A rude awakening

Although my time spent in the Ethiopian hospitals has been short as of yet, I have been pretty blown away by the conditions here. I have really only seen St. Paul's, which is one of the nicer hospitals, but it's hard to imagine that this is what health care in low resource countries is like. It seems totally unjust and unfair. I never particularly felt strongly that health care is a natural human right but I'm beginning to think it is. It especially hits home as I hear stories of twenty year olds with pulmonary hypertension and cardiac failure due to an atrial septal defect that was never closed, something that is so simple to do in the US. As one of the pharmacists at the clinic told me, it is merely chance that we are born where we are.

Outside of Pathfinder's HIV/Reproductive Health Clinic at St. Paul's

The VIA/Cryo clinic room

The entrance to the ER at St. Paul's. It is packed with people carrying their family to the entrance trying to get in. 

I spent this past Friday morning with Dr. Engeda Abebe, a general surgeon at St. Paul's. After morning report, we headed up to the ORs. There are three working ORs and most look like they have never been cleaned. There is no concept of a sterile core and most people wander around with all of the OR doors open. Scrubs are not regularly laundered and there are barely enough scrub caps and masks to go around. There is only one glove size, limited suture, and limited gauze because all of their surgical supplies are donated from other countries. The length and extent of surgeries and closure type are based mostly on how much suture they have. Apparently 80% of hospital acquired infections here stem from surgical wound infections and I can definitely see why.

An OR at St. Paul's. It looks a lot cleaner in this picture than it really is. Note the open window.

After changing into scrubs and finally hunting down a surgical mask, I was informed that all of the ORs were down due to an equipment malfunction. We waited for an over an hour before the surgeons called off the entire day. Luckily all of the cases were elective (thyroidectomies, cholecystectomies, etc) but I could not believe that the ORs are shut down on a regular basis due to equipment issues. As I was leaving, I saw one man undergoing a procedure just there in the hallway with no sterilization of the incision site and bare bones equipment. It was pretty shocking. 

I spent the rest of the morning rounding with Dr. Engeda, the surgical residents and medical students. It is definitely different than the US. There is no clear hierarchy or structure and it is not evident who really is in charge of the patient. Charts were left empty and films were scattered around with no patient labels, and the patients were in beds covered in blankets that looked like they hadn't been cleaned for weeks. The resources are so scarce here that this is the best care that they can give. Dr. Engeda himself works very hard to implement structure and adopt more Western standards of care but he is working within a system that gives him little room to grow. 

While it is often painful to see, I am hoping to spend more time with the surgical team and learn as much as I can and to observe how to feasibly improve the system. I think the patients here deserve so much more.