Ethiopia, Korea and Djibouti

What is your memory like? Is it an organized place where you can readily retrieve any file you need at a moment’s notice – subdivided by sights, sounds, smells et cetera? Or is it more like mine, wherein it seems as if I stand on a modest height in the middle of a junk-yard. From here I can often see the specific memory I wish to retrieve, but just as often must rummage around through the heaps – peering under the theme-song from “The Courtship of Eddie’s Father”, past the cake I had for my 7^th birthday, and around the minimum alveolar concentration of methoxyflurane (0.2%) to find what I want. I know it’s all there, but it’s often impossible to lay a hand on it at a moment’s notice.

Thus when I look back at the highlights of this busy week, they seem to me as a jumbled, riotous kaleidoscope of sights, sounds and tastes. The demands of narrative however would be ill-served by presenting them to you thus, I reckon, so come along and let’s do this in order.

Tuesday night we assembled to bid a final farewell to Christian, the departing French general surgeon. Now, those of you with more linear memories may well recall that we had made our “adieus” in a past entry, but as it happened at that time, the topic of L’Étoile-Kokeb came up, and it was decided that nothing would do but that we all meet again one last time for an evening there. As Christian’s flight was Wednesday morning, Tuesday evening was decided on – and off we went into the bathwater warm Djiboutian night. We stopped first at Pierre-Emmanuel’s house at the French hospital for a chat over the obligatory pastis, and then headed tout ensemble into the heart of the city. It was full dark as we parked on a side street off the central square. We were immediately met by enterprising young men who insisted on the honor of watching The Mystery Machine while we dined – recompense to be decided later. This by the way is always the case in Djibouti – sometimes the, uh, attendants are there from the beginning and just as often they show up only when you are about to leave, insisting that unknown to you they were watching your car the whole time, preventing only through their vigilance and good stewardship the direst of fates for your vehicle. We always pay them a few coins, dismaying the French – but we’re Americans after all, and far too simple creatures to be appropriately skeptical. Well, let’s leave the van there in any case.

Why L’Étoile-Kokeb? The restaurant, whose names mean “star” in both French and Amharic, is an Ethiopian restaurant where the food – either Ethiopian dishes or fondue – is tasty and plentiful, and the service is accompanied by a floor show. As listed on the laminated programme music and regional dances from 11 of Ethiopia’s distinct cultural groups (did you know that there are 84 indigenous Ethiopian languages?) were to be performed. In the event, the entertainment was provided by two musicians – playing the krar, a type of 6-stringed lyre and the kebero, a large hand drum – and a male and female dancer. The music sounds a bit alien to at least these western ears, as it uses a unique pentatonic tonal system, but the rhythms are immediately appealing and are made more so by the dancers. Each of the 11 dances involved a costume change and often different props. I am alas but an indifferent student of dance so shan’t be able to describe to general satisfaction the grace and vivacity of the dancers. Suffice to say then that we were entranced by their agility and finesse, charmed by their evident enthusiasm, and impressed by their fortitude. Despite the ceiling fans, the nine of us were warm just sitting. How the pair were able to gyrate, shimmy, twist and gesture for the hour or so of the performance without being visibly fatigued was a matter for wonder.

Anyway, the evening was a great success. The food was lovely – I shared Ethiopian style food, served on injera – the large sourdough pancake/flatbread made of teff flour - with Paul, the new French surgeon, while at the other end of the party beef and cheese fondues were the call. Delicious and plenty, but I’ve described both before and shall not bore you further. We finally waddled out after a couple of hours. We thanked (and tipped) the dancers and musicians, and made our au revoirs and mutual pledges of hospitality in France and San Diego before slipping our indefatigable vehicle attendants a few hundred Djiboutian francs and heading home. And that was just Tuesday.

Wednesday evening was an altogether different affair. The Republic of Korea ship Choi-Young (DDH) pulled into port on a training cruise, with 122 South Korean Midshipmen aboard. The Korean Chief of Naval Operations, Admiral Ok-keun Jung, flew in to meet her and a gala reception was to be thrown aboard the vessel. At 1800 therefore, clad in my summer whites (some day I’d like to meet the genius who decided that white shoes would be a cute idea for a Navy uniform and pelt him with the 10 or so useless, uncleanable pairs I’ve accumulated in 20 years), I picked my way through the dust and gravel, and through the fierce heat of the fleeing Horn of Africa July day, to the bus waiting outside the air-terminal here on base. There I joined about 20 other service members as we waited for the bus arrangements to be finalized – that is for a bus with functioning AC. This ultimately accomplished, away we rumbled. The Choi-Young was docked in a part of the port I hadn’t visited before – through the commercial section of the docks and cranes to the military docking area. Through the bus windows the scene was that of a post-apocalyptic science fiction film – weathered machinery, cranes, crates and containers lit or sunk in shadow according to the whim of the harsh sodium lights.

The Choi-Young when we reached her was draped in lights, with a red carpet leading to the gang way, and side boys standing by to render military honors to the arriving guests. The military niceties were executed to perfection, and we were ushered by immaculately uniformed crew members through the passageways (the cleanest shipboard spaces I have ever seen. Ever.) to the aft helo deck, where a brightly colored and lit awning transformed the deck into a reception hall, and the immaculate hangar into a buffet line. We arrived and were all greeted by tables of smiling, eager, respectful midshipmen and officers. They were by turns charming, deferential, funny and informative. Their eagerness to please, pride in their ship and pride in their service made cynicism utterly impossible. I was ushered to bar and buffet, the dishes sweetly explained – with cautions about the hotter ones. Recommendations were made for the condiments which would best compliment my soup, and my rough skills with chopsticks praised beyond their meager degree. It was already a lovely evening when the entertainment started. We were treated to music performed by a small band and by a quite junior enlisted sailor with an American Idol-ready voice. The music selection was startling at first: “Tonight” from West Side Story, “Besame Mucho” and then a spirited rendition of “Funiculi Funicula” by the Midshipmen’s chorus. It was a bit surreal at first – standing on a Korean ship, in a French- speaking African country listening to Italian popular music…but as I said, the pride and joy evidenced made any response but honest enjoyment impossible. There was a too brief performance of Korean music as well – a 4 piece percussion group with an amazing 5 minute piece that wrung more rhythm, melody and emotion from drums and gongs than I would have thought possible. The evening wound down about 9 p.m.. The breeze, which had made the evening bearable, had ceased at about 8 30, and as reluctant as we were to say goodbye to our hosts, the thought of that air-conditioned bus was a considerable inducement. A wonderful night.

The last part of the week was given over to the visit of General Ward, the 4 star head of AFRICOM, here on a visit to his largest asset on the continent. He brought a team with him that included the AFRICOM surgeon. We spent a busy morning touring the local hospitals and other exotic locales like the city dump – long story, I’ll tell you more of some time. Last night an evening social and dinner in honor of the General and his team here in the little common room of the “White House”. The general seems like an awfully nice guy – a characteristic I’ve observed of most Flag officers (Generals and Admirals), likely because so much of their success depends on their ability to inspire loyalty in other folks.

And that brings me (via a 2 a.m. call for a contract worker with severe asthma) to today. Whew! I hope you won’t think me a dull fellow if I say that the chance to stay in tonight and watch Firefly reruns on my computer sounds like bliss. There is doubtless much more to be mined from the experiences of this very rich week, and I look forward to revisiting them as summer stretches on - for my edification and your possible amusement. Tonight though that is it.

Pictures of Ethiopian dancers, and some Korean cadets with a possibly recognizable US Navy guy.

In hot water, again

Not that I'm counting, you understand, but presuming that I go home when originally scheduled I am officially at the 1/3rd mark of my wee trip to Africa. I'll celebrate with a bowl of ice cream, I think. Maybe strawberry.

So here's the thing. We "make" all of our own water here on Camp Lemonnier. It is generated by an immense reverse osmosis water purification unit. In this process "raw" water containing all that stuff you wouldn't want to drink (let's call it solute) is forced by external pressure through a synthetic membrane leaving all the solute behind and emerging as pure solvent (let's call it water). Of course, the military being who we are, we can't resist an appealing acronym. Revere Osmosis Water Purification Unit is thus R.O.W.P.U., pronounced "roh-poo". Refreshing glass of ROWPU anyone? Anyway, this is all very impressive when done on the giant scale we do it here - hundreds of thousands of gallons a day - but there is one little problem. As you can imagine, all that water is pumped through the miles of pipes to its final destination - let's take my CLU for instance. And indeed here it arrives, flow in gushing abundance from faucet and shower head. It's fresh, clean, potable and...hot! I have never once turned on the hot water in my months here, and it is almost uncomfortably hot to get in the shower - especially after coming back from the gym already steaming. Not that I'm complaining you understand. I'm appropriately grateful for the wonders of science and the dedicated engineers who make my morning shower possible. Besides, it feels marvelous when it stops.

What else? Let's see...we have a new French surgeon in town. He's here to start his 2 year tour, and is now looking for a house in town so that he may bring his wife and children here with him. Naturally such an event can only be marked with a dinner, so we gathered up a group of our surgical staff, piled in the Mystery Machine and headed out. We met at the house of Pierre-Manuel, the French anesthesiologist, and after sitting for a bit to chat and gather the rest of the diners we headed out to L'Historie. This is a third story restaurant just off the by now familiar main square, with a Franco-Djiboutian menu. It is one of the few places open on Fridays, the Muslim sabbath day. Food was superb. I had the house aioli - intensely garlicky sauce with a mayonnaise-like consistency - served with a plate of vegetables and steamed fish. It was lovely, but made me a bit wistful. The best aioli in the world is made by my lovely wife, laboring with mortar and pestle, carefully combining olive oil, garlic and egg to make a condiment that will knock your socks off. The aioli was good. But it wasn't Donna good. Sigh.

Anyway, it was a delightful evening. As an aside, as you'd imagine in Djibouti on a Friday night all the restaurant diners were European. More interestingly, they were almost all tables of men in smaller or larger groups. One of the French at our table told me that the locals call late July and August "the season of the whites", as all the French families have gone home to the cooler climes of France, and the men left here are out most nights for dinner. They did look a bit morose, on reflection - a recognizably hang-dog expression that men too long away from their families begin to wear. School starts again in September, and spouses and children will be back by then, so our wistful soldats français don't have too long to wait. Interestingly, the French school here is quite large - the largest Francophone school outside the mother country - and has an excellent reputation.

Yesterday we spent at Peltier, but were limited in the morning by the fact that the hospital was

out of oxygen (!). This was amended by early afternoon in time for a laparoscopic

cholecystectomy. As it turned out, getting the oxygen back couldn't have come at a better time. Later in the evening as I attended the Coalition Officers Hail and Farewell, our surgeon Bill and Herman our nurse anesthetist headed back out to help the Djiboutian team with a stabbing victim who had sustained an injury to his kidney and great vessels. (They're call great vessels because when your trauma team hears they're injured they think "Oh great, just great...). I can't think of two folks I'd rather have working on me and I'm sure their efforts were much appreciated. As for me I was left to make what conversation my poor abilities would permit with my table mates, and to once again be deeply impressed by the multi-country, polyglot group we've got here; by how well they function together, and by how strong the bonds thus forged seem to be. We bid farewell to officers from Pakistan, Egypt, France and Great Britain, all of whom went on at length about the value of what the team here is doing and, as importantly, about the value of the coalition experience itself. It is at such times one sees the world as it might be - a place where difference is respected and cherished, while striving for a common good forges bonds of amiable good will. But there I go getting all "UN" again.

Not much else. Got in a simulated 10K today, and an early brunch. I'm in the CLU now, as my valiant little AC unit, turned to "Antarctic", struggles unsuccessfully against the mid-summer Djiboutian sun. I've got a couple of things coming up this week which should be interesting (and yes, they both involve a meal). My friends in the OPSEC world suggest that I tell you about them after the fact, and so I shall. Stay tuned!

Today's picture is of sunset over the mudflats of Djibouti city - the cranes of the port are visible in the background, and a soccer game in silhouette is in progress.

A marvelous bird is the pelican...

Hello All.

Once again what has been a fairly diverting weekend by the standards of camp life may not seem so in the telling, but here goes…

My first big event was the arrival in the mail on Friday of my long awaited “Birds of the Horn of Africa”. It seems odd, but at least as regards avifauna, Djibouti (or at least the Horn of Africa) is a pretty diverse place. There are at least 70 unique bird species, and a huge number of Palearctic species, which transit the region from Europe to winter over in Africa. In a few minutes of reading I was able to put names to many of the species I’ve run into so far. These included Great White Pelican, House Crow (gruff but knowledgeable birds that walk with a cane and are experts in differential diagnosis), Osprey, Speckled Pigeon, and some variety of swift that I need a better look at, and my favorite, the Shining Sunbird (Cinnyris habessinicus). There are at least a dozen more I haven’t gotten a good enough look at yet to venture a guess, and I rather suspect that when the temperatures drop into the merely scorching range, more species may be visible. I think, save for the heat, the abysmal roads, the remoteness, and the occasional land mine left over from old border conflicts, Djibouti could be the next big eco-tourism destination. Seriously though, the geology, marine life and the birding are first class. And we’ve already established that there’s plenty of good food out here.

A propos of the last, we had a chance to explore the cuisine at Djibouti’s true 5 star resort, the Djibouti Palace Kempinski. You can check it out, and even make your reservation at http://www.kempinski-djibouti.com/en/home/index.htm. The property sits oceanfront on the western side of the peninsula, and is notable from the outside for its well manicured lawn (Lawn!) and palm tree lined driveway as well as the tight security at the entrance points. This is characteristic of a couple of the resort type hotels around here, and must reflect the dangerous neighbors that the wee country of Djibouti keeps. Anyway, past the gate guards and other measures, you find yourself in an immaculately groomed, marble and tile, Middle East-meets-Africa motif luxury hotel that compares well with some of the nicer places I’ve stayed in the US. There is a cocktail lounge bar complete with piano jazz combo, a casino, a couple of nice pools and a spa.

The occasion for our visit was the Hail and Farewell for our arriving and departing wardroom officers. This was held in the hotel’s restaurant, which features a large seafood buffet, highlighting French inflected Red Sea fare. The food was lovely, the setting refreshing and the speechifying well done and graciously received. I caught the bus home early, as there was some possibility I would have to take an aero-medevac patient to Germany. This turned out not to be needed, and I wasn’t sure whether to be relieved or disappointed. I’ll have to take a “personal sanity” break and stay overnight at the Kempinski some time soon. The thought of a bathtub sounds very tempting.

Incidentally the Kempinski is a hotel chain that had its origins in pre-war Germany. The NY Times reports the following “As part of the Nazi regime's Aryanization program in the 1930's and '40's, the Kempinski family was pressured into selling what was then a chain of restaurants and wine dealerships to a non-Jewish competitor whose finance director was a member of the Nazi party. The Kempinski family scattered, some of its members escaping while others were arrested and sent to their deaths in concentration camps. Later, some relatives received compensation, but others remain embittered that the hotel, which opened in 1952 on the site of their restaurant on the chic Kurfurstendamm, continues to carry their name." And so it goes.

The next day we had a smaller get together at the American Embassy's pool, for the officers and enlisted of the EMF. The Ambassador has a nice place, once you get past the security gates and barriers, on the ocean looking eastward from the Plage des Tritons. On the grounds are the Ambassador's residence, the pool and barbecue facilities, some administrative buildings and a small clinic overseen by a charming and delightful Kenyan nurse. The grounds are full of large trees, and roosting in one (besides the inescapable crows - house crows) was a solitary Abdim's stork. These are normally a gregarious species, but apparently the noisy Americans splashing in the pool below were more than enough company as he remained alone the whole time. Anyway, great fun was had by all, and I once again took the early ride home as I was the "duty Doc" and didn't like to be away too long. Beyond a solitary benign chest pain case though, I wasn't needed the rest of the night.

Since then, not so much. Met a couple of other groups of interesting and friendly French officers - one a pair of Mirage pilots over a superbly prepared omelette at the local wine négociant and the second the French veterinarian and epidemiologist who came to Camp Lemonnier to visit and discuss our common interests. Off tomorrow to Peltier hospital to help out our Djiboutian colleagues, and perhaps a beach/snorkeling trip this coming weekend if the winds in the gulf permit.

Hope you all are well. I learned of another Djibouti article in Esquire while chatting with some folks last night. I read it over today, and while the author's biases are obvious, at least some of the information he gives about the Camp, the CJTF and the mission is a good synopsis of what it is we think we're doing here. You can find it at http://www.esquire.com/features/africacommand0707

Take care all. Write if you get a moment.

Pizzaiolo

I know that many regular readers will have gone without sleep these past nights wondering whether French conversation class or shopping and pizza won out for my Wednesday night plans. Well, tossed on the horns of a cruel dilemma, I did what any right thinking chap would do in similar circumstance. I rationalized until I arrived at the answer I wanted. In the end I reasoned that, whereas there was no reason not to consider ordering a pizza in French a type of "conversation", it was unlikely in the extreme that our French class would feature any pizza at all. The preponderance of benefit therefore was going out to eat and shop. Quod erat demonstrandum. Ah, the lifelong benefits of higher education!

Anyway, about 6 pm I joined about 40 other folks from base at the air terminal. We received a briefing during which we were urged to stay together, remember our status as representatives of the US of A, as well various other cautions, admonitions and exhortations aimed at avoiding a clash of cultures. Suitably prepared, off we went.

There is something very relaxing to me about travel as a bus passenger, head resting on the window glass, watching the world slide by. Every traffic stop is a little vignette, a little silent movie starring the passers-by. The eye takes in the costumes, the action, the background, the mise en scene, and almost as soon as our busy hominid brain assigns some meaning to the protagonist's actions, the whole affair slides away to be replaced by another. It is a curiously pleasant type of passivity and especially so in a new country where the actors, costumes and settings are new and fascinating. Of course, this was an air-conditioned chartered bus, and thus I wasn't crowded and sweaty, and I didn't have to sit next to anyone with a live chicken...

We made our way up the peninsula, angling to the northwest off of Blvd. General de Gaul just past the French hospital, heading into what is denoted on the tourist maps as the "European Quarter". As sunset this near to the equator is always pretty close to 1800ish (it varies from about 1750 to 1830), dusk was falling as we touched down at our first stop - the basket market. This actually sounds a bit grander then the actual site - a short parking lot alongside an office building with cars parked on one side and the sellers sitting on the ground on straw mats opposite. All the vendors - there were about 10 - were women. Some of them were engaged in weaving while displaying their wares, and others smiled or called out to the 40 or so Americans now milling about the little space. Most of the actual selling though was done by men - youngish Djiboutians of about 25 years I would guess, whose relationship to the artisans was hard to guess at. They tended to speak a bit more english in any event. Were they brokers? Relatives? Anyway, the weaving was quite extraordinary, and I bought some baskets of various sizes and patterns to send home. I spent about 10,000 Djiboutian francs, which I'm sure was an awful overpayment, but I have nothing of the haggler in me. I left happy anyway. The women, all wearing colorful shash headscarves and brightly printed garabasaar shawls over their traditional dirac dresses, alas all declined to be photographed, a wish I respected. I had to smile at their girlish giggling when the question was put to them, though.

20 minutes or so and back on the bus, and off through the rapidly darkening streets to Pizzaiolo. This is a pizza place (no, really) about half a block off Place Menelik, the heart of the quartier Europeen. It sits in a non-descript block of businesses, shops and offices and is a popular place with the French, American and other ex-pats. Pizza was really quite good - a wood fired thin crust very much in the southern Italian or Provencal fashion. My "Sicilian" featured oil-cured olives, capers and anchovies, and would have been at home in Palermo or Catania. It cried out for a nice Cotes-Rotie or a cold beer, but as we were not off base on that type of a liberty chit, a Perrier had to suffice. Sigh.

Dinner finished we trooped back up from the cozy cellar dining rooms of Pizzaiolo, into the full dark night and back to the bus. Now we headed south to the approximate area of Place Rimbaud - the beginning of the quartier Africain. Here one is on the border of the "blue door" district, at the end of the sealed road and in what the Lonely Planet calls "the real soul of the city". It is a bustling, crowded, cacophonous and chaotic place, so I don't know what this implies for souls in general. What of you gentle reader? Is your soul a hurly burly market place or a quiet sunny piazza? I'm afraid mine may be a strip mall somewhere in Ohio, but that's a different matter...

Anyway, if you've ever been to a 3rd world outdoor market you'll have a good idea of the atmosphere. The one street we were allowed to explore was lined on both sides with shops and booths selling a colorful array of clothes, electronics, African jewelry, art, carvings, masks, spears, knives and doubtless a thousand other things. As you can imagine, a busload of Americans being conspicuously dropped off in the middle of this teeming third-world center of enterprise has an effect somewhat like throwing a fresh side of beef into a tank full of hungry sharks. In seconds we were surrounded by dozens of men who ardently claimed to be our friends and to have nothing but our best interests at heart as they urged us in one direction or another, assuring us that everything at their kiosk was practically being given away. It was fun for a while to saunter along, peeking at this and that and surrounded the whole time by a small crowd of hopeful entrepreneurs. I bought a child's T-shirt for Jack. I would have loved to get him one of the Afar or Issa style tribal knives, as these are among the very few actually Djiboutian artifacts available. The carvings of camels, giraffes and elephants as well as the masks and jewelry are from Kenya mostly, and the clothing from China. Alas tribal knives are not permitted to be bought or to sent through the mails (and it may be that they aren't the best gift for your 8 year old anyway). A T-shirt it will be.

After about 50 minutes of wandering about, we were shepherded back on the bus. The fuss had died down as the shoppers became less and less interested in the wares on display, but it was still with a good deal of relief I plopped back into the relative calm (and cool) of the bus. An old friend of mine once used the term "Mall Head" to describe the sensation of saturation with noise, bright lights and bustle that the mall shopper begins to suffer from after too long an immersion at the local Galleria. I had Djiboutian mall head. Mall a la tete?

Anyway home we went, bellies full of pizza and arms full of purchases. It was nice to have a chaperone for the trip, but I think I feel comfortable enough now with the streets and the city that I'll venture out in a smaller group next time. Does anybody out there need a wooden camel? I can get it for you practically free!

Talk to you next time.

Earth, Wind and Fire

I guess I should be careful what I wish for. I was thinking to myself that I really didn't have anything newsworthy to put in a blog entry, and was wondering if this would be a good chance to embark on my long delayed career as a free verse poet when...

Well, first thing I noticed this morning as I stepped out of the CLU was the wind. This wasn't very perceptive of me, as it blew the door shut while I was blinking furiously trying to get the gritty sensation of Djiboutian dust off of my eyeballs. Gusts into what I would guess were the 20 knot range swirled around me, the resultant eddies marked by dust swirls, like smoke in some test lab's wind tunnel. I was in a hurry, and was running late after a frustrating morning of trying to get Skype to work. In general Donna, Jack and I will chat at about 0500 my time, 1900 theirs as this leaves some time before Jack's bed and my workout. This morning we couldn't get the video portion to work at all despite several efforts at troubleshooting. It's interesting of course what one comes to consider the acceptable standard of communication. Last deployment (the 1st Gulf War), Donna and I would number our handwritten letters so that if one or two were delayed in the mail we would know what order to read them in. 4 weeks was pretty good turn around time, and the ability to call home after a 45 minute wait in line by a pier side phone booth seemed the height of convenience. Today I'm still irked that all I could do was a voice-only chat from the comfort of my CLU. It's a small enough thing I guess, but gosh it's nice to see their faces.

Anyway, forgive the divagation. Too late to make breakfast, I headed straight to the Green Bean - our little coffee house - for a little fortification against the day's labors. Coffee in hand I made for the EMF. With my hat brim pulled low against the wind (I believe this is the Khamsin - the summer wind from the northwest), I almost didn't notice the group of people gathered near the flagpole on my left. When I did look up I saw that it was most of the medical department - in various states of dress suggesting they had rapidly exited some place without time to locate hats or DCU tops. As I stopped, it occurred to me that perhaps the sirens I had caught wind-whipped strains of as I was walking might not have been a test as I presumed (they do test them some mornings). I walked up to the group. "Fire" said a petty officer, "in medical".

After checking to be sure we were all accounted for, or that steps were being taken to do so, I walked the 50 feet to the EMF. The front doors stood open, and a couple of our nurses and corpsmen were at the entrance. The smell of combusted material - the acrid scent of hydrocarbon and volatiles - wafted out. As it turned out, in one of the OR's, a light fixture had shorted out, causing a small electrical fire, which was in the process of spreading to the adjacent wall and ceiling when our nurses noticed it and quickly extinguished it. This was lucky, as the ORs are unoccupied at that time in the morning, and the fire didn't have a chance to do any real damage. Still the smell was pretty spectacular and has remained so through the first part of the morning. My office in the adjacent ICU was sufficiently aromatic that I've elected to "telecommute" until afternoon to give the fumes a chance to dissipate. Fortunately no surgeries were scheduled, and we have reserve OR capacity readily to hand. Still...pretty exciting stuff for our little clinic. We are getting things back to normal though and should be open for routine sick call this afternoon.

Had been a pretty routine week to that point. Sunday night a few of the officers were invited to a small dinner at the home of one of the embassy's officers, and she and the embassy nurse - a Kenyan native - put on a lovely spread for us. The meal was wonderful - a Kenyan style of baked chicken - and the chance to eat someplace with crystal, real plates and actual silverware was a great treat. Our hostess has been here about 3 years, a typical posting I guess. She will be heading back to the States in a month for the purposes of getting her "tween" age son into a school. When asked though, she was was eager for another chance to come back in a few years. I guess life here, especially outside the camp, is not so charmless at that. We do provide medical care at need to the embassy staff - dental most commonly - and it was a pleasure to get a look at life in HOA from their perspective.

On Monday we were back at Peltier assisting with a bit of rudimentary neurosurgery. A young man with an old (a month or so) depressed skull fracture and a chronic accumulation of fluid beneath the site. Bill assisted the Djiboutian surgeon as they drilled through the skull, and drained the subdural hematoma. He (the patient, not Bill) woke up quickly enough, and time will tell if the decompression of the fluid collection will help him. No word on how the nurses strike was resolved, but we'll presume it was to general satisfaction.

Tonight I must choose between Major Perot's French class and the Morale, Welfare and Recreation trip to the shopping district. I guess you can watch this space for the ultimate outcome. Coming up this weekend is both the wardroom Hail and Farewell at the Hotel Kempinski - a true 5 star resort on the on the tip of the Djiboutian headland - and the EMF going away/weclome aboard party poolside at the American Embassy. I've been to neither locale before, and am looking forward to each happening.

Today's picture has nothing to do with the fire, unless you wanted to make believe my little reptilian friend there could be a dragon. This is one of the skinks that lives under this row of CLU's. I haven't seen him since this photo was taken about a month ago. Could it have gotten too hot for even the cold blooded? For the answer to these and other questions, tune in next time to your faithful Djibouti correspondent. See you then.

Doctor, the Nurses are striking!

Yes, they're very attractive, but that's not important right now. We've got a surgery to do!

Okay I apologize. There may be some medical term for the constitutional inability to resist a good straight line. If not, maybe I could get it named after me...Shapira's syndrome. Hmmm, not bad.

Have I mentioned that the EMF's van resembles nothing so much as "The Mystery Machine" from old Scooby Doo cartoons? Well, there we were, bombing down the Somali road en route to General Peltier hospital to assist with evacuating a chronic subdural hematoma, and then a possible gastrectomy for gastric outlet obstruction of unknown etiology. Given the dearth of diagnostic technology - the countries' only CT scanner is currently broken - surgical exploration of the Djiboutian patient population is like a box of chocolates. Never sure what you'll get, to quote famous medical expert Forrest Gump. The cell phone queeped (Jinkies!) and Bill-the-surgeon answered, turning to us a moment later to say that surgery was on hold due to a nursing strike. Well, actually he said "The nurses are striking." So I said...well you get the picture. We'll try again on Monday.

Besides the doctors at Bouffard (french) and Peltier (djiboutian), there are a couple of French flight surgeons who work at the clinic at the French Foreign Legion base, right across the airport from us. They are nice folks, one chap is from Aix-en-Provence and the other from northern France. They are flight surgeons by training, and fill a sort of emergency medicine/family practice role for their posts. Remember that the French are here for 2 to 3 years at a time, and bring wives and children along to experience la vie djiboutienne. The French clinic thus has a significant pediatric and limited OB/GYN role which we by and large avoid on this side of the runway.

Anyway, Christophe, the northerner and his wife Muriel were headed home for a month's vacation in France, and we got together with them and Christophe's provencal colleague at a nice restaurant en route to the airport last night to make sure that they were properly fed and wined prior to the 7 hour midnight Air France flight to Paris. We went to Restaurant Bel Air, and were seated in their outdoor courtyard for yet another superb franco/ethiopian meal. I had a greek salad with the local feta (hey, all those goats must be good for something), and then grilled grouper (merou in french), and quite tolerable rose, which held up well on the addition of ice. We communicated by means of smiles, gestures and mutual assaults on each other's native tongues. On the whole, I'd say English came out of it better than French. Sigh. Back to Rosetta Stone. Anyway it was a delightful evening.

I'm using Hal Higdon's Half Marathon Training program, and ran the prescribed 7 miles this morning. My hope is to finish both his "novice" and "intermediate" regimens prior to getting back home, with a view toward attempting the Half Marathon Triple Crown in San Diego in 2010. Be that as it may, allow me to observe that even with ESPN on the big screen, and lots of tunes in my iPod, 7 miles is long way to go on a treadmill. I don't think I could last the distance outside however...hopefully come fall it will be a bit more bearable on the outdoor track. Anyway, today's picture shows the Gym - it's the large cement circus-tent shaped structure on the right - and looking past it the dust obscuring the outlines of the eastern camp.

First Netflix DVDs arrived last week, and having watched "The Wrestler" on Friday night, I believe that here in CLU 17 there'll be a Sunday matinee showing of "The Curious Case of Benjamin Button". As always, movie, music and book suggestions gratefully accepted.

And that's a wrap!

Pet Scan

Well, if the length of the blog entry were to be proportional to the number of things of interest which have occurred since the last entry this one would have ended at “if”. As pictured above, one of our military working dogs (her name is Winni) developed a sore paw, so we brought her in for a quick fluoroscopy of her paw. She was a good patient in general, and although I was intrigued to have the opportunity to assist with veterinary anesthesia, in the event no restraint beyond the comforting embrace of her handler was required. Sigh. You’ll be glad to hear there was no fracture and all seems to be well.

Weather has varied from hot, dry, windy and dusty to very hot, humid and still. Hard to decide between being steamed and being sand-blasted as being the more pleasant state of affairs – fortunately we don’t have to choose!

I got a note from my friend DJ, one of my San Diego based officers who is deploying to Afghanistan. He too has a blog, which deals mostly to this point with his 3 months of training at Fort Riley, Kansas in preparation for his imminent deployment. If the topic of military guys headed overseas interests you, you should check him out at "danieljmt.blogspot.com". Of course, then come back …

The big news here at the EMF is the arrival of the replacements for the majority of the folks here. Most of the officers and enlisted are here on a 9 month rotation – the current folks arrived last November and will head out in a couple of weeks. It is a sort of sociologically interesting phenomenon that a career in the Navy affords one the opportunity to observe repeatedly. That is, as we are rarely in one spot longer then a couple of years, we are always replacing or being replaced – or observing the process. It is interesting to watch the new folks especially as they transition from juvenile wide-eyed newbies never more than a couple of steps away from their incumbent sponsors, to confident-appearing veritable teenagers just itching to get out from under the old guy’s shadow. A symmetrical sort of disengagement takes place on the opposite side as colleagues once passionately engaged in the matters of the day transition into absent minded, slightly vague creatures chafing to be gone. Doubtless this growing impatience for the change to be effected is the product of evolution or benevolent Providence, assisting we sublunary beings to accommodate the unceasing change which is our lot.

Well, I can tell when the philosophy starts, it’s time for me to go. I should mention in passing that today marks the 25% mark for my shorter (7 month) deployment. Well, 26.5% actually, but who’s counting?

Ciao!

A Day at Peltier

Monday was a day of anticlimax - a good thing in Anesthesia, perhaps less so in life's other aspects. As I'd said, we were off to assist our colleagues at the Djiboutian hospital with a sort of challenging case. If you study the neck film on the top you'll see a picture of a very lucky unlucky guy. The bright spot to the viewer's right is the way a bullet appears on x-ray. Many people with a bullet in that location - near some prime real estate in the human body - will not have survived to seek medical care. This chap did make it, still walking and talking, but developed a communication (that's a hole) between his carotid artery and his jugular vein on his wounded side. This turns out to be a bad deal - even if better then the other potential outcomes - as the high pressure blood in the carotid would much rather take a u-turn and head back down the low pressure jugular vein then take much more tortuous and wearisome route to its original destination, the brain. Brains though are pretty particular about getting all the blood they want, and this fellow had many symptoms of low perfusion of his cerebrum. Not to mention the constant hum (we call it a bruit) of the blood gushing from high pressure to low through the small rents in the vessels, which the patient complained about being too loud to sleep through. Finally of course, this type of post-factory modification of the Designer's original plan voids all warranties, and the abnormal junction between the vessels is likely to fail in time, with catastrophic results.

Our mission then was to assist the Djiboutian surgeon and anesthesia team with a fairly complex case, combining such skill as we had and resources as we could spare with those of the good folks at Hopital Generale Peltier. We brought along one of our monitors, some materials for pressure monitoring, and a few drugs that we knew we would want if things went wrong. In the team were a couple of our OR techs, our OR nurse, Bill our surgeon, and Herman and me to provide anesthesia support. We probably didn't both need to go - but heck we've only got one surgeon so anyone who stayed back at camp wasn't going to be doing much. I was going to say that nobody ever comes by for just an anesthetic, but events surrounding Michael Jackson's passing may yet prove me wrong.

Well, although I could talk anesthesia and surgery all day, I'll spare you the details. Our set-up went well despite the failure of our expired carbon dioxide monitor to work as desired. As it turned out, the answer would have been to turn it off then turn it on. Try to find that in the instruction manual though. Anesthesia was uneventful (anticlimactic) and Bill and Dr. Elias quite skillfully found, isolated and repaired the injuries and closed the patient's incision back up. Our wake up was a little slower than we could have hoped. In Djibouti the anesthesia machines use halothane, an older volatile gas that tends to hang around longer than the more modern agents used in more well resourced areas (heck, we don't even teach halothane to our residents anymore). Wake up our patient did though, apparently doing well and with a normal neurologic exam. It was a long day - about 8 hours from our arrival to departure - but a good one. I don't mean to imply by the way that the Djiboutian team couldn't have done the case without us - they are excellent folks and would have done fine I'm sure. As it was it was nice for both sets of folks to have a chance to work together through a case that was a little unusual for everybody concerned.

In any event, the picture on the right is of Herman, Dr. Mustafa and me right before we got started. I'm in the middle. :-)

The next part of the day was to have been the party at the US Embassy celebrating Independence Day. It was to be in summer whites for officers and "business casual" for civilians. I was feeling just the least bit smug for thinking to have Donna send my whites against just such an occasion. As you can imagine, a bright white uniform with white shoes, is an awful potential burden here in the land of blowing dirt, so most folks leave them at home. When you need your whites though, it is nice to have 'em handy. As I started to get dressed, however, I realized with dismay that I had omitted to ask Donna to send along my name tag - it goes over the right breast pocket - and would thus have an incomplete uniform. Argh! As Proverbs 16:18 doesn't quite say "Pride goeth before the fall". (What it actually says is "Pride goeth before destruction and a haughty spirit before a fall". Nobody ever quotes that though - the other being a bit more compact and pithy). I thought about it for a while, and decided that although it was a small omission, I didn't want to be out in a uniform that was less then perfect, not at the Embassy and not on that occasion. I called my ride and begged off. I felt like Cinderella on the night of the ball.

As it turned out, the folks who attended had a fine, if hot and sticky time as the affair was held outdoors. I'm sorry I didn't get to meet the embassy folks, but I've met a few as it is and will hope to have other chances. As for me, I went to my CLU, watched the last of season 1 of The Wire, and had a grand night's sleep. Anticlimax again.

And that wraps it up. After some thought, and some advice from my very thoughtful correspondents, I've decided to stay with the blog format. This seems to suit me just fine, and I can't help the suspicion that I'm just not cool enough for Facebook.

Nothing big on the horizon, but rest assured that your faithful Djibouti Djournalist will keep his eyes open and his trusty Mac at the ready. Take care, gentle readers, until next time.