Journals from the heart of Ethiopia, first days May 2011

Posted by on 06.11.11 | 6 Comments
Filed Under ancestral wisdom, devotion, presence
My dear friend Linda Johnson is on a month long work tour in Ethiopia with the Reach Another Foundation*.  Linda is an RN and an administrator.  She has applied and been accepted for the Peace Corps, but is awaiting deployment later in 2011 or early 2012.  We are posting her journal entries, several at a time for the month.  Hope you are inspired and challenged by her stories.  You can leave Linda comments at the end of each of these posts.  She will be looking at and responding when she returns to the States.
You will hear mention of Marinus Koenig, MD in Linda’s stories.  Marinus is the glue, the founder, the heart behind Reach Another. I had coffee with him before he and Linda left for this trip and was ready to sell my house and go try to be of service.   While that may happen sometime, for now, the most need is for awareness and for funding.
Info about Reach Another Foundation (RAF):

Who we are

Reach Another is a humanitarian organization dedicated to improve the quality of lives for the world’s poorest citizens and empower them to choose their own  destiny. We work to increase access to healthcare, education and safe living  conditions.
What we do
RAF is dedicated to the notion that education is the most productive way to improve the  long term health of the people in low income countries. Our projects bring health to the sick, water to those who are thirsty, hope to those in despair. We bring medical care and education, supplies and funding for  our operating areas. We believe that by providing our skills and resources to teach health care professionals abroad we will have the biggest impact on a population’s health.  Our goal is to provide long term, stable education in specific locations to maximize this transfer of skill and knowledge. Our medical volunteers are physicians and urses and other healthcare professionals from around the world who each contribute  their specialized knowledge. Our volunteers have helped thousands of people become better able to care for themselves and their families.

Hydrocephalus

The following  are Linda’s unedited journal entries.
Day 1 May 26, 2011
Arrived late last night at MCM hospital, and arrived at our room at 11:15 p.m.  The airport in Addis
Ababa is quite large, and there were several very large planes that landed at the same time as ours.  There was a large
contingent of Peace Corps volunteers (mostly women) also entering the country.  The airport was well-staffed in
the Visa department, about 6 people working to process visas in very short order.  I noticed no armed guards in the
airport, which was surprising to me because I have seen them in Kenya, Egypt, and most European airports.  Our driver
picked us up and it was perhaps a 5 minute drive to the hospital compound.
My roommate is Lindsay, a very nice young woman who has just graduated last week with her Master’s in Special Education.  She is here to help set up a school for autistic children, and seems quite young but enthusiastic to me.  Our suite is like a giant dormitory—we each
have a nice private room, share a bath that is adequate, and a small kitchen.  We boiled water for tea and then
save the water for our water bottles every day.
There is no air conditioning, but at night none is required.  The grounds are lovely, with a garden that is in the process of being expanded and improved. There are plumeria, bouganvilla, hibiscus, banana trees, eucalyptus, and other flowering plants on the grounds.
Breakfast is provided with our room, and it is a chance to meet the other foreign staff that are volunteering here.  The food is Korean, and for breakfast we had rice, soybeans in a sweet sauce, salad, kimchee, and fried eggs with a cinnamon bread.  Lunch was also good with a rice
and vegetable dish served with a meat and vegetable sauce, more salad, and a cold item with bean sprouts that was very spicy.  I enjoy the different flavors, but I can tell that I will be longing for something else soon.
We spent the morning at the hospital, and started the day with the surgeon’s meeting to discuss cases.
It became very apparent that the Ethiopian doctors are trying to learn very fast, and the Norwegian and American doctors are kind but effective at teaching them even more.  I have sat in many similar conferences in the US in quality assurance committee, and there
was always an assumption that any test or diagnostic regimen could be obtained.  Here, as doctors requested the
results of certain tests, I realized very quickly that those tests were not done because they were not available.  The
same was true for many of the drugs that were standard treatment in the US—they simply were not available in the pharmacy.  In a later conversation with Dick, I learned that many drug companies will donate drugs to the hospital, but the Ethiopian
Ministry of Health has very strict importation rules so that the country is not flooded with inferior or outdated products or so that the free drugs do not undermine the country’s ability to produce its own drugs.  While this last reason is a good one, the net
effect is that many people die from lack of basic medication that could make their recovery possible.
After the surgical meeting, I was introduced to Mintweb, or Matron, the Director of Nursing.  One of my assignments for the week is to build a relationship with her to see if I can begin to develop a plan of quality improvement. She was polite and efficient, and gave us a 15 minute tour of the hospital and then delivered us back to Dr. Koning.  It may be a challenge for me to get to know her better, as her days are full..  We
were next introduced to Vinka and AnnaKaren who are Norwegian nurses here for a year through a program in Norway that is similar to our Peace Corps.  Last year, their program set up two trauma tables in the ER complete with a crash card, wall suction, a ventilator,
defibrillator, and other basic equipment that is present in every hospital room in the US.  Vinka is now developing a
trauma treatment program and is training ER nurses in trauma care.   This afternoon she is teaching a course in CPR—it seems the nursing schools here do not teach the importance of the A,B,Cs (airway, breath, circulation) of first aid treatment, and that amazes me.  The
hospital does not require CPR training for the nurses, but Matron is encouraging the nurses to get the training.
MCM is a private hospital, so only Ethiopians who can pay are able to get care here.  All other care is provided by the university hospital or the government hospitals which are public.  Those hospitals are, of course, poorly funded and under equipped, so the best care is provided at MCM.  They have the only CT scanner in Addis Ababa, I believe. There is a problem with keeping good nurses at MCM hospital, with a
turnover rate of about 55%.  Even though it is a private hospital, the perception is that the public hospitals pay higher wages, so the MCM nurses get good training and then take their skills to the public hospitals.
Vinka reports that the nurses provide medications, and do dressing changes.  A patient’s family is responsible for all other care—helping the patient to the bathroom and bathing, turning them in bed to prevent bedsores, and any other treatments needed.  I observed many nurses hanging out at the nursing stations at 9:00 a.m. which is a very busy time in a US hospital, as this is when patients are going for treatments, or being discharged, or being bathed.  There is no training on the need for hand-washing.  In the ER, I did not see a single sink, and there was no Purell provided as an alternative, and the nurses rarely use gloves.  The infection rate here is very high.  Obviously, to implement good hygiene would be very costly, requiring new plumbing work and installation of sinks.  This is a huge problem.
The surgeon that Dick is replacing wants to meet with me when he returns in 3 weeks to talk to me about working with his NGO in the
peace corps to help him build a trauma care system in the country.  Vinka and AnnaKaren both work for him and they seem very happy and fulfilled here. This gives me a glimpse perhaps of the type of work I may be doing in the PC.
AnnaKaren has just obtained approval for a curriculum in critical care to train nurses to work in the ICU and trauma units.  The Ministry of Health has approved it, along with the University school of nursing. They are now looking for a location to hold the classes, and then will
need hospitals to serve as practicum locations. This will really improve the skills of the nurses and improve patient care.
After lunch, jet lag got to me and I took a 2 hour nap.  Then Dick, Lindsay and I went on a walk down the main street two blocks away.  The street was just paved two years ago, and there is a lot of building going on.  There were about a dozen new
apartment buildings constructed in the last six months, with many satellite dishes on the balconies.  The first floor
is shops of all kinds.  We saw butcher shops, internet cafes, mini-marts, clothing stores, tire shops, tiny
restaurants, and many other tiny enterprises. The traffic and exhaust fumes were very strong, and I can understand why
there are so many traffic accidents.  There is no auto insurance, and if a driver hits someone it is their responsibility
to pay for the victim’s care. Fortunately, if you own a car you presumably have the resources to pay
for the care.  The problem is that there is no EMS system here, and if an injury occurs then a taxi is called to take
you to the hospital.  One of the new initiatives is to teach CPR to taxi drivers so they can do some trauma first
aid to get an injured person to the hospital.
In a few minutes we will go to the school where Lindsay will work.  We have already arranged for her driver
to pick her up each morning to go to the school and bring her back.  I can hear the call to prayer, which woke me
up at 5:00 a.m. this morning.  About 35% of the country is Muslim, and about 45% is Orthodox Christian, and the
remainder is a combination of evangelical religions and others.
I am tired, and can see that there is much to do here.  The work is daunting, but so essential.
This afternoon was a mix of crossed connections, and I ended up playing cards with my roomie instead of going to the school.  As Dick says, TIA  (this is Africa).   Tonight we went out to dinner, and took the local bus which was an experience.  After
hearing about all the trauma, mostly from auto accidents, it is a little daunting to get in a vehicle that rattles a lot and has no seat belts.  The restaurant was fantastic authentic Ethiopian food.  After reading Kapitoil and Cutting for Stone, I was really looking forward to eating injera, and we did tonight, with our fingers (no eating utensils). There was a floor show with some amazing dancers, and an actual wedding party on stage.  I learned a lot about the culture.  The people here are absolutely beautiful—tall, high cheekbones, bright eyes, and
extremely attractive.  A number of women have their faces tattooed along their jaw line and it is quite elegant looking.
All in all, a fascinating day that I’ll be processing for a long time.
Ethiopian Journal, Day 2 5/27/10

I woke early this morning to the sound again of Muslim morning prayer as it permeates the city from the mosques at around 5:00
a.m.  It reminds me of my honeymoon in Bali where the roosters woke us up just before daybreak, only the prayers are
much more soothing to me.  I really like a society/culture where there is a pause 5 times/day to say thanks to the
Creator for all that is given to us.
Breakfast today was yet another adventure, with a very watery soup that I think was rice soup to mimic oatmeal—not sure, mostly water,
kind of bland.  The fried eggs were good, and there was much on the plate that I couldn’t identify, so I steered towards the things that looked like fresh vegetables (anything green) and a pretty good coffee cake.  Lunch was much better, but still difficult.  They had injera today which
I had last night for dinner and loved.  I opted for the spaghetti/lasagna, fresh mangoes, a tossed salad and some steamed eggplant.  I think overall I am eating pretty healthy, except for the handful of stuffed chocolates that one of the female physicians fresh in from Holland brought with her.  She brought a full tin and the 7 of us at lunch ate the whole tin—yum!  My eating every 2-3 hours is wishful thinking, as the days are long and busy.
The plan for the day was to attend surgeon’s conference and then go to the OR for a day of surgery.
Don, one of the orthopedic surgeons, stopped by our breakfast table and he ranted for about 10 minutes with his frustration about inefficiency (by American standards)in scheduling surgical cases in the OR.  When he and other physicians are here, they
want to perform as many cases as they can so they can help more patients, which is understandable.  Yet the scheduling of
cases and the preparation of the room between cases is hampered by lack of supplies, or lack of knowledge by staff, or cultural differences about time, which results in fewer cases per OR being accomplished than would be in an
American hospital where there is adequate equipment and staffing.
This is a familiar refrain from the American surgeons that I have met  here.  After the surgeon’s conference, we made
rounds on the floor.  Our first patient was a post-op patient from the day before with an infected fistula in his arm
that is used for kidney dialysis.  We did a dressing change and sent him home—his family was all around and delighted to
take him home.  Next we went upstairs to the third floor where the semi-private and private rooms are to visit a man
from Holland who had suspected meningitis—he had gone down to the cafeteria for breakfast with his family, so we went down there to see him.  He was nowhere to be found, and on our way to the OR we were called by the ER nurse Venka to see a case down there.  It was a non-emergent case of a young boy from Belgium whose father works for the European Union to improve economic development
in all of Africa.  The boy had been referred to Dr. Koning for a circumcision, which wasn’t really needed.  After a good lesson in good hygiene, the boy and his mother left with big relieved smiles.
Next we saw an 83 year old man with pain in his calf when he walked.  With the RN as translator, we had to search the hospital for a portable Doppler machine to make sure there was no vein obstruction.  During these exams, the doctor had to ask for gloves to examine the patients, and they were locked away in a cabinet—clearly rarely used.  After a good exam, the man was sent home with an order to increase his
exercise.  Finally, at about 10:30 we went upstairs to the OR for surgery.  But first we had to chase down Matron Mintweb to get her permission to allow Lindsay and I into the OR.  When we saw her, she smiled at me—progress!
After gowning up for surgery, we observed an unusual but life-changing surgery performed by an amazing orthopedic surgeon I’ll call Dr.
E.  The surgery was on a young boy aged 9 who had been severely burned on his right leg at the age of 5.  The scarring on his leg was so bad that his leg was completely contracted in a closed position so his foot came under his butt.  The foot was twisted 180 degrees
in the wrong direction, and his patella (knee cap) was on the side, not center, which kept him from straightening his leg.
In this condition he had one normal leg and the bad one, so he couldn’t walk.  Further, the position of the leg
did not allow for a prosthesis, so his future ability to support himself as anything but a beggar was pretty grim.
Dr. E did the first of several planned surgeries, opening up the part of the leg with scar tissue and contractures and removed all the scar tissue.  This allowed the leg to go from completely closed to about an angle of 45 degrees from completely straight.  He put external rods to fix the leg in an open position so the muscles and ligaments would stretch without nerve damage.  In about 30 days he will come
back and move the patella to its proper position which will allow the leg to open up more completely and the bones to come around to proper alignment, creating the possibility of normal growth in length and a future surgery to correct the foot angle.  This kind of
surgery would never be seen in the US because we would intervene well before the contractures occurred, and no one would let a child go untreated for four years for this kind of condition.  His life will be dramatically changed with this surgery and he now has a chance for
meaningful employment as an adult.
As the surgery concluded, we were called back to the 3rd floor to see the patient from Holland with the suspected meningitis.  He was much improved over the past 48 hours and eager to fly home for further care.  It was a very unusual and interesting case and no one really knows what he has, but agreed that he was healthy enough to fly home with an IV and a nurse to tonight.  The next 30 minutes was spent chasing his chart around the hospital and trying to figure out how to work with his insurance company to pay for his flight home.
The conversation at lunch was lively and fun, with two Ethiopian neurosurgeons talking with us about the hydrocephalus program and
what they wanted to see in the future, which is really pie in the sky for now, but they can certainly have tremendous improvement in their ability to treat this condition here.  There was discussion about how to get donated equipment into the country without having
to pay huge amounts of tax on it.  The collegiality among the volunteer staff and resident physicians is really
heart-warming, as there is an eagerness to learn more and improve care.
Just back from a delightful dinner with Dick, Lindsay, Gweb, and Venka, nurses from Norway.  Both are
here as a part of the Norwegian Peace Corps; Venka is an ER nurse, and Gweb is an OR nurse. We went to a wonderfully international restaurant with peaceful ethnic music and signature dishes from all over the world.  We shared interesting clinical stories from
our past patients, and shared perspectives on how opportunities for improvement in quality in the hospital.
After a long and very full day, we called it a night fairly early and went home to bed.  I find myself reflecting and processing my day nearly non-stop, and it feels good to be changing and growing every day, although at the end of the day I am exhausted.

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