Tuesday, June 21, 2011

Visitors, June 2011

Mesfin Shibishi popped up one day while I was making rounds. Mesfin is an Ethiopian-American having immigrated to the U.S. a number of years ago. He currently is a PGY-IV ortho resident in Ohio. He was in Addis Ababa visiting his sister and stopped by MCM. We made rounds and discussed cases and the future of orthopaedics in Ethiopia. Mesfin is a fine young orthopaod, well trained and planning on returning to MCM when his schedule permits.

Don and Mesfin

Venke ByBerg is a trauma nurse from the University Hospital in Stavanger, Norway. She has been working for Trauma Care Ethiopia for the past 3 months.  She came to Ethiopia because of her experience with trauma care in Norway and wanted to help out our trauma care program and to experience a different culture. Venke works primarily in the ED, where her knowledge, experience, and kind and gentle nature is eagerly received.

Anita Rugland is a Norwegian nurse who previously worked with Venke in the ED in Norway. She currently works on an oil platform in the North Sea! In that location she does not have the ancillary help available as one does in Norway or the western world (e.g., no ambulance, no 911, no specialists). She came here for a visit to experience what trauma care is like with limited resources. I suspect our weather would be a draw as well!  Anita will participate in Trauma Day this week for hospitals in the city to teach personnel basics and finer points of trauma care. Her contribution is greatly appreciated.

Anita and Venke

Monday, June 20, 2011

Grand Opening of the Nehemiah School for Autistic Children, June 12, 2011

The Nehemiah Autism Center opening celebration was 12 June 2011 with its goal of "maximizing potential for a full and satisfying life." Mrs. Rahel Abayneh and Mrs. Meseret Gudetta combined a dream and a need to put this project together. Dr. Ferdu was instrumental in driving this forward in the face of overwhelming odds. Promised pledges were never fulfilled and the need is so great. I asked Dick Koning to write his insight and personal experiences on Autism which follows:
The room was dark, but despite this you could see tears rolling down many cheeks as we were watching the video of three families with severely autistic children.

The parents tell of how they have trouble managing their child’s behaviors; how he can be aggressive and sometimes bites his mother or sister so hard that a piece of flesh comes off. How he has to be locked in the one-room house and screams all day and tries to reach through the tiny opening to get to the leaves off the tree, which he eats. When it is dark his mother comes home after carrying her daily ton of water ( literally), exhausted from the days work, with just enough money to buy one meal for the family. Half-starved she kills herself to provide. Another family has autistic twins. Both parents have good jobs, but they too cannot care for their children and work to make a living.

It is a miracle that the school is open and functioning. The building is a well-cared-for home with a series of classrooms around the periphery of the lot. There are rooms for art, for reading, for daily routine training, for sensory perception training, for music, for speech therapy. The rooms are clean and painted, there are supplies and equipment, the students have been screened and education of the parents and the staff started. There are plans for a playground and a chicken coop for the students to learn to care for animals and thus learn routines themselves. Two months ago it looked like it would fail.

There are speeches, and finger foods (all foods are finger foods in Ethiopia), and soft drinks. Enthusiastic board members and teachers guide the visitors. There are Portuguese and Italian NGO’s who helped put on the opening. There is Gebre Gziabher, a lank tall man in a silk business suit who is an Olympic Marathon and 10K medalist, there are Katherine Simpkins PhD, a government Special Education consultant, Dr. Don Pearson and his wife Barbara and many others I did not know.

I feel fortunate to be able to attend—until asked to give a speech. "Without you this would never have happened," Dr. Ferdu says, and he asks me to tell our story. It was a great pleasure for me to congratulate the Nehemiah School’s founders, Rahel and Solomon  and Ferdu and Meseret with their achievement.

I had come to Ethiopia to work with the surgeons at the Korean Hospital, now nearly three years ago. One day Ferdu and I were seeing patients together and then, during a break he told me he had an autistic son. "Wow, that is coincidence," I said, "I have an autistic daughter!" So there we are, from different cultures and different continents, comparing notes on our lives. How difficult and how wonderful it is to have such a special child. How it gives meaning to the saying that God will provide you with the strength to carry your burden. It was the beginning of a deep friendship and when last fall the topic came up of building a school for autistic children that would be open to all, regardless of ability to pay, I promised help immediately.

Through our Reach Another Foundation we were able to send Lindsay Ryder Perez, our special education teacher, at just the right moment and help get the school organized, help screen the children, and set up programs and teaching methods. We had help from many others with ideas, advice and supplies. So, suddenly, there is this Grand Opening, and I am giving this speech.

I know what it feels like to be such a parent. KK, our daughter, demands constant attention, she too would bite herself and sometimes others. She would snatch glasses off unsuspecting passers by, or throw her teddy bear in the river and be unconsolable till I had retrieved it with an icy swim. We put an alarm on the doors to keep her from going for a walk in a midwinter night, barefoot. Finally we took turns sleeping in the hallway by her room to protect her at night and keep her from putting the dog in the drying machine. Then she moved to a group home, and some time later caught pneumonia. She was very sick and on a breathing machine for 6 weeks. Then we had a call from the doctors. Here comes the talk about taking her off the ventilator, I told my wife. The doctors were very kind. They said we had been good parents, and that it must be very hard to see KK so sick. They had tried everything possible to treat KK and had run out of options. Now would be a good time to make the decision to stop treatment and turn off the ventilator.

I understood how they think, and they were right. Maybe that was the right thing. We were all tired, maybe this was the end of the road, that this race was not winnable.

Then they asked my wife what she thought. She hesitated for a moment and spoke words so wise that they bring tears to my eyes every time I tell this story.

She said: "I know that by everyday standards KK does not have a very good life, but within her own world she is happy and full of joy, and I don’t think that I can take that away from her."

Those simple, profound words changed my life. KK survived and her face lights up every time we see her and we are grateful for having her in our life.

Those simple words had a profound impact on me. Especially when resources are scarce—and believe me that topic comes up in the United States, too—people make value judgements about others, and those who are Other do not seem as worthy. So we put them at the bottom of the list and let them fend for themselves or die.

Today we celebrate the opening of this school. We have taken a big step to make the lives of these autistic children and the lives of their parents and siblings more full of joy.
 Dick Koning, Rahel, and Dr. Ferku
I am grateful that I have been of some help. I am grateful for people like Rahel and Meseret and Lindsay and Linda and all of you who will support the school in the future.

As I write this, the mullah sings his midday call to prayer. It sounds like a loud cry, a primal scream, a cry for help. Is it just me who hears?

Sunday, June 19, 2011

Visitors, May 2011

Julie Zilienski, Pediatric Orthopaedist from Chattanooga, Tennessee, came back in May. Julie did her orthopaedic training in Michigan and then did her pediatric fellowship with my friend Chad Price in Orlando. Chad had been over here with me several years ago and encouraged Julie’s interest in developing countries. Julie came over last August, immediately after her fellowship and just before she started private practice, and helped greatly with many of our pediatric cases. During this visit she addressed new problems and made patient rounds, surgeries (many difficult cases), conferences and rounds at Black Lion. Word got out she was here and parents and friends brought in pediatric patients from all over Ethiopia. We had kids lined up to see her. Worku, a resident rotating from Black Lion during the month, spent a lot of time with Julie and was inspired by her “coming” to Ethiopia “for him” and her willingness to share her knowledge and time. Julie is a talented young lady who has so much to offer. We feel privileged to have had her here and look forward to her return.

Lacey, Dick, and staff sizing up the gap on Robyn's chin

Lacey Menkin and Robyn Sharma, third year medical students from the University of Miami, came during their break at school. Lacey’s dad Marty Menkin is a neurologist at my hospital in Orlando. He has treated my family and been a friend of mine for many years. She had expressed interest in developing-world medicine and he referred her to me. These young ladies were a delight; their enthusiasm for medicine, concern for the patients and how to help global medicine were exemplary. They were not hesitant about participating in conferences, surgery, or becoming involved with the local culture. Dick Koning, a surgeon, originally from the Netherlands, trained at Columbia Presbyterian and has practiced for many years in Bend, Oregon. He was here and guided Lacey and Robyn during their stay. Robyn fell in the operating theater and sustained a laceration of her chin. Dick called on his plastic surgery skills for a great cosmetic repair.

 Lacey, Robyn, and others reviewing a CT scan

Dick brought a young special-needs teacher just out of her masters program and a nurse supervisor-administrator with him, who have assisted him in supporting and developing an Autistic center here in Addis Ababa. It’s exciting to see the many facets that bring disparate individuals together thousands of miles from their home in an effort to support hurting people half a world away.


Hand Surgery, April 2011

Germaine Fritz, D.O. hand surgeon from Michigan, came in April. I had recruited Germaine at the Health Volunteers Overseas booth in San Diego in February at the American Academy of Orthopaedic Surgeons annual meeting. Germaine has been a volunteer with HVO on a number of occasions around the world, and I hooked her on trying Ethiopia. She came and was busy involved with patient rounds, lectures, surgery, Black Lion conferences and case presentations.

 Germaine and Janice

Tekelyn, a first year orthopaedic resident, was rotating through our department at the time and spent many hours in a one-on-one teacher/student relationship with Germaine. She has great depth of knowledge and has a most talented ability to teach. Her teachings were clear and concise and presented in a way that the recipient could recall the information on demand. She indeed has a remarkable teaching gift.  

 Don, Tekelyn, and Germaine

Janice Mitchell, a medical student from Texas was here at that time. Germaine mentored and encouraged Janice in her interest in OB-GYN. She has plans for an OB-GYN residency. Germaine’s humbleness and gentle manner have endeared her to us here at MCM as a special friend and the welcome mat is out waiting for her return.