Day 9: Healthcare in Ethiopia

"The hospital has not had a budget for maintenance for many years. Our elevators do not work, our oxygen lines leak, the plumbing does not work, one third of our operating rooms are shut down because of broken equipment, and the government does not care. So why do I stay? I have been here too long to leave now." These words were spoken by the chief of the cardiology department at Black Lion Hospital, the largest hospital in Ethiopia and the referral center for all of Ethiopia. It is also home to the only medical training program in the country, with interns and residents assisting in the care of the patients. Think of it as the Massachusetts General or Mayo Clinic of Ethiopia in concept. In practice, it is as far from those examples of American medicine as you could imagine.

A cardiac surgical team from Germany was there, led by an Ethiopian man who was trained and does cardiac surgery in Germany. He had visited Black Lion in 2003 and met a young woman suffering from end stage cardiac valvular disease, the result of repeated bouts of rheumatic fever. In the US, we see very few patients with valve problems from rheumatic fever, and these are usually at least middle aged if not elderly people. At Black Lion, the median age at death from valvular disease is only 22 years of age. The German surgeon had attempted to arrange for the young woman to fly to his country for surgery, but after 3 months of governmental delays, she died before she could be operated. He then became determined to bring a team to Addis instead, and this was the second team he had brought to Black Lion. The team of 26 people included surgeons, anesthesiologists, perfusionists who run the heart-lung machines they brought with them, and even cardiac nurses. They had completed 16 of the planned 18 surgeries, all multiple valve operations, on patients aged 16-22. My host, the cardiologist, explained that with similar teams they have had a total of 80 open heart surgeries at the hospital. When a foreign team leaves, the patients wait in hope that another team will come soon.

We then walked thru the patient wards. The room sizes were comparable to ours, with a number of single and double rooms, but mainly 16 bed wards. But the rooms were dingy, lights did not work, the bed was merely a spring frame, and there were few nurses. RNs at Black Lion will administer meds, start IV lines, and check vitals, but the care is otherwise given by the patient's family. They have to leave and buy medications prescribed by the doctors at an outside pharmacy, and bring them back to the hospital for the nurses to administer. If they cannot afford the medications, they are not treated. Patients may wait weeks and even months once arriving in Addis before they are seen, often running out of money and turning to begging on the street to survive the wait. At the cardiac clinic, which cares for all of the patients referred to Black Lion, there was one very old EKG machine and one echo machine, this for the entire hospital patient base. There are no angiograms performed, and the only cardiac surgery performed is that done by visiting foreigners.

Perhaps the most sobering site though was walking thru crowded hallways filled with patients waiting to be seen in the emergency room, perhaps 300 or so patients, and then entering the ER: 3 beds in one small room, no curtains separating the patients in them, dusty cardiac monitors on a shelf above the bed. "They haven't been working for years" my host noted. As we walked away, he said that of the 40 residents who graduate from the medical school program each year, 60-70% leave Ethiopia for other African countries or the Middle East, so that about 15 physicians are produced yearly for a country with 70+ million people. "The new doctors are paid $200 per month by the government, and a senior staff physician about $400 per month. A bank clerk makes more in Addis. Why should they stay?" I could not come up with any reasonable answer.

That afternoon, as we took a brief break from our medical clinic in Bole, the docs on our team visited the government health clinic in Bole, with which the SIM/MTW project has partnered. The project has one case manager and another clinical counselor to help with the growing population of HIV/AIDS patients at the clinic. Open only 7 months, they already have over 930 active infected patients at the clinic, and are enrolling new HIV patients at the rate of 30-40 per week. We asked the physician at the clinic about her staffing, as the Bole clinic serves about 330,000 people in that district in Addis. "I am the only physician, and I have two nurses who help me" she replied. Imagine one medical clinic with only one doctor serving the people from Redwood City to Sunnyvale, and you have a sense of the enormous need in Addis Ababa.

The reality of healthcare in Ethiopia is that it is non-existent to many of the population. The physicians we spoke with today estimated that half the population never receives any healthcare. This only served to emphasize the importance of the small mobile clinics we can run, and the larger community clinics sponsored by Mekane Yesus staffed by the clinic workers we taught. Seeing gratitude of people receiving help, sometimes for the first time, directed away from the clinicians and towards God, is a wonderful experience. Tomorrow we will run a mobile clinic at one of the local churches, as we will the next day. Please pray that we are able to serve the patients we see, but also pray for these people in Ethiopia.