I spent the day at Zewditu Memorial Hospital which is a government hospital. It was originally started by Adventist missionaries but was in decline in the previous government after the Adventists left. It was closed for renovation for eight months and just re-opened two weeks ago. No one from our team had been there before, but I went because it was a place for the nurse anesthetist masters students to train. They need a Western trained anesthesiologist or nurse anesthetist teaching them in order to obtain credit for their clinical care. We had a 13 month old baby with a meningomyelocoele that had not been repaired. This is a condition in which some elements of the spinal cord are exposed outside of the body. In the US this would have been repaired at birth. The child has many developmental abnormalities and will not have a normal life. She was a high risk for infection based on recent rupture of the membranes. It is doubtful to me that she will even live very long because if her serious condition. Today she is showing signs of infection. It is the kind of surgical case that we just would not see in the US.