Christmas Newsletter

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Norwegian National Anthem

Hospital activity, Barb's new stove, Norwegian students

Activity continues at rapid pace in the hospital. The usual rotation of visiting medical personnel each month and new faces on hospital-related business reminds us of the significance of this facility and its mission. Mr. Kim is constantly meeting with visitors and dignitaries looking to MCM to meet their healthcare needs. Our new CT Scanner, C-Arm, and radiology equipment are ready to be installed and anticipate will be up and running by Christmas. Revised long-range plans were announced last week. The timetable for the medical school and nursing school has been accelerated, and expansion of the outpatient and inpatient facilities, including a new 4 story wing, will begin soon. It is exciting to be on board for the journey.
    We went shopping and bought Barbara a new stove. It’s about half the size of our stove at home. Cute little fellow. They sell the cord separately but no plug! So we searched and plugged it in. OK for the first 20 minutes but then the breaker flipped. How do you explain "blew a fuse" or "tripped the breaker" in Korean or Amharic in the middle of the night? Lots of sign language! She’s working now and Barbara has surprised herself with some great high-altitude creations (8,000 ft. here).

    The Norwegian medical students have left for Tanzania to climb Kilimanjaro, do a safari, and then to Zanzibar before returning to Norway. They had 3 research projects they initiated here and presented  at grand rounds last week. On the night of their departure they all came to our apartment for farewell wishes. Seven students and 5 others of us gathered around our table in the tiny kitchen. It was a delightful, spontaneous, and cozy event. Their positive attitude and enthusiasm will be missed by all.

    Our Sign nail sets are on their way. We are anxious to use them in our treatment of fractures as this will be a big step forward in improving care. Dr. Luis Arrazola, a transplant surgeon from Seattle, has been with us doing biliary and hepatic surgery (not transplants). The surgeons are grateful for his teaching skills. The volunteer neurosurgeons from Denmark and Norway are much appreciated.

-- Don

Raining

It has been raining here for several days and that makes for chilly days. Our next door neighbor, the mother of my little students, brought us an electric heater that looks like a fan. It even rotates. Quite interesting and efficient. I don't think I have seen anything like it in the states.
    We have been showered with kindness since coming. I have been brought pumpkin soup, rice soup, fried seaweed, potato pancakes, some kind of Korean sushi-type little rolls, and French fries, which by-the-way were superb and one of the best things we've had since arriving. A runner up in the food category are the homemade wheat rolls brought to us by one of the MCM doctors. His maid makes them and they are big, soft, and yeasty, with just the right amount of rye seed in them. Don and I could not resist and sat right down and ate one. Most of the bread here is quite dry and part of that may be due to the altitude and baking without making allowances for the 8,000 feet we live in. At least our two high-altitude cookbooks talk a lot about baking, especially bread, and the adjustments that must be made.

-- Barb

Interview with Mr. Kim

God Is Love

September 30, An Eventful Day!

Seventh-Day Adventist School/Clinic
Dr. Fekede and his sister, Harget, came to pick us up at 9:30. Dr. Fekede is an Ethiopian physician, living in California, but makes frequent visits to Addis and through the years has developed a school and clinic on the outskirts of Addis. The family of his sister’s husband have held this land for over 5 generations and managed to retain 35 acres after the takeover by the communists. They have developed this site into a school for pre-school children through the eighth grade. We toured the school site and visited the children in their classes, each with 50-60 students. It seemed that most of the classes had one or two teachers. On entering, the children would stand and with smiling faces greet us in unison, “Good morning!” They are taught English as part of the curriculum.
    This is a lovely setting and well-thought-out planning is evident from solar power and solar oven, to vegetable farming, a dairy, to crafts and seamstress courses for parents that might want to learn a trade to earn extra income.
A brand new out-patient clinic is in the final stages of preparation. It also is well designed and will be well furnished with modern medical equipment. We will explore the possibility of mutual cooperation with MCM. A hospital in Florida sent a container of medical supplies, which had just arrived. The clinic should soon be ready to open.
    Dr. Fekede and his sister, Harget, are dear new friends who made us feel like we’ve known them forever. We look forward to working with them in their ministry. (See slideshow in sidebar.)

Korea Day
While out on the farm with Harget and Dr. Fekede, I got a call to promptly return to the hospital. Mr. Kim, MCM administrator, asked me to attend a luncheon at the Sheraton with the Korean ambassador! What was this all about? It was only some men from the hospital staff being invited and the proper attire may require wearing a suit. It is Korea Day, but not really. Korea Day is October 3, the celebration of the founding of the country. But it’s Barbara’s birthday…however, she insisted I go, as Mr. Kim needed me. I did have teary eyes as I entered the room and was overwhelmed by all the things that she would have loved to see. There was a long colonnade passageway and at the end a reception line of 3 couples. I was pushed ahead to be first to meet the ambassador, his wife, attachés and their wives. There was much bowing and greeting, even I got into the custom. The ladies dresses were stunning. I was speechless after the receiving line, and tried to absorb all that I was seeing and hearing. There were huge tables of exquisite foods from Korean, Ethiopian, Italian, to French pastries. These delicacies were a delight to the eyes. It seems that those in attendance represented every nationality.
    I was introduced to several groups of Ethiopian veterans. These were proud, distinguished gentleman, most in their eighties, who had served in Korea during the conflict in the 1950’s. A special fondness for Korea was evident and this feeling was reciprocal, I’m sure.
    “Dr.Pearson” I would hear, as I wove through the crowd taking pictures. Mr. Kim introduced me to so many friends of various nationalities. He was gracious and was always greeted warmly. My colleagues, Dr. Einar and Dr.Kjell Magna, joined us with Dr. Kim, the chairman of the MCM steering committee in Seoul, and Mr. Kim, MCM administrator. It was a memorable experience. Next year we’ll waive Korean custom, and we’ll crash the party with Mrs. Kim and Barbara! (See slideshow in sidebar.)

Birthday Party
A dinner party at the Top View restaurant was arranged for Barbara’s birthday. Lillian Eriksen invited 14 ladies to join together for dinner. Barbara’s comment, on hearing how many were to attend, was, “I don’t know 14 ladies here! Why would they want to come to a party for someone they don’t know?” It was indeed an international event with one lady from Finland, one from Sri Lanka, another American, and the remainder from Norway. Barbara met and made new and interesting friends, who were very special to come to her celebration.
    She received many wishes from America, hugs by the Korean family, and best wishes from the Norwegian medical students that are here. She was brought an arrangement of roses by Soon Jae, the MCM chef. “Debra,” Pastor Lee’s wife, made a 3-foot tall balloon “angel,” an art of creating figures by twisting and tying balloons. They brought her sweets and sang Happy Birthday to her. It was an unforgettable birthday! (See slideshow in sidebar.)

-- Don

Video: Arm-Wrestling

Photo Notes

Smiling Baby
The Koreans had a lovely garden in which they grew some Korean-type vegetables, lettuces, peppers, and tomatoes. It looked wonderful when we were here in March, but was in a sad state on our arrival this time. I asked several people why it had been allowed to become overgrown with weeds, but didn't get a clear answer. Perhaps during the rainy season they let it go. A few days later some Ethiopian workers began to clear the weeds and work the soil to ready the garden for planting. This baby's mother and others worked on the garden. The baby, just beginning to walk, stayed with his mother and I assume a brother who looked to be about 8 years old. I don't know why this brother was not in school unless they didn't have the money for books, which I understand have to be paid for. Or perhaps he stayed home to help with his younger brother so Mom could work. I watched them from our balcony and was touched by the tender care given the child from his mother, brother, and other men who were helping. He was just a cute, fat, little one.

Rollerbladers
Recently arrived, and in the apartment next to ours, is a young Korean couple with their two pretty, little girls. Mr. Moon has a degree in computer science, I believe. Getting these names sorted out is difficult. On their door is a welcome sign that says, "Welcome to the family of Moon Sung Chung," or something like that, yet he is called "Mr. Moon." The little girls have added another dimension here, as there are no other children. They seem to do really well at keeping themselves entertained. During the soccer-tennis match Saturday evening between the Koreans and Norwegians (a follow-up to the arm-wrestling event), their parents were watching the game, and the little girls, fully dressed in roller gear, skated over the uneven stone tiles, actually doing quite well. The parents are trying to get them into an English-speaking school, but I believe when tested were told they must learn more English before they can attend. I think the mother is home schooling them.

-- Barb

Sabbath Dinner at Dr. Rick's

On the plane from Amsterdam, we ran into Dr. Rick Hodes, a Jewish internist from Johns Hopkins who has lived for the past 20 years in Addis, treating children, principally children with severe medical conditions. A few days after we arrived, he called and asked me to see a consult at the Mother Teresa Mission, which is a compound where many severely handicapped and disfigured live, as they could not live or be accepted in the outside world because of their functional limitations or appearance. I saw the child, who had severe fibrous dysplasia of the hip. Many other of his patients have unimaginable deformities.
     Rick invited us to his house for dinner Friday night, the Sabbath was a time of fellowship. He said others would be there.
     Mulagetta II came to pick us up and off we went. His Lata runs with a wind-up rubber band and is held together with baling wire. The inside door handles have long since fallen off, so he has to jump out and run around the vehicle to let you out. The headlights emitted light equivalent to a votive candle, and of course, we had to go to two filling stations before he could purchase petrol. There are no street names in Addis and numerical identifications are superfluous. I had previously recorded the directions from Rick: “Go down Pele road towards the city center, make a left on the street that goes away from Desalegan Hotel (sometimes called the Atlas Hotel) and at the Jupiter Bar make a left and it’s the third house on the left with the green awnings.” Mulagetta’s English vocabulary is the same as my Amharic: zero! We did make it after a lot of sign language and a telephone call to Rick.
     We entered a room filled with some 20 to 30 people lounging on furniture that had seen these occasions many times. They all greeted us, and then Rick gathered us in a circle after all the men had their heads covered in Jewish tradition and sang, read and prayed. He led in the singing of “I’ve Got a Hammer,” and then he went around and broke off pieces of bread and tossed it to each person there, first to his adopted children with a touch of the head. A cup of chowder was offered, followed by an Ethiopian buffet.
     There were patients of various ages and deformities, from dwarfs to amputees (chondrosarcoma), severe scoliosis, and other Ethiopian folks, some of whom share his home.
     There were Jewish volunteer students from the states and Christian US and South African students passing through: Charlie, an American professor at the University of Addis, teacher of demography for 20 years, had to leave early for Morocco for an international demographers convention; Jessa, from New Orleans (originally from Oregon), wandering through Africa by herself, an attractive young lady trying to find a meaningful job; Paul, a South African smiley young man living in London, doing volunteer work; Roger, a Mother Teresa Mission volunteer from Massachusetts, gregarious, enthusiastic, recent college graduate preparing to apply to medical school; Andrew, a recent graduate of U. of California, Berkley doing volunteer work for a Jewish benevolent organization in Uganda; and another young woman from Washington D.C., visiting relatives in Addis.
     There was no lack of conversation. Each person’s story was interesting and their experiences fascinating! Rick captured the attention of everyone with his computer full of patients and their stories. It was remarkable to see the before and after documentations of their journeys with severe disabilities.
     It was also easy to detect in this filled room the love for this man and his commitment to the less fortunate in Ethiopia. He is a quintessential “giver.” (See the Links section in the sidebar.)
     At the end of the evening, an entourage of colorful figures, some still wearing the “menorah-shaped” hats, walked us to the end of the block (the landmark Jupiter Bar corner) to get a Blue Donkey (taxi) home.
     We will fondly remember this unique Friday night Sabbath experience. (See slideshow in sidebar.)
-- Don

Arrival in Addis Ababa!

Don and I are doing good and have been warmly welcomed and made to feel at home. We left Orlando with 9 pieces of luggage and $750 lighter and arrived safely with only one piece of luggage...the water skis! (We returned to the airport at midnight and found 7 more pieces of our luggage. The missing one finally came in on another airline. Go figure!) Seppo and his wife, Mr.Kim and his wife, and many others met us at the airport.
    We are settling in and establishing a bit of a routine. The first several days were spent unpacking, getting past some jet lag, and acclimating ourselves to the elevation of over 8,000 ft. It takes some adjustment for Florida folks! The new guest house isn't quite ready, as the furniture, cabinets, and kitchen equipment are coming fom Korea and are now in the port of Djibouti. Supposedly the container will arrive this week. We shall see. Even if it does arrive, installation has to take place. Some road work and clearing of debris also must occur. Meanwhile, we are just fine in the apartment we were in last year.
    In some ways we feel like we have come home. Upon arrival on Saturday night, we were met with  many smiling and familiar faces. Our apartment had been "spruced up" with some new paint and other special touches of flowers and food. We had so much luggage, Mr. Kim, the hospital administrator, asked if we were immigrating!
    We were warmly and lovingly welcomed by other hospital  personnel who reside at the guest house, as well as the kitchen staff. These are sweet young Ethiopian ladies and all wanted to know about our daughter, Kim. When she was here with us in March, she taught the staff to make some Western-type food.
    We have been invited out on several occasions for lunch and dinner. We are invited to the home of Dr. Rick Hodes for this Friday evening dinner. We met him two years ago and were amazed at the miracles he has been able to pull off or arrange for children and young people with most unusual cases. Imagine our surprise to find him on our KLM flight from Amsterdam to Addis! So we have reconnected, and in fact, Don is on the way to the Mother Teresa Mission, where Dr. Hodes has worked for over 20 years. He is an American doctor, Jewish, and working in a Catholic facility. He has 7 adopted Ethiopian boys and about 10 foster ones.
    A Norwegian staff doctor invited me to join in a birthday celebration for his wife. This was an all-ladies event. Most of the women were Norwegian and were the most interesting group, highly involved in the life of this community, and I think all were participating in ministering to the Ethiopian people.
    I met our young Ethiopian friend, LemLem, (LumLum) for lunch yesterday and a little grocery shopping. We had a great time, and I felt as though she was another daughter. Her husband is an orthopaedic surgeon, formerly on the staff here, but now working in another city. We plan more times together, which will be fun for me and hopefully take away a little of her loneliness without her husband here in Addis.
    Don had surgery this morning, and I think quite an audience. There are about 6 Norwegian medical students here for several weeks, and they have been anxiously waiting to observe Don in surgery. They are eager and excited. There are so many Norwegians here right now that the hospital administrator is saying, "The Vikings have landed!"
    I have been preparing some meals for us, which can be time consuming. The vegetables must first be sterilized and then rinsed in sterile water before they can be prepared for cooking. Most of my morning today was spent in preparing vegetables to have ready for the next time I need them.  We have a two burner, portable gas stove top, which sometimes takes a bit of juggling to get everything cooked at the same time.
    Gratefully, we have a washing machine in our building. There are no dryers, which is just fine as the clothes dry quickly when hung on a rack on our balcony. However, this morning, just as I got the wet clothes hung out to dry, the rains came. I remember my mother facing the same battle and the mad dash by both of us to the backyard to bring in the clothes.
    Almost every day we are brought gifts of food or something else. The Koreans have treated us so kindly and we don't seem to be able to do enough for them. We are continually surprised. It is nice to have such close neighbors, in fact, it sometimes feels like we are in a dorm. We have great neighbors in Orlando, but rarely see them as we all live behind the shrubs.
    We know you will keep us in your prayers.
-- Barbara

A Letter from Dr. John Tanksley

In a few hours I will board a plane bound for Addis Ababa, Ethiopia, where I will work at the Black Lion Hospital (BLH), the government teaching hospital. Black Lion Hospital is massive, underfunded, and extremely inefficient. Surgery may be canceled on a given day due to lack of water, breakdown of the sterilizer, lack of clean linen, and the list goes on. Yet, for over 20 years Black Lion has managed to maintain a rare jewel for Africa: a training program for orthopaedic surgeons. We all hear the urgent cries for treatment of the infectious disease epidemics like HIV, malaria, and tuberculosis. But there is an even bigger world wide epidemic of trauma victims that does not get much press. Did you know that the World Health Organization estimates that the world wide cost of years of life lost to death or disability caused solely by accidents is greater than "life years" lost from HIV/AIDS and malaria and tuberculosis combined?
    In Asia and Africa it is not uncommon to see a family of 6-8 people riding on a single motorcycle. For only $50 down a $400 motorcycle may be purchased on a monthly payment plan providing a family with cheap but hazardous transportation. Add to this the common means of transportation of the poor in Africa, which is a 15-passenger van packed with over 20 occupants and piloted by reckless and irresponsible drivers over rutted roads, and you understand where the accident epidemic comes from. But for the survivors, surgery to fix broken bones is expensive, and trauma care is a low priority for the strapped budgets of many governments. A victim who lives long enough to make it to a hospital, often lies in bed for weeks waiting for his family to collect the money to purchase the necessary surgical implants at a local pharmacy before surgery is scheduled. Or months in traction may follow, all the while the patient's family attends to the injured person's needs, taking even more earning power away from the increasingly impoverished family. Non-united fractures, deformity, infections, arthritis and disability often result.
    By the generosity of an organization started by surgeon Lew Zirkle from Washington, I am taking a supply of SIGN nails specifically designed for use in the developing world. Presently at Black Lion, patients with broken thigh bones are treated for weeks or months in bed in traction followed by more weeks in a cast or on crutches. But after SIGN nailing they are out of bed the day after surgery. I will work with staff orthopaedic surgeons to start a SIGN program at BLH.
    I hope you will pray for the plight of trauma victims to be improved in Ethiopia. I want to find people to train and to encourage who have skill and a heart to help people. Pray for me to see the good things God is doing in a difficult situation. And pray that the people I work with will be inspired and encouraged to help others. Ask God to raise up a movement around the world moving champions from churches, the press, governments, and donors to find ways to provide resources like organized trauma systems, surgeons, nurses and implants, as well as laws and enforcement to combat the causes of trauma.

"..I was sick and you looked after me,...(Lord) when did we see you sick?...Whatever you did for one of the least of these brothers of mine, you did for me.." Jesus (Matt. 25:35-45)

-- John Tanksley

SIGN Conference

Richland, Washington, August 12-15, 2009. Curiosity prompted me to fly cross country to attend the SIGN (Surgical Implant Generation Network) Conference. The theme of Treatment of Difficult Fractures Around the World was clearly appropriate. Orthopaedic surgeons from all corners of the world presented papers, lectures and discussions of their work with the SIGN Nail system. North American presenters complemented the international presentations. All at this meeting faced the anathema of poverty in caring for orthopaedic patients worldwide. It was readily evident that the attendees had respect, love, and devotion for Dr. Zirkle, who has committed his life to bringing equality of fracture care around the world. His is a remarkable story of commitment and persistence and an inspiration to all of us.
    The SIGN system is developed to provide fracture care for poor countries without the ancillary assists that we enjoy such as x-ray, image intensifier, modern operating rooms, etc. The system is developed to a remarkable degree, and the course design was for sharing and teaching. In addition to the lectures and discussions, there was a “Sawbones” lab where we could actually learn hands-on and practice introducing the implants.
    The persistent poverty in the world prevents mitigating the human suffering. As orthopaedic surgeons we are called to address that task of improving quality of life. This was a meeting and fellowship of like-minded folks. Thanks, Dr.Zirkle, for your work and inspiration. (See slideshow in sidebar.)
-- Don

Preparation

Considerable time and effort has been expended to obtain orthopaedic implants and instruments, items that are useful to us in Ethiopia; however, they have been written off by the benefactor here in the states. These are charitable gifts with no resale value. I anticipate that this good start will permit us to initiate a meaningful teaching program for the residents. They are eager and anxious to learn how we do orthopaedics. We are continuing to secure materials for this purpose.
   Shipping is troublesome. Orthopaedists do things big! Orthopaedic implants and instruments usually made of stainless steel are bulky and heavy. The airlines frown on excess weight these days and charges can be costly. Fortunately we have been offered space in a container from the Greater Orlando Area bound for Addis Ababa, within several weeks. A serendipitous joy, albeit a mountain of paperwork required.
   The key to this project is the volunteers! Docs and staff that are willing to take 2 -4 weeks away from family and practice to contribute to the education of their Ethiopian peers is the cornerstone to improving the health care of their people. We are not going in and doing it for them. This is a sharing and teaching project directed to and created for their health care team. Starting in January 2010 there are volunteers taking on this challenge. I am confident that they will be rewarded greatly in personal satisfaction knowing that they have shared with those in need with what we have so generously been given.
   To those who have graciously given of time, money and support a big thank you. One day when each of the Ethiopian docs stops and reflects on how they have been impacted, how did this come about, what went into this and why, then the true goal of the project will be realized. (See slideshow in sidebar.)
-- Don

Background

Ethiopia is a large African country with severe health care problems. The 83 million population face a multifaceted healthcare problem. There is a paucity of modern teaching in surgical techniques and preventative strategies. Perhaps the most alarming problem is the mass exodus of trained healthcare professionals out of the country frustrated with low salaries and lack of resources. Direct interviews with Ethiopian physicians cite frustration over lack of resources and training as the number one issue causing them to leave. This pattern prevails throughout much of sub-Saharan Africa. Africa receives 1.3 percent of the world's health workers while it carries 25% burden of disease(WHO 2004). The World Health Organization recently ranked Ethiopia 180th out of 190 listed nations in a global health report (WHO press release/44, June 2000). Currently there is roughly one physician for every 30,000 Ethiopians.
    Most traumatic injuries are treated without surgery and people are left with incredible morbidity from relatively straightforward injuries. Ethiopia has one of the highest percentages of AIDs cases in the world, however, the leading cause of death among young adults is trauma. There is virtually no adequate trauma care in the entire country. Spinal injuries get minimal treatment as well as compound fractures, and femur fractures are treated in traction, bedridden for 2 months with poor outcomes. These events, too often, render a family provider to a non-provider permanently. In 2004 MyungSung Christian Medical Center (MCM) was opened in Addis Ababa. This facility was built and funded by a South Korean Presbyterian Church of the same name. This is a relatively modern facility with 4 functional operating rooms. They have just opened an intensive care unit a trauma center, and a burn center. Previously, most burn patients received no treatment and die from dehydration and infection. The University of Bergen in Norway, has partnered with MCM and Addis Ababa University to establish a formal neurosurgical training program. Norwegian neurosurgeons are present throughout the year at MCM and will assist in the training and education of the residents. They currently have 7 residents in various stages of training. This alone will more than double the availability of neurosurgeons in Ethiopia.
    The issues with orthopaedic care are slightly more complex. Modern orthopaedic care depends on equipment and implants to provide good surgical outcomes. Many surgeons have brought in suitcases full of implants,however, the equipment is either incomplete or in very short supply. Our goal is to revolutionize the delivery of orthopaedic care in Ethiopia. We have been invited by the administration of MCM to help develop a comprehensive training program in orthopaedic surgery. In order for this to be successful we need short-term orthopaedic volunteers and a sustainable supply of modern implants and instrumentation as well as supply lines to restock the equipment. We will drastically reduce morbidity and mortality associated with all types of orthopaedic diseases. Join us. (See slideshow in sidebar.)
-- Don