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.

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