Roller Coaster

One afternoon, I accompanied Dr. Samuel on a trip to the nearby town of Guliso.  If the road in Dembi Dollo was the Indiana Jones ride at Disneyland, the road to Guliso was Goliath at Six Flags.

Over the course of the ride, we were slammed against every side of the vehicle.  We zipped along tortuous hillside roads, blazing past cornfields and young children shouting as we passed.  Our driver floored the van at 70 kilometers per hour through the rocky unpaved road only to slam on the brakes at the sight of an upcoming puddle or hole, sending us hurtling forward.  As the van careened through muddy ditches, we were hurled back and forth from left to right, with feet flying high in the air.

If I ever wondered why there were no amusement parks in Ethiopia, I now wonder no longer.

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.

Days of Being in Clinic Redux

One morning in the exam room of the clinic, a familiar tune entered the room via the window facing the restaurant next door.  In a town where I never heard English unless someone was intentionally trying to communicate with me, it was quite a shock to hear the recognizable bars of Jesus Culture's "Your Love Never Fails."  Initially, I was certain it was a fluke- the restaurant next door regularly played Afan Oromo songs for its customers, and I reasoned that the American worship song must have slipped into the playlist by accident.  Yet when "Oh Happy Day" played next, followed by the Newsboys' "I Am Free," and Jeremy Camp, I knew the worship songs were no fluke.  Throughout the rest of my weeks working at the eye clinic, the music streaming in from the restaurant next door served as a constant reminder of why I was there in Ethiopia.

 

 Using a slit lamp tonometer to measure a patient's eye pressure

My eye clinic experiences in the second half of the trip were no less remarkable than those in the first half.  One noteworthy case was a man who came in complaining of temporary vision loss in one eye, which led us to suspect he had amaurosis fugax, essentially a mini-stroke in a blood vessel supplying the eye.  On another occasion, an elderly man who had recurring pain in his eye proclaimed that I was a "god-man" after I gave him some anesthetic drops in order to take his eye pressure!  Even though we were only midway through the exam since we hadn't figured out the underlying cause of his pain, the man was ready to leave, having been temporarily cured of his ailment.

A week and a half after the Gambella eye camp, Mario returned to the US to prepare for a new research job at the University of Miami.  The clinic sent him off with a traditional Ethiopian shirt, and Sister Alganesh at the Daughters of Charity compound had him perform the obligatory coffee ceremony before his departure.

 Mario busting a move in his new Ethiopian shirt

 Mario and Peace Corps volunteer Trudie bidding farewell on Mario's last night

In my last few weeks at the clinic, some of the kids of the clinic nurses and assistants began to stop by to visit their parents.  Whether they were playing, climbing mango trees, or trying to help their parents, their presence always made the day just a little more enjoyable.

Ophthalmic nurse Mitiku's son at the top of the mango tree

 

 

 Kids of the clinic staff

 

Mitiku's daughter (Mayti), son (Lanejo), and niece

One evening after clinic, I accompanied Mitiku to the Dembi Dollo hospital, where his sister-in-law was preparing to give birth.  The hospital, which had started as a Christian mission hospital, had in more recent times been taken over by the government.  One doctor there told me most adults were admitted for diabetes, congestive heart failure, and tuberculosis, while many of the children were admitted for pneumonia.  The hospital offered services from baby deliveries to psychiatric counseling to eye care, though they were lacking in doctors in many fields, most notably ophthalmology.  A small wing was devoted completely to ophthalmologic services, but because the hospital could not entice any of the few Ethiopian ophthalmologists to work there, it was manned entirely by an ophthalmic nurse, Sehai, who split her time between the hospital and the eye clinic.

Mitiku's sister-in-law hours from giving birth

hospital cook serving lentil stew on injeera

pediatric unit

In my second to last week in Ethiopia I learned that the eye camp planned for the next week in Kamashi had been canceled because a corruption scandal had landed many of the town's government officials in jail.  Hoping to work with Dr. Samuel one last time before I left, I asked him if I could work with and learn from him at Aira hospital, four hours northeast of Dembi Dollo.  He graciously agreed, and the next day I was zipping along in the Toyota Landcruiser on my way to Aira.