The Last Hurrah

For our second to last day of training, we spent all day in the clinic and I have to be honest I was kind of dreading it. It is literally the most exhausting thing to try to manage trainees. I am at St. Paul’s essentially by myself with two clinics seeing patients at the same time. I have nurses who know how to do VIA/Cryotherapy in each of the clinics but neither of them know our study protocols so I have to be watching everyone like a hawk to make sure that the consent forms and surveys are done, plus making sure that they fill out the forms correctly. I also need to watch them do the screening to ensure they do all the steps adequately.
            Although I had less trainees with me today, Alisa wasn’t able to help me out in the other clinic so I had to run back and forth between the two ensuring that all the paperwork was done and that everyone had enough copies of all of the forms.  Luckily the other room was completely on top of it, but it was still really stressful. Then I had women again pounding and pushing on the door and on me to be screened as I pushed them back. It’s great that everyone is so enthusiastic, but it makes me immensely stressed out to physical force patients away. One woman was particularly persistent that her 63 year old mother be seen and would not listen to me when I tried to explain that we are only seeing women up to age 45; however, she barker her way into the room telling me that she was a doctor with the ministry of health and proceeded to question me on the details of the study. Of course, this caused me to be a little flustered and a little irritated that a so called professional would be so aggressive with me right off the bat. I quickly stepped out and called Dr. Goedken asking her to ensure that a head physician of the project be here at all times in order to help me keep the peace since no one really listens to the white girl. We aren’t really sure if this woman was actually with the ministry of health, but we screened her mother anyway. I felt a little guilty that I had treated her a little brusquely since all she wanted was help for her mother, but her first reaction to me was so hostile that I couldn’t help but respond with a little force behind my words. Maybe not the best way to have handled it, but I was trying to juggle fifty other things that my stress got the best of me.

Ethiopian physicians have literally no concept of IRB or patient awareness. It was a point actually brought up at the MEPI workshop I attended Thursday morning, but in a slightly different context. The leaders of the conference said that in recent years, the IRB process here has become more stringent (my roommates and I can attest to that!) out of a very real fear that developed countries doing research in low resource areas often take advantage of African patients. However, they have become so strict in their policies that it is almost impossible to get any project approved and the committee nit picks over minor details in order to exact some sort of control. Even though they continue to stone wall research and tout the idea that “policies” must be followed, the physicians here have no idea what they are even upholding. There is no such thing as privacy here and a woman’s medical information is discussed openly in front of others. They do not understand that patients need to be the final decision makers in their medical care and sweep patients into treatment fast tracks without stopping and really discussing options with them. For example, the woman from the ministry of health was furious that I was denying her mother care and questioned my IRB approval, but when I explained to her that I didn’t have approval to screen her mother because she didn’t fall into the appropriate age range, she didn’t seem to care so much about the IRB approval then. The patients here are denied so much due to lack of resources that when they become available, it’s a mad dash to the clinic door regardless of protocols or patient rights.

Somehow I survived the day and spent the evening with Dr. Goedken, Alisa, and Sunyiat, an OB/GYN from Michigan and Ethiopian ex-pat, at Dr. Dawit’s house as he had invited us over to dinner to meet his wife, Tigi, and their newborn son. Barkau (no idea how to spell it, but it means “blessings” in Amharic) was the sweetest little baby and made the most hysterical faces. Definitely gave me some baby fever. We had a wonderful dinner of Ethiopian food, fish, and vegetables, and we eagerly stuffed our faces because by the time we actually ate it was almost 9:30pm. Dr. Dawit kept the wine flowing and was a little over generous with my glasses if I do say so myself. We were all getting a little louder and a little looser as the night went on and the rainstorm outside pounded down on top of us. By 12am we decided it was time to head back to the hotel as we still needed to write the exams for the participant testing in the morning. Finally by 1:45am, I was on my way home, but not without some aggressive habesha bargaining with the cab driver on my part. Unfortunately the power was out in our house and my phone was dying so I was slightly panicked that I wouldn’t wake up in 4 hours. I lay in bed and mentally repeated my wake up time in my head hoping that I wouldn’t sleep in, but luckily my phone lasted the night and I was off to the Desalegn Hotel yet again at 6:45am.

When Dr. Goedken and I met up over breakfast, we realized we had some last minute details we needed to tie up so I headed over to St. Paul’s to have our training certificates signed by Dr. Abdulfetah and buzzed back as quickly as I could given the Lada taxis here don’t go much about 15mph, and made it back in time for the testing. Everyone did very well on all of the assessments and passed with flying colors! We handed out the official training certificates and sadly said our goodbyes. I am proud to say that we have officially trained 15 new healthcare professionals how to screen for cervical cancer using VIA! I can’t believe it’s all actually over. I have spent the past two months dedicating my life to this project and it’s unreal that the largest part is done! I still have the “data” to review, the papers to write, and possibly the return trip in December if we get funding, but my training “baby” as I refer to it, is all said and done. Thank goodness. 

The whole group! From the left: Fikirte, Hussen, Mesfin, Terafeyuw, Zeleke, Jalel, Tilahun, Sherangizaw, Dr. Goedken, Abebe, Fikre, Dr. Hezkiel, Me, Nigussu, Dr. Dawit, Genet, and Betre

Dr. Hezkiel, me, and Dr. Goedken. Yes, Dr. Hezkiel is holding my hand. All Ethiopian friends, whether its two men or two women or a man and a woman, are very affectionate and always hold hands. So habesha.

Dr. Dawit, ladies man.

The whole group!

The certificate of training. So official looking!