9 months into our work here, I wrote a little article for the American Society of Pediatric Otolaryngology (ASPO) talking a little bit about why we needed to set up a residency program like we did here. I’m placing a link here just to help give this next paragraph some perspective. The article is towards the end of the PDF in the international section. Enjoy.
Also, disclaimer, I wrote this post about 3 weeks ago and finished it today.
Just as our Head and Neck surgery residency is essential because of the advancements of care at Ayder, electricity is essential for the basic care of complex patients. It may sound like 1st world problems, but that’s where Ethiopia needs to be. They have set themselves a new standard and its essential to stick to that.
One such standard for my life is access to worldwide data. I grew up on the leading edge of the millennials experiencing life without internet and then having it fall into our laps when I was old enough to embrace it. All of us in my cohort remember the excitement induced endorphins triggered by one of the most annoying sounds on earth. The AOL/modem connection sound. I know its playing in all of your heads now. But just as Pavlov’s dogs drooled at the sound of a bell, I eagerly anticipated that terrible screeching sound that preceded a sudden connection to thousands of people all over the world at one time.
As I grew, so did the tentacles of worldwide information, creating an infrastructure for how I interacted with the world. So, when I moved to Ethiopia, I had no problem instantly connecting to loved ones or absorbing global events. The internet and access to it insulated my isolation. My social support network literally fit into my hand.
In a span of 3 weeks, 2 big events showed me how emotionally reliant I am on this network. Three weeks ago, the Ethiopian government decided to turn off all internet connections for 6 days straight. This was in hopes of preventing widespread cheating on the final high school exam. Something that was leaked to facebook 3 years ago and cost the government millions of Birr to reproduce and replace these exams. Never mind if this was a good decision or not, it resulted in a complete loss of my global social network. Although I was as busy as ever at work, at night (often sitting in my electricity devoid room; there will be a post on this soon), I could do nothing but think about what I no longer had access to.
For the first time in my life, I couldn’t just reach out to anyone I wanted to. I didn’t have instant access to everyone and everything. Its odd, I used to love to “get off the grid” while traveling or for a weekend getaway, but this was dramatically different. I wanted nothing more than to look at the top right of my cell and see the “H+” of my network pop up. Even now in retrospect, I can’t quite explain it. Am I just a spoiled 1st world kid?
Then, a worse event occurred the week following and is still going on as I write this. Keep in mind that the only information I have is from word of mouth and the government run news. But, there was an apparent military coup against the local government in Bahir Dar (The home of Hana and a place I’ve visited many times). Simultaneously, in the capital (Addis), 2 generals were executed at work. Both events appear to be linked. As a result, the internet was again switched off.
Now, this was different, the country is deliberately trying to minimize and manipulate what information gets to the general public. In reality, no one in the entire country has any idea whats going on other than what the Ethiopian news lets out. The world news agencies apparently covered some of it, but I had no access to this. Nevertheless, I still felt safe in Mekelle even though all US government-related workers were quickly evacuated to the capital.
As you will learn, I had a 72 hour trip to the US that was supposed to be for paperwork for Locums, but I have decided to use it to escape from this oppressive and smothering government’s political reaction to unexplainable violence. It will help me gain information and perspective on what’s actually going on. Not to mention, that I still need to make a decision about my trip to Mali next week and need to talk to the local physician there to understand the violence and its relationship to the mission. I couldn’t do that in Ethiopia, so hopefully I can from the US.
When I arrived in Addis on the way to the US yesterday, the entire city around the airport was on lockdown. It was a police state. Only uniformed armed men as far as the eye could see. I had to walk around all the construction from the domestic terminal to the international and I was stopped 6 times to present ID and to have my person and bags searched. I was honestly nervous.
Despite all of this, whenever I ask my friends in Mekelle what they think of the decision to cut the internet. They are happier for it. Worried that “crazy” people will get online and post nonsense leading to violence. I get it, it probably would. But why do people have to react like that? Why does rational thought get replaced with polarizing violence if free speech is allowed?
It’s this misunderstanding that makes me fear for my wellbeing far more than when I was jumped 7 months ago. That was rational. Explainable. How people react here sometimes isn’t. I can’t help but think that there could be an army driving up Mekelle’s streets at anytime. Looking for their piece of the power pie. It’s happened or is happening in countries all around us (Sudan, Egypt, Somalia just to name a few), why not here?
However, my fear isn’t justified. Not yet at least. I don’t have all the facts, but I intend on getting them during this 72 hour trip to the US. To be continued…
Flash into present time…
I now write this update on my plane back to Ethiopia, not after 72 hours, but 3 weeks later. It was hard, but based on the facts I had, I decided to delay Mali and to allow Ethiopia to reset to normal before heading back. But, of course, last week there were many people murdered in the southern part of Ethiopia during political riots. So once again, we go into the confusion that is Ethiopia.
As for Mali, there have been many very violent episodes between ethnic tribes over land rights that scare me. Although they are directed towards specific peoples, then end up taking out an entire village at a time. This isn’t occurring where I would do surgery, but the whole concept of violence there combined with random terrorist attacks unsettles me. Not to mention the state department. This is their statement about traveling there that helped make my decision to delay our work there until things settle down.
I know it doesn’t seem rational to return, but my conscience is weighing heavily on me now. I know I can’t treat everyone that has come to me in Ethiopia and I would have to leave at some point, but I made a promise to a large handful of patients that I would. Thus, the Mekelle team has set up an ambitious 2-week schedule to see and operate on as many of these patients as possible. It’s going to be an exhausting 2 weeks, but I can’t think of any better way to end my yearlong commitment there. A final test of sorts. Plus, perhaps more importantly, I miss my residents.
I’m sure there will be many great posts from these experiences. Till next time.
Global Head and Neck Surgery 