Government Hospital:Things are Up and Walking

Dr. Stephen Chmil has been waiting for two hours to operate on a bypass patient. There is an undercurrent of frustration in the operating room. WSF medical staff is eager to be of service and is disoriented by the slow pace. Doctors who are accustomed to well-oiled machines back home are not used to delaying surgery because there aren't enough gowns and sterile drapes to go around. The "deficiencies" of the Black Lion Hospital that were foreshadowed by the Dean of the Medical School are now materializing.

Public hospitals in Ethiopia are in desperate need of more support, more training, and more missions. Although there are some very competent physicians at these hospitals, there appears to be a very real disconnect between the needs of patients and the administration of available services. Even if there are services available they are not being provided in an efficient and timely manner. Tanya, an engineer from the United States, has had the job of being in charge of biotech equipment for the Black Lion for the last six months. "There are no systems in place for maintenance of equipment. Equipment that breaks down just sits in a closet with no hope of being used again." Looking around one can quickly see that systems for patient follow-up, organization of meds and supplies, and many other necessary components to the daily operations of a hospital are not in place here. The challenges posed by an under-sourced public health system are a reality
here in the largest city in one of the poorest countries in the world.

An X-ray film hangs in the light. From looking at the luminescent photograph one can easily see that something is off from center. A hip joint hangs a little too low, dangling just beneath the pelvis. The film next to it shows a clavicle in two pieces. Could this be the same patient? This man was in a car accident eleven days ago. On the day of the accident he was rushed into emergency surgery to repair a lacerated liver and ruptured bowel. He has waited a week to get his bones back in place.

Dr. Maxime Coles discusses a plan of attack with a visiting orthopedic surgeon from Scotland. "Let's get him in a lateral position." They discuss the possibility of completing a closed reduction of the right hip. Why cut if you don't need to?

A couple of rooms down, Dr. Bucs preps a patient who exhibits multiple symptoms that indicate tuberculosis of the spine. HIV and tuberculosis are reaching epidemic proportion in Addis Ababa. A doctor sitting in the lounge spouts off some statistics he has heard. "A person who gets pricked with a hollow needle from an HIV infected patient stands a three in a thousand chance of contracting the disease." Contracting HIV seems unlikely, but no one appears eager to test their odds.

Dr. George Faries gently slides the scope down through the esophagus and into the stomach. Eager Ethiopian surgical residents wait for their chance to try it out. Rules are that the "attending physician goes first" and they will have to wait their turn. Dr. Faries narrates the scope's journey into the stomach and through the opening into the duodenum. Suddenly, the end of the scope opens up like a tiny crocodile's mouth and little metal teeth plunge into the wall of the stomach, swallowing a tiny biopsy. "Got it!" exclaims Dr. Faries. It may not be the biggest catch of the day but it's a keeper.

Meanwhile, Dr. Coles has decided against a closed reduction of the hip. There may be some stray bone fragments in the leg. It looks like they'll have to cut after all.

In the storeroom, an anesthesiologist holds an essential component to an anesthesia machine. "These are disposable? You need to be able to take this out," he says while pointing at a small blue cap on the device. "I suppose we could drill a hole and tape it up later. I can't see any other way of doing it." In the meantime, we've learned that our crate full of equipment and supplies is finally in Addis Ababa. Now it just needs to clear customs. The hope is that it can be cracked open and sorted this weekend. Perhaps by Monday Taritku won't have his surgery delayed for a few gowns and drapes.