IMHO Ethiopia 2010 Trip Summary

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IMHO ETHIOPIA: VOLUNTEER MEDICAL TRIP 2010 Bahir Dar

Debark

Gonder

Sheno

Immense needs at the Bahir Dar Felege Hiwot Hospital. Need for development of a School for the Deaf.

Requests for expansion of maternal & child care unit, surgical training, dental care unit, and counseling/education.

Possible medical education/ telemedicine program, and filling in the gaps.

Site of a future cancer hospital being planned by the Life’s Second Chance Foundation.

Report on IMHO’s first directly implemented effort in Africa.

Team of 6 IMHO volunteers descends on NW Ethiopia for 2 weeks of volunteer service.

A land of extremes where the beautiful landscapes contrast sharply with images of mind‐numbing poverty, Ethiopia is an ideal new frontier for IMHO, where a little service can go a long way in saving and improving the lives of the most vulnerable. For two weeks, a team of 6 IMHO volunteers embarked on an incredible journey, marking IMHO’s first directly implemented effort in the African continent. The team had several objectives, including delivering a number of health & medical supplies, carrying out a needs

assessment at each of the hospitals & clinics visited, conducting medical lectures & trainings, and laying the foundation for future long‐term efforts. While necessary amendments to these objectives were made once on the ground, each was accomplished, thanks to our committed international volunteers and local counterparts. Joining us for this trip were Dr. Bonnie Wirfs (an internist from WI), Dr. Betsy Finigan (a family medicine doctor from NY), Dr. Alan Krohn (a psychologist/ psychoanalyst from MI), Ms. Hayat Ali

(an MPH grad from Canada), Ms. Anouk Vashe (a photographer from CA), and Mr. Greg Buie (IMHO Programs Coordinator from CA).

Working in partnership with the Amhara Development Association (www.amharada.org), IMHO targeted the cities of Bahir Dar, Gonder, and Debark, all in the Amhara Region of Northwest Ethiopia. This area has had a legacy of under‐development, evidenced by the fact that 90.4% of the rural community has no access to potable water, 56% lack health

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Bahir Dar Felege Hiwot Hospital There was no shortage of identifiable needs at this hospital that serves an area of 5‐7 million.

Most immediately, the hospital needs basic equipment and medicines. Malnourishment/ undernourishment is rampant; there are many HIV/AIDS patients; the hospital has serious water & sanitation needs; there is a severe shortage of beds; and there is a high demand for trainings.

services, and 53.7% of school age children do not have access to any education whatsoever. Primary education benefits only 46.3% of the population, and secondary education reaches a mere 6.3%. The low levels of agriculture productivity, combined with the continual sub‐divisions of land due to rural population increase and recurrent drought in parts of the region, result in approximately 3.5 million people (almost 25% of the population) being left food insecure.

Bahir Dar Felege Hiwot Hospital

Our first stop was in Bahir Dar, a city of approx. 200,000 on the banks of beautiful and serene Lake Tana.

There we visited the Bahir Dar Felege Hiwot Hospital. This hospital serves a catchment area of 5‐7 million and sees 700‐1,000 patients/day. It is the only hospital in Bahir Dar city and functions as a referral center. With such immense demand, the hospital has a chronic shortage of beds, medicines, and supplies, and the staff is overworked. This huge burden also

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prohibits the hospital from developing or moving forward. The needs at this hospital were massive and clearly evident. Even basic medical equipments are either not functioning or non‐existent. The list of requests this hospital made to us were essential items that any basic hospital should have. A full list of requests (both equipment and medicines) is available on our IMHO website.

Based off our group’s observations, we were able to identify a number of areas in which IMHO may be able to make a large impact on this highly underequipped and overstretched facility. Getting a shipment together of in‐kind donations (equipment, machines, medicines, supplies, etc.) is the most obvious. Aside from that, there was great possibility and interest in trainings, which would be possible through the establishment of a telemedicine program. During our time there a 2‐hour training in mental health counseling was conducted by

Dr. Krohn and Dr. Finigan (and translated by Ms. Ali), which provided a glimpse into what future trainings could look like. Volunteers are certainly welcome to come teach in any number of subjects at the hospital, but in the absence of such volunteers, a telemedicine program would ensure long‐term sustainability of this medical education component.

The hospitals record‐keeping system was also in need of support. Thanks to a grant for the hospital’s HIV/AIDS program, electronic records are kept for all those patients. However, the rest (ie: the vast majority) of the remaining patient records have yet to

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56% of people in the Amhara Region lack access to any health services.

go digital, making for a rather chaotic and inefficient system. In order to do this, the hospital needs computers, software, training for staff, and development of a new system that all staff will need to be trained in.

Bahir Dar Health Clinic

As the only 1 of 4 health clinics in and around the city of Bahir Dar still functioning, this clinic was a refreshing break from the massive issues facing the Bahir Dar Hospital. The clinic functions as a community hospital, providing care to patients by 18 nurses and 6 community health workers (there are no doctors). The clinic was fairly well stocked with medicines and equipment, the facilities were clean, and the staff were efficient and well‐trained. They made several requests for equipment, but all in all, this clinic is a strong model for what community primary care clinics in developing countries should look like. As a gesture of goodwill, IMHO donated a number of medical supplies and medicines here that were brought over from the U.S.

Bahir Dar “Yekatit 23” School for the Deaf

A special request was made during our trip by a few of the IMHO volunteers that we visit a school for the deaf, which we found in Bahir Dar. With very few opportunities for

deaf children in Ethiopia to even go to school and learn sign language, we realized that these 28 children were very fortunate to have special classrooms set aside for them. Most deaf children in Ethiopia are either left out of the educational system entirely or forced to learn alongside their hearing‐abled peers, in which case very little is actually learned at all. Two classrooms had been set aside in a separate section of this school for several thousand children, in which parents of deaf children who had learned some sign language were acting as teachers.

Their commitment was clearly evident—they had done everything in their power to transform the classrooms made of basic wood, mud, and tin into a place for learning.

Yet, they are struggling. And when the children reach Grade 5, they are integrated with the rest of their hearing peers.

A long‐term, comprehensive plan is needed to develop this school for the deaf, including the construction of new classrooms and a live‐in student compound, training of new teachers and care‐takers, provision of supplies and learning materials (such as art supplies, books, teaching aides, toys, Braille boards, sports equipment etc.), and classes for adults/parents of deaf children. To help in the

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interim, two of the IMHO volunteers (who are fluent in sign language) took the 2 teachers shopping and purchased approx. $200 worth of books, supplies, and toys on their behalf for their classrooms. Many of the deaf children at this school are orphans, have been abused, and are dealing with other physical and mental disabilities, which makes the need for such a development plan all the more necessary. It may be possible to look into support from the National Technical Institute for the Deaf in the U.S. and other deaf resource organizations to make this project a reality.

Debark Hospital

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ambulance is available, making patient transfer exceedingly difficult.

Like all other hospitals we visited, there is a shortage of most medicines, most strikingly magnesium sulfate, which was the top medicine requested everywhere we went.

These shortages are a national problem and not specific to any one hospital. The hospital, which serves an area of 2 million, sees about 1,300 regular HIV/AIDS patients and 500+ diabetes patients. They are currently working on development of an eye care center that will be able to perform cataract surgeries. For further expansion, the hospital administrators and doctors are hoping for the following: 1. Training of key staff in general surgery and how to perform a c‐section; 2. A dental unit; 3. Further expansion of the maternal & child care unit; and 4.

Medical education and counseling for doctors & staff.

Debark Secondary School & VTC; Walia Primary School

As we made our way into the dusty rural town of Debark, at the base of the breathtakingly picturesque Simien Mountains, we expected to find a hospital in poor shape.

However, built in 2006, the Debark Hospital is a new facility that is extremely well‐managed. The administrative team has a vision for growing the hospital and adding to the basic structure currently in place.

This 42‐bed hospital essentially serves as a large primary care clinic, as no specialty care is yet available. With no surgeons, no OBGYN, and no other specialists, the hospital refers many patients to the hospital at Gonder, which is about 3 hours away. Only 1

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IMHO ascribes to the World Health Organization’s definition of health, which states that “health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.” As such, the IMHO team of volunteers visited two schools in Debark. The Debark Secondary School and Vocational Training Center for young adults is a sprawling campus, but one that lacks many basic resources, including adequate chairs, benches, and tables, as well as textbooks. The ratio of students to textbooks varies by classroom, but is usually within the range of 1:5 or 1:10. According to government standards, this number is supposed to be 1:1. But

with student to teacher ratios at approx 1:50 or so, there are simply too many students and too few books.

The school also lacks a health clinic & nurse, and there are no computers, no internet, and no water. Requests were made by the school administration for laboratory equipment, textbooks and reference materials for all subjects (English language), dictionaries, trainings in English, computers, & leadership, and more.

These same needs were repeated at the Walia Primary School where IMHO donated sports equipment brought from home. As we displayed the items we had brought with the school administration, the school’s 2 physical education teachers excitedly showed up and explained that the school did not have a single ball or piece of sports equipment with which to conduct classes…until now. We hope to be able to provide more equipment like this in the future.

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In a country of 80 million where cancer abounds, the disease is almost always terminal. Only 1 hospital nationwide treats cancer patients, but the level of care is extremely poor due to lack of resources, facilities, training, medicines, etc.

The time has come for Ethiopia to have its own cancer hospital. Millions of lives will be saved…

Gonder Teaching Hospital

At 450 beds, the Gonder Teaching Hospital is a massive facility. However, the demand is even greater, leading to major overcrowding and a serious strain on the hospital’s human and material resources. Each year the hospital sees an incredible 200,000+ outpatients and 20,000+ inpatients. The spread of disease, including maternal sepsis, is high on account of the sheer number of people who are in and out of the hospital. In particular, the pediatrics ward is the most overstretched. Most infant & child health problems are related to poor nutrition.

The possibility for projects at this hospital are more limited, given the size of the hospital and the fact that USAID is funding the construction of a new hospital (due to be completed in 2 years).

During our visit our team conducted a few medical lectures, including “Symptom Relief at End of Life” and “Sexual Abuse of Children and Adolescents”. A few manageable needs were also identified while we were there, including a number of broken machines or equipments that

simply need to be repaired. Investment in training a handful of technicians to fix broken equipment at this hospital and others would be one such worthy effort. The very receptive staff and administration also encouraged future trainings, be it through volunteers coming in‐person or via telemedicine. A request was also made for 5 voltage converters—a simply fix for a number of machines that were donated from the U.S. but did not come with voltage converters and thus cannot be used.

Sheno Cancer Hospital—Life’s Second Chance Foundation

About 80 kms. outside of the capital city of Addis Ababa, lies the small community of Sheno, home to about 15,000 people. In May 2008, the President of Ethiopia inaugurated the site as the home of a future cancer hospital, a massive undertaking headed by the Life’s Second Chance Foundation. Cancer is a silent killer in Ethiopia, as it is in almost the rest of sub‐Saharan Africa as well. Despite the fact that the disease kills more than twice the number of AIDS, TB, and malaria deaths each year, it is not well‐known or understood by the people. In Ethiopia, only the Tikur Anbesa Hospital in Addis Ababa can treat patients with cancer. Yet, only about 500 patients get treatment each

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year, and the vast majority of those cases are in fact terminal.

Having visited the pediatrics ward at the Tikur Anbessa Hospital where child cancer patients are integrated with other cases, our team can attest to the incredibly dismal quality of care (and quality of life) these patients and their families endure while fighting this battle. Only a handful of chemotherapy drugs are available at any given time, and families must pay the high prices for them. For poor patients, drugs are often too expensive. And for many patients, when one drug fails, there are few or no other drugs to switch to. After a period, many parents simply take their children home to die, rather than see them suffer in the overcrowded wards bursting with sick patients. While we were unable to take photos during our visit, the images of these children so bravely fighting this disease and the unrelenting commitment of their loving parents will forever be etched in our minds. Something must be done to improve this situation dramatically…and fast.

The Life’s Second Chance Foundation was started in the U.S. in 2006 by a leukemia survivor of Ethiopian descent. It is now a registered nonprofit organization in Ethiopia as well. The foundation is driven by the vision of raising funds to equip and furnish the first ever cancer care and research training center in Ethiopia with the most up‐to‐date medical equipment. The strength of their local team of volunteers was evident during our visit, and there is incredible community buy‐in and support of the project. As this is a massive undertaking, the need at this point is simply to start somewhere, then slowly build out. If IMHO were to choose to take on this project, the potential impact and benefit to those in need would be immeasurably high.

Medical lecture at Bahir Dar Hospital for doctors and staff

A typical classroom at Walia Primary School in Debark; many other classrooms at other schools were simply made of mud, wood, and tin.

PLEASE SUPPORT OUR WORK! If you have been moved, inspired, or motivated by what you have read here, please get involved with IMHO and help support our efforts in Ethiopia! Volunteers and donations are always welcome. Please email Greg Buie, IMHO Programs Coordinator at coordinator@theimho.org if you’re interested in getting involved. Or send your tax‐ deductible donation earmarked for “Ethiopia” to:

IMHO Treasurer P.O. Box 61265 Staten Island, NY 10306 6

www.TheIMHO.org

Children waiting outside the Bahir Dar Health Clinic, seeking treatment.

Health services in Ethiopia have a long way to go in developing the available care and infrastructure to ensure the next generation is healthy and productive.