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.