Hospital Acute Care

This reflection is by no means intended to incriminate the hospital system in Ethiopia, but I wanted to paint a true picture of my experiences here. Today I got to experience the acute care area of the hospital- specifically the medical ward. It was an extremely overwhelming experience. It was particularly eye-opening to see the conditions the patients are living in as well as the conditions that plague them- many of the hospitalizations could have been prevented had vaccinations, screening processes or other medical care been provided earlier.
For a cost of 2.5 birr/day (less than 20 cents), patients are placed in the general rooms that may have 12 patients per room. Patients may also opt to stay in a less crowded room (2-4 patients per room) for a slightly higher fee. Imagine this: as previously mentioned, the halls are fairly dark due to frequent power outages. The patients that I treated were in rooms with 12 patient beds in a space the equivalent of maybe two patient rooms put together at Spring Valley Medical Center in Las Vegas (my last clinical experience). There were 1-2 nurses for the 12 patients and there did not seem to be much interdisciplinary (ie-PT/nurse/MD) communication, aside from the rounds that occur once per week. One toilet/shower was available per floor unit and patients had no privacy/dividers, and were lucky if their soiled sheets were changed in the duration of their stay because everything is hand washed. It was common to see pots on the floor catching the water dripping down from the ceiling, and there was an overpowering scent of sweat, urine, feces and bleach mixed together in the air. Patient family members and friends were gathered around the patients beds and pots of lentils and injera crowded the windowsills.
My first patient was previously a world class distance runner who had a rusty nail break through his shoe a few months ago. He proceeded to get tetanus and was so atrophied and weak by the time we saw him that sitting up was an immense effort. He was in the ICU for 5 weeks and on a ventilator for several weeks, during which time he was literally bedridden and immobile. His therapy had up to that point consisted mostly of passive range of motion and efforts to improve his elbow joint contractures. PT here has proven to be fairly conservative in general which has been a challenge. After some coaxing, everyone agreed to let him try walking with me. We walked about ten feet before he succumbed to extreme fatigue but the smile on his face was priceless when we left. It was so frustrating to hear his story knowing that in the US he would have received immediate treatment upon initially injury and never would have gotten to such a near-death state requiring such a lengthy recovery.

We saw a number of other patients. The patients stories are heartbreaking to say the least. One of the PT’s, Nigatu, has told me that the only way he can do his job is by not truly “hearing” the stories. It is easier to put up a wall and not get attached to patients he has said. I’ve had a really hard time with this factor. Other conditions I treated have included cancers, spinal fractures, bacterial meningitis/hydrocephaly, and Brown-Sequard Syndrome. Fractures are so very common and I think it is definitely tied to widespread nutritional deficits here.
My classmates have also worked with very interesting cases- for example, one patient had an affair with another man and her husband beat her and buried her alive. Miraculously, some nearby children heard her screams and came to her rescue. Another story- a 12 year old boy was beaten so severely by his teacher that he needed skin grafts, developed contractures and is now months later just attempting to stand up again. While outpatient care has been very culturally educating, the inpatient side of things here even more greatly outlines the vast cultural differences between the US and Ethiopia. It’s incredibly humbling yet frustrating.