10-2-10 0745 The Apartment, Bole Ave, Addis. Gradually I am getting some idea of where I am...I mean outside of the task at hand, which is to sit in meetings with the Ethiopian medical and administrative people were are here to advise. So although yesterday I didnt really get further than the Coptic church nearby, reputedly the largest in the country, there is still a kind of osmotic transfer of information. Of course, this is still the hemisphere that I am used to, so the sun seems to be moving the right direction (it's always unsettling to be South of the equator, where my direction sense really doesnt work ). And after several days, I am settling down to 9,000 feet elevation.
The work..well, the most interesting part is, of course, the interactions. I think it was Lawrence Durrell who has one of his characters (maybe Justine) quote another (probably Pursewarden) saying something like 'beginnings are such delicate times'. Its one of those things that I tend to lump under 'communication skills', that have been part of what some call the 'hidden curriculum' of medical training. And if you would like to see what I mean, get one of those older doctor movies, like the series 'Doctor in the House', which portrayed medical students as engaged in a running battle of wits with their teachers...basically trying to do as little medicine and as much seduction as possible. Then fast forward to the Rex Morgan MD period, and then on to the ER and Hospital current edition. Or even "House" which by creating a cartoon level social leopard as philosopher king and even, paradoxically, humanist, creates a kind of artistic negative space that shows us the positive qualities we would like to see. Communication is now taught in all modern english speaking medical curricula..the question is how. The way we would like to think is best is to start communicating, in small groups where students encounter themselves over and over, and be mindful about the process. It is, of course, a version of the 'Action/Reflection' model of learning. That's what small groups do, whether its overtly appreciated or not. In a lecture, the communication is moslty one way..although anyone who has lectured to a large audience knows how much feedback they actually receive...the necking couple, the sleeping back rows, the super attentive front benchers, and so on. In a small group, such as our meeting, you hit the ground communicating, and thats the beginning that is so delicate. Thats what anyone in a service profession does, maybe 20 times a day or more, when they walk into the exam room, the office, or whever the enounter takes place, and say 'how can I help you today?' That process, call it 'joining' (as we tend to in family practice residency training) or 'the patient encounter' as internists tend to, is such a delicate and important part of medical care, its hard to believe that in the very recent past its been relegated to the 'hidden curriculum', the learning that took place in the hallways, the dorms, the late night cafeterias, and, yes, the bedrooms associated with the medical school and hospital, but in no way part of the planned or supervised curricular process.
So we are here talking not just about how to make 7000 doctors in 5 years, but how to make that many who are able to communicate effectively, have some sense of cultural humility, a well oiled moral compass, a good understanding of public health, as well as knowing how to intubate, how to crack a chest, and how to manage concurrent AIDS and tB. Hmmm. More to come.
ok maybe I wont get to Harar, but that is probably the city that you would most immediately realize that you are far from Kansas. I had a vague memory that some place here had decided to realize the true potential of the amazing hyena, and of course would love to get there. Take a look for yourself.
http://www.globalpost.com/dispatch/africa/100716/ethiopia-hyenas
I need to find out more myself about the Coptic faith, and its history, Perhaps you already know.
" The Ethiopian Orthodox Tewahedo Church (Amharic:Yäityop'ya ortodoks täwahedo bétäkrestyan) is the predominant Oriental Orthodox Christian church in Ethiopia. The Ethiopian Church was administratively part of the Coptic Orthodox Church until 1959, when it was granted its own Patriarch by Coptic Orthodox Pope of Alexandria and Patriarch of All Africa, Cyril VI. It should not be confused with the Ethiopian Catholic Church, which is a Chalcedonean church." (wikipedia)
This is a very alive and kicking faith, and the church we visited (outside only) is new, modern, and surrounded by assembly space. Services are often in Ge'ez, which is its own Sephardic language, perhaps like Latin in relationship to Catholicism. But as I say, I need to know more.
I became interested in it because of my vague recollection of Prester John. But that came later, . Again from wikipedia,
"Towards the close of the 15th century the Portuguese missions into Ethiopia began. A belief had long prevailed in Europe of the existence of a Christian kingdom in the far east, whose monarch was known as Prester John, and various expeditions had been sent in quest of it. Among others engaged in this search was Pêro da Covilhã, who arrived in Ethiopia in 1490, and, believing that he had at length reached the far-famed kingdom, presented to the nəgusä nägäst of the country, a letter from his master the king of Portugal, addressed to Prester John."
Well there are a lot of guys named John, just as there have been many named Jesus, or Gautama, or Mohammad. Ethiopia has exerted a fascination over all the rest of us for a long time. After all, remember it all started here.
Today, we are going to the market early, and then back for more meetings. What will be in the market? Well, the main exports are (in order) coffee, seseme and other oil seeds, and khat. Personally, I am looking for wooden spoons, but only the good kind, thank you Sala.
OK, ok, I will get going on finding out more about khat. Its definitely not part of the daily meetings, I want to assure you. But coffee is. And good.
Its fun working with Kevin and Bob. Our discussions are like standing around in front of a canvas throwing paint on it, creating something that can then be adjusted to be useful, but for those first creative moments is not well formed, not pretty even. Its just new, as new as 'eggs laid by tigers', to quote Dylan Thomas on the creative process. I love the creative process most at such early stages...find someone else to get the product to 90%..I am definitely a 75% guy. Just now we are sitting around a table in the apartment. Everyone is staring at computers...We all have coffee. There is some light music tinkling from someones computer. Its very gemutlich. But not very deep under any lightness is the sense of the serious level of the task that our Ethiopian colleagues are necessarily undertaking. This is about hyenas AND modern diseases. This is about 40 million people. This is about the place it all started, the uncolonized and amazingly beautiful land that, among other things, has the real city of Gondar within its borders.
OK, enough. Beka.
Alan
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