A piece of my practice : you cannot shake my hands!

Solomie Deribessa, MD, MPH

After the morning report, patients’ charts had piled up on my desk and the nurse started calling one by one.
The first patient came just to refill drugs, the second one had common cold, the third had skin infections but then comes Abiti.

Abiti was my fourth patient. He was brought to the clinic by his aunt who wore prosthetic appearing shoes. I stretched my hands as I would greet all my patients but she held back.

I was caught by surprise and again stretched my hands.

She burst in to tears. I was shocked and went around the table to comfort her. Her eyes welled with tears, she wrapped her hands with neṭela (ነጠላ) which is a handmade scarf-like cloth made of cotton. I shook her wrapped hand and I tried to console her.

“You know Doctor” , she said and continued, “HIV , Leprosy and poverty are deadly combinations . Though I am walking, I feel like I am a dead person. It has been several years since I became diabled like this because of Leprosy,” she paused to wipe her tears.

“Two decades have passed since I received a hand shake from people.”

I asked her why?

“Because people think that they may get Leprosy if they touch my hands or body but the worst of all is they think I have HIV. After I lost my brother and his wife because of AIDS, I brought his two sons to live with me , both of them are HIV positive but we didn’t know until later after my husband died. When the neighbors knew that I am taking care of kids with the virus and later after my husband died of HIV, they completely shut me off; they are not even talking to me. “

Back in 2007 the stigma towards people living with HIV had been immense, that was the time that people used to expel HIV positive people renting their houses and were closing their doors for HIV positive neighbors. The stigma is still strong in Africa and many parts of the developing countries. In Western societies and among educated people in many major cities in Africa, HIV is just another chronic illness and millions are living with the virus taking their anti-viral medications.
She continued her story,

“On top of everything I became a widow; my husband died a year ago of HIV/AIDS.”

Looking at my perplexed face, she quickly followed,

“The death of my husband was my fault”.

She said her husband was bed ridden because of leprosy. They had meager resources and barely had anything in the house. They shared needles and blades to shave; didn’t have money to buy extra. They didn’t know then that the boys had HIV.

I felt terribly sorry and wanted to cry. I asked her if she has been screened for HIV and she said she had never been tested. After a brief counseling I asked her if she was willing. She agreed but also added that she is a dead woman walking.

One hour after we took the test, all of us in the clinic sighed with relief. She tested negative for HIV. We overjoyed to tell her the result and we called her to the private counseling room to announce the good news. She was somewhat relieved but she still has to take care of Abiti and his brother … and the stigma…of both HIV and leprosy… and the challenges of deep poverty.

They left the clinic reassured that I won’t abandon them like their neighbors.

(This is based on a true story, actual names are not used)

Dr Solomie Deribessa is an experienced pediatrician who is a pediatric infectious disease fellow at the Addis Ababa University in Addis Ababa, Ethiopia.

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Saving Ethiopia

April 2, ….

I, my wife, our 9 year old daughter and 7 year old boy are taking off the Ethiopian after a 13 hour flight from Washington DC. For our children this was their most important trip. They were 1 and 3 year olds when we first visited Addis together.
It was a comfy flight but our daughter kept asking nonstop questions about Ethiopia and most of which were directed to me.
I was dozing off when she said,
‘Daddy, I am excited to see Ethiopia
I am excited to see my nephews and nieces
Grand ma and dad.
But do you know who I am excited to see the most? ‘
She got me curious.

‘The riverside in Addis. I want to go to the park. Would you drive us from Entoto to Akakai ?’

Of course we will see that.

I reassured her. I wanted to see it myself. When the prime minister proposed his “The Beatifying Sheger ” project within few months of coming to power, I though it will just be a dream and won’t be completed. It was a billion birr project. He pulled it off. We heard it has become a tourist attraction and no wonder my daughter has seen the video on YouTube.

‘Daddy, what does Sheger mean ?’

It is another name for Addis.

Does Addis has other names other than Sheger ?

Finfine in Oromigna

‘Daddy, why do you only teach us Amharic, we want to know Oromigna ,Tigrigna, Guragigna.’

I would love you both to learn Oromigna. It is a beautiful language but I missed the opportunity to learn it well when I was at a medical school in Jimma.

She was visibly upset that we didn’t make effort to learn major Ethiopian languages and yet we are fluent in English and try to learn Spanish.

Our boy finished the inflight entertainment Ethiopian move that caught his attention and joined our conversation. My wife is trying to sleep and nudged me to keep our voice down. An elderly woman on the flight who was sitting just behind us peeked her head and asked if the kids have seen Awassa.

‘No they haven’t. They were kids last time we visited Ethiopia and it was not safe to visit Awassa.

‘Everything is peaceful now.’ She said loudly and continued.
‘The whole country is peaceful now. The first two years was difficult for the prime minister but he made bold decisions and sailed the ship despite the turbulence.’

“It was not the prime minister alone. It is Team Lemma.” That was from the passenger next to her.

All were visibly happy.

Soon, the flight attendants started getting us some snacks. The children were nicely distracted. I used the moment to take a nap.

‘Dadda, daddy, what is it that the prime minister did that made the country peaceful? ‘

That is a good question I said to my boy and tried to explain to him. In 2018 and 2019 the country was in a difficult transition. It was almost slipping in to an ethnic based civil war like Rwanda. You guys were kids but we were all concerned and tuned ourselves to daily news outlets. Especially your mother was busy listening to the Ethiopian Television, ESAT, OMN, Zehabesha, and many other news outlets including the print media. The country’s elites were fighting an ideological war. Unlike today the country was divided among 8 ethnic based regions and one multi ethnic region, southern people and nationalities. There were elites who believed that ethnic and language based regional divisions was better for Ethiopia given its many ethnic nature and historic grievances while others felt that it would be difficult to build modern democracy in an ethnic based administrative divisions and that can lead to ethnic conflicts. The latter group mention Kenya as an example. Kenya is also multi ethnic multi linguistic society but the political parties were not based on ethnic groups. At the time Kenya was also ahead of us in terms of democracy even if they also had their short comings.

‘Daddy, what is our ethnic group?’ Asked my daughter.

We are mixed. Between me and your mother we have every major ethnic group so we call ourselves of Ethiopian decent. All your aunts and uncles are also intermarried. I want to tell you both however that it is now illegal to ask one’s ethnicity so be careful; don’t get us in trouble.

‘Like Rwanda ?’

Yes like Rwanda. Thanks to the Prime Minister who followed the footsteps of Rwanda to ban it but took many years to implement it. Ethnic identity was embedded in every civilian discourse for three decades in Ethiopia.

My wife was upset that I have engaged our children in heavy political languages that they barely understood. I wasn’t only talking to them. The couple who sat in front of us had joined the discussion when I mentioned Kenya. They were both from Kenya and were curious.

The flight attendants started picking up trash and interrupted our discussion for a moment.

I continued. At first the prime minister appeared undecided but when I look back he was just getting everyone come along with him. He was ahead of everyone and had to wait for others to catch up. He had many challenges and resistance from the very same party he was elected to lead. He was not alone. There were many journalists and scholars who warned about the impending ethnic conflict and its tragic consequences. I remember grand ma how worried she was and like many mothers kept praying.

‘Daddy, why do you say prime minister? Isn’t he a president?’

Well, he was a prime minister then. He unified his party in to a multi-national one and minimized the role of ethnic based parties. He convinced the major players to change the constitution to a presidential system and won handily.

‘Like the USA?’

Yes like the USA.

“I wish he banned ethnic based parties”, said the lady behind us.

It is democracy. I said. The country can’t close its doors to any opinion but as long as the majority are not coerced to follow those opinions.

The Kenyan woman followed when I paused.

“You guys are lucky. The youngest prime minister in Africa has made a tremendous contribution to the whole Africa. In the past 6-7 years since he came to power, he has made progress in integrating the horn of Africa, pushed Eritrea to democracy, South Sudan is at peace with itself, has helped the democratic transition in Sudan, and has created a win –win situation with Egypt. The completion of the hydroelectric power on the Nile has lit the whole region.”

The kids have slept once they realize that the adults are taking the conversation seriously.

Are you guys transiting or going to visit Addis?

“We are headed to watch the African Nations cup. Kenya is in group D along with Gabon and Burundi. They are playing in Lekemte stadium, Wolega region. The group stage is played in many cities including Jijiga, Awassa, Jimma, Metu… The quarter final is in Mekele. The semifinal is in Bahir Dar. Addis is hosting the final.”

I had no idea that the country was selected to host the cup.
Where will you be staying?

“It is a five star hotel. It is only a short drive from the stadium.”

I couldn’t wait to check it out. It will only be a short flight from Addis; a weekend trip.

The captain was overhead announcing the final decent.
The landing was smooth.

A sign welcomed us to the new mega million international airport in Bishoftu!

We picked up our luggage and took a high speed train to the city of Addis, Sheger, Finfine as they all used interchangeably and affectionately. We checked in our condo that we still paying for using diaspora financing initiative the country introduced at the new luxurious La Gare multi-complex development next to my childhood home, Sengatera.

The country has become one!

Daddy, daddy , daddy , wake up it is the roosters crowing.

April 3, 2025!

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Celebrating Adwa : great victory day for Ethiopia and Africa

Image result for adwa

March 1st, 1896

It is a victory that led to the idea for the Pan-African movement!

Chronology of events:

•1883 : Italian government buys Assab bay from Italian commercial firms
•1885 ( Feb 5): Italian landing to occupy Massawa
•1887 (Jan 27th) : Ras Alula defeats Italians at the battle of Dogali. Italians suffer 512 casualties.
•1889 ( March 9) : Emperor Yohaness IV fatally wounded in the battle of Metema against Mahdists, and names Ras Mengesha his heir. The death of Yohannes IV and the eruption of Great Famine (1888-1892) facilitated the expansion of the Italians as they met little resistance on their way.
•Menilek laid claim to the Ethiopian throne thanks to lineage reaching back to King Solomon and Queen Sheba. For Taytu Betul, marriage to Menilek ( who divorced princess Altash ,and had relationship with Bafena ) would fulfill a prophecy of royal destiny. Menilek and Taytu sealed their union on Easter Sunday in 1883. Taytu is of Oromo decent and was born in Semien, near Tigray with family contacts throughout the north bringing Menilek a local legitimacy.
•1889 ( March 26th): Menilek of Shewa declares himself emperor
•1889 ( May 2nd) :Treaty of Wuchale between Italians and Menilek. Antonelli signed on behalf of Italy. Article 17 stated in Italian version that Italy would control Ethiopia’s external affairs; the Amharic version said that Menilek could choose whether or not to ask the Italians to act on his behalf, but was not required to do so. Ethiopians said it was a trick; Italians blamed the Ethiopian translator (Geraz. Yosef Neguse who knew French but not Italian)
•October 1889, Italy declared a protectorate over Ethiopia on the basis of article 17.
•Queen Victoria expressed her happiness at learning of Menilek’s accession but advised him to send all subsequent messages to London through the king of Italy.
•A great Furor resulted at Menilek’s court. Count Augusto Salimbeni was called in and shown the Amharic version of the treaty. Menilek had been assailed by domestic critics for having “sold” the country. Empress Taytu came close to accusing her husband of treason.
•France never recognized the treaty of Wuchale despite Rome trying hard. The French government awarded Menilek the Grand Cordon of the Legion of Honor for his efforts to abolish slavery and bring “ civilization” to his country but refused arms.
•1890 ( Jan 1st): Italians formally establish colony of Eritrea
•1891 ( Nov 1st) MajGen Oreste Baratieri appointed commander of Italy’s African forces
•Menilek adhered to Article 16 of the treaty which provided for review after 5 years from date of signature.
•Feb 27, 1893 he declared to the governments of Italy, Germany, France and Great Britain that: The Treaty of Wuchale would be null and void as of 1May 1894 but that he is not nullifying friendship with Italy
•Feb 1894 : King Tekle Haimanot of Gojam and his army joins Menelik in Addis, was impressed by the palace; looking out he could see that the windows “ let in light, but not the wind”
•Isolated in Tigray, Ras Mengesha concluded that a sovereign Ethiopia was better than a colonial state.
•June 1894: he ( 32 yrs) and his army of 6000, Ras Alula and other chiefs arrived in Addis. Menilek pardoned them bringing Tigray back in to the empire. Menelik counseled Mengesha Yohannes not to make any rash moves against Italy. Highlands of Eritrea tried to rejoin the motherland; Italians quickly suppressed the insurrection.
•In 1894, Adwa was plundered by the native troops of Barattieri.
•Ras Mengesha marched to Koatit and Senafe in 1895 against the Italians.
•May 5 1894 , an Anglo-Italian protocol was issued which placed Harar within Italian sphere of influence. Paris objected but Treaty of Wuchale was mentioned as a reason.
•Pietro Antoneli was appointed the undersecretary of Foreign Affairs by Prime Minister Crispi ( who took power Dec 15,1893) send him to Menilek to resolve “their difficulties”. No one in Ethiopian believed any longer the intentions of Italy.
•1895 ( Sep 17th) Menilek calls for total mobilization of Ethiopian forces
•Estimated Ethiopian Army: 145, 0000 men of whom 57,000 mounted and 71000 with fire arms with 28000 having breech –loaders; 10,000 women lead by Empress Taytu. Ethiopia had 80,000 rifles, 8,600 horses and 42 guns
•1895 ( Dec 7th) Ethiopians wipe out Italian garrison at Amba Alagi
•1896 ( Jan 20th) Italian garrison at Mekele surrenders on terms
•1896 ( Feb 14): Menilek and Taytu arrive at Adwa

•1896 ( Feb 29th) : Baratieri decides to advance the night of the 29th.
•The Ethiopian guide (misdirection or sabotage) led the Italians astray.
•At 4 am on March 1st Menilek, Taytu and the Rases were at mass. A number of couriers and runners rushed in to report the enemy was approaching in force.
•The green, orange and red flag was unfurled and at 5:30 am Menilek’s 100 K strong army moved forward. The Ethiopian army was led by Menilek and Taitu (troops of Shewans, and south and south-western Oromos); Ras Mekonnen (troops of Harar); Ras Wolle (Yejju contingent-Amharans and Oromos); Ras Michael (Wallo Oromo army); Ras Mengesha (Tigrian troops); Ras Alula (Tigrian troops of northern frontier); Wagshum Gwangul (Wag and Lasta troops); Negus Teklehaimanot (Gojjam troops); and Ras Sebhat and Hagos Teferi (Agame troops).
•By 9 am Italian center crumbled.By noon retreat started.
•March 1st: Menilek destroys Italian army at the battle of Adwa. Italian loss: 6133 men killed ( 261 oficers,2918 while, 954 permanently missing, and about 2000 ascari). Another 1428 wounded ( 470 Italians including 31 officers, and 958 ascari). 3000-4000 taken prisoners. Italy lost 70% of its forces. Ethiopian losses: 4000 – 7000 killed, 10,000 wounded ( far smaller percent of strength)

 

 

Refereces
1.Jonas, R. (2011). The Battle of Adwa: African Victory In The Age of Empire,Cambridge:Harvard University Press
2.McLachlan, S. (2011). Armies of the Adwa Campaign 1896: The Italian Disaster in Ethiopia, Oxford: Osprey Pulishing Ltd.
3.Prouty, C. (1986). Empress Taytu and Menilek II: Ethiopia 1883-1910, New Jersey:The Red Sea Press.
4.Marcus, H.G. (2002). A History of EthiopiaLos Angeles: University of California Press.
5.Hansen, J.(2004).African Princess: The Amazing Lives of Africa’s Royal Women, NY: The Madison Press Ltd
6.Meredith, M. (2011) The fate of Africa: A history of the Continent Since Independence, NY: Public Affairs.
7.Harris , J.E. (1994). African –American Reactions To War In Ethiopia 1936-1941, Baton Rouge: Louisiana State University Press.

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Barbers and stylists as health educators

 

Is this a creative option for Ethiopia?

We trained few barbers about hypertension and how to measure blood pressure in our project to address hypertension in East Cleveland. Each barber shop was provided with an automated blood pressure measuring machine. Any of their customers would have free access to these blood pressure machines to voluntarily take their own blood pressure. They were also provided with an easy access to a health care provider for advice if the customer’s blood pressure was elevated.

The barbers were fascinated when we reviewed the history of barbers in delivering health care that dates back to at least 1163 in Europe when Pope Alexander III issued a decree that prohibited members of religious orders from spilling blood. Because of their dexterity with scissors and razors, barbers began working as physicians or surgeons. In addition to shaving and hair cutting, barbers began performing bloodletting, which was a common form of treatment for many ailments, incision and draining of abscesses, and toot extractions (1) among other surgical procedures.

Imagine going to a dental place in January of 1164 in London and having your tooth out following a nice hair cut!

Henry the VIII in 1554 merged the fellowship of the surgeons with the company of barbers to form The United Company of Barbers and Surgeons restricting each to their own profession except tooth extraction which was practiced by both groups. That lasted until 1745 when King George II separated the two groups and then surgeons formed the Company of Surgeons which later became the Royal College of Surgeons in 1800 ( 1).

There are several studies that used barber shops and beauty salons to reach out particularly to minority communities in the United States for blood pressure and other health screening educations with rewarding results (2,3).

Hypertension and its complications such as stroke, heart disease, and kidney disease are a major health burden throughout the world including sub-Saharan Africa where the prevalence is increasing. In a recent community based screening in Ethiopia (4) involving over 9000 people aged 15-69, the prevalence of elevated blood pressure was 15.8%.  Low income countries don’t have adequate resources to address this and other emerging chronic illness such as diabetes and heart disease.

There is often a unique and trusting relationship that exists between the customer and a stylist or barber. Barber shops and beauty salons are located in almost all major cities in Ethiopia and can be a means of reaching large numbers of individuals in screening for hypertension and other health issues.

Imagine sitting in a barber shop or hair stylist in Addis Ababa just before the upcoming Ethiopian New Year and having to check your own blood pressure while awaiting your turn!

 

References:

 

  1. J Vasc Surg. 2018 Aug;68(2):646-649
  2. Am J Prev Med. 2014 Jul;47(1):77-85
  3. Arch Intern Med. 2011 Feb 28;171(4):342-50
  4. PLoS One. 2018 May 9;13(5):e0194819

 

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Electronic Health Records: Challenges for sub-Saharan Africa

I knock at the door, walk in, greet the patient, and sit next to a desk top with access to the electronic medical chart. The patient had already been seen by a nurse, medications updated and vital signs taken.

I only have 20 minutes allocated to see the patient, review and discuss findings such as labs and imaging, chart my exams and summary of my assessment of the patient’s conditions and outline treatment plans. Often times medications are send electronically to the patient’s preferred pharmacy. The patient is given a print out of the visit summary. It is all digital.

This is the status of medical practice in America which is changing rapidly; more patients in less time. It is all possible, however , due to the availability of advanced electronic health records.

Come to sub-Saharan Africa, there are enormous challenges in adopting electronic health records (EHR) despite significant benefits of improving quality of care and patient safety, decrease health care cost and greater efficiency. EHR systems increase accuracy, reduce mistakes through allergy alerts, access to laboratory data, immunization history, improve organizational and societal outcomes. Data can also be used for health care research. If implemented, it will have tremendous impact in a region that has about a quarter of the world’s disease burden but 1/8th of the world’s population.

In an excellent review (Int J Health Sci (Qassim). 2017 Sep-Oct; 11(4): 59–64), the authors pointed out 4 main barriers to adoption of EHR in sub-Saharan Africa: high implementation and maintenance costs; limited computer skills; poor electricity supply and lack of constant internet connectivity, and lack of prioritization of EHR. They suggested financial support, using low-cost technologies and phased implementation as potential solutions.

In another systematic review (JMIR Med Inform. 2017 Oct-Dec; 5(4): e44.) that was done in collaboration with the University of Gondar Hospital in Ethiopia, given that the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, the open-source approach as a good solution for these underserved areas was suggested which has been used in low income countries in Asia and South America.

About a year ago this time, I accompanied my cousin to see a physician. I was pleasantly surprised that everything from the initial checking in to the actual physician’s visit was paperless. He had a chest x ray first before called in to see the physician. A senior lung specialist greeted us, logged in his desktop, pulled up my cousin’s electronic chart, listened to his lungs, and looked at the CXR films which was loaded by the time we got there, compared it to the previous one and outlined treatment plans. Only this time it was in one of the new private hospitals in Addis Ababa, Ethiopia.

Health information is an essential tool in modern health care delivery; the role of the private sector shouldn’t be underestimated in advancing the reach of electronic health records in sub-Saharan Africa.

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A dollar a day

There is a call by the PM of Ethiopia to Ethiopians and people of Ethiopian origin to contribute a dollar a day for supporting the development of the country.

The class of 1989 at the medical school in Jimma University (South West Ethiopia) which used to be called Jimma Institute of health Sciences started with a class of 55 and after a grueling 7 years, about half, 27 to be exact, graduated.

Include me in that list.

The list goes down to 24 if you count out our Eritrean friends. Tuition, food, housing were all paid for by Ethiopia’s meager resources.

Fast forward to 2018, about 12 of the 24 (50%) graduates in 1996 are now practicing outside of Ethiopia. Our class has produced US board certified internists, a cardiologist, surgeon, endocrinologist, nephrologist, public health experts, pediatricians who are involved in private practice, academic and in international institutions.

This trend is well described in a recent publication (Hum Resour Health. 2017 Jun 26;15(1):4). The migration of African -educated physicians to the US has grown substantially from 2005 to 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries increased by over 300% in the 10 years specified above. Ethiopian trained physicians practicing in the US increased from 355 in 2005 to 666 in 2015, which is an astonishing 87% increase. This is not limited to Ethiopia. In the same study, Egypt, Nigeria, South Africa, Ethiopia, and Ghana account for 76.0% of all African-educated physicians in the United States.

If you break down the number of Ethiopian –educated physicians practicing in the US in 2015 by medical school, 365 were graduates of Addis Ababa University School of Medicine, 152 were trained at Gondar College of Medicine and 149 were trained at Jimma University.

In a paper published in 2011 looking at the financial cost of doctors emigrating from sub-Saharan Africa that studied 7 countries including Ethiopia (BMJ. 2011; 343: d7031.), total educational cost per student was $29898 in Ethiopia, $28620 of which was spend in medical school per medical student. If you extrapolate that data and multiply it by the number of Ethiopian trained physicians practicing in the US in 2015, it comes close to 20 million US dollars which is a lost investment for Ethiopia due to immigration of doctors to the US alone in the 10 years up to 2015. For the 9 countries included in the study (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), the overall estimated loss of returns from investment was $2.17bn.

So when the new Prime Minister of Ethiopia called for the diaspora Ethiopians and people of Ethiopian origin to contribute a dollar a day, he is reminding us that more is expected from us.

We certainly can do more than a dollar a day!

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At the end of the morning report

 

Eritrean –Ethiopian war (1998-2000), a brief reflection.

I took brisk steps as I approached the main entrance of the hospital’s auditorium. I was the on call GP. It was a busy night call.

I barely had a moment’s sleep. I had to pull the charts to be there on time to present the admissions and main events that happened overnight in this hospital in the center of Addis Ababa.

It was not an ordinary hospital; being late was not tolerated.

It was not an ordinary time, in the middle of the Eritrean –Ethiopian war.  It was in 1998.

The senior internists and general surgeons had taken the first raw followed by the two pediatricians, gynecologists, radiologists. And almost all of the general practitioners had taken the back rows. The room was unusually full. I found a spot towards the back next to my good friend Dr T. We both were recent graduates but from two different medical schools.  The hospital’s ear, nose and throat surgeon walked in next followed by the medical director of the hospital.

A former colonel, the medical director of the hospital was respected when it comes to medical knowledge but was also feared.

“Good morning,” he paused and looked at us.

“I want you all to stay after finishing the morning report.”

The room remained quiet.

The medical director looked at me and indicated to start the report.

I did a summary of how many patients I had seen in the hospital’s urgent care, how many I had admitted and I recall telling them with excitement the delivery of twins, a boy and girl that I had assisted. Respiratory ailments like tuberculosis, bronchitis, asthma, heart failure were all presented in a precise summary.

It was unusual in that no one was interrupting me with questions or comments  like the other morning reports. Even the surgeons were quite.

Everyone looked tense and away.

Shortly the chief nurse walked in and took a sit next to the medical director. We knew than something was up.

 

“Well, I know that you all may not be aware but today we have to pick one of you to join the medial team that will go to the war.” He said firmly.

The war was raging at the border between Ethiopia and Eritrea including at the disputed Badme. It was a war that eventually would kill several thousands and by some estimates close to 100,000. Unfortunately it was a war between two countries of the same people but there was no time to reason out. Logic didn’t exist.

Every one knew it was coming but at least some of us had no idea that it would be that fast.

“It is going to be a rotating service for 3 or 6 months,” he followed.

“The first one goes to,” he looked towards where I was seated next to my good friend Dr T unrolling the piece of paper that he picked.

Dr T was the lucky one. When the chief nurse announced his name he was stone cold and was still sitting after everyone else had left the room, in a hurry ,to call their families. I stayed behind.

It was a sacrifice the country requested.

He packed up the following day and joined the team that was heading north to assist the war. Dr T came back safe but with many war stories about heroic deeds and near survivals. Until the end of the war in 2000, many of my colleagues and other health providers followed… some of us were spared because of sheer luck but put up the time to cover our colleagues . It was a war that touched many lives.

Today, 20 years later, partly because of the change sought by the likes of the twins that have come of age since the war, the leaders of Ethiopia and Eritrea have resolved their differences and made peace so that the same people in two different countries ,however late , can restart living together in peace.

And no more surprises at the end of the morning report.

 

 

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