Long Live The Sar

I've been trying to write a post on "The State of Medicine in Ethiopia" since my last blog post. A small topic. Needless to say I have failed to conjure any new ideas, synthesize my own feelings, or fully encapsulate my experience thus far (a full 11 days). Add to the mix the fact that I am currently sitting on the balcony of an apartment I rented in Dar Es Salaam for the weekend. Muhimbili Hospital in Dar Es Salaam started an ED Department and residency program 1-2 years before the Addis program started. Famous for building one of the continent's best ED departments and setting the standard for emergency medical care in East Africa, not to mention frequently training visiting residents from nearby countries such as Ethiopia and Mozambique, this program is amazing and further deepens/conflicts my feelings about Addis. But that's going to be its own post. Rather than delivering a treatise on healthcare in Addis today, I thought I'd simply share some of my re...

Tenastellegn Addis! Has it really been 6.5 years since I was last here? It must be because while so much of the city is comfortably recognizable, the daily reality of 2018 Addis is full of new surprises, challenges, and landscapes. In the summer of 2011 I had just finished my first year of medical school, was excited to show off my knowledge to my mentor, Rick Hodes, still couldn't tell the difference between a systolic or diastolic murmur (I think I finally can now?) and had only the slightest inkling of how much medicine I didn't know. Now, 78 months, 2 degrees, 83% of a residency, a marriage, and a dog later, I'm back. I will be in Addis from January 1-28, 2018 as part of Emory's Global Health Residency Scholars Program working with and learning from the Emergency Medicine residents at Addis Ababa University and Black Lion Hospital . For those worried that I am cockier than before, don't worry, I am now acutely aware of just how much medicine I still don...

The Jewish Federation mission trip arrived in Ethiopia yesterday. I was lucky enough to be invited to have dinner with them @ the Sheraton Hotel - delcious - and got to reunite with some greensboro folks. Great evening. Also got to tag along while Rick gave a tour of the JDC clinic in Addis; it was my first visit to that clinic. It is a small, well-staffed, clean clinic that is definitely one of the nicer medical facilities I've seen here. They are in a tough spot right now because they are charged with medically evaluating and treating anyone who has an open immigration file with the Israeli Embassy; all of the Falash Mura in Addis have been denied immigration by Israel. But the clinic still treats them and their role in the future is hazy as to whether or not they'll continue to see these people or how they will transition to their new role. It was also interesting to watch the 50+ gathered Ethiopians play their political games - they were all wearing their kippahs when the ...

I've been meaning to write a post on this topic for a while, but it's a daunting subject. Expect revisions to come! To understand the practice of medicine in Ethiopia, you first have to understand the country's condition. My take - Ethiopia has been in the dark for the last 30 years and is now trying to match modern innovations with the old technology/infrastructure. This feeling is prevalent everywhere in the country, from the Mission, to the internet cafes, to the hospitals, and the banks. They build 10 story buildings, but the scaffolding is made from tree branches 20 feet long nailed together, not a single one thicker than my arm, and some as crooked as a question mark; it sways in the wind and it's amazing that it stands up at all. Internet cafes are everywhere with brand new computers, but internet no faster than 40 kbps (slower than old dial-up). Government officials drive brand new Cadillac Escalades but there are holes in the street 2 feet deep. MRI's...

are the ~5 euro volunteers helping or being destructive? tough to tell if you are being facetious. I don't know that they're being destructive, but I'm sure that their dressing skills, especially at the beginning were sub-par. I say this only because they didn't watch at all before jumping in and starting to touch multiple patients w/o changing gloves, not using new forceps for every patient, and other things of that nature. I'd imagine they're better now (I haven't spent much time watching them lately) ( update: They seem to be doing just fine and will be working at the mission for the next 6 weeks, so they'll be pros by the end) what are the international ngos that are helping fix the infrastructure problems? Don't know of a single NGO that is making a huge difference here, especially not in infrastructure ( update: Save the Children, UNESCO, USAID , and a few other NGO's are doing good work according to Rick) . The bureaucracy prevents a...

Unbelievable morning. It is mornings like today's when you think this country may have a future after all. As the European volunteers worked their magic in the dressing room again this morning, Zev , Jake, Abebe , and I decided to walk over to the nearby Yekatit 12 Hospital. The GW students had visited and highly recommended us meeting Dr. Thomas who runs the burn unit at the hospital, supposedly the most advanced burn unit in all of Africa. I haven't seen any other burn units, but regardless, Dr. Thomas is an unbelievable individual. What follows is his short biography, a synopsis of our visit, and the bits of information I remember clearly enough to put down here. Born in Ethiopia, Dr. Thomas did his medical training in Norway with additional training in India and Scotland. He is a trained plastic/reconstructive surgeon and built the burn unit @ Yekatit from the ground up. He has now trained 8 doctors from Ethiopia to work in/run similar units and has a competent nursing...

I haven't been doing too much work in the dressing room in the last 3 days because of the sudden presence of ~5 british/french/european volunteers. They have kind of taken over the dressing room (we won't discuss the new level of patient care) and so the last two days have been an interesting departure from the routine. Yesterday, Jake, Zev, Mekais (an Ethiopian starting his 2nd year @ Harvard Med), and I followed Dr. Germa on his rounds through the mission. His cases aren't as complicated as Rick's but he sees the more severe cases of some of the more unique diseases. A short list of the things we saw yesterday: ~Parkinson's ~Leprosy - as with everything else here, a text book example. ~An Abdominal Cyst that dominated the lower half of her abdominal cavity - It was so large such that looked pregnant, but b/c it was so large they were unable to find where it originated from in the ultrasound, maybe the ovaries ~Scabies ~A Leopold exam on a lady who was 30+ weeks pr...

One of the most interesting things about practicing medicine here is that you see a lot of textbook cases. Because most of the patients don't seek care until their disease/infection has progressed to a very severe stage, most of the cases we see, when we look it up in the Merck Manual, are exactly what the textbook describes (if the disease goes untreated). With the two newly arrived med students - zev and jake - we've been looking up many things in the Merck Manual, which is only mildly helpful because the cases are only covered by the last sentence of every entry that starts, "if left untreated..." It is very interesting to see what can happen to the body if nothing is done to help heal it.

As usual, this saturday morning was extremely busy. Even with Rick gone (in LA for 10 days), there was more than enough dressing to be done by the 3 teams working - Dr. Solomon (an orthopedic surgeon I was told), the GW students, and Jim, 2 other volunteers from Lyston (a 23 yo kindergarten teacher from raleigh and a 17 year old girl from morehead city), and the other nurses normally staffing the dressing room. The GW students invited me to scrub up with them (i.e. putting on gloves) and when I told them I only knew what we had been doing the past week they said I knew more than them. When I saw the teacher and the 17 yo helping dress wounds, I realized that I will probably turn out to be much more effective than even I had hoped possible. It was a welcome discovery that maybe I do know what I'm doing, at least in a the setting of the dressing room/opd @ the mother theresa mission.