"Be the change you want to see in the world" - Gandhi

  I remember years ago when I was a young girl, way back in the late 50’s, when one particular issue of LIFE magazine arrived in the mail. It had a full pictorial spread about “Project Hope” and its ship ("HOPE" = "Health Opportunities for People Everywhere") that made stops around the world. I devoured that issue and couldn’t imagine a life more exciting than traveling and taking care of people at the same time.

   I’ve done a lot of both since then; 30 years as a nurse and 20 years as a flight attendant. But it wasn’t until David and I retired that I found the amazing opportunity to do both at the same time.

  How often I hear from friends: “I wish I had done what you’re doing now!” So, well…do it! Don’t wait! You’ll never be as young again as you are today! All the coulda’s, woulda’s, shoulda’s need not be a replacement for giving back and living with (at least a little) gusto! Think “global”, think ”you”, add the word "volunteer" and put it all together with the word "how". Now, add a question mark to that sentence and figure it out! Find a creative way to express your profound goodness and generosity and gratitude to our overwhelmed and overwhelming planet.

  I wrote in my blog about Fikadu with the Chiari 1 malformation and about Melaku, the young shoe shine boy with such a terrible tumor. Several of you requested an update.

   Fikadu was seen by Rick Hodes in his clinic last week. David had asked if he might receive treatment in the Seattle area as a charity case, but that’s rarely done for foreigners. Rick will probably send Fikadu to India where he will be seen for a complete evaluation by a top-notch neurosurgeon, at minimal cost.

  Mecado is a more unfortunate case. As you can see by his photos/scan, his cancer occupies a large portion of his head, and his chest x-ray indicates lung metastatses. Radiation therapy, even if it were an option, has a 2 year waiting list in Ethiopia; chemotherapy is difficult to obtain, prohibitively expensive, and may not even be a treatment option.

  Rick Hodes is just a wonderful human being…the kind we all really want to be, but somehow silly things get in our way. But Rick is different, he just doesn’t let silly things get in his way. He works tirelessly and his Foundation finances the opportunity for young kids to have a chance at life, or maybe better said..a chance at “staying alive”. What kid doesn’t deserve that? If you want to help, send $20 (or $5, or $50) to www.rickhodes.org . Don’t let some silly thing get in your way. Rick gets by with a little help from his friends. You can be his friend, too, and a friend to the kids who come to his clinic. It’s all a good thing.

   Want to dive into a good book, the kind that brings a whole new standard to truly great reading? Borrow “Cutting for Stone” by Abraham Verghese from your library. It takes place in Ethiopia, and chronicles 2 young brothers/doctors as they unravel the mysteries in their lives. You’ll never want it to end.

                    “Our world turns on our every action and our every

                             omission, whether we know it or not”

                                                           Abraham Verghese

                       (Which would you rather the world turned on...what you do..or what you don't do?)

Melaku, 18 years old with a bad prognosis

MR scan: large cancer at mid-face with
cerebellar metastasis

At Rick's home with David. Two terrific guys-

Chest X-ray showing Melaku's metastases.

My dear neighbor sent me a picture of my sad kitty when he came by for feedings.
"Come home, Mommy, come home soon!"
.

Back in Seattle we have an opportunity to share our experiences with friends and colleagues...and we do!
We think Global Volunteering is for everyone!

On our last day in Kenya last year, I found the small red soapstone heart at a store. I bought it right away, it  felt like I was leaving a little part of my heart behind. This year, at the souvenir shop at the airport I saw another one.
What if I had one for every time I thought about our Kabongo kids ...
 Could there ever be enough windowsills for all of the hearts?

     I hope you enjoyed this trip as much as we did!
                      Here's a really great idea-
       Why don't YOU think about Global Volunteering?

For those who may want to read our "Volunteering in Kenya Trip 2012", you can find the blog by clicking on "About Me", underneath "Complete Profile" on the right side of our main blog page...or.... at
                    http://dtpit12.blogspot.com
                           See you in 2014!
                            Mara and David 

Kabongo - feelin' the love-

   Those of you who followed our journey to Kenya last year may recall that while on an outreach trip with an HIV/AIDS program, our van stopped in a dusty country area called Kabongo, in search of a patient who had missed an appointment. I stepped out to speak to a young girl washing clothes by the side of the road, asking why she was not in school. Though she spoke little English, she told me her parents had died and she had been sent to live with first one grandmother, and now another. This grandmother grew maize and millet on a small plot nearby and had no money for the mandatory school transfer fee, books, shoes and uniforms. By the end of the afternoon, I had enrolled my new little friend Veronicah in a private school just ½ km. from her house and taken her shopping for all her school needs. The next morning at 7AM Grandma walked her to the school gates; she had freshly sharpened pencils in hand and was ready to learn.

  Three days later on our last day in Kenya, I decided to stop by Veronicah’s dirt home to say goodby. Much to my surprise, more children greeted me in the dark room (they have no electricity or water).Veronicah had 3 siblings! The oldest Sharon (approx. 13) had been sent away to work as a domestic for 2 years, her brother Kelvin (12) had worked the fields with Grandma and young Moses (8) had stayed with an uncle and had not attended school. We enrolled them all in the Patrician School with a supplemental 2x daily meal program, hired a tutor to teach them English (unlike Ethiopia, all classes are taught only in English, and they spoke only Kiswahili), signed them up for Scouting, bought 2 solar lamps for evening study and a phone for Grandma.
                                       

First day at the Patrician School with Brother Paul in their new uniforms.
Spring 2012

                                   
     Since that time we have called them every month and we speak to all the children. We also write letters to them and they all write back. We have helped Grandma purchase fertilizer so her crop yields have improved, thereby providing her with more food to feed the family. It has been a long and glorious year, filled with a tremendous amount of hard-work (nothing happens easily in Africa).

    None of this could have ever happened without the diligence and dedication of our dear friend Carolyne Mabeya, wife of western Kenya’s only fistula surgeon, Dr. Hillary Mabeya. Carolyne was a tireless advocate for managing the needs of this family and supporting our efforts to give these kids an opportunity to succeed. We have kept in weekly contact and Carolyne helps us resolve thorny issues about class levels, birth certificates and tutoring.

   I was very excited as I watched our plane touch down in Eldoret, Kenya. And there to greet us was our dear, dear friend and “Bro of all bro’s” Brother Paul, founder of the Patrician School.

  It had been just over one year since I had seen these friends, and I had missed them all so much. I could hardly wait to hug each and every one of them. I let my heart spill freely into theirs-

First stop Patrician :School and a meeting with the teachers. From left are Kelvin, Moses, Sharon,
and Veronicah. Grandma Jane is at the far right.

Sharon loves her new American Nikes!

New shoes for everyone...those hot pink ones are for Grandma Jane!

                                             

Brother Paul (on left, oh please, that's my DAVID on the right!) met us at the airport and toodled us around in his absolutely essential 4-wheel drive. Rainy season was starting and roads were troughs of mud.

Toys, of course!!! We brought lots of toys! and books and flash cards and puzzles and clothes!
 

New googles and swim suits for everyone!

Veronicah does a little jig in her new "dancing" shoes!

Swim day/Fun day at the pool. We enrolled the kids in weekly swimming lessons

Dinner with our dear friends the Mabeyas at their home.

David gleefully meets a greatly admired Kenyan runner:
 Kip Keino, World record holder and Olympic Champion
***************************
Below are 3 very short videos:
1. Kelvin and Veronicah showing how they march at Scout meetings
2. Fun day at the pool, diving for coins
3.Kelvin reading.
4. Moses reciting his ABC's. He is now in pre-school and will start 1st grade next January, just several months shy of his 9th birthday. Unfortunately he had no schooling prior to this, so we started him with private tutoring. He is a smart little guy, admires his older siblings and we hope, will catch up quickly.

 

 

 

                                                                                

Little things mean a lot...

“Ethiopia” comes from the words “artho” meaning “I burn” and “ops” meaning “faces”. It is the “Land of scorched faces”, aptly so.

 We saw many scorched faces; scorched by the relentless sun that burns 13 months of the year (more about that later).

Yes, scorched...but more like burned. Burned by the apathy of government that seems to put its own people at such a low priority. Burned by the wilt and drift and resignation of good souls who try to hold on to any vestige of dignity in such poverty and hopelessness in their daily lives.

   Since our time with Rick Hodes, he sends David his latest cases, perhaps a couple a week, seeking new opinions or some viable options for the beleaguered youth he sees in his clinic. Just yesterday David received a new file with x-rays belonging to Melaku, an 18 year old shoe-shine street kid with a terrible tumor. What’s to be done? or in truth: Can anything be done? Already his lungs are full of metastasis. How do you give hope to an 18 year old orphan with a deadly disease? I'll tell you more in my next post.

    Our 2 weeks in Ethiopia had many “hiccups”: power outages, internet frustrations, non-functioning Ethiopian telephones, basic food finding, transportation, etc. Nothing was easy. In fact, we mused that it always seemed to take much longer to “prepare” to do something, than it took to “do” the actual deed. As I see it, most of this could be rectified with a collective mentality of “follow-thru”, which seems to be so lacking. I was brought up that if I take on an assignment, I complete it intoto and then I get to “check it off my list”. Now, doesn’t that just feel SO good?!  We sensed a cultural disconnect with this kind of thought process: the undertaking of a task, then working the series of steps to its completion. Frequently, we were left waiting and wondering and hoping that some basic and not too complicated dilemma would be seen to its conclusion. It rarely was, without our intervention, and prodding.

   Much to my surprise and joy, David found the medical residents to be smart and truly on their game. They will soon be fine neurosurgeons. Let’s hope some are willing to stay and raise the quality of life for their fellow Ethiopians.

   We also found the people to be very kindly. We never felt scared or threatened, even when walking on the streets in the evening. Small change could be dropped on a ragged cloth near a blind man or in a pan next to a crippled child; there was no aggression. Perhaps their voices had been silenced over the years since nobody ever seemed to listen anyway.

   We had endless frustration with connectivity and sought help from the I.T.(Internet Technology) Dept.in an adjacent building. The instructor acknowledged that he also didn’t have connectivity there but offered to accompany us to the veranda at the hospital.  Much to my surprise he made an announcement in Amharic to the 40-50 students (using jumpdrives) on the classroom's computers, then abruptly locked the barred entry doors, leaving everyone locked in without any escape exit. I was horrified and immediately exclaimed: “You can’t do that! What if there’s an emergency?!!” “Of course I can!” he responded, “I do it all the time; that’s the only way we can guarantee security of our equipment”.How can we understand such values?

    We prepared to leave Ethiopia, but not Africa. We still had one very important visit – 4 days in Kenya and a chance to see our dear friends, the Mabeyas  and our adopted “family”. Ethiopia had been the main course, the substance, the meat and potatoes of our trip, but now we were ready for dessert…and how insanely delicious that would be!

       It’s time to visit Kabongo!

      Sharon! Kelvin! Veronicah! Moses! Grandma Jane!

How are you, my darling Sweetcakes???? Here we come!!!!!

One of many slum areas. The government is razing these on 3-day notice. Those with deed for actual plot are eligible for low-interest condo loans. Those without, remain without.

Condos under construction. They provide jobs for Ethiopians and housing for middle class.Those who can afford to pre-buy, get to choose their own kitchen colors!!

A mom and 2 young boys live in this dwelling on the main sidewalk from the hospital to downtown.They keep their puppy safe on a leash. In the evening the boys often sit on low stools and play checkers. When I spoke to the older one, he responded in excellent English and was well-dressed, obviously attending school. 

Having grown up in the teeny-tiny town of Stowe Vermont, I was thrilled to find the breadth of knowledge this young man had about it. "Yes", he exclaimed, "I know all Stowe. It is a place in Utah". He had mistaken the "VT" for "UT".

An Ethiopian watch. They keep time according to the Ethiopian-Coptic calendar (not the Gregorian, like most of the rest of the world). Each month has 30 days, and a few extra are added to create a partial 13 month. All days start at sunrise, and one hour later is 1AM . This causes many difficulties since the hospital uses the Gregorian and the University, and many  ancillary medical depts. use the Coptic. When David asked for a more recent set of scans on a clinic patient, he was told the ones in his hand had been taken the previous week, even though dated Sept. 2005.

What to do with that "extra" month? Make it a tourist attraction!!!!!

                                           

Coffin sellers, usually located across the street from hospitals.

I enjoyed this juxtaposition of two worlds: a cell phone tower including dishes for multi-station TV viewing, and construction of a building using archaic and highly dangerous hand-lashed scaffolding. (OSHA, are you there?)

                                        
                                       

                                        

"But it's the truth, even if it didn't happen!" (Ken Kesey)

    Our 2 weeks in Addis were slowing coming to an end but there was still one more important place I wanted to visit: Emanuel Mental Hospital. When I asked about it, I was told just to “go ahead over there and see for yourself”. That was not how I envisioned a mental hospital to be run. I wanted to have a chance to speak with someone who could tell me more about it so I made an appointment with Dr. Samia.

    Upon arriving, the gateman readily let me in but warned me that pictures were not allowed. His assistant led me in search of Dr. Samia’s office, no easy feat, since the complex was a series of multiple low buildings, some attached, some semi-attached via parapet and others fully detached yet very close in; all at different angles from one another and in a hopeless jumbled maze . I followed my guide as we wandered from one area to another. I was struck by the vast throng of people everywhere, it was like the inside of a Wal-Mart on sale day only some folks wore orange clothing, others were in non-descript neutrals or black. I felt myself to be part of a “stream".  There was a mass of people moving with me but I fought for walkway with an equal sized stream flowing against me. I followed my guide thru narrow corridors, then outside on cracked sidewalks and then up and down stairways. He looked back from time to time to confirm I was still keeping pace and I gave him a scant nod thru the sea of blank faces. Suddenly a pair of hands emerged from nowhere and rose up, poised to encircle my throat in a choke hold. Mere inches from me was a wide eyed toothless woman laughing at me. As quickly as her hands momentarily started to tighten on my neck, they disappeared again and the woman faded behind me in the fleshy flow. It was disconcerting. I felt like I was on the set of Munch’s “Scream” and hastened to catch up.

    When I finally did connect with Dr. Samia, she told me about Emanuel Hospital, Ethiopia’s only public residential mental hospital. For the past 25 years it has housed 250 patients, with some wards having as many as 40 beds. They recently received a very fine donation of orange pajamas and now have enough clothing for the majority of the residents. The staff is pleased about this, as they find it quite difficult to distinguish the patients from the visitors, of whom there are always so many.
    Emanuel Hospital also allocates 14 beds as an outpatient facility but in truth, it seems to be more of a 10-day “holding” area, after which time the patient is either sent home with appropriate medicine, admitted if a bed is available or, if no bed is available at that time, told to return at a future date. During the 10-day outpatient (inpatient, actually) stay, the patients are involved in group therapy sessions and interviewed by case “teams” to assess their level of sanity. Dr. Samia said there is a great stigma in Ethiopia and patients are brought in at the last moment by family members, often in a flagrant state of profound mental illness.

   In terms of treatment, everyone is uniformly dosed with haloperidol 1.5mg  and chlorpromazine 25-50mg. daily. When I asked her about “talk therapy”, she said that each patient has a meeting 2x week with a health care team which includes either a psychiatrist or medical resident, nurse, social worker, OT and aides during which they discuss meds, progress and planning. I restated my question about talk therapy, defining it as a 50 min session, one-on-one with a psychiatrist, as a probative tool for understanding the basic pathology of the illness. No, she said, we don’t have that.

   Residents who have a “poor” card are admitted and receive their care free of charge. Those without this documentation pay a total of 200-500 birr ($11 - $27) for a 1-3 month stay. Recently a small private psychiatric hospital has opened in town, the only one of its kind in Ethiopia. It has 20 beds and the charge is 300 birr ($16) daily, which includes all treatment and meds.

   Dr. Samia showed me different wards around the hospital compound, most of them empty of any patients; easy to see why…they were all "on the move"! By now we had a small coterie of followers standing very, very close to us as we conversed; some in orange pajamas, some not. We seemed to all move together as a wave or a swirl. When we walked, they walked; when we stopped, they stopped. Dr. Samia must have been used to it; she paid them little attention, and shooed them away only when they touched us.This was not unfamiliar to me from my  nursing days on the psyche floor: vacant stares, word salad, self-stim, tremors; and those sitting cross-legged against the walls were trapped in hallucinations, incoherent babble or profound withdrawal. It was just a real busy sort of place.

    I asked how they managed patients in extreme mania and she matter-of-factly stated “we chain them to the bed”. She added that there was one patient chained up at this time. They had attempted to let him mingle among the general population but because of his bi-polar state and overt homosexual tendencies, he was found to “bother” the other patients and chaining was the best option.

   By now we had made a series of loops around the facility and we were finishing up at the Occupational Therapy dept. which had 5 sewing machines, a loom for weaving and a cupboard full of yarns. The staff members greeted me as they worked on their own sewing, weaving and knitting projects. Where are the patients? I asked. “they come and go”. At this time, they apparently had all gone.

   What is the biggest problem you face here? I asked Dr. Samia. I had expected her to comment about the tight quarters, the dilapidated state of the buildings or the lack of true psychiatric intervention. “Wander off”, she said, “our patients tend to wander off. At least now, with the orange pj’s they’re easier to spot in the Mercado (market).”

   I thanked Dr. Samira for the time she spent with me but in truth, she hadn’t seemed to be very busy. She is an internist who was assigned to Emanuel for a couple years as “pay-back” for her education. She only sees patients who are admitted with secondary medical concerns. She had been called to assess a hot abdomen the night before but that had resolved itself by morning. She said there are more psychiatrists than ever in Ethiopia, the count is now around 40.
  When I remarked about the hopeless/homeless “sleepers” I see on the sidewalks of the city at all times of the day or night, she said that “khat”, a chewable vegetation that provides a cheap euphoric state, is very popular among the street people. It is also flown out daily on 747’s from Ethiopia to Djibouti, the Netherlands and the UK where it is legal.

   Dr. Samia arranged my transport back to town with a nurse who was ending her shift. We headed out to the Mercado where we did a little shopping. I kept my eyes peeled in case I caught sight of a pair of orange pj’s wandering off. Then I caught a mini-shuttle for 1 birr (5 cents) that dropped me off at the gates to the Black Lion. It felt good to be back home.
                                         

Entrance to Emanuel Mental Hospital

My "shuttle-buddies". Mini-busses are privately owned but routes are given by the government.
They are always packed, noisy and have no schedule. The more often the bus owner comes around, the more
money he makes.Charge is 1 birr (5cents)

                                     

A busy street in the main market area


Below is a short street video I took at at the Mercado, the largest open-air market in Africa.
Click on the arrow in the middle of the picture.

                                               

                                              

Quality Care at a High Price

  There is a saying one hears in Africa: “If you educate a man, you educate a man. But if you educate a woman, you educate a generation”. I think this is precisely what the Mother and Child Rehabilitation Center (MCRC) is intending to do; to educate a new generation.

  The MCRC (www.mcrc-addisababa.org ) was founded by Jutta De Muynck who had moved to Addis with her businessman husband in 2002. She had been a teacher for 25 years in Germany, working primarily with children who had suffered  social, psychological or medical trauma. Her heart went out to the many homeless children and she opened up her home' turning her garage into a classroom, then building dormitories until there was no more room. When she counted 64 children living with her, she knew she needed to make other arrangements. She requested NGO (non-government organization) status and received a large tract of land from her husband’s company on which she built her center.

   Upon entering the expansive facility I heard a boom box hammering out  “Zumba” style exercise music and saw a dozen or more little kids whipping thru jumping jacks, somersaults, backbends and push-ups.The air of utter happiness was infective and I quickly shed my sweater and joined in with the young Ethiopian “coach”. By the time I had worked up a good sweat and been thoroughly outdone by this pack of 4-6 year olds, Jutta invited me into her office.

  At this time she houses 80 orphans (20 of whom are HIV+/AIDS) 40-45 mothers plus their children/infants, as well as the 12-14 kids who still reside at her own home (total count: approx.200). She spoke at length about the difficulties in establishing and maintaining such an ambitious project but she is clearly dedicated to this cause and has made it her life’s work.
   All the children are driven to private schools with a warm breakfast in their tummies and a bagged lunch in their hand. They return at 4PM for snacks, tutoring and a hot evening meal before its time for “lights out”. She works hard at the re-unification of families, and has set up 28 mothers and babies in small individual furnished apartments while her foundation teaches the dad a profitable trade so that he can eventually assume responsibility for his family.

   In 2011 the Ethiopian government closed down its orphanages and halted almost all adoptions due to reports of child-trafficking and baby-selling. Jutta is very circumspect and suspicious of those around her (including me, she freely admitted), almost to a point of paranoia, thinking anyone could be a government “spy”. She maintains immaculate record-keeping and is always prepared for the week long bureaucratic audits that take place every 4 months. She states that the  government assumes all NGO’s harbor a secret political agenda and would have no qualms about closing them all down, regardless of the fine work they do for the Ethiopian people.

    All children/moms who come to her must have a “poverty” card, issued by the government to certify they are truly destitute and without any means. That is one of the conditions under which she is forced to operate (ie, making it almost impossible to bring in street children) and failure to do so would close her establishment. I think many of her residents live here for years. She provides an astounding array of services besides free room and board: 13 teachers/physio-therapists, 3 nurses, 2x weekly visits by a pediatrician, all medical care including private hospitalization for staff and residents, job training, parenting classes and music, craft and exercise sessions. Her facility is spotless, modern and functions superbly.

    However, all this comes at a very high cost. Her monthly budget, funded by corporate donations as well as the Rotary Club and the U.N. Population Fund is an astronomical 20,000 Euros ($26,000) a month. I repeated that figure to her just to make sure I had heard it correctly.

    Another major concern she has is staff retention. She said that to find Ethiopian people who are literate and qualified is very difficult, and not infrequently one NGO will “poach” staff from another, offering higher wages and better conditions. She is required by law to pay taxes and retirement benefits to the government on all of her employees, and since she actually “pays” most of the women living off-site to come in for parenting and job-training classes, they must also be included in her payroll taxes. I asked her why she needs to “pay” these women when she provides them with such unimaginable benefits. She replies that they are illiterate and don't understand the value of investing in their family.
    Her focus is on the child and she clearly states that whatever it takes to raise a new generation of strong, healthy and educated children, it is worth it. She said she currently has enough funding for the next several months, which is the way it usually is, but more money always seems to come thru just in time.
     I'd say she's been pretty lucky so far-                               

                                              

The charming office building, one of many quite similar that
house classrooms, dormitories, infirmary, dining areas, nursery, craft areas, music rooms etc.

Toddler play-time session. Children are always supervised by therapists but moms participate
 to encourage bonding.Children are  well-clothed, well-fed and clean, as are all the residents.

Sewing class where moms learn tailoring skills as a future livelihood.

The pristine nursery where order and tideness reign. All personal hygiene area
were sparkling and immaculate.

Lunch time  for many happy toddlers. Older children are sent to private schools, the younger
ones are taught by certified teachers on premise.

                                           

Aerobics class, 30 minutes daily. The kids love every moment and are loaded with energy.
Note the kind donation of T-shirts from Germany.


**************************************************************************







 

 

The Match-up between the Two Big Boys

There are about 20 hospitals in Addis Ababa, 10 are private and 10 are public. Some are quite small and their only locator may be a small wooden sign with a directional arrow nailed onto a neighboring fence. But when you talk about “hospital-heavy weights” there are only two: The Black Lion, where David and I had already been for a week, and the Korean Hospital, close to the airport. I was anxious to answer that old 4^th grade essay question: “Compare and contrast…”

  One early weekday morning I got my chance. We had been invited to make AM rounds with the neurosurgeons at the Korean and we reported to duty at 8. We knew several of the neurosurgical residents who were now cycling thru their 2-3 month rotation, and we met Dr. Kim Hun-Joo, the chief neurosurgeon. Just walking into the hospital was an entirely different experience than what I had known at the Black Lion: we were greeted with sparkling pale tiled floors and shiney white walls, clearly marked signs for various departments, wide open halls with comfortable, modern (and matching!) chairs for admissions, bill pay, administration etc. It looked like a “real” hospital, the kind I had worked in for years!

  We headed up to ICU and joined a small conclave of white lab coats conferring over a patient. The equipment was all new, the bedding fresh and clean with turn sheets, matching spreads and pillows; the medical apparatus needed by the patient (suction, O2, IV’s) hung on appropriate hooks or stands in its own designated location. Everything was as it should be. I felt I could just put on my little nurse's cap and get to work.

    The Korean Hospital in Addis has 200 beds and is supported by donations thru a private Christian church in Korea as well as fee-for-service. Like many hospitals in 3^rd World countries, they count on visiting doctors to handle almost everything but the simplest of surgeries, and looking at this throng of doctors, I struggled to ascertain who actually belonged here vs. who was here on rotation or as a visiting physician. Dr. Safi, a delightful retired neurosurgeon from Pakistan who rounded with us, stated that he comes regularly for 2 or 3 months at a time and has been doing so for years. He said that besides himself, there was one full-time retired Ethiopian doctor who coordinated all the activity for the neurosurgery department. The other 2 Korean neurosurgeons we had met would come for a week or 10 days, then return to Korea for several months and then come back again to Addis. There had been times when no neurosurgeon was “in house” and emergency cases were sent to other hospitals or even out of the country.
    As is the common practice here, when a hospital knows a physician with a certain specialty will be visiting, they admit all the patients awaiting that particular surgery and blitzo them thru while the doctor is in town. Neurosurgery had been one of those difficult specialties to staff since the one and only program in Ethiopia was started just 6 years ago at the U. of Addis. (Also in the pipeline are a pediatric surgery and a cardio-thoracic program, but it may be several more years before they graduate their first class).

   An Ethiopian physician told me that doctors at the government hospitals earn approx 2500 birr ($135) monthly, while doctors at the Korean earn 8000-10000 birr ($432 - $540) to start. Many Ethiopian doctors, once they have completed their specialty training are eager to leave the country and practice elsewhere; and conversely, for obvious reasons of poverty and life style, many foreign nationals have little interest in coming to Ethiopia to work on a full time basis.

  For the most part, the Korean Hospital is able to get whatever supplies it needs though it still occasionally finds itself at the mercy of customs agents. Not only did it have a medical treasure-trove of pedicle screws and plates (of which Black Lion has none, zilch, nada) but their basic hospital infrastructure was far superior, enabling them to take on more complicated surgeries. The Black Lion has 6 ICU beds and only 2 (!!!!) ventilators, the Korean Hospital has 8 ICU beds and FIVE ventilators. Several times during our 2 week visit, necessary surgeries at the Black Lion were cancelled or postponed  because no ventilator was available for post-op care. The Korean Hospital will occasionally take a transfer from the Black Lion as a “charity” case, but this requires some serious  pleading and arm-twisting. They say they allocate 10% of their funding toward such charity cases.

  Regardless of the facilities found at either hospital, Ethiopia presents with its own host of problems that will always challenge even the most advanced health care system. Here are a few that come to mind:
1) Ethiopians, on the whole, tend to be poor and destitute. Its culture has been poverty-ridden, and though there are the few highly ambitious individuals who refuse to stagnate in its yoke, it must be said that job opportunities are minimal, education is not equal for all and the citizens get little support from their government. Unemployment in the urban areas is over 20% and Ethiopia remains one of the poorest countries in the world, ranking 169 out of 177 countries measured on the United Nations Development Index. The latest figures from 2008 show that Ethiopia spends just $16. per person per year for health care. By comparison, here in America we spend $8233 per person per year.

2) Secondary to the above mentioned poverty is an array of medical conditions that follow in its wake. Hydrocephalus, scoliosis and juvenile heart conditions (rheumatic fever, congenital heart /valve disease) are often not diagnosed until the disease has made a significant impact on its victim.  A diet lacking folic acid (routinely given in pill form in America to all wanna-be-moms) is known to cause neural tube defects which often are life-threatening, or seriously debilitating. Asthma in infants is common, the air is polluted from exhaust and dirt. It was not unusual to see a woman walking the rush hour traffic line, baring her breast as she nurses her infant and asks for change. Crippled adults and children with maimed extremities are seen standing, lying or begging on every street, often the result of birth defects, car accidents, or just walking on any sidewalk and falling into a hole 6 to 10 feet deep, with no planks, barriers or cones to indicate this danger. (We never walked after sunset without a flashlight to light our way.)

3) For a reason no one is able to explain, there is not an adequate blood banking system. Relatives don’t want to donate blood, nor does anyone else. Heart surgeries requiring several units may languish for weeks or months until blood becomes available.

4) No rehabilitation or nursing home care. For the poor souls (of whom we saw plenty) who perhaps had been involved in a terrible accident (tree-chopping, scaffolding collapse, concrete block falling, mangling under car tires) hospitals have no option but to eventually send them home. Not atypical was that the families would mimic the care they saw in the hospital but then be unable to maintain it at home, and the patient dies soon after.

5) Infection rate, not good. A doctor we rounded with at the Korean Hospital was willing to peg the post-op infection rate at 40% and he was baffled by this. Clearly, an inservice on sterile technique is one that bears very frequent repeating.

  On a positive note, the Black Lion is installing a new Tesla 1.5 MR imaging machine which should be free for its patients (current cost of CT in private hospital $40, more than most can afford). It is also in the midst of completely remodeling an old ward and creating a new and modern ICU with 20 beds and almost as many ventilators. It is expected to be completed at the end of 2013. This will allow the Black Lion to do aneurysms, skull base and instrumented spine surgeries which must now be sent out, that is if they can ever get their hands on those %#$&! screws and plates and microscopes....

                                              

Bright and well-lit hallways at the Korean Hospital

                                              



Waiting areas at the Korean were clean and had plenty of chairs for all



ICU - modern electric beds, curtains for privacy, clocks that actually worked.
 Nursing staff made rounds with the doctors

                                             

A dad loving up his very sick young son. Hydrocephalus is a major problem and
if not corrected early by shunts, will lead to brain damage and death.