Devastatingly Expected

Today was my first day to officially survey our clinic at Black Lion. I can’t really say I’m surprised that I found it in the state that it was in, but it didn’t make it any less frustrating. Several changes have happened within the administration of the hospital that have made it difficult for the clinic to function properly. First of all, the whole management of the hospital has changed. Instead of individual departments (OB/GYN, Medicine, Pediatrics, etc) running their own inpatient units and outpatient clinics, there is now one director of all inpatient care and one for outpatient care. Due to this, the work staff has been completely reorganized such that the departments didn’t necessarily maintain their own ancillary staff. So a nurse who has essentially specialized in OB/GYN may now be working in a gastrointestinal medicine clinic. The other major issue is that the outpatient clinics are currently devoid of any water or sewage system. Unfortunately for us, this has meant that the clinic has essentially not been running for the past four months. Without running water, we are unable to create sterilization buckets for speculums and other instruments and the autoclaves are not working. Without any way to clean our instruments, we can’t routinely exam patients. Because of the lack of water, amongst other suboptimal changes, the nursing staff has “revolted,” to use Dr. Hezkiel’s words, against the outpatient care director and are refusing to work until the piping system is put in place. Additionally, the whole outpatient floor is being redesigned such that our clinic will actually be moved to another location in the coming weeks. Hopefully once we are relocated and the water is back up we can really begin to screen in earnest, but I’m worried that we have lost the momentum of the training. We will have to start a serious advertising campaign in order to get the word out again as now very few patients are coming to clinic requesting the screening.

To add to these problems, the multitude of forms we left the clinics with are either not being filled out or are not being filled out properly. There are no patient surveys for the additional patients seen over the past four months, and some of the patients don’t have a clinic data form in the clinic binder, but instead the document was put in their hospital chart. Hospital charts at Black Lion are like ghosts. Somehow patients get their hands on them when they have appointments but tracking them down is nearly impossible especially given that we don’t have any of the patients’ names as they also weren’t logged in the clinic log book. Simply put—not only is the Black Lion clinic not running, but there is also no data. Luckily my work here over the summer has hardened me enough that I am not having a complete breakdown but it is so remarkably disheartening.  The one uplifting factor is that Dr. Dawit and Dr. Hezkiel still have such a passion for the project and continue to make efforts to incorporate VIA/Cryotherapy into the curriculum and to spread the method to rural areas, such as at Dr. Hezkiel’s clinic in Debre Markos. Now we just have to find a way to work around the issues we are struggling with right now. Unfortunately, these are issues endemic to low resource areas, so even if we fix it now, who’s to say the same problems won’t pop up a few months to years down the line.

As I mentioned yesterday, Dr. Dawit and Dr. Hezkiel want to hold a training in 2-3 weeks for the rising fourth year OB/GYN residents so that they are able to participate in our clinics during their final year. I brought up the idea with Dr. Hezkiel and he mentioned the need for incentives for the residents to participate in the training. He has told me this before and tried to explain that it is just part of the culture here, but it wasn’t any less grating. I would think that any training that can further your career and help your patients would be one you would gladly participate in. In the US, any conference or continuing medical education session offered generally comes at a price, yet here, we must pay for people to attend? It seems so backwards to me. I tried to explain that our budget was completely drained by the last training and that while I was in search of grants, acquiring those funds would take time; however, he continued to insist that we provide some sort of compensation. Hopefully they can still manage to conduct the training with departmental funding or just insist that the residents attend, otherwise I don’t think we can expect the expansion of knowledge we were hoping for.

While Dr. Hezkiel mentioned that a patient might come in the afternoon for screening, I decided it was a better use of my time and better for my sanity to leave and work on data entry. I took the mini bus to my old neighborhood, hoping to enjoy a macchiato from Kaldi’s and get some work done. On my walk from the mini bus drop to the coffee shop, I was joined by a young man who started asking me about what brought me to Addis, the election, and other things about my life. After a few minutes, he turns to me and asks if he can get my advice. Feeling a scheme come on, I agreed, but made sure my bag was secure and began walking a little faster to my destination. He started by telling me that everything he was about to say was top secret, which made me begin to think that he might have some mental issues. He then went on to explain that his parents were murdered by people within the government and that out of fear for their lives, he contracted a broker to help his little brother and little sister leave the country. However, now they were in Italy and he had no way of contacting them. He told me that he is a graduate of the history department at Bahir Dar University and that he wants to come to the US. At this point, I am expecting either a plead for money or a marriage proposal, but what I get instead is, “Can we be friends on Facebook?” It was one of the oddest conversations I have had here to date. I still have no idea if anything he said was true, but it was so out of left field and he was so endearing that it really could have been. It sort of reminds me of this patient I had on my psychiatry rotation at Grady. The patient had bipolar disorder and during my patient interview, told me all about his humanitarian efforts to rid this one tropical island of its massive infestation of coconut rhinoceros beetles. He kept going on and on about it while I nodded and tried to empathize as best I could. Well, when my assessment was done, out of curiosity, I did a quick Internet search. Much to my surprise, there indeed was a huge coconut rhinoceros beetle infestation at this one particular location right around the time my patient said he had been there. The man was definitely delusional and had a serious case of bipolar disorder, but still, maybe he was there. Maybe that was the one truth he could still tell. How can you really know?