There is never a dull day in Addis Ababa!!!

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Thursday, October 4, 2012

As I am sure we have already mentioned, the people in Addis are what makes this place so unique. Our time here is so enjoyable. We have gotten to know many of the interns and doctors in the ER, and were able to learn much more about the practices and values in Ethiopia.

There is much to be said about the education system here, the doctors are incredibly knowledgeable and their level of education is similar to that of an intern's in Canada, with expertise in presentations more commonly seen in a 3rd world setting. We’ve had the pleasure of getting a glimpse into the lives of some medical professionals, and just through observation, you can tell most are truly passionate about what they do.

The schooling system here in Ethiopia runs from kindergarten to grade 12 and they intermittently write exams to determine their level of comprehension, much like we do in Canada. In grade 12, they are to write a national exam that will determine their career path for the next 6 to 10 years, if not inevitably. Their prospects are listed from most suitable to least, and they are then to enter into the most appropriate field…whether it be their passion or not. Although education here is paid for by the government, in the cases of doctors, they are required to serve the system for 2 to 5 years after internship as a GP, and it is following this that they can specialize in the department of their choosing. Some will have the choice to switch professions, but the degree for the most suitable, as well as the service owed, must be completed first.

We worked on the surgery side of the Emergency Room this week. The cases were incredibly interesting. The most common conditions were trauma due to either motor vehicle collisions or fighting. In Ethiopia, men and women alike physically fight when they are not getting along.  Today we had a very sad case where a woman from a rural area in the South of Ethiopia was in a fight with her husband. He swung an axe at her leg and caused her to have an open fracture of both her lower tibia and fibula (lower leg). She travelled for 5 days using all sorts of transportation to reach the hospital. When she arrived, the wound was not in a good state. On top of it all, conscious sedation (anaesthesia) is not used when people present this way. The doctors gave her some painkillers and manipulated the joint as well as debrided it without anaesthesia. Carissa and I had a very tough time being in the room while this was being done.

It seems like here in Ethiopia, there is an overrepresented amount of patients presenting with bowel obstructions secondary to sigmoid volvulus (bowel twisting onto itself).  The doctors here have told us that most of the patients who present with this finding are priests. When questioned as to why this is the case, they have told us that it is proper ritual for priests to hold their flatus during prayer and ceremonies and that this causes them to have too much gas in their bowel and it twists. This was very interesting for us!

When people complain about the ER wait times in Edmonton, they should think again. Patients here wait an average of 3 days to have all of their investigations completed and treatment to be initiated. And these are basic investigations like chest x-rays and basic blood work. There are often very sick people sitting in chairs for days at a time. It is said that 78% of patients seek alternative treatments from witch doctors and herbal healers before seeking medical treatment. This means that they often are very sick by the time they reach the hospital. Today we had a patient who was kicked by an Ox almost one month ago. For this he sought herbal treatment from a local witch doctor. By the time he came in to the hospital he was septic and his foot was swollen to almost 5 times its normal size. By the end of the day, he was still sitting in his chair waiting to be investigated and treated. I imagine he will still be there tomorrow morning although I am not sure how his prognosis will be if he waits much longer. The injuries here often involve animals as in the previously mentioned case. Patients are kicked and bit by donkeys all of the time.

I think it is a global phenomenon that patients are not satisfied if they show up to a hospital without receiving some type of treatment at the end of their visit, even if they don’t require it. It is often difficult to reassure patients that their common cold will get better on it’s own. In Ethiopia, this is no different. The interns have told us that patients will refuse to leave if they do not receive some type of medication; in particular they want an injection of some sort. The interns here have established the solution to this problem in Ethiopia. They will draw distilled water into syringes and inject patients who demand medications.

On another ethics-related topic, patients often don’t receive information or details about the results of their investigations. We had a man the other day present with weight loss, jaundice, abdominal pain, and a palpable abdominal mass. Thinking back to our gastrointestinal block, I recalled a triad that we had once learnt about which included the latter three symptoms called Courvoisier's sign. This is a sign for a tumour of the biliary tree (near the gallbladder). We ordered an ultrasound for him and the result (which arrived a couple of days later) confirmed a Cholangiocarcinoma. This man is only 38 years old and the prognosis for this cancer is grim at best. When the results arrived I looked over at him suffering in the chair he had been sitting in for 3 days. I asked the intern if I could come with him when he delivered the news and he stated that he wouldn’t be telling him the results of the ultrasound. When I asked him why, he stated that if the patient finds out, he will disappear from the hospital and that it is best to admit him and have general surgery see him in a few days. I thought about patient autonomy and the differences between how we deliver bad news back home and how it differs from the practices here. 

Today, while we were out to lunch, there was a mass casualty near the area of the hospital. This was from a motor vehicle collision and 12 people were involved. When we got back to the Emergency Room, the atmosphere was chaotic. Luckily everyone survived and only a few needed invasive treatments. One intern named Dame handled the situation on his own. The interns here are very competent.

On Tuesday Dr. Zelalem (our preceptor in the ER) was kind enough to accompany us to Merkado, as we desperately wanted to see the local market and purchase souvenirs for our loved ones back home.  This market is easily spread over 8 blocks with shop after shop lining the busy streets. The shops are typical of currios seen in other parts of Africa and contain woodcarvings, traditional clothes and other merchandise. As we are obviously foreigners, we found it difficult to avoid high prices, and although bartering isn’t new to either of us, (especially Andrea), there seemed to be little wiggle room. Pedestrians dodge cars and mini busses whose drivers make their way through with little regard for the risk they pose to citizens. While bartering in one particular shop, a van missed us by inches and struck a man on crutches. Although we’ve been told this is not an uncommon occurrence, many were quick to rush to the man’s aid. It was our first true experience witnessing such a thing here, although if the reality of the traffic practices here are any indication, it may not be our last.  We are happy to report that the man was fine.

The next day, still not quite satisfied from our minimal haul at Merkado, we made our way to another market, SheroMeda. Although not quite as busy, nor as overwhelmingly large as the last, we found many ideal items at a pretty generous price. It may have also been an advantage shopping alongside locals, who were not as likely to be blind-sighted. Children coming home from school flooded the street and their kind salutations brought a smile to our faces. Beggars would follow us from shop to shop until we gave them something, and although it is not always advisable to do so, it was heartbreaking leaving a child tugging at your clothes with a destitute look upon their face.

The reality of the massive street population in Addis is unfortunate and the disadvantages these people face, whether it be the misfortunes that land them there in the first place or the stigma they face as a result, is something that can’t be ignored.

This place is amazing in every sense of the word and we are sad that we are going into our final week here.

We hope everyone is fantastic back home!

 <3 Andrea and Carissa             

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Suzanne on

Again, your amazing writing and courage gives us the chance to visualize what you are doing so far from home. Be safe, and keep the updates coming as it is truly remarkable!

Julie Weeks on

Again, a very well written blog which allows us to "see" what you are doing :) What amazing young ladies you are ! So proud of you! Big Hugs!

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