Day 5 (Tues 14th): Trinidad - rest day

Spent the rest day appreciating the elegance of Trinidad and chilling out by the pool. Trinidad is a beautifully preserved old Spanish colonial town with houses painted in hues of blue and pink. One of the most interesting places was the Museo Historico in the former home of a sugar magnate. The elegant rooms with tompe d'oiel were preserved and I could imagine relaxing at the piano.  Trinidad revolutionary history was captured in documents and artefacts on the move away from slavery.  The  bell tower was crowded with  people  being photographed against the beautiful view for their Facebook page. Seeing a monastery that had been turned into a revolutionary museum warmed me.

Trinidad is heaving with shops selling tourist tat, acres of Che fridge magnets and Fidel in a cigar shape and I wondered about the economics of producing these goods for tourist pesos rather than consumables for Cubans. I wonder what the Cubans themselves think about the tourists who have so much in comparison to themselves.

I have also noticed an absence of engagement with the outside world. I have not seen any newspapers or magazines and certainly no internet cafes and very low mobile phone use. 

Day 4 (Mon 13th): Cienfegos to Trinidad, Castro's birthday

We biked 88 km at 35 deg and by the end I had almost lost the will to live. In the morning we rode across a rolling upland with beautiful views. Later we crossed several rivers draining in the Caribbean where people  were out on the beaches. We also went into a village store which had no signs outside, inside it had pitiful stocks of rice, beans, spaghetti and expensive plastic buckets. The male household head holds the ration book and the rations are insufficient for a month so then people pay market prices. Poor quality and no choice. Very tough running a household here. 

I have been wanting to dance since I arrived so a group of us went down and danced salsa and heard rumba in open-air bars to celebrate my roommate's (Tamsin) birthday. Surprisingly there were no big celebrations for Castro.

Day 3 (Sun 12th): to Cienfuegos

Another hot day and fortunately we completed the biking in the morning along a beautiful coast road with deep blue sea on one side and forest on the inland side. Went down to the sea to dip our toes in but the coral was too sharp. Visited the Bay of Pigs Invasion Museum which was full of pictures of very young revolutionaries fighting off the USA-backed invasion. Ended the day in Cienfuegos which was founded by French settlers (1820) and so had a neoclassical square and town hall. Ended the day at a local carnival with packed crowds dancing on the seafront and drinking home brew dispensed from barrels. I watched the closing ceremony in London, Cuban-style, drinking moijtos.

Day 2 (Sat 11th Aug): to Bay of Pigs Swamp

Did all the biking in the morning through rolling conutryside with small farmhouses. Farmers using ox carts and smoking vast cigars. Small towns with crumbling colonial buildings. People live in small concrete bungalows with neat gardens. Obviously very houseproud. Endde the day in a Butlins-like beach resort in the swamp.

Not German but Italian, experiencing the South Tyrol.

I enjoyed the differences between Italian Verona and German south Tyrol.

I found the jubliee overdone so i was delighted to escape to Verona for a dermatology conference. Verona is a lovely city and walking around one sees the marks of past civilisations. The Roman arena is used for concerts and this design template is visible 20 centuries later in the Olympic stadium with stands for merchandise as well as sport tracks. There are wonderful 14 century frescoes in the St Fermo, the ceiling has 400 saints heads painted on it which reminded me of the saints heads one sees in Ethiopian churches, notably Gondar. The Venetian occupation can also be discerned in the pillars with the Venetian lion and the shapes of the windows. The imaginative new photography gallery (Sacvi Scaligeri) combines old and new with subterranean galleries built around the roman foundations and one walks over roman roads, drains, and swimming pools. The ancient cobbles were hard to negotiate with the buggy carrying Joan, Steve and Eglantine’s 8 week old baby.. The exhibition was of Robert Capa’s war photos and we experienced war in Spain, London, France, Germany and then Vietnam. He captures emotions brilliantly, the steadiness of men under fire, the dejection of refugees, the fear created by a rogue sniper in liberated Paris, firing on the celebrating crowd. The exhibition ends with a series of portraits of Capa’s friends, William Faulkner crossing a river in Wyoming, Picasso on the beach holding up an umbrella for his second wife, all capturing the person’s character.

 Verona at night was very Italian with people sitting outside the arena drinking and much promenading going on. I think one gets the best Italian ice creams in Verona, we had excellent ones from a long established shop and then even found a shop open after midnight for that late night ice cream.

I then headed to the south Tyrol with a train ticket costing 8 euros for a journey of 312km, and not even bought in advance, unlike British tickets. The train goes along the Adige valley up to Bolzano.

I first came to the German speaking south Tyrol in 1994 when my friend Jorg came as a summer locum family doctor in Kurtasch/cortaccio village. The area was in the Austrian empire and ceded to Italy in 1919.  The houses are Alpine with sloping wood roofs, and the towns have a Germanic look with large houses. The area feels prosperous, the orchards on the flat valley floor are neat and tidy, even the vines on the valley sides are neat and the area oozes quiet efficiency and prosperity. It feels more German lite than Italian. Jorg is German, married to an Italian doctor Tina, their kids Martha and Frederico are fluent in Italian, german and English as well as being passionate about modern dance and football respectively.

We went up towards the Brenner Pass and walked around a small lake surrounded by pine trees, the meadows were full of daisies and buttercups. The village church (Durnholz) was tiny with medieval frescoes showing the day of judgement. Outside were the memorials for the soldiers killed in the two world wars, they all had Germanic names and they had died all over the Austro-Hungarian empire (Germany, Italy, Ukraine). That afternoon there was a terrific storm and which was followed by beautiful scenes with light coming through clouds and water glistening on steep rock faces.

On Sunday morning i woke to the sound of a village brass band and a Tryolean village procession was celebrating Corpus Domini. The women were all in dirndl skirts and the boys wearing lederhosen and the men had hats with feathers. They all then tucked into wurst and beer sitting in the village.

These borderlands are interesting places where cultures and boundaries clash. Geography really defines the inhabitants of a place. Here the Alpine climate defines the housing, the food and the transport but it is the historical associations that define the language and the ethos, so the South Tryol for me feels more German than Italian. At least one can transcend these geographical and national differences by being a European and i came home laden with Italian cheese.

Ethiopia April 2012: Interactions between The Gulf, Buildings and Health services

I visited Ethiopia to see how Saba and her project for improving the treatment of leprosy reactions was progressing. When i last visited in July 2011 the drugs had only just arrived and she had to negotiate their release from the airport. The study is now in full flow. We had expected difficulty in  recruiting patients for the study on one of the chronic complications of leprosy, erytheme nodosum leprosum but these studies now have recruited enough patients. The other study on type 1 reactions  needs 100 patients and is accruing patients far more slowly. We talked about ways of improving the patient numbers and as well as talking to local referral centres Saba will also do a radio broadcast. Every week there is a half hour broadcast on leprosy on the Addis Ababa station contributed by the leprosy patients association and she will talk about the trials that we are doing. Hopefully this will encourage patients who at sitting at home ill to attend the hospital. 

As soon as I arrived  at the hospital i was shown patients with difficult or unusual problems.  I saw patients with all types of leprosy reaction. Two patients had been on steroids for years but their immune systems are still reacting and their skin was inflamed and their nerves tender.  There is still a steady flow of leprosy patients into the hospital. Diagnosis and treatment of leprosy has been delegated out to the primary health care posts and now we are seeing many patients with advanced leprosy which  suggests that patients are not being diagnosed out in the periphery. I gave a talk on how diagnosis of leprosy is delayed in London and mused on the parallels between Ethiopia and London, in both places health workers need to be aware of the possibility of leprosy. In India new surveys have been done and many undiagnosed patients have been found. I suspect that if we did such surveys in Ethiopia we would also find many patients.  It is going to be a huge challenge for the next twenty years to try and diagnose patients. I can see that the last decades of my work will be concerned with enhancing leprosy diagnosis in different settings.  This partly a result of the premature announcement by WHO in 2004 that leprosy is eliminated s a public health problem. .

I again enjoyed Saba’s warm hospitality. Last time i wrote about the nanny who wanted to go to the Gulf to work. She got a job with a family and went with high hopes. There was then a seven  month silence and then she rang Saba one day. She had a sad tale to tell, she had been treated like a slave, working  18 hours a day with no breaks and she was not paid and imprisoned in the house. Fortunately she escaped, with her passport, and found refuge with helpful Ethiopians.  She now has  another job and is not  back in Ethiopia. I suspect that Saba only heard part of the tale and she was probably sexually abused as well. The new nanny, Alem, is another nice girl, she has just completed her education Alem’s sister who is working in the gulf is warning her not to go there. But the lure of the money in the Arabian Gulf is irresistible for Ethiopians.   Leo is now a fine 18 month old running around everywhere. He loves books and was delighted with the suitcase fo books that i brought from Saba sister here in London.  Less flatteringly he called me nona the Italian for granny. He clearly has a sharp sense of age. 

Addis is booming, with buildings going up everywhere, much of this work is funded by money from The Gulf  notably from Mody, a Ethiopian Saudi and the richest man in Addis . His building sites are badged with green and yellow painted hoardings and much of the town was encased in the Mody colours.  He also imports Filipino workers who work to a higher standard than the Ethiopians, as the poles do in London They also live in dormitories and have a minimal life style. The new Africa Union building is being built by the Chinese.   Mody  built the Sheraton  ten years ago and i was given a ticket for the very glamorous opening with Didi bridgewater singing jazz.  On The edge of town are acres of new six storey condo buildings, in the rain these look oppressive and East German like but In the afternoon these become lively vibrant spaces with all the ground floor being used as shops selling piles of fresh vegetables and newly butchered meat. Boys play football on the larger spaces and people sit on yellow plastic chairs at open air bars.  The nicest ones are painted grey and pink colours which give attractive local colours

We also had some time relaxing and swam in the hot volcanic spring fed pool at The Hilton. The outside air was cold so it was very refreshing. Afterwards we showered in the communal shower and i was surrounded by black voluptuousness and felt very white and stick-like.  We also visited the Taitu hotel ,  a large colonial style building form the 1930’s in the central piazza area. It still has a beautiful large wooden staircase and verandah that will be perfect for a post work drink on another visit. We spent an evening in a jazz venue hearing a group play 60’s style Ethiojazz which fuses jazz and traditional Ethiopian music. The line up was a little reminiscent of Buena vista social club but not quite so old.

I read Peter Gill’s book “Famine and Foreigners,  Ethiopia since Live Aid” and learnt a lot about the repression of democracy in the 2005 election. I had seen how little opposition there was in the 2010 election, this was not surprising because they have been driven overseas by violent repression. The absence of a free press is noticeable, the Ethiopian Daily Herald is clearly a mouth piece for government views and has such a tedious style that I barely stay awake to read about the latest government successes.  Soviet style central planning is still being used here.  In March 2012  DrTedros Ghebreyesus, the Ethiopian minister of health visited LSHTM and enthused over his plans for fast development of the health service. 2,000 new health posts have been established over the last 5 years each serving 25.000 populations. The health workers have many tasks including detecting leprosy, but the patients report that the health posts are often not staffed or the drugs are not available.  The other plan is to train 3000 doctors per year and flood the Horn of Africa with Ethiopian graduates. The difficulty is that no thought has been given to the curriculum or teachers in these new institutions. I met a very lively American trained Ethiopian returnee doc who was part of this programme. He exuded the enthusiasm of youth but i could see that he would probably not be around for troubleshooting in these new institutions.  I wonder what measures of outcome are being used to asses these projects. Alem , the new nanny has eight years of education but is functionally illiterate so the omens are not good.  I also saw signs of totalitarianism, all the hospital staff were taken off the hospital site for a day and a half in which they were harangued by the minister of health over their apparent poor performance of the hospital, attendance was compulsory and Saba was one of the few people left behind to look after the patients. This did not appear to have motivated people in the hospital.

So i had another interesting visit to Addis,  I enjoy staying in Saba’s household and getting  an inside view on Ethiopia. There visible improvements in the country but also worrying signs of repression and democratic development t here looks less likely.

Diana Lockwood

May 2012     

Capital Ring 2012

I decided to walk the capital ring route as my own mark of being a Londoner in The Olympic Year. It is a 78 miles route which loops round London going through parks and woods with Charing Cross as a central point about 10 miles away.

I started the walk with my 25 yr godson Alastair and we may do the whole walk together or i might link up with different friends for the different sections. I shall walk about 10 miles per section and i hope to enjoy the parks and architecture of different parts of London.   

The Capital Ring 1 April 1 Woolwich to New Eltham: Light, history and renewal

This 8 mile walk was suffused with a sense of new beginning. It was fun to be starting a new walk and spring was evident everywhere, in the fresh new leaves on the trees and the rustlings of small animals in the undergrowth.  The view of the Thames here is impressive, it is a quarter of a mile wide at this point and was reflecting the light. We looked upstream at the futurist domes of the Thames barrier and beyond to Canary Wharf. Opposite us the planes took off from my favourite airport, London City, favourite because of its size and speed and the wonderful views one gets of the City as one lands there.  Charlton Park seemed like a manicured space with mown lawns, mature trees and people playing football in the sun. The route wound through the woods of Shooters Hill and Oxleas woods. Underneath the triangular Severndrooge Tower, a dilapidated monument to a long forgotten battle in India we had a fantastic views out over south London to the north Downs.  We ended our walk in New Eltham where the streets were pink with cherry blossom and we replenished ourselves with fish and chips.  The Shard dominated the beginning and end of our journey. It rises straight out of London Bridge station and reflects the light in interesting angles. There was also another link to an older time on the river. The building work at London b ridge was enclosed in a huge Canaletto (1720) picture of the river full of barges and boatmen, very different to the nautical quietness on the river now.  We ended our day in The George pub, a balconied Southwark pub several centuries old. I sensed  London’s ongoing renewal , there were modern new waterside flats, a military hospital had been converted into private apartments and Woolwich has been improved with a fine new station in nautical white and blue.