I just got this letter from my friend Joyce Hooley-Gingrich, a western North Carolina pediatrician working in Addis Ababa. You may enjoy the picture she paints of life in the medical trenches and wish to support her work with a donation to the address mentioned at the end of her letter. Thanks! # 7 Letter from Ethiopia October 4, 2013 Dear friends and family, I arrived back in Ethiopia at the end of August after 4 months in the States, and a brief vacation en route with Bob in Scotland. I am just now getting around to sending a note home. I have been working three days a week at the Embassy Health Unit in addition to volunteering at Blue Nile clinic and at Sele Enat orphanage ( see below) so have had less time for writing. The medical director at the Health Unit asked me to work three days a week for the month of September a nd was able to get permission from the Embassy management because they had extra money at the end of the fiscal year. As of October 1 however, I am back to one day a week. So far I have heard nothing about being furloughed for the government shut down but the work positions of family members of state dept employees are the first to go here, so we shall see…. I am also including in this letter a report on my work related to the medical fund to which some of you have contributed. (Thank you again!) Life has become even harder for most residents of Addis Ababa recently because the government (with the help of China) is building a new intercity railroad system and the construction has torn up the roads and disrupted water supplies. (broken water lines) Many neighborhoods have been without water for months, so those residents are having to purchase and transport water themselves, a real hardship on top of everything else. If they have a rain barrel that helps, but even a large plastic rain barrel is something out of reach for a lot of people. The electricity is often off, the internet and phones unreliable. I wonder how anyone can keep a business going here. We are very lucky to have the help of PC staff and a generator at our house. The traffic is even worse than it was before, requiring long complicated detours on narrow dirt back streets in backed up traffic to get anywhere. I have given up driving to the Embassy on work days and now take the Embassy shuttle instead. In March of last year I began visiting Sele Enat, an orphanage near the PC office and within a half hour’s walk from our home. An American woman who serves on the board of Blue Nile Clinic and also is a representative from an adoption agency which places children from Sele Enat with adoptive families in the states, asked me to visit and make recommendations regarding ways to improve the infant and toddler care there. Before I left for the summer I completed that assessment and recommendations and did some trainings of their nannies regarding infant development and ways to support all aspects of development. They have since instituted morning massages and are providing more “tummy time.” One of my recommendations was to hire more nannies for the infant and toddler rooms in order to be able to provide more individualized care. This is a big challenge for them because of limited funds, Ethiopian labor laws, and fluctuating numbers of children in the orphanage, but over the summer they were able to hire 9 more nannies, 6 of whom have thus far attended my subsequent training sessions. Since returning at the end of August I have begun rounding once a week with their nurse, Kibrealem, helping to take care of medical problems that come up. I really enjoy working with her, as well as with the director, the chairman of their board, and the volunteer coordinator, all wonderful Ethiopians who are very receptive to my suggestions and are truly dedicated to providing the best care possible despite tremendous difficulties due to government policies and financial constraints. Before I left Addis for the summer I sent Daniel, a newly arrived 3 year old orphan at Sele Enat, to CURE hospital for repair of bilateral club feet, and to the Korean Christian Mission hospital for repair of a large inguinal hernia. The CURE services are free and the Korea hospital surgery cost was about 5000 birr, ($300.) I paid $180 out of the medical fund to which some of you have donated, and Sele Enat paid the rest. The pediatric surgeon there is an American and the charge is low because the Korean hospital and their Bethany Kids International Unit is a mission supported hospital. Danny had serial casting of his club feet with good result, and recently had the final casts removed and foot/ankle braces fitted. However he has a very long way to go to be able to walk. He is a very bright boy, and his upper body is strong, but his lower extremities appear to be completely flaccid. He has some marks over his sacrum which make me suspicious for a lower spinal chord abnormality. I recently met the medical coordinator for HOLT adoption agency at the orphanage, who told me they may have an adoptive family lined up for him. So I am hoping that with their help we might be able to get an MRI of his spine, and that eventually he may be fitted with more extended leg braces which could make it possible for him to walk with a walker. He is such a bright little fellow and charms everyone who visits the orphanage with his friendly smile and his enthusiasm for singing. Dr Yodit has returned from her maternity leave at CURE hospital so I am no longer working there. During my last week at CURE hospital back in April, I arranged to take “Dufte,” a 7 year old little boy who was recovering from bilateral club foot repair, into the Piazza area of town for a visit with an eye doctor. I was concerned that he had a herpes infection of his cornea, and wanted an ophthalmologist opinion before treating him without benefit of lab diagnosis. The poor fellow was wrapped in leg bandages and cotton blankets around his hospital pajamas when his father and a CURE nurse wheeled him out in a wheel chair and lifted him into my car. It was only then that I thought to myself, “What was I thinking?” I suddenly remembered the last time I transported a patient in my car to see an eye doctor, (Ishmael) a journey punctuated by stops for vomiting. I fully expected a harrowing time as I tried to negotiate downtown Addis traffic through a neighborhood I did not know well, this time without Bob with me to help. It was Dufte and his father, who speak no English, the Ethiopian male nurse, and myself in the car, communicating in pigeon Amharic-English, trying to respond to Dufte’s needs and to the traffic while finding our route to the clinic. I had never been to this office but knew of the practice from PC volunteers who had been seen there. (Dr. Taliksew’s office where we took Ishmael, was too far across town for me to be willing to drive him there. ) I was pretty crazy to try this but amazingly we made it in good shape. We found the office, squeezed into a makeshift parking space along the road, and carried him through the rain to the office door. Shortly after we arrived and registered, the electricity went out and as the office had no generator, we waited in a dark waiting room. While we waited I rewarded Dufte with strawberries which he had never had before but appeared to enjoy immensely. The eye doctor examined Dufte and agreed that he had a herpes infection. She prescribed the drops which I would have prescribed myself had I not had the option of her consult, (Acyclovir eye drops,) still I was glad to have her confirmation. CURE pharmacy does not carry this medication so we then needed to find and buy the drops at a local pharmacy, - which was no small challenge. We negotiated more winding narrow streets following the directions of the nurse to several nearby pharmacies until we finally found one who carried the medicine. Triumph! Dufte’s eyes responded to the drops and by the time he left the hospital for his home in the countryside they had cleared up. The cost of those drops was only $7 and the cost of the eye doctors’ consult was $6. Dufte very likely would have eventually had serious visual impairment if not blindness in that eye without treatment. In April I also sent to CURE several of my Blue Nile Clinic patients. A pediatric urologist just happened to come along with an ENT team from Philadelphia who comes regularly to do cleft lip and palate repairs, so I was able to get two kids seen, one with undescended testes, and another with urethral meatal stenosis. ( In urethral meatal stenosis the hole for peeing is too small, causing pain with urination and bladder distention.) Just last week I saw the little fellow who had the meatal stenosis repaired in follow up at BN clinic, and he is so grateful to be out of his discomfort! There were no charges for any of this care. I continue to see pediatric patients at Blue Nile Clinic once a week. I treat a lot of pneumonia, intestinal parasites, impetigo, fungal skin and scalp infections, eczema, eye infections, dehydration, chronic under nutrition, as well as the occasional goiter due to iodine deficiency and occasional typhoid. Since returning at the end of August I have been delighted to see in follow up several of the babies who were undernourished when I last saw them in the spring, and who gained weight well over the summer due to improved nutrition from the supplemental solid foods (in addition to their breast milk) partially supplied by our medical fund and partially by their mothers’ continuing purchases. Their mothers are so pleased, and I pass along to you the gratitude they bestow on Selamawit and me. This past week, the father of one of my patients, an Orthodox priest, blessed me by tapping my forehead and the sides of my face with his cross in the way he that is done to bestow an Ethiopian orthodox blessing. There are bad days at BN too. One day I sent two patients to the nearby St Paulos public hospital hoping they would be hospitalized and after finishing in the clinic, Selamawit and I drove over in her old truck on the very rough muddy road to check on them. I found the place truly chaotic, the hallways and waiting areas dark and dirty and packed with people. Both my patients were sitting in their parents arms waiting in a jam-packed waiting room. One of the fathers was being berated by the doctor for not having brought the child’s registration card with him, (this was the very doctor to whom I had called ahead to ask for her help) and the other one was still waiting to be checked in. I eventually was able to diplomatically cajole an admission for the first patient but the second one who had a bad pneumonia, I learned the next day had been turned away after I left. I had hoped he could spend a night with oxygen, but thankfully he improved with the injected ceftriaxone we had given in clinic before we sent him over, and was ok when he came back to clinic for follow up the following day. The private hospitals are all the way across town and cost a lot more money but I think I will have to use them in the future if I really need to hospitalize a BN patient. On a happier note, the raised bed gardens that Bob and I helped the orphans to build and plant back in the spring, were all grown up with cabbages, kale, lettuce and chard when I got back. They had been taking produce home to their foster families but I noticed the beds were full of weeds. I said something to Selamawit about this and the next week I noticed that they were all weeded nicely. When I asked Selamawit about it she said she had refused to give out weekly foster care allowances until the weeding was done! Summary: #3 Report on use of Medical Fund Over 7 months (since Nov 2012 with 4 months at home this summer ) thus far I have spent at total of $2002: $ 190 diagnostic tests, (labs and radiology), $ 284 specialist consults (Cardiologists, eye doctors, physical therapists) $1224 medications and vitamins $ 147 medical equipment, (a nebulizer and related equip) $ 157 supplemental foods. ( “Metin,” a locally produced cooked cereal mix of grains and seed flours for infants 6-12 months, shiro, milk powder, and locally produced peanut butter.) There is currently about $1400 left in the fund. I had told some of you when I left the states that there was no need to contribute further, but it looks like I should solicit a bit more. I plan to be here until April and suspect I may need as much as another $750 to $1000. Thank you to any of you who feel you can contribute. Please send checks written to me, with “For Ethiopia Medical Fund,” on the memo line to : Mary Alice Lodico, 46 Central St., Waynesville NC 28786. Thank you!
Posted on: Mon, 07 Oct 2013 13:10:46 +0000
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