Can you repeat that? Nevermind... I give up.

Tekwar Tree: these are really cool. Like big oaks with wide shading. Grasping roots reach over rocks and walls. They seem to survive and thrive in adverse conditions.





Liz's frustrations (take solace in the beauty and resourcefulness of the tree. Be the tree, Bogel):

I have understood approximately one of every three words intended for group communication this morning. First there was morning report. Sonal and I had spent 6 hours yesterday and 6 hours the day before preparing a talk on a serious clotting disorder (DIC) caused by a wide variety of diseases/conditions seen here and at home. It's a good talk! Initially we had planned on discussing adrenal insufficiency but our chief resident, who had proposed this topic, told us three days ago this had been discussed recently. So we chose a new topic, learned it quickly and well, and practiced our final presentation. Elliott said we sounded smart :) We expected to give the talk Thusday and then he changed this to Friday. We arrived early this morning to set up our computer and realized we would be (nearly silently) discussing overnight admissions AND having journal club presented by a resident who had cut and pasted the entire NEJM article into crude powerpoint without understanding, himself, the import of the article. Good points were made by the attendings though nobody seemed clear on how to interpret the statistics (perhaps the subject of our next talk?). When we were already running ten minutes over time and had not yet begun, he asked us to give the talk next week instead. Gah!

We then went to round in the C ward after introducing our new medical student friend to the rounds crew on the D ward. It's as if bedside rounds are a secret. From whom, I can't yet tell. From the other interns to ensure they learn as little as possible while fearing public humiliation for this lack of knowledge? From the nursing students who hover around deferentially trying humbly to learn? From the attending who may snap a correction at a mistake? There is no way, at this volume, for an outsider to participate meaningfully in rounds. If I find out in the third post-presentation discussion question that this patient is pregnant how can I learn or teach? If I didn't hear that the patient has heart failure how can I give my opinion on appropriate therapy? This is a systemic problem demonstrated by interns, residents, and attendings and not corrected by my incessant requests to have critical information repeated. I will discuss this with attendings soon but felt unable to challenge the group on such a pervasive and damaging trend in the middle of rounds given the importance of their hierarchy. Thank you, Pacific Northwest Family Medicine for fostering the opposite of this ridiculousness. As interns we often have hesitation and shyness at offering an independent management plan but doing so is encouraged, our conjectures applauded and kindly corrected, and our confidence intentionally fostered.

A kind and enthusiastic-seeming whity physician from the Baylor Pediatric Aids Foundation came to morning report this morning and thanked the intern class for participating in a one-year intervention to target the 6 diagnoses deemed most important in influencing the pediatric mortality rate at the Gonder hospital (eg. acute severe malnutrition, heart failure, tuberculosis). A subset of the goals was to decrease mortality within the first 24 hours which was particularly high. The interns had been given both a didactic (lecture) session and a skills session in an on-campus simulation lab outfit with CPR mannequins (and currently being remodeled by a separate grant). He presented preliminary results which showed remarkable drops in overall mortality as well as 24-hour mortality and dramatic increases in the interns' knowledge (as evidence by pre- and post-tests flanking the interventions). The new rates quite closely approached the WHO goals for pediatric treatment outcomes and, besides the cost of the mannequins, reportedly cost $60 (U.S.) and Dr. Baylor applauded the interns who, appropriately, applauded themselves. That saves lives. Asking, "What was that? Did you say "renal failure' or 'retroviral'? does not. I'm glad we're going to the mountains this evening.

My interpretation of the plan which I theoretically participated in hatching on the phone today with Mulu (http://ethiopiasimientour.wordpress.com/) begins with our departure this afternoon and a drive up into the Simien Mountain park to camp and acclimatize for the night. Tomorrow, Sunday, and Monday morning we will do a combination of trekking by foot and driving by 4 x 4. Given the amount of flexibility he suggested, we may be the only three clients on the trip. The three nights, and parts of 4 days, including guiding, sleeping facilities (not sure what, really... but whatever), and food will cost us $200 each. I was expecting a little less but that's pretty darn good for a birthday get-away far above the smoky city air.

Don't be distressed at the lack of bloggage over the next few days.

Elliott has Gonder adventures: (Liz is not, actually, bitter at all just ready to play outside a little with her sweetie and return to meaningful work with renewed enthusiasm.)

A house seen on my exploration. There are some very brilliant flowers in Gonder, I can only imagine what it looks like right after the rainy season ends in October. They say it is very green, spring time in fall. The weather here is perfect. 80 to 90 degrees for high, low of maybe 50. Nice breeze too.








Here is the gate to the Debre Berhan Selassie church. Built in the 1600's, protected from the marauding Dervishes of Sudan by a holy swarm of bees, bombed by the british. It was a nice 2km walk from the piazza to the hilltop neighborhood where the church is located. I had to wait a while for the church service to end (2 hours spent hanging with the kids from the surounding homes), but it was worth it. This gate was built to resemble a Lion. The tail runs along the base of the wall on the inside.





The inside of the church is covered with paintings done in the 1700's, including these cherubs on the ceiling. A great hike today, I'm really getting into exploring the back roads and paths around town. They are quieter and less dusty without the vehicles flying by. bye