A major problem of which we had been made aware of beforehand, is the obtaining and maintaining of essential operating room equipment. The cord and hand piece of a new Stryker electric drill donated by a Norwegian surgeon were lost shortly after delivery, rendering the entire unit inoperable. A new ultra-sonic aspirator is missing its foot pedal, misplaced by central supply. No one assumes responsibility for this shoddy management of over $100,000 worth of state of the art donated equipment. We trust and assume they will make good use of the supplies we brought with us.
At this time, the Black Lion has no working power drill, so all burr holes and craniotomies must be done by hand, something that has not been done in America for over 40 years. An entire day of surgery was cancelled when the one and only autoclave broke down. The waiting list for certain skull base surgeries is long due to having only 2 ventilators and 6 ICU beds for the entire 400 bed hospital. Equally frustrating is the lack of spine fixation hardware (pins/plates/pedicle screws) - these items are just not available and patients often lay flat in bed in traction for weeks, hoping for "natural" healing.
On the plus side, this is a young neurosurgical program with a total of 20 neurosurgery residents. At the end of this year 4 of the residents will complete their residency.
The government is working hard to create more doctors for its people. It sponsors free education to those who qualify and accepts 300 new medical students every year. In return, they are obligated to spend 2-3 years working in a remote part of Ethiopia or 4-5 years in Addis (as assigned by lottery, not by choice). At the completion of this "stint", the government will hand them their M.D.diploma.Ethiopia has 85 million inhabitants and up until 6 years ago, there were only 2 neurosurgeons in the entire country. Now there are 3 at the Black Lion Hospital and 2 at the Korean Hospital and this year 4 more will graduate. It's a tough world out there.
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| David's clinic day. Patients usually arrive with their own scans/x-rays. There is no appointment time, they just wait, filling up every bench and hallway until they can be seen. |
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| There is always family around, and they all come into the examining room, or stand by the open door if they don't all fit inside. |
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| A neurosurgery resident examines a patient's reflexes. Progress notes are scribed by hand. The doctor's desk doubles as an exam table. Patients do not change into gowns, and doctors do not leave the room -patients just cycle in/out. |
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| David discusses his findings of a scan with 2 residents as the patient puts his shoes on. The rooms are small, perhaps 10'x10'. Most have a small sink with a single cold water tap for hand washing, but no soap or towel. |
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| Waiting area at the Emergency entrance. There are always people here. |
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| Emergency room, busy, noisy, chaotic. Beds do not have sheets, family brings their own bedding. No side rails either, the family stands close by to manage the patient and takes care of his needs. If by chance a patient is left unattended, the bed is pushed into another, so the patient would roll into another patient rather than fall off the gurney . |
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| David at radiology rounds. View boxes are finally operational in the OR, prior to this x-rays were taped to the windows for viewing. ***************************************************************************
Greetings friends and family,
David and I just returned from an amazing trip to Ethiopia. We’re so tired but quite thrilled at the same time. It was wonderful and we’re delighted to share it with you!
Unfortunately, our internet connections was abysmal. We were only able to get on line the first several days and then connectivity virtually stopped. A day later in the global Herald Tribune we read that a Dutch company “Cyberbunker” had been blacklisted as a spammer by Spamhaus, an international “watchdog”. In retaliation Cyberbunker responded with an unprecedented avalanche of spam, causing wide-spread jamming of computers around the world. Cyberbunker bragged that it had initiated “one of the largest DDoS (Distributed Denial of Service) attacks in the history of the internet”, 5 times as large as what was recently seen against major American banks. We stopped trying to connect. Aznallehu! (Amharic for “sorry”)
We have picked up our blog again and will continue writing for another week or so. We will let you know when we complete the final post.
Dave and Mara
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