Category Archives: Medical

Ethiopia: Our Eyes Together

She stands in the doorway, shoulders slumped, hair in tangles from not being washed in a week, shirt stained with blood, tears streaming down her cheeks. One hand is in her lab coat pocket, the other fumbles with the keys that mysteriously no longer work in the door to her sleeping room. Four women walked in with dead babies today alone, with several mothers struggling in other beds; it’s been a difficult day.

She longs to quiet her mind, to place the images of death in perspective with the job at hand. She signed up for this, with full knowledge of the difficulties. A diversion please. Shower? There is no water. Chocolate? Gone. Music? Too much of a reminder of home. A nice note of encouragement via our CDMA internet connection? It’s 3:10am back home, so no news. Like many Ethiopians who are hungry, worn or troubled, she reaches for sleep. But in this place, on this day, it does not come. Tossing and turning, stomach in knots, a fever arises and she whispers: “This is hard.”

Death is a part of the fabric of life here in Ethiopia. The people have come full terms with the likelihood of its occurrence. According to World Health Organization figures, 10,000 babies and 1600 mothers die from childbirth complications every day. Here at Mota Hospital, the director responds to the question regarding what is the most difficult aspect of midwife retention with the words: “We see death of our mothers and sisters every day, on our doorstep, and we have little supplies to help them.”

The problem is quite complex, as many intertwined issues exist in Africa. When a girl or woman labors at home, she may not even be aware that there is a health center nearby. Hospitals have a desperate need for doctors, which are first priority, and they rarely have money for outreach and education. Even if she does know about the hospital, often a woman will suffer in silence and not want to bother her husband, father, brother who toil in the fields all day. By the time she musters the courage to say she thinks she is in trouble, it is often at such a late stage that the baby and mother are well headed toward death.

If she is lucky, the husband, father, brother may then rally several men to carry her over the rock strewn and rugged terrain to get her to the hospital, walking for hours, sometimes days to get her here. And then, once here, they see the costs that are associated with care (most often less than $100) and they quickly realize that they will have to sell all of their cows in order to pay the bill. The pivotal decision must be made: get the care their loved one needs and become destitute, or turn away and go back home. At times, treatment will be started only to have the family run out of money and leave mid-treatment. And perhaps the worse situation is when a woman is carried to the hospital only to find that it is not staffed.

We often long to pay for services when we see that they could save a life. We are told that this is not sustainable for the hospital, as many problems arise when the hospital cannot pay for other villagers after we have gone. Money is best donated toward equipment and occasional free services where they deem it to be appropriate. So, we assimilate to this way of life, and now, here in this tiny village, the problems of Ethiopia become our problems. No longer are we a simple bystander. We feel the loss. We see the complexity. We are saddened by the pain these women and their families suffer.

And, we hold hope, just as the doctors do.

A new road is being built that will connect Addis Ababa to Bahir Dar. Mota will become a stop mid-way, and many believe that this road will create a demand for better services in Mota, such as desperately needed water flow. This will enable the old rusted truck ambulance be to retrieve patients from outposts. It will bring better telecommunications services. The doctors tell us that they have seen immense progress already in the few years that they have been here. I ask them what support they have to mentally keep going when they see so much suffering and death every day. Their answer is said with quiet and passionate devotion: “These are our mothers and our sisters. Of course we will work for them.”

I have often reflected on the eye contact that is present in Ethiopians. I have traveled to many countries, witnessed many rituals and interactions, and never have I seen such an intense and long-holding gaze as here in Ethiopia. A few weeks ago, an Ethiopian man said something to me when I asked about courtship here that plays out in my mind today. His words: “Everything starts and ends with the eyes. It’s all within our eyes. Words are never needed.”

Ethiopians are creative, full of wonder, and tender. They know and experience many things that most of us will never endure, let alone fathom that these situations even exist. When I look into their eyes, I see more than the current situation at hand. I see belief, hope and an almost father-like twinkle that tells me they see me as a child: innocent, comfortable and maybe even if I am lucky, endearing to them. They see through me, because my life, my world, is transparent and thin compared to theirs. Their heart beats hard every day, while mine has long periods of rest, boredom even.

I look at Dr. Philippa as she finally finds sleep, and I admire her dedication to enter this world and exchange information with the midwives, and to also bring us all into the equation of moving toward the goal of creating healing environments for anyone who suffers here.

It is now morning, and Dr. Philippa rises with vigor and purpose. She picks up her stained lab coat, grabs a piece of bread, and pushes the door open to go round on the patients. Before she leaves, she hesitates, looks over at me and starts to say something. She searches my eyes, and then without words, closes the door behind her.

Ethiopia: Degie’s Story – Part 2

By now, many family members are crowding the doors, becoming more desperate as time moves on. I try to ease their concern by saying “teru doctor” (good doctor) but they look past me. Crying turns to sobbing, as each family member finds a stoop to sit upon outside of the operating room that is maneuvered without running water.

By the time I have changed into scrubs, I see that the nurse anesthetist is already preparing Degie for her spinal block. I rush into the room, find a position that is far from the sterile field, and set up my camera. Within literally minutes, Dr. Philippa exclaims with excitement, “And…..WE HAVE A BABY!”. The room is filled with the glorious sound of the cries of a newborn baby.

Though extremely weak, Degie is now alert, and begins fervently looking about the room, her eyes tracking every move of where her baby is. I ask a midwife to bring the baby over to her so she can see it. He does so, and she stares deeply at the infant. I take a few photos of the baby, and exit the room. I can’t take my scrubs off fast enough to make my way outside. I show the family the photo of their newest addition and say ” konjo baby” (beautiful baby). The sisters and brothers press against each other to get a peek at the photo. The grandfather shouts for joy.

Degie’s parents are both dead, but she has a wide circle of support with her many brothers and sisters and grandparents. One young man looks particularly shy, and stands apart from the group. I move away from the crowd and show him the back of the camera. A slight smile starts at the corners of his mouth, and he looks intently into my eyes.

“Degie husband”, someone whispers. I turn to try to say something to him, but he has moved away. He now stands in front of the doorway, trying to get a glimpse of his wife.

Ethiopia: Degie’s Story – Part 1

Degie is curled on her bed, her body is still. Her breathing is shallow, and her eyes can’t seem to focus. Her tattered gabby cloth swirls around her body, and one bare foot is dangling over the side of the bed. I look at her for a long time, wishing I could help her. I hear a voice, and see that the woman in the bed over in the corner is also watching her.

“She sick. Very sick,” she says in broken English. I nod silently in agreement.

Degie is tiny. Her rail thin body is listless, and her mouth gapes open as she tries to take in each breath. I try to find a midwife to ask about her, and as I start to move away, Degie screams out in agony. A midwife rushes into the room, followed by our medical team. She has been in labor for a long time, no one knows for sure exactly how many days it has been. A few family members are sitting near her bed, and as the day progresses, more brothers and sisters trickle in, having heard how sick she is. Many are openly crying.

In rural Ethiopia, family members are expected to fill in as nurses and to provide other items of support such as food and bed sheets, but it is apparent that this family is here because they love her dearly and they are deeply frightened.

This is Degie’s first pregnancy, and she is near death due to this long labor.

The midwives administer Pitocin, and wait for her contractions to come more frequently. Once they do, they ask her older brothers to carry her into the labor room, and they comply in a stoic manner. It is not hard to see the concern on their faces. Degie continues to contort her body as each contraction comes, yet she is so weak she can hardly breathe, let alone scream during her pain. The midwives ask Degie to start pushing. They try everything to get the baby out, but it will not move.

Degie is suffering from obstructed labor, which often results in death for both the mother and baby.  If a woman does live through obstructed labor, she frequently develops a fistula, which has devastating physical, social and psychological effects.

After two hours of pushing and an attempt at delivering the baby with a vacuum, one midwife, Selam, asks for visiting obstetrician Dr. Philippa to return to the labor room. Once Dr. Philippa arrives, she agrees with Selam that Degie’s tiny pelvis will not accommodate the birth of this baby and the baby can only be delivered by cesarean section. When they ask for Degie’s consent, she shakes her head no. She is scared and is worried about the money: less than $100. The midwives tell her brother that both Degie and the baby will die if the baby does not come out soon. Degie’s brother assures Degie that they will sell precious cattle and do whatever it takes to find the money. He pleads with her to say yes.

Degie gives her permission, and is swiftly transported to the operating room where a team of midwives, a nurse anesthetist, Dr. Philippa and Physician’s Assistant Darlene have assembled. They are ready for her.

Ethiopia: A Convergence Of Support

In our fury to obtain water and find sources of clean vegetables and resolve the insect biting problem and find the latest irrelevant lost object, we sometimes forget why we are here in this dusty, remote village of Mota. Bekaset’s story is a jolting reminder of the desperate need for help in this region.

Bekaset’s pregnancy progressed normally until she went into labor. As she labored, her pelvis was too small to deliver the baby, and the baby became wedged in her birth canal. She knew something was terribly wrong, but she lived far from any health care and there were no midwives in her village who could help her. Her labor became obstructed, and the contractions forced the baby lower and lower into her birth canal. The relentlessly intense pressure eventually tears her uterus open, and the baby quickly dies.

Had Bekaset not heard good reports about Mota Hospital, had she not made the decision to leave her safe and comfortable home in her village of Debrework to try to find help here, had she not felt physically able to make the long bus and foot trek to Mota Hospital, had the men in her life not supported this journey by carrying her as she labored, had she suffered in silence like so many Ethiopian women do, she would be dead today. This would have left her children motherless and her weary, loving husband, who toils all day in the fields, uncared for. It is apparent in the eyes of her husband, Niguss, that he is desperate for her to live. He looks at her tenderly, his fingers slowly stroking the edge of her blanket. Words are unnecessary at times such as these, and cultural differences disappear. His pleading, yearning, silent eyes say everything. They will haunt me for life.

Instead, Bekaset is now under the care of skilled midwives and our medical team. A decision is swiftly made to remove the dead baby and her uterus, so she does not perish. Her surgery proceeds without issues, and her recovery is quick.

Days pass, and it is now time to go home. Her husband and father, who have been patiently caring for her and bringing her food during her days of recovery, are there to walk with her to the bus terminal. Her face is drawn; she has lost the baby she had come to know within her, and she also realizes that she will never bear another child. Yet, there is a deep respect for those who helped her here at Mota Hospital: she is alive, well, and able to return to her other children and household duties.

We give her a pair of donated KEEN shoes to make her walk home a bit more comfortable, and I watch as her family take tiny steps behind her to ensure that she is supported. The love is so apparent, more so than I have witnessed in many recent years of observing my own culture. They know what Mota Hospital has done for their lives, and without words, we all know why we came here.

Eyes speak, hearts leap, hands join.

Ethiopia: Birth!

I am a mother three times over. My offspring are away at college, and I try hard to release my hold on them and not hover like a mama bear. But it is an undeniable truth that they are a physical part of me, each one, with all of their idiosyncrasies and troubles and joys. I feel them, like they are appendage, even when they are miles away.

Before I had my first child, I never thought I would be changed because of the experience. I had grand plans to return to work after a respectable six weeks off, only to hold my firstborn son Ben in my arms and sob uncontrollably, knowing that my decision making was altered for life. Everything, everything, began to be centered around what is best for this child. My own desires seemed lofty and were suddenly not so important.

My first pregnancy progressed well, and I ballooned a 60+ pounds. I was proud of my spindly legs carrying such an enormous belly. People stopped to stare when I was only in my seventh month, thinking I was about to deliver any minute. I soaked up that attention and felt like a queen everywhere I went. Doors were opened, chairs were offered. The whole while, I felt glorious, never sick or weak, only blissfully content as a felt each kick.

Ben announced his entry into this world almost exactly on his due date, and all seemed fine at first. Then, after laboring for 17 hours and pushing for 3 hours, it was determined that he was in extreme stress and he simply could not fit through my birth canal. A whopping 9 lbs 11 oz of a baby he was! He also broke the hospital’s record for being their longest baby at 23 1/2 inches long. I was proud of my Big Ben.

I reflect on this now, as I watch a mother suffering her labor after walking miles to get to Mota Hospital. Had I lived here, I would surely have died during childbirth. I would never have come to know my three children. I would not have seen Ben write his first magazine article, or Aaron develop his love of the electric bass, or Brynn fly effortlessly on her feet while she danced. I would not have settled countless arguments or worried late at night when they did not come home or cry when they said they hated something I did.

I am now in the birthing room, and I watch Adele suffer. She repeatedly pulls on her ragged dress in pain, and I see that the baby is not easily coming. The midwives scurry to get the vacuum and swiftly adhere it to the baby’s head. With mighty force, they begin to pull, as she writhes in pain. They pull harder. They yell at Adele. Two people pull even harder together. They must cut her to widen the opening, determining she does not need a C-section. They pull with all of their might. Dr. Philippa steps in, and tells them to alter their angle: lift up, not down. Finally, after much screaming and fierce pulling, the baby is out. Adele stares at the ceiling, her eyes not searching for the baby at all. I can’t fathom what she is thinking. I watch her, and slowly she turns her head in search of her first born child.

The midwives ask her to get down from the table, and she walks over to the door where her mother and grandmother wait for her. They will assume post care, feeding her, keeping her warm.

I am in complete awe of the midwives here at Mota Hospital, and it is a true honor to even be in their presence. Tedele is quiet as I acknowledge his skill. He looks away, then down at his bloodied hands. I am sure that not all of these situations resolve so easily. He knows that I am only seeing one small aspect of his job.

Tedele turns to the buckets of water and silently washes his hands.

Ethiopia: For The Love Of Water

Water. Glorious, delicious, comforting water.

Much has been said in recent years about the importance of water, the impending worldwide scarcity, the droughts that countries suffer. Yet it can never quite hit home or feel like a reality until the loss of water is personally experienced, when each drop is precious.

We knew this hospital would not have running water. We stocked up on drinking water before we left BahirDar, and made sure that we had sufficient cleansing wipes for our hands while working in the hospital. But what happens when a bottle of ketchup drops on the floor, splatters everywhere and there is nothing to clean it up with? This leads to an invitation for cockroaches, an increase in mosquitos, and a myriad of other issues. Or when we need to clean a dish, or fry eggs for a dinner, or wash a utensil or wash our hands after handling something we know is contaminated? Do we use precious bottled drinking water for that?

We conserve the best we can, yet find ourselves battling with the wash lady over how much water she is using, literally fighting with the handle of a bucket in order to keep one in the house for other uses. We get water from the government a few days a week, but as soon as it it turned on, the hoarding begins, and it quickly runs out. We join the hoarding by purchasing more buckets to fill up with the scarce resource, and even collect the bad water from the leaking sink to use for flushing our toilet. Swiftly, we join the thousands of other Ethiopians who live in extremely unsanitary conditions.

Public health posters plead for people to wash their hands to prevent the spread of disease. This action is embedded into our Western culture, yet what do you do when you have no water?

Animals pass on the road, their bodies thin, bones protruding. Every day, there is a multitude of decisions over who gets how much water and when. Bathing goes to the wayside, and still, we have trouble choosing how we will use our supply. We decide to drastically reduce our cooking, which uses more water than we can spare. Boiling eggs requires little clean up, and we can use the water for something else, so that becomes our staple protein. And when we sparingly use water to occasionally wash our hands, we do so over the toilet so that water can flush waste.

We stop drinking water, from subconscious thinking, and I faint one morning from lack of fluids. We have no car to retrieve more water, so our minds turn to how we can pay someone with a donkey cart to help us. All the while, we see women and small children carrying, for miles, large plastic containers full of river water. And we realize how fortunate we are: we have the means to purchase water. Now I know why kids fight their way to the firenji when we stop in villages, scrambling to get the last bit of water in our water bottles.

Wash your hands to prevent the spread of disease? This sentiment seems a joke to me now. And it makes me incredibly sad that water is scarce here at this hospital, a place where sanitary conditions are expected. A well would serve this health care community in ways that are immeasurable. A simple system of collecting rain water and saving it for the dry season would drastically have an impact on the lives of the doctors, patients and students who long to be of health service in this isolated terrain.

Ethiopians have a right to water just the way we do in Western society. I think of this every time I face the sink at home. I say a silent “thank you” every time my hand turns a faucet. I long to be able to build a big pipe that travels across our continent, under the sea and over the mountains to be able to flow here in this little village in Ethiopia. Surely we can find a way to conserve, and share, this resource.

I accept this time of extreme difficulty without the luxury of flowing water. It teaches me many things. And knowing that it is a temporary situation gets me by. But oh how my heart aches for those who will remain here, struggling each day to find their drops of glorious, delicious, comforting water.


The Mota hospital scrub room.

Ethiopia: Home Sweet Home

Here are a few photos of our home here in Mota, Ethiopia.


Our living space.


Our kitchen. Sink leaks badly. But hey! We have a refrigerator!


Our bathroom: water comes a few times a week if we are lucky. Toilet does not flush, but we can pour water into it.


Our trusty Mr. Bleach. Food is soaked in it, kitchen is cleaned with it. I love Mr. Bleach.


The outside of our home.


Wash day!

Ethiopia: Off To Mota

We said goodbye to Dr. P and Darlene, and off to Mota they went. We were excited to know there was cell reception in Mota when we got our first call from them. The news was equally as exciting. In less than 24 hours, they had been harassed significantly in BahirDar, found themselves in the middle of a religious celebratory mob scene in Mota, learned that there is no internet in Mota, found out that we would have water only three days per week, and that no cook existed for us.

The good news: sheets are pretty clean, the hospital staff is warm and inviting, and the air is cool without too much threat of malaria carrying mosquitoes. And the rooms are in the hospital compound so we can be locked in at night.

From all accounts, they are navigating the obstacles the best they can. This does not come without a bit of sleeplessness and anxiety….and lots of “what ifs”.

What if a women dies while we are there? How will Dr. P and Darlene feel about removing a dead fetus? What if a woman is hurt? What if a referral needs to be made, knowing there is no place to refer in the vicinity? What if the village gets angry? Will they accept a female doctor?

Most of these questions seem less of a concern during the daytime. But when the head hits the pillow, we all lie awake churning the scenarios over and over.

This is the hard part. And we signed up for it.

Dr. P and Darlene get ready to take off on their plane to Mota, while Jay and I turn toward Arba Minch

Ethiopia: Dr. Catherine Hamlin

Holy cow! An interview with Dr. Hamlin!

We thought we would be lucky just to be able to meet her and shake her hand. Never in my wildest dreams did I think we would be granted an interview and the ability to photograph and film her. We make our way back to the hotel to pick up the equipment and Jay and I cannot help but express our giddiness…and concerns. We had not had time to test out all of the equipment and work flow, thinking that our first interview would not occur until days later. Some of the equipment was purchased hours before we got on the plane, so one can only imagine how we felt going into this interview.

Sound levels ok? Camera functioning? Will everything talk to each other?

We then turn to preparing some questions for her. She is 87 years old and still performs surgery. She came to Ethiopia in the 70’s, thinking she and her husband would stay here for only a few years. The fistula patients made a great impression on their hearts, enough so that they decided to dedicate their lives to this work. A very interesting subject indeed!

On the bumpy taxi drive back, Jay is still testing sound levels to make sure the H4N works properly. I am lost in my head, thinking about how to set up the camera with the least amount of fuss and intrusion.

Dr. Hamlin enters the room, her tall and graceful stature filling the space. Her kind eyes fix on us, and we are instantly at ease. The door opens again, and in walks Mamitu, the famous illiterate surgeon who was once a poor fistula patient and learned how to repair fistulas by working alongside surgeons rather than complete formal training.

My eyes fill with tears as I look at these two women who have had such a profound effect on fistula patients’ lives. It is such an honor to be in their presence.

Jay and I quickly set up the equipment, and we get started on the interview. Our questions were not really a necessity, as Dr. Hamlin has many things to say to us from her own agenda and determination.

Ethiopia: The Hamlin Fistula Hospital

During this past year, I have kept in contact with the communications director of the Hamlin Fistula Hospitals. I promised to bring her several bags of KEEN shoes that were graciously donated so that patients could walk home more comfortably, even though the weight of these shoes would add a bit of complexity to our travel. Getting the shoes through customs can be difficult, which often means having to be held back for questioning.

Sure enough, we were stopped by the customs officer, with his incredulous question: “These shoes! Are they all yours?” (Really now, do Americans give the impression they would travel with 40 pairs of shoes?) I put on my most confident stance, and picked up the heavy bags, explained that they were donations, and turning on my heel to take off, did not give him time to ask me anything else.

We arrived at the Hamlin Fistula Hospital the next morning, and were instantly astonished at the site of this hospital. Lush gardens were the dominant feature, overshadowing the buildings. It felt as though we were in a fairy tale. We talked with Feven about many things, but one topic was of utmost importance: which direction we should take with our documentation and film.

Feven explained that young girls are often married off young to avoid abduction and rape. When the girl becomes pregnant at an early age, her pelvis is too small to give birth to her baby and she labors for many days and sometimes weeks. The constant pressure of the baby creates many problems.

When the young girl who lives in the rural countryside realizes that her baby is not able to be delivered, she usually has little choice but to wait for the baby to die in her womb. Even after the dead baby shrinks and is able to be delivered or extracted by a family member, she is often left with a fistula condition, where a hole is formed between the bladder and/or rectum and the vagina, and waste continuously flows, resulting in ostracizing from her village and abandonment by her husband.

A girl with a fistula usually will live on the outskirts of the village, afraid to walk for fear of contaminating her surroundings. She sits in a makeshift nest, and waits out her days, sometimes having to fight off hyenas due to her constant smell.

Sadly, this can all be prevented if there was better access to health care in the rural countryside. The Ethiopian government is building hospitals and clinics all over the country to address this. However, most of the clinics stand idle, in desperate need of doctors.

Our time here will be spent in a tiny hospital, which has no running water, in Mota. Dr. Philippa Ribbink will be training Ethiopian Health Officers how to perform emergency obstetrics. We know that this work will have a profound impact on all of us, but sitting here and listening to Feven, we are energized to do this work.

Feven asks us to focus on the inaccessibility that a young pregnant girl faces. Sometimes this means lack of access to hospitals, sometimes it means that while a hospital may exist, no doctors are present. Often it means that the young girl cannot get to the hospital. Foot bridges are washed away, the terrain is too rugged to walk during the 4th or 5th day of laboring, or family men cannot leave their farming work to be able to carry her on a makeshift stretcher. We also hear that more donkey carts are desperately needed to help facilitate her ability to get to a hospital during prolonged labor.

A few weeks earlier, I had made a request to meet Dr. Hamlin. Nothing was promised, as many people ask to meet her and her time is extremely limited. I watch as Feven picks up the phone and dials a number. It is a apparent that she has called Dr. Hamlin, and she asks if she has time to meet us. After a bit of dialoging, we make a plan to come back at 3pm, with our cameras. We have been granted an interview and approval to film her.


A young patient sits on the grounds of the Hamlin Fistula Hospital, in Addis Ababa.


Dr. Hamlin and Feven Haddis are delighted by by the donation of KEEN shoes

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