Ethiopia 2010 Day 3

10-1-10 0700 The Apartment, Bole Avenue, Addis.
Yes you wake up to the crowing of chickens and a few soft bird noises. Yes it rains loud on the tin roofs (but the main rains of September are over now) and yes the children begging along Bole (named after the airport) all look like Joaquin and Amalia. Oh, my heart!! Makes you realize why people think of that organ so tenderly...there is a kind of autonomic pause that occurs with emotional responses (which of course, as modern reductionists, we all know emanate from ze brain, not from el muscle that pumps das blood). (We are all reductionists, aren;t we?). So interesting that people like Tom who measure things like shyness and other emotional states of children actually use such pauses...changes in the delay between components of the electrical timing signals in the heart...to accurately monitor the emotional state of children.
Well...here we are, as they say. And where is this. Well, over 2300 meters high, thats close to 8,000 feet, baby!! Enough to bring flutters to the pumping muscles of certain sea level adapted humans. What I notice is a little breathlessness when I try to multitask. The surrounding Entoke mountains, which were what attracted Memlik II to the area back in the late 1800's, go up to almost 10,000 ft.
I still know next to nothing about the geography of the city. Seems to be two main roads, and we are just off Bole, which is one of them,
Walking along the road, the customary contrasts of construction and decay. Beggars and boutiques. Signs are in English and Amharic (the second largest sephardic language, behind Arabic). Stares and smiles. And smells...wood smoke and flowers. The building is poured cement with rebar and a cement block fascia. Like sausage, tall buildings in the developing world should not be seen in the making. But this is where I am.
And where is this? Well, generically including the Rift Valley to the SE, it is...well, let me quote from Wikipedia....
"After analysing the DNA of almost 1,000 people around the world, geneticists and other scientists claimed humans spread from what is now Addis Ababa 100,000 years ago.The research indicated that genetic diversity declines steadily the farther one's ancestors traveled from Addis Ababa, Ethiopia"
So we have arrived to learn about diversity, and perhaps to teach something about how to talk about it, how to incorporate thinking about it into being a doctor.
And Addis in particular, Ethiopia in general, is diverse in the ancient sense of DNA, and also the modern sense of Pan Africanism and politics. Quoting again from my favorite reference source,
"Although all Ethiopian ethnic groups are represented in Addis Ababa due to its position as capital of the country, the largest groups include the Amhara (47.04%%), Oromo (19.51%), Gurage (16.34%), Tigray (6.18%), Silt'e (2.94%), and Gamo (1.68%). Languages spoke include Amharic (71.0%), Oromiffa (10.7%), Gurage (8.37%), Tigrinya (3.60%), Silt'e (1.82%) and Gamo (1.03%). The religion with the most believers in Addis Ababa is Ethiopian Orthodox with 74.7% embracing that belief, while 16.2% are Muslim, 7.77% Protestant, and 0.48% Catholic."
Julius Nyerere, who was the school teacher ( Mwalimu) who became the first President of the then newly minted Tan(ganika)Zan(zibar)ia in an amazingly bloodless evolutionary revolutionary process had some good understandings of tribalism and the difficulties it posed for African development and unity. Contrast events in Kenya, with its two major tribes, and Tanzania with its multiplicity. Nyerere argued that the actual conduct of affairs in Africa was generally as socialist as could be, but that the superimposition of tribalism might hold people back from what he called 'Ujamaa', one of those wonderfully accreted Kiswahili words that is usually translated as 'working together'...socialism. I mention his name because as history moves along we often forget the names of those who came before. Like Queen Taytu Beytul, Memlik II's consort, who picked out Addis because of the mineral springs, and the presence of an old church, both of which she liked. So it was a combination of geographic military advantages and hot tubbing that created the city I have the privilege of writing from.
Its almost time to start the work,which today will probably consist mostly of a detailed review of several systems of medical education using medical cases..and trying to show, rather than tell, what their relative strengths and challenges are.
Again and again I ask myself, we ask ourselves, whether we are really sure that the curricular method we prefer, problem based small group student centered process, is robust enough to 'work' in a social context that is so different than the one(s) we are most familiar with.
And the encouraging part, of course,is to actually meet and interact with the Ethiopian doctors and educators who have invited us here to help them realize their own lives longing for itself. Of course they are wonderful. Warm, funny, and very serious about their medical situation.
And they have been working hard for years. Yodi, the military doc, summarized her program to retrain military medics as doctors. And there have been a succession of innovations, some bourne by expatriots, some by Ethiopians.
They are talking about one of those great leaps forward...thousands of doctors in a nation that was recently satisfied with a yearly graduating class of 50 to 100. They want to make such a leap. In all ways possible, they HAVE to make such a leap. The conjoint threats of global climate change and AIDS + tB are as real here as anywhere else on the continent. And that is a reality that the developed world is barely able to deal with.
So its exciting to be here, and also quite sobering.
And with that, I will move on to the day. Lucy has been waiting 3 million years, a few more days can't matter, but I can hardly wait. Of course, whats on display is a replica...perhaps the time I visited with her in Dar those many years ago was the closest I will get in this lifetime.
Dehna adara (good morning) (or Dehna aderk...if you are old enough to deserve it, mzee)

alan