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IMHOETHIOPIA:VOLUNTEERMEDICALTRIP2010

BahirDarImmenseneedsattheBahirDarFelegeHiwotHospital.NeedfordevelopmentofaSchoolfortheDeaf.

DebarkRequestsforexpansionofmaternal&childcareunit,surgicaltraining,dentalcareunit,andcounseling/education.

GonderPossiblemedicaleducation/telemedicineprogram,andfillinginthegaps.

ReportonIMHO’sfirstdirectlyimplementedeffortinAfrica.Teamof6IMHOvolunteersdescendsonNWEthiopiafor2weeksofvolunteerservice.Alandofextremeswherethebeautifullandscapescontrastsharplywithimagesofmind‐numbingpoverty,EthiopiaisanidealnewfrontierforIMHO,wherealittleservicecangoalongwayinsavingandimprovingthelivesofthemostvulnerable.Fortwoweeks,ateamof6IMHOvolunteersembarkedonanincrediblejourney,markingIMHO’sfirstdirectlyimplementedeffortintheAfricancontinent.Theteamhadseveralobjectives,includingdeliveringanumberofhealth&medicalsupplies,carryingoutaneeds

assessmentateachofthehospitals&clinicsvisited,conductingmedicallectures&trainings,andlayingthefoundationforfuturelong‐termefforts.Whilenecessaryamendmentstotheseobjectivesweremadeonceontheground,eachwasaccomplished,thankstoourcommittedinternationalvolunteersandlocalcounterparts.JoiningusforthistripwereDr.BonnieWirfs(aninternistfromWI),Dr.BetsyFinigan(afamilymedicinedoctorfromNY),Dr.AlanKrohn(apsychologist/psychoanalystfromMI),Ms.HayatAli

(anMPHgradfromCanada),Ms.AnoukVashe(aphotographerfromCA),andMr.GregBuie(IMHOProgramsCoordinatorfromCA).

WorkinginpartnershipwiththeAmharaDevelopmentAssociation(www.amharada.org),IMHOtargetedthecitiesofBahirDar,Gonder,andDebark,allintheAmharaRegionofNorthwestEthiopia.Thisareahashadalegacyofunder‐development,evidencedbythefactthat90.4%oftheruralcommunityhasnoaccesstopotablewater,56%lackhealth

ShenoSiteofafuturecancerhospitalbeingplannedbytheLife’sSecondChanceFoundation.

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services,and53.7%ofschoolagechildrendonothaveaccesstoanyeducationwhatsoever.Primaryeducationbenefitsonly46.3%ofthepopulation,andsecondaryeducationreachesamere6.3%.Thelowlevelsofagricultureproductivity,combinedwiththecontinualsub‐divisionsoflandduetoruralpopulationincreaseandrecurrentdroughtinpartsoftheregion,resultinapproximately3.5millionpeople(almost25%ofthepopulation)beingleftfoodinsecure.

BahirDarFelegeHiwotHospitalOurfirststopwasinBahirDar,acityofapprox.200,000onthebanksofbeautifulandsereneLakeTana.TherewevisitedtheBahirDarFelegeHiwotHospital.Thishospitalservesacatchmentareaof5‐7millionandsees700‐1,000patients/day.ItistheonlyhospitalinBahirDarcityandfunctionsasareferralcenter.Withsuchimmensedemand,thehospitalhasachronicshortageofbeds,medicines,andsupplies,andthestaffisoverworked.Thishugeburdenalso

prohibitsthehospitalfromdevelopingormovingforward.Theneedsatthishospitalweremassiveandclearlyevident.Evenbasicmedicalequipmentsareeithernotfunctioningornon‐existent.Thelistofrequeststhishospitalmadetouswereessentialitemsthatanybasichospitalshouldhave.Afulllistofrequests(bothequipmentandmedicines)isavailableonourIMHOwebsite.Basedoffourgroup’sobservations,wewereabletoidentifyanumberofareasinwhichIMHOmaybeabletomakealargeimpactonthishighlyunderequippedandoverstretchedfacility.Gettingashipmenttogetherofin‐kinddonations(equipment,machines,medicines,supplies,etc.)isthemostobvious.Asidefromthat,therewasgreatpossibilityandinterestintrainings,whichwouldbepossiblethroughtheestablishmentofatelemedicineprogram.Duringourtimetherea2‐hourtraininginmentalhealthcounselingwasconductedby

Dr.KrohnandDr.Finigan(andtranslatedbyMs.Ali),whichprovidedaglimpseintowhatfuturetrainingscouldlooklike.Volunteersarecertainlywelcometocometeachinanynumberofsubjectsatthehospital,butintheabsenceofsuchvolunteers,atelemedicineprogramwouldensurelong‐termsustainabilityofthismedicaleducationcomponent.Thehospitalsrecord‐keepingsystemwasalsoinneedofsupport.Thankstoagrantforthehospital’sHIV/AIDSprogram,electronicrecordsarekeptforallthosepatients.However,therest(ie:thevastmajority)oftheremainingpatientrecordshaveyetto

BahirDarFelegeHiwotHospitalTherewasnoshortageofidentifiableneedsatthishospitalthatservesanareaof5‐7million.Mostimmediately,thehospitalneedsbasicequipmentandmedicines.Malnourishment/undernourishmentisrampant;therearemanyHIV/AIDSpatients;thehospitalhasseriouswater&sanitationneeds;thereisasevereshortageofbeds;andthereisahighdemandfortrainings.

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56%ofpeopleintheAmharaRegionlackaccesstoanyhealthservices.

godigital,makingforaratherchaoticandinefficientsystem.Inordertodothis,thehospitalneedscomputers,software,trainingforstaff,anddevelopmentofanewsystemthatallstaffwillneedtobetrainedin.

BahirDarHealthClinicAstheonly1of4healthclinicsinandaroundthecityofBahirDarstillfunctioning,thisclinicwasarefreshingbreakfromthemassiveissuesfacingtheBahirDarHospital.Theclinicfunctionsasacommunityhospital,providingcaretopatientsby18nursesand6communityhealthworkers(therearenodoctors).Theclinicwasfairlywellstockedwithmedicinesandequipment,thefacilitieswereclean,andthestaffwereefficientandwell‐trained.Theymadeseveralrequestsforequipment,butallinall,thisclinicisastrongmodelforwhatcommunityprimarycareclinicsindevelopingcountriesshouldlooklike.Asagestureofgoodwill,IMHOdonatedanumberofmedicalsuppliesandmedicinesherethatwerebroughtoverfromtheU.S.BahirDar“Yekatit23”SchoolfortheDeafAspecialrequestwasmadeduringourtripbyafewoftheIMHOvolunteersthatwevisitaschoolforthedeaf,whichwefoundinBahirDar.Withveryfewopportunitiesfor

deafchildreninEthiopiatoevengotoschoolandlearnsignlanguage,werealizedthatthese28childrenwereveryfortunatetohavespecialclassroomssetasideforthem.MostdeafchildreninEthiopiaareeitherleftoutoftheeducationalsystementirelyorforcedtolearnalongsidetheirhearing‐abledpeers,inwhichcaseverylittleisactuallylearnedatall.Twoclassroomshadbeensetasideinaseparatesectionofthisschoolforseveralthousandchildren,inwhichparentsofdeafchildrenwhohadlearnedsomesignlanguagewereactingasteachers.Theircommitmentwasclearlyevident—theyhaddoneeverythingintheirpowertotransformtheclassroomsmadeofbasicwood,mud,andtinintoaplaceforlearning.Yet,theyarestruggling.AndwhenthechildrenreachGrade5,theyareintegratedwiththerestoftheirhearingpeers.Along‐term,comprehensiveplanisneededtodevelopthisschoolforthedeaf,includingtheconstructionofnewclassroomsandalive‐instudentcompound,trainingofnewteachersandcare‐takers,provisionofsuppliesandlearningmaterials(suchasartsupplies,books,teachingaides,toys,Brailleboards,sportsequipmentetc.),andclassesforadults/parentsofdeafchildren.Tohelpinthe

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interim,twooftheIMHOvolunteers(whoarefluentinsignlanguage)tookthe2teachersshoppingandpurchasedapprox.$200worthofbooks,supplies,andtoysontheirbehalffortheirclassrooms.Manyofthedeafchildrenatthisschoolareorphans,havebeenabused,andaredealingwithotherphysicalandmentaldisabilities,whichmakestheneedforsuchadevelopmentplanallthemorenecessary.ItmaybepossibletolookintosupportfromtheNationalTechnicalInstitutefortheDeafintheU.S.andotherdeafresourceorganizationstomakethisprojectareality.

DebarkHospital

AswemadeourwayintothedustyruraltownofDebark,atthebaseofthebreathtakinglypicturesqueSimienMountains,weexpectedtofindahospitalinpoorshape.However,builtin2006,theDebarkHospitalisanewfacilitythatisextremelywell‐managed.Theadministrativeteamhasavisionforgrowingthehospitalandaddingtothebasicstructurecurrentlyinplace.This42‐bedhospitalessentiallyservesasalargeprimarycareclinic,asnospecialtycareisyetavailable.Withnosurgeons,noOBGYN,andnootherspecialists,thehospitalrefersmanypatientstothehospitalatGonder,whichisabout3hoursaway.Only1

ambulanceisavailable,makingpatienttransferexceedinglydifficult.Likeallotherhospitalswevisited,thereisashortageofmostmedicines,moststrikinglymagnesiumsulfate,whichwasthetopmedicinerequestedeverywherewewent.Theseshortagesareanationalproblemandnotspecifictoanyonehospital.Thehospital,whichservesanareaof2million,seesabout1,300regularHIV/AIDSpatientsand500+diabetespatients.Theyarecurrentlyworkingondevelopmentofaneyecarecenterthatwillbeabletoperformcataractsurgeries.Forfurtherexpansion,thehospitaladministratorsanddoctorsarehopingforthefollowing:1.Trainingofkeystaffingeneralsurgeryandhowtoperformac‐section;2.Adentalunit;3.Furtherexpansionofthematernal&childcareunit;and4.Medicaleducationandcounselingfordoctors&staff.DebarkSecondarySchool&VTC;WaliaPrimarySchoolIMHOascribestotheWorldHealthOrganization’sdefinitionofhealth,whichstatesthat“healthisastateofcompletephysical,mental,andsocialwellbeingandnotmerelytheabsenceofdiseaseorinfirmity.”Assuch,theIMHOteamofvolunteersvisitedtwoschoolsinDebark.TheDebarkSecondarySchoolandVocationalTrainingCenterforyoungadultsisasprawlingcampus,butonethatlacksmanybasicresources,includingadequatechairs,benches,andtables,aswellastextbooks.Theratioofstudentstotextbooksvariesbyclassroom,butisusuallywithintherangeof1:5or1:10.Accordingtogovernmentstandards,thisnumberissupposedtobe1:1.But

withstudenttoteacherratiosatapprox1:50orso,therearesimplytoomanystudentsandtoofewbooks.Theschoolalsolacksahealthclinic&nurse,andtherearenocomputers,nointernet,andnowater.Requestsweremadebytheschooladministrationforlaboratoryequipment,textbooksandreferencematerialsforallsubjects(Englishlanguage),dictionaries,trainingsinEnglish,computers,&leadership,andmore.ThesesameneedswererepeatedattheWaliaPrimarySchoolwhereIMHOdonatedsportsequipmentbroughtfromhome.Aswedisplayedtheitemswehadbroughtwiththeschooladministration,theschool’s2physicaleducationteachersexcitedlyshowedupandexplainedthattheschooldidnothaveasingleballorpieceofsportsequipmentwithwhichtoconductclasses…untilnow.Wehopetobeabletoprovidemoreequipmentlikethisinthefuture.

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Inacountryof80millionwherecancerabounds,thediseaseisalmostalwaysterminal.Only1hospitalnationwidetreatscancerpatients,butthelevelofcareisextremelypoorduetolackofresources,facilities,training,medicines,etc.ThetimehascomeforEthiopiatohaveitsowncancerhospital.Millionsofliveswillbesaved…

GonderTeachingHospitalAt450beds,theGonderTeachingHospitalisamassivefacility.However,thedemandisevengreater,leadingtomajorovercrowdingandaseriousstrainonthehospital’shumanandmaterialresources.Eachyearthehospitalseesanincredible200,000+outpatientsand20,000+inpatients.Thespreadofdisease,includingmaternalsepsis,ishighonaccountofthesheernumberofpeoplewhoareinandoutofthehospital.Inparticular,thepediatricswardisthemostoverstretched.Mostinfant&childhealthproblemsarerelatedtopoornutrition.Thepossibilityforprojectsatthishospitalaremorelimited,giventhesizeofthehospitalandthefactthatUSAIDisfundingtheconstructionofanewhospital(duetobecompletedin2years).

Duringourvisitourteamconductedafewmedicallectures,including“SymptomReliefatEndofLife”and“SexualAbuseofChildrenandAdolescents”.Afewmanageableneedswerealsoidentifiedwhilewewerethere,includinganumberofbrokenmachinesorequipmentsthat

simplyneedtoberepaired.Investmentintrainingahandfuloftechnicianstofixbrokenequipmentatthishospitalandotherswouldbeonesuchworthyeffort.Theveryreceptivestaffandadministrationalsoencouragedfuturetrainings,beitthroughvolunteerscomingin‐personorviatelemedicine.Arequestwasalsomadefor5voltageconverters—asimplyfixforanumberofmachinesthatweredonatedfromtheU.S.butdidnotcomewithvoltageconvertersandthuscannotbeused.

ShenoCancerHospital—Life’sSecondChanceFoundationAbout80kms.outsideofthecapitalcityofAddisAbaba,liesthesmallcommunityofSheno,hometoabout15,000people.InMay2008,thePresidentofEthiopiainauguratedthesiteasthehomeofafuturecancerhospital,amassiveundertakingheadedbytheLife’sSecondChanceFoundation.CancerisasilentkillerinEthiopia,asitisinalmosttherestofsub‐SaharanAfricaaswell.DespitethefactthatthediseasekillsmorethantwicethenumberofAIDS,TB,andmalariadeathseachyear,itisnotwell‐knownorunderstoodbythepeople.InEthiopia,onlytheTikurAnbesaHospitalinAddisAbabacantreatpatientswithcancer.Yet,onlyabout500patientsgettreatmenteach

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year,andthevastmajorityofthosecasesareinfactterminal.

HavingvisitedthepediatricswardattheTikurAnbessaHospitalwherechildcancerpatientsareintegratedwithothercases,ourteamcanattesttotheincrediblydismalqualityofcare(andqualityoflife)thesepatientsandtheirfamiliesendurewhilefightingthisbattle.Onlyahandfulofchemotherapydrugsareavailableatanygiventime,andfamiliesmustpaythehighpricesforthem.Forpoorpatients,drugsareoftentooexpensive.Andformanypatients,whenonedrugfails,therearefewornootherdrugstoswitchto.Afteraperiod,manyparentssimplytaketheirchildrenhometodie,ratherthanseethemsufferintheovercrowdedwardsburstingwithsickpatients.Whilewewereunabletotakephotosduringourvisit,theimagesofthesechildrensobravelyfightingthisdiseaseandtheunrelentingcommitmentoftheirlovingparentswillforeverbeetchedinourminds.Somethingmustbedonetoimprovethissituationdramatically…andfast.

TheLife’sSecondChanceFoundationwasstartedintheU.S.in2006byaleukemiasurvivorofEthiopiandescent.ItisnowaregisterednonprofitorganizationinEthiopiaaswell.ThefoundationisdrivenbythevisionofraisingfundstoequipandfurnishthefirstevercancercareandresearchtrainingcenterinEthiopiawiththemostup‐to‐datemedicalequipment.Thestrengthoftheirlocalteamofvolunteerswasevidentduringourvisit,andthereisincrediblecommunitybuy‐inandsupportoftheproject.Asthisisamassiveundertaking,theneedatthispointissimplytostartsomewhere,thenslowlybuildout.IfIMHOweretochoosetotakeonthisproject,thepotentialimpactandbenefittothoseinneedwouldbeimmeasurablyhigh.

PLEASESUPPORTOURWORK!Ifyouhavebeenmoved,inspired,ormotivatedbywhatyouhavereadhere,pleasegetinvolvedwithIMHOandhelpsupportoureffortsinEthiopia!Volunteersanddonationsarealwayswelcome.PleaseemailGregBuie,IMHOProgramsCoordinatoratcoordinator@theimho.orgifyou’reinterestedingettinginvolved.Orsendyourtax‐deductibledonationearmarkedfor“Ethiopia”to:

IMHOTreasurerP.O.Box61265StatenIsland,NY10306

MedicallectureatBahirDarHospitalfordoctorsandstaff

AtypicalclassroomatWaliaPrimarySchoolinDebark;manyotherclassroomsatotherschoolsweresimplymadeofmud,wood,andtin.

ChildrenwaitingoutsidetheBahirDarHealthClinic,seekingtreatment.HealthservicesinEthiopiahavealongwaytogoindevelopingtheavailablecareandinfrastructuretoensurethenextgenerationishealthyandproductive.

www.TheIMHO.org