Shiro!

Shiro tegabino is my favorite food here. It's pretty simple - a sauce-like mixture of water and spices and you eat it with injera. It's bubbling in a little pot when they bring it out to you at restaurants which makes it even more exciting.

Really, the only thing I haven't liked so far was kitfo, a mixture of raw meat that we had on Easter. It tasted okay but I couldn't wrap my head around the idea of eating something that raw.

Injera (the pancake-like white thing in the picture) has definitely grown on me - it's really sour, may be an acquired taste at first, but I've started to have these intense cravings for it lately, even though we are eating it all the time! It's made out of teff which is this really tiny grain that is one of Ethiopia's main crops.

Good thing Denver has a lot of Ethiopian restaurants...

Mother and Children Rehab Center

Third stop of the day.. The Mother and Children Rehab Center, also in Addis. This center houses nearly 80 children who would otherwise be on the streets. It was created by a woman named Jutta (unsure of proper spelling) who is from Germany and she provides schooling, art, dance, music, and other types of training for women and children. Her philosophy is that she can't help everyone, but those who she can support will live well. While we were there the children performed dances and songs for us. It was so beautiful that it brought a lot of us to tears- yup, most of us lost it when the kids starting singing "Lean on Me" in English!!

By the end of the day we were all pretty overwhelmed. I felt like my life is so insignificant compared to what these "heroes" are doing! These people have given up their entire lives to creating better lives for children and adults in need. Absolutely amazing.

Mother Theresa Mission

Our second stop was at the Mother Theresa Mission, where we met with Rick Hodes, an American doctor who has recently been gaining media attention in the US for his 20+ years work in Ethiopia. Most recently, he was on Good Morning America: (http://www.huffingtonpost.com/2010/04/13/rick-hodes-american-docto_n_535533.html) and an HBO Documentary entitled "Making the Crooked Straight" (www.makingthecrookedstraight.org). 

The organization is worldwide and it's mission is to treat "the poorest of the poor." Dr. Hodes specializes in patients with heart conditions, spinal tuberculosis, and cancer.  He takes it upon himself to seek pharmacological interventions and surgeries for the patients that need them- he finds the best surgeons around the world to perform these life-saving operations. Dr. Hodes has adopted a number of the children himself in order to get them health insurance for the operations. He is a hero in so many ways and it was a privelige to meet him and his patients and to see the facility.

 

The Fistula Hospital

One day, three heroes...
Yesterday we visited three different facilities and I'm overwhelmed (in a good way) by the dynamic leaders that I met at each.

First stop was the Addis Ababa Fistula Hospital. (For more information on fistulas, check out my earlier blog post on "Maternal Mortality." Also, PBS.org has a free documentary on this facility called "A Walk to Beautiful." - see my link)

 Dr. Williams led us on a tour of the facility and it was fascinating to finally see this place that I've been reading about for the last year. It was a very beautiful, clean facility. Each woman there was given a hand-woven blanket (like the ones in the picture) on her arrival and it was clear that quality of care is a high priority here. It's much more than just a hospital - programs are running for midwifery training, rural outreach, job training/employment, etc. We spent some time in the PT treatment room and I hope that we will have a clinical site there next year as it could be a great opportunity for collaboration.

Originally the hospital was founded by the Hamlins, who did a lot of ground-breaking work with surgical techniques in this area. Catherine Hamlin wrote a book "Hospital By The River" (amazon.com) which gives a very interesting overview of her life's work, the hospital and maternal medical complications in Ethiopia. She is now 80 years old and still performs surgeries once per week! We were lucky to run into her while we were there and I was so excited to meet one of my "heroes." We also got to meet Hans Dietz from Australia who is a leader in the field and happened to be doing some ultrasound research there that day. He showed us some imaging and I learned quite a bit from him in just a short time.

Currently, 75% of fistula cases are completely cured at this facility. That's pretty amazing. I was astounded by the spirit of these women after what each one has been through- most had been ostracized from their communities and left to die before they found the Fistula hospital, yet here in recovery they were all smiling, laughing together. Clearly the hospital also plays a role in their psychological recovery and renewed sense of community.

Easter at the Orphanage

Three us walked to a nearby Catholic church Sunday morning in hopes of catching an Easter service. There are three Catholic churches in all of Addis and it was difficult to get information about the services. Unfortunately we missed the mass but went inside St. Mary's to have a look anyways. St. Mary's also runs a school and orphanage on the property and we ended up wandering to the backyard where the children were playing. There are several orphanages in Addis but I believe that this is the only Catholic-based organization here. We got a little tour of the area - it's a very clean facility and the children all looked happy and well-fed. We found about ten babies in one of the rooms and I am thinking of bringing them all home with me now :). Ethiopians are very beautiful people in general- distinct facial features and very nice skin - and the children are all so adorable. A side note- pretty much everyone at our hotel outside of our group has been there for adoption. Definitely something to consider down the road!

So we ended up spending most of the day on this impromptu visit to orphanage- holding babies, playing sports with the older children, singing songs, having my hair braided by little girls.... They were such greats kids and I'm impressed by how much English is spoken at such a young age. It was a memorable experience, very hard to leave at the end, and a nice way to spend the Easter holiday.

In the evening myself and Keri met with some of the PT's from our hospital. We had dinner at a place called Teuj Bet - or "honey-wine house". It was a giant tukul with low chairs and tables and teuj was served in these glass carafes. Teuj is a drink usually only prepared for holidays and it's pretty strong... not my favorite Ethiopian beverage thus far, but I was glad we got to try it!

After dinner we finally got the 'real taxi' experience (our group has used the same land rover drivers thus far) which was not as crazy as I imagined - everyone had their own seat for this ride. However, when we got out of the taxi, some guy was running by and bumped into me head on, almost knocking me over. People around us started screaming and I jumped out of the way as 5 men in white clothing (holding these huge spears) ran by chased him over a fence. Apparently, he was being chased for some kind of theft. Yikes!

Just when you start to forget you're in Africa...

A patient case

It's so difficult not to get attached to the patients here. During my two weeks at the hospital, I became particularly close to one of my patients. Here is her story...

At the age of 19 and 8 months pregnant, Susina (not her real name) at the small frame of 5 foot 6 and maybe 115 pounds began having terrible headaches and neck stiffness.
By the time she got to the hospital, she'd had an intracerebral hemorrhage secondary to a pre-ecclampsia-related condition called "HELLP" (Hemolytic anemia Elevated Liver enzymes and Low Platelet count).
Her blood pressure was severely elevated and as a result of the infarct she became cortically blind and had left sided hemiparesis. Her baby was delivered immediately and fortunately is now a healthy 3-month-old.

However, Susina is now suffering from the physically disabling complications.
The first day I saw her in the clinic, she was carried in by family members and all of her treatment was performed in supine by her PT- mostly PNFs and other manual resistive exercises. Her PT and family were afraid for her to walk because "she is blind and maybe she fall down." While she had 3+/5 quadriceps strength in her left leg, her ankle dorsiflexion was 1/5. I coaxed them into some gait training using an arm crutch and she was able to walk - with left foot drag and knee hyperextension - but she was walking! At first she was very nervous about walking without vision but over the last week we have significantly improved her confidence and gait pattern.

We also performed some vision training using bright objects and mirrors. I had difficulty finding research on this with limited internet access so I just made exercises up! Cortical blindness is unique in that the optic nerve and other ocular structures have no damage. Thus it is solely cortex structures that inhibit what the patient perceives. It was pretty incredible but she was able to gain some vision in only two weeks time. Patients with this condition can have some spontaneous recovery so it is difficult to say whether what we did was related to the change, but she was able to recognize how many fingers were held up on her last visit.

Other treatment aside from gait training included quadruped exercises with a stability ball to improve hip extension strength, seated stability ball exercises with upper extremity movements and reach/grasp training. We also practiced sit to stand and over one week's time she went from max assist with sit to stand and gait to contact-guard assist with the arm crutch!

Susina was excited with her walking and vision progress but still depressed about her overall condition. Particularly, her family babied her a lot and did not want her to hold her infant son for fear that she would "drop him or poke his eyes out." Such interesting cultural perspective! I asked if I could meet her son and one day she brought him in for her PT session and we were also able to do some holding/positioning training with the infant!

The hospital has an orthotist and I prescribed her an AFO. She owed the hospital over 14,000 birr (about 1300 dollars) and she said that she would not purchase it because of financial reasons. Myself and some classmates/professors decided to pitch in and purchase her AFO, proper shoes, and an arm crutch. In the US a custom AFO alone may be around $1000 USD, but here it was 300 birr, or a little under 30 dollars! I was able to accompany the family to the fitting sessions with the orthotist which was really interesting to see.

In the end, Susina was able to ambulate with stand-by assist over flat ground, outdoor conditions (uneven ground) and stairs, with occasional verbal cues for visual assistance. It was so exciting to be a part of her PT and it seemed that we were able to impact her quality of life. Susina had an incredible amount of courage and perseverance. I know her road from here will not be easy- without vision she is especially limited in the Ethiopian trades and even daily cooking,childcare and house duties. I'll never forget her story.

Ethiopia Reads

Last night Jeremy and the nursing students arrived! Today we met with Gebregeorgis Yohannes, founder of non-profit organization "Ethiopia Reads." (www.ethiopiareads.org). This is an incredible organization that supplies school and independent libraries around the country from donor support. Yohannes is a very intelligent, energetic and inspirational individual who grew up here in Ethiopia and has a very interesting life story. (Perhaps for another blog posting...) Prior to this organization, virtually no books existed for children to read in their native language, Amharic. Now, thanks to Yohannes, there are hundreds of books available for various age groups in various languages (Amharic, Oromia, English, French, German, etc.) This organization has created 43 school-based libraries around Ethiopia with a start-up cost of $10,000 USD per library. There are no maintenance costs as the libraries are maintained by school staff. Unfortunately the organization has been strongly affected by the US economy and the disaster relief work in Haiti. The largest branch here in Addis was recently shut down in January. To learn how you can help, check out the website and talk to me.

The MERKATO!

The commercial part of Addis Ababa has two central areas- Merkato and Piassa. Piassa has a more Italian feel with European-style buildings, cobblestone streets, and fashionable clothing, shoes and jewelry. Both areas are bargain-friendly, as are most shopping spots in the city. Most of our shopping has taken place in shops near the Black Lion Hospital.
Yesterday I was carrying a bag with my Asics running shoes in it and many of the vendors swarmed around them offering to buy my (gross,dirty used)shoes for 500 birr (about 45 dollars!) I neglected to take the offers as I suspect I will need a pair of shoes for the next few weeks!
We went to a few stores in the Piassa area this week in search of orthotic-appropriate shoes for one of my patients. Today we ventured out for some shopping at the Merkato in the center of the city. The Merkato area has historically been known for its higher level of crime, pickpockets and prostitution. Currently, the biggest threat seems to be pickpocketing and we were very cautious- I would not recommend bringing a purse or backpack. There were many armed men walking the streets and standing around but fortunately we saw no signs of violence.
However, the entire experience was sensory overload and mass chaos- people navigating potholes and manure shoulder to shoulder, donkeys with loads running up the street, cars and trucks and taxis zooming in and out of the crowd, people carrying live chickens and goats/crates/other food on their heads, children following us begging, words in Amharic coming out of loudspeakers, vendors waving their handicrafts in our path. A massive afternoon rainstorm added to the colorful scene and one of our drivers, Fantu, led us for about 20 minutes through the crowd until we reached an area that sold handmade baskets and musical instruments. Taxis here are the blue and white buses that are generally overloaded with 20+ people and one person literally hangs out of the window shouting out the destination to people on the street. It’s difficult to discretely go anywhere in public here… We are now used to the stares and have seen few other “ferenjis” (foreigners) here – aside from some hospital staff and other Americans at our hotel. Apparently most tourists don’t spend much time in the capital city and instead head to the other tourist areas in Ethiopia. I always love to try blending in to countries but unfortunately for me I am a) WHITE and b) with a group of 10 other white people. Needless to say, we get a lot of unwanted attention!

I hate goodbyes!

Today was our last day in clinic due to the holiday starting tommorrow. It was sad- I really do hate goodbyes! All of my patients wanted my contact information- questionable whether for VISA opportunities or really just to keep in touch. It was also difficult to say goodbye to the staff at the hospital. They have all been so welcoming and hospitable. Over the course of the two weeks it’s been a great growth into collaboration across cultures. The first few days were difficult- we learned that we were the first American PT students to ever come to the hospital. But, as we got to know eachother it turned into a fantastic learning experience for both sides. We took turns doing inservices in the afternoons- the Ethiopian PT’s taught us about unhealed fracture management that is so common here and we did inservices on low back pain and spinal manipulations. There was a clear difference between our schooling background and theirs and we noticed many discrepancies in information. We had many great discussions about evidence-based practice and the future of PT in Ethiopia. Currently, the only PT school is in the town of Gonder, but it looks like in the next year there will be a PT school at Addis Ababa University- ran out of Black Lion Hospital. Even more exciting- there are some passionate individuals who are aiming to make it a DPT program! My professors had many meetings while we were here in order to build on partnerships and we are hopeful that this country will make great strides in the advancement of the field in upcoming months. Regis University, a PT school in Switzerland and the Ethiopians will be working together to get this program going. There are many obstacles unique to this country – the government, financial resources, technological resources, educational resources, etc. – but we are hopeful that the future will be bright when it comes to PT. As the Ethiopians always say, “We will hope.”