Dust

Greetings All,

 

It's been an interesting weekend, although I'm not sure it will seem so in the telling.  June is one of the months for dust storms here in the desert middle east and, although we've had no dramatic wall of dust roll suddenly over the camp, the sky over the last couple of days has taken on a dun, opalescent cast.  At first glance, especially with the high humidity, it seems like it could be fog, but as the breeze freshens throughout the day and the tannish hue of the sky remains, its real nature becomes obvious.  This afternoon as I write there is a perceptible haze here at ground level - the outlines of buildings at any distance are softened, and the color spectrum shifted toward yellows and browns.  Haven't noticed any respiratory effects yet, but I wonder how things will go at the clinic if this goes on.

 

If you presume that the weekend starts on Thursday - a reasonable assumption in college dormitories and Islamic countries - we started ours off with another superb dining experience.  We'd been working at CHA Bouffard with our French colleagues, and as we changed to head home the Chief Anesthesiologist, Pierre Manuel asked if we'd care to join them and their "biologist" for dinner that evening.  Now, gentle reader, it's not that I don't worry about my figure, but I reckoned that any sacrifice made with the goal of improving public relations would not be in vain.  I did go home and run 5 miles before going out though.  Anyway we made our way out at about 7 pm and on the drive into town could see occasional volleys of fireworks over downtown.  The weekend was dedicated to the celebration of Djiboutian Independence day - June 27th, 1977 - and on Thursday the folks were just starting to warm up for the festivities.

 

This became more apparent as we wended our way through the busy streets to the general vicinity of Menelik square, and met our French friends at a small outdoor café.  The streets were hung with blue and green Djiboutian flags and strings of colored lights were stretched between the buildings lining the streets.  It reminded me in many ways of coming into a small Sicilian town on the eve of una festa.  The same air of excited confusion and amiable bustle pervaded the square.  Unfortunately we didn’t get back out the next night to observe the festivities themselves – there being some risk of disorder in the opinion of our security folks (who I have great respect for).  I’m told there are fireworks aplenty, but really I have no idea what else goes on.  Fireworks are interesting though.  Donna and I always scratched our heads in Sicily when our little town – Motta Sant’Anastasia – which was in dire need of road work, grounds upkeep and myriad other civic maintenance items would vaporize tens of thousands of Euro every year on extravagant fireworks displays.  Somebody once explained that the local politics were so contentious that the only thing town councils could agree on was fireworks for la festa di Sant’Anastasia.  As Djibouti is essentially a one party government, hard to imagine that is the case here.

 

Food, at Chez Marco, was lovely.  Warmed chevre salad to start, the n grouper with a garlicky aioli, and a meringue glacée for desert.  Wine was a pleasant Côtes de Rhône.  Not exactly right for the fish but hey, they’re the French for Pete’s sake.  Like I’m going to pick the wine!

 

Had a brief visit over the weekend from a former colleague, a nurse anesthetist I knew well in Sicily.  He is now on an ERSS.  Can’t tell you what the letters stand for, but he’s on a small surgical team that bounces from ship to ship on deployment, essentially bringing a limited surgical response capacity to Navy ships that wouldn’t normally have one.  Ken was holding up well, but the rigors of transporting team and materiel to one rolling vessel after another were obviously considerable.  We got one or two good Bob Hope Galley meals in him anyway.

 

Last big event was the coalition Officer's Hail and Farewell diner - held up here in O-6 country on Saturday night.  It is mostly an affair for the Combined Joint Task Force folks, but I guess either because of my gift for repartee and conviviality, or because the venue is right by my CLU, I was honored with an invitation.  We Hailed and farewelled officers from Ethiopia, Kenya and Great Britain, and I got a chance to chat with some of the civilian folks from the embassy as well as with the very nice fellow who is in charge of our Army contingent (of Puerto Rico Army National Guardsmen).  If the meal wasn't quite Chez Marco, well at least I understood more  than 20% of the discussion going on around me.

 

Watched "The Reader" and lots of "Madmen" over the weekend, immensely enjoying both.  I've got Reza Aslan's "No god but God" on my Kindle - a well written (so far) history of Islam, and am listening these days to Blue October's "Foiled" and exploring a bit more Brahms than I have done before.  Started with the German requiem, and have also been enjoying his cello and violin sonatas.  Hope you are well.

 

Ciao!

 

Local Flavor

 (A borrowed picture of the blue door district.  Our location was a bit more commercial, and a bit neater)

Ah, Djibouti.   So, we pile into the van at about 6:30 pm, head out the Scorpion Gate, turn right onto the Somali road, past the dead camel and the khat stands (of course the herb still remaining that late in the day is of the most inferior quality – most of the active ingredient now degraded to cathine) and we… What?  The dead camel?  Oh, well I’m no camel coroner but I’d say that this unfortunate “ship of the desert” was undone by an automobile some days ago.  This is not too hard to imagine, as the camels really do just wander seemingly at will in and out of the city.  Furthermore, they seem constitutionally disinclined to move quickly and are unimpressed with the potential lethality of the cars and trucks weaving through the streets and alleys.  In general they seem to rely on sheer bulk and a bilious stare to assert their primacy as occupants of any thoroughfare they select.  Alas, these potent assets are set at a considerable discount by the falling – with equatorial rapidity – of the Djiboutian night.  The roads are poorly lit, dust and smoke are common companions of the night-time motorist, and windshields are often glazed with a layer of baked on road film.  Moreover – and I can attest to this from personal, terrifying experience – “camel” is not a particularly high visibility color against a dark background at night, however nice it looks over your Brooks Brothers suit.

Doubtless all these factors conspired in the untimely demise of our unfortunate dromedary friend.  I can only imagine what shape the car that hit him is in.  The inertia of a full grown camel must compare with that of a moose – no antlers of course.  It may be that were we to continue down the road we’d find the carcass of the car as well.  In this littered landscape it would stand out less than the bloating remains of its camelid opponent.  And, of course, it can be raided for spare parts.  The same is apparently not true of camels.  Justin, our veterinarian assured us all that the bacteria in the creature's multiple stomachs (one less than a cow) would be rapidly multiplying and that an explosion was the inevitable outcome.  As we were on our way to dinner, even the hardened medical crew in the van exclaimed “Eeeeeewww!” and threatened to put him out on the side of the road.  The, um, decedent has been there about 3 days now.

 

Anyway, I’ll move on.  No sense beating a dead camel.  Sorry.  We were on our way to dinner as I say.  Now, I know that most of my posts are about eating, but absent the occasional dive trip or medical adventure that is the most interesting thing that we do.  Maybe I can publish a Djibouti restaurant guide in 6 months!  Watch this space.  The occasion this evening was the imminent departure of René, our German flight surgeon/diving medical officer.  He’s heading back to his home just a bit south of the Danish border, which sounds blessedly cool, to be replaced by another physician from the German Navy.  We’ll definitely miss him though – he was a great resource for us, and speaks better English than many Americans.   He had wanted for a while to take us to one of the German's favorite hang-outs, in the "blue door" district, behind Menelik square.  

The square has been  the main hang out for the French, and for cruise ship passengers traversing the Suez Canal since 1897 - although cruise ship traffic has dropped off a bit since then.  It was named after the Emperor Menelik II of Ethiopia in honor of the agreement between France and Ethiopia when the boundaries of the protectorate that eventually became Djibouti were marked out.  It has the feel of the place of a French town (or the piazza of an Italian one), only neglected for 50 years and left to bake in the desert heat.   The "Blue Doors" is an area of labyrinthine streets and alleys, that forms a less official market district just a few blocks off the square.  I don't know the significance of the color but all the doors of the jumbled together shops, stands and kiosks are in fact cobalt blue.  On display, as we rumbled down the unevenly paved roads, working our way into narrower and narrower streets, was a huge assortment of wood carving, baskets, electronics, clothing - from t-shirts to dashikis - and almost anything else your heart might desire.  

Ultimately our German guides (we'd followed them from their hotel) stopped at a corner in the heart of the district.  In fact we were in Moukbassa central - not that you can google map it. To our right was a dilapidated low building, which could have been a warehouse save for a doorway with a beaded curtain and a small sign shaped like a fish, hanging askew from a hook overhead, that read  "Chez Youssouf".    Across from us was a vacant lot that seemed to be filled with the rubble of a building which might once have stood there.  Among the bricks and debris a number of dogs slept or scratched too enervated by the heat, even now as night fell, to even look up at the skinny cats that picked their way delicately around the  refuse.  Gulping, through the beaded curtain we went.

As we're starting to get a bit on the long side here, and as perhaps - with apologies to Tolstoy - all good meals are the same I'll just say that the food was fantastic. Fresh, plump barracuda, split, seasoned and roasted over a wood fire were served in the Yemeni manner - with copious baskets of piping hot flat bread from the same grill, lemons and a spicy sauce reminiscent of a rouille.  We ate, and tried our terrible German skills on our very indulgent colleagues, and regrouped and ate more.  Amazingly good food, and the least expensive I've eaten since our arrival.  We waddled out a couple of hours later, bid au revoir to Rene and our teutonic colleagues, and climbed back into the van (which had been watched over by one of the locals for a 1000 franc fee).  With the guidance of an enthusiastic gathering of local folk, we turned the vehicle around and we made our way cautiously through the streets - crowded now at about 10 pm - avoiding carts, animals, pedestrians and many small groups of people who seemed to just slumped down where the spirit took them, in or out of the road.  A left at Khat corner, down the Somali road, past the dead camel, through the sentries and back to air conditioned, citrus n' sage scented CLU.  

Ah, Djibouti.

 

 

Tempus per annum

Tempus per annum

 

The reference of course is to the Latin term from which English speaking Christendom derived “ordinary time” – that part of the liturgical year during which nothing especially significant happens.  That, dear friends, is where your correspondent finds himself today.  This is perilous ground indeed, as one is tempted either to flights of speculative musing:

 Has it ever occurred to you that it is impossible for human beings to conceive of a potential point of view – as in vantage point - without implicitly imagining a viewer?  From this observation proceeds much to do with psychology, art and theology…

or to paroxysms of complaining:

There is something indecent about admirals and generals just walking among hoi polloi as if they were regular people.  It is just not right to bump into flag officers without knowing they’re coming.  I propose the use of an escort of toga clad lictors, as ancient Roman magistrates with imperium would employ. They could carry rods decorated with fasces as in the example above.  I like it…                                       

I sound in the first case like Woody Allen and in the second like Andy Rooney.  Sigh.

Well, let’s see.  Today is “Taco Tuesday” at the Bob Hope Galley.  (23 more to go, but who’s counting?) The dining facility here is, as I’ve mentioned, one of the highlights of the base.  The building is large and windowless as most here are – there is simply no visual temptation sufficient to warrant the loss of thermal integrity.  This occasioned an interesting discussion at lunch about whether life here might predispose one to seasonal affective disorder – many folks quite deliberately limit their time outside to the minimum required to transit from CLU to CWU to galley to CLU.   No data on SAD incidence though. 

Anyway, one washes one’s hands at the wash stations outside and enters.  The wash stations are liberally posted with admonitions to prevent swine flu (guess they didn’t get the “Islamic country H1N1" memo).  In the first room is the sandwich bar – open 22 hours a day with cold cuts, soup, chili, hot dogs, potato chips and cereal along with wall-length coolers full of milk, sodas, water and unbelievable amounts of Gatorade.  We go through far more Gatorade than water, juice or soda -  semi trailer truck loads of the stuff.  The appeal completely escapes me – it tastes like lime flavored sweat to me – and most people are working inside and don’t exactly need the sugary-salty volume expansion.  I wonder what the inventor, Dr. Cade, would have thought.  Oh well, I don’t get reality TV either.

Presuming a sandwich is not what you’re after, you pass then into the main dining room – roughly square, about 50 yards square and the walls are once again lined with beverage coolers.  There’s a salad bar in the center, a fresh fruit cart to one side and an ice cream counter to the other, a “speed line” at the far end with anything from fajitas to crab legs, and then an annex housing two cafeteria lines, each always with a beef, a fish, a poultry and a vegetable dish (often more then one of each).  Entrees vary by day – steak, roast turkey, ribs, pork chops, roast chicken and various gumbos and stews are common offerings.  The quality – while certainly not any threat to The French Laundry – is good in general.  It is in here, surrounded by food, with relatively little else to tempt one, that the real danger of coming home weighing all of 300 pounds looms.  Fortunately you have to walk past the gym to get to the galley and it may be that many a late night expedition in search of a bag of Doritos finds its way to the treadmill instead.

Tomorrow we are außer haus essen gehen to meet with our German colleagues (they provide hyperbaric chamber cover for our official and recreational diving activities).  They are here on 4 month rotations, and have a small base a bit further north up the small urban peninsula.  Their base won't accomodate housing, so they are billeted instead at the Sheraton.  I could insert a joke here, but to encourage creativity among the readership I’ll let you come up with your own.  Anyway, they’re all nice fellows and we’ll be getting together at one of their favorite hang-outs here in town – a seafood restaurant.  More stories to follow.

 

I reckon I’ll stop there for today...I feel more philosophy coming on!

Ciao!

Arta lover

I admit that I was tossed on the horns of a dilemma today, but I'm glad I chose play over work.  At a lovely get acquainted luncheon on Thursday our French colleagues had invited me over to do some pediatric tonsillectomies (the anesthesia part, naturally).  Somewhat disconcertingly, the French call these amydalectomies.  Now to an American trained physician the amygdala is "a roughly almond-shaped mass of gray matter deep inside each cerebral hemisphere, associated with the sense of smell". It thus took me a while to figure out that they weren’t proposing 3 neurosurgical cases  - there being no neurosurgeon - and must mean something else.  In any event, as luck would have it one of the embassy staff had invited Dave, our XO, out for a snorkeling trip on the embassy’s boat (darling, all the embassies have boats) along with 5 colleagues.  Reasoning that there was also a dandy re-anastomosis case for Sunday, and rationalizing that I couldn’t let our XO go without a medical attendant...well the attached photo tells the rest of the story.

This time on leaving from the fishing pier we turned left and headed due west into the Gulf of Tadjura.  The boat was a nifty 23 foot cabin cruiser style, with twin Yamaha 150’s on the back, and when Lulu, the smiling Ethiopian man who is the embassy’s boat guy pushed the throttles forward, the little craft gathered herself up, like a lady picking up her skirts, and then planed across the wave tops as prettily as you please.  The breeze thus generated was a blessing, as the sun on this still day, so near to the summer solstice, was taking no prisoners.  Anyway, we headed along the Djiboutian shore with the self conscious glee of 5 boys playing hooky, slathering on SPF 250 as we went.

The coastline as you make your way west gradually rises.  The city of Djibouti is situated on the low plains, in what would be a flood plain if it ever rained, or a river delta if it rained even more.  This gives way to rugged hills of dark, tumbled basalt, covered in some places with brown dust and sand.  Parched brown shrubs cling to the hill sides with only the most occasional, inexplicable green bush or tree relieving the very subdued palette.  The gulf in this direction is a darker blue - not quite indigo but getting there.   The hills to our left had gotten quite high - 1500 meters or so when we passed one final headland and pulled into the bay at Arta.

Lulu dropped anchor, we scrambled into our gear, and leapt into the water.  When entering thus from a boat, there is always that moment of disorientation as the bubbles clear away.  I floated, took a few breaths, and ...oh. my. word...  Paradise shimmered in the dappled light 10 feet below me.  Visibility was great - 20 feet or more, the water was warm, the current was minimal, and hundreds, nay thousands of reef fishes of all colors, sizes and shapes flitted among and around the most pristine corals it has ever been my pleasure to dive on.  It was one of the most beautiful places I’ve been - breathtakingly so.  And we had it entirely to ourselves - in our 4 hours or so at anchor there was not another living soul evident as far as the eye could see (save a French helicopter or two).  A short list of sightings includes moray eels, giant clams, clown fish (we should change their name to “Nemos), wrasses of every description, puffers, box fish, snapper, sea fans, sea cucumbers, and acre after acre of coral in every conceivable shape and hue.  Way, way cool.

I did take some underwater pictures with a disposable camera, and will send them off to Snapfish (how apropos), and then hopefully post a few of the better ones.  We’ll see if National Geographic is interested.  Anyway, divers out there, take my advice and cancel that cliche old trip to Bora Bora or Palau.  Dive Djibouti!

There is not much more to tell about the day.  In and out of the water several times.  A lunch of galley-prepared pastrami sandwiches (although only mayonnaise.  Oy.), and an ice cold beer.  A final circumnavigation of the reef, and then Lulu powered up those Yamahas and home we rocketed.  The return trip was a bit rougher as the breeze had picked up and we were directly in its teeth the whole way.  A great trip though!

Anyway, tomorrow I’ll present my - hopefully not too sunburned - face at CHA Bouffard for some surgical time.  I’m sure the French will understand.

The usual garbage

Picture:  Along the Somali Road

Do you remember the movie “Sex, Lies and Videotape”?  The first spoken line is by Andie MacDowell who says “Garbage. All I’ve been thinking about all week is garbage. I can’t stop thinking about It”. She should have seen Djibouti.  The first impression one has upon emerging from the lunar base camp environment of Camp Lemonnier, and turning onto the Somali Road into town is that, perhaps, a garbage truck has exploded flinging refuse in every possible direction.  Then you drive on, and the further you get the more apparent it becomes that, no, there is just a lot of garbage everywhere.  In the more urban areas it is often swept into heaps, or piled in alleys or vacant lots, but as the superheated air over the coastal plains starts to rise during the later morning, the onshore breezes waft the lighter bits of trash hither and thither around the city.  This explains the ubiquity of what the Americans call Djibouti flowers; blue, pink or yellow plastic shopping bags lodged in the rocks, shrubs, trees and fences and fluttering in the blast furnace breeze.

 

No one has explained to us what the story with the refuse might be, leaving room for speculation.  Nothing loathe to fill this niche, I have three theories (*)which I present for your reflection.

 

1. Weather:  Perhaps it’s just too hot to bother with picking up trash, and perhaps even if it were picked up it would just be carried back to the streets and sidewalks by the winds (this last probably wouldn’t apply to the tires, abandoned machinery, etc).
2. Sociology:  When we were in Sicily, which prior to Djibouti was the most casually garbage strewn place I had visited, at our “cultural indoctrination”, our instructor explained that i Siciliani had a “weak civic ethic”.  This was accounted for by the long history of exploitation, repression and abuse which the Sicilians had suffered at the hands of just about everybody since their cultural apogee in the 13^th century.  Do Djiboutians have a weak civic ethic?  There is a good deal of tension between the Issas and the Afars (a civil war having concluded only a decade or so ago), and there is a large and destitute refugee population here who presumably feel little affection for the land of their exile. Certainly you don’t see any signs saying “This highway adopted by the Djibouti Rotary Club”.
3. Khat:  If you’ve got to get most of the work done in the morning to make time for an afternoon chewing khat and an evening recovering, there might not be time for such low reward activities as the policing of trash. 

 

(*) I mentioned my theories to Alex our OR nurse.  He said maybe it’s because there are no trash cans.  Hmmph.

 

In any event, after you spend some time here, a strange thing happens.  The garbage becomes invisible.  Do you remember Hans Christian Andersen’s story The Snow Queen?   When Gerda rescues her friend Kai from the queen’s castle, a bit of ice (the troll mirror) falls from his eye and he no longer sees only the bad and the ugly.  Some similar phenomenon is at work here, in reverse though.  It happened in Sicily too the mind filters out the appalling accumulation of trash, and one sees the city and the countryside as normal.  It’s a fascinating phenomenon and one that I think explains our both our tenacity as a species, and our occasional distressing complacency…we can get used to anything.  Except sauerkraut in my case, so I guess there are limits.

 

Just returned from a 2 hour luncheon with our French colleagues from CHA Bouffard.  They have both a reservist general surgeon and orthopedic surgeon here in town for the next couple of months and they were anxious that we get acquainted, which was thoughtful of them.  We met at Bouffard, stopped for a spot of pastis at the residence of Pierre Emmanuel – the head anesthesiologist, and then they took us to a smallish Ethiopian/European place nearby, where my salad niçoise was fine, and Herman reports that the shrimp were good as well.  A glass or two of wine and I must admit that despite the dark Ethiopian coffee at the end, a nap seemed like a fine idea.  Being made of sterner stuff though, I settled down to my keyboard instead.  We’ve been invited over for a few pediatric tonsillectomies and a bowel reanastomosis this weekend, so our schmoozing was not without some beneficial effect.  I’ll admit that after a couple of days in the third world conditions at Peltier, the Djiboutian hospital, a chance to work in the relative luxury of Bouffard seems worth giving up a couple of weekend mornings.

 

Apropos of that, on my last visit to Peltier I spent the day with one of their anesthesiologists, Dr. Mustafa, who had just returned from a volunteer trip to Mogadishu in Somalia.  In a mix of French and English he told me that it had been a life changing experience for him, because although he thought he made do with next to nothing in Djibouti, in Somalia there was literally nothing  with which to treat the war shattered wounded while the sounds of explosions and gunfire echoed through the streets.  To him now Djibouti is luxury.  I guess we can get used to anything.  Although he did ask if could bring him a set of American scrubs next visit….

 

Anyway, I’ll sign off here lest I overstay my welcome…

Moucha Island

Sunday at 0730 I made my way to a bus waiting outside our little air terminal here on base, and there joined about 30 other adventurous souls en route to “Moucha Island”, one of a smattering of small islands that lie about 10 miles to our Northwest in the Gulf of Tajura (Tadjura is an alternate spelling for you Google Maps aficionados).  We made our way along the port road, wending a path around the traffic circles, to one side or the other (the choice is evidently arbitrary) of slower moving cars, donkey carts and trucks, finally turning off just short of the huge cranes and hulking freighters that signal the start of the Port itself.

 

We clambered over a lively floating dock, and found seats aboard “Lagon 1”, a 30 foot power cat that soon thereafter backed out of her slip and launched us into the warm waters of the gulf.  We travelled slowly at first, skirting a French frigate tied up at the corner of the opposite pier.  Her gray, nearly windowless, radar-deflecting, asymmetrical shape (the stacks angling off to port) reminded me of a building by Gehry.  Turning to starboard as we exited the channel, two Turkish frigates – much more conventionally shaped - bobbed at their moorings, one tied up outboard of the other like two amicable friends shoulder to shoulder in the light of early morning.  At this point our pilot pushed in the throttles and we were off.

 

I'm always intrigued by the different colors of the sea in various parts of the world.  The ocean off Hawaii for instance, once you're well off shore, I remember as an implausible indigo shade, The Persian Gulf as a light blue with a yellow green cast, the Mediterranean as wine dark (but I blame Homer for that) and the Caribbean - in my honeymoon recollection - is azure.  The Gulf of Tajura is a medium blue, darker than the sky but just by a shade or two.  The spray that splashed up over the gunwales of the boat felt as warm as bath water.

 

It was about a half hour's ride to the island - a flat, obviously sedimentary atoll, with several sandy beaches.  At 0830 the sun was already a tangible presence, so we paid our $45 dollars and scattered to the palapas that stretched along the cove, arranging the lounge chairs so as to be out of the direct rays.  I took a few minutes before the heat really started to build to explore. The ground, where not covered in sand or the sparse vegetation, was made of honey colored rock, studded throughout with embedded shells, impressions of corals and various maritime fauna, like a geologic version of peanut brittle.  Lined up at the margin of sea and shore were a collection of what I imagine were terns – a bit bigger than our San Diego exemplars but with the same black heads and general body shape.  They did have an odd cry, which sounded sometimes like a cat, sometimes like a startled infant.  It was an impossible sound to ignore, and I’m afraid my attempts at novel reading were often frustrated - reflexively looking up at each utterance.  After a few moments, I donned snorkel, mask and fins and shuffled over the warm sand and rocks to the water.  Sitting down a few steps in to get the fins on, the sea was slightly cooler than blood…slightly.  Mask on, I kicked my way out to see what I could.

 

Corals, more varieties than I had seen intact in one place before, were scattered along a sandy bottom. Both hard and soft corals – brain, staghorn and table corals, gorgonians and sea pens and many more flourished within easy free dive depth.  Scattered among the corals were myriad fishes in the riot of colors one expects from the reefs of Hawai’i or Tahiti.  Amazing!  Parrot fishes, and Moorish idols, angel fishes and wrasses flitted among the folds and branches of the coral.  Gobies nervously guarded their little sand caves, eyeing the clumsy human interloper like suspicious shop-keepers.  In the plains and valleys between the coral communities bigger fishes – colored like the sandy bottom - glided in and out of the middle distance.  An amazingly rich eco-system lay just feet beneath my slightly leaky mask, and I bobbed happily for hours just watching it all unfold.  Moucha island and nearby Maskali are maritime preserves, and I must say that after the garbage strewn aridity of the mainland, this was as a balm in Gilead for the nature lover’s soul.   In all likelihood – at least according to Wikipedia – the balm of Gilead mentioned in Jeremiah  was an ancient trade item now known as balsam of Mecca, produced from the tree Commiphora gileadensis (syn. Commiphora opobalsamum), native to southern Arabia.  Small world, eh?

 

Anyway, I passed a pleasant day between snorkeling, relaxing with a novel and an iPod under my shelter, and cooling in the breeze which picked up as the day went on and the air over the mainland heated and rose.  Luncheon was served at 1 pm at the little open air self proclaimed “bistro” just off the boat dock and was surprisingly good.  At about 4, we packed up and made our way back to the boat – salt crusted, sand scraped and sun burnt, but happy.  I think – for me – the happiness was in part inspired by seeing the first beautiful things that Djibouti has had to offer, poor shattered place that it is.  Bright fishes and the occasional smiles of children – I think I can make it for 6 months on that.

 

Today is my 48^th birthday.  Odd to think that 48 years ago, on the Mediterranean coast of North Africa, on another French base on loan to the USA, in a little Navy hospital, I first saw the light of day.  Ain’t life interesting?

 

Dear readers,

My apologies for not getting new blog posts out for the past few days.  A dear friend of mine passed away Thursday.  I have struggled to find a more eloquent way of saying that I have just been too sad to write, but there it is.  I promise to get back to it soon.

David was my mentor, my pole star and one of the finest men it has ever been my privelege to work alongside.  He was my predecessor as Chairman and also one of my predecessors here at Camp Lemonnier.  It was my great honor to speak at his retirement from the Navy, and on that occasion he was presented with an American flag which had flown over Camp Lemonnier, in token of his many accomplishments while here.

Our picture today therefore is of the colors flying over the camp, one of the many places David left a little better than when he found it.   Go in peace my dear friend, and let your burden pass unto a new generation.  We shall strive to deserve the example you set us.

I'll get back to the blog this week.

Cheetah'd

Hello All,

 

Well, I had hoped to have enthralling accounts of my visit to the Cheetah refuge to share today, having signed up last Sunday for the trip.  Alas, it was not in the cards.  About halfway through the afternoon, our internist cum emergency medicine “specialist” Mark found me to say that we had admitted a Japanese patient with epiglottitis.  

For those of you who aren’t of a medical bent, the epiglottis is the little flap that covers up your windpipe when you swallow.  I don’t know if it is actually used in yodeling, but that probably wasn’t an issue in this case.  In any event, the big concern for anesthesiologists in the epiglottitis sufferer is the prospect that the inflamed little booger may swell up and occlude the trachea – with the obvious bad result that your only available organ of respiration is now your skin.  Not particularly effective – “Goldfinger” myths notwithstanding.  The solution in such a setting is to intubate the trachea with one of those tubes you’ve doubtless seen on ER or House.  Such intubations are famously fraught with peril, and are usually turfed to the most experienced chap available (with a surgeon at hand to rapidly do a tracheotomy if things go south).  Well, both Herman the nurse anesthetist and I were signed up for the trip, and as it turns out I trained him.  Sigh. Anyway, although this fellow didn’t look very sick – he could lay flat for instance – it seemed imprudent to leave base.  I couldn’t imagine the level of international incident that would be engendered by having a Japanese airman die on our ward while I was petting Duma the cheetah.  I guess I’ll go next month - Herman said it was worth the trip. Our patient survived the night with no worse suffering than that associated with having to watch movies with the rest of the ward patients in a language that he didn’t speak.

 

Needless to say I was vexed with life in general.  I consoled myself with an extra slice of pizza at dinner, along with a scoop of ice cream, and later in the exclusive confines of the White House, had a nice glass of a lovely, dry French rose.  As I say, I’ll try again next month.  In the meantime, I’m hoping to go on the upcoming Moucha Island trip – beaches and snorkeling, and a trip to the market.  I shall be more careful though not to count on going.  Else, we’ll have a Romanian diplomat who needs a double lumen tube for lung surgery…

Oh, and the picture above is of Herman and I at the trash incinerator.  No cheetahs, but I'm pretty sure I saw pigeons.  Is there any place they don't live?

 

A visit today by the French physicians from the base across the runway.  These are the folks who work in the French equivalent of our little clinic.  They don’t have the surgical capability we do – they can refer their patients to CHA Bouffard in town – but they do function as primary care for the French active duty folks as well as spouses and children.  It turns out that for our Gallic colleagues Djibouti is a 2 year tour during which they may be accompanied by their families.  There is housing both on their base and out in town, and the boulangeries, patisseries, charcuteries are by report abundant enough to make life in the French style acceptable.  Myself, I wonder how I would explain to Donna that we’ll be moving to Djibouti for a couple of years. 

“Honey?  You know how you’re always wanting to get away to some place warm?  And how much you like French food?  Have I got some good news!”  

Best check that any firearms in the house are unloaded first.  In fact the scenario is not too unlikely (not for me, imshallah), as plans are to build a little hospital here on Camp Lemonnier as the base moves from an expeditionary to a permanent establishment.  That done, the standard orders will shift indeed to a year or two, and accompanied tours may be the norm.  I suppose it wouldn’t be so bad.  The kids could attend the French school and come home speaking French, Arabic and Somali.  Not sure how effective a selling point that would be.

Not much else of note to, um, note.  Spotted a fair sized skink ducking under the block of CLUs as I was returning home last night - a thick bodied lizard about a foot long, yellowish in color and with a large diamond shaped head.  I’ll keep an eye out for him in the future.  Beyond that and the house geckos not too much wildlife to report.  I did see a small group of finches in a tree nearby, and I get the occasional glimpse of fast-moving flocks of robin sized birds, but with curved beaks and odd looking wings.  Nowhere near enough to get a useful look however.

 

Tonight’s ward room movie is Kung Fu Panda...I guess there'll be beer.

Prancing Ants and Panting crows

Greetings All,

Our picture today, from the ongoing "When life give you Lemoniers, make Lemoniade" series, is of the sun, at about 6 pm, setting to the west of CLU-ville.  Actually, since the CLUs are in blocks by letter, with "A" furthest west and "F" furthest east, many on camp call this area "Fomalia".  What prompted me to take the picture is the peculiar aspect of old Sol.  The filtering here is through the haze of suspended particulate matter - smoke from diesel engines and the dump to the south combined with dust - and fog that envelopes us on many days.  I know it will appear that the dimness and peculiar cast of the light is a phenomenon of approaching sunset, but it is in fact not uncommon for the sun to appear tiny, distant and brownish all day.  One might think that this would be accompanied by a diminution of the heat, like when a fog rolls over our house in Ocean Beach, but the better model here is the planet Venus, where the thick atmosphere traps the sun's heat and renders the planet's surface a searing, inhospitable wasteland.  Just add CLU's, the internet and a galley and you'd have Camp Lemonnier!

Recent doings by your HOA correspondent include another trip to Peltier, where I worked with Dr. Assam, the Egyptian anesthesiologist.  He's a very nice fellow, with reasonably good english (certainly better than my French).  We passed a pleasant few hours discussing Egyptian medical training in comparison to that in the US and Canada.  In a nutshell, the Egyptians (as voiced by this representative) are quite proud of their medical establishment and accomplishments,  but are unable to or uninterested in support for research based academic medicine as is characteristic of university based North American programs.  For that reason, a chance to study in the US (or England - not so much France, I was assured) is highly prized by physicians from Egypt and environs.    The discussion was interesting and quite collegial, but I did find myself in an odd sort of bind.  

As you might imagine - and I'll send along OR pictures some time - the nature of the practice of medicine, surgery and anesthesia is a much more rudimentary affair here than where I work.  For that reason, I'm interested in the choices the folks here make in providing care - why this instead of that - as it provides me some guidance in my somewhat more austere setting back at base (apples and oranges - but those are both fruits, after all).  It was difficult though to ask  questions without seeming to criticize the practice here.  Thus, "Do you give pre-operative antibiotics to your patients?", seems to come across as an implied slight on their clinical conduct.  It is interesting to what extent one becomes a symbol of the culture or the profession when in a foreign place, and the status of US medicine - despite the ongoing debates about how we must change - as a paragon of medical modernity and virtue gives that symbolism a real power.  It must be somewhat like being a citizen of the Roman Republic must have been in the hinterlands of the Middle Sea in the days of the Caesars - the mere fact of membership in the ranks of dominant empire lending weight to one's judgments and questions.   In any event, it was an educational day and I shall look forward to more such.

So, how hot is it?  Well, about a week ago, on a really stinky hot day (although my standard of comparison is still evolving) I was walking back to the CLU at lunchtime.  Perched on a window sill was a crow.  Not too unusual here, where the corvid brethren are an ever present raucous, impertinent, opinionated mob.  They are, for all that, pretty wary and it is rare for them to allow a human within 10 feet.  (They are also camera shy, as I believe I have mentioned.  I suspect that they are used to having things aimed at them).  Anyway, not so this bird...he sat there until I was well within 4 feet and then with a poisonous glare flapped his wings just as many times as required to reach the branches of an overhanging tree.  As I watched him, I noticed that there were about a dozen of his grey and black brethren already in the branches, nestled into the densest shade they could find and all (now including my initial contact) sat with their feathers fluffed, their heads pointed ever so slightly skyward, beaks apart and tongues hovering between upper and lower jaw.  And they were all absolutely silent!  It was a bit ominous at first - were they poisoned?  Victims of mass hysteria?  Was this some ancient crow religious ritual?  It took me a bit to work out that they must have been desperately trying to cool down.  Birds don't sweat of course, so to cool down one of their strategies is to pant - open mouthed and, as I now know, silent.  How hot?  So hot that the crows are panting.

Most recent "wild life" encounter was this morning when I noticed a ping-pong sized ball of tiny ants in the lower right corner of my window, bearing eggs and larvae on closer inspection.  I try to be an evolved and superior creature when possible, but on reflection I decided that the "no pets" policy would apply to management of a free range ant farm, and called the guys from vector control.  They showed up 2 hours later with some ant baits, but their eyes got big when they saw the incipient colony, and the junior of the two was sent back to the truck for something with a bit more persuasive power.  I stepped out while the ants and exterminators negotiated and when I returned a few hours later, only a few dazed survivors wandered here and there.  I wonder though.  The Argentinean ants, which these guys resembled in size and disposition,  are pretty difficult to get rid of.   Is the aardvark an African animal?  Could I convince the folks in housing that it was a service animal?

Not much else of note.  Went out to the Ethiopian/Fondue place on Sunday evening, and tried the fondue this time, with a lovely French rose wine.  Both eminently satisfactory.  Tomorrow, I'm off to the cheetah refuge, so should have some pictures and stories to share.  Reading Bernard Lewis'  The Middle East, which is good as far as it goes, but a bit too superficial.  Does anyone out there have a suggestion for a good Middle Eastern history book that's readable but a bit more in depth?  If you do, I'd love to hear about it.

All the best!

Anesthesie

Bonjour, Tout le monde!

Your faithful Djibouti correspondent here, with tales of adventure from the shores of the Gulf of Aden.  Well, today was unexpectedly interesting.  Last night, as I was getting ready to retire with Colleen McCullough's The First Man in Rome - an interesting combination of bodice-ripper and extremely well researched historical fiction - the phone rang.  Now, my phone never rings, so the tendency is to assume it's either a wrong number, or a catastrophe.  If you guessed one of those, you'd be right 50% of the time, historically.  This time though, it was our surgeon Bill, asking if I wanted to go to Peltier - the Djiboutian hospital - to assist him in assisting Dr. Elias with a common bile duct exploration.  I would be the first to admit that back in San Diego I might have turned up my nose, waiting for an open heart case to come along, but that was then.  " What time do you want to meet?" I asked.

Thus at o8ooish (after colors and the Rogers and Hammerstein anthem of Djibouti), Bill and I set off on our excursion.  A couple of firsts were gotten out of the way, actually.  Neither Bill nor I had driven on the Djiboutian roads to this point, and neither of us had actually done anything at Peltier.  As to the roads and driving in Djibouti, well I can only say that I hereby apologize for any criticisms made or implied by me about the terrifyingly random driving habits of Sicilians and Neopolitans.  

Friends, any object on any road or roadside in Djibouti - trucks, really big trucks, goats, dogs, camels, pedestrians, donkey carts, scooters, taxis, children to name just the more obvious actors - can at any time be in any lane going any direction at any speed from 0 to 60 miles per hour.  This has been explained to me as the imshallah philosophy as applied to traffic patterns: If Allah the merciful, who has ordered even the fall of the grains of sand from the top of the loneliest dune in the most remote desert, wishes one to die in traffic then it would be impious even to attempt to avoid one's fate.  I can't comment on the accuracy of this imputation, nor on its theological merits, but it does make driving here resemble Mr. Toad's Wild Ride.  Luckily Bill was driving (surgeons always want to drive), so I could watch the whole thing between the fingers of the hands I was holding over my eyes. 

Anyway, we made it.   On arrival, after changing into scrubs in Dr. Elias' office, we made our way to the OR suite.  As it turned out, Dr. Elias was delayed, so we cooled our heels in the Bureau Anesthesie  (pictured) while we waited.  A bit different from my cherry wood desk and panoramic view of San Diego bay!  The 5 OR's are quite, um, spare.  The fixtures are old, and many are broken - held together by a range of ingenious adaptations of materials donated,  left over, or supplied by the Health Ministry.  Tile is missing in patches from floors and walls, and the ORs are curtained off from the central hallway.  The staff consists of the several surgeons - the orthopod and "visceral" surgeon were operating today - two Djiboutian anesthesiologists, augmented by a Chinese colleague, and 4 anesthesia assistants.  These latter are nowhere near the capability of an American CRNA, nor I suspect of our AA',s but they are often left to themselves to manage patients as the anesthesiologists move from room to room.  The drugs and supplies are pretty familiar stuff, especially if you trained about 15 years ago, although they do have Paracetamol - IV tylenol - that I don't think we'll ever get to use in the States.  The Anesthesia machine is a simple Italian model, with oxygen as the only available gas.  Local anesthetics and spinals are preferred where possible as they are easier for the physicians to leave in the care of their assistants, and use fewer resources.  The recovery room is spartan so prolonged recoveries are not a good option either.

In any event, as always the people were friendly, or as friendly as was possible given language barriers (the American english speaking anesthesiologist speaking to the Chinese manadarin speaking anesthesiologist in French, assisted by the Cuban trained Djiboutian).  The two local Docs - Dr. Meseret, a diminutive Djiboutian lady, and Dr. Assam, a darkly handsome Egyptian man - were happy to have us there.  We've been invited back to give some lectures to the Anesthesia Assistants, and shall look forward to doing so.  As it turned out, by the way, the bile duct case was postponed (her serum potassium was worrisomely low), so I observed mostly "lumps and bumps" sorts of fairly minor surgery.  

This was interrupted when a Djiboutian man who had been struck by a car was brought into the OR suite - for evaluation as far as I could tell.  He had obvious significant head trauma, a fractured lower leg and multiple other injuries.  They finally got his leg splinted, and pulled the gurney out of the room - I thought - to the CT scanner to evaluate his head trauma (his neck must have been stable anyway, as his head was yanked this way and that as a bandage was wrapped around a major scalp laceration, and yet all four extremities were moving).  I was surprised therefore about 15 minutes later to find that they were in the next OR sewing up the scalp wound.  Somebody asked me if I thought he should have some morphine, and instinctively I said "No".  His mental status was obviously impaired, and he needed to have his neurological status carefully followed (he needed a CT scan).   I was brought up short though when Bill murmured that, as there was no neurosurgeon in the country, and no prospect that he could be treated for any neurologic injury, maybe fixing his superficial wounds and a little comfort care was all that could be done.  Ouch.  Kind of an adjustment coming from our model of rapidly escalating care for the seriously injured.  I left the team to make their own decisions...

No other news (and I've been typing this for 3 days!).  Off today - in my role as the Captain & Colonel lounge liquor distributor - to see Mr. Moda - the wine and beer negociant in the city.  I'll be restocking the White House fridge and wine storage area.  I think I might pick up a couple of nice French roses (I can't find a way to get the accent on the compose screen),  in additon to whatever else the gang wants.

And with that I'll sign off and get this posted.  26 more taco tuesdays to go... :-)

Miscellany

As a blogger, it has quickly become apparent that, unless I am to rely on such mundane happenings as:  "Got up early.  Flossed.  Why do they only sell the waxed stuff?", 

I need to bring some means of jotting down the truly interesting things that happen (or that occur to me) during the day.  To that end I have taken to carrying a little red spiral notepad to record observations, musings and other "blog fodder".  It seems to be working well so far, but one runs into the following issue: lots of things which are noteworthy are not paragraph worthy.  And for that reason they are toted around in my right breast pocket, these poor orphan phrases, just waiting for the right paragraph, aside or excursus to come and rescue them.  No more.  Today - nothing especially interesting having happened - we'll open the door to these solitary verbal doodles, and let them make their way in the world.

Firstly, our photo today is of a possibly recognizable chap, sitting at the desk in his "office" which doubles as the ICU.  Fortunately it is rarely the case that we have any IC going on in the U, so the situation is not as problematic as one might suppose.  Short hair seems to work well here - and mine is rather longer than most folks here on base - so I've settled on the #4 on top, 1 1/2 along the back and sides.  Cool, easy to care for, and I think my bottle of Aussie Mega-shampoo will last the whole 6 months!

The Djiboutian National anthem:

The national anthem of Djibouti was adopted in 1977, the words written by Aden Elmi, the music by Abdi Robleh.  This is of course interesting as far as it goes,  but the melody itself is a source of some speculation for some of my colleagues and I.  It's a topic of conversation because every morning at 0800 the American and Djiboutian flags are hoisted over Camp Lemonnier, to the accompaniment of the national anthems.  As a courtesy to our host country the Djiboutian one is played first,  the music reverberating throughout the camp over the pole mounted public address system called - I love this - "Giant Voice".  I imagine a jolly green man with a microphone saying "Ho, ho, ho....".  Anyway...the music is quite western.  By that don't mean Occidental, or just that, I mean that it sounds sort of like Rogers and Hammerstein might have written it for Oklahoma, but decided that "Surrey With the Fringe on Top" just worked better.  I tried to find a good example on the net to direct you to, but all the ones I found seem to have been recorded with a synthesizer, and don't really give you the flavor of the full orchestral arrangement.  It's sort of catchy, for an anthem I mean.

When Djiboutian eyes are smiling...

Folks, Djibouti is sort of a solemn place.  Life here is harsh, inconceivably so for many thousands of people outside the concrete and earthen limits of our camp.  The people are mostly solemn as well.  To a large extent of course, for the lucky 500 or so Djiboutians who come to work here every day, this may reflect the discomfort of a sojourner in a foreign place.  I have noticed in my brief trips off base too, however that gravity of mien seems to be the prevalent expression of those on the streets and in the shops.  There have therefore been less then a handful of times when I have seen a Djiboutian really smile - where it goes all the way to the eyes.  How they are transformed!  The folk hereabout are slender, tall and elegant of form when age or long burden has not bowed them.  Complexions are a burnished ebony or like well roasted coffee.  When they smile, you get a glimpse of what life here in the ravaged Horn of Africa might have been, might be in a better world.  An elegant, ancient, austere vision. It is the sun blazing forth through the storm clouds - lending a transient supernal radiance to the darkened landscape, and vanishing as quickly as it came.  I almost gasp every time. 

I reckon I'll stop there  today.  Thanks to sister Moira for music suggestions - Ray Lamontagne is entirely new to me.  How exciting!  I see that Eels have released a new album too.  Although I first grew to like them - embarrassingly enough  - while listening to the Shrek soundtrack with Jack, they have been favorites for a while.  Thoughtful,  a bit cynical, by turns profane and reverential, and with a really interesting range of music.  There, I've set up as music critic!

French class was to start tomorrow, but it now appears as if the Navy's Tuition assistance program won't pay for me to do it (odd as they paid for Italian class in Sicily), and I'm not sure I want to pony up the nearly $1000 dollars that University of Maryland wants to charge.  Maybe I'll stick with Rosetta Stone, and the Coffee Break French podcast.

In any event, au revoir mes amis.  A la prochaine!

Poor General Lemonnier!

Sometimes life here is fascinating.  Most recently I have been intrigued by the very multinational aspects of life here on Camp Lemonnier.  Before going on though, please permit the following excursus.   

In a casual comment made last week by one of the French surgeons, I learned that "Lemonier" - the name by which the American camp is known - is incorrect.  Doing a little research I discovered that the original French base had been named after General Emile Rene Lemonnier, the commanding general of the second brigade Indochine, under the Vichy French administration in Indochina, who met his untimely end when he was executed - beheaded actually - by the Japanese in March of 1945 at the outset of the "Second French Indochina Campaign".  This tantalizing bit of history, which is almost all I have been able to ferret out,  has me wondering exactly what a Vichy administration was doing in Vietnam at that late date - surely France had fallen to the Allies by then - and why the Japanese, who were the nominal allies of Germany and presumably of the Vichy, were attacking it.  Surely Japan had bigger fish to fry.  If anyone out there has any other info, or a recommended source on the topic, please let me know.

Anyway, in the transition from a French Foreign Legion base to an American (or multi-national) one, the second "n" was dropped from the unfortunate general's name.  A further indignity heaped on the late brigadier, which I fear will likely not be corrected any time soon.  As you may imagine, there now exists quite an impressive array of signage, stationery, web pages, T-shirts, etc., with the erroneous spelling affixed.  In this era of multiple demands on the military budget I doubt that there will be much support for the expense of a base-wide correction.  And thus "Lemonier" it will remain.  I know next to nothing about General Lemonnier, as I have said.  A good leader?  A nice man?  A petty military martinet?  Who can say?  I shall presume, I think, that he does not deserve the final indignity of having  his most visible legacy on this planet misspelled, so from here on, dear reader, shall be writing to you from Camp Lemonnier.  Ain't life full of  interesting ironies though? 

Well, if the shade of the  General would be peeved by the institutionalized error at his namesake,  I wonder how much more upset he would have  been to have observed yesterday the arrival of a large Japanese P-3 (submarine reconnaissance plane) squadron here in support of anti-piracy operations? We went from a small 20 man Japanese advance party to about 150 officers and men overnight.  The photo above was taken from the upper level of 11 Degrees North - the all hands club - and shows the reception for the JDF squadron thrown by the base last evening.  There were speeches by all manner of dignitaries, and various  hors d'oeuvres and, of course,  the mandatory sheet cake, at the cutting of which both Japanese and American officers were admonished to come and get a piece.  A sort of butter icing brotherhood, I suppose.  I'm not sure what the Japanese made of the appetizers - fried cheese sticks and bacon wrapped pieces of Kielbasa - but ever polite,  they turned to with a right good will, and the evening was a success.  I essayed my carefully studied Japanese phrase,  kon bon wa, or "Good evening" only once but am pleased to report it was at least understood.  The Japanese will be here for the long term, rotating new squadrons through every few months.

Shortly before these events, our Army camp security force was rotated out,  and the previous regular Army contingent was replaced with a force from the Army National Guard, based in Puerto Rico.  As you can imagine, the vibe of the base changed significantly then too - the mellifluous  sound of Puerto Rican Spanish, mingling now in the air with the elegant sibilants of French, the broader strains of Nigerian, British and South African English,  and the harsher music of Somali.  This is to say nothing of Tagalog, Turkish and Korean.  There is one lonely Romanian officer here as well, who alas I fear must have to wait until he Skypes his family at home to hear his native tongue.  An interesting place.

I had "duty" last night, and found myself in the uncomfortable position of trying to reach the French opthalmologist, from the American base, in Djibouti, to refer a Turkish contract worker with a bad corneal abrasion, and his Polish safety officer.  I swear, they don't need doctors here, they need diplomats!

In keeping with the international theme,  I was visited today by our colleagues from the German base.  I met with their sole medical officer, a personable flight surgeon who did three years of training in the US, including Flight Surgery at Pensacola and whose youngest son was born at Portsmouth Naval Hospital.  Although we provide some support to the German forces - mostly dental - it is they who provide the real value in the relationship as they possess the only hyperbaric chamber with reliable maintenance records in the country, and provide us coverage for both our military and amateur civilian divers.  As the sole (former) diving medical officer on base, it is my job to be the liaison with the chamber and this visit was a "get acquainted"visit with medical officer and chamber operator.  It was a nice visit, and we are promised a return visit to the German base, but I can't help but suspect that part of their desire to stop by had to do with being tired of the food at the Sheraton, where they are billeted, and a desire to see what was available at the Navy Exchange.  No matter, they were nice volk, and I'll look forward to seeing them again.

A very interesting place, as I say.  I'm sure there are serious things going on at all the operational, trebly locked and guarded activities here on Camp Lemonnier, but some days it feels like a big, international summer camp.  If I could just find out where the s'mores are...

Well, I'll stop there and bid you all sayonara until the next time.