Medical mission in Ethiopia - week 8

November 30, 2014

November 30, 2014

What a week. I wish I had been writing as the week progressed, but here we are, it is Sunday night, and I will try to capture the events and emotions.

This week the French were here. Three urogynecologists from Paris and Lyon came to the University of Gondar to help teach the faculty some advanced urogynecology techniques for patients with extreme pelvic organ prolapse. Dr Bertrand (“Bertie&rrdquo;), Dr Georges, and Dr Stephan are as French as French can be. I was delighted to try my French language skills and they were gracious enough to let me try. Their English was very good, but in true French form they would prefer to avoid using that language. The French and English have a long history of granting each other plenty of autonomy. These three were no exception. They are also fabulous surgeons. My interest was piqued, and I decided to Google one of their names. Dr Georges’ name surfaced to the top of a dozen prominent gynecology studies, and a few patents involving one of the most successful urinary incontinence procedures available today – worldwide. And here he was in Gondar, Ethiopia!

The residents had worked hard during the previous weeks and prepared 32 patients with grade 3 or 4 pelvic organ prolapse. This is the kind of prolapse in which a patient’s bladder, cervix and uterus, and sometimes rectum is prolapsing through the vagina and hanging outside by several (10+) centimeters. In the U.S. and in Europe we usually use synthetic mesh during surgeries to re-suspend everything back inside. Synthetic mesh cannot be used here. One, it is MUCH too expensive. And two, there can be some serious complications that would require technological expertise that just is not available. So, Dr Georges has perfected a technique called the “Richardson.” He essentially creates a layer of perivesical fascia (strong tissue under the bladder) that he then forms into a mesh-like sling and secures with permanent suture. He uses a special instrument called a Dashone (that may be misspelled). Dr Bertie and Dr Stephan were once students under Dr Georges. Bertie and Stephan are in their 50s, and quite accomplished in their own right.

One of the prominent surgeons, Dr Mulu, from the Hamlin’s Fistula Hospital was also here during the week. The fistula-focused Non-Governmental Organization “Women And Health Association” (WAHA) is based in Paris, France. WAHA made the connection with the French last year. Dr Mulu has been practicing fistula surgery for 20 + years and has written numerous articles and books about the subject. She is a very kind person, with a good sense of humor. Her English is some of the best I have heard here, she understands innuendo and raises her eyebrows with a twinkle in her eye. Dr Mulu has two children of her own and empathized with me about the difficulties we have had trying to adapt to the Gondar school system.

So this week we had some extremely talented and apparently prestigious surgeons in the ORs. Adding to the hoopla of the week was a visit from the Prime Minister’s wife. We were between surgeries when a gaggle of photographers (the Ethiopian paparazzi), men in dark suits and women in dress suits and scarves swarmed into the Fistula Ward. Before I knew what was going on, my water bottle and plate of injera with tibes had been swept away and a row of chairs cleared for photo ops. Dr Mulu looked quite relaxed and comfortable explaining the care, projects, and accomplishments of the Fistula Ward to the Prime Minister’s wife. The Prime Minister’s wife shook some hands, had her photo with the primary Ethiopian physicians, met a few patients, and after about 20 minutes or so she went on her way. After this brief interlude we turned back to the operating rooms and more patients with grade III and IV prolapse.

Our discussions during the week revolved around the uro-gynecology subject, but of course strayed into pleasant “getting to know you” conversations. It turns out that Dr “Bertie” has an extremely long and formal name that ends with “de Bouchard.” “de” preceding someone’s last name in France means that this person, or someone in their direct lineage has been formally recognized as contributing to the French society. Dr Bertie’s great, great, great, great grandfather (there may be some more greats in there) was one of the primary French Generals who helped liberate the United States from England during the American Revolution. Well, that is kind of cool. I thought it was very appropriate, therefore, to invite these three Frenchmen to an American Thanksgiving dinner. They seemed quite interested, especially when they learned that we would be eating chicken. It is fasting season in Ethiopia, which means no animal products until Christmas. It is difficult to find prepared chicken in Gondar right now. The French are not terribly fond of “fasting.” Seriously, one does not visit France to experience how to make do without any animal products. That would include cheese, cream sauces, custards, buttered croissants, not to mention all of the wonderful meats and chicken dishes! Alas, the OB/GYN department planned to take the French out to celebrate their week’s work on Thursday night, and they had to decline our invitation.

So, we had Thanksgiving without the French. We had previously invited the kids’ tutor Sam and Mark’s trusted workmates, Nick from England and Rajath from India, and we only have 7 plates, so all worked out well. I visited the closest restaurant (“The Shiro House”) on our street and asked if someone could buy and prepare three chickens. See, there still are chickens in Gondar. One just needs to know where to find them. I am sure these three chickens thought they were safe for a month, but alas, they were discovered and brought squawking to the Shiro House. On Thursday noon they were flappin’ around the dirt floor of the Shiro House kitchen. By one o’clock they were beheaded and skinned clean.

Endalet, the primary cook, wanted to know what I was doing with these chickens, so she, her infant son, and a young lad about 10 years old, came to our apartment to learn and help prepare our chicken Thanksgiving dinner. We had a fantastic time chopping then sautéing onions, garlic, a few carrots, spinach, then tossing that in with broken up fresh bread and wonderful poultry seasonings. Mmmmmm. It smelled like Thanksgiving. We stuffed those three poor little chickens and placed them in the oven. Endalet and her helpers bid us “ciao” and I sat down. Suddenly, I didn’t feel so well. I had felt nauseated in the morning and it quickly turned to be a 12-24 hour stomach flu. I hadn’t eaten anything all day other than a piece of bread, so it was NOT my cooking! Mark finished the food preparation, I went to bed. As I slept, the power went off, Mark created a Dutch oven on the propane stove to cook those chickens for an hour or so, the power came back on, guests came over, laughter and talking and eating and drinking ensued. I later heard that my apple pie was a great hit, and they were kind enough to leave me a piece that I ate the next day. Sam, our token American was suddenly unable to come to dinner on Thursday, but he was able to join us on Friday. We had leftover Thanksgiving dinner that everyone was able to enjoy, and we finished off that apple pie.