A transcript from my presentation I gave to my coworkers at a nursing conference. My slides were my pictures from the trip. This presentation has been modified from its original version. It has been reformatted to fit your screen.
For about two weeks in April I went to Ethiopia with a group called Health Gives Hope. It is run by two people; Amber Kaufman, an American, who worked with us last fall, and an Ethiopian named Israel Dejene. The organization takes medical relief trips in April and November and they have done so for about five years. In addition to medical relief trips, Health Gives Hope also runs trips to bring those with particular skill sets to solve other problems. Most recently they evaluated water sources and infrastructure to deliver clean water throughout various villages.
When I told someone I was going to Ethiopia they would mention one of two things to me: Ebola or Sally Struthers. The ebola outbreak was occurring on the west coast of Africa in Liberia and Sierra Leone while I was working on the east coast. It would be akin to me catching a disease from LA while working in NYC.
The other thing people remembered was Sally Struthers asking for donations for the Christian Children’s Fund during a famine. Another famine could certainly happen, but the main problem in Ethiopia is infrastructure. The government has pushed for investments in textiles, tourism, and manufacturing. As you can see from these photos, there are roads and new construction. There is a horse on this highway in the capital of Addis Ababa. The roads were paved or stone in the cities, but between the cities you may trade asphat for packed earth. This definitely affects the logistics of moving man, materials, and machines.
And this is what Ethiopia looks like. It’s rather green. Not unlike Flagstaff really. It was mountainous, dry, cool in the morning and warm in the day. The weather was awesome. Also, every photo you take cannot sufficiently capture the beauty of Ethiopia. I highly recommend going just to see it in person. When you go on a trip like this, you learn a lot about yourself. I thought I was a night owl, but it turns out I was just in the wrong time zone. Here are the other lessons which were reinforced from my trip.
- Improvise Adapt Overcome
“Improvise Adapt Overcome” for those who served in the military I am sure you know this phrase or at least this sentiment. Generals make battle plans, but then have to change them once the plans meet the actual battle field. This whole trip was about being flexible and figuring out what you could accomplish with your brain and two hands. There are many times we made plans to do something only to have to change them for some unthought of reason.
For example, the Easter holidays occurred the week before we left. On Friday we were supposed to render medical treatment to prisoners, but we were unable to do so because Ethiopians are orthodox. Their holidays are celebrated a week later thus every thing was closed for Good Friday. All of the administrators for the prison were on holiday. None of the guards had the authority to let us in. They could not reach the prison administrators. We had to adjust our plans and it all worked out because I got to use this as an example for improvising, adapting, and overcoming.
The other lesson which was reiterated is teamwork. And honestly I hate this. It is such a cliche and we’ve all been on teams where we said, “I’m putting my name down twice because I did my work and yours”. But this team worked out really well. We all clicked and I think the main reason for this is because we wanted to be a part of something bigger than ourselves.
Which brings us to the story of baby Israel. He is a 15 month old who came in with lethargy, vomiting, and severe dehydration on the last day we were in clinic in the village of Bora. These are our two nurse practitioners. Amber is an FNP and Heather is a pediatric nurse practitioner. Heather started a line on baby Israel and wanted to do a bolus. We did not have any IV pumps however. In fact, the saline bags do not even have volume lines on them. So what are we to do? Improvise adapt and overcome. I got to do the thing that all nurses know how to do, but never do except on the medical math test in nursing school. I calculated a drip rate! I love nursing because you never know what bit of knowledge will be useful for your patients later on. Nursing encourages you to learn everything.
Calculating the drip rate also excited me because I got to use math to overcome a hurdle. This only got us over one hurdle though and there were many more to come. At the end of the day, baby had two 140 mL saline boluses, received saline at a maintenance rate, received 770 mg of ceftriaxone, and ibuprofen & acetaminophen as needed and he still wasn’t doing much better. We had to decide what we were going to do with baby given this was our last day in clinic. We could discontinue treatment and send mom and baby back home which was a 12 mile hike up and down mountains. We know what would happen if we did that option, so it wasn’t really an option.
We could hike 6 miles down a steep mountain and take the baby to Chencha. There is a clinic and doctor there, but we don’t know what capabilities they have. They could be the same, better, or worse than us.
We could remain in the clinic and have a slumber party. The main advantage here is that all of the medications and supplies are here. This second set of photos shows the interior of the clinic. You can see a good looking guy there in a ball cap triaging some patients. I also need to give a shout out to our non-medical people. We had two nurse practitioners, three nurses including myself, two pharmacists, and six non-medical personnel. The non-medical personnel were awesome at keeping the clinic running, building side projects, and just generally doing things so the medical people did not have to worry about any thing.
Our next option was to hike 1 mile from the Hidota clinic to the village Bora. This by the way is the view we had every morning and evening as we hiked to and from the clinic. This one mile hike beats any thing you might see on the Dan Ryan, I40, or I65. We could turn on of the huts in the village into an ICU.
We opted to hike down to Bora. We did this for logistical reasons. The clinic does not have beds or furniture, our gear was in the village, and dinner was in the village. You can see our two NPs discussing differential diagnoses. The gentleman in the kelly green scrubs was one of the two pharmacists. His wife was the other pharmacist and they were also our photographers hence you typically see one of them, but not the other. They were awesome pharmacists. They prepared all the meds they thought we would need so we could treat baby overnight without having to think, “How do I reconstitute this again?” And you can see me carry the IV bag. If you are six feet tall you are perfect height to be an IV pole.
The man in the camouflage jacket is Israel, our Ethiopian guide, translator, and everything else. The other guy in the lab coat is the chief of Bora. When we arrived in the village Israel and the chief lead a prayer with some of the villagers around the baby. The whole time we were converting our quarters to be an ICU there were villagers coming in to wish mom and baby well. They have an amazing support network which would actually prove problematic later on.
Baby had been vomiting and we had only been giving him normal saline. In order to balance his electrolytes we made an oral rehydration solution out of our water flavorings. Again this excites me because I got to use basic chemistry to get over another hurdle. My excitement should not surprise you as you all are aware I am a nerd. Amber, Heather, and I rendered care to baby Israel throughout the night. At about three in the morning we heard our diagnosis. Let me say that again. We heard our diagnosis. We know what that means; baby Israel has pertussis. As you’re all aware pertussis is extremely contagious and we just had an entire village come in and wish mom and baby well.
In the morning baby Israel was improving by leaps and bounds. The nurse practitioners and Israel, the adult, figured out who came in close contact with mom and baby and thus needed prophylactic treatment. I stayed with baby Israel while the rest of the crew went up to the clinic to get the medications for prophylaxis. Amber, Heather, and Israel returned to our makeshift ICU while the rest of the crew began their 6 mile descent to Chencha. Yesterday was our last day in clinic and we needed to return to our base city after all. The four of us distributed medications, provided “discharge instructions”, and packed our gear for the descent. Upon our arrival in Chencha, the team greeted us and took us to get this.
The most glorious cup of coffee I have ever had. No one on the team ever thought about just his or herself. They thought about the team. And this team thought about our restless night and took us for coffee.
Baby Israel is just one of many patients that we had. We encountered patients with dehydration, typhoid, parasites, GERD, and much more. I need to thank all of my family and friends who donated to send me to Ethiopia with Health Gives Hope. Their donations helped save baby Israel and brought quality healthcare to hundreds of others. This trip is definitely a cherished experience for me. I love any opportunity that lets me challenge my mettle. It was fantastic to be a part of such a motivated team.