Melkam Fasika/Happy Easter!

 Ethiopian lent is 55 days long and Catholic one is 40 days long. I know couple of people that are Catholic and they give up their beer or coffee for lent.. Ethiopian Lent MAN.. You will go vegan for the whole 55 days, give up your breakfast, some hardcore once give up lunch too. It is recommended you sleep on the floor, not on bed and some devout couples even sleep apart for the whole time and they are not filing for divorce. :)

And this is your price at the end/DORO wat 

It is nice to be back to MN... Warming up and people are running and biking around the lakes. I had a wonderful time in Ethiopia. The Medicine Department had a farewell party for me and I earned a new name DR.FIRA. Fira means a relative.

Internal medicine residents, Interns and Staff docs. 

Traditional Arsi garment presented to me by Department of Medicine 

From right Bekele, Dageme, Godana, Me, Yitbareke Internist and at the end on the left ER doc/Temesgan 

The resident office finally done!

Prior pics for comparison of the resident office being demolished/was an old bathroom 

TEJ/Ethiopian Honey Wine 

Me learning how to make a scarf

MY ride in Adama 

Family picnic 

Beer time with DAD

Last dinner Before departure 

See you back  in June Ethiopia!

Now am am ready to be a nocturnist by night and a DADDY/BABA by day!.

I got a cool Big brother.. don't mess with me 

----to be continued in June 

Power transfer from the 70th Aba Gada Guyo Goba to the new Aba Gada of Borena kuraa Jarso/Painting by local Artist 

The new Aba Geda kuraa Jarso 

The Oromo People has beed using traditional and spiritual system of governance called Aba Gada for ages. I had a chance to visit the power transfer between the 70th Aba Gada Guyo Goba to the new Aba Gada of Borena kuraa Jarso. This happens every 8 years using their own lunar calendar.  The election is democratic and peaceful and follows it own geda structure.  The system was registered under UNESCO  as Intangible Cultural Heritage of Humanity in 2016. I was a little ashamed how little I knew about the Aba Geda system, probably one of the oldest democracy in the world!  There are few books written on the Aba geda system. I am currently reading a book by asmerom Leggesse written on oromo Democracy 

Team of doctors who went to the Aba Gada celebration 

Dr.Lado one of my resident. Was given a scholarship by the Ethiopian government from south Sudan 

                                                                             
Adama Hospital Medical college graduated its 1st  medical students in Feb/2017. I was very happy to be part of this historical day. The College has also started  residency training  in different specialties. I have been rounding with medicine residents and medical students. I am hoping for continued research and teaching collaboration.    

Adama/also known as nazreth has elevation of 1712 meters and is located 99 km southeast of Addis Ababa.The city is part of the great rift valley. The population is estimated to be 220,000.

Going to graduation with Dr.Dagem on of the internist 

some of the graduating students 

Staff 

Oromo elders came to bless the graduation!

skype time..longing to hold them soon 

Week 4 and 5

Over the past month I have seen variety of cases, infectious and non infectious disease. Malaria is endemic in the surrounding area. RVI/OI is the commonest cause of in hospital admission and death. Cardiovascular disease is on the rise due to sedentary life style in the cities. Below are few of the interesting and sad cases I saw in my 4th and 5th week here in Adama;

1. 32 years old female admitted with LOC 24 hours after given birth. Delivery was at home, she had witnessed seizure by family member while giving birth.  presented to ED with LOC. GCS of 4/15. BP 210/120. Admitted to ICU with working dx of eclampsia and now fighting for her life. concern for intracranial hemorrhage..imaging is not available in the hospital. Heartbreaking to see a mother die from pregnancy and child birth related complication

2. 25 years old female came in encephalophatic, foaming and hydrophobic...
Hx: 20 days a go she got bitten by a street dog on the neck... Rabies is under reported killer in east Africa. Main victims are women and kids beaten by street dogs. Rabies immune globulin is not available in the country. There is no national vaccine program. The community usually kills street doges by stoning or shooting them.

3. 36 years old male Recent DX of RVI at a health care center/base line CD4 not available to us came with headache which started a week after starting ART. Head MRI shown below. V/s stable, no latralizing sign on exam. DDx Toxo, creptoccocoma, Tuberculoma, PML... not settled yet.

cephalic tetanus from a head wound 

another tetanus case from a nail foot injury 

4. 19 years old male came with cranial nerve disfunction and ultimately developed generalized tetanus. He is being managed in a dark room along with one another patient. His frequency of spasms has reduced from 20 to 1 per day now, has been getting diazepam and CPZ. His laryngeal spasm was minimal and did not require tracheotomy!! Will be discharging soon. Tetanus is another common preventable cause of death in Ethiopia

my favorite snack in Adama

multi purpose wheelchair stocking the pharmacy  

went to visit a land that I inherited from my grandpa. With God's will I plan to build primary school in his name.

I made peace with the dogs and new puppies in my compound!

The residents office progress 

Zeritu kebede my favorite Ethiopian artist /https://www.last.fm/music/Zeritu+Kebede