Journals from the heart of Ethiopia: part 2

Posted by on 06.11.11 | 1 Comment
Filed Under compassion, devotion, grief, kindness, look yet again

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From Linda Johnson’s unedited journals while in Ethopia May/June 2011 withn Reach Another Foundation.

Ethiopian  Journal Day 3, 5-28-11

Today is Saturday, and in spite of my usual routine of sleeping in until I awake naturally, those plans won’t work here.
I took an Ambien last night and had the best night’s sleep in a week.  And I knew breakfast would be at 7:00 a.m. so
if I wanted to eat I’d better get up.
The call to prayer was at the usual 5:00 a.m. followed immediately by
the continual broadcast of Korean evangelical prayers (none of which are in
English) and then extremely loud Ethiopian music at 6:00 a.m.  And so it goes.

Today is a national holiday, like our 4th of July.  There was a major public celebration in the
main town square which I still haven’t seen, with thousands of people in
attendance, parades, and speeches by the prime minister and other lesser
ministers.  The streets were pretty deserted because everyone was at the celebration, and the compound here is
absolutely silent (now that the major music and prayers are over).

After yet another mysterious but spicy breakfast, Dick, Lindsay and I did rounds at the hospital.  In African fashion, we walked in intending to
do one thing and ended up doing another.  We first visited our Holland patient who had been trying to get home
yesterday.  We ran into him in the hallway, and talked for awhile.  His
nurse had taken out his IV and had stopped giving him his IV antibiotics
(assumption on her part that his discharge meant that he didn’t need them
anymore).  And we found out that no one had taken his temperature in 2 days, in spite of the fact that he had a serious
blood infection and had been admitted with high fever.  This would be grounds for dismissal in the
States, but here it appears to be normal.  We walked him upstairs and asked the RN to
start his IV and take his temperature.
Then we were called to the ER. In the ER we met with the ER doc who had requested a surgical consult on a 42 year old
man in some pain with a distended belly. He had been sent to MCM with a suspected aneurism of the splenic artery
which supplies the spleen.  After examining him and the CT taken the day before, a new CT was ordered with contrast
dye.  This man’s story is amazing.  He had malaria 10 days ago, and was treated
for it.  Then 3 days ago he fainted and fell, and was driven the next day in a four-wheel drive to Addis Ababa in a
long 4 hour bumpy drive.  When he got to the other hospital, his belly was distended and painful, his blood pressure was
very low, his hematocrit was extremely low, and he was critically ill.  The CT showed he was bleeding into his belly,
which could be fatal.  The other hospital kept him overnight and sent him to us (by his own transport) this morning.  I learned that malaria, while quickly treated, can cause severe swelling of the spleen, and can cause spontaneous
rupture of the spleen.  The fact that he survived his challenging bumpy trip to the hospital and a delay in care for
another 24 hours is a testament to the body’s amazing ability to heal.  We decided to get a CT with contrast to see
if he was still actively bleeding and if not to just watch him.  Any surgery would be highly risky due to the
amount of blood that is pooled in his belly and his low hematocrit.  This kind of condition would never be seen in
America, which several of the doctors mentioned that they love about working
here.  Quote “in America, we do well-baby exams, and in Ethiopia we get to treat really interesting and unusual cases.”

We went back upstairs about 20 minutes later and our Holland patient’s  IV still wasn’t started and temperature still
not taken.  We learned a lot from him.  He is an agricultural project
manager for a major firm doing business in Ethiopia.  His project is to oversee the production of
50,000 chickens for sale to NGOs and private farmers.  The chickens are primarily to lay eggs to
help people build a source of food and income for their families.  Some of the chickens are then raised for
food.  His job is to provide technical assistance and instruction to the local farmers to help them raise a
sustainable batch of chickens.  He said  he had excellent success with the private farmers, but dismal success with
NGOs.  When I asked why, he said that the NGOs are all about giving the chickens away to poor people as fast as they can,
and they don’t have the time or inclination to teach the poor people how to
take care of the chickens properly, so the chickens die and the people stay
poor.  I am just barely beginning to understand some of the challenges that NGOs have in Africa, and I am eager to
learn more.

His case is also interesting, because we suspect he might have been infected with Malaria
but his blood work says not.  His high fever, rigors, severe headache and pain are classic symptoms of malaria, but
there is no evidence of malarial infection. We still don’t know what he has, but his IV antibiotics do seem to be
helping.  The Holland doctors will have fun with this exotic tropical disease challenge whe n he gets home.  Again, this isn’t a well-baby exam!

After rounds, Dick, Lindsay and I hired a driver to take us to the National Museum.  That’s where Lucy is (the oldest know human), and I had my photo taken with a replica of Lucy.  Then we went to a huge orthodox Christian church compound with an associated museum.
We had to remove our shoes and tour the church barefoot.  The tour included the actual tomb of Haile
Selassie and his wife, and a great deal of history about Ethiopia.   I got some great photos, and a bit of excitement.
We were encouraged to take photos throughout the church and surrounding
grounds, and I was doing just that.  I had just completed taking a photo of a bunch of baskets on the ground when a large
group of men began to shout at me to stop taking photos.  Then a soldier with a big gun ran up to me
and snatched my camera away from me and ran off.  I was stunned!  Our driver and his friend, along with me, ran
after them to get my camera back.  Our driver spoke Amharic and the soldiers didn’t speak English, so I was
stuck.  Somehow, we convinced them to allow me to delete the photo of the baskets, and he said that was good enough
and he let us go.  Apparently the baskets were too close to a military installation that I never saw and they don’t take
kindly to photographs of installations.   Whew!

After that, we toured a cemetery and then came home for another Korean mystery spicy lunch.
I’m trying to steer towards things that look like they are vegetables, but
today even the salad was so spicy that it opened up my sinuses.

This afternoon we went to visit the Nehemiah School for Autistic Children, meeting
with the two couples that are opening the school.  We toured the house that they have converted
into a school and spent several hours talking with them about how to set the
school up.  Both couples have autistic
children, and most of the teaching assistants are also parents of autistic
children.  We learned that they have
accomplished a great deal in the past two months, securing funding for the
start-up of operations, finding and renovating the house, and have established
relationships with a speech therapist, a Dutch teacher, Their relationships
have resulted in a network of skilled advisors, including Lindsay.  They receive their first group of 6 students
next week, and they looked at us eagerly and said that they really didn’t know
what to do next, and that they were grateful that Lindsay could tell them how
to set things up.  I believe this was quite a bit more than Lindsay expected, but she is intelligent, knowledgeable,
and energetic.  While she may not get much sleep this weekend, she is already outlining a plan of training for the
next 10 days before she leaves.  The appreciation of the Ethiopian parents was so visible and touching.  After the meeting, we went to a coffee house for some cake and more of that wonderful Ethiopian coffee.  It was a vibrant and lively scene, with an
atmosphere that strongly resembled any Starbucks in the States, with a little
more energy.

Every day here I understand the power of relationships more than I ever have.  I always thought I was relationship oriented,
but now am realizing that as an American, and as my mother’s daughter, I more
easily focus on results and doing the work, and that building relationships
first is not a natural inclination for me.  I think the American focus on excellence and productivity is in my
bones, and the “hanging out” that is required for relationship building is not
something that I am all that familiar with. In fact, as a child such behavior
would have been called lazy by both of my parents.  To win approval, I had to work very hard and
never rest.  While this has served me well in most of my career, I can see now the limitations to this way of
being.  So, my next growth edge may very well be learning to relax and be comfortable relating without a purpose or end
in mind.  Who knew!!?!

One of the more frustrating parts of the past two days is the lack of internet
connection.  It appears to be city-wide.

Tomorrow I look forward to attending church and allowing the day to evolve.

Ethiopian Journal 5-31-11

Yesterday  was a down day.  The pace of learning and insight, the changes in time zones, and my own need to feel productive led to a
very quiet day yesterday with my laptop. I completed the first draft of the MOU for the hydrocephalus program,
stayed in the compound all day, and went to bed very early for me (9:30 p.m.).  My psyche needed a day to integrate.  And I am aware that “being productive” is still a place I go to feel valuable.  Sometimes it is hard to walk away from the drug.

After a good night’s sleep, today has been active and wonderful.  After another stimulating breakfast with my
colleagues here, I asked Dr. Haggos if I could attend his three scheduled surgeries for shunt placement.

Part-way through the first procedure, I learned that the other two cases didn’t show up
for surgery.  I hope this does not mean that they have died, but I am afraid that may be the case.  In the public hospitals, there are not
sufficient resources to perform the operations in a timely manner, so the parents and child are sent home to wait for the needed supplies, or OR time, or other necessities.  When the child’s turn comes up for surgery, the nurse scheduler calls the family and in very many
cases the baby has died waiting for their turn. At this hospital, because it is private, the baby may have the surgery
in a timely manner if the family is wealthy. If not, the family must try to raise the money for the surgery and this
may take time.  It may be that the two cancelled cases today need more time to raise the money—but any delay places
the child at more risk.  The program Dr. Koning and I are trying to solidify here will help children without resources
to obtain timely treatment, and will help the hospital with the expenses associated
with the surgery.

The surgery on the 1 year-old baby was to repair a previous shunt that had become
disconnected and was not draining any longer.  The baby’s head was huge, and the surgery seemed routine, with the
Ethiopian resident doing a really nice job.  Having said this, there were several things I noticed.  The most amazing thing I noticed is that
there was no pediatric ventilator to support the patient during anesthesia.  Gro, the Norwegian nurse anesthetist, was
hand-bagging the patient during the entire procedure, while also administering
drugs, recording care, and monitoring the patient’s status.  In the US, I believe a pediatric ventilator
is the standard of care.

The  OR nursing manager, Meseret, introduced herself to me and shared with me that they were using very inexpensive shunts
and that they were using inferior equipment because they didn’t have enough
supplies or money to buy them.  When we met later for coffee, she talked about her commitment to improving operating
practices, especially reducing infections.
I observed her throughout the day, circulating in and out of the
different ORs, making sure they were operating as efficiently as possible. We
met for coffee in the afternoon and she shared with me her aspirations and work
on infection control, and her passion for excellence.  She has developed some standards and
protocols for all surgeries that will help to reduce infections, and we talked
about some ways to shorten preparation time between surgeries so more can be
scheduled in the existing number of rooms.  Meseret is a strong and committed leader in the OR, and has the
commitment needed to make substantial improvements; and yet, additional
supplies and equipment are needed to make some of her goals a reality.

After the surgery was complete, I followed the baby to the recovery room.  First, the patient oximeter didn’t work, and then the hand-held monitor didn’t work.  To calm the baby, the mother was brought in to hold the baby, which is almost always the best thing to do.  The love between this mother and her child was incredibly touching, a universal language that crosses ethnic and regional borders.  I found myself nearly in tears sitting there, as this mother soothed and rocked her obviously deformed child.

After nearly an hour, in spite of a nurse circulating through the area and charting, the baby did not have a single set
of vital signs taken.  I spoke to the recovery room nurse who was an Ethiopian young man who told me that he had
graduated from nursing school just two months earlier.  He was quite excited to be in this job and
seemed to be eager to please and do a good job.
And yet, when the equipment failed him, he did not possess the skills to
pick up his stethoscope and listen for the heart rate and breathing rate.  I really do not know what to make of
this—some people have said that the nurses are lazy, but I’m not sure that I
believe that.  I’m not sure if it’s a lack of training, or a lack of expectation and clinical protocols and policy,
or whether it is something much deeper and cultural.  I know I felt myself wanting to search for a
stethoscope myself, or to begin teaching them about how to take vital signs to
monitor a patient effectively.

After lunch, I observed a surgery by Dr. Koning to remove the spleen of the patient I
spoke about several days ago that we had seen in the ER.  The surgery was expectedly messy, as we knew
there was a massive blood clot in the abdomen.

Once inside, there was a major fresh bleed that seriously compromised
the patient’s life.  Prior to surgery, the team had placed four packs to absorb any bleeding—those were used in the
first 10 minutes of surgery, and when more were urgently needed, there were
none to be had.  The doctors had to resort to suction and packing with literally dozens of small gauze bandages to
perform the minimum needed to identify the source of bleeding.  Four more of the bigger packs arrived 10 – 15
minutes later as they were sterilized, and I was struck again with how lack of
financial resources seriously compromised patient care.  The nurses were working as fast as they
could, but they were not up to the demands that an American hospital operating
room would require.  I felt a sense of helplessness watching this drama play out, and found myself praying for this patient
to survive out of God’s mercy.  There is
so much we take for granted.  The quality
of care provided here is tremendously better than existed even five years ago,
and yet so far from our knowledge of what is possible.  And in spite of it all, the human body has a
capacity to heal that is amazing.

At lunch, I met an amazing artist named Fikru, who is a friend of Dr. Pearson.  Fikru is famous internationally, with major
shows in Paris, Amsterdam, New York, LA, and other locations.  His work is reminiscent of Picasso, and the
galleries that he displays in have works by Chagall, Monet, Picasso, Gautier,
and others.  He has contributed financially to the hospital and medical care in Ethiopia, and is passionate
about his home country, Ethiopia.  He currently is building a home in Addis Ababa that  is quite nice; he currently
has homes in Paris and Amsterdam.  When asked why he was returning to Addis and leaving Paris, he talked about how
isolated people are in America and northern Europe.  With the wealth and affluence and pressure to
produce, people in those countries think of themselves first, not talking to
their neighbors or others they don’t know, and becoming very isolated and
alone.  He misses the relationship-based culture of Ethiopia, and it’s sense of humanity, which he feels is essential to
human existence.  It is amazing to me how this theme keeps resurfacing and repeating while I am here.  I could have talked with Fikru all day, but the afternoon surgery called.

After the splenectomy, Dr. Koning and I met with Dr. Kim, the Medical Director and CEO of
the hospital.  It was a very interesting meeting, one that I felt was very guarded.

One of the statements that he made was that he was open to our proposal,
but any agreement must, of course, be built on a relationship of trust.  Of course I agree with that, but found myself
wondering exactly what was needed to build trust with the hospital.  Was it donations, trips over, meetings, or
something else that would convey that we were trustworthy to do business
with.  I might have thought that our meeting to share our commitment to provide care to indigent children would
establish some level of trust, or our willingness to fly around the world to
volunteer and bring medical supplies to the country would have built
trust.  I would love to know his thoughts on what specifically we should be doing to establish that trust.  At the end of an hour long meeting, we agreed to submit our proposal to him in writing by Friday.  Once we have reached agreement, he will need
to write a proposal to the Ethiopian government to gain their approval of our
program before we can implement it.

We finished off the day with dinner and beer at the biergarten, a local german restaurant
and brewery.   We had ebony beer brewed there, served  in a very tall (4 foot)
clear glass cylinder with a spigot at the bottom.  The beer was excellent, as well as the two
pizzas we shared. Dr. Koning and I took Dr. Haggos out for dinner to build
relationship with him and to enroll his support in our hydrocephalus treatment
program.  Dr. Haggos is an extremely
intelligent man and a very competent neurosurgeon, and passionately committed
to his country.  He gave us his
perspective on Norwegians (he spent 4 months there recently for training) and
what democracy should look like.  Nearly
mirroring Fikru’s perspective on the culture of Paris, New York and LA, Dr.
Haggos talked about the Norwegian’s sense of independence and self-sufficiency,
and loss of community.  He spoke quite
emotionally of the most recent major elections in 2005 when there was a party
change.   During the election season
which ran for almost a year, one tribal culture that was in control began to
massacre thousands of people, targeting his ethnic group in particular.  His group now has the controlling interest in
parliament, but he was targeted during the elections by the opposition, stoning
his car windshield several times, and he had to shield his children from people
trying to intimidate and hurt him.  His
perspectives on how NGOs foster dependence instead of sustainability were
helpful for me to see and think about as I contemplate Peace Corps service next
year.  Finally, he told us of his dreams
to improve infection control in the hospital.
He is a certified infection control trainer, and has taught successful
courses to teams in other hospitals, and would love to do so at MCM.

Dr. Koning is also interested and encouraged
him to submit a proposal to us.  Yet another possibility to make a difference shows its face.  His passion and clarity for sustainable
change is essential as Ethiopia charts its future; and is also greatly
beneficial to his people.  I feel honored to have spent time with someone so talented and committed.


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