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.