Master Classes with Dr. Samuel

 

"If you do not remind yourself why you are practicing medicine, you will become angry, frustrated, and say things you don't mean."
-Dr. Samuel

the ophthalmology department

The town of Aira sits northeast of Dembi Dollo, roughly a three hour car ride away.  A small agrarian town, Aira also happens to be the birthplace of Dr. Samuel- he was the first child in town delivered by C-section- and the site of one of Ethiopia's major hospitals.  Founded and supported by the German Lutheran church, the hospital at Aira serves as a sort of tertiary care center for western Ethiopia, in that patients whose conditions are too difficult to treat in their hometowns are referred to Aira.  

By its very nature as a higher-level hospital, Aira Hospital allowed me to learn about a variety of conditions I hadn't previously seen.   One such condition was a case of Elschnig's pearls, which is when grape-like growths made of cells from the outer eye appear on the lens, typically after cataract surgery.  I had the chance to observe trabeculectomies to treat glaucoma, and combined trabeculectomy/manual small-incision cataract surgeries for patients with glaucoma and cataracts.  In the trabeculectomy procedure, the ophthalmologist creates a small pouch or "bleb" in the eye to allow aqueous humor, the fluid in the front sac of the eye, to drain, thereby reducing eye pressure.

 creating a "bleb"

I also observed a number of surgical patients with arcus senilis- fat deposits in the ring around the iris- which occurs most commonly in the elderly.

Dr. Samuel also showed me how to differentiate between vitreal detachment and retinal detachment on ultrasound, and discussed Mooren's ulcers and peripheral ulcerative keratitis- two conditions which present similarly, but which stem from unknown causes and autoimmune diseases such as lupus, respectively.


One case which shocked even Dr. Samuel was that of a young boy who had an abscess, or collection of pus, under his left eye.  When Dr. Samuel went in to drain the pus, the fluid strangely did not leak out.  Upon further investigation, Dr. Samuel realized that it wasn't pus that had accumulated under the boy's eye, but rather a mango fly making a rather comfortable home for itself!  As the fly wriggled out of the boy's head, I couldn't help wondering how such a fly had entered in the first place.

mango fly crawling out from under the boy's skin

On other days, I was able to witness an evisceration and an enucleation.  The evisceration, essentially a drainage of the eye which leaves the outer layer and ocular muscles intact, was performed on an elderly man who was awake and alert throughout the procedure.  The man had lost vision in his left eye, and had it drained in order to avoid any risk of sympathetic ophthalmia, a condition wherein trauma to one eye results in inflammation in the opposite eye.

An elderly woman underwent an enucleation, which went one step further than an evisceration in that the entire eyeball was removed, including the outer layer.  The glaucoma in this lady's left eye had progressed to the point where her vision in that eye was irreparably damaged.  Dr. Samuel had found a potentially cancerous mass in her left eye, and advised her to undergo an enucleation to not only determine if the cells in the mass had spread to other parts of her body, but also to prevent such an occurrence.  Upon removing the lady's eye, Dr. Samuel sliced it open and determined that, thankfully, the potentially cancerous cells had not spread anywhere else in her body.

[no pictures shown of the two procedures described above for obvious reasons]

the hospital's guesthouse, where I stayed

the guesthouse caretaker's children- the middle kid always burst into tears whenever he saw me

During our daily tea time break from surgery, Dr. Eric, a Danish orthopedic surgeon who had served at Aira Hospital for over 10 years, regaled us with stories of his most trying cases in the early days of his time in Ethiopia.  Conversation would generally drift to current events, and Dr. Eric engaged me and the doctors in some much-appreciated debate over Edward Snowden, the current political situation in Egypt, and the causes of the 2008 recession.

Dr. Eric, Sister Sennait, and Dr. Samuel

One evening Dr. Eric and his European-raised, Eritrean-born wife Sennait had Dr. Samuel and me over for dinner.  Sister Sennait was as kind as Dr. Eric was entertaining, and together they made very enjoyable hosts.  We enjoyed soup, fresh baked bread, and Danish fish egg paste in a Western-style home overlooking mountains and valleys that almost made me feel as if I were in Hawai'i.


Every evening after all the patients had been seen, Dr. Samuel and I would take walks around the town of Aira, and he would reflect on how this town that he had grown up in had changed over the years.  As we trekked up hills, through abandoned air fields, and into churches under construction, he would note how much he enjoyed the simplicity and tranquility of the town.

 tree in front of Aira Hospital

 Aira's "airport"- a small airstrip for planes to land on

A new Mekane Yesus (Lutheran) church being built- the two-story sanctuary shown here, with a floor of offices and meeting rooms underground

 

 kids sliding down the hill

My first week in the Dembi Dollo eye clinic, a shy but pleasant seven-year old boy had come in with trauma to his right eye.  Unsure of what course to take, we had recommended he see Dr. Samuel at the eye camp in Gambella.  Once there, Dr. Samuel determined the boy had a traumatic cataract, and advised him to travel to Aira, where he could perform cataract surgery.  On one of my last days in Aira, as Dr. Samuel and I passed by the inpatient ward for ophthalmic patients, a man standing near the entrance reached out and shook my hand, saying, "Dembi Dollo."  Confused, I turned to leave when Dr. Samuel explained to me that this was the father of the boy I had seen in the Dembi Dollo eye clinic.  I entered the ward and found the young boy lying in a bed, recovering from surgery, but with a healthy eye and vision restored.

It seemed the boy's path had intersected mine at all of the major points of my time in Ethiopia, and I found it fitting, in a way, that near the end of my trip, I had seen his condition resolved.