Medical Mission in Ethiopia: Month 7

March 30, 2015

March 29, 2015

It rained today, yesterday too.  I understand better Toto’s “I bless the rains down in Africa” lyrics.  Yesterday Sonja’s American friends and she were playing in her room.  The rains started, then pelted down.  I heard an interruption in the play, and then three faces peered around the corner, “is that rain?!?!?”   The next moment Sonja had dressed her two friends in rain jackets and all three rushed outside to just stand in the rain.  Sonja lifted her face and tried to catch raindrops in her wide open smile.  Squeals of laughter penetrated the courtyard.  I smiled, too, then went outside to just watch them.  The rain sounds soothing.  It smells good.  It feels luxurious.

This evening we walked to a hotel to try and find some meat to eat for dinner.  All four of us wore our rain jackets.  I think that coming from Seattle, our gortex rain jackets are a bit like “blankies.”  They remind us of home and give us comfort.   There isn’t much else that reminds us of home here, so rain and rain jackets are welcome.  On our way home from my chicken leg dinner, Mark’s fish goulash, and the kids’ spaghetti we were reminded again how far we have come.  The entire city of Gondar lies in darkness.  There is no power, again.  Yesterday we had no water, again.  I suppose we should feel fortunate that both the water and power were simultaneously functional for a few hours today, because we did have hot water for showers tonight.  Short showers, but hot showers none the less.

I mentioned that we went in search of meat for dinner.  It is fasting season for the Ethiopian 55 days of Lent.  I am getting a glimpse of what it feels like to live in a culture that is not my own.  I feel very much a Christian, but I am not an Ethiopian Orthodox Christian as 87% of Gondar is.  The Orthodox Christians do not eat any animal products during Lent.  That means no meat, no milk in your coffee, no eggs, no cheese, no butter.   All of the butchers have closed for these 55 days.  The egg shop is often closed, but occasionally opens.  We live in the area of town called “Mosqued,” which means “Mosque.”  So, there are several Muslims in the neighborhood, and they, thank goodness, still eat eggs.  Fortunately there are some tourists and hotels serve tourists, so we can usually find chicken or fish at the hotels.  This probably sounds silly.  After all, many people are vegetarian.  We can survive without animal products.  Oh, but what I would do for a juicy hamburger.

The hospital is keeping us busy.  Mark’s biomedical engineering colleague and our friend, Nick, went back to England after his 6 month stay.  We will miss Nick, he has been a fun companion.  So Mark and Rajat are the two biomedical engineers for the hospital.  Mark and Rajat give projects to two interns doing internships from a Jimma University Hospital.  Mark seems to enjoy teaching them how to figure out problems and solutions.  He gets so excited when they think of an idea remotely close to the answer.  I often marvel at his continued energy output.  Things keep breaking, they fix them, and then they break again.  Usually equipment breaks because people try to make it do stuff it just should not do.  Everything is used so hard here.  Josh and Sonja often comment that the locals work their horses hard.  They do.  Horses, donkeys, hospital equipment.  Everything gets pushed so hard, literally to its breaking limit.

The people are pushed to our limits, too.  This week two mothers died in childbirth.  Both mothers had ruptured uteruses.  One mother left behind 6 children, then other had one child.  One woman died within 20 minutes of arrival at Gondar Hospital, then other had a hysterectomy, but died post-operatively.  Both mothers came from the same referring district hospital.   There are no ob/gyns at this referring hospital, but there are health officers.  Health officers have three years of graduate emergency surgery experience, including cesarean sections.  These mothers didn’t need to die.  If they had only reached Gondar Hospital hours earlier in their labor, they would probably be alive.  Or, if they had a cesarean section at this district hospital they probably would be alive.

WHO cites the Three Delays that cause perinatal and maternal mortality.  The first delay is the delayed decision to seek prenatal care.   This is due to lack of education, fear of medical establishments, acceptance of maternal death, and socio-cultural barriers.  One husband told a health care worker that he had not given permission for his wife to be pregnant, therefore he did not give her permission to seek prenatal care.   The second delay is a delay in reaching health care, i.e. transportation.  The third delay is a delay in receiving appropriate care, including appropriate transfers to higher level facilities if needed.  Gondar Hospital sees many of these third types of delays. More than 90% of the perinatal and maternal mortality at Gondar Hospital is due to this third delay, a delay to refer.

I presented the survey about referrals to the department this last Friday.  I used techniques learned during the College of Congregational Development, and overall it went well.  There was great involvement from most of the department.  Essentially, I collected quantitative and qualitative data back in January with the help of the two chief residents and one general practitioner.  On Friday I presented this data and had the department create a SWOT analysis (Strenghts, Weaknesses, Opportunities, and Threats).  From this data the residents and seniors selected 5 areas of focus and then made a list of suggestions.  We voted on the proposals and I will present them to the head of the department. The proposals were:  1) provide training for local health center practitioners, 2) use a formal referral form and fill it out completely with adequate information, giving supportive feedback and 3) creating a liason officer responsible for specific local health center communications.  I thought these top three suggested interventions were great.  I just hope we can try to implement at least one of the options.  We shall  see.  We shall see.