By Surafel K Gebreselassie
I drove faster than I normally would. It was in January, in the middle of a snow storm. My car skidded and stopped at the edge of Superior Avenue. I normally wouldn’t take Superior to go to work. The speed limit on Superior was only 25 miles per hour. I paid a fine once for just being 5 miles over. It’s true; two hundred American dollars. My old Honda was clear on the photo. I wanted to grab a small cup of coffee. Otherwise I would have taken Carnegie, the first road I learned after I moved to Cleveland.
I was pleasantly surprised to find Ethiopian Sidamo coffee. I paid for a large cup instead.
It was more than a decade ago, fresh out of medical school. We had to do mandatory medical service in government hospitals for 2-4 years but the location was decided based on a lottery. I was assigned to Awassa, the capital of the Southern States including Sidamo. Short of getting a job in Addis, the capital, Awassa was one of the few coveted spots. After about a 6 hour bus drive I arrived to this beautiful lake side city.
The conference room had filled up half way when I arrived. Most were late because of the snow. The fellows were seated on the left corner, all but one. I saw some new faces, a mix of medical students and residents. The staff physicians trickled in, some yawning. Every Wednesday morning there was a case conference except the third Wednesday which was allocated for kidney biopsy reviews.
‘I am presenting this case today to see what you guys think about it? Do you all have the case summary?’
The master clinician asked scanning everyone as quickly as possible pointing to the pack of papers.
A 68 years old patient was described as having been treated for kidney failure. He read the summary loud with a melody that looked like an entry to a good novel.
“He has renal failure,” he quipped.
Then drilling the fellows started as usual reminding me of my training days. The differential diagnosis was discussed in good detail.
‘So what do you think about the elevated potassium? What are the symptoms of kidney failure? How would you use the blood and urine data? How would that help you at all?”
In the ensuing silence, I drifted back to Awassa and then to Turmi, a small city in the Omo Valley. The drive was rather dramatic. I made it to Arbamich the following day but I missed the weekly bus service to Jinka, just by a day, it turned out. I didn’t have enough money to wait for a full week so I paid what I had to ride on the roof of a heavy truck, a 12 wheeler. It would take us 24 hours to reach the city of Jinka, about 200 miles. The road was bad. The drive was challenging. To my astonishment, the driver decided to take a break around mid night.
“We are stopping here,” he said in the middle of nowhere. I was still sitting on the roof of the truck hungry and tired. Through the front light I could see some families from distance all lying on the dirt circling big trees with their cushioned two legged stools giving them neck support. I couldn’t see very well but suspected they might be families of the Omotic community such as the Hamar people.
“Get off the truck and take some sleep,” shouted the assistant driver his voice echoing in that barren land.
“We have to take a break until down. There are ghosts and wild animals,” he followed.
I got off and stretched myself. I thought I could fall if I tried to sleep on the roof. I pulled out a towel and lay on the side road resting my back on the roots of a eucalyptus tree. They left the truck’s light on to scare away wild animals. I was too tired to be afraid of Hyenas or Lions or Tigers.
When we finally made it to Jinka it was mid-day and I wasn’t alone on the roof. A Konso family joined me later. They are known for irrigation and terracing of mountain slopes and erecting carvings of loved ones or important persons. A brief stop in the health office in Jinka, the main city in the Omo region of Ethiopia, brought another surprise. I had yet to make another trip, this time to Turmi, a market town home to many of the Hamar people. Word was out that I was coming to Turmi, what could have been the first doctor to run a health center. I was welcomed.
I still remember the light honey wine (birz) that I enjoyed surrounded by the beautiful Hamar people. My first patient was a middle aged man who came with his two beautiful daughters, 19 and 20, with elaborate hair dressings of red clay.
He had nausea, vomiting, swelling around his eyes and both legs. He wasn’t making much of urine.
I thought of getting married to a Hamar woman and settling down in front of the Burka Mountains and run the clinic but I had no chance unless I jumped over a line of 10 to 30 bulls without falling, four times, completely nude.
The medical students were quite. They even look confused. He scanned them with his eyes. He cleaned the blackboard with his clinched fist and started drawing the collecting duct of the patient’s kidneys, a scratch and sort of two parallel lines.
One is facing the urine, the other the blood.
“What are the symptoms of kidney failure?” he asked them again.
Nausea, vomiting, body swelling, decreased urination, fluid buildup around the lungs and the heart, confusion, even coma.
The discussion was getting hot.
Everyone was chipping in but me.
I drifted back to the Omo Valley.