It's been awhile since my last entry. I've since finished my fellowship at the CDC, transitioned from inhabitant to tourist in Egypt, introduced Alberto to a small piece of Cairo and travelled to Ethiopia. I'll save Ethiopia for my next entry, but I'll tell you that I wrote this entry in a small hut sitting in a garden on the edge of beautiful Lake Tana in the northern part of the country... I'm now typing this message after a long 5 hour bus ride from that small town. Internet and electricity are scarce here, so I’ll write when I can.
My CDC work came to a close, and I feel like I had an amazing experience working with incredible Egyptian epidemiologists. We mainly worked together on 3 projects: 1) Device acquired infections in the ICU 2)Hospital acquired viral respiratory infections 3) Severe acute respiratory infections (getting patients as they come into the hospital from the community). Until medical school, I never realized just HOW DIRTY hospitals are. They are filled with potent bacteria exposed to antibiotics daily. I'm sure you've all heard of MRSA -- the staph bacteria that can be deadly. This is just one example. Currently, there is little if any data regarding hospital acquired infections, let alone antibiotic resistance, in developing countries. The few numbers that do exist predict that hospital acquired infections are double that of developed countries. Physicians crave this data. I had a particularly memorable experience in Jordan monitoring on-going projects (more on this later) who was giving an infant a very strong antibiotic (vancomycin) for community acquired pneumonia. This child was very sick, and the physician's logic was that he couldn't risk that there was MRSA (the very strong bacteria, which vancomycin kills) in the community. It felt great to reassure him that if all goes to plan, we'll have exactly this data for him in a few years. And preliminary data in maybe 6 months to one year.
The second 2 projects mostly dealt with flu surveillance. You may remember that a few years ago a bunch of birds -- and a few people -- died of a very potent form of the flu in Southeast Asia. There's a growing concern within public health circles that we are on the brink of a flu pandemic. Therefore, it's important to get developing countries' diagnostic, quarantine, and flu treatment protocols polished NOW before we are in the midst of something serious. These studies would provide baseline numbers for these countries (the CDC currently has major sites in Thailand, China, Egypt, Guatemala, Kenya etc.) so that in case something starts in their respective regions we'll be able to pick up on the subtleties of numbers instead of when things become obvious (lots of deaths).
My experience with these projects was complimented by a trip to Jordan where the Egypt CDC has a number of projects. In fact, the CDC generally starts projects in Jordan because the projects usually have great success due to the enthusiasm, organization and well-staffed hospitals. I was surprised to find the hospitals in both rural (Irbit and Karak) and urban (Amman, the capital) to be extremely clean and well funded. In Guatemala the CDC hires retired nurses to run the studies in the hospitals, while hospitals in Jordan (and Egypt) have their own study infrastructure in place -- an "Infection Control Team".
Jordan is under the rule of King Hussein and his picture is paraded everywhere -- on the front of vehicles, restaurants and stores -- in both private and public enterprises. I tried to figure out if this was genuine or forced, but of the several nurses/health officials that I asked the response was, "We love him."
I also learned that Jordan's population is composed of 40% Palestinian refugees, and in fact, the Queen is of Palestinian origin. She shows a lot of sympathy to the Palestinians -- granting them citizenship to Jordan -- according to my Egyptian colleague. However, I met a Palestinian in Egypt who felt differently, and said that Palestinians are ashamed of her. "She'll send 1000 candles to light in the Gaza strip, but won't push for anything substantial." I think I’m too uninformed to really have an opinion regarding the Israel/Palestine conflict, so am just writing what I've heard... although, I've spent much more time listening to tidbits about this conflict than I ever have in the US.
Amman, the capital, is located in the mountains. It was actually cold and rainy when I arrived at night and instantly realized that I had not brought proper clothes. Not much I could do, though, as all of my "appropriate" clothes were back in the US. In fact we had to rearrange our hospital visits due to snow blocking a mountain pass. Who would have ever thought... snow in the Middle East? My ignorance for the region shines through again.
Each day the Jordanians fed us a delicious lunch. The first day was Kabobs of lamb and veal mixed with fried vegetables. My favorite meal, though, was roasted lamb -- literally, the skeleton cooked -- laying in pieces atop a pile of yellow rice and roasted pumpkin seeds covered in a milk/yogurt sauce. You are supposed to eat with your hands surrounding the communal plate, but "Team Egypt" always refuses this way of eating due to its difficulty. You are supposed to role the rice+meat+seeds+sauce into a small ball and throw it into your mouth. Our leader, Maha, once tried this, only to have the ball fall apart mid-air. She said it literally looked like she had just thrown a pile of food at herself.
My stay at the CDC culminated in participating as a facilitator in a US Dept of State workshop, mostly organized by my two roommates, Lisa and Meg. It was a huge affair -- two weeks of training for physician, epidemiologist, and laboratory staff from Morocco, Tunisia, Afghanistan, Djibouti, Jordan, Sudan and Egypt. Including Match Day, I served as a facilitator for 3 sessions and was paired with the Afghanis. We grew fond of each other over the sessions, and each of the 6 Afghanis wanted a picture of me shaking their hands in front of the "USA + Afghanistan = :-)" sign we had written on the board. I also was able to see my friends from Jordan again, who welcomed me even on my "own turf". It felt great to participate in this small role of medical diplomacy.
Alberto arrived in Egypt, and I had one day to give him a snapshot of how to behave and function in Cairo as I had to go to the workshop the following day. Top on the list were location of the Metro (so accessible and easy!), street crossing (not so easy), and a few key Arabic words such as "ha'ram" (forbidden) which went along with the "behavior" lesson.
Many people are one time tourists in Egypt because they find it to be an unpleasant experience due to the aggressive, shameless, and "take-advanatage-with-any-opportunity"-ness of the Egyptians that work in the tourist industry. Living and interacting with Egyptians that are not apart of the tourist sector has been an amazingly pleasant experience, and I'm saddened that most people leave with such a poor perception of Egyptians. My interactions with "non-tourist" Egyptians, also helped build my confidence in knowing that most Egyptians don't approve of such behavior... and therefore, I can handle the "tourist Egyptians" with assertiveness and confidence.
That doesn't mean it isn't annoying or discouraging. Egyptians dubbed "touts" by the guidebooks will regularly stand near tourist attractions and lie to you saying that "The museum is closed for the next two hours" or some other random lie. If you listen to them, they will undoubtedly take you into a shop -- either theirs or one where they get a commission -- to go "shopping". They also will shamelessly demand tips for doing essentially nothing. Their tone and mannerisms really make you feel guilty refusing to give the tip... to the unknowing tourist; I would even give out a tip, and I don't tip easy! That's because it's not even beyond uniformed police officers to demand a tip for ... letting you hold a rock at one of the pyramids, or telling you to look at the back of a statue. Once I throw out the "Wait" (explained in the last email) signal -- if approached in the middle of conversation -- the people know that I’ve been living in Egypt for awhile and usually bug off quite quickly. Alberto and I also took to speaking Spanish, which for all intensive purposes, is a completely worthless language in Egypt. =P Convincingly NOT understanding English is also a great way to get people to go away.
Transitioning to tourist, of course, also means more of your time is focused on daily needs like shelter, bathroom, and water access. Having been in Cairo a few short weeks, I felt quite comfortable with these tasks, but having arrived in Ethiopia especially with the language barrier, alphabet difference and different time schedule (yes, they don't use our clock, more on this later 6am = 12pm) dependence on random people and necessity of "riding the good luck wave" becomes more prominent.
I hope each of you is doing well. You'll get a good dose of my Ethiopia impressions soon. I feel very lucky that the internet lasted this long!
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