Sonal and Elliott in their short pants proudly cooking up some gummy spaghetti in beet-purpled water and sauteing said beets, carrots, hot peppers, garlic, and berbere spice: yum! And what a fine stove, eh?
Two little girls whose only (though fully mastered) English words are, "hello" and "ciao". I guess "ciao" isn't English. Details, details. They are daughters of one of our (unnecessarily) armed guards at the guest house and chase us down on most departures and returns hoping for a hand shake.
Pre-work coffee and biscuits in the shared courtyard outside apartment #5.
Happy 4th of April!
Several firsts today:
1) E and I bought sweet bread/donut-like items from a nearby stand for breakfast. They were wrapped in a November 11 edition of a British newspaper updating us on the Champions Leauge autumn action. We left Elliott reading this in the courtyard this morning.
2) We met Han, a neurologic physiotherapist from the Netherlands and Rose and Sandra, British nurses. They also are all here to teach in their respective fields, have neat perspectives and experience to share, and are staying the the Guest House and working at the hospital so we all walked to work this morning. Friends!
3) Sonal and I taught the House Officers this morning: what a trip! They are in their early 20's, very bright, and described by Dr. Shitaye as "between nurses and interns". Theirs is a system based directly on exam results so, although they placed a bit lower on placement exams, they are very bright, inspiringly enthusiastic (more so than the interns, I think), sweetly shy, relieved by our Seattle informality, and hanging off our every word. Hah! The more fools, they! Soon after we walked into the men's ward (D ward) we were swarmed with 25 white-coated house officers (again, 2 were female). One of them had prepared a 4-page, microscopically detailed history and physical report on a patient admitted with cryptococcal meningitis (opportunistic brain infection seen in AIDS patients, among other immunosuppressed folks). I told them we were here both to learn and to teach, that we were unfamiliar with their accents, and that vocal projection would be helpful. Then we spent an hour talking about this 60yo fellow, discussing physical exam findings, asking them to defend their differential diagnosis, choosing three labs (instead of the full panel of available labs) that would be helpful to narrow that differential, discussing how our labs supported his history of poor oral intake and vomiting (why is the hematocrit 44 when we expect anemia and see a high mean corpuscular volume? what does a high BUN to creatinine ratio suggest?), if he has meningitis why does he not demonstrate Kernig's and Brudkzinski's sign if the text book says he should have it? what is that horn growning on his belly below his umblicus? (we have no idea, by the way; it looked like a chronic keratinized HPV lesion of some sort.) what are some reasons that his CD4 count has not risen with HAART over the last year?
We then moved on to examine a woman in C ward who had had a cerebellar stroke. We demonstrated cerebellar function tests on each other (Sonal has excellent cerebellar function) and learned the words "dysdiadochokinesis" and "dysmetria", taught about the importance of physical therapy post-stroke, measures to avoid aspiration after stroke, and then broke for lunch.
This is satisfying work. And it was so fun to lead this discussion with Sonal. We played off each other nicely and complimented each other's knowledge areas. I'm grateful that our residency has emphasized teaching over the last two years.
Friday we'll be teaching the interns and residents on DIC (disseminated intravascular coagulopathy) and just discovered that, not hemorrhage, not malignancy, not sepsis, but desert snake bites, are the most common cause here. Hah! We'll adjust the powerpoint to reflect this...
Elliott is currently off hoofing it up a mountainlet to Goha Hotel in the mid-day sun with the reward of a Dashen at the pinnacle. I fear he'll waste away on a diet of coffee, bananas, and Dashen with all the walking he's doing. I think he's going to the Royal Enclosure this afternoon (Aran, this is the castle in the photo) and maybe we can get him to blog a bit of explanation and maybe share a painting.
We're trying to arrange a trip to the Simien Mountains this weekend. Although my birthday will still be observed on the 8th, Easter will wait until next week in Ethiopia. Our altitude will about double (from about 7,000 feet to 14,000), and we're hoping to find gabis (traditional blankets/head and shoulder wraps) for fashion and cold air comfort before then. Where did you guys find them?
Ciao for nao, xo, Liz
1 comment:
I enjoyed the description of Liz's teaching (should punctuation be "Liz'"...?)! Separately, in the picture of Sonal and Elliott cooking spaghetti, if there had been no comment about a small stove and short pants, I would easily be convinced that Elliott had grown two feet on the trip, and that the stove and pants were normal size.
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