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.

—Don

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.

—Don

Human Trafficking & Human Slavery

Today Sasu Nina, the Executive Directress of the organization Agar, came in with one of their clients. Agar, which means helper in the Ethiopian language, is an organization whose mission is caring for and empowering the vulnerable in Ethiopia. One of its project is to respond to and rehabilitate girls that have been abused from Human Trafficking.

Halimat is a 20-year-old girl from a very poor remote village in northeastern Ethiopia. She has no education and cannot read or write. Young men solicit these girls with stories of a plethora of opportunities and a good life working as a domestic in the Mideast. In their own village the future is one of despair and poverty, so the sales pitch falls on fertile ears. Usually the trafficking route is through Djibouti, on a ship across the Red Sea to Yemen, where they walk for endless miles, are put in trucks for many days, and are sold by brokers several times to dealers on their way to Mideast countries. They enter the countries illegally and are placed as domestic workers with no pay.

Halimat, after working for a family in Abu Dhabi for 20 months, asked for some salary. The wife in anger pushed her off a fourth floor balcony. She sustained multiple fractures of the jaw and face. She could not open her mouth. She also had a right femur fracture. The police arrested her in that once she stepped outside the house she was illegal, i.e. illegal domestics are a prisoner to the house and cannot leave. She had surgery on her femur and then she was put in jail. The police paid for her air ticket back to Ethiopia, where she had multiple surgeries on her mouth and face. Agar strives to rehabilitate these girls as there is nothing for them in their home villages.

Destination countries include Saudi Arabia, Syria, Yemen, Dubai and Lebanon. Sasu has had 128 girls this past year at Agar as a result of human slavery from these countries. In one case the girl’s legs were cut severely when she asked for a salary. Many end in death.

I cannot imagine the courage that these young girls have to muster to embark on this evil journey. In the face of dismal poverty, no hope for the future and no family support they entrust their lives to strangers on trust and hope alone. Then to be betrayed into slavery and abused emotionally and physically is an injustice that defies imagination. The kindness, compassion and love that Sasu and Agar give to these abused girls must be honored. If it soothes the wounds of one young girl, it is a job well done by a faithful servant. (For more information on Agar visit their website.)
-- Don

Fromsa Jemal, March 20, 2011

Fromsa Jemal, a 10 yr. old happy boy, was brought in by Sister Maria from the Sisters of Charity. This lad has had swelling of his right leg since birth, and consequently, his right leg has grown out of proportion to his left leg and the rest of his body. His mother has neurofibromatosis (von Recklinghausen’s disease; genetic transmission) as well as leprosy as seen in her hands. It was concluded that Fromsa’s case is giantism associated with neurofibromatoses. John Tanksley, a visiting orthopaedist from Missouri did an epiphysiodisis on the knee (tibia and femur)  to stop growth so his left leg could catch up in his remaining growing years. Vascular surgeons Kjell Manga Kiplinsund from Norway and Jan Koning from Delft, Netherlands, did a partial debulking.

The literature gives mixed reviews of this procedure and he may ultimately end up with an amputation. It is rather sad not only for the child but the mother, who most likely was hoping that he could support her in her old age as they are dirt poor. (See slideshow in sidebar.)
-- Don

Visitors, March 20, 2011

Vascular surgeons Dick Koning from Portland, Oregon, and his identical twin brother Jan from Delft, Netherlands, and Jan’s senior resident Brean Meese (who will graduate from surgery residency and also receive a PhD this spring with a vascular fellowship in Australia next year) were here for several weeks. They have contributed so greatly on their numerous trips to MCM with not only their surgical skills, but their wisdom and counsel. They energize all of us.
-- Don

Watch Out for the Red Shoes! March 20, 2011

 Brean Meese, Surgeon, The Netherlands, Dr. Tomas, Ethiopian Neurosurgeon, and I (Orthopaedics, USA) have decided to make an OR statement...beware of the Red Shoe Brigade! Give us an early OR starting time or those red shoes will go into action!!
-- Don

Run for the Burns, March 19, 2011

Saturday the ICS (International Community School) sponsored a fundraiser walk/run for Einar’s Children's Burn Care Foundation. There is a monumental need for resources for the burn victims, who most commonly are children impaired for life. These come usually from falling into a fire, such as a seizure patient, or hot oil or water from cooking spilling onto the body. Einar is committed to caring for these children and is a passionate advocate for them. He does life-changing work for children from all over Ethiopia and the surrounding countries. We were pleased to see some 300 people show up for the run, including Olympic Gold Medalists Meseret Defar (Athens 2004) and Million Wolde (Sydney 2000), both of whom raised awareness of the need. Of course Einar dressed me in a Burn T- shirt and conned me into sponsoring the fastest runners. It was a good day for a worthy cause. (See slideshow in sidebar.)

-- Don

Baby Cheetah, Followup, March 14, 2011

Today I received the following good news email from Steve:

"Hi Don

Just a quick note to say thank you for your help with the little cheetah (called Kuching) on Saturday. Both Rea and I, and I am sure Kuching, were very grateful. Rea took him back to the site on Saturday and I saw him yesterday. The cast seems to be holding and he is playing happily with his litter mates, so fingers crossed all will be well.

Once I have got through the next two weeks of manic-work & visitors, I will be in touch and get you, Einar, and the others out to the site.

Wishing you a good week and, again, thanks.

Steve"

-- Don

Baby Cheetah, March 12, 2011

Each day is an adventure full of surprises. Today, Saturday, was no different. I missed morning conference at 8 AM as I overslept from having read a novel late into the night. When I got to the hospital there was a call from Stephen Brend, Project Director, Born Free Ethiopia. They are working jointly with the Ethiopian Wildlife Conservation Initiative. The story unfolds in the X-ray department.

Poachers were stopped at the border of Ethiopia and Somaliland (the upper third of Somalia), and they found four cheetah cubs about 3-months old, which the authorities immediately confiscated and took to their conservation post at Holeta, some 40 kilometers from Addis Ababa. The poachers had killed the mother and were taking the cubs to Somalia to sell to sheiks in the Mideast as they are highly desired as pets. The cubs were placed in the program of rehabilitation to be returned to the wild of Ethiopia when a carpenter doing some repairs at the conservation post suddenly hit one male cub with a large stick and broke its front leg and possibly the scapula. Their wildlife veterinarian, Rea Tschopp, bound the foreleg to the body and asked for an X-ray.

We were asked to obtain the X-ray and with Dr. Soloman’s permission a team of us, with the help of sedation, got the X-ray. The humerus was fractured and widely displaced. With Ketamine sedation in the emergency room we manipulated the fracture, applied a cast, and then rebound the foreleg to the chest.

We elected not to get a post-reduction X-ray as the veterinarian, Rea, was uncomfortable with giving him more sedation. He was a sleepy boy when he left to be returned to the wildlife conservation post. He will be given special care for the next several weeks.

Steve says that wildlife conservation efforts in Ethiopia are encouraging and the numbers of animals are increasing. However, it seems that cheetahs are a prime target of poachers, which makes them particularly vulnerable. Their speed of up to 70 miles per hour is unsurpassed in wildlife, so our little one will have to make a dramatic recovery to regain the ability to hunt in the wild again.
(See slideshow in sidebar for more photos.)
-- Don

Catching Up

There has been a lot of activity since the last posting. So much so that it threw me out of kilter and resulted in the prolonged delay. Following is a summary of some of the interval highlights.

Enkutatash, the Ethiopian New Year occurred on September 11. There is always a big celebration among friends after 3 months of heavy rains. On New Years eve, torches of dry leaves and wood bundled in the form of tall, thick sticks are also set on fire in front of houses as the young and old sing. Early in the morning everybody goes to church followed by a family meal of Injera and Wat. The operating room staff shared an additional celebration.

Meskel Flower celebration is another big event and is an annual religious holiday commemorating the discovery of the True Cross by Queen Helena in the 4th century. It is celebrated on September 27 which coincides with the blooming of the Meskel flower coming at the end of the rainy season. The fields are covered in a blanket of yellow flowers.

October brought us many guests and events.

Our church celebrated International Day. Over sixty nations were represented.

Korean Day was celebrated on October 3. The Korean Embassy invited us to attend a celebration at the Sheraton which included fancy food and a special performance by the "Little Angels." They are talented children from Korea with irresistible singing and dance programs. The Ambassador and his wife were the hosts, and the Ethiopian Veterans that served in the Korean war of independence were honored. It was a memorable event.

We had a special visit from the Florida Hospital group of Orlando headed up by CEO Lars Houmann and his wife Julie. Lars grew up in his early years in Ethiopia as his parents were Danish missionaries to Ethiopia. Summit compound is near us on the outskirts of a fast growing part of the city and is composed of a school of over 600 students and a beautiful new medical clinic. This is a Seventh Day Adventist initiative and we are all excited about developing the potential of Summit. We are thankful for this special group of folks whose paths have brought us together.

Dr. Mark Hardy and his wife Ruth visited us from Columbia Presbyterian Hospital in New York along with a surgical resident and a medical student. He developed the transplant program at Columbia and made a number of presentations at our grand rounds on the subject and where our hospital stood in the future of transplants. His wisdom and experience was well received and we look forward to a return visit.

Oncology groups from Harvard and Georgetown sent representatives for their respective adult and pediatric programs. Most of their work will be done at Black Lion Hospital, and we are appreciative of their work, which is so desperately needed for cancer patients that have had to fight their disease without the latest medical advances.

Gladys and Deji Otegbeye came with the Florida Hospital group, but spent some days with us. Deji and I have traveled together for years doing volunteer work from our church in Orlando. They are a very special couple to us and committed to God’s work.

Dick Koning, surgeon from Oregon has had a special interest in the hospital and done much to further the improvement of care. He is another doc that has contributed much to the hospital and is a special person to Barbara and me. His identical twin brother from the Netherlands and a friend came also for a short visit and did some highly specialized surgery. Dr. Knut Wester, Neurosurgeon from Norway heads up the neurosurgical residency program and has been an example of success with perseverance. John Gleysteen, a general surgeon from Alabama, spent time with us before traveling down to Sodo to work. We hope John returns soon and helps us with the residency programs

John and Karen Tanksley come from Missouri to be with us. John is an orthopaedic surgeon and Karen is a pediatrician. John developed kidney stone symptoms a few days after arrival and had to go back to Missouri. He promptly passed the stone and returned to Addis! His wise council and knowledge is an immense help in developing our orthopaedic program. They are coming back in March, and I very much look forward to seeing them.

My good friend Rick Hodes, called me and asked Barbara and me to come over for dinner with Dr. Zeke Emmanuel. I didn’t recognize the name but he had been sent by President Obama to assess medical needs in several African countries for his Global Medical Initiative. It was an interesting evening of dialogue

Fikru, our Ethiopian artist friend had a house warming for his new house in the CMC area of town. His wife Josephine is French and has a PhD In archeology. Ethiopia provides many areas of interest for Josephine. Fikru introduced us to Wosene, an Ethiopian artist that lives in California, He was in Addis to open a show. We attended the opening, which was at the National Museum, and was a gala event packed with people including representatives from The Smithsonian in Washington and New York representatives.

On November 22 Barbara and I returned to the United States to celebrate Thanksgiving and Christmas with our family. We also prepared our home for listing to sell. I returned to Ethiopia, on January 7. Barbara’s passport was lost in the certified mail department of the post office, and she, therefore, could not return with me. She obtained a new passport and a visa from the Ethiopian Embassy and is now ready to travel with me to Africa.

Glen Barden, hand surgeon from the University of South Florida, his wife Em, Jeremy Miles, a first year orthopaedic resident and his wife Amy, a PhD in Physical Therapy and Mark Landfear a surgical tech from Lakeland, Florida, came as a team. They all contributed greatly and special events occurred while they were at MCM. We were delighted to learn at the outset that the final approval of Black Lion orthopaedic residents was approved for them to rotate through MCM! This is something Dr. Wouballem (head of Ortho at Black Lion) and I have been working on since September of 2009. Medical student Andrew Pirette came from Missouri, to savor the medical activities at MCM.The next event was a visit to the British Embassy. Ambassador Norman Ling and his wife Selma invited the group for hors d'oeuvres along with the Facing Africa group from the United Kingdom. The ambassador and his wife were gracious and kind and everyone enjoyed a delightful evening.

Facing Africa is a British foundation that comes twice a year to operate on Noma patients. These are children who have one side of their face eaten away by aggressive oral bacteria when they were very young and usually on the verge of starvation. They are so disfigured that they are ostracized by family and friends. These surgeons come in and operate on 30-40 of these kids to reconstruct their faces. It is difficult surgery and extensive but it improves the lives of these otherwise rejected children.

One day last week the hospital was all atwitter. The African Union annual meeting is held in Addis Ababa, and all the Heads of State of the African countries assemble in the great African Union Hall. Streets are shut down unannounced when dignitaries move about or go to the airport, making travel by ordinary drivers miserable. However, the Secretary General of the United Nations, Ban Ki-moon, attended and made a side visit to the MyungSung Korean Hospital. He came with an entourage of dignitaries and secret service. They called me to be in front of the receiving line with Dr.Kim and Mr. Kim! It was a momentous occasion. He was articulate, gracious and spoke flawless English. His wife was lovely and had a heavy heart for the young Ethiopian girls that go to work in the mid-east and are abused. She is working on an initiative in that area.

I have returned to America to go to the American Academy of Orthopaedic Surgery annual meeting in San Diego. Barbara and I plan to return to Africa at the end of February. (See slideshow in sidebar.)
-- Don