Black Lion Hospital

Last Thursday and Friday, our team was reunited in Addis to visit Black Lion hospital. The first thing that is unique about the hospital is it is HUGE—it had over 7 floors, with both pediatric, surgical, and medical ICUs, a neonatal ward, and 3 laboratories. The other unique aspect of Black Lion is they have a biomedical engineering team. We met with Mulugeta, the head biomedical engineer, who explained all of the functions of the department: they perform preventative maintenance as well as corrective maintenance, provide some equipment training for clinicians, identify donated equipment and determine if it’s working before it’s sent to some other hospitals, and are even working on a biomedical engineering curriculum to start at Addis Ababa University. Like other hospitals, a big challenge for them in repairing equipment is they do not have replacement parts. But, they seem to be really clever about taking parts from a different piece of broken equipment in order to make repairs. They even have some electrical diagnostic equipment. Still, another big challenge is that with all the donations they get, they hardly ever have the same machine twice: He said they have over 1000 pieces of equipment from 300 companies and 22 different countries. It’s impossible to build expertise on the equipment because there is such an extensive range of donated brands. Additionally, 99% of the time, the donations don’t come with manuals. Mulugeta has a lot of resources online to try to find manuals, but he said sometimes the company expects you to pay for them. Mulugeta also has a lot of clever ideas for bioinnovation himself, including: a more robust BP apparatus he’s trying to get manufactured in Ethiopia instead of purchasing from China, a sensor device on aspirators to give a warning when they’re close to overflow, and a motorbike-based ambulance.

Overall, Black Lion did have more equipment than the district-level hospitals we had visited. For example, the ICUs had oxygen tanks and a few ECGs and pulse-ox. Still, there were plenty of things pointed out to us that were not working or in short supply. In the OR, we noticed the ECG electrodes and cautery grounding pad were being reused many times. Mulugeta and the OR nurse explained the reused grounding pad can be a problem because the poor contact with the skin can result in burning the patient.

Black Lion has the only neonatal care ward out of all government hospitals. There is a big shortage of working warming lights and incubators; the large number of light and incubator tables are used just as beds. Another issue with the working warming lights and UV lights is they have no detector or periodic test to tell the clinician if adequate warming/UV is being delivered to the infant (the efficacy of warming/UV is a concern since the machines are so old).

We also learned bottles are banned from the neonatal unit because they can't be properly disinfected and carry a high risk of bacterial infection. Instead, moms and nurses feed the babies with little cups.

The director of the unit showed us some makeshift infant CPAPs they created using old IV bottles filled with saline. The depth of the oxygen tube within the bottle determines the amount of pressure directed at the infant.

We also had a really productive talk in the labor and delivery ward and got some good feedback on the epartogram.

Another interesting aspect to Black Lion is they have the only SPECT in the country. We also got to see the radiation therapy department. The radiation therapy technician told us the most common cancer treated is cervical cancer, and most often it’s caught so late that treatment is only palliative. Unfortunately, Ethiopia currently does not do any routine screening for cervical pre-cancers.

Belated Ethiopia South Rest Day

Today (Saturday) we had some free time to do some more sightseeing around Hawassa before we head out to Arbaminch tomorrow. Our driver, Tamrat recommended a hartebeast sanctuary nearby so we headed out early in the morning. It was quite a drive to the sanctuary so we got an opportunity to see more of the countryside. The traditional huts set in the gorgeous mountainous landscape looked so perfect. We ever got to see a couple of huts that were being constructed. Part of the drive to the sanctuary was off the main road and we got to see some interesting species of birds. We also saw more children on the road, playing with each other or helping the mother with chores.

Getting the sanctuary we hired a guide to show us the different animals at the sanctuary. The most notable was the hartebeast, think of elk and a deer (picture posted). Lauren and I definitely got very excited at the first sighting of the hartebeast.

Driving around the park felt like suck of safari ride! The landscape was flat with the odd tree. It was gorgeous, I felt like I was in one of those nature shows, especially riding around in jeep-like car. Of course, we climbed onto the roof of the car to get better views of the wildlife. We also got out of the car in an effort to get closer to the hartebeast (did not work, but we did get to experience how stiff the grass in the plain were).

In addition to the hartebeasts, we also saw some deer like creatures called senkele. They were pretty shy so we could not get as close. Finally on our way out we also spotted a family of horses, probably belonging to some of the local people who lived by the sanctuary.

After a morning at the hartebeast sanctuary, we headed back to the Hawassa for lunch. Yodit decided to take us on another "adventure" by Awassa lake were we got to taste some local fish, fresh out of the lake! We drove up to this make-shift tent on the side of the lake were some teenage-looking boys were frying up fresh fish. Of course, we had to try it and it was DELICIOUS! I don't think I have ever had any better fish. Rubbed with just a little of salt, the fish was fried until its fins were crispy enough to eat. With a little splash of lemon, everything was delicious. Holding to the local customs, we ate our email with our hands, which was a very interesting experience since the fish came right out of hot oil. Nevertheless, Lauren and I each ate three fish!

Being full of sun and fish, Lauren and I headed back to the hotel for some rest before the checking out the nightlife in Hawassa. After taking us out to dinner, Yodit took up to a traditional music house and we tried some of the local honey mead (definitely more sour than sweet). The music house was quite different from anything I have previously experience. People sat around the periphery of the house while a pair of singer and dancers walked around making jokes about people in the house. As soon as we sat down, the singer came up to us and started making jokes about foreigners and Chinese people. Lauren and I didn't understand the jokes, since they were all in Amharic, but we got caught up in the atmosphere and had a great time. Everyone was laughing and dancing. We even got a chance to join in on the dance!

Braids!

After wrapping up at Yirgalem hospital where we were able to visit the OR and watch a hysterectomy, Lauren and I decided to highjack Yodit's trip to the saloon. There Lauren and I both decided to get our nails done and get our hair braided. Lauren went for the full head of corn rows (which looked gorgeous) while I only did half my head. I really like the braided look and I loved the designs they put on my nails! It felt so nice to get pampered after walking around the hospital.

Sightseeing in Hawassa

We didn't have reliable internet access in the South, so the following are some belated blog entries. Since Lauren has covered most of the details from our hospital trips, I am going to give some insight about our free time.

Besides visiting the hospital in Yirgalem, Team Ethiopia South had some free time to check out the local points of interest in Hawassa and Yirgalem. An interesting fact that we learned from Yodit, Yirgalem was built before Hawassa and was at one point a place where the emperor would visit. However, one of the emperor's son was killed in Yirgalem (supposedly by someone in Yirgalem) which upset the emperor and caused him to move out of Yirgalem, refusing to visit ever since. However, Yirgalem is still one of the most fertile locations in Ethiopia and is one of the major producers of coffee. Thus, we paid a visit to Aregash Lodge and saw coffee plants! Definitely, more green than I thought.

Our first stop in Hawassa was the infamous lake that Hawassa was named for, Awassa Lake. We decided to take a boat ride on Awassa lake to get a better view of the hippos. The lake was beautiful and the clear blue skies made everything even better. After a joyous ride through the clear waters, we arrived at a location full of tall reeds and hippos swimming in the water. Yodit was quite paranoid about the boat tipping or a hippo attacking the boat. Luckily neither happened, despite having Lauren and I moving up and down the boat trying to get better pictures of the hippos. At one point we were about 15 feet away from one! We even saw a baby hippo stand on its mother's back. After observing the hippos (and taking about 150 pictures between Lauren and I), we decided to head back. The ride back was also gorgeous, though a little wet. Yodit and Lauren had to hide underneath a On the way back the captain also told us about how he made the boat that we were riding in himself. That explaining the tipping and the water seeping into the bottom of the boat.

After the hippos, we headed over to a park to see some stork-like birds (or as Lauren would describe it, a cross between an ostrich and a pelican). Since I can't really describe the bird so I included a picture, please let me know if you know what kind of bird it is. Some of the boys in the park had bits of fish to attract the birds. While feeding the birds, this monkey came up to us and started begging pineapple (we pick some up on our way to the park). Of course, we obligingly fed the monkeys and as we ventured deeper into the part, more monkeys came out treats such as peanuts. The monkeys were so daring that they would walk right up to my hands and pick peanuts straight out of my hands! On our way out of the part, we were also introduced to a black and white species of monkey that was native to Ethiopia. As the monkey was being coaxed out of the tree, we noticed how thoughtful its face appeared. These black-and-white monkeys actually let me feed peanuts right into its mouth (so much for rabies precautions). In fact, some of the boys in the park were able to convince one monkey to climb onto my shoulder! Lauren had one climb onto her shoulders too!

After a fun filled day in Hawassa, we returned to our hotel for rest for our visit to Yirgalem hospital. I honestly do not know what to expect, so I am both a little excited and nervous.

Belated Report on Arba Minch Hospital (Team Ethiopia South)

Luccie and I (Lauren) were without internet during the last few days of our southbound trip, so here are some belated stories from Arba Minch Hospital.

The hospital was larger than Yirgalem. Though it is technically a regional hospital, it is basically acting like a referral hospital for a large area around it. The manager told us it serves an area of about 2 million people, and actually sees over 100,000 patients per year. Even though they serve so many patients, they only have 5 specialists (and I believe one of them was a foreign surgeon who just left). They have one other surgeon and a gynecologist, and the last remaining surgeon is planning to leave soon. Though they have 4 operating rooms, there is only one anesthesia machine, and they don’t have enough doctors to do the procedures. Here we are checking out the OR:

The hospital was originally built to house 50 beds but has now expanded to 300 beds. Yet, they only have one working (or at least seemingly working—it’s pretty old) autoclave, one laundry machine, one suction machine, and one oxygen concentrator, according to the manager. An additional challenge for the staff of 360 people is that they have no transportation system to help them get to work. And, like most other hospitals outside of Addis, there is no ambulance to transfer patients to Arba Minch.

A lot of the observations at Arba Minch were similar to Yirgalem. Most of the problems verbalized seemed to center around equipment that breaks, and the fact that they have no access to replacement parts or technical support. One new observation was that the hospital did not have a blood bank; they just don’t have the equipment for it, so it is stored by the red cross a long distance away that makes it fairly impractical for obtaining during a surgery when a patient needs a blood transfusion.

Another new issue we learned about is the development of fistulas in women who have had obstructed labor. Fistulas are a big problem in Ethiopia for a few likely reasons: For one, in rural areas, women get married young and get pregnant before their pelvises are fully developed, so they are more likely to have obstructed labor. Another problem is that the women are so far from hospitals or health centers that they do not travel to seek medical attention early enough. We spent quite awhile talking with the nurses and a patient in the fistula clinic. The patient (who spoke only her local language, so the nurse translated to Yodit in Amheric and then Yodit translated to us in English) had a very sad story. She attempted to deliver her baby at home and was in labor for four days before the family made the decision to send her to a hospital. Then, it took four more days to receive the necessary money from her father to transport her to a health center. By then, her baby had died days ago, but they were able to remove it vaginally by performing a craniotomy on the fetus. The patient had both a rectalvaginal fistula and a vaginal-bladder fistula, making her completely incontinent. When she returned home, her husband left her and the rest of the community ostracized her, which is common for fistula patients. The patient had already had one operation 3 months ago that did not heal properly, and recently had a second one. The healing process was not looking promising, but she had to wait another 3 months before they would try another surgery. Here we are with the fistula nursing staff and the patient we spoke to:

We also talked to both the medical director and an internal medicine doctor. Both were extremely knowledgeable and helpful. We heard about many issues similar to Yirgalem. One that is surprising to me is that even a hospital as large as Arba Minch has no ECG machines. They are treating myocardial infarction patients with only oxygen because they don’t have enough diagnostic capability to use other treatments like beta blockers. And, even though the hospital has one working defibrillator, they never use it because there is no ECG to monitor the patient’s rhythm.

Additionally, we got to visit the labor and delivery ward, and got to see an uncomplicated birth using and hand-pump vacuum to assist delivery. Here is one of the new mothers with her baby:

A final highlight was visiting the antenatal care clinic, where we got to discuss some of the challenges of seeing mothers prior to delivery, and demonstrated the partogram and antenatal screening pens to the head clinical nurse and a large group of nursing students.

Another picture I just have to include is me with some cute girls who couldn't stop looking at us and giggling while we chatted at the cafe with the medical director. They were thrilled to take the picture.

Ethiopia North: Return to Addis

(Written two days ago)

We’re back in Addis! And suddenly everything here looks a lot more modernized and developed than it did when we first arrived. Even our hotel rooms suddenly seem much nicer. I guess perception is relative to what it’s compared to, right?

Yesterday we returned to the University of Gondar Hospital and met with some other clinicians including the Dean of the School of Medicine (who is an obstetrician), the Head of the School of Internal Medicine, and a couple OB/GYNs. We asked them many questions about the needs we have identified and received very helpful feedback. After the hospital, we met with members of the District Ministry of Health who sent an assistant with us to visit a health post. I was very surprised at how nice and yet how limited the health post was. As strange and contradictory as that sounds, it’s true. This was one of the nicer health posts in Ethiopia. It was a 3 room facility right off the side of a busy road and was built with both wiring and plumbing. Most health centers can’t even be accessed during the rainy season because the roads are too muddy and they have no water or power capabilities because they are made of trees and mud. This one even had a water heater and a sink! But there was just one problem; it was not connected to any electric or water sources, so many of the features were unusable. And just the lack of those two sources alone means no heating, no refrigeration, and no sterilization capabilities. Sine vaccines that must be kept between 2-8 degrees Celsius, they frequently have to be obtained from the nearest health center because they can’t keep them cool enough. And of these health centers (which are about 10 km away, up to 25 in rural areas), only about 3 out of 7 in the North Gondar District have electricity themselves. Health posts would likely be able to do far more for patients if they could use sterile gauze or tools, refrigerate drugs and vaccines, and warm patients or neonatal, but currently this is not possible. In general, health posts test or provide treatment for malaria, HIV, malnutrition, birth, intestinal parasites, contraceptives, and vaccinations. They are also used to provide health information to the people for family planning, sickness prevention, and pre/post maternal delivery. When they encounter cases that require expertise outside these parameters, they refer the patients to the Health Centers which, as previously mentioned, can be a long distance. It was very eye opening to see the limitations the workers here face. There is a lot of room for innovative solutions to allow the health extension workers to provide better care.

After the health post, we briefly visited a castel in the center of Gondar and I couldn’t believe how HUGE the place was! It is actually the ruins of six castles that were built in one area that date back to about 400 years ago. These castles belonged to Ethiopia’s royal family when Gondar was the capital of Ethiopia. Most of them are ruins now and tourists can walk around and inside them to get a feel for what they must have been like. It was really interesting!

Then today, we made the 12 hour trip back to Addis and are back in our same hotel again. Tomorrow and the next day, we are going to the Black Lion University Hospital which is viewed as the hospital with the newest equipment and greatest care capabilities.

This is the health post we visited:

Yeah, we drink a LOT of water here!

Here we are at the castle of Gondar:

We passed the baboons again near the White Nile on the way back:

Meeting of a Lifetime

My wife, Kaity, and I have the privilege of sponsoring a child here in Ethiopia whom I have sponsored for the last 5 or 6 years. We sponsor him through an organization called Compassion International. Using monthly donations from sponsors, Compassion provides food, supplies, medical care, and schooling for children in developing countries throughout the world. Sponsors and their children are able to write letters back and forth in order to develop a relationship with each other. Today, I had the opportunity of a lifetime, as I got to meet Philimon, the child Kaity and I sponsor. I was extremely excited, and even a little nervous, to meet him this morning. He lives in Sheshamane, which is a four hour drive south of Addis Ababa, and the director of his Compassion program had accompanied him to Addis for our meeting. It was only his second time to the big city. It was an exciting moment as we met for the first time, having only previously communicated through letters. It was pouring outside so we went up to the restaurant here at our hotel to sit and talk for a little while. Today is Philimon's 14th birthday, and it also happens to be my birthday. We exchanged happy birthday greetings in our respective languages and I presented him with a backpack full of assorted goodies, including some Hopkins gear (thanks Marybeth!). He was very appreciative of the gift and excited to see what was inside. We spent some time talking using Atkelt, a worker for Compassion here in Addis, as a translator. We talked about our families and some of our favorite things to do and he told me he wants to be an engineer! Perhaps he'll be a Hopkins man in the future. The rain finally let up and we went outside to play frisbee, which was one of the gifts I'd given Philimon. He'd never played before, but quickly caught on. A crowd of about 15 or so kids all gathered around to watch us, most of whom wanted to clean my shoes after we were done playing in the muddy field.

Next it was on to an arcade where Philimon schooled me in the art of foosball and I taught him a thing or two about air hockey. We also had fun racing motorcycles and playing some other games. Following the arcade we went to eat some lunch before Philimon and his program director had to leave for their journey home. I introduced Philimon to his first ever piece of pizza, which he thoroughly enjoyed. Our time at lunch was spent learning more about eachother, as well as about Atkelt. Atkelt was sponsored by a couple through Compassion while growing up here in Ethiopia, and the experience touched him so much that he now works for Compassion. At the conclusion of lunch we said our goodbyes and wished eachother well, not knowing if we'll ever have the opportunity to meet again. The experience of meeting Philimon is something that's difficult to put into words. It's a very gratifying feeling to get to meet a child, whom you have a hand in providing for, and see that he is living a happy healthy life and has major goals and aspirations. The fact that we got to meet on both of our birthdays, was icing on the cake. It really is a great feeling to have such an impact on a child's life, and I would encourage others to consider sponsoring a child as well.

Life doesn't get much more rewarding than today.