Medical mission in Ethiopia - week 2

September 22, 2014

Monday, September 22, 2014

We have been in Gondar 5 days now. Honestly, the first day here, I cried. I wondered what we were doing thinking we could live in a developing country for a school year. We are fortunate to be experiencing this as a family, as the necessary hugs to persevere are readily available. It has been interesting to me that the family seems to decompensate in a serial fashion. The other three support the decompensated one until they can function again, and then life is okay for a time, until someone else crumbles. So far all four of us have gone through some difficult emotional times. Food and sleep definitely help. Everyone has slept through the night for two nights now, and the emotional break downs are more sporadic.

I have had a difficult time getting used to so many people asking for money, touching me, shaking my hand and yelling “hello!!!” from across the street. Josh seems to have handled this the best, returning the “hellos” and handshakes. But today even he said that it is exhausting. “I’m just another human being, can’t they see that?” He also reflected that in the U.S., “it’s just not right to surround people, and if you do get surrounded, it’s dangerous.” We recognize that it is not dangerous here. But we are a spectacle, especially the kids. I think people are used to seeing white adult tourists, NGO workers, and some hospital or university faculty, but white children with red and blond hair? Last night our quiet courtyard (and attached reception hall) was rented out for a wedding. Josh and Sonja had been playing soccer (futball) in the courtyard when the wedding party just showed up. Soon, about 15-20 young men who had come to the wedding were playing futball with Josh. Sonja wisely escaped and found the musician playing the local ukulele instrument, but Josh hung in there. The game became quite lively and physical with lots of fancy footwork and exuberant vocalizations. Many of the young men took selfies with Josh, and by the end he had shaken many hands. Perhaps it is a cross cultural phenomenon that young men would rather play a futball game than attend a wedding reception.

This morning I went to the hospital to meet the 3 OB/GYN attendings, the interns and residents. I snuck in during the middle of morning report. In a very traditional fashion the interns gave the patient reports, the attending physicians asked questions until the interns didn’t know the answers, then the junior residents piped in, and finally the senior residents. My stomach turned. Ugh, I hated the feeling of being grilled as a medical student 16 years ago. The visceral response was still there. All the medical education is completed in English including oral rounds and morning report, so in theory I should have been able to understand everything. After the report I introduced myself and said I would need to grow some elephant ears because everyone spoke so softly. Definitely not brash and outspoken Americans here.

Tomorrow we will meet the kids’ community school director with documents in hand. Last week we went to the school but we did not have all of Josh and Sonja’s grades and test reports. Little did I know that testing the kids for Spectrum and Advanced Placement in the Seattle School District last year would play any importance at all here in Ethiopia. Children test into the University community school and I guess that includes American children who don’t speak Amharic. On the other hand, maybe it’s the documents themselves, and the content is not so important. I am not sure when school actually starts. It started last week in Addis Ababa, but hasn’t started here in Gondar yet. I was told to take my time settling in and then come to work at the hospital when I felt ready. Mark has yet to meet anyone with whom he will be working. Everything seems so nebulous. Maybe this is a cultural thing. It will happen when it happens.

Kids in the courtyard of our guest house. There are other families visiting, including an Ethiopian family. The little girl making a funny face is from San Jose, she is visiting her Ethiopian cousins.

Wednesday, September 25, 2014

This is a difficult place.

Today I followed some of the gynecologists during gyne rounds. We checked on a patient who is 5 days post-op from her second vesico-vaginal fistula repair. She looks about 12, but apparently is close to 20 years old. Her home is a remote village. A few years ago she became pregnant. She went into labor in her home village and had an obstructed labor. So, the baby died and after 3-4 days of labor and pushing she made it to a hospital where she had the baby removed vaginally (dismembered) and several months later had a successful fistula repair. She then became pregnant again last year. A month or so prior to her due date she tried to make her way to a hospital because she knew she should have a cesarean section, but it was the rainy season and there was flooding surrounding her village. So again, she went into labor in her remote village, had an obstructed labor, and the baby died in utero. She eventually made her way to Gondar hospital. The deceased baby was again removed vaginally in the same manner. Interestingly, they do an exploratory laparotomy at the same time as the vaginal extraction due to the high risk of uterine perforation so that if there is a uterine perforation, then it will be recognized and repaired immediately. She did not have a uterine perforation. But, she did have a recurrence of her vescio-vaginal fistula. So, about a month after her delivery, the gynecologists attempted a 2nd fistula repair. That was 5 days ago. Today, she started bleeding out of her urine catheter. The attending did an exam and concluded the bleeding was from the base of the urethral-vesical junction, the site of the repair. The tissue surrounding the urethra was scant, and pale yellow. A 30 cc foley catheter balloon was placed with vaginal packing, and it seems to have decreased the bleeding. Her fistula repair has likely fallen apart. I noted she was alone and asked if she had any family with her. The attending replied, “We [the gyne department] are her family.”

Between rounds, one of the administrative staff tracked down the attending to ask her to sign a typed copy of another patient’s History and Physical. I just read the first few lines. “12 y.o. G1P1 admitted with vesico-vaginal fistula and recto-vaginal fistula following 3 day obstructed labor with term gestation, intrauterine fetal demise. The patient states she became pregnant after sexual assault by her neighbor.” The typed and signed copy of this H&P was requested by the girl’s father who had been in prison prior to, during, and after the girl’s pregnancy. I was told that when he was released he found his daughter in the hospital and was deeply saddened. The H&P will be going to the police.

I am full of admiration for these doctors. The stuff they see every day is so difficult, emotionally AND medically. The chief of the gyne/obs department only finished residency 4 years ago, and the other 2 attendings are less than 6 years out of residency as well. So they are young, but not inexperienced.

Saturday, September 27, 2014

Ethiopian calendar: September 18, 2007, MESKEL

This morning I woke to feel the stinging of smoke in my eyes, the smell of campfires, and a view cut to about 100 yards.

Meskel is a Christian and cultural festival that celebrates Finding of the True Cross. Earlier this week we noticed people gathering a particular yellow flower. Some of the Bajajs (3 wheeled taxis) decorated their roofs and mirrors with flowers. People started wearing these flowers in their hair, their ears, their noses, and anywhere else that would accept a stem. Yellow flowers appeared in store fronts, scattered on the sidewalks, they were everywhere. Last night we noticed several crosses being erected throughout the city. There were giant town square crosses, neighborhood crosses in intersections, and small crosses in front of homes. These crosses were laced with these yellow flowers and supported by a cone-shaped stack of wood branches.

We started asking some questions. What is this holiday? Finding of the True Cross? Do Westerners have an equivalent celebration? What is going on?

Eventually we learned that Gonder would be celebrating Meskel today, September 27, 2014, and that we should make our way to the Piazza (the town square) between 10 and noon. Mark had to fly to Tanzania at 1pm today, so the kids and I bid him farewell and made our way to the Piazza around 10 am. Along the way we saw several piles of ashes where smaller neighborhood crosses had stood the night before. There were lots of people throughout the Piazza, roads were blocked off to cars, the air was festive, boys ran around in semi-formations chanting and waving big sticks in the air. We chose a street curb to sit down and just observe. The giant decorated cross in the center of the Piazza which had stood lonely yesterday was no longer lonely. Priests and religious women surrounded the cross taking shield from the sun under beautifully decorated umbrellas. A huge crowd surrounded the cross and people were watching and listening to the priests chant religious prayer from a nearby stage. Looking around we saw priests collecting donations in upside down fancy umbrellas. Women were dressed in beautiful traditional dresses and their hair was done up in fancy braids. Some men were decked out in full white 3-piece suits.

Soon we were the ones being observed. Well, the kids were really. It began to get uncomfortable for Josh and Sonja, especially Josh. Kids would just stop and stare, then touch his hair, pinch his freckled skin, and swarm around him. Janis, a British anesthesiologist ex-pat, joined us, and we decided to just start walking and keep walking. The crowd had swelled and it was fairly easy for a group of 4 to wriggle between people, but not so easy for a crowd of a dozen or so kids.

The Piazza is in front of the Gondar castles. Gondar was the capital of Ethiopia in the 1600’s. The castles are encircled by a great stone wall (appropriately) which made for a convenient loop to stroll around while waiting for the highlight of the festival…the burning of the cross. By the time we had made this loop the crowd had doubled. I asked a man when the burning was supposed to occur, and he said 9:00 Ethiopian time. That’s 3pm. So we decided to pop into a sidewalk restaurant for drinks and tibes (the traditional cooked lamb dish with injera). Again, food helps the soul. Josh and Sonja were soon in good spirits again and we ventured back out into the crowds. Janis happened to glance toward the square and lo and behold, the cross was in full flames. It was 12:45pm (translation issues?) Now we were far from the square and it was crowded. Really crowded. African crowded. We wriggled this way and that and eventually were able to see the spectacle. I hope that some of the photos come out, because this is difficult to describe.

Imagine loud chanting coming from several directions. Clapping, singing, laughing, high pitched yodeling. The cross burned and burned. Flames were shooting up to the sky. And then, the cross toppled over, fell to the ground and a HUGE cheer burst from the crowd.

Chilling.

The crowd suddenly became more active. There were some people almost trying to run through a middle channel. One young man seemed to be running directly toward us. It wasn’t until he was less than 10 feet away that I realized he was carrying a hotly smoldering stick. Josh ducked, and the young man dropped the stick to the ground. People rushed forward to snatch ashes from the stick then made crosses on their foreheads with the ash. We backed away to the curb again where a rather frantic man motioned to us then practically gathered us in his arms and told to leave the area and move toward the stage. “It’s a fight!! It’s a fight!!”

I don’t know if it was a fight or not, but I have never been in a more jubilant and exuberant crowd. And it did feel much better to stand further away from the swarms of young men and boys running around with burning sticks. I reflected that this man appeared as an angel sent to help us. Yet another person who has intervened and helped us in an extremely foreign environment.

“TIA” said Janis.

“What does that mean?" I asked.

“THIS is Africa.”