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.