Hospital in Debre Berhan

A quick note about the hospital and its response to the outbreak:

The Debre Berhan Referral Hospital is a compound of ~30 single-story buildings with nearly 115 beds. There are wards for medicine, pediatrics, surgery, and OB-GYN as well as an emergency department, an outpatient clinic, and an ophthalmology department. There are close to 10 senior physicians on staff and more GPs (General Practitioner – graduated 6 years of university/medical school but no further training) overseeing patient care. Dr. Aelaf and the GPs live on the hospital grounds in 15'x15' single rooms. We visit the hospital's shai bet (tea house) at least 3 times every day.

As for the outbreak:

Only a handful of people seemed to care about the fact that we were in the midst of dealing with an epidemic or that the patients were at serious risk of death if not managed correctly. The Chief Clinical Officer, a caring, well-intentioned physician, works hard to improve the hospital and often considers Dr. Aelaf’s suggestions, but he is hamstrung by the politics of the institution and its limited resources. The senior physician in the medicine ward is a nice guy who is relatively open to discussion (compared to many other Ethiopian physicians) but he is anti-fluid therapy, which is a small problem in a diarrhea epidemic. He has since taken control of antibiotic management and has spent at least 3 coffee meetings with us discussing the possible agent of infection. This is how work gets done in Ethiopia: we have a meeting and then we immediately have 1-2 meetings in the coffee house to talk through the issues raised in the initial meeting.

One of the GPs in the ward rarely does more than the bare minimum amount of work necessary, if that. I think deep down somewhere is good, but in the meantime, he is inattentive to the patients in his care and has frequently delivered substandard care. The head nurses are good at their jobs, when they do it. Like with Dr. Aelaf’s patient the other night, it is not uncommon for Aelaf to explain a protocol to them in explicit detail and leave very clear instructions, only to return in the morning to find that nothing had been done in the intervening hours. There are some good people at the hospital, but there are just as many people who care less than they should, are lazier than they should be, and inadvertently contribute to substandard patient management, care, and outcomes.

I don’t want to come off as too negative towards the Ethiopian healthcare system. In my time here, I have met GPs who are picking up extra shifts and nurses who take vitals regularly and are attentive to the patients’ needs. I am simply disappointed that their positive work ethic and concern for patients is not more pervasive throughout the system.