Ethiopia: New Life

Difficult labor is the cause of prolapse and fistula conditions, yet a rural woman’s purpose in Ethiopia is to get pregnant and raise her children.  Over the years, her body will bear the brunt of extreme pressures, and she rarely is offered the choice to not have more children.  We find that many women who come in for prolapse surgery also want to have their uterus taken out as a contraceptive option.  Abortion does exist in shady corners utilizing sticks and other sharp objects, and some young girls will abandon an unwanted baby. But for the most part, it is a great honor to bear a child and nurture it with vigorous focus and determination.

To witness a woman struggling so very hard to stay well enough to feed her children here is very disheartening.  A human life is precious, and when I look into each child’s face I encounter – whether found wandering on the streets, or in the arms of a loving mother, or working hard to shepherd a herd of cows – I feel a sense of awe in that they are able to survive at all despite so many obstacles.  And yet, they continuously find reasons to express an easy smile.

As I contemplate what might be needed to help this country, I think of several things right away: establishing reproductive and health education, getting more doctors and midwives to be willing to work in rural areas, building more rural hospitals, obtaining sources for clean water, and developing better transportation options for those who are ill.

Yes, it can be overwhelming to see so many problems intertwined and having a domino effect upon each other. But for some reason the thought of new Spring growth comes to mind: is the crocus intimidated by the cold, hard, winter packed Earth?  No, the fragile flower transforms into new life by slowly pushing a tiny bit of dirt away at a time in order to make its way to its fullest expression.  If we really think about it, how does that flower break through the heavy Earth?

Perhaps this is how we can all work together to help a woman in Ethiopia: one small gesture at a time.

Ethiopia: Going Home

As the women heal in the recovery room, I start to see more and more smiles – elation even – and the energy swirls up like a sweet summer ocean wave and starts to take over the room.  The recovery rooms are overflowing, and we have to move patients into the auditorium.  Here, the women chatter happily and start to move around as their bodies heal.

I think back on the Fistula Hospital in Barhirdar, and wish that Gimbie had the same program where women who were recovering received books and other education.  But nothing really matters more on this day other than watching the transformation of spirit.

As I make my way downstairs, I see Jisse, the Oregon doctors’ first patient, as she is walking toward the front door.  Her son is there to help her during her long walk home.  Both of them can hardly contain their joy, and she throws her hands into the air, yelling words that do not need to be translated: she is very much thankful for her improved condition!

Janice, one of the coordinators of our team, is there to hand out dresses that she collected before she left the US.  The women are ecstatic when they see that they each will get a new dress to take home with them.

I think about how little it takes to make someone happy here in Ethiopia.  A pencil.  The sharing of a bit of food.  A wave of a hand.  A used t-shirt.  Clean water.

And health.

Ethiopia: A Generation Of Support

Out of the corner of my eye, I see Dinkiyo excitedly leading a very old woman through the hospital hallways.  I find out that this is Tarike’s mother, Dinkiyo’s grandmother.  She has walked from her far away village to greet her daughter after she heard that she came through the surgery well.

Tarike is lucky, as she has her children and her mother by her side.  She is thrilled that she can now return to her wood selling business and her physical condition can allow her to gather more wood and sell it at market.

Ethiopia: A Commitment To Return

As the operating room becomes more and more efficient, patients start to be moved rapidly through their procedures and faces blur.  Stories are very similar: many children to care for, abandonment by their husbands, little food, unsanitary conditions, a desperate pleading to help them become more physically functional.  One by one they come through and I feel myself becoming less shocked by it all.  Even the stench of dead bodily tissue is not as bothersome as when I first arrived.  But what is concerning me at this point is how we take for granted each day back home.  I hear the surgeons talk about the petty complaints from their stateside patients, and I cant shake the sickness I feel in my gut.

Is it really fair that we have so much, and they have so little here?

We discuss our plans to return.  It is the only way we can face the possibility of leaving so soon.

Ethiopia: Sadness From Turning Women Away

Word gets out that doctors from the US are at Gimbie hospital.  Each day, women line up to try to see a doctor.  Some of them have walked for days to get to the hospital.  As we interview the women, we find that most women have lived with a prolapse condition for many years.

When a woman has a prolapse, she experiences a great deal of pain. Sometimes the prolapse includes ulcers that bleed.  Walking, which is their only means of transportation, becomes extremely difficult, thus preventing them from working in the fields, gathering firewood to cook with, and tending to their children. Her children start looking for food elsewhere, and often times the children roam away from home and try to live on their own, banded together foraging for food.

The boys can survive this nomadic lifestyle easier than the girls.  A wandering girl is a target for many things: early marriage, physical abuse, excessive domestic work, rape, and early pregnancy, which starts the cycle all over again.

One can see how desperate a woman becomes when she hears that there is a chance she could be cured.

Even though there are four surgeons, we all soon see that the needs in Ethiopia are overwhelming.  This calls attention to the issue of extended follow up care: our Oregon doctors are performing many surgeries during the week, but there are only a few doctors who can handle the follow up after the Oregon doctors leave.  As the lightning quick bush communication spreads, people start to mob the front doors of the hospital, pushing and shoving to try to get in.  For the women who are lucky enough to have a support system, the fathers and brothers are here to demand that their loved one is seen.  Desperation is readily seen on their faces, and it is disheartening to know that we only have a few more days to get as many surgeries done as possible.  And in order to not overwhelm Dr. Tekle, the lone Ethiopian surgeon who works permanently in Gimbie, we soon will be cutting off surgeries.

Reality sets in, and we all know that one of our most difficult tasks is turning people away, especially after they have walked for days, in excruciating pain, for their only chance for help.

Ethiopia: Jameke & Her Frail Baby

As I pass through the overcrowded aftercare wards, I see a young girl who stands out from the rest of the patients.  She has beautiful deep black skin, and there is an air about her and her family that persuades me go to the nurses’ station to ask about her.  I can’t recall if she is a patient of any of the doctors.  Is everything OK, I ask?  Each nurse just shakes her head and looks away.

I find out that her name is Jemate and she has arrived last night from another hospital.  There, she had tried to give birth to her baby, but the baby could not move through her birth canal.  They tried many things to extract the child, but to no avail.  With her baby wedged in her birth canal, Jemate walked many miles to Gimbie Hospital, and her baby was delivered swiftly by cesarean section.  Her baby, Emanuel, is now holding on, yet fading fast.  Jemate’s family sits in silence.

As we move through our days, I make sure that I check in on Jemate each day to shake hands with each of her family members.  I learn how to say “beautiful” in her language and keep saying it as I peer over Jemate’s father’s shoulders at his grandson, baby Emanuel.

There is stillness between these family members that is difficult to describe.  Coming from a culture where maternal and infant mortality is low, we don’t know the signs of impending death very well.  Everyone here knows that the baby will soon die, and they sit in this accepting silence as other healthy babies cry and are nurtured by other mothers in beds surrounding Jemate.  In addition to baby Emanuel’s fragile condition, Jemate’s body is also recovering from this trauma birth, yet she musters a few smiles through her devastating sadness.

Two days later, we hear that baby Emanuel is still holding on, being fed formula by a syringe.  But, as often happens in Ethiopia, Jemate has slipped into death’s grips while the doctors’ concern was focused toward her child.

Ethiopia: A Baby Is Abandoned

The hospital staff is clearly concerned and something is very wrong.  I hear that the mother who just delivered her first child and is threatening to kill it, has been taken into isolation to be watched.  I find the young girl sitting in a stark room, with her baby at her side.  The attending assistant translates for me, and I ask her why she wants to kill her child.  Tears run down her face, and she says that her mind isn’t capable of taking care of a baby, and her father is very upset with her for having a baby. Her mother died when she was 8 years old.  We get little else from her.  When her tears subside a bit, she smiles hesitantly, and looks at the baby beside her, reaching her hand out to touch the newborn girl’s hair.

Just then, I am called into the OR to photograph a particularly odd medical case, and I am torn about fulfilling my duties to the surgeon and staying near this mother. The attending assistant assures me that he will stay with her, and she will not harm the baby.

Soon I am scrubbed in and heads down with my macro lens into an ulcerated prolapse, my mind on rote as I try to figure out the difficult lighting conditions to get a good medical photo. We all get caught up in this surgery, and time flies by.

When we finally exit, we hear that the young mother has left the hospital, abandoning her baby.  The nurses have the baby swaddled in blankets, and we all take turns holding her. We do our best to make her feel loved.

Ethiopia: Tarike & Dinkiyo

After several days have passed, I notice a woman who has been patiently waiting since we arrived.  Tarike is 30 years old, and has walked very far to get here.  Her 9 year old daughter, Dinkiyo, waits with her, a tiny replica of herself.  She has three other children and makes a living selling firewood.  Business has been down, as her rectal fistula prevents her from working in the fields.  Her first husband died of some undiagnosed medical condition, and her second husband abandoned her a few years ago when her fistula appeared after hard laboring during childbirth.  She lives with her mother, and together they eek out their existence.  They live on very little food and water, in highly unsanitary conditions, but this does not seem to deter her from being a loving mother to Dinkiyo.

I see that she has been selected as a candidate for surgery today, and I watch closely as Dinkiyo tends to her mother, fear shadowing her face often.  Many times, when someone enters into a hospital in Ethiopia, they are subjected to procedures without anesthesia, their health falters, they die.  Dinkiyo never leaves her mother’s side.  I try to find an interpreter to talk with her, but they are all busy in surgeries.  Instead of talking, I give her four pencils, one for herself and three others to take home to her siblings.  She beams, and shows her mother the brightly colored erasers on the end.  She is beside herself with happiness from such a small item.  I wish I had a pad of paper to give her.

Soon it is time to bring Tarike in for surgery.  She gasps, and reaches out to her daughter.  The nurses give her little time to say goodbye, and I hear her voice get louder with words I can’t understand as she is led away toward the operating room.  I follow, and try to find a nurse who speaks English.  What is she saying? I ask repeatedly.  No one, understandably, is listening to me.  They have much more worry on their minds, as word circulates that a mother has delivered a baby in the room next door and is threatening to kill the baby, because she has no means to take care of it and has been disassociated by her family due to her early pregnancy.  I still persist a bit, and finally someone asks Tarike what she needs.  “My daughter.  Please take care of my daughter.  She is alone outside.”  I drop most of my equipment on the nearest chair and go outside to find Dinkiyo.   She is sitting quietly on the stairs alone.  I extend my hand and without asking if it was permitted, I bring her into the recovery room away from the crowds.  Brynn sits down beside her, and Dinkiyo’s face lightens up as she shows Brynn her new pencils and begins to count them in English, “one, two, three, four”. She giggles as she continues counting, her confidence growing as she sees that Brynn is impressed  by her knowledge of how to count in English.

Ethiopia: A Band Of Surgeons

The surgeons push on late into the night, assessing patients, prepping them for surgery, waiting for instruments to be taken out of the autoclave, and discussing efficiency improvements.  They are exhausted, yet thrilled to be working so hard together.  One of them makes the remark that this feels like when they were interns, working around the clock yet incredibly interested in all that happens.  A camaraderie builds, and out of their weariness, humor rises.  I bring in my iPod speakers, select some blues music, and spirits soar.  I’m glad I ended up packing that heavy thing after all.

Four surgeons are rotating patients and assisting each other with any menial task.  There is no questioning of roles, no ego, no positioning of power.

Dr. Rahel Nardos, a uro-gynecologist fellow and native Ethiopian, is here to assess the hospital’s capabilities and create a proposal for Oregon Health and Sciences University (OHSU) to send rotating residents and staff to perform surgeries and train local doctors.  It is vitally important to make sure knowledge is increased at the local level, so that more expertise is developed with Ethiopian doctors, otherwise our mission is more altruistic than humanitarian focused.  The residents benefit as well, as they will see a vast variety of pathologies that they would otherwise not see in years, if ever, in the US.

Dr. Michael Cheek is a gynecologist from the Lincoln City, Oregon area, and this is his third trip to Gimbie.  His cheerful nature helps everyone get through even the most intense situations. He works alongside his brother, Dr. David Cheek, a brilliant anesthesiologist. Together they make a great team, especially when they break out in harmonic song at any given time, their voices intertwining in a perfectly matched manner.

Dr. Kim Suriano and Dr. Philippa Ribbink are OB/GYNs and owners of a private practice, Everywoman’s Health, at Legacy Emanuel Hospital in Portland, Oregon.  They are familiar with each other’s surgery styles, and move about the operating room needing very little words to convey what they will do next.  Dr. Tekle is the only local Ethiopian doctor in the room, and he is joined by an exceptionally talented local Ethiopian nursing staff.

Patients come and go, bizarre pathologies are seen in addition to the prolapse cases, and soon the operating room’s activity is like a finely tuned band of musicians.  My daughter Brynn enters the room, scrubbed and ready to do whatever is asked of her.  I am a bit stunned that this is permitted, and even more surprised that she was willing to come in to observe the surgeries.

Before I can process my thoughts, she is handed some instruments and is asked to cut suture, spread cavity walls, and dab blood.  She does it all, seemingly unfazed by the fragility and rawness of life that rests vulnerably in front of her.  She stays throughout the four hour completion of the surgery, and is clear headed and confident as she leaves to go work with the outer clinics with their dental activities.

Ethiopia: Operating Room Day 1

We wake to the sounds of declaring roosters, distant priests chanting and wildly chirping birds.  It is dark, and the air has a quiet balmy breeze that reminds us that our hot restless sleep under the mosquito nets might be overshadowed by the morning’s peace.  We go out on the veranda and look East as sun rises over the hills.  Our quiet solitude is broken by the hurried bustle of voices as our cooks arrive to start the day’s meals.  They enter with gusto, arms full of supplies, with confident vigor as they start to move about the kitchen.

They soon are working alongside each other, with one obvious commander.  Cooking for ferenjis (white people) takes special care so we don’t get parasites, and they do this with a glint of humor in their eyes.  Frail white people we are. I instantly feel like a wimp, as I compare my life with theirs.  They are loving and gracious, and any time one of us would enter the kitchen, it was like we ourselves were a parasite to them.  All eyes turned to see what we needed, and anything we asked for was granted. They know the doctors are here to help their people, and they want us to have as much energy as possible as we start our day.

And, they know what our hearts will encounter within the halls of Gimbie Hospital.

Day One in the operating room is chaotic.  The doctors scurry madly to assess the equipment on hand and to supplement it with the equipment they were able to get through customs.  We knew that gauze was re-washed and suture was scarce and that electricity sometimes failed.  As they discuss position on the first case, a sense of urgency prevails.  They want to complete as many surgeries as possible and this is no time to waste time and energy.  Within minutes, they are ready.  Jisse Fufa, age 45, is led into the room.  She has had her prolapse for two years, and had just walked two hours to get to Gimbie.

There is little time or the language to sooth her fears, so I assume the role of looking deeply within her eyes and smiling, sharing the task of holding her hand and stroking her face with the nurse anesthetist.

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