Laura's Blog

Another thunderstorm was slowly rumbling toward us that afternoon. Again, just as they had the last two days, clouds came together in the sky, mounting their attack on the few buildings that stood there on the outskirts of Debre Zeyit. From inside the church, I looked out through a wall of windows to watch as a new group of students came toward us. It was the last class of the day, some thirty of them, and by the time we would finish we would have seen nearly 200 children by mid-afternoon. Just as every group had before, their young faces wore bright smiles. This may be a seemingly small consolation when compared to the many alarming things we witnessed on our trip. And yet this, more than anything, is what struck me the most. These children had next to nothing. Two years ago, when not a church nor schoolhouse nor cafeteria stood on this land, they did have nothing. And I’d be more than willing to bet that they were smiling then, too. They were happy. I thought of how much we as children privileged enough to be raised in a developed and wealthy land have been given throughout our lives. I thought of my young nephew, Chase Alexander. He is the sweetest little boy. He has been loved and cared for by his mother as much as any child can be. It is hard for me to imagine him having just one meal to eat each day, or just one set of clothes to wear. What if he could not bathe in warm water each evening, read a bedtime story tucked in his soft little bed at night, and wake up to Mommy warming his hot chocolate on the stove? How relieved it made me to think that he will never have to live this way. But if he did, could he still find hope and joy in his life? Our entire three weeks there I observed this phenomenon – happy children. These children, who were lucky to have clothes to wear, see a hot meal everyday, or find clean water, were smiling. They were genuinely happy. It warmed my heart.

I was lucky enough to experience more of their joy one day during the lunchtime hour. The team had finished eating our lunch, and having some time to spare I set out to see what sort of games the children played on their recess. I made my way up the hill to the cafeteria. I could see a group of students had gathered there. One of the teachers was inside with his guitar, and as I stepped in he smiled. It was choir practice, he explained, and they would be honored to sing to me. And so I listened. They were lined up in rows, and as they sang they swayed gently from side to side, clapped their hands, and twirled about in unison. They had the most beautiful voices. They belted out the words with all their might, smiling at one another and then at me. It was an overwhelming moment. Later I would learn that they had been singing praises, thanking God for all that He had done. Those few minutes reassured that which I had known, but couldn’t quite fathom. These young children had a tremendous joy for life, and such gratefulness for what they had been given. The thought of this brought tears to my eyes. They had so little. In the scheme of this great big world and all it has to offer, their roll seemed so small. But to them the world is bright. They are filled with hope and love.

It taught me a great deal about the beauty in the children of Ethiopia. They are truly loved and cared for by their parents, as can be attested by the tremendous turnout at the meeting we held, as well as by their desire to start a health committee. These children love one another, and they find joy and hope and gratefulness in the simplicity of everyday life. They have lived through harder times, and despite their young age they are wise. They are an inspiration to all of us who were lucky enough to experience their unwavering spirits. I will never forget the smiles on those faces.

Cultureal Education

Dear Reader,

The nostalgia of my summer experiences returns with a rapid and wailing thump in the frontal cortex of my brain.
I had a great summer, my life will forever be changed and I will never forget my experience, but it is sad how fast it fades. While I am impressed at our adaptability, I am struck by how fast we forget the people of Ethiopia and the nearly ubiquitous plight of the world (perhaps more distant but including the U.S.) and return to our American rat race, our "book-eating" and our gout-ridden foods. I am only reflecting and admit to adopting the same behaviours. How lucky we are to be on this side of the fence...the buffer is only so thick.

I vastly enjoyed all of my experience in Africa and was glad to forgo any inconvenience. I would do it again in a heartbeat. Perhaps my favorite experience was during the first two-days of clinic in the mud-walled, three-roomed school at Senkeli with Dr. Berggren. It was a rich combination of experiences because it was the first time for most of us to interact with Ethiopians, run and set up a mobile clinic, and pester Dr. Berggren with the impossible multitude of questions that come from a medically ignorant MS1 mind. The Ethiopian children were often extremely shy and docile while we were screening them but affectionate, loud and happy as soon as they were back on the playground. Like any other child, I saw that they were happy as long as they could play with their friends.

We saw a good number of cases on our first day in clinic. Many of the children presented with conditions that are rarely seen in the U.S. because of this and our minute diagnostic skills we were constantly barraging Dr. Berggren with questions and requests for consult. For the most part, my paranoid inquests resulted in an,"I'm not impressed," or ,"Just give him a vitamin," from Dr. Berggren. After about four hours of her critique, I was only just able to differentiate lice, tinea capitis and scabies. In total, we saw about 200 patients while Dr. Berggren was at the Senkeli clinic with us. Many were adults that seemed to have chronic conditions of serious affect to the health of the individuals and the community. It was shocking be examining an older child with a productive cough and see scrofula removal scars or hear them say that they had incomplete TB treatment when they were 4. Some patients laughed at the idea of going to the "local clinic" for treatment and others providing HIV tests was ridiculous. It wasn't because these were bad ideas, but because they implausible and hard to believe. Treatment for HIV requires a support network. A network that could be extremely useful in many parts of Africa, but doesn't remotely exist.

I had many other experiences during my 44 days in Africa, but the first two days of clinic were certainly the most impressive. I came to the realization over the span of my trip that happiness is the most flexible feeling. I had always thought that happiness was something that you achieved or sought for by doing what you always wanted or being loved by alot of people, but it really isn't. Happiness is about acceptance and contentment. That doesn't mean we should stop striving for greater things but that happiness is with you all the time. It not something that you are going find after you graduate from medical school and receive your first paycheck or once you get married and have kids. Happiness is found by accepting yourself and your surrounding. I saw bunches of happy people in Africa and I can say that they weren't rich or loved by all but they had accepted themselves and their surroundings. Seek happiness in all things and in all places because if it isn't with you now, it never will be.

Trisha's Blog

It is hard to choose which experience to write about, but I think my time at the fistula hospital effected me most profoundly. I stayed in Ethiopia after the team dispersed, to shadow Dr. Andrew Browning at the Bahir Dahr Hamlin Fistula Outreach Center. This is one of six hospitals in Ethiopia where women can go to have their obstetric fistula's repaired. Obstetric fistula is a devastating childbirth injury caused by prolonged obstructed labor. Without too many details, the results of this prolonged obstructed labor is the death of the baby, and damage to the mother's vagina and bladder and/or rectum, resulting in the constant leaking of urine and feces. These women are often ostracized by their families and communities due to their smell and condition, and many fall into deep depression. Before the Hamlin's opened the fistula hospital in Ethiopia, there was no where for these women to get help. There are over 200,000 new cases of obstetric fistula each year and over 2 million women living with the condition world wide. If surgeons trained in fistula repair worked at full capacity year round, only 9,000-12,000 could be repaired a year. This brief overview will give you some idea of the massive scope of this maternal health problem.

I began my days with Dr. Browning at the fistula hospital by shadowing him on rounds of patients. We started with the patients who had recieved fistula repair surgery and were recovering. These women were so happy! Some of them had lived with this condition for decades. They would grab Dr. Browning's hand as we walked by and cover is arm in kisses. They were so grateful for this second chance at life they had been given.

After we checked on the recovering patients, we visited the patients awaiting surgery. The contrast in the countenances of these women compared to the recovering women was staggering. These women had to carry buckets to empty their constant flow of urine into. The smell was overwhelming. They were subdued and ashamed, and would not make eye contact. I could not begin to comprehend their suffering, and was amazed that this preventable and treatable condition was wreaking havoc in the lives of so many women.

My time here reaffirmed my desire to pursue a future in Obstetrics and Gynecology and to return to the fistula hospital to work and contribute to this massive problem. I will hopefully be joining Dr. Browning again in the future to assist in his work there. I know this is why I am supposed to be a doctor; to ease the suffering of these unseen millions and to bring their cause to the attention of the western world. I am eternally grateful for the opportunity to meet and interact with these women and hopefully, contribute to the alleviation of their suffering.

Allison's Blog

It’s difficult to choose one experience out of so many from our adventure in Ethiopia to write about, but one day in particular stands out in my mind. It was the day I realized that our hard work and our mission would persist long after we were gone.

We drove out to the village of Debre Zeyit that Friday morning with what we planned to say weighing heavy on our minds. I couldn’t help but be nervous, and my stomach did somersaults at the thought of addressing so many people. As we entered the church, we saw the parents, grandparents, young children, and other friends and relatives waiting patiently in their seats as the pastor addressed the group. We didn’t know quite what he was saying since he was speaking in Amharic, but many eyes turned towards us as we took our seats at the front of the building. We each took our turns, one-by-one, walking up the small set of stairs to stand center stage and speak to the families about various health issues, and Asrat, one of the team’s translators, translated for everyone what we were saying. Robin took on the task of explaining the importance of teeth-brushing, while Gabe discussed lice, scabies, and tinea. Laura had a big job of outlining the causes of intestinal worms, and I talked about trachoma. Allen gave an extremely informative speech about tuberculosis, and our time with the families was summed up by Laura offering the team's thanks and gratitude for their gracious welcoming of us into their community. She did an absolutely beautiful job, bringing tears to many eyes.

The pastor and other school leaders then began calling for volunteers to serve on a community committee that would be dedicated to recognizing the health issues we presented as well as other emerging concerns and strive to create solutions. Slowly, individuals began raising their hands and climbing the same stairs we had climbed to the stage. One woman that worked as a gardener at the school had joined the committee in gratitude. The team had just enough azithromycin to rid her of trachoma, and this was her way of giving back to us. Seeing everyone up on the stage was awe-inspiring, and they all received a hearty round of applause. The meeting ended, and we slowly said our goodbyes accompanied by hugs, snapping a few pictures as we left. And as we drove home, I realized why this trip was so necessary.

It was easy, as we worked each day in Senkele and Debre Zeyit, to get frustrated and discouraged with the thought that many of the children we were helping will probably get worms, or lice, or scabies again within a few weeks or months. Our efforts might have seemed to be futile to some. What were we doing here?

Yet after our meeting with the community of Debre Zeyit, it all became clear. Our job was not only to help the children we could, even if it was temporary, but to also provide the lasting education concerning what causes disease and how it can so easily be prevented. I am confident our work will have a lasting impact, and hopefully, our group and others will be able to return to the same villages and see positive changes.

Overall, I found my time in Ethiopia to be extremely fulfilling, and it allowed me to focus on others’ needs rather than my own. I learned so much from other members of the team and from the Ethiopian people, and it opened my eyes to the extreme need of other parts of the world. My experience is something that I will carry with me forever.

Amy's Blog

Due to some unforeseen events, we were not able to blog throughout our stay in Ethiopia. So, the following entry is a compilation of some of my journal writings that will hopefully capture my experience in Africa:

Sunday, May 25, 2008

Yesterday we drove out to the rural village (Senkele) where we will be working in order to survey the site. We drove about 2 hours out of Addis and through many dirt roads and hills and pollution. If the weather stays dry we will be able to work there, but if it rains, it will not be possible to drive through the muddy terrain. So hopefully that won't happen. The weather here has been very nice and cooperative thus far. When we got to the school, it was all very sad. The school had 4 classrooms made out of dung, mud, and hay. The benches were very rudimentary and falling apart. There was no electricity. They did have a well with a pump for water, but the children are not allowed to wash their hands in it, it's only for drinking. And of course, the outhouse was merely holes in the floor. It will be an interesting week. There are about 200 children from grades 1 through 4 who we will be examining. It's funny, when we walked around the school, children and adults came and followed us and just stared. We are "forenji" or foreigners and many have never seen an asian, hispanic, or caucasian person. It was quite an experience: children were hanging all over the window sills just to peer into the classroom we were standing in!

Saturday, May 31, 2008

Working in Senkele has been an amazing experience. I saw lots of scabies, tinea, lice, and trachoma. Furthermore, there were many cases of suspected TB. The children watched us with wide-eyes and followed our every move! I found that the boys are very confident and will walk right up to you but the girls are extremely shy and reserved.

So yesterday, we were supposed to go to Senkele, but because it rained all throughout the night, we couldn’t make it through the dirt (now turned into mud) road that leads to it. I was really bummed because we were supposed to educate the village on what diseases we saw and what they can do to alleviate the problems and now, I’m not sure when we will be able to go back. It would be really unfortunate for us to have gone in and treat what we could but not be able to teach them prevention, because odds are they will get what they had again in a few short weeks.

Last night, we went to Dr. Rick Hodes’ house for Shabbat. There were about 20 Ethiopian children living there with him. I had never been to a Shabbat before coming to Ethiopia but what we did was we all got together in a circle wearing our funny hats and we sang some Shabbat songs. Afterwards, we played all night with the children and it was a fun, relaxed atmosphere. Dr. Hodes invited us to the hospital where he works, Mother Theresa Mission House, to do rounds with him this morning, but we declined because of a scheduling conflict. Hopefully, we’ll get the chance to do it sometime next week, though. He had previously taken us to the Mother Theresa House for a tour, which was amazing. When you first walk up to the Mission House, it’s this nondescript, unmarked blue gate, but once you enter, there are hundreds upon hundreds of destitute patients, each with some severe illness. We saw the cutest little toddlers running around with these huge distended bellies due to a variety of pathologies. We saw all sorts of spine cases, AIDS cases, cancer patients, etc… We saw some things that I’m sure we would never see in the US. It was all very eye-opening and emotional. Ironically, the mood inside the House was rather light-hearted. People were playing chess, singing, laughing, and playing outdoors. Dr. Hodes equates the patients’ stay at the House as a vacation in Florida! They get to hang out all day and just relax. J We were informed though that while none of the patients have to pay, the nuns have the hard job of sending the patients on their way once they are healthy.

Thursday, June 5, 2008

So Monday morning we drove about a 1 ½ hrs out of the city to a small town called Debrezeyit. The town is beautiful. There are mountains, lakes, beautiful greenery and of course, the Ethiopian people and children are all so sweet and accommodating. Even though there is a clear language barrier, they went out of their way to tell us how much they appreciated us. It’s all really touching. So over the course of the last 4 days, we set up our stations again. This time, I got to do the eye station and the dermatology station. At the eye station I was flipping all the children eyelids up and looking for evidence of trachoma which is basically spread by poor sanitary conditions and flies. It’s a bit traumatic to have your eye lid flipped by a stranger, but most of the students did a great job and didn’t cry or anything like that. This one kid, though, couldn’t control himself. So I was sitting at my station waiting for my next patient and Trisha brings forward this little boy, maybe 5 or 6 years old. The boy was not even looking at me but was staring at another girl who was in the process of having her eyelid flipped. He was staring in horror at what we were doing to his friend and when he finally turned around and saw me, the poor kid started shaking involuntarily! I’ll never forget his face, Trisha had to help me while I flipped his eyelids and another woman had to hold his head for me to even get a peak under his eyelids. As soon as I was done, though, he was smiling and laughing – even before his tears were dry!

As for the derm station...where do I begin? I found dermatology to be quite challenging. Bumps can be anything from infectious scabies to flea bites to plain ol’ scars and it’s very hard to tell when the only reference book we had had only pictures of white people. In the end, I did get a lot better at determining scabies, tinea, and lice.

Friday, June 6 2008

So today is an exciting day. Right now it is about 6:30am, and we are leaving to go back to Debrezeyit at 730am. We are going to be talking to all the parents about the statistics with regard to what diseases we saw and then we will hopefully educate them on how to prevent it! I’m excited to do this because I think this is the most important part of our job in each city and we weren’t able to do it in Senkele because of the rains.

Saturday, June 7 2008

The parents’ meeting was a success! We had a packed auditorium and we explained to the parents what we found in terms of disease statistics and then we educated them on what they could do to improve the health of their children. I was so excited to see how many parents came to our meeting. I was pleasantly surprised to see that the parents in Debrezeyit were just as worried and cared just as much for their children as my own parents. The only difference is that the parents in Debrezeit don’t have the opportunity or the finances to do what my parents were able to do for me.

Tuesday Jun 10, 2008

So yesterday we went to two hospitals. In the morning we went to the My Yung Sung Korean Hospital which was surprisingly very well-equipped and nice. Then we went to the Fistula Hospital, which was in a word: amazing. The hospital was started back in the 70’s by The Hamlins. They have created this sanctuary for women with fistulas. I learned that fistulas are caused by small pelvises due to malnutrition or young age at childbirth and then when these small women give birth for extended periods of time with no medical help, the pressure of the baby causes bladder fistulas or rectal fistulas. The result is that they become incontinent and leak urine and feces. I literally saw about a dozen women waiting to get triaged and they were like a leaky faucet. I could see their urine dripping as we walked by. These poor women have to travel great distances to get to the fistula hospital and what I love about the Fistula Hospital is that no one is turned away. 98% of the women have successful surgeries and are given a brand new dress and allowed to go back to their village, thus regaining their village’s respect. The depressing cases are the 2% who undergo surgery but will never recover. The Fistula Hospital takes these women in and trains them to be nurses’ aides or they teach the women how to do certain trade and crafts. They also teach the women how to read and write and the minimum time a woman spends there is 3 weeks. In return, a lot of them also come back to help those who are going through the same ordeal. The whole process is very full circle.

Coming home from my trip to Ethiopia people ask me what it was like and honestly, I don't even know where to begin. I saw so many different things, I marveled at how friendly all the Ethiopians were. I was horrified at the state of things in both the rural communities and the city of Addis Ababa. And I was touched by many people's stories. This trip has definitely been one I will never forget and it was one which opened my eyes to a lot of the injustices that occur. It's one thing to read about it all in a book and it's another to see it first hand. I am fully aware that I live a sheltered life and that there are those with almost nothing. This trip has really inspired me to do more.

Robin's finally writes a blog!

Well, what can I say? The 2008 Ethiopia team had all wished and tried to write while we were there but found there wasn't a computer connection in the country that would allow us to get on this blog site! There is so much I could write about but in the interest of getting back to studying for second year, I'd better be choosy.
Overall, the trip was an amazing learning experience. The different people we would come into contact with were often so inspiring to me I found my breath being taken away. For instance Dr. Hodes, the well known American physician who has been living in Ethiopia for about 20 years, has adopted about 5 kids and has about 20 others living with him. I have never met anyone who has devoted their entire life to service like that with absolutely no ulterior motive.
We first met him at his house for Shabbat dinner. As the only Jewish person on the trip I was both delighted and surprised when I heard we were going to celebrate Shabbat. When we arrived to his house in Addis Ababa, I saw this was going to be nothing like other Shabbats I had participated in! First off, there were Ethiopian kids running around everywhere, must have been about 30 or so of the cutest kids you'd ever seen. It was absolutely overwhelming trying to meet them all, and a bit intimidating trying to make conversation with someone as famous and respectable as Dr. Hodes. But after all holding hands and singing "If I had a hammer" I think we were all feeling pretty welcomed. Just being around the kids was a great learning experience. They all had a story; some had obvious spinal disorders, and some used to but had been helped by Dr. Hodes; some had heart problems, and some were simply siblings of them who he had also welcomed into his home. It was by far the most interesting Shabbat I have ever experienced!!
A few days later he invited us to rounds with him at the Mother Teresa Mission where he volunteers. The mission was started by Catholic nuns I believe, and take in the poorest Ethiopians from the most destitute of conditions. As we followed Dr. Hodes through the mission, he would frequently stop at a patient and give us a story or even perform an exam. I remember having a feeling I have never had before—the feeling of being an equal and the realization that I am actually a part of this noble profession. And being treated with respect by not only a doctor but an example of that rare person that you respect so much, you can’t even believe they’re real. And here we were, on ROUNDS, in Ethiopia, with a world famous doctor seeing conditions most medical students only see pictures of in books.
For example we saw several extremely swollen necks from what Dr. Hodes always hoped was Hodgkins lymphoma (being that non-Hodgkins is harder to treat). In that same vein, we saw several happy and healthy children running around and then Dr. Hodes would show us pictures of them from just a few months ago where they had enormous swellings in their neck and face, and now were completely normal. It was simply amazing to see these transformations.
The case I remember most vividly though was a woman bedridden with extremely severe Psoriasis. She was completely bald and you could see her skin was shedding all over her bedsheets. I don’t cry easily and I wanted to be professional but tears were filling my eyes as we all surrounded her bed. An Ethiopian doctor had joined us at this point and I watched as the two clinicians interacted with her and with us. They were so compassionate and respectful to this woman, and Dr. Hodes immediately said, “I’ll send a biopsy over to America”, in order to further help her. To witness a condition like this, and to see these perfectly altruistic people help her first hand was truly inspirational. Every man woman and child we met in the mission looked at the extremely humble Dr. Hodes as if he was a hero and I’m sure he deserves even more than that.
This interaction was only one of many unique and inspirational experiences I personally had in Ethiopia. The clinics we set up were a wonderful learning experience where we not only developed clinical and diagnostic skills, but also learned a way to set up a mobile clinic in a rural area. The other hospitals we visited all painted the picture of health care in Ethiopia, and educated us on health care in a third-world country in general. I truly believe this trip made us more aware and educated, and will contribute a great deal to being well-rounded physicians.

Korean Hospital Experience

On Monday, June 11th, we had the opportunity to take a tour of the Korean Hospital, a private hospital, as well as shadow various physicians working there. The Korean Hospital was created by Korean missionaries and is supported by funds from Korean hospitals, but there are doctors from all over the world who work there. The first thing we did was observe some surgeries. One group watched a neurosurgery (draining hydrocephalus, from my understanding), and another group watched a gastric bypass surgery. To me, the Korean Hospital seemed quite up-to-date, in terms of their ORs; the only thing that was different from the U.S. was the lack of air conditioning in the OR, which made it hotter, and slightly more uncomfortable.

After the surgeries, we ate lunch at the hospital and then took a tour of all the various wings. It was interesting to see the different types of rooms they offered to patients. First was a third class room, which is shared with four other people; a second-class room had a total of three people; and a first class room was a private room that was nicely equipped with modern-day conveniences, furniture, and a spacious bathroom. However, none of these compared to the VIP Hospital Suite (on reserve for US Presidents!), which had a separate family waiting room, and a humongous bathroom with a fabulous shower. At the entrance to the hospital was a long corridor in which people sat on chairs and waited to be called in to one of a number of offices where the general practitioners and internal medicine doctors were located. They also had an impressively-sized ER as well as one ambulance (often, family members bring their relatives to the ER rather than ambulances).

After our tour, Shannon and I went to see if anything was going on in the OB-GYN wing of the hospital. One woman there had just given birth earlier that day, and as luck would have it, another woman was in the later stages of labor and would probably be delivering later that afternoon. Shannon and I talked with the woman's husband and watched as the midwife and later the doctor came to check on the progression of her labor. They decided that they needed to perform a c-section in order to prevent septicemia from occuring. It was very interesting to speak with the midwife and to learn that only 10 percent of Ethiopian women go to a hospital to have their babies.

In the OR, I was able to witness my first c-section, which was really cool to see. After the baby was out, they pulled the uterus completely out of the body and stitched it up while it rested on the woman's belly. We followed the baby back into the OB-GYN unit and congratulated the father after watching the nurse take the baby's measurements. I found it very interesting that the father, though overjoyed, did not hold the baby at all or touch him, he just looked. We had asked this man earlier if he would be present for the birth (when we thought it was going to be a vaginal delivery), and he said that men were not normally present for the births of their children. This is an interesting cultural difference between Ethiopia and the U.S. During the c-section, it started pouring down buckets of rain, and we could hear it all pounding on the tin (?) roof-- it was so loud that it became difficult to hear what was being said during the surgery.

Overall, visiting the Korean Hospital was a great experience for all of us-- seeing surgery being performed in foreign country is always an amazing experience, one in which each of us felt honored to be allowed to participate.