water. After lunch we decided to look next door to our hotel for the internet cafe that was apparently there. It was at this point, when we stepped outside, that we realized we weren't in Kansas anymore. The picture was basically that of Dessert storm, or Saudi Arabia, or a winter white-out. The city of Massawa could not be seen, and all we could see was the dessert that sat across from our hotel and the white sand blowing through. We chose to wear dresses to the beach, and they were being blown this way and that all the while, our skin was becoming absolutely caked with sand and dirt from being out in the sand storm. I would like to add that I am still finding areas of my body containing or caked with sand--particularly my ears--after this experience.

In a way, this introduction to Massawa was the most funny (though distressing at the time) part of the trip. The rest of it was notable as well, but the heat, sweat, and sand made us ask ourselves number one, how do people live here, and number two, how did we get there. There is too much to tell about the rest of the trip. That will have to be for tomorrow. Good night!

Some random thoughts

Today was nice. Hannah and I met for our usual morning breakfast in the hotel cafe. Every morning we both have a macchiato served in a play-sized coffee cup. We brought the last of the things we are giving away to the medical school and people here today. On our way here we both brought numerous books, which made our luggage quite heavy and which now will be a part of the medical school library here. I am giving away the 2 white coats I brought, but I have to keep one until the last day of course. And then there are random things I brought like a couple of notebooks, my reflex hammer, some gloves, an extra flash drive, some N95 masks, some alcohol hand sanitizer, a small but very powerful flashlight I have been using for a pen light/when the power goes out at the hotel, and in Hannah's case some clothes that we gave away today. If I had known how much little things like these were needed I would have brought more extra stuff that I have laying around my house. The people here appreciate all of these little things so much--so much more than I do--because it is so hard for them to get things here. Anyway, we got rid of the last of our stuff today because our interns will be changing on monday, and we wanted them to have a lot of this stuff.

Hannah and I both made rounds today on our respective sides of the medical ward. For some reason today seemed to be much smoother on my side than usual. I felt like I actually had a decent plan on people, which in many cases actually included consideration for discharge. Apparently the rate of discharges goes up quite a lot when we visit simply because we are so oriented to getting people out of the hospital. We also recognize sometimes more readily when the patients really shouldn't be in the hospital for outpatient issues and in the case where there isn't really anything that can be done for the patient in the hospital setting. I don't have a lot of cool patient stories because most of my ward has left and now there are a lot of chronic players. And as I have said before, there aren't tons of new admissions all of the time like in the US.

Henish made it out last night and should be back in the US sometime today. While he was here, he made quite a lot of corny quasi-jokes and his joking sort of brought out my idiotic sense of humor. When we were driving with Tsige the night before he left, we were driving behind a one-horse carriage. He then said, "look, its one horse power". This is probably a "you just had to be there" sort of moment, but it was really funny at the time.

After rounds today, we made it back in time to watch the royal wedding in full. It worked perfectly that it happened to be right a lunch. We sat in the hotel cafe in front of their flat screen TV where we watched the whole thing. I honestly can't remember a time when I was more into something on the TV. For us girls though, I think there is something magical about the royal wedding because we all sort of grow up dreaming about being a princess. It was so exciting to see a regular girl turn into a princess with an "I do". It was also awesome to see all of the dress for the affair including, of course, her dress. I was a little bit disappointed with the kiss, but I guess I will give them that it was very "British". :) There are two older men from Britain (Yorkshire) who are here on business working for the government while they are here. We see them every morning in the hotel restaurant eating breakfast while watching BBC news which is always on. We've talked to them a few times about what there is to do in Asmara and about going to Massawa. So, one of them came up to us today as we were watching the royal wedding and handed us some paper-towels for all of our tears--as a joke of course. I would like to say that not a tear was shed from either of us during the royal wedding today.

Hannah and I are going to be heading to Massawa this weekend for a one night stay in one of the hottest areas of this country. We are excited to finally see the Sea (ha!) and to see the countryside on our way there. Before we go, I would like to share some random thoughts/comments about our trip to Eritrea:
-The first several days here we were out of breath because of the altitude. Thats gotten a little bit better.
-In nearly every restaurant or even coffee bar, there is a full liquor selection, but there is never anyone drinking any of it. They all just drink the Asmara beer, which is the only beer available here.
-The cakes all taste like bananas.
-Every morning, I have to peel Hannah's banana. lol. She wont touch the bananas here because they have black on them, but if I peel it she will eat it.
-The exhaust on the streets is really bad because of all of the old cars even though there are relatively few cars here.
-The dogs like to pretty much only bark at night while we are trying to sleep. Thus, I wear ear plugs to sleep every night and sometimes by ears wake up hurting from them.
-Every item served in a restaurant is served from a tray. Even if you order a bottle of water, they will bring it over on a tray. If you order a banana, it will come on a tray and on its own little plate.
-Everyone here takes a 2.5 hour lunch break from 12:00 to 2:30. We also learned that if it is a hot day, they will take longer unannounced breaks and sometimes not come back (to open stores) until 3:30 or 4:00.
-I usually trip at least once per day while walking.
-Even though most of the people here speak only Tigrinya and not Arabic, most of the commercials are in Arabic and feature people from middle eastern countries. Presumably there is no such thing as Eritreawood to make movies and commercials.
-If a public bathroom has a toilet, it will invariably not have a toilet seat nor will it have toilet tissue. Luckily there a women on most street corners selling packs of facial tissue and gum.

We also constructed a top 10 list of things that we wish they had in the hospital here readily available. Number 10) A cath lab (or tPA). Number 9) Statins. Number 8) A pathologist. Number 7) Soap (consistently) Number 6) Pyridoxine (B6) for inpatients. Number 5) Ejection fractions. Number 4) Gloves (consistently). Number 3) Blood sugar test strips (consistently). Number 2) Oxygen on the floors. Number 1) Oral potassium chloride.

Thats all I've got for a couple of days. Hopefully we will come back with plenty of stories from Massawa this weekend.