Aira Hospital

What do you do when a patient presents a one week old displaced olecranon (elbow) fracture like the x-ray below and you don’t have any sophisticated tools or hardware to fix it?

You dissect the fracture, reduce it and with any - preferable stainless – steel wire you keep the displaced fragments together.

The steel wire you can buy in any hardware shop. If you can’t find stainless steel don’t worry. You sterilize it before use so the rust will be sterile and harmless. Anyhow you can always remove the hardware after the fracture has healed in case it creates any problems.

The result is not perfect, but quite all right.

Remember the perfect is the enemy of good!

As stated before the surgical cases you see here are pretty much the same as back home only that they present far later and are far more larger and advanced.

Never did I see a soft tissue tumor of this size back home in Sweden.

It is a soft tissue sarcoma. Malignant in that sense that it will recur and spread locally if not excised radically, but seldom metastasize distantly or widely.

The best would be to have one surgeon do the excision and another the reconstruction. Otherwise there is a tendency to cut the corners short thinking of how to cover the defect later. You have to behave a bit “schizophrenic” – cut radically without thinking of how you are going to repair the defect later, and then do the reconstruction as if being another person.

In this case the tumor was removed radically together with the whole abdominal muscle layer. After that it was easily covered by skin grafting.

Hopefully and probably the result is a cure.

It has been completely impossible to get connected to internet for a lomg time now. It takes too much energy and patience to even try when you come home tired after a busy day in OR. After trying to call and connect some 50 – 100 times or more without success you tend to give up.

Although we are temporary short of staff in the operating theater with 4 persons away for workshop and training we still managed to perform 35 surgeries in one day. High surgical activity benefits the patients and raise money for the hospital. That is what I consider true “income raising activity”.

Otherwise the popular idea of “income raising activity” always means something else for other people. Several years ago the hospital was evaluated by “experts” who in their report suggested that the hospital should start growing vegetables as “income raising activity”.

Think of a shoe factory which needs “income raising activity”. Would one consider growing vegetables or opening a cafeteria to generate money in that case? I think not. Then why is that seriously considered appropriate for a hospital?

Some years ago the hospital applied for a grant to build a much needed eye clinic. The donor advised the hospital to include some “income raising activity” as that would make the chance of receiving a positive response much higher. Therefore the hospital came up with the idea of building a cafeteria as well as an eye clinic. The simple fact that an eye clinic in itself would be income generating no one thought about.

Since more than two years the cafeteria building has been standing empty, which clearly proves that it is not needed and nobody has the knowledge/interest to start it up.

Have you ever seen a “white elephant”? Here is one – the cafeteria:

On the other hand we badly need more operating theaters. Since more than one year the number of eye surgeries has increased tremendously and the only limiting factor is lack of operating facilities. With more space the production and income will increase substantially. 

The hospital administration calculates very optimistic and unrealistic that the cafeteria could make an income of 5-7 000 birr a month (if it ever opens that is). In the operating theater we already take in 5 -7 000 birr a day. With an additional operating theater that could reach the double.

My only hope is that the hospital will not employ staff to run the cafeteria because that will definitely turn it to an “income loosing activity”. Better to let a private business rent the building, but I doubt that anybody is willing.

When electricity came to town more than 3 years ago some business people from Addis Abeba opened the first Mana Kaki (café) in town with bonbolinos and macchiato (doughnuts and latte). It closed after some months. There was obviously no market for such extravagancies. That should have been a lesson for the hospital administration.

As always I have excellent ideas. Since the construction of the building started I suggested using it as a new operating theater after some modifications. As always I am shouting in the desert!

The end of June is approaching. On the kitchen table we have a calendar with pictures from Aira and a bible verse for each month. The calendar is a gift from a German group which supports different projects in the area even so Aira Hospital.

The picture of this month is an old gentleman dressed in ragged cloths with a stick over his shoulder. He is known to everybody around Aira as the most perseverant, notorious and chronic beggar.

Unintentionally the calendar has caused some good laughs around Aira because the picture is accompanied by Psalm 90,17 which in the short version of the English Bible says:

“Lord our God may your blessings be with us. Give us success in all we do!”

Many are the ferenjs who in all their best intentions cause fortunately most often harmlessly wrong due to lack of knowledge and understanding of the culture and what’s going on around.

I remember very well an incident which happened during my very first assignment in Ethiopia more than 30 years ago. I was working in a rural hospital in the northern part of Ethiopia with my beloved wife Sennait acting as translator. A patient with dirty and badly stinking cloths came into the examination room. Sennait demonstratively opened the window and waved out the bad smell with her hands not hiding her disapproval. I promptly reproached her in Swedish that she ought to show more respect to this poor patient. While laughing loudly she replayed “Poor? Ha-ha. This man is rich and showing of his wealth by drenching the cloths in butter. That’s why they are smelling bad and covered with dust and dirt”.

Had I not been married to a habesha (Ethiopian) I would probably never had learned that, and I can assure you that this was not my last lesson during the following many years.

One of the nearby hospitals relies very much on short term expatriate volunteers. One such volunteer worker, a gynecologist from a big London hospital, described vividly her experience in a blog on the web.

No doubt that all short term volunteers want to do good, but not knowing/understanding the culture and what’s going on around, often behave like elephants in a china store. Some even have a very arrogant attitude, thinking that they know best and firmly believe that their own culture is superior to ours who live here.

Many let loose all restrains and do things they would never have done back home, presuming that here in Africa there are no laws or regulations

 In her blog the above mentioned lady gynecologist describes in detail an unfortunate and tragic mortal complication after a vaginal hysterectomy done two weeks earlier at Aira Hospital. Having absolutely no knowledge about Aira Hospital – even unable to spell the name correctly - she condemns “the surgeon” at the hospital who according to her has no gynecological competence! Published on the World Wide Web – Thank you for that!

I tried to correspond with the lady in question, but she turned out to be one of those arrogant “ferenjis” (white people) who knows everything better than us who live here.

Hundreds of vaginal hysterectomies are done in Aira Hospital every year by the two permanently employed surgeons. I personally did my first procedure 1974 and have kept on since then.

Five presently admitted ladies newly operated with vaginal hysterectomy for uterine prolapse (UVP)

Complications are rare, but do happen. Usually we are able to correct them in time. In this unfortunate case I was unaware of the problem until it was published on the web.

It would have been very easy for that lady gynecologist to give us a call or send a mail to inform us about the complication so that we could learn from our eventual mistake and prevent similar complication in the future. But she preferred to publish it on the web for the whole world to read.

Fortunately we have very good relationship and cooperation with our neighboring hospitals and our colleagues working there. This incident will not change that. We only pray “Our heavenly Father, forgive her. She does not know what she is talking about”

Mark Twain said something like: “The problem with people is not that they know too little. The problem is that they know too much wrong tings”

In Aira Hospital we thank and praise the Lord that we are not dependent on ignorant and arrogant volunteer workers from abroad.

 PS It seems that the blogging gynecologist has taken advise from somebody because she has now removed the offensive and incorrect remarks on her blogg - we can do without an apology.