Ex Africa semper aliquid novi.

Three hundred fourteen years ago on July 21, 1699, a French physician and apothecary, Charles Jacques Poncet, arrived in Gondar, Ethiopia.1 Gondar is the site of a study of physician satisfaction with laboratory service that this commentary considers.2 The study’s period is much more recent than that of Poncet’s adventure—the satisfaction survey at Gondar University Hospital was carried out only last year (March 1-25, 2012)—but Poncet’s experience, the first contact of modern Western medicine with Ethiopian society, can serve to introduce Gondar. Three centuries after Poncet’s Ethiopian sojourn, many North American and European physicians and medical scientists, including readers of this journal, find themselves drawn to practice in Africa. Besides East African and other practitioners in resource-limited settings, these Western medical venturers into sub-Saharan medical settings will find the report of Addis and colleagues2 of interest. Jacques Poncet was practicing in Cairo, Egypt, when representatives of the emperor of Ethiopia, the negus, engaged him to venture up the Nile to treat the emperor for a skin ailment.1 Poncet found reaching his patient, Iya’su I “the Great,” a challenge. It took a year to journey up the Nile. Poncet rode into Gondar debilitated by a gastrointestinal illness, probably dysentery, that had just claimed the life of his colleague, Pere Charles FX de Brevedent, SJ; Father de Brevedent, Poncet’s sole European companion, had succumbed just 12 days before the physician finally reached Gondar. African practice continues to present logistical obstacles and risks not usually experienced in resource-rich settings. The Gondar that Poncet entered was a major Ethiopian religious, cultural, and political center. In Poncet’s time, Gondar drew European missionaries such as Pere de Brevedent because it was the center of Ethiopian Coptic Christianity. Now, in the early 21st century, the Ethiopian Church is the largest Monophysite Christian Church (these churches include the Oriental Orthodox Churches of Egypt, Syria, Armenia, and India); it claims an estimated 38 million baptized members, about half of whom are reckoned to practice.3 In Poncet’s day, Gondar was also the cultural center of the province of Amhara; Amhara supplies the name to the Amharic language. Today, Amharic is second only to Arabic in numbers of speakers among Semitic languages.4 Placed geographically just north of Lake Tana, the source of the Blue Nile, Gondar was also the political capital of Ethiopia when Poncet arrived. In the late 19th century, the country’s political center shifted south into the province of Shoa, where Addis Ababa, founded only in the late 1880s, became the national capital.5 At the court of Gondar, Poncet found Iya’su I (ruled from 1682-1706) an intelligent, actively engaged patient. Iya’su had Poncet demonstrate topical preparations before applying them. The emperor also asked the visiting physician to project, as he began a regimen, the effects that he hoped each preparation would produce. Iya’su further asked Poncet to keep a written record that the patient and practitioner could refer to as they reviewed the applications’ effects.1 Historians speculate that the skin condition Poncet saw was mycobacterial lymphadenitis-dermatitis or mycobacterial dermatitis, but the physician himself left no record of diagnostic maneuvers he may have attempted. Nevertheless, germane to the current study—which assesses physician and nurse satisfaction with diagnostic and monitoring clinical laboratory testing1—Poncet received a report of imperial patient satisfaction from Iya’su I in a letter the emperor dispatched to the