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.

Ethiopia: Desperation

We reluctantly leave Barhirdar to start our next leg of travel.  There is so much we want to do to assist Dr. Andrew Browning at the Fistula Hospital, and we make a commitment to spread the word about his devotion to helping these suffering women.  As we board the plane that will take us back to Addis Ababa, we all feel a longing to find a way to help in the most effective way, whether that takes the form of fund-raising, connecting resources, or returning to actually perform work there.

In Addis Ababa, we rejuvenate by eating spicy plates of injera and attending a traditional coffee ceremony.  Morning comes quickly, and we join the larger group of doctors to start our nine hour drive to Gimbie, where prolapse surgeries will take place at Gimbie Hospital.  Women suffer prolapse as a result of prolonged laboring during childbirth.  Unlike fistula, there is no odor or fecal spill, but prolapse is a highly uncomfortable condition and results in the same social ostracizing and abandonment effects.

We wind along curving highland roads, dodging cows, donkeys, baboons and an occasional horse adorned with flowers.  People turn to stare as our entourage glides through small villages.

In Gimbie, we are given a warm greeting by masses of orphaned children who live around the hospital grounds. It is striking how many of them surround us, and we can see the effects that the Western visitors’ handouts have had on these children.  Energetic and hopeful, we hear the same story over and over: how their parents have died from AIDS or some other affliction and they need to get money to buy school books, pay tuition, eat a rare meal.   They are relentless with their begging, and it is difficult to walk from one building to the next without persistent demands to help them, with frequent competitive fist fights breaking out in attempts to get our undivided attention.

Little did we know that this experience with the orphans would only serve as preparation for the larger issue of watching grown adults positioning for the chance to see one of the doctors.  Rural bush communication is lightning quick, and within a day, women are lined up to try to get into the hospital.  Many have lived with their prolapse condition for years, and they see this as their opportunity to be healed so that they can then go back to working in the fields.  A few members of our group have raised funds to provide for 50 surgeries.  From the desperation that is readily apparent, we quickly see that this is a drop in the bucket against the need.

I find an interpreter, and begin to interview each woman.  Over the next few days, I watch the desperation level increase, as they know that the doctors will not stay for long.  For the women, they express this quietly in the longing in their eyes.  For the men who have come to fight for a chance for their sisters to be seen, the desperation comes in the form of pushing, screaming and shoving at the hospital entrance.

A guard stands by to perform the difficult task of deciding who gets to enter, and who does not.

Ethiopia: Overwhelming Needs

More often than not, women are abandoned by their husbands after their prolonged labor results in a fistula.  They reek from fecal odor, and they walk around with blood and body fluid stained clothing. Most women resign themselves to a corner of their hut, and will not emerge during day hours for fear of being humiliated and chastised.

It is rare that a male will show concern or support, and when we do see tender gestures coming from them, our hearts break from watching their helplessness.  It is comforting to know that Dr. Andrew is able to fix the fistula, but the need is so overwhelming that he can’t get to all of the patients.  The fortunate women who find their way to the hospital have to wait weeks before their surgery can take place.  While they wait, they sit in the garden outside of the hospital.  The sun beats down, and an eerie silence ensues.

Everyone knows that time is of essence.

Ethiopia: Abebech, A Young Victim

Abebech, age 8, rests on the operating table, her eyes following the nurses’ every move. She appears relaxed, even though she has not been given any drugs.  Trust is apparent, and a smile creeps across her face as Dr. Andrew Browning enters the room.

On the other side of the room, another woman is being prepped for her fistula repair.  Two surgeries can occur at the same time in the pristine clean operating room.  The woman and Abebech exchange smiles, knowing that relief will soon come to them.

Abebech was brutally sodomized, with a resulting rectal fistula.  Rape was only recently deemed illegal here in Ethiopia, so the culture has not caught up with the new law.  Most women will not admit that rape occurs.  In Abebech’s case, she says that it was “an accident”.  Dr. Andrew knows that the injuries indicate rape.  I ask Andrew if this is the youngest rape victim he has seen.  He shakes his head no, and relays that the youngest was four years old.

My heart yearns to hold her, to take away the reality that she most likely will go home to her perpetrator.  I don’t want to think about how she might suffer this injury again.

Dr. Andrew whispers something to her, and she smiles again.

Ethiopia: Psychological Support

Sometimes a woman needs urgent care while Dr. Andrew Browning is in surgery at the Fistula Hospital in Barhirdar.  The nurses do their best to help until he can tend to the woman in need.  Often, their needs rest in the psychological aspect of their experiences.  Healing does not end after their surgery.  After being released from the hospital, women return to their daily lives of back-breaking wood collection, water fetching, navigating numerous disappointments and bracing against fear of repeated painful bodily injury.

A psychologist is unheard of in rural Ethiopia, and women are accustomed to bearing their own problems.  They live for their children, and will repeatedly return to a man who causes great physical pain, just to live out their desire for motherhood.

At times I get asked why I do so much international work when there are so many needs in the United States.  I have pondered this a lot during this trip.  I think part of the reason is that I am in awe of seeing women with such an unwavering commitment to raising their families and keeping the cycle of life going, despite such dire hardships.  The explosive joy when they see their first baby, a tender touch on the cheeks of their pleading children, a knowing smile they give to one another, the giggles when they carry a heavy load of wood on their hunched backs when they see me, a firenje, the fierce support they lend to one another.  All of this is so magnified to me, living in a society where my life is so easy yet insular.

These women remind me of the power of grace, and the depths to which a loving hand can heal.  I watch them interact with one another, and am humbled by their devotion to life.

How can I not extend a reciprocal hand?

Ethiopia: A Devotion To Women In Need

Dr. Andrew Browning is tired. He spends his days and nights performing surgery on women who find their way to the Fistula Hospital in Barhirdar, working with the staff to ensure that the hospital runs smoothly and is free from the spread of disease, and tending to his own family.  Some women walk days to get to see him and he has to make hard decisions on who gets treated and who gets turned away.

In addition to all of this, he also works on his goal of establishing a C-section program at an outer clinic hospital in Mota to prevent fistula and prolapse cases form the bush rural areas.  Most often, if a women can walk to a hospital within days of continued labor instead of weeks, a C-section will prevent the horrific fistula from occurring and/or death of the baby and mother. Reality hits Andrew hard when a woman shows up after walking for weeks, carrying a dead baby in her womb.  Worse, is when he hears of a lay “doctor” or husband who tries to extract the baby without anesthesia or sterile tools.

Andrew needs many things himself.

He needs more doctors to come to Ethiopia and help him. He needs reliable water at the hospital in Mota.  He needs more sources of support for the work he is performing.

And he could use a bit of cheer in the form of a rare bite of aged cheese, an ice cold beer or a laugh or two.

Weary, with his face lined from processing all that he sees, he is a tender man with extraordinary devotion to these women.  I can only imagine how he feels when his head rests on his pillow at night and darkness tries relentlessly to still his mind.

Ethiopia: A Man’s Involvement

The various health issues that arise in a society that marries off their girls at age 12 and expects a male to start his family before age 18 are abundant.  Rape is illegal here, but it happens often.  And even if the marriage is based upon love, a girl’s body can’t handle childbirth at that young age.

In Ethiopia, divorce or abandonment is not seen as a cultural taboo.  It is very common for a male to move on to another family, and for the woman to be left behind with a large brood of children to care for.  Most often, the women band together and help each other survive on very little.  They continue their jobs of gathering wood, fetching water and preparing food.

But on the occasion where we see continued involvement by the men who are concerned about the health of their wives, there is a focused desperation.  It is almost like they are fighting two battles: to obtain medical care for their loved one, and to push through the cultural norm of indifference.

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