OB-Gyn surgery and establishing referral networks

Wednesday

Wednesday, I was holed up at the Ras Hotel, sick. Leo and Mark returned to build at the clinic site. Most of the healthcare professionals returned to teaching and patient care at Black Lion, but two of them accompanied ROMC Clinic Director Amsale Yilma to Marie Stoppes clinic and Das Resten Hospital. Marie Stopes is a British NGO that operates more specialized clinics than ROMC, and Das Resten is the government-run district hospital where many referrals from ROMC would be made. Some of the volunteers' stories follow.

Ob-Gyn Surgery at Black Lion (Kristen Austin and Carol McLaughlin)

This morning we (“nurse Carol” and “Dr Kristen”) went to the Black Lion obstetrical and gynecology department. Carol was welcomed by the nurses, who put her to work helping on the labor and delivery ward. In very short order, the labor and delivery nurses had invited Carol to eat with them. Homemade injera with shiro and meser wot soon appeared with hot tea. It seems that socializing and eating at the labor and delivery nurses station is a cross-cultural activity!

Today was the gynecology department’s operating room day. Similar to back home, the ob/gyn doctors lament the few hours allotted them to operate every week. Also similar to home is the complaint of prolonged time between operations for set up and cleaning of the rooms. Some things are the same no matter where you are. Today, Dr. Mahlet had a diagnostic laparoscopy scheduled. This particular case was for a woman who had infertility. The ability to have and raise children is extremely important for many Ethiopian women. In some rural communities, if women are unable to have children, their husbands will leave them and they are outcast from their communities.

There is one laparoscopy room at Black Lion, and they have some nice equipment that is currently working. One of the big problems at this public hospital is there are few, if any, technicians trained to fix the medical equipment. One American neurosurgeon we met told us a CT scan (“catscan”) machine had been donated, but was sitting dormant, because some fixture broke, and no-one knows how to fix it.

Anyway, the laparoscopic equipment was working today, and I was able to help teach some laparoscopic techniques to Dr Mahlet and a couple of residents. On open laparotomy the Ethiopian physicians’ surgical techniques are excellent. Laparoscopy is something new here. I was able to teach several surgical “tricks” to help make laparoscopy safer and easier for the physicians. This was exciting for both Dr Mahlet and myself. On the other hand, Dr Mahlet and her residents taught me how resourceful they are. There are no lights in the operating room, so they position the patient facing the window. Fortunately, Ethiopia is a sunny climate. If they couldn’t see a certain area while operating, the resident who was not scrubbed would hold his cell phone light to illuminate the surgical field. There is no suction-irrigator machine, so some intravenous tubing connected to a hollow instrument was configured, and voila!, irrigation. A bladder catheter became the uterine catheter to evaluate if the patient’s fallopian tubes were open.

In general, the ingenuity of the Ethiopian people never ceases to amaze me. The operating room is no different.

Kristen and Carol.

Making Connections at Mary Stopes

Today we (Leslie, Amsale and Liz) had the opportunity to visit Marie Stopes International- a British based organization focused on family planning, safe abortion, prenatal care and delivery services. Marie Stopes is currently providing care to women in over 43 countries with 30 sites just in Ethiopia alone! Check it out at www.mariestopes.org.

We were hoping to establish a relationship that would enable us to refer patients for vaginal births and c-sections.. We initially arrived at the wrong Marie Stopes clinic(just another mishap that turned into a bonus!) and met a very warm and welcoming site director who was clearly committed to women’s health. Once realizing that we were not at the Marie Stopes obstetrical site (the lack of pregnant women should have been our first clue) we quickly hustled to the 3 story obstetric center. Again, the staff was incredibly welcoming- and obviously very busy! The building buzzed with activity- proud families, recovering moms, crying infants and laboring women with 5 to a room! (Two quick observations- women and newborns stayed at the clinic only 6 hours after giving birth and the operating room was on the 3 floor in a building without an elevator. Imagine carrying a laboring women up 3 flights of stairs for emergency surgery!)

After our tour of the facilities, we met to discuss future collaboration with a clearly very competent and skilled medical team. We agreed to sharing resources- particularly Blue Nile medical volunteers providing training for staff- in exchange for discounted prices for our patients. For example, Marie Stopes received a donated colposcope, but did not have any staff that knew how to use it - several members of our volunteer team do. Currently the cost for a vaginal delivery is around $10 and a c-section around $20- a shocking price in our country but well out of reach for most Blue Nile patients.

Following our visit to Maries Stopes, we were fortunate to have a brief meeting with the director for our local district hospital. Again he was very welcoming despite our unannounced visit and looked forward to working together on inpatient care for our patients.

Overall, a very productive morning!

Leslie and Liz