Jimma Report 2009

Jimma Report 2009

I left Brisbane on Monday evening 8th September flying Emirates. I had a good trip to Dubai landing at 11.30 on Tuesday morning. There were no problems passing through Immigration or customs. The Friday was Ethiopian New Year which meant I only had two days in Addis Abeba before travelling by EAL to Jimma on Saturday 13th September. During my stay in Addis Abeba I visited the Fistula Hospital and had a meal with the Bennetts and Catherine Hamlin. And I visited Bingham Academy and met up with a number of Ethiopian friends.

Jimma is a town of about 200,000 people situated 350 kilometres from Addis Abeba. It has a University with 16,000 day students and several thousand more night and distance students. From a medical point of view they are now accepting 60 each year for the 6 years of an undergraduate course for a medical degree. They have 4 surgical trainees / year for each of the 4 years for a higher surgical degree. There are also trainees in a number of other post graduate medical courses plus nursing and health officer students.

The hospital has about 400 beds and is the tertiary hospital for about 15 million people.

The government is pushing hard to overcome the deficiency in trained medical personnel but there is a question as to whether or not there are adequate senior staff to train the oncoming students and post graduate trainees adequately.

A new hospital in being built but is at least one year away from opening. The present hospital has several new blocks – e.g. for paediatrics and O & G but the surgical unit is the old part of the hospital. It is kept clean by third world standards but is grossly underequipped. Half of the operating rooms cannot be used because of the absence of operating tables and /or anaesthetic machines. Often one of the remaining operating rooms is closed because of lack of oxygen. It is much more common to rinse your hand in alcohol than to scrub as we normally do, because of lack of water.

Much of the senior surgical staffs’ time is taken up in Administration and teaching. Thus there is much operating done at a trainee level which is frequently un- or under-supervised. Due to multiple factors many beds are taken up by people awaiting surgery which is often cancelled a number of times before being performed – ORs closed; no oxygen; blood unavailable etc.

Pathology

My first operation was on a man with a 30 kg scrotum due to massive lymphoedema (elephantiasis). He also had a minor degree of the same disease in his left leg. He had been in hospital for longer than 2 months awaiting surgery for whatever cause. There are many patients with burns, thyroid disease – benign and malignant (3 were malignant); enlarged prostates with obstruction; trauma.

I will mention just a few situations particularly highlighting some of the children.

1. A boy with a hyena bite – who had lost a thumb; portion of a buttock and of his left calf and who had been scalped! He had been in hospital for a couple of months awaiting granulation tissue from the edges to cover the bare skull bone before grafting. Two weeks after drilling multiple holes into the outer table of this cranium he is now almost totally covered with granulation and ready for grafting. He is a great kid!

2. A boy who fell onto a stake a long distance from the hospital and injured his ascending colon. He was passing faeces on the right back several centimetres from his spinous processes. I was able to resect portion of large bowel and permanently close it and to bring an omental flap across to stop his bowel falling into the wound. It was possible to see his 12th rib; the lower pole of his kidney and his iliac crest in the hole. He is doing well – the staff are packing the wound and allowing it to granulate.

3. A girl of 5 or 6 spontaneously burst her colon in an almost identical position after a 2 week febrile illness. It almost made me vomit removing the dead tissue from her back. I then had to do a right hemi-colectomy as her disease in the bowel was much more extensive. She didn’t have enough omentum to use for anything and with the complete removal of her right colon her small bowel, when packs were removed, kept falling out the back wound. I had to close it with a large skin and muscle flap a week or so later and it seems to be working well.

4. As far as I can work it out, a local healer had burned the abdominal wall of a 3 year old and she, for 6 months, had had her perforated transverse colon hanging out just below her umbilicus. Treatment was delayed because of TB but I was able to resect the colon and send her home well.

5. There are two teenagers (a girl about 16 and a boy about 14 with papillary cancer of the thyroid. I am trying to sort out a way of getting them radioactive iodine therapy in Kenya if possible. It is not available in Ethiopia. They have had their surgery.

I shared in examining the 4th year medical students at the end of their surgical term.

Attitudes

The surgeons, the surgical trainees, the interns and the medical students all seem very keen for me to return. I was taken out to meals by two teams of trainees to beg me to return.

The OR staff were very co-operative although the OR conditions are abysmal. (I think this is the most accurate adjective I can think of) they tried to look after me well and even spoil me.

Once when a huge urachal cyst (the size of a 32 week pregnancy) burst all over me and there was no water available one of the anaesthetic orderlies chased up water from outside and poured me a shower after the operation was completed!

Conclusion

So after much thought and prayer and realising that there will be many frustrating and trying moments, Robin and I have decided that I should accept their offer to come back as Associate Professor of Surgery. I will sign a 1 year contract – and at the end of that considering age, health etc I might extend it.

Dr Hamlin still runs the Fistula Hospital aged 86 with hip replacements and other medical conditions!

Robin and I will work out details of her times table over the next few weeks. I spoke at a Saturday afternoon meeting of the Student Christian Fellowship at which there were about 2000 present. They told me numbers were down a bit as it was exam time.