Ishee

“Ishee” is a word you will hear hundreds of times a day here. It loosely means “OK” and is used as people start and end a conversation and shows active listening in between. This is the one Amharic word I have truly mastered… There are a lot of sounds in Amharic that are hard for a forenji (foreigner) like me to pronounce.

Last Sunday Andrew and Kayo hosted a lunch for the “gourmet club” they are a part of. It was quite an international crowd: Ethiopian, Egyptian, Swedish, Armenian, Italian, Chinese, British, Japanese, and American. They meet once a month at a member’s house and feast on fabulous food from the country of the host. Kayo prepared an amazing Japanese meal with bento box appetizers and then grilled tuna that Andrew had brought back from his recent trip to Djibouti (I am amazed he was able to check a cooler filled with 30lbs of fresh tuna).

Kayo's beautiful bento boxes

Elegant outside dining

There is a tortoise that lives in Andrew and Kayo’s compound. It usually seems to hang out in the flowers and shrubs, but occasionally strolls across the lawn. It decided to make an appearance during the party:

Tortoise

It has been good to get into a routine this week with Dr. Y. We arrive at Bethzatha Diagnostic Laboratory at around 9am each day and do a few lymph node and thyroid FNAs in the morning and look at slides that have come out. Then a little before midday we walk a few blocks over to the Bethzatha Clinic to do a couple bone marrow aspirates (we need a nurse to help with those). On Mondays, Wednesday and Fridays we then head to ALERT on the outskirts of town and eat lunch at the best (and only) restaurant I’ve ever been to that is housed in a shipping container (see picture below), run by a former ALERT patient. After we’ve had our fill of injera and wat, we do a few more FNAs and then sign out cases.

Shipping container/restaurant

Yesterday afternoon we saw a 6 year old boy whose left foot had swollen over the past year to a surprisingly big size. All his toes but his big one had auto-amputated. We did an FNA that was totally dry so we have no idea what is going on with him. I wasn’t able to get the full story and don’t know what kind of imaging or other tests he’s had.

Big Foot. I wish we knew why.

We see lots of lymph nodes containing caseous necrosis which in this neck of the woods is pretty much diagnostic for TB. No one wears masks in the health care settings here that I have seen to prevent the spread of TB. So many people have the infection that pretty much everyone has been exposed at some point or another. Dr. Y says they don’t use PPDs much here at all because everyone would be positive.

Pink Tuberculosis mycobacteria seen on acid fast stain

On Tuesday and Thursday afternoons we gross in surgical specimens back at Bethzatha which for all you non-pathology folks means looking at any tissue that is taken out of a patient in the OR or office, be it a big specimen like an entire uterus or colon resection or smaller pieces of tissue like GI or skin biopsies. I am impressed with the recycling that occurs to send specimens—jam jars, IV bags, syringes, even a Nutella container!

Specimen Containers

The description of each specimen is much more limited here than in the states… often it is just one or two measurements of whatever was submitted. I’ll be interested to see if things are different at Black Lion Hospital (the main teaching hospital of Addis Ababa University) when I start there next week. We usually take 1 or at the most 3 sections of any given specimen. Most of the time it’s only 1.

The formalin they use to fix tissue here is incredibly strong! Dr. Y had me try my hand at grossing in specimens and I didn’t last long before my eyes watered profusely and my lungs burned. I was relieved when he offered to take back over for me. I’m definitely used to a system with loads more personal protective gear, sharp knives, milder formalin, etc.

Dr. Y grossing specimens

This coming weekend we are heading out of Addis for some site-seeing and then next week I start at Black Lion Hospital, the main teaching hospital for Addis Ababa University. It will be interesting to see if they do things differently than Dr. Y who is nearing retirement and is a one-man show. I am also looking forward to meeting some Ethiopian residents and med students.

A couple fun facts about Ethiopian time:

Ethiopians use a different system for telling time: 12 hours of day starting at our 6am and 12 hours of night starting at our 12 pm.

Ethiopia uses its own calendar, the history of which I'm a little fuzzy about. In the Ethiopian year there are 13 months, 12 of which have 30 days and the 13th of which has just 5 days. They are ~7 years behind us.

Here’s a pic of me sampling the fabulous coffee here:

And I’ll leave you with a picture of me and my favorite nephew: