Injera and The Match, then, How Much Does it Cost to Learn a Lesson Again, then, Matched!

This is a day late. I wrote it yesterday, but am still working on publishing it via Blogger. Ethiopian internet is not astounding in funcitonality. Anyway...

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Greetings from Addis Ababa, Ethiopia. I would say it in Amharic, but I have no idea how. Even the word for thank you is about 5 syllables long and rather difficult. I’m writing from an internet café atop a hillside, hidden behind a clothing vendor, in the Piazza district of Addis Ababa. I would never have found it myself, but some nice Rastafarians gentlemen whom I somehow picked up on the street were kind enough to show me.

So basically two big things have happened/will soon happen in my life. First, I’m in Ethiopia. Why – you may ask? Well – one can only eat eggs and French Fries for so many meals…

I kid, but the food was a strong draw. I love Ethiopian food. No one with a tongue loves Kenyan food. Also, I’ve heard nothing but great things about Addis. Also, the women are spectacularly beautiful. Also, did I mention the food? It’s amazing how much your quality of life improves when you enjoy what you’re eating. I’m staying with a nice gentleman named Solomon from Couchsurfing.com and thoroughly enjoying every injera based meal he whips up.

The second big thing is The Match. From when I began to write this entry, I have 4 hours until I find out where I’ve matched, which is to say where I will live, work, train--maybe even sleep--for the next 4 years. I found out on Monday, in Nairobi, that I matched somewhere, though they do not initially tell you where. I figured a change of scenery for the big news was appropriate.

First impressions of Ethiopia -- they drive on the right side of the road, and not all crazy-like. The people are spectacularly friendly. I think that Ernie (my ex-roomie) could pass for an Ethiopian guy -- so long as he didn't speak.

Look out for a Match update in a few hours… Wish me luck…
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Addendum -- so what's happened between 4pm and 6pm?

I would title this entry, if it were separate:

How much does it cost to learn a lesson.
Or
How much does it cost to learn a lesson again.

This afternoon, the answer was 400birr, or roughly 36 dollars. As I was wandering around town, a nice gentleman suggested that, because today was a holiday, if I went to a certain place, I could see traditional dancing. I thought: okay. I went.

Along the way, I got directions from another gentleman -- more than directions, he was walking in the same direction, so he came with me as my guide. He led me to a door in a sheet metal wall which was a bit more sketchy than I would have imagined. I hedged. I slowed. I looked both ways.

When I went through the doors I was greeted by many young 20-something Ethiopians who begged me to come watch them perform traditional Ethiopian dance. Sounds sketchy, right?

Well. I got the back story. They were Ethiopian students, on break from college, and they came to the city on their break to perform traditional dance. Still sounds sketchy, right?

So I ask from outside the door -- How much does it cost? Free. I ask again. Free.

Okay, I come in.

My guide and I sit on couches, while the girls start to perform some wholly unimpressive traditional Ethiopian dancing. Picture fairly normal dancing, but with more shoulder movement. I'm sure the experts are excellent, but experts these were not.

One of the girls sits with me on the couch and I try to get the story, since it still doesn't make sense. So she says that they're brought in by the church (which is huge in Ethiopia) on their vacation, and they do these dances, and if you buy a drink or get a coffee ceremony or whatever, the proceeds go to the church for orphanages (or something). I think -- okay -- overpriced drinks. I can deal with that.

I order a coke. My guide orders something that is yellow and comes in a large unmarked bottle (Tej, traditional Honey Wine). We watch rather uninspired dancing, and different girls come and sit and introduce themselves. They each have fairly convincing back stories -- one studies Marketing. One is a med student. They each name a different home town around Ethiopia. Etc...

Then one says to me -- would you like to buy us some drinks? I think -- okay -- this is gonna be it. I ask -- how much are the sodas? She says, oh -- 10 or 15birr. The conversion is 11birr to the dollar. This means they're way overpriced sodas. Okay. For the church. I can live with it.

How many bottles will you get? Oh -- we will share. How many? We will share. I didn't get a number. There were about 10 girls. I figure, a dollar a girl. Okay, fine. After all, they've been performing mediocre dance for me for like 20 minutes now.

So I agree to buy them drinks. Hurrah's all around! Dancing continues! Moments later out comes a tray filled not with cokes, but with the same bottles of Tej that my guides was drinking, and they were immediately opened, rapidly distributed, imbibed, and enjoyed. I made sure to get myself some Tej along with my Coke, too.

Would I like to buy another round?

Well hold on -- how much was this one? I'll go check.

About 15 minutes later the waiter/proprieter/whoever guy comes back -- you want the bill? Yes.

The bill: 900birr. That's about 80 dollars. 1 coke: 10birr. 12 bottles Tej at 75birr a piece.

So crap.

So here's the question -- how much do I argue? How much do I believe the back story? How much is it my fault? How much money do I actually have on me? What will happen if I refuse to pay?

Here's the thing about all scams I've encountered in the developing world: it's not that you couldn't do anything about it. It's not that you couldn't call the police. It's not that you couldn't make a huge scene. But when you start to think about it, and if you're familiar with how level of functionality of local enforcement agencies, you realize that it's just not worth the hassle. You give in. You rationalize. You take the easier way out. Whether it's 10 dollars in Zanzibar at a traffic stop for not wearing your seatbelt (a friend of mine -- I had learned that lesson in Ghana -- check my very first blog entry), or money for overpriced booze and bad dancing.

I let out a sigh that must have been audible above the Ethiopian music and claps of mediocre dancing that continued around me. Capitulation. I made some small show of objecting -- I was told it was this 10 or 15 a bottle. I was not told how many bottles were coming -- I was told a few would be shared. Blah, blah, blah. This was really just to kill time while I decided how much of a fight to put up and how much to cough up.

Their responses were something like -- you should have asked the price before (I did), you should have asked ME (the proprieter), you should have specified the number of bottles. Whatever.

What it came down to, at least as I presented it, was: I don't have this money. That was somewhat true. I had about 470birr.

We also take dollars! Oh -- well that's very nice of you! I, in fact, travel with a 100$ bill hidden inside my wallet, but no one was getting that without a fight. And I'm scrappy.

I had not told them how much money I had. I was still sighing and staring blankly into a mass of mediocre dancing.

In a surprise move, my guide -- really just some random dude from the street, unless this was WAY better orchestrated than I suspect -- coughed up 200birr.

I pulled out my wallet, which contained 400birr (in 100birr notes, from the ATM this morning), making sure to leave the smaller bills loose in my pocket. I keep smaller bills outside the bill clip so that I don't have to constantly pull my wallet out in public. I made a show of giving him everything in my wallet (excepting the hidden 100$, of course).

Didn't I just have a 20$ bill? Nope.

So that was that! He took the 600birr and called it even. He even thanked me, performing the traditional formal handshake (with left hand to right elbow).

I stood to leave.

The girls, who had been paying no attention to these proceedings, continued to dance, and asked if I was leaving? So soon? Please stay! There was still some Tej left! I considered whether I shoudn't drink every available drop before leaving. Probably bad form.

I left with my guide. I looked over my shoulder. Only a sketchy corrugated metal wall. That was that.

So. The answer is: 30-some dollars. That's how much my lesson cost today.

Were the girls really students? I would still buy it. Was it a scam? Yes and no. Certainly it was designed to bilk visitors from more money than intended, but perhaps it could have been avoided with more scrupulous ordering skills. And I believe that I could actually have come and gone and seen mediocre traditional dancing for free if I had not bought anything. Was the money going to the church? Highly unclear.

I walked home. I could have taken a minibus, as I still had the 70 birr, but I had daylight to kill.

I stopped at the same ATM I went to this morning. Another 500birr withdrawal. For me, in reality, it's just a blip. For whomever has my 400birr, hopefully an orphanage, but even a scam artist and some possibly fake students, it's a lot of money.

Alright -- an hour and 15 min to match!
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The Match:

Yale!

Very Exciting!

Please Do Not Feed The Rock Hyrax

Let me start by cutting to the chase so that you (Mom and Dad) don't get too worried:

I probably don't have rabies.
And I'm probably taking sufficient treatment in the event that I do.

So. It's been a fun few weeks since I wrote last! I finished my last week of medical school type stuff and parted ways with the guys. Traveling on my own, I decided to stop at a few well known parks on my way towards Nairobi, the first of which was Lake Nakuru National Park. A rather small park, it's located just outside Nakuru, Kenya's 4th largest city, and is easily accessible as a half-day safari from town.

Unable to afford a solo excursion, I joined a middle-aged Venetian couple whom I met outside our lovely rooftop rooms at the Mt. Sinai Hotel (only the wazungu -- whiteys -- like to stay on the roof for the view; no one else likes the 6 story climb). We rented a small Jeep for a morning jaunt into the park. The park starts abotu 4km from the city center, and as such is one of the few national parks that has fenced boundaries. Some city dwellers can watch zebra from their windows! The lake boasts an impressive array of flamingos, storks, cranes and other large birds, and the park is packed with a selection of your standard African game. It doesn't have many big cats, and no elephants, but it has quite a large population of rare White Rhino, which had been reintroduced from South Africa. It also has Rock Hyraxes.

Rock Hyraxes are adorable little guys, which look kind of like big gerbils. And, as my tour guide put it: they have the same skeleton as elephants! Right. It turns out he meant that they are rather more closely related to elephants than to gerbils or other rodents with whom they share certain gross similarities.

Rock Hyrax are also known to become rather quickly accustomed to humans -- tame even. I discovered this during our mid-morning break at a picnic area on Baboon Point. How cute! They'll walk right up to me and eat cookies out of my hand! How cute! He's licking the crumbs of my hand! Okay -- one more piece of cookie... Damnit!

Turns out they have really sharp teeth.

He only got a little piece of my fingertip, but it was more than a scratch. My guide advised me not to worry about it. It's not dangerous. And, specifically: No -- there is no rabies here.

That was enough to make me feel better. For a few hours. Because it was what I wanted to hear. Then I came to terms with what I knew to be the truth -- in casual speak here "No! You have nothing to worry about! There is no rabies here!" Means something like: I wouldn't do anything about it. I've never heard of there being any rabies here.... Though I've never thought to ask about it or look into it..... And there was that ranger who went crazy then died....

I double checked the WHO and CDC recommendations on rabies post-exposure prophylaxis. Given that I didn't catch and/or kill the animal, and could therefore not observe it for symptoms, I was supposed to take the full treatment course -- 5 shots of vaccine spread over a month, and an injection of Anti-Rabies Immunoglobulin as soon as possible.

I wasn't wholly convinced. I mean, what were the chances that THAT random hyrax had JUST gotten rabies, and was infectious, even though it was still acting normally and showing no other overt signs of infection? Very small. Definitely very small.

But were they risk-uniformly-fatal-central-nervous-system-infection small? Geh.

I decided to do some research. I found, amongst other things, that I was not the first person with this problem. But unfortunately that Rock Hyraxes can carry rabies. Still, there are only 11 known cases of Hyrax rabies (out of over 15000 total cases) in South Africa from 1928 to 2002. Furthermore Virus is rarely present in the saliva before overt behavioral changes (http://www.nda.agric.za/docs/rabiesB5.pdf).

Plus I was pretty sure it was going to be a pain in the ass to get the treatment. Let's be honest. This is Africa.

I turned out to be half wrong! I went to a clinic the next morning and found that I could get a rabies vaccination (essentially no questions asked and no consult needed) for about 23$. That's great! In the US it's 100$ a shot, and there is a shortage right now, so that you can only get post-exposure, not pre-exposure vaccinations. Believe it or not, knowing that I have a thing for strange wild animals, I tried to get the vaccinations before I came, and was told I could not get them because of the shortage.

The immunoglobulin was a different story. I was told that there was no Rabies Immunoglobulin present in Nakuru. So. Where did that leave me. I had gotten my Day 0 vaccination (now I only needed days 3,7,14 and 28), which would begin to prompt my immune system to create a response to clear any rabies virus present. But that response is not immediate... what if the virus is already creeping towards my peripheral nerves, from whence it will gain entry into my central nervous system, no longer susceptible to the humoral immunity which is induced by the vaccine? Shouldn't I rush immediately to Nairobi?

Probably a good idea. But nah. It's probably okay.

Instead I went to Lake Naivasha and Hell's Gate National Park (which was towards Nairobi, Mom). Hell's Gate is great because you're allowed to walk or bicycle through it. And I was alone. So just my bike, the animals and me. Sometimes just my bike, the buffalo and me. Sometimes me way too close to the buffalo... But that's another story.

So yeah. Rabies. I decided not to rush to Nairobi, but I was a little conflicted about it. I had gotten the initial vaccination, so I planned on getting to Nairobi by Day 3 for my next shot, but what about the immunoglobulin?

Despite these misgivings, it was pretty easy to relax on the shores of Lake Naivasha, renting a tent for two nights in a campsite notable for the electric fences which were turned on at 630pm nightly to keep the grazing hippopotamus from mauling tourists.

Eventually, yesterday afternoon, I arrived in Nairobi. I called around and found a private hospital which stocked the Immunoglobulin, and went into casualty (what they call their ER) for a consult. As I waited in the waiting room I read a plaque noting that the hospital building had been built with the kind funding and support of a number of large corporations, such as Barclays Bank Kenya and Kenya Airways. A good sign -- in poor countries the rich people will pay to build a hospital that they are willing to visit. I had found the right place.

The consult fee was equivalent to 15$. And the doctor basically looked at the little (tiny) wound on my finger and said I didn't need the immunoglobulin. Despite the WHO rec's, they only give the immunoglobulin in cases with high risk animals and severe wounds. My case had neither. The last time he had given the immunoglobulin was to a tourist who had been mauled by a baboon, and who had 4 finger-sized puncture wounds into her thigh to the bone.

Subtitle: Don't feed the rabid baboons.

He said that we COULD give me the immunoglobulins, but that it would really just be to make me feel better. I told him I felt alright.

So! I was vindicated! I'm glad I didn't rush to Nairobi to be told that I didn't need the treatment. And I'll be sure to finish the vaccine series, which shouldn't be too hard...

Today was Day 3. I needed my second shot. And I guess it wasn't TOO hard.

I did have to pay some sketchy doctor 500shillings (6$) to write me a prescription for the additional shots. It turns out that the pharmacies in Nairobi, at least the ones that carry vaccines I would take, are more uptight than those in Nakuru and require prescriptions. After a bit of the run around, and after borrowing a piece of gauze soaked in rubbing alcohol from said sketchy doctor, I gave myself my second vaccination in men's bathroom outside the clinic. It kind of gave me a new respect for IV drug users.....

Anyway.

Only three more to go!

And here's hoping that I won't get some semi-vaccinated paralytic form of rabies!

Work and Play

As usual, play is more interesting than work, but here is the update.

About a week and a half ago the other students and I moved from Eldoret - a modestly sized city with a large referral hospital - to Webuye - a rather unimpressive town with a district hospital. The referral hospital in Eldoret is used to having students. The district hospital in Webuye, on the other hand, is not. The hospital does have a Family Medicine Residency program, which is affiliated with Moi Referral Hospital, and run by some American family docs, but that didn't end up meaning that they had any idea what to do with 5 visiting medical students. We decided to focus our time on work for the research projects that we are required to do as part of the rotation. Two of the guys are doing a survey on pain prevalence and pain control, while the two other guys and I decided to do a survey on GI disease (diarrhea, vomiting, abdominal pain) and health, sanitation and hygiene education and practices (like latrine use, hand washing, ORS use, water treatment). So essentially we've spent all our time here filling out surveys. It hasn't been very interesting. I won't tell you any more about it.

What HAVE been interesting are our weekend adventures!

The weekend before last we decided to go on a little PikiPiki adventure. PikiPiki is the swahili word for motorcycle. Given the size of motorcycle engines here, it turns out to be a quite pleasing and appropriately onomatopoeic term. Trey - one of the other med students and our local motorcycle enthusiast - fomented enough excitement to get quite a little posse together. The plan was to head to the Kerio Valley -- about 60km away -- and head down into it (another 60km) to a secluded national park (down a 25km sometimes passable dirt track) reknown for birding and crocodiles. We rented four motorcycles at a cost of about 9 dollars per bike per day. Trey and I were both riding. I also had one of my new Kenyan intern friends as a passenger. Naomi, our Moi University med student liaison, jumped at the opportunity to learn to ride, and after only 2 short lessons from Trey and I during the week, was adamant about joining us. Phil, another visiting med student and novice cyclist was going to join us, but thought better of such an adventure given his experience, and opted to hop in a car with the other guys and meet us there. This, it turns out, was a fairly wise decision.

It's not that there were any MAJOR injuries. It's just that, as spectacularly curvaceous and entertaining as the descent into the valley was for we rather more experienced riders, it turned out to be a little too much for Naomi, who at some point got a bit nervous, hit a turn too fast, mistook the clutch for the break and drove off the road into some rocks. And some thorn bushes. She escaped with some scrapes and bruises and only one huge thorn in her side. Her bike wasn't completely nonfunctional afterwards, but it wasn't exactly in peak condition, having lost a mirror, the front brakes, the headlamp, any semblance of alignment and the rightwards range of motion of the front wheel. I tried calling AAA, but it turns out we were in rural East Africa. We bent the bike into shape sufficiently to drive it to the nearest town, where a mechanic charged about 8 dollars to fix everything. The alignment was still a bit busted, but it was far more ridable. With daylight remaining, we still made an attempt to make it to the park, down what turned out to be an alternatingly insanely rocky and uselessly silty road. Naomi opted for the car for this portion.

Despite our valiant efforts, we never made it. Daylight was failing and we didn't want to brave Kenyan roads at night, so we turned around. Impressively, Naomi got bored in the car, and decided to ride again. While this seemed reasonable at the time, it turned out poorly, as she became increasingly frustrated and despondent as her motorcycle troubles continued, and the stress of heading back up the valley wall turned out to be too much. We ended up having to stop in a town called Iten on the valley edge and hire someone to drive her bike back to Eldoret, while she got a ride in a car. This took an unfortunate amount of time to arrange, and by the time Trey and I eventually arrived back in Eldoret we were sufficiently tired, dusty, and freezing from the night ride home to know that it was a good day.

This past weekend was arguably more exciting, and it was even motorcycle accident free! This past weekend we went to Uganda. Webuye is only about 70km from the Ugandan border, and it's only about a half day's trip to Jinja -- the burgeoning Adrenaline-Sport capital of east Africa (per lonely planet). Jinja is a nice little southern Ugandan city on Lake Victoria at the mouth of the Nile. At this point it's the Victoria Nile (it becomes the White Nile somewhere in Northern Uganda, and the Blue Nile comes from Ethiopia, I believe), and it boasts some of the worlds best class 5 rapids.

Rafting Ensued.

What can I say? It was awesome! And we only seriously thought we were going to die once. Luckily there is DVD video of it. Our boat's colossal crash made the highlights real in slow motion, though the clip doesn't continue to the point where I resurface somewhere downstream, having gotten trapped under water between our river-guide's legs somehow and having failed miserably at my attempt to breathe Nile water.

My advice to future rafters -- take a deep breathe BEFORE the raft flips over. Then just enjoy the ride. Also -- apply copious sunblock to the legs. While I have learned that I am incapable of achieving other than a Lobster Tan, and apply lotion as such, one of my compatriots neglected to protect his legs, and ended up essentially bed-bound for 2 days, with a burn so painful he could not bend his knees.

There was also Bungee jumping. Despite my father's email pleas to reconsider, I bungeed. Sorry Dad. I can't think of a lot of spots more ideal than this alcove of the Nile, with monkeys playing along the steep banks, and the sun setting over the western bluff, to stupidly thrown myself off a cliff with rubber bands tied to my ankles. When you get up to the edge they say don't look down. For me, the looking down wasn't a problem -- I've never had much of an issue with heights. I think they should have said -- Don't Think. Becuase if you think, you'll realize that you're about to do something incredibly foolish, and if you let rationality take over, you're just not going to have any fun!

I bungeed 3 times. The second time is half price and the third time is free. How can you resist! The first time I went for the straight down, full submersion dive, hitting the water up to about my thighs. The second time I went for distance -- if you jump out you don't get as much water, but the rebound is real real fun. The third time I went for something they called a Harness Jump, but I think should have been called the Leap of Faith. Basically rather than being tethered at the ankles, you wear a harness with an attachment at the chest. Then, instead of a dive, you just run off the edge as fast as you can. Basically, all techniques are awesome. The only style I didn't try was backwards. They say it's the scariest way to bungee. It was tempting, but you gotta save something for your second time, right...?