10-8-2010 0745 Apartment Bole Addis
Well, my ambitions have finally led my abilities onto a river with class IV holes and a flow rate of 30,000 cfm and I dont have either the strenth of ability to power through this.
In other words, this will be short because I've been working on a last minute power point to try to illustrate how our case based method works, at a level that would be intelligible to a smart person with no background but pivotal to the decision as to which direction a counry takes.
We, Bob, Kevin and I, are sitting around the dining room table. All on computers, on line.
Bob said yesterday,'nothing has changed since medical school; sitting around pecking on computers with a bunch of roomates in underwear'.
Except I am older, with less memory and far less finger to brain connectivity.
And so it goes...homage to Kurt Vonnegut.
More meeting today, the last one with the full team, since K and B leave tonight. I stay on through Wednesday.
Yesterday we went to Adama, aka Nazreth, named by Ras Tafari himself after the biblical town. Its on the main road to Djibuti, and thus the truck transport corridor of the country. Along the way, an incredible rolling view of the feats and folly of development. The country itself is Eden, high enough to be healthy, enough rainfall and soil to be bountiful. Along the highway, a more or less continuous development zone. There are collections of eucalyptus poles for sale; eucalyptus being the bamboo of this nation at the moment. About half of the structures are unfinished reinforced concrete and cinder block buildings in skeletal form only. Some are clearly years old...others are currently going up. Of the in progress half, about half of that are finished, but surrounded by barbed wire and not clearly operating. The others are functional factories of some sort...the finished ones include trap rock and perhaps gypsum...plus cement block manufacturing. There are also a few assembly plants, for Korean cars, and a huge Chinese sponsored site that will be the base for a new highway, 8 lanes wide.
'The Chinese' are definitely the largest investors. More on the mechanism later, but, as in Tanzania so many years ago now, the Chinese policy of not making internal policy a matter of concern regarding investment is extremely attractive to emerging nations. If you want a road, they will contract to build it, offering a loan to facilitate. Then, of course, you have to find the money to pay off the loan somewhere else, like the World Bank. Then, of course, the World Bank has conditions, looks at human rights, etc etc. But the Chinese dont let that possible impediment hold up the project. You need electricity to support rapid growth of the agricultural sector, or new industrial development? You want a big dam? The Chinese are ready to help.
At this time, I'm not sure how 'the chinese' are really structured, but whatever it is it clearly matches up with the corporate monster that the USA led the world in developing. Ah well, so it goes.
The hospital at Adama probably has the most specialists of any in the country. Originally developed in an old warehouse, primariliy by missionaries, it was nationalized during the Derg regime, and now operates as an independent cost center. They have a CEO who has all the current industry standard jounrals on his coffee table, and gave us a warm welcome and a concise description of their operation, which I will expand on later.
The actual physical plant would be a severe shock to anyone accustomed to Alta Bates, The Brigham, or even Montefiore or SF General. Ethiopian indoors tend to be dimly lit in any case, and the wards at Adama are no exception. Dont look here for the tools of modern midwifery. Or multistoried buildings requiring power to operate the elevator. But the range of services is good, and in some sectors (the lab) the computerization is parallel to what we had in Garberville. And the consequences of downtime on the machine is the same; no lab results until fixed. No backup.
Yes long lines, but no longer than Highland in Oakland. Yes limited resources, but not really much different than rural USA. Yes dirt in the corners, but the infection rates are not higher than many rural hospitals.
And then we returned, after lunch at a luxurious 'safari lounge', where the wood paneled rooms with private baths ranged around a pool and spa with an open air restaurant, shaded by tropical vegetation and where Kevin finally had his cheeseburger...whew, that sentence got away from me...where the rooms cost about $30 a day, and the meal was about $7 each.
We returned to addis, and to visit St Pauls. Initially commissioned by Ras Tafari in his manifestation as Haile Selassie the President, the current modern multistoried building was finished by missionary money in the 70's. We've been meeting with the Dean for the past week, and on this reciprocal visit, we met some of his teaching faculty. They've implemented a very successful lecture based early curriculum, with a Prologue and immediate clinical attachments. They use assessments that revolve around a student portfolio, and include mentoring. Sounds great; im going back tuesday to sit in on one of the classes. And I hope MOnday night to check out the ER.
Whew...and now its on to the meetings of today.
later
Alan
No comments:
Post a Comment