Facilities Perspective (11/15)

After the arrival of the container on Thursday, 11/12, many members of the group turned their attention to the physical clinic building for three days, jumping in with Mark and Leo, who had been working on the building all week. Mark Kuiper is an engineer who came on the trip with his wife, Kristen Austin, MD. He was kind enough to provide a wrap-up on facilities as of Sunday, November 15th.

Facilities Perspective (11/15) -- by Mark Kuiper

When we arrived on Saturday, Nov 7, the basic clinic structure was in place with walls, a floor, and a roof. However, there were no functional toilets or sinks, storage shelves, or supplies to fill the shelves. There was lots of work to be done in our seven working days in Addis. We wanted to get it in working order for basic exams, even if laboratory facilities, x-rays, and other major technologies would have to wait.

Leo and Mark began the shelf construction project with a visit to the Merkato, the Ethiopian version of Home Depot, Fabrics n Things, and Fred Meyer. The Merkato to is a large open air mall that stretches for a half mile in each direction. One can find just about anything there. We found the building supplies section and proceeded to bargain for tools at a dozen different shops. With the help of Selam and Masresha (BNCO Executive Director and clinic administration volunteer, both Amharic speakers) we drove away five hours later having purchased some basic tools at a reasonable price. It was Monday with six working days to go.

Leo and Mark spent the better part of three days planning and constructing the pharmacy shelves. There were moments when we weren’t sure if we would finish in time. For example, while the Merkato shops did have the basic supplies we needed, the shops did not have the tool and screw size variety one might find at a home improvement store. Leo and Mark settled on sizes that seemed appropriate and moved ahead. During shelf construction, they discovered the need for longer screws. Without the luxury of longer screws, they looked at what we had and decided to pre-drill a deep hole in the wood. This technique would enable using the shorter screws. Unfortunately, the correct drill bit size to pre-drill the hole was not available. In the spirit of Ethiopian resourcefulness, they drilled a hole with a smaller bit, wallowed out the hole as much as possible, and finished the job by burning the hole to size with a nut driver bit and a healthy dose of friction. It was Thursday with three working days to go.

With the pharmacy shelves complete, Leo and Mark began constructing the records room shelving. During construction of these shelves, they taught Dante (BNCO carpenter) how to safely operate a power drill. It was Friday morning with two working days to go. The file room shelves were about 50% complete when news of the shipping container status arrived.

The container had been on its way from Seattle to Ethiopia since July. It contained many of the supplies needed for the clinic debut. Only there was a problem. The truck blew a radiator hose and was stranded just a mile away from the clinic. The truck driver borrowed the shelf construction hand tools, some plastic wrap, and a pop bottle and set out to fix his truck. Leo, Mark, and Sisay (BNCO public relations) joined him to help out where they could. The driver fixed the leak in short order. With the help of a siphon tube and a five gallon jug of water resting on top of Mark’s head, the radiator was filled and the container was on its way again. By nightfall with the help of a crane, the container was resting on foundation blocks at the clinic. It was Friday night with one working day to go.

On Saturday, an army of volunteers began sweeping out four clinic rooms, washing walls, and cleaning sinks. Leo hack sawed off the two customs locks and cracked opened the container. Clinic beds, chairs, and tables were unloaded. Clinic supplies were organized on the freshly painted pharmacy shelves. A 2000 liter water tank was erected onto a 4.5m platform using only Ethiopian human strength and ingenuity. Mark and Brian (BNCO photographer) visited the Merkato with the plumber to buy water pipe and couplings. Leo coordinated proper attachment of the sinks to the clinic walls. The clinic facility was shaping up.

The morning of Sunday, November 15th was a busy time. The medical staff arranged the rooms to suit patient needs. A patient medical history area was developed, complete with calibrated bathroom scale and pencil lines drawn on the wall for patient height measurement. The city water was now up and running which made additional clinic cleaning much easier. However, the sinks had never been tested with water before and several leaked. A crescent wrench and some silicone caulk improved the situation considerably.

There are still many items on the “to do” list at the clinic. The records room shelves need to be completed. Glove staging shelves must be built for each clinic room. Additional clinic rooms need cleaning. The reservoir and hot water tanks need attachment. The concrete floor needs sealing. Many of the clinic room doors need adjustment. And the clinic doors, walls, and shelves need a final coat of paint. Surely, it is a work in progress. However, progress surely has been made this past week.

Our first Thursday in Town

Our First Thursday in Town (11/12)

The first Thursday the team was in town, many of the providers returned to Black Lion Hospital for teaching and patient care. Others went to other sites, and Leo and Mark headed back out to the ROMC site to work alongside the BNCO carpenter and other workers.

Kristen Austin went to a Marie Stoppes clinic to help deal with a too-typical scenario. Someone had kindly equipped the obstetrics-gynecology clinic with a colposcope (a device used to visualize and biopsy the cervix of a woman who might have cervical cancer), but not provided any training on its use. No one at the clinic knew how to use it! Thursday morning, Dr. Austin taught the physicians how to use it, using a flower as a stand-in for the cervix. (How poetic!) She would return the following Thursday (11/19) to provide additional training with real patients in need of colposcopy. Marie Stoppes provides many services that are beyond the planned scope of ROMC (delivery by caesarian section, for example). They said that in exchange for our help with their continuing professional education, they would be able to work out discounts for extremely poor patients referred from ROMC when it opens.

After the morning's work, the whole team gathered for lunch and a coffee ceremony at the Addis Ababa home of BNCO Executive Director, Selam Kifle. Then the whole group went to the ROMC site, rolled up their sleeves, and got busy sanding, painting, and otherwise making the rooms ready for service. That was the night a container of donated items shipped from Seattle finally arrived - after a sea-voyage, delays in customs, and an overland trek from Djibouti. Leo Dirac relates the final excitement, below.

The Container is Here! (11/12)

Working in Ethiopia can be challenging for Americans used to a high-paced go-go-now culture. Things are more laid back here. Relaxed and happy mindsets dominate. Times are often approximate. All this can lead to delays.


Photo by Leo Dirac, available under a Creative Commons license (http://farm3.static.flickr.com/2767/4102577600_6a5de5ed8f.jpg)

Moreover equipment we take for granted in the US is often in short supply here. We loaded a 40' shipping container, the standard for international logistics. But here in Addis Ababa there are not very many semi trucks on the roads -- smaller trucks dominate. Hiring a semi to move our container to the site was complicated, and it broke down on the way to the site. To repair it, the drivers had to borrow some basic tools from the clinic construction site -- a screwdriver and a crescent wrench. The last bit of dirt road to the clinic site was barely navigable by the combination truck. All these delays meant that the crane (which was also quite hard to find here) had to unload the container in the dark, which nobody had expected. But with one borrowed headlamp and a lot of determination, we made it work.

Now the container is in its permanent home. Once fully unloaded it will probably be converted to an office. The whole mission crew is excitedly emptying its contents into the building, finishing the conversion of a concrete building into a real medical clinic.