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 4th 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 3rd 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).
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.
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....
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| Bright and well-lit hallways at the Korean Hospital |
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| Waiting areas at the Korean were clean and had plenty of chairs for all |
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| ICU - modern electric beds, curtains for privacy, clocks that actually worked. Nursing staff made rounds with the doctors |
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| 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. |
