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.

The Quest for Gondar: Days 1 and 2

Yesterday we left Bahir Dar on a relatively short 170 km drive to Gondar, which is where we’re scheduled to visit Gondar University Hospital. Before leaving Bahir Dar, we drove up to a hill overlooking the entire city, along with the Nile River. It really was a spectacular view. We got some great pictures, and were even able to see some hippos from afar. We were a little disappointed because we couldn’t get close enough to get good pictures. Gondar is a nice little city built into the hills of northern Ethiopia, relatively close to Lake Tana. Apparently Ethiopians have nicknamed it the 51^st state because a lot of people left here for the US in the 1990s. Many of them are coming back here now and building large houses, which we drove by on our way into town. We had a relatively relaxing afternoon and evening, enjoying some food at a local hotel before turning in for the night. Many of the food dishes here have slices of jalapeno in them. I had picked most of them out of my lunch today and had them lying on my plate. Creighton reached over with a toothpick and ate the largest slice, with the most number of seeds, like he was the champion of peppers. He looked fine as he chewed the pepper and swallowed it. However, within seconds his eyes started to water as he realized he’d never faced off with a jalapeno of this magnitude. Unfortunately he’d just finished off his water and had to run to the bathroom with teary eyes to blow his nose. It took him a decent amount of time to recover, but he eventually did. Ethiopian Peppers: 1, Creighton Petty: 0.

Today we visited Gondar University Hospital, which was the nicest hospital we’ve been to so far. It’s also a teaching hospital, so there were many medical, nursing, and midwifery students around. We began the morning by briefly meeting with the Vice Dean of the School of Medicine, before being assigned a guide to take us around to the different units of the hospital. First, we met with staff in the ART Lab. The power was out around the city for most of the morning, which was a substantial problem at the hospital. The workers in the lab were unable to perform any tests without power, and feared blood samples and reagents being stored in the refrigerator may go bad. Apparently power outages at the hospital are near daily occurrences for varying amounts of time. This is definitely a major design constraint for whatever project we choose to pursue. After the lab we spent the rest of the morning in the surgical unit. One of the surgery residents gave us a tour of the facility and answered our many questions. We were then able to view the beginning of a cholecystectomy. The organization and flow within the Operating Room is actually pretty similar to the way things are done at Hopkins. We left mid-surgery to head over to the delivery unit where we were just in time to witness a birth. The delivery went very smoothly as a healthy baby was delivered. The mother was fine as well and we were a little surprised at her nonchalance during labor. She was extremely calm during and after the birth. We didn’t identify many needs, but I’m sure we will during our meeting with the OB/GYN department tomorrow.

After a quick break for lunch we had a meeting with the pediatrics department to kick-off the afternoon. There were many more kids here than at the hospital in Bahir Dar. They were able to point out many needs for us, including shortages of supplies and lack of equipment, specifically oxygen generators. We viewed the neonatal unit as well and were able to present the staff with NeoNatalie, which they were very grateful for.

Our last meeting of the day was in the main testing lab, where we spent almost 2 hours! The lab staff was extremely excited to share all the gaps they’re aware of from their 8 different laboratories. We were able to have some good conversations with them about point-of-care tests that would be extremely beneficial, as well as rapid testing that is not currently available within the laboratories. I think we’ve gathered several very good needs from the time we’ve spent in laboratories in the hospitals we’ve visited. Before we left, the staff had a very interesting question for us. They asked how we could guarantee that any technology we provide to them to solve a problem would not be a short term solution. They were concerned that we will provide them with a technology, and once they change their standard of care and procedures to implement use of this technology, it would somehow not be available to them anymore. We assured them that we are not looking for short term solutions. We are looking for low cost, easy to use, permanent solutions. It is not our intent to implement technology for a short amount of time, and then take it away. We explained to them how our partnerships with Jhpiego and Laerdal provide avenues for manufacturing and distribution of potential solutions to ensure implementation is permanent. It’s actually quite sad to see the hesitation to adapt an improved standard of care for fear that resources may not be available in the very near future.

Overall, it was a great first day of learning and interacting at Gondar University Hospital. We’ll be back there tomorrow morning to meet with the departments we didn’t visit today. In the afternoon we’re hoping to visit a health post, which is the lowest level healthcare facility within Ethiopia’s system. We should be able to define some very good design constraints here.

Ethiopia North: Rest day

Today was a bit of a break for us to go out and experience more of the country. We went on a boat to Lake Tana which is the largest lake in the country. We traveled to two “islands” (one of them was really a peninsula) and we got to walk around and explore a bit. There were some beautiful plants and birds that made it really interesting. On one of the islands, we went to a monestary that they say was built near the beginning of the 14^th century. It had some really interesting paintings and carvings around the outside (we weren’t allowed to go in) and a museum with many old artifacts. It was really interesting. We didn’t see any hippos like we thought we would, but the scenery was great. I still can’t get over how green this country is!

At lunch, I tried something called shiro. They give you a very large piece of ingera and then dump an orange mashed-bean like substance on it and you eat it (like most Ethiopian food) with your fingers by tearing off bits of ingera at a time, and scooping up shiro with it. I enjoyed the flavor, but it started to be a little much after I’d eaten most of it and my stomache acted like it didn’t know what to do with it. It felt a little weird for a bit, but nothing bad.

Then tonight, we decided to go see some African dancing. So we went to a place we were told was good. It was like small bar with chairs and benches lining the outside of the room so the middle was open for people to dance. They was a drum player pumping an African beat as another man played his single stringed violin-like instrument with a horsehair bow and his fingers. Periodically, one of the dancers would blow a horn in beat that produced two pitches, seemingly one from breathing inward and the other from blowing out. I had no idea people could move and shake the way these dancers did! Their shoulders and head could shake and move like they were completely unhinged! Their body would smoothly move with the beat, but their shoulders and head could vibrate and jump all over the place. Or they would jerk themselves around while standing or kneeling on the floor. Within a couple minutes of entering, the violin-like player spoke to us directly and (we found when it was translated to us) said something like “Hello and welcome. We hope you enjoy being here tonight. We will not forget you”, and then continued to play. Soon after, a dancer came up to me and pulled me onto the dance floor. Now I can hardly even dance in the United States much less in an African style! Think of the Tin Woodman from the Wizard of Oz, and you’ll get the idea. But I gave it my best shot. Before long, they pulled Nate on the dance floor too and I’m pretty sure everyone there was watching us. We imitated what we saw them doing (somewhat) and everyone had a lot of fun with it. We had a few people come up to us and show us how to shake our shoulders and dance like they do. After a couple songs we sat down and observed the others. A woman dancer came up to us and starting singing at us, but we had no idea what she was saying. Our friend from Jhpiego, Sarewet, was laughing. “She says ‘I am dancing for you and you don’t do anything. She wants you to give her money on her forehead’.” By the time we figured it out, she’d moved on. I’d seen a couple other people do it, so I pulled out 10 birr and gave it to her next time she came by. We stayed a bit longer and had a great time.

Tomorrow we will be traveling further north to Gondar to visit a university hospital and a health post on Monday and Tuesday.

Team Ethiopia North: Hospital Days 1 and 2

Yesterday and today we got our first taste of life in the hospitals here in Ethiopia. It’s definitely a lot different than what we experienced during the summer at Hopkins, but it was extremely enjoyable and we learned a lot. All of the people are very nice and welcoming. We began by visiting Felege Hiwot Regional Hospital. The structure of hospitals in Ethiopia is as follows:

1)      Specialized Hospitals, of which Black Lion is the only one in the country

2)      Regional Hospitals

3)      District Hospitals

4)      Health Centers, which provide care for patients as well as support 5 health posts within the area

5)      Health Posts, which are run by 2 health extension workers who are responsible for providing basic care to 1000 total families

Within this structure, each level will refer patients up the chain if they aren’t able to provide adequate care or treatment. Upon arrival at Felege Hiwot we met with the CEO of the hospital to explain who we were and what we were doing at his hospital. He was very welcoming and said he expects big things from us in helping them fill some of their gaps. He assigned Sister Yeserash, one of the head nurses, to guide us around the hospital during the day. She proceeded to take us around to all of the units in the hospital to meet the staff and ask questions. The units included antenatal care, vaccination/family planning, pediatrics, neonatal care, general medical care, surgery, and maternal care. Personnel within each unit graciously took time out of their day to allow us to interview them in an effort to identify existing problems, as well as discuss some of the problems we are already aware of. The feedback we received was extremely valuable and everyone seemed to be excited that we were there. It was a joy to see how much the healthcare workers genuinely care for their patients and are actively seeking ways to improve the care they’re able to provide. They really do make the most out of the limited resources they have.

We also had the privilege of visiting the test lab and the pharmacy. The test lab had some relatively modern equipment that allowed for blood chemistry testing as well as hemodynamics. However, there are still many limitations and gaps the staff identified for us. Within the pharmacy the most significant problem seemed to be the expiration of drugs. It was unfortunate to hear that a lot of the drugs that are donated to the hospital are near their expiration date at the time of donation and expire before they ever reach the hospital. There is commonly a shortage of potent antibiotics and even things that seem simple in the US, such as saline, are in great demand here. The day was definitely an eye-opening experience. After hours of interviews (our translator, Sarowit, must have been exhausted from talking so much) we headed back to the hotel for some food and much needed rest.

During our second day at Felege Hiwot we were hoping to view some surgeries and deliveries since we had spent all of the previous day speaking with the hospital staff. Unfortunately, the hospital preferred that we did not observe these things. We were a little disappointed, but found other ways to stay busy. We hiked back behind the hospital and viewed the incinerator and the way medical waste is currently segregated and disposed of. The hospital is currently in the process of building a new incinerator, which is nearing completion. We also had the opportunity to observe a BEmONC (Basic Emergency Obstetric and Neonatal Care) training course being funded by Jhpiego at the hospital. The course is taken by nurses and midwives from health facilities throughout the region. The training consists of 3 weeks of classroom learning and simulated labor situations. We were able to meet with the trainers, who provided us with some additional needs specific to the training as well as general care. A picture of the training is posted below.

Before leaving we went back to pediatric unit and handed out some toys that we had brought from home. This was definitely the best part of the day. At first the children were a little shy and unsure of why the Ferench (what they call white people) were there. However, they quickly warmed up to us as we started handing out mirrors, squishy balls, frogs and coloring books. The kids and their families were anxious to pose with us and their new toys for pictures. 

They love to look at the pictures on the camera because they think they’re on tv. We said our goodbyes and thanked everyone who’d helped us at the hospital before heading out.

In the afternoon we went to the Merawi Health Center, which is about 30 minutes outside of Bahir Dar. This is two levels down from Felege Hiwot within the Ethiopian health system. We showed up unannounced, hoping we would be allowed to observe some things, and we were welcomed with open arms. The doctors and nurses at the center spent a couple of hours guiding us to various units of the center as we peppered them with questions (Sarowit continues to be our hero as a translator) and took pictures. It was interesting to compare the center with a regional hospital because the capabilities and resources are even more limited. Some of our needs are beginning to come into clear view across all levels of the health system here. At the end of our time at Merawi we presented the staff with a couple of the penguins and they were very excited and thankful.

We’re continuing to learn new things as well as gain a depth of understanding of some of the problems we have already identified. This is such an incredible experience! I apologize for the semi-long blog entry, but a lot has happened over the last 2 days. We have tomorrow off and hope to do some sightseeing on Lake Tana. Hopefully we’ll have some good pictures to post. Stay tuned!

Team Ethiopia South: Yirgalem Hospital (Thurs and Fri)

On Thursday, we headed further south to Yirgalem hospital and again saw a lot of rural scenery on our way. We arrived at the hospital and it was of course different than what we’re used to—lots of open-air passageways linking several buildings, with people crowded around outside the buildings waiting. Some people were lying on stretchers made of canvas tied over the top of a recycled metal frame. We started out sitting down with the hospital manager, a doctor, an environmental engineer and a couple of biomedical technicians to explain our mission. After we showed them the examples of projects last year and explained our goals, they had a whole list of issues to tell us about. A lot of the issues center on existing donated equipment that isn’t working and they don’t have the parts or service support to repair it. Yodit did a great job of helping to explain that we were there to look for ideas for new medical inventions and I know we will help a lot of developing hospitals in the long-run, but I still couldn’t help wishing I were also a device technician who could go around and fix at least some of the literally dozens of malfunctioning equipments they have. After that extremely useful overview meeting, we visited the eye clinic and talked with them about the exams, glaucoma surgeries, and cataract surgeries they perform. We learned all the eyeglasses frames and lenses are donated from an organization in Germany, and the Yirgalem clinic re-shapes the closest available combo of lenses to fit into a frame. Interestingly, the eye surgery team also travels out to health centers 10 days out of every month to perform cataract surgeries on more rural patients. They have to pack up a bunch of equipment that’s not really designed to be mobile and take it with them… Their microscope for doing the surgeries has a malfunctioning light, so they have to use an external light source to illuminate the eye from the side, which I think would make the surgery a lot more difficult. The clinicians were extremely knowledgeable and I really admire the level of skill they must have to be able to do procedures with far less than optimal equipment and conditions.

We also visited the waste disposal area to see the incinerator and waste pit. We got to talk with the laboratory about lots of different tests that they do, and had a really long visit in the labor and delivery ward, although there were not any active labors going on. Finally, we visited the ACT center for managing HIV patients before calling it a day.

It was a bit overwhelming not only to see the contrast in the facilities compared to what we’re accustomed to, but also to hear so many issues from the clinicians about their equipment and other resources. There are so many things that need to be tackled… And I wish there were a way to give them a more immediate improvement to their everyday work. It’s going to be a challenge choosing the biggest problems… It’s only been my first day of actually being in a hospital and already I wish we were choosing more than 4 projects for the developing world.

Today (Friday) we were back at the hospital to visit more areas. We talked with people and observed in the ER, x-ray room, maintenance/repair room, laundry room, children’s ward, delivery recovery room, and the operating room. We watched a hysterectomy being performed and got to talk to the surgeon afterwards. He made a very good point about them not needing the “best” or “latest” equipment, but just needing simple stuff that doesn’t break! The biggest issue that seems to be facing the hospital is equipment that breaks down and doesn’t have parts/support for repair. In the maintenance area, we also learned that the only available defibrillator was not working. The ER was also interesting: We learned they have one ambulance to bring people from as far as about an hour away, and the ER staff deals with whatever emergency comes in the door, but the only equipment they had were a BP machine, stethoscope, meds and suturing supplies.

Team Ethiopia South: Travel to Awasa (Wed.)

On Wednesday Luccie and I traveled south from Addis down to the city of Awasa. The drive took several hours and we really enjoyed the scenery on the trip… Around the Addis area, there were a lot of seemingly abandoned construction projects going on with rickety-looking scaffolding built from raw tree branches. There were tin houses and shops alternating with frequent decorative orthodox Christian churches and Muslim mosques. As the city slipped away, grassy meadows with dramatic hills in the background appeared. There were more and more donkey-drawn carts on the road, and the clusters of tin houses became fewer and farther between. I dozed off briefly a couple of hours into the drive, and when I awoke, my first thought was whoa, I’m in the African Savannah! The gray morning had transformed into a sunny day; there were patches of dirt fields surrounded by grassy plains as far as I could see, and huge trees that spread into flat far-reaching branches dotted the landscape. Occasionally someone would be walking along the street with a few cattle or there would be people laboring over hay or other crops planted alongside the road in the good old fashioned way. I think mostly because it was so flat and the views so far-reaching, it really seemed like we were in the middle of nowhere. There were traditional huts with mud walls and straw-thatched roofs. Some people had painted random murals on the outside of the muddy walls that look pretty cool and most certainly African! As we got closer to Awasa, the drier dirt transitioned to a greener landscape full of more large-leaved palm-type trees and other more lush vegetation. Jagged hills once again appeared on the horizon. We had our first wildlife sighting of HORNBILLS, and when we stopped to get photos of the birds, we also drew some attention from cute curious kids!

We arrived in Awasa and found it to be a cleaner and either newer or more up-kept city compared to Addis. We settled into our hotel before our Jhpiego leader Yodit met up with us. Yodit might be the coolest person ever—She is really easy to talk to and extremely knowledgeable and also fun! She showed us around the area a bit, including Awasa lake, where we may have accidentally found ourselves on a boat ride and may have spotted hippopotamuses… There were also a couple different kinds of monkeys and some huge ugly birds around the lake. Yodit took us to a traditional Ethiopian coffee ceremony as well and told us lots of interesting facts about the country before leaving us to rest up for our first big hospital day.