Addis Ababa

So I've landed in Addis Ababa again. And feel like a proper entry in this blog.

Sadly i can't leave the airport on this occasion but my fondness for this place remains.

The weather is beautiful today and as always, the smell of beautiful ethiopian coffee awaits me in the airport.

Perhaps I'm tuning into this smell and not the smell of cigarette smoke (banning smoking in public is probably one of the other major public health interventions we have undertaken in several countries).

Most people know very little about Ethiopia and how ancient their civilisation is. My exposure came from my grandmother telling me about her trip to visit her sister who was posted in Diredawa and Asmara which is now in an independent Eritrea (in the 1940s/50s).

During my last trip, the piety of the people, the majority of whom I came across in Addis were Coptic Chistians, was most striking. Most people associate Christianity with Europe and the holy land, but few acknowledge that it was in Ethiopia and Armenia who were two of the first nations to adopt it as there own religion, long before Europe did.

As a result, Christianity appears to be practiced in unique orthodox way here, and is steeped in symbolism. I remember walking into a church filled with Ethiopians, praying, in the middle of the working day, in Addis. This would be a rare sight in the UK.

Whether religion is a force for good or evil is a subject for debate by many. The world would certainly not be what it is without it, but I doubt very much it would be wholly better.

A recent radio 4 program spoke about physicians embracing the placebo effect as an intended therapy for chronic conditions. Ethical - probably not. Effective - probably much more than many "chemo-active" drugs.

My point - hope and belief enhance quality of lives, and if faith provides this, or equally a pill containing nothing more than a placebo, it is of value.

If I tell a patient when I first meet them, "we see that patients symptoms improve with certain treatments which are unorthodox and rely on the placebo effect, would you be happy to try them whilst you are a patient here if you need them, and tell us if they work" - I wonder how many of them, when they return with say a chronic pain syndrome, would not be grateful, if I took their longstanding symptoms away.

Is it wrong that doctors may effectively heal by "giving hope" - I think not. As long as the patients consent (most helpful ahead of time), and they know that the objective is to make them better, I think. How and why though does it work, and have a role in the NHS?

It is probably the mutual discussion, time to listen, follow up, and hope given by several "non-traditional" therapies, including placebos, that makes chronic symptoms better.

So next time we just hand a prescription to a nurse to hand out, think twice about the time we are in fact wasting in the long term.