Catherine Hamlin Fistula Center/ An Ethiopian Oasis

  The Hamlin Fistula Hospital is well known in Ethiopia. I had first learned of it last year in Kenya when I spent time with Dr. Hillary Mabeya in Eldoret.

     Fistula: a narrow passage or duct formed by disease or injury; an abnormal opening between one hollow organ or cavity to another.

   Medical people in America know about obstetric fistula, even though they are practically non-existent here thanks to timely Caesarian sections.

   For the 3 million sub-Saharan African women with inadequate medical care, obstetric fistula is a life-changing situation. It is estimated there are between 50,000 to 100,000 new cases every year and pitifully few doctors willing to treat it. It is the “by-product” of an uneducated culture firmly rooted in its traditions and maintained thru relentless poverty. Young girls are married off early, often by 14, so as to assure their virginity for a suitable marriage partner. They are frequently treated as second class citizens (domestic violence is not uncommon) and they are prized for their ability to procreate. Far removed from medical facilities and with no prenatal care, it is not unusual for these very young women to be in labor for several days, frequently resulting in death of the fetus. The prolonged  and unrelenting pressure of the infant’s head in the birth canal cuts off blood flow to the wall between the bladder and the vagina (or rectum, or both, in some cases), leading to tissue death. This tissue death leads to erosion with “holes” (fistulas) to the neighboring organs. Vesicovaginal fistula is an opening between the vagina and the bladder that allows the continuous and involuntary discharge of urine into the vagina, from where it flows freely out of the body. Rectovaginal fistula, occurring in 20% of the cases, is bowel incontinence thru the vagina. Some women may have both bladder and rectal fistula. With subsequent childbirth, these fistulas often enlarge and get infected. Without treatment, this leads to weakness, cachexia and possible death.

   The psychological toll almost defies description. Imagine being an adolescent girl in such an appalling situation! They often restrict liquids and food to decrease the seepage, resulting in marked malnourishment and kidney disease. They are shunned by their husbands who frequently leave them, and their own family members view them as offensive. It is not unusual for them to be sequestered in small outlying huts with limited personal contact. They are so poor that they use whatever rags they can find to absorb the soiling, then wash, reuse, wash, reuse.  Eventually they may present to the fistula hospital with extreme leg contractures /foot drop from having spent months, even years curled up in a ball, thinking, erroneously, that this would encourage healing. It is estimated that 500,000 women die every year due to fistula and its complications.

      The Hamlin Fistula Hospital was founded by Australian born obstetricians and gynecologists Reginald Hamlin and his wife Catherine in 1974 in Addis Ababa. While treating a broad range of obstetric situations they set their focus on fistula repair and perfected a surgical technique with a high success rate. Their hospital has continued to grow, thanks to generous funding by private donors as well as World Vision, Ethiopia Aid and the Fistula Foundation in Santa Clara, CA.

Catherine Hamlin, a very, very wonderful woman

   Today the Fistula Hospital can accommodate 140 patients, has 4 operating rooms and 3 physicians. It has also created 5 birth centers in outlying areas, each with its own doctor. In 2006 it established the School of Midwifery with the intent of training midwives to manage difficult births in the countryside. Each midwife commits to 5 years of this work upon certification from the program.

     In 2004 Catherine Hamlin appeared on the Oprah Winfrey Show to discuss her 50 years of service to the women who suffer with fistula and the 25,000 surgical repairs that were done at her center, all at no cost to the patients. In 2005, so impressed with Dr. Hamlin’s actions, Oprah visited her hospital in Addis and taped a second segment, which elicited an outpouring of donations from her many fans; enough to add a new wing and classrooms.

   I had made an appointment to visit and was invited to come by in the early morning, outside of the regular “touring hours”. I approached the main station and saw Catherine Hamlin in a lab coat and white skirt, starting to gather the nurses around her. After a quick introduction, she asked me to sit down beside her. She did a short Bible reading and then spoke from the heart, out loud, in Morning Prayer. She asked for divine help in healing the women of her beloved Ethiopia, that they be given strength to endure the hardships and that their children may come to know an even better life than the ones their mothers have. After an “Amen” the nurses dispersed to attend to the 40 post-op beds and 8 recovery beds in the large ward. Catherine started to chat with me at length about her life. I felt very honored that she made herself so available for conversation.

   She and her husband Reginald had leased then bought the original multi-acre site for their hospital. After being donated a neighboring lot, they expanded the center to include a state -of-the-art physical therapy dept. (tunturi bicycles, treadmills, weights, etc), a counseling office, occupational workshop with knitting, sewing and weaving, a large dining hall and a teaching center with classrooms for education and nurses-aide training. After half an hour, she asked Sister Yalemtshaye (Ethiopian for “Sunshine”) to show me around. The entire compound was the epitome of charm thanks to Catherine’s  great love of flowers, and roses in particular. It was like a lush tropical resort. I watched gardeners gently plucking faded blooms off verdant shrubs as we walked on stony paths from one small building to another, all laid out with that element of surprise: what will I see around this next corner? The main office was a large tiki-style hut with a thatched roof. The hospital wing was clean and sparkling and fresh with windows open to the sunshine. I could hear gentle subdued voices in the distance but they only enhanced the feeling of being in a private area. Sister Sunshine took me to the kitchen where 8 Ethiopian ladies were starting to prepare lunch. She handed me a warm yeast bun straight from the oven rack and poured me some tea (for which Ethiopia is famous). Sister Sunshine had worked here almost 40 years and would be retiring soon; she wasn't sure what she would do with her free time.

   Catherine had trained some of her fistula –survivors to become nurses aides; this was their first opportunity for employment (since most are illiterate, they cannot be certified by the state).
   A disturbing complication that was being seen more frequently was girls coming in with cut ureters, post- C-section . She said it was due to new young doctors being careless with their scalpels...pardon me? These are tricky to repair, said Sister Sunshine.

                                                            

A delightful day with Catherine Hamlin and Sister "Sunshine".
I purchased a hand woven basket sold in their
small handicraft store. All proceeds go directly to the patient who created it.

Tegbareed Technical College - there's hope after all!

   I had audited classes at 3 schools ( St. Francis Primary School, Tikur Abessa Secondary School, the Cathedral Secondary School) and was  unimpressed with all of them, though years before they had produced some of the fine young neurosurgical residents David encountered in the program. The students in the classrooms I had visited seemed disinterested and the teachers were not in control. Education in Ethiopia is based on the 8+2+2 system; that is, 8 years of primary school, 2 years of lower secondary school and 2 years of higher secondary school. Prior to 1974 the illiteracy rate was over 90% so there had been some serious catching up to do. Currently it is estimated to be at 42%.

     10^th grade seems to be the most crucial as that is when the grades on state exams dictate whether a student attends a secondary school geared toward a profession or, if he/she joins the blue collar/tech field. I was anxious to find out if the “professional-oriented” but disinterested students I had seen were the norm or if there were another specie of student among Ethiopia’s youth

  I set up a meeting with the Dean of the Tegbareed Technical College in downtown Addis. It was built in 1942 and appears like a fortress with massive archaic dark metal entry gates. Behind these are concrete walls and buildings. It looked like a Beirut war zone with scattered broken cinder blocks, torn up tree trunks and dirt piles strewn around the large open courtyard. Many of the school's 1,000 students were in motion. Break time was almost over and they were heading in to class. 

  I was introduced to Immanuel, a young and lean overgrown kid who seemed the same age as most of his students; and he probably was.  Immanuel was everything the other teachers I had met, were not. He was energetic, knew his subject well and truly loved it. He felt the sense of responsibility every good teacher knows (or parent, or nurse) and that is: “My task is to teach this child/young person what they need to know to make it in this world. If they don’t succeed, then I have not done a good job”.

  I chose his class because he was teaching “Bio-Medical Equipment Repair”, which is a very serious problem we encountered at the Black Lion Hospital. During our visit, one full day of surgery was cancelled due to a non-functioning autoclave, their one and only electric drill from Stryker had been broken for months and their very snazzy donated ultrasonic aspirator had “lost” its foot pedal, thus rendering it useless. Such conditions are absolutely unheard of in 3^rd world countries, where items would be immediately repaired and returned to service. Yet no one seemed to be able to fix things around here and this was having a tremendous impact on the modernization of health care, and certainly other industries as well.

   The class was entirely foreign to me; not just because it was lead in Amharic but also because it dealt with transistors, transmitters and diodes...whatever... After a short presentation by Immanuel, the students came forward, one by one, to explain various principles and illustrate them on the blackboard. If there were any talking among the students, Immanuel immediately clapped his hands to show his disapproval and all was quiet again. There were 50 students in the class, each had Xerox handouts (texts were too pricey) and wore maroon lab coats. I stayed after class to chat with Immanuel.

  He told me he had been a teacher for only 8 months, having just graduated the year before from this same college. Immanuel would very much like to continue his studies and obtain an electrical engineering degree at the University but since he is now needed as a teacher, he must work for 2 years before being eligible for applying. The average salary for a graduate who will work at a hospital is 1600 birr a month ($84) while those with an electrical engineering degree make 2500 birr ($135). As a teacher, it is unlikely he will get any raises. As a point of comparison, Ethiopian food is very inexpensive but housing is not. A one-bedroom apt. rents for $500, and a small room in a private home may cost about $300. One hour on internet runs $4. That monthly $84 doesn't go very far-
    I asked about his qualifications for teaching and he replied he was given 5 days of “teacher-training”. I praised him heartily for his natural teaching skills. Clearly, he was well-liked by his students, despite the fact that at the end of every class day he instructed them to sweep the floors and wipe down the beleaguered desks and benches. Now, that’s my kind of teacher-

   Most classes have at least 45-50 students and there are 1,000 students in the entire technical college. Upon completion of the first year all students take a national exam to determine if they will continue on to the 2^nd year. The 3^rd and 4^th year are internships and the students spend 2 days a week in training at government hospitals, private hospitals or medical supply companies. This is the only chance they will get to work on more modern equipment; the first 2 years they had to make do with antiquated donated cast-offs.

                                             

Immanuel in his lab

                                             

                                            

                                              

Old donated anesthesia and operating room equipment used for training

Lives in Limbo:The Poor, the Sick, the Homeless, the Dying

The Mother Teresa Mission (supported by the Mother Teresa Foundation based in Calcutta) serves those in need here in Addis and we wanted to pay a visit. Taxis abound in this city; they are easily identified as the decrepit beat up/banged up de-upholstered blue and white pile of “mobile crap”. Of course, they are without meters and every fare must be negotiated. The usual starting point, regardless of destination (but dependent on ethnicity of passenger) is 150-200 birr ($8-$11). One counters with half which is immediately refused, then there’s the “walk-away” until an agreement is made (which may/may not be valid since the driver may/may not ”choose” to have the necessary change at the end of the trip). Mama mia!

   Mother Teresa’s Mission has been operating for 35 years and this is where the very poor, the homeless, the profoundly destitute can go when no one else will take care of them. The facility holds around 1,000 hapless souls and there is a separate area for orphans as well as mothers with babies. Mother Teresa visited Addis in 1974 with 2 nuns and asked permission of Emperor Haile Selassie to open her center. At this time there are 120 nuns who work in the 18 homes spread out around the city. This mission is the largest.
   Not including the mother/baby and pediatric areas, the mission is divided into very large wards with approximately 50 beds per ward. The men’s wards we visited are: medical, HIV/TB/malaria, trauma, mental, and Alzheimer’s; and there is a separate equal size facility for women. I noticed very minimal “care” being given, probably because few of these patients can expect to improve. The only nurse I saw and spoke to said that when anti-viral drugs for AIDS are available they are given IV, and these patients are sometimes discharged after treatment. The facilities are very basic, by almost any standard. All meals are eaten outside on benches. This mission welcomes everyone and provides shelter, food and safety to those who would otherwise languish and die on the streets.

  On the day we visited it started to pour in absolute sheets of rain, unlike anything we had experienced in many years of travel. We made our way from one ward to another under connecting parapets and found the patients quite unfazed. Those sitting out on a veranda merely tucked their feet in slightly to avoid the deluge. Otherwise, the slow hum of ennui and languish remained unabated. The residents seemed neither happy nor sad but rather resigned and neutral.There was nothing disturbing to us, it was merely a place we were visiting and would be leaving soon and the residents slow gaze as we passed by seemed to show an acceptance that they would be staying.

  As Mother Teresa said: “The worst poverty of all is to reject a human soul in need”. No one is ever rejected here; we were as equally welcome as those so ill.
                                     
                                                            

One of many large wards. Most patients seemed to be asleep or resting. There were not any visitors or radios or telephones. Only the pouring rain broke the peaceful silence.

                    
                                                               

Waiiting for the rain to stop, or perhaps just waiting. The patients all seemed content.
Not too much to wait for...

                                                              

Personal care area for the residents (in the rain).

Rick Hodes: Ethiopia's Renaissance Man

Rick Hodes M.D. – Ethiopia’s Renaissance Man

  We had heard of this amazing physician and were eager to contact him. A couple weeks before our departure we sent him an email about our impending visit and he invited us to attend his clinic on the outskirts of Addis as well as a Friday night Shabbat (Jewish sunset celebration ) at his home.

  After contacting Rick Hodes about our trip to Addis, he immediately e-mailed David several cases with history and physical exams as well as CT/MR scans, and asked for his opinion. As we were soon to learn, he has a multitude of unusual cases and is always eager for new ideas on how best to manage them. Rick, an internist who graduated from Middlebury College, Johns Hopkins medical school, and trained at the U. of Rochester, has been in Addis for over 25 years and runs several clinics in different areas of the city. His primary focus is on pediatric scoliosis (congenital and/or tuberculosis) and congenital heart defects/rheumatic disease. Ethiopia, and probably most of Africa, has an inordinate number of such cases due to the lack of early diagnosis and intervention. It is heart-breaking to see these young kids with such an absolutely catastrophic anomaly that will certainly marginalize their futures.

     Rick has established his own foundation from which he pays for whatever treatment he can obtain. At this time he has 23 kids recovering in Ghana where the best spine surgeon on the continent operates. Surprisingly, the surgeon is able to obtain the necessary instrumentation and hardware for such complicated and risky procedures, which is elusive in Ethiopia. When the kids are recovered, they return to Addis. If they are orphans, or have family out of the city who are not able to provide the necessary care, Rick moves them into one of his 4 group homes and provides them with follow-up care in a family setting. When they are well enough, he enrolls them all in school. At this time he has 24 kids in the US for whom he has assumed legal financial responsibility and close to the same number more here in Ethiopia and he has adopted 5 Ethiopian kids as well.

  He tells a wonderfully heart-warming story of a young child found on the streets of Addis who earned his own mere subsistence by shining shoes, as do many of these “street urchins”. By chance, an American journalist, Marilyn Berger, who came to Addis to write a book about Rick, passed by the disfigured youth daily and could tell he was acutely ill. She asked Rick for his help. “Let’s go find him!” said Rick and they hopped in his car and searched the sidewalks. Rick brought him to the clinic, ascertained that his severe kyphosis was secondary to TB and found a doctor in NY to donate his services so this young child could stand upright and walk again. Marilyn Berger was the wife (now widow) of Don Hewett, the producer of ABC’s “60 Minutes”, and this young shoe shine boy from the streets  of Addis now lives on Park Avenue, sharing a street address with Steve Martin and Bono and receiving a quality education.

   Rick makes regular trips to the states for fundraising so we were lucky to catch him when he was in town. He lives very simply in one of his group homes, which are more like a high school dormitory. His medical clinic is well-known and that makes it somewhat chaotic. On the day we were there, 8 students from an American college were also visiting, there were 2 young visiting medical students on a 6 month stint, as well as one of Rick’s kids who had finished school for the day, not to mention the young patient, her family members and a translator. (Rick speaks excellent Amharic since he has lived here for over 25 years, but Ethiopia has 83 spoken languages). I counted 22 people in the small 12x15 foot exam room, where Rick also read x-rays and did physical exams. Whew…

   After examining his patients he readily opens his wallet and counts out as many “birrs” as needed for medicine or transportation for those patients without means. CT scans run $40, much more than the homeless could ever earn in a month.

     Rick laments about the worst part of his job: deciding which patients (of which he has many!) will give back the most “bang for the buck” for his investment. He is acutely aware that his funds come from donations and he must spend the money wisely. On the day we visited, several patients were hopeful for spine reconstruction but they were “older” (i.e., past puberty) which made them less likely to have a truly successful outcome. He carefully factors in  information about their education, the chances of their lives being truly enhanced, their general physical condition to be able to withstand the rigors of surgery, as well as management of their post-op care. He relentlessly networks any surgeons, any hospitals, any “foster families” in any country, who will sign up and help. He has been the subject of documentaries and books and is deserving of all the amazing adjectives used to describe him. HBO did a feature documentary about Rick in 2010 and “This is a Soul: An American Doctor’s Remarkable Mission in Ethiopia” by Marilyn Berger describes his extraordinary dedication.

  Check him out at http://rickhodes.org , and U-tube. He is one of a kind! (feel free to donate to his foundation, if you wish. He truly helps those in need.)

A 9 year old girl with kyphosis of the spine
secondary to TB. She will be sent to Ghana for spine
reconstruction, paid for by generous donors.

This lovely young 20 year old woman could not be helped.
Since she was post-puberty there would be no significant
height or mobility change and the $25,000 needed for surgery in Ghana
could be better spent on someone younger.
Always, these are very tough choices.

Pott's Disease (TB of the spine)

Scan of the young man in above picture. He was sent to Ghana for sucessful treatment.
As Rick says: "The worst spines in the world come to my clinic"

Friday night Shabatt, the most festive meal of the week. All are welcome, and over 50 of us crowded into Ricks home.Cooking is a community affair and everyone helps out.

Life is always fun at Rick's house! The young 14 year old girl in the center of the picture had been "married off" at age 12 to a much older man. As luck would have it, her brother was being treated by Rick for scoliosis, and when he shared her plight, Rick freed her from this illegal imprisonnment and  brought her to his home where she now lives. She attends school daily and hopes to be a doctor. (notice greeting card from the Obama's on the fridge!)

                                                                             


David consults with Rick in his little exam room, as other observers stand by.

                                                                             

Charinet, who had recently returned from Ghana after extensive heart
and spinal surgery, holding a fun little "gecko" flashlight, one of many donated by Sun Company in California. He must wear his chest brace for several months.

Below is a link for the HBO documentary about Rick (try it, I hope it works)

HBO: "Making the Crooked Straight"

I Love Lucy!!!!!

      It was Sunday and time for David to shed his lab coat and get out and about! We headed for the Ethiopian National Museum in Addis, established in 1944, not far from the University of Addis Ababa Graduate School. The Museum is a 3 story medium size building with lovely gardens by its entryway. Adjacent was a small gallery that housed works by visiting artists, and we also planned a visit there.
     Exhibits in the museum range from paleonotology and pre-history (our Lucy! also known as Dinknesh, meaning "wonderful"...what a gal!)), archaelogical findingsdating to the 16th century A.D. and ethnography of the various tribes that have long inhabited Ethiopia.Although some areas of the museum were closed for renovation, we still found plenty to capture our attention for over an hour. Simply said, it was quaint and charming with appropriate ambient lighting for clear visualization of  the many fossils as well as less ancient artifacts such as robes, crowns, thrones and semi-precious jewels. We noted that the entry fee for "non-Ethiopians" was almost 4x the basic price for Ethiopians, around $1.20.
    Lucy was discovered in 1974 in the Hadar region of the Awash Valley. Lucy (and "cousin" Ardi, who happens to be about 1 1/2 million years older but was not discovered until 1994) was widely recognized at the time as being the oldest upright "homonid", over 3.2 million years old. This country continues to be rich in its bounty of archeological treasures.
     Darling Lucy was only 3'7" tall and was calculated to weigh about 64 lb, not much different than a common chimp. She was discovered by Don Johanson, an American anthropologist, curator of the Cleveland Museum of Natural History and his team, and was named after the Beatles song "Lucy in the Sky with Diamonds", a tune frequently played in the camp.Under an agreement with the government of Ethiopia, her skeleton was brought to Cleveland for reconstruction and then returned to Ethiopia some 9 years later, where she now resides in a hermetically sealed safe area. The "real" Lucy was deemed too fragile for display so plaster replicas were created from the original, and these are what one sees at this museum, as well as "on tour". Several hundred pieces of her skeleton were discovered and based on one complete sacrum and pelvic bone, it was determined that lovely Lucy was a "lady"! The structure of her knee and pelvis indicate that she walked upright on two legs, like us, which is the single most important distinction between humans and apes.
     After taking in the museum, we walked to the neighboring Italian style building where Fekadu Ayalew, a well-known Ethiopian artist, was having a showing and much to our surprise, we found him to be another interesting speciman! After viewing his paintings we introduced ourselves to the artist himself, who leaned uncomfortably by the doorway, selling postcards of his work for $1. each "to raise funds for medical care". It was clear this was a very pleasant but also very ill young man who had lost function of his extremities. He walked with great difficulty, needing canes for balance and was clearly no longer able to hold a paintbrush. He wore a cap to cover the scars on his scalp.When questioned, he stated that he had had several operations for a syrinx (a rare, fluid filled cavity within the spinal cord or brain stem which causes cyst growth and obstructs the flow of cerebro-spinal fluid) and was now uncertain if another surgery would improve or worsen his sad state.Fekadu was quite flabberghasted to find that, by chance,he was relating his medical history to a visiting American neurosurgeon. David surmised that this syrinx was a component of a Chiari 1 malformation ( a downward displacement of the cerebellum which controls the "balance" part of the brain). After much thought and exchange of email addresses, David felt Fekadu's best chance would be to make an appointment with Rick Hodes, M.D. Extraordinaire, who had a clinic here in Addis. Rick was Ethiopia's "Last Chance Savior" for those with horrendous spinal afflictions.
   As I write this, today, April 5, 2013, our friend Fekadu is scheduled to see Rick in his office tomorrow morning. It would be much too optimistic to say "help is on the way", but if it IS "on the way", Rick is the man who will get it there.
   I'll write more about Rick soon, but why wait, check out his website
http://rickhodes.org (or any of the other 98,000 entries about him on google). He's for real!











 


Entry to the National Museum





Fekadu felt his shunt was not working but David assured him it was functional.



Lucy!!!

David examines 34 year old Fekadu at the door of the gallery.

Fekadu has had 3 operations for his syrinx and stated that after each surgery he was worse. Syrinx are well-known to be very difficult to manage and the symptoms (weakness, atrophy, loss of sensation) usually increase over time. Fekadu, 34 years old, was desperate to slow or reverse his symptoms and return to his beloved  livelihood.

"The Spirit of the Nile"
Fekadu Ayalew
 Oil on canvas



 



















 









David gets to work!

 David's schedule: Once a week was clinic day, with teaching rounds in the afternoon. 3 days a week were scheduled  in the operating room. 8:00 AM were rounds with the medical residents who discussed their new admissions or those patients who were in the ICU or had come in from the ER. Then there was radiology conference, neuroscience conference, presentations. David greatly enjoyed making teaching rounds with the residents and participating in these conferences. He had 2 busy weeks.
   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.




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.

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.

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.



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.



Waiting area at the Emergency entrance. There are always people here.



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
.





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



HIV/AIDS in Ethiopia

   The Black Lion Hospital has a large outpatient HIV/AIDS Clinic that I wanted to visit. They have 7,000 patients registered in their computer and estimate that they follow approx. 4,000 regularly. “Lost” patients are a major problem, and those numbers may be rather optimistic. In Kenya, AMPATH (Academic Model Providing Access to Healthcare; funded and managed by the University of Indiana) has successfully mobilized a very ambitious outreach program that sends vans to the countryside seeking out new patients, as well as those who are non-compliant. No such program exists here, and only patients who present themselves are seen.

   Today after the AIDS doctor saw 15 patients (“chronic-follow up”)  and there were no more in the waiting room, he went home. It was 11AM. His nurse, an older man who had worked at the hospital for 32 years stayed on till noon to counsel the 8 patients who had come in for HIV testing. The nurse said the stigma is quite great, so very few will get tested in their own area and instead come to Addis.

   This clinic receives all its drugs free of charge from Johns Hopkins and Tulane University, and frequently American doctors and researchers come to the clinic to assess the information gathered and use it for their research. Certainly, this to be a very symbiotic relationship. Only one drug is available, Lopinavir (Kaletra) and it is taken twice daily. Patients from all countries are seen for free, many come from Djibouti, Sudan, Eritrea and Somalia and will receive as much medicine as needed until they are able to return to Addis, often enough for a year or two. The nurse said the most prevalent mode of transmission is unprotected sex and he counsels about this and readily distributes free condoms. He said homosexuality and prostitution are not a problem in Ethiopia, though that must be his own opinion; research does not bear out him out.