The Work of God
Two of our staff go out into the rural areas around Soddo every week to deliver much needed prenatal care. Over 95% of women in rural Ethiopia will deliver their baby with no professional attendant - midwife, nurse, or doctor. Even more than that will have no prenatal care at all. These are the reasons that we continue to see high maternal mortality and neonatal mortality in this country. (A woman aged 15 has a one in 67 chance of dying in childbirth. In the US, it is one in 2,400.)
Well our staff are doing something about it! Every week, Sophie and Jodi head out "into the bush" to tend to these pregnant ladies. Women come from all over, and line up to see them. Occasionally, they will see a critically ill mom who needs prompt attention - those get referred on to the hospital. One such woman came last Thursday.
Her complaint was that "water was coming out," and indeed she had what we call "premature rupture of membranes" - her water broke too early. She was only seven months pregnant. Not only that, but she had lost two babies before. Both at exactly the same time - seven months.
They loaded her up in the car, and brought her straight to Soddo Christian Hospital. She was seen by Dr. Mark Karnes, our obstetrician, but the situation looked grim. She was admitted, but a few days later went from bad to worse. She abrupted her placenta (where the placenta tears away from the uterus), and began hemorrhaging. It required an emergency C-section. (Dangerous for mom because of the bleeding. Dangerous for baby because these little ones often don't have developed enough lungs to survive once they are out of the womb. They lack something called surfactant which keeps the air sacs open in the lungs. Fortunately, if the mom receives steroids in the hospital, this problem can be helped.)
A beautiful little girl was born, weighing less than three pounds, but breathing on her own - only occasionally requiring oxygen support. Her mom couldn't be more thrilled, and is cuddling her close to her body to keep her warm. Something that is called "Kangaroo Care." And the new little one's name says it all - Yabsera. Literally "the work of God".
How Much Injera Do We Eat?
Ever had injera? Well, if you're reading this from Ethiopia, then the answer is "yes". But if you're anywhere else in the world, you might not have had injera. So what is it?
Wikipedia defines injera as "a yeast-risen flatbread with a unique, slightly spongy texture traditionally made out of teff flour." Teff is unique itself, almost exclusively found growing in the fields of Ethiopia. So this is a very Ethiopian food. The injera is used as an eating utensil, essentially sopping up the delicious stews (or "wots") that make up Ethiopian cuisine. A piece of injera is typically around 15 inches in diameter.
Of course our hospital goes through a lot of injera. It is served with every meal, and we serve our patients 3 meals a day. So, how much injera do we go through then? About 400 per day, or 3,000 per week. In one year, at Soddo Christian Hospital we consume over 150,000 giant pieces of injera!
SCH Graduate Makes History
Recently, the very first graduate from the PAACS program in Ethiopia did something unique in his own country. He led a team that separated conjoined (“Siamese”) twins. To our knowledge, nothing like that had ever been attempted in Ethiopia. Dr. Frehun Ayele, who trained as a pediatric surgeon at the BethanyKids at Kijabe Hospital PAACS program after graduating from the general surgery program in Ethiopia, led a team of surgeons from Myungsung Christian Medical Center to perform the incredibly delicate and complicated operation. The baby sisters were born at a health center in the countryside and were abandoned by their mother. They were given to a Catholic mission group here who then brought them to MCM. One of the twins had a severe, fatal heart defect and it soon became clear that she could not survive. This made transfer abroad impossible because of time considerations, so Frehun made the difficult decision to take them to the operating room to separate them. It was clear that one of the twins would die, sacrificing her life for her sister's. Dr. Frehun concluded that if he did not intervene urgently, both babies would die. The surviving twin, Mariam, is doing well. Please pray for her as she recovers. We praise God for Frehun's faithfulness in serving Him as he serves the sick children of Ethiopia.
Hot Zone in Soddo
Last week, we had some pediatric patients come in with upper respiratory symptoms. A few of them had a rash and had been given antibiotics, so there was a thought that maybe it was a "drug-related rash." But it wasn't long before a few more kids came in, and it was clear that this wasn't a medication-induced rash. Yep, this was measles.
It didn't take long before our entire pediatric ward was full of measles patients. We were in the middle of a genuine outbreak. The feared complication of measles is pneumonia, and indeed most of the patients we were getting had it. Many have them were requiring oxygen. In the picture below, the machines on the floor are oxygen concentrators.
The health department was notified, and they began taking measures. Much of the outbreak was centered on an orphanage down the street from us. So we contacted them and gave them specific instructions. First, isolate any kids that were showing symptoms. Second, send any kids to the hospital that were showing signs of pneumonia or respiratory distress. We took a trip down to the orphanage ourselves to see the patients who were not sent to the hospital and check on them.
By God's grace, the outbreak seems to be relenting. Our hospital has admitted around 15 kids. Sadly, a few of them have succumbed to the disease. The thing about measles in outbreak settings, is that it affects the very young. Children are vaccinated against this virus between nine months and one year of age. So the most vulnerable are the babies less than nine months. Formula-fed babies (like the orphans) are particularly vulnerable because they don't get protective maternal antibodies. Fortunately, some who were very sick are pulling through. The situation itself feels like a war zone. Our doctors and our nurses are tired, but they are doing an amazing job - rising to the occasion and providing excellent care. We praise God for using us in this situation, and hope to bring Him glory through it. As it says in 1 Cor 15:58, "Be steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain." Pray that we will be steadfast. And that no more of these precious little ones will die.
The other thing about situations like this, is that it stretches our thin resources to the maximum. We don't have enough oxygen concentrators. We don't have enough pulse oximeters. And we can't mechanically ventilate kids with severe pneumonia. We hope to buy non-invasive ventilator machines, and perhaps one or two mechanical ventilators. We'd love to be even better prepared the next time this happens. Would you consider a donation today that would help us do that? Just click donate in the upper right corner of the site. Thanks for your support and prayers.
What? You don't have Idraparinux?
What kinds of medications are available at an African mission hospital, and from whom do you procure them? These are questions that we get asked a lot. Here are two lists. Five things we have, and five things we don't! Most of our medications are imported from Europe and Asia. A few are made locally in Ethiopia. One thing we can't use is expired meds - it's prohibited by law - so even though we'd like to take these off your hands, please don't send them to us!
Five medications we have:
- Most antibiotics! We have penicillins, 3rd generation cephalosporins, macrolides, aminoglycosides, fluoroquinolones. We even have vancomycin most of the time.
- Pain meds: For mild pain, we carry ibuprofen and tylenol. We also have stronger IV pain meds for our surgical patients, and fractures.
- Blood pressure and diabetes medications. We have oral calcium channel blockers, ACE inhibitors, diuretics, and some beta-blockers. We use metformin and glibencamide for diabetes control, and we also have insulin.
- Albuterol multi-dose inhalers. These are key for our chronic asthma patients, and COPD patients. We don't have nebulized albuterol (which we'd like to have), but we can substitute these MDIs, and they work quite well.
- GI problems? We've got proton pump inhibitors (Prilosec for example), and we even have Zofran for nausea and vomiting.
Five medications we don't have. We are hoping that in time, our access to some of these meds will improve:
- Fancy antibiotics. Anti-pseudomonal penicillins like Timentin and Zosyn. These are great for severe infections. Also, we still lack a good IV first generation cephalosporin.
- Artesunate. This is the WHO-recommended standard for IV treatment of severe malaria. It is difficult to find however, and we rarely have it. Instead, we use Quinine which is an acceptable but less desirable medication.
- Newer blood pressure and heart failure medications like Carvedilol. Also, newer diabetes meds like long-acting insulins.
- Low-molecular weight heparin. Ever heard of Lovenox? It makes treating deep venous thrombosis and pulmonary embolism so much easier. But alas, it is rarely available on the African market.
- IV calcium and sodium bicarbonate - rarely we will have these. It does create problems managing a hyperkalemic patient or profoundly hypocalcemic patient. We have other therapies that we can use though.
Others you are wondering about? Ask in the comments and we'll respond!
Welcome Home!
There's no place like home! And now, after many years of prayer and preparation, the new Soddo PAACS apartment building is complete, and our residents have moved in to their new homes.
The finished building has 7 apartments (1 three-bedroom, 3 two-bedrooms and 3 one-bedroom apartments). These new apartments will allow the surgical residents to have a reliable source of power and water. And, since they are on the hospital's campus, it will significantly improve their home security, including that of their families. From an educational standpoint, this will also allow us to improve the residents' experience with night call. This will allow senior residents to take back-up call in the night and gain experience in teaching junior residents under faculty supervision in the night hours.
We want to extend our deep appreciation to everyone who gave so graciously to make this happen. We have been encouraged by everyone's support and gifts, even in the end as we raised money to furnish each apartment. A big thank you goes to Africa Mission Healthcare Foundation for their donation that funded over a third of the project costs!
The residents are enjoying living in the same building and often eat together, sing praise music together and enjoy holidays together since they are away from their extended families. Dr. Surafel said, "Living on-campus together gives us lots of time for fellowship and we eat many meals together. It is also easier to see patients more quickly."
playground!
White Coat Ceremony
What is a white coat ceremony, you ask? Well, according to Wikipedia, it is the ritual that marks the transition of a student of medicine from the pre-clinical years to the clinical years. The white coat has been worn for over 100 years by medical professionals, and is clearly associated with the trade. Everyone likes ceremonies, and for doctors, this is an important ritual that bestows the rights as wells as responsibilities on new doctors.
Though typically done with medical students, we have developed our own version of the white coat ceremony for our PAACS residents. Performed as they begin their five year training, we assemble in the chapel here at Soddo Christian Hospital and deliver a charge to the new young surgeons. This past week, we welcomed Dr. Gezahegn and Dr. Ebeneezer into the ninth class of surgical residents here. Here is how it happened:
The time was opened with a song and prayer led by Pastor Daniel, SCH’s head chaplain. Then Dr. Gray read John 13 reminding all of the servant leadership by Jesus and do likewise. “For I have given you an example – you should do just as I have done for you.” John 13:15. Dr. Mark Karnes shared his prayer for the residents from Colossians chapter 1. He charged them with 3 important things to remember throughout their training. First, God is in control; rest and trust in this. Second, treat all patients with care and compassion as if they were family. Third, know your limits and don’t be afraid to ask for help.
Next, Dr. Seigni Bekele, SCH’s chief resident encouraged the interns with some scripture and words of wisdom. He read from Hebrews 12:1-2, mentioning the men of faith that are listed in the chapter before this. He emphasized that there are many people of faith who pray continually for PAACS and for the residents here. He challenged the interns to remember they are a part of something great and many people have gone before them in sacrifice and prayer to get the program to where it is today. And for that we are thankful and give glory to God. “Keeping our eyes fixed on Jesus, the pioneer and perfecter of our faith.” Hebrews 12:2
Dr. Gray spoke last pointing out that in order to be the greatest we need to be the least. And that the desire in us to be the greatest is not wrong, but it is what we are aiming for that makes the difference. If we stay focused on eternity and we strive to do well for the eternal, then the world may consider us crazy, but we will know we are aiming for something great.
Finally, following Jesus' example from John 13, Dr. Karnes and Dr. Gray washed the feet of Dr. Gezahegn and Dr. Ebenezer. Not something you'd find in most white coat ceremonies, but servant leadership being the focal point of our training, a practice that we feel is essential to this rite of passage. As staff physicians, we want to model servant leadership to even our newest trainees, as we begin to mentor them. A blessing was prayed over them as we concluded the ceremony.
Feeding the Soul
Look at all those onions!
These are three of our committed kitchen workers at SCH. Our hospital is unique in that we provide three meals a day to our patients (at other hospitals, the patients’ families have to bring the food), and this is a critical part of getting them healthy. In addition to providing great food, kitchen staff meet in two Bible St.udy groups weekly. They just completed a study on maturing in Christ. When asked how the study has impacted their lives, here were some of the answers:
“We used to get angry easily in the kitchen. Now we understand that this is wrong.”
“Before, I didn’t want to give to the poor. Now I have compassion. My heart is broken and I try to help them.”
“Now sometimes we will even cook food for the patients’ families too.”
One of the groups collected money for two poor patients in the hospital in order to help them pay for transportation costs home from the hospital. Praise God for how He is using these women, and how He is transforming their hearts!
Another Surgeon For Ethiopia
This is a guest post from Dr. Jon Pollock, originally featured on his personal blog. Dr. Pollock is a staff surgeon at Myungsung Christian Medical Center in Addis Ababa, our sister hospital. Our surgery residents, including Dr. Daniel Gidabo, train at both facilities: here in Soddo and at MCM in Addis. (In fact, Dr. Pollock himself previously served as one of our staff surgeons here!) The following is his account of Dr. Daniel's graduation:
Last Saturday, we celebrated the graduation of the sixth PAACS resident in Ethiopia. Dr. Daniel Gidabo finished his five years of training in general surgery at the end of August. Daniel has taken a position as a surgeon in his hometown, a city of more than 100,000 people that has not had a full time surgeon in a very long time. There Daniel will have the opportunity to treat hundreds and thousands of people who otherwise would have died without surgery. We are very proud of Daniel and his accomplishments. He has a well deserved reputation as a bold and effective evangelist and has led literally hundreds of people to Christ during our time with us.
During my remarks at his graduation ceremony, I spoke to Daniel from Psalm 34, one of my favorite Psalms. It begins with triumphant words of praise.
I will extol the Lord at all times;
His praise will always be on my lips.
My soul will boast in the Lord;
let the afflicted hear and rejoice.
Glorify the Lord with me;
let us exalt his name together.
These words were particularly appropriate for this day. We praise God for what he has done for us. When Daniel started his training five years ago, he had no guarantees that his work would amount to anything. The PAACS program in Ethiopia was not accredited at that time. There was little hope that this little upstart program would ever amount to anything. Fast forward five years and we are accredited by both the Ethiopian Ministry of Education and the Ministry of Health and the College of Surgeons of East, Central and Southern Africa. We have expanded from one hospital to two and have tripled the number of residents in the program. This is only because of what God has done to bless the work he has called us to do. Praise God for what he had done. I sought the Lord, and he answered me;
He delivered me from all my fears.
I assured Daniel that there will be times that he will be afraid. Fear is an integral part of being a surgeon, particularly in the first year starting out on your own in practice. I urged him to seek after the Lord, and He would deliver him from all his fears. Delivery from fears comes with another promise if we look to him.
Those who look to him are radiant;
their faces are never covered with shame.
I encouraged Daniel to look to Him and be radiant.
This poor man called, and the Lord heard him;
He saved him out of all his troubles.
I reminded Daniel that his hometown has been without a surgeon for years and that people were crying for help.
Taste and see that the Lord is good;
blessed is the man who takes refuge in him.
As PAACS surgeons, this is as essential to our lives as anything we do in the operating room. We have the unbelievable privilege to invite people to “taste and seek” that the Lord is good. I encouraged Daniel to continue to be bold in his witness.
The righteous cry out, and the Lord delivers them;
He delivers them from all their troubles.
The Lord is close to the brokenhearted
and saves those who are crushed in spirit.
Finally, I told Daniel that as surgeons in Ethiopia, if we let ourselves, our hearts will be broken and our spirits crushed. There are so many challenges, so much pain and disease, so much death that if we are not careful, we can become hardened and uncaring. But as painful as it can be, we must allow our hearts to remain soft and able to be broken, because the pain, disease and death that we face everyday, breaks the heart of God.
One in a Million Babies
One in 729,000. That is the odds of having quadruplets naturally - without the aid of fertility medicines. And for this young Ethiopian lady, it happened 5 days ago. With no prenatal care, and no knowledge of the multiple babies she was carrying, she made the trek from her rural home to the local health center. There she gave birth to four babies, one of whom died soon after birth.
She was advised to seek further care at a hospital, and found her way to us. The mother herself is being treated with antibiotics for a suspected uterine infection, but she is expected to make a full recovery. The three surviving kids are doing well. Two of them have a mild omphalitis (an infection of the umbilical cord stump) and are being treated with IV antibiotics. They are expected to do well.
The three celebrated the Ethiopian New Year yesterday on their fourth day of life. The new family is the talk of the hospital as we ring in the New Year. A multiple gestation pregnancy is high-risk in any country, but especially here where over 90% of the women have no access to prenatal care. Though we mourn the loss of one of the babies, we praise God for the miracle of a healthy mom and three healthy infants.