Medical mission to Ethiopia - week 1

September 19, 2014

September 13-14, 2014

Today we fly to Ethiopia. It has been several months in the planning, almost a year really. Although my initial announcement of my family’s plans was met with some hesitation, the recent outpouring of support has truly been overwhelming. My Swedish family is extraordinary. Patients, staff and colleagues have wished us well. Our Swedish OB/GYN Issaquah (SOGI) group has been through some challenges these last three years, many related to astronomical growth. But today, as I head to the other side of the world, I can look back and see that some of those challenges have made SOGI an incredibly strong and awesome practice. This is probably the best “well wishes” gift I could have received, to leave a practice that is doing well. This practice we have worked so hard to build is positively solid. And I feel that I am bringing some of that strength with me. At our annual clinic picnic I said that I could not do this trip without them, and that I feel I am bringing a piece of everyone with me. I believe that.

This morning we will land in Addis Ababa. We head to a small clinic about one hour from the center of the city. Blue Nile Children’s Organization (BNCO) serves a very poor area of Addis. We will stay there for a few days. BNCO is starting “Delivery Services” this year, which is Ethiopian for midwifery care. The sign actually says “Deliviery Services,” but it’s doubtful many people will notice a little detail like an extra “I.” Hmmmm. I know a little something about starting “delivery services.” In fact, the nurses and docs at First Hill L&D all have fleeces that say “We Deliver.” It’s the other side of the world, but we are all still people, working together to make something happen.

Sunday

First day. In Ethiopia, it is September 5, 2007. They use the Coptic Calendar. This is wonderful news. Not only am I 7 years younger, but the kids in Ethiopia start school the first Monday in September, which is today. So, our kids will start the school year with the other kids in Ethiopia. (That is, they will start school when they can keep their eyes open past noon given the 11 hour time zone difference!)

In celebration of the beginning of school, the Blue Nile Children’s Organization Clinic (BNCO) had a celebration. Sponsored orphan kids from the area assembled with their foster families in the clinic. The older kids had prepared small speeches to proclaim how grateful they were to begin school. They even performed a skit in which one child was anxious about starting school, but her friends encouraged her and helped her obtain school supplies. At least, that is what it looked like. They were all speaking Amharic. There was also a great deal of mimed hand washing during the skit. I’m not sure what that was about, but I am all for improving hygiene so clapped heartily at the end of the skit. The kids then all received new school uniforms for the year and school supplies.

Monday

We woke up early – really early. The kids were up by 4 or 5am due to the time zone change. We are staying in the provider quarters at the back of the clinic. Around 6:30 we took a stroll in the neighborhood. Received a few “good mornings”, several “Selams”, and many stares. The clinic guard met us a couple streets down. Whether to make sure we did not get lost or for protection, I’m not sure. Our Amharic vocabulary consists of “hello” and “Thank you” at the moment, so this is what we said. He did teach us the word for sun, and we agreed the sunrise was indeed beautiful.

Around 8:00 am people began streaming into the clinic. It opens at 9:30. There was one house officer (similar to an ARNP) on duty, a couple of nurses, and a lab technician. 38 people registered to be seen in the morning alone. This place is busy. About 8-10 people came for family planning (birth control). I offered to see some patients, realizing my restrictions as an obstetrician/gynecologist in a limited community clinic. I saw 2 patients who had the primary complaint of infertility for 2-3 years. My sense is that having a family is extremely important, as anywhere in the world, but maybe more so here. One woman had a completely normal exam, and I told her male infertility could be considered. I am not sure if this a culturally accepted diagnosis. We sent off for a couple of lab tests, and at the end of the exam we agreed that if the Lord is willing she will have a family.

Another patient arrived for her first prenatal exam. She wanted to know her due date, and looked expectantly at me. I asked for her last menstrual period, and she stated 30/9/2006. In my world, today is 9/17/ 2014. I could see very quickly that my pregnancy wheel was not going to be very helpful. The Coptic calendar has 13 months. 12 months have 30 days in them and the 13th month has the left over days. (That extra month is a national holiday for everyone). Their new year starts in September, not January. I knew that they give you the day/month/year when describing the date, but now the 1st month of the year was September, not January, so 30/8/2006 really meant May 30, 2014. Eventually I figured out that she should be about 18 weeks and her due date should be approximately 13/6/2007 (Feb 2, 2014 for us Westerners). Then I measured her fundal height and she measured 29 weeks. So either she is having twins or she has an unsure last menstrual period, and my head is hurting. Obstetrics in Ethiopia is going to be a challenge, and I haven’t even moved past calculating her due date.

Tuesday

Sleep evaded us for many hours again last night. Around 2am, Mark and I heard a loudly dripping faucet from our bathroom. We investigated, and it appeared that the water pressure had increased so much during the night that the hot water tank was finally filling. Oh joy of joys! Prior to this point Mark and I had braved ice cold showers. We hadn’t even made the kids try to bathe and they seemed perfectly happy with that. We decided to have hot showers at 2am, because we weren’t sure if our good fortune would last. Eventually the entire family had hot showers. This also seemed to fix the dripping faucet problem as the hot water tank was no longer over pressurized. Ha ha! Two accomplishments! At 2am.

The kids are currently playing with some of the other kids in the BNCO clinic yard. Initially they played some soccer and volleyball, then a torrential downpour chased everyone into the tool shed. Almaz, one of the clinic nurses, also acts as a children’s program coordinator and she soon had everyone reading books. Josh and Sonja joined them immediately. They just wanted to fit in, and if the other kids were reading, then they were going to as well. I left them at this point and heard a report later. Josh came bounding into our room, “We went to school with the other kids!” Indeed, one of the lab technicians did tutor the orphans for a while. Josh thinks he was teaching them pronouns, but he isn’t sure, as again, they were speaking Amharic. After the tutoring session the local kids tried to teach Josh and Sonja some traditional dancing. There was much laughing and giggling to be heard throughout the clinic yard. Today Josh and Sonja had great smiles. Kids like to be with kids.

 
Kids reading during the monsoon downpour.

One of the girls arriving for the beginning of school celebration at the BNCO clinic. She saw me with the camera and asked to see her picture taken.


The BNCO clinic. The grass has not been cut, because Belay Tessefa, the clinic manager, plans to auction it off for animals to graze, and make a little money to help support the clinic and orphans.

Thursday

Yesterday we caught our Ethiopian Airlines flight from Addis to Gondar. We barely made it and were close to the last ones on the plane. There were long lines, and we had those eight huge bags of luggage and 4 heavy carry ons. But the Ethiopian Airlines attendants were all very friendly and helpful. They didn’t even charge us for the extra bags. The flight was uneventful as well. We landed at the airport. It tannish, that is Amharic for small and consisted of old, castle style brick buildings with a small baggage carousel at one end. I think only one or maybe two flights come in and out of there per day. Six of our eight bags made it. We were not the only ones missing bags. There were about 15 other people, and no one seemed angry about it. A driver met us with a sign “Mark and Kristin.” Solomon called us on the phone as well. It was a very friendly greeting.

Then I went into culture shock. The kids were excited to see the donkeys and goats wandering the streets, little kids yelling “helloooo!!” at us through the windows, muddy roads with large puddles, people everywhere. We arrived at the guest house, and the layout is very nice: 2 bedrooms, 2 bathrooms, a living/dining area and a kitchen. But it is dirty. There is black mold on the bathroom ceilings, dust and grime everywhere, the walls are filthy with chipped paint peeling. The kids hardly seemed to notice and quickly claimed a room. We unpacked some of our things, then decided to try and eat. So, the four of us foreign-gees wandered up the street and found Escalon Hotel. The only Amharic words we knew for food were “injera, tibes, Coca-Cola and ambo,” so that is what we had. It amazes me that Coca-Cola is EVERYWHERE in the world. What a brilliant business. I should buy stock. After eating I could at least assess our living situation. Food helps a lot. Maybe with a thorough cleaning, some white curtains that I’ll fashion out of all of those white scarves I see women wearing everywhere, and some colorful posters to cover up the walls then I’ll be able to live here. I guess I know my current tolerance for dirt. It will be interesting to evaluate again at the end of the year.

Today we visited the hospital. We were met by the CEO who exclaimed several times that they were very happy to have us here and have high expectations. Then he proceeded to tell us some of their challenges. First, the hospital was built in 1920 by the Italians during their occupation. It was built to service a population of about 20,000. Now, the population it supports has grown to 5 million. And the hospital is the same. In the obstetrics/gynecology department there are three (3) Attendings, 40 OB/GYN Residents and another 40 Interns. They deliver about 30 patients a day, but only record about 15 patients a day. Documentation is an issue. They do not have a cervical cancer screening process and would like to start that, but don’t have space. They want to start a quality system, and wanted to know if our hospital at home had a quality department. I could go on and on. There is obviously not a shortage of projects. The CEO was even more excited to talk to Mark about the Bio-engineering department that they would like to start. Apparently 40% of the medical equipment in Ethiopian hospitals lays unused in a storage area because it is broken and no one knows how to fix it. They need an improved procurement system, a maintenance system, a quality system, a repair system, and disposal system. And it sounds like they want Mark to lead all of it. Hmmmm. I was incredibly impressed with the CEO’s knowledge about the problems, his transparency about the issues, and willingness to meet us in the parking lot. If positive change occurs from the top, then it seems they have a good person leading this hospital. Oh, and his advice to us was “don’t get frustrated.” Okay.

First, we headed back to our guest house apartment and started cleaning. The whole family pitched in. Sonja thought it was so much fun, that we should have “Cleaning Fridays.” Sounds good to me. One of the cleaning staff saw us and joined us after I asked for a dust bin. I quickly had another Amharic lesson and now know how to say “dirt, clean, broom and water.” Odesso and I had a good time cleaning together and trying to teach each other Amharic/English. The only catastrophe was that I broke her broom. So then I learned the Amharic word for “no problem.” I may need to use that Amharic word for broom to get her another one. Ooops.

The power has gone out twice in our first 36 hours here. The first time was for 12 hours. It is back on now, so I am going to take this opportunity to cook something for dinner.

Friday, September 19, 2014

We have met a few kids who live across the way from us. One of the families is from San Jose and is visiting for 6 weeks. They will be here another month. The little kids played with Sonja and Josh. They kicked a ball around.