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.

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.

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