Aira Hospital

“Smile Train” is the world’s largest aid organization supporting patients with cleft lip and palate. It is also the most cost effective. During its 10 years long existence free surgical treatment for more than 500 000 cleft patients has been accomplished in the Smile Train program.

How is that possible? Because”Smile Train” works together with local hospitals and surgeons whom they support financially. Besides that the organization train local surgeons and staff, give free educational support and even give special grants for purchasing equipment. That is the very best way to help not only the cleft patients, but also the third world countries to develop and become self reliant in the future.

That is in contrast to most other organizations which send their own expatriate staff and equipment at extremely high costs to do surgical campaigns, leaving nothing behind when returning back home. No training of local staff, no equipment or materials are left. An extremely expensive and inefficient way to do things - but the best way to keep the receiving country dependant and backwards.

The idea seems to preserve and secure “National Health Parks” to come and visit and do medical safaris in.

Aira Hospital recently became a proud partner to Smile Train, and is now able to offer free surgical treatment to all cleft patients. The rumor that free treatment is available is spreading among the population around, and we are seeing a steady increasing number of cleft patients in the hospital.

Anane is a 9 years old girl living in the western part of Ethiopia. She is very shy since she has been submitted to a lot of harassing from other children and adult neighbors calling her “Sharafa” which means hare lip. To protect her the parents have not allowed her to start school. A pity since she is obviously a very bright and smart girl. Thanks to Smile Train she got her lip repaired and can now start school and learn. She virtually got a new life.

This is a 10 year old charming and very lively girl from western part of Ethiopia. Her parents gave her the name Dinekenesh which means “you are beautiful” in Amharic (dinke = beauty, nesh = you are). And she is a beauty. The parents love their girl, but suffer buy seeing her isolated socially because of the stigma. She is in fact attending 3’d grade at school, which is unusual for children with this entity. Most often the parents do not want to expose a child with cleft lip to the harassment from other children.  

I am sure she is a clever student. She reminds me very much of Pinky from the Smile Train documentary. She is the same charming and lively girl.

The parents could never afford to take her to the hospital for surgical treatment. Only thanks to the Smile Train she got this chance to another life.

Kabure is a 26 year old farmer from the town Aira in western Wollega. He supports his family by hard work on his small piece of land.

Shortly after Aira Hospital became partner to Smile Train and started to give free surgical treatment to all cleft patients, Kabure came to the hospital for help. He is living in Aira town, only 10 minutes walk from the hospital. But he is so poor that he never managed to save enough money for the surgery.

His oldest son served as his attendant during the hospital admission and during the post operative outpatient care.

The son is proud of his father and very happy that he will never be exposed to any harassment from neighbors or other children anymore.

Please visit www.smiletrain.org  Every contribution helps Aira Hospital as well!

The hospital’s struggle to survive financially continues. As you remember there has been no regular financial support to the running budget since more than 3 years. The recent donation from Betel Mission in Turku (Finland) is now being used to purchase drugs and medical equipment and has saved the institution from immediate collapse.

The poor fund is empty. Last year’s earmarked grant is consumed, and the grant for 2010 has not arrived yet. Since January 1’st we have not been able to give free treatment to poor patients. That is ethically a very difficult situation for a Christian nonprofit charity (?) hospital.

In spite of serving an impoverished rural population in one of the poorest countries in the world the hospital is able to cover 75 – 80 % of the budget. That is a remarkable achievement. The EECMY hospital in Gidole never raised more than 30 % of its budget. The catholic hospital in Attat, which is very similar to Aira Hospital in terms of size, staff and budget receive 50 % of the budget as financial support from the (catholic) church abroad. Aira Hospital would need only 20 – 25 % of the budget as financial support to survive. But from where?

A nonprofit charity hospital providing medical treatment 24 hours around the clock can never ever be self supporting – nowhere in the world - and the least in a poor country like Ethiopia. No community hospitals in the rich western world manage their budget without heavy subsidy from the government so why do people insist that this should be the case for our hospital?

Three poor patients came to the hospital the other day.

The man with the congenital cleft lip is living in Aira town, 10 minutes by foot from the hospital. He is a poor farmer who during his 26 years long life never had been able to raise enough money to be operated although the fee used to be only 300 birr (150 €).

Thanks to our partnership with Smile Train we are now giving free treatment for cleft patients. He heard the announcement in the church and came with his son as attendant to have his cleft lip corrected surgically.

The young lady with the large tumor like growth on one leg is suffering from the special form of elephantiasis called podoconiosis which affects people who walk bare footed. It is caused by the minerals in the red soil which penetrates the skin and blocks the lymph system. It is easily prevented by wearing shoes, but as the lot of people around she never could afford to buy herself a pair.

How could she ever find money for surgical treatment? She was very lucky that Sr Christel passed by to supervise a local elephantiasis project in Dilla where the lady is living. She covered the expenses for her treatment – 887 birr (45 €). Otherwise the girl would never have got the chance to a better life.

The third patient with a large intra orbital tumor is in desperate need of life saving surgery. She was told to come for admission but never turned up. Either she is trying together with her husband to raise enough money for the deposit – 800 birr (40 €) - or she has given up and accepted her fate as a poor women in a poor country. She is by the way 3 months pregnant and a mother of two.

We are repeatedly being told by aid organizations from the rich world that we have to run our hospital more businesslike.

My elder brother is running a private hospital in Copenhagen. I asked his advice.

First of all - he told me – it is very difficult to make money on health care. People like to save money for a car, a new fridge or a summer residence, but when it comes to health care money is tight. If it is difficult to run a private hospital in the richest part of the world such as Denmark, how on earth can it be done in the poorest part such as Ethiopia?

Move the hospital to the capital Addis Abeba where the money is was his first advice. Don’t give emergency care – that is not profitable. Check the credit value of your patients before admission; if not high enough send them away. Do not engage in any major, risky or complicated surgery. Stay with minor surgeries which make the best profit and don’t bring any costly complications.

The best advice is to marry a wife who is a plastic surgeon. She can do face lifts, breast augmentations and nose corrections which will make the business go around.

Is that what we want for Aira Hospital?

Don’t forget that what Jesus said was “Heal the sick and spread the Gospel” not “Heal the sick and make business”

Many charity organizations are interested to come and help children with cleft lip. During my six years in Aira several different organizations have offered to come and do surgical campaigns. That would off course be a great and exotic adventure as well as good practice for surgeons who do not have too many cleft lip patients back home. For our institution however it would be devastating in the long run since we would lose income and competence. It would be much better if they instead would give financial support to the existing service, but that suggestion has always been turned down.

One such organization comes regularly to the university hospital in the capital city for a week long surgical campaign. According to the reports I have got from that hospital a team of 45 persons including nurses, anesthesiologists and plastic surgeons from abroad invades the operating theatres for a week - bringing their own sophisticated equipment and expensive materials. Ethiopian doctors are not attending the surgeries, and when the team goes back home nothing is left behind - not even a piece of gauze.

That is the best way keeping things “status quo” - preserving dependency and underdevelopment. Obviously the aim is keeping things stationary so that there will always be opportunities for doing “cleft lip safaris” in the future.

To make things worse I am told that the large team is staying at the most expensive luxury hotel in town at more than 100 US $ a night. Imagine how much could be done for all that money, not to mention the flight tickets.

Fortunately there are exceptions. One is “Smile Train”, the largest international cleft lip charity NGO.

The explicit goal of that organization is to reach as many cleft lip patients at as low cost as possible. It is successful because local expertise and facilities are being used as much as possible. Existing local services are supported financially, local surgeons are trained, and free teaching materials are supplied generously.

It is a great privilege and honor for us that the Smile Train organization has chosen Aira Hospital to be a partner.  Aira Hospital will receive funds so that we can do cleft lip surgery for free.  A tremendous help for all those unfortunate patients with cleft lip, who are so poor that many of them have not been able have their deformity repaired.

Visit Smile Train on www.smiletrain.org  - and remember that a donation to that organization will benefit patients at Aira Hospital.

This weekend is Ethiopian Easter, the most important holiday of the year. Everybody are home to celebrate and only very few patients come to the hospital.

Today we removed the skin sutures after surgery of bilateral cleft lip on this young fellow. He lives only 2 hours with car from Aira, but had probably never come to the hospital unless our fellow missionary Rev Thomas from Ghimbie had brought him and sponsored the surgery.

The surgical fee which we charge for this operation is only 300 birr (20 €) – for us a trifling sum, but unaffordable for many patients. We used to give free treatment now and then for the very poor ones, but now when the hospital is on the verge of financial collapse, that is not possible anymore. This young man was lucky to get help, but there are a lot who are not so lucky.

We are in contact with a large international cleft lip charity organization, and there is a realistic hope that the organization will make our hospital a partner. If that happens we will receive financial aid so that we can offer free surgical treatment for all cleft lips. That will be an enormous help for all our poor patients.

How can preventive health care help a patient like this young man with an ugly cleft lip? It cannot! Surgical treatment alone can help the patient to a decent life. As all patients with cleft lip he is extremely shy and subordinate due to years after years of continuous harassments and social isolation. After surgery he can walk around without being stared and shouted at – what a relief that must be. Now he also has a chance to find a job, get married and have a family.

Why is that so bad i the eyes of all the NGOs which do not want to support curative health care?

Almost one week has passed since I wrote on the blog. That is due to a combination of too much work and too slow internet connection. I have been too exhausted at the end of the day to mobilize enough patience to produce a new post on the blog with an ultraslow internet connection.

This week four relatively newborn babies were brought at the same time for cleft lip repair. All came from very different locations. All the four mothers had either seen or heard about someone else having had a cleft lip repair done here in Aira Hospital.

Otherwise most of the cleft lip repairs we do are on older children and adults. Two other small babies had cleft lip repair done as well, so totally 6 repairs were done this week on relatively newborn babies, from 3 weeks to 3 months old.

Hopefully a sign of growing awareness among the population?

Many organizations from abroad are interested to send surgical teams to Ethiopia and do cleft lip repair. They all print out fancy and glossy brochures asking for financial support - “a donation of only 300 $ will cover the cost for one cleft lip operation”. 300 $ is equivalent to 3 000 birr – in Aira Hospital we charge 300 birr for the procedure.

I have been in contact with some of these organizations in the vain hope to get financial support so that we could offer free surgical treatment in our hospital.

One such organization makes regularly surgical campaigns in a hospital in Addis Abeba. The organization brings its own staff, fancy anesthetic equipment, surgical instruments and all other outfit from abroad. No Ethiopian surgeon is present in the operating theaters during the campaign. Nothing is left behind - not even a piece of gauze - when returning back. The absolutely most expensive luxury hotel – Sheraton – is used as accommodation for the visiting team.

In their home country surgeons will never get access to such a high volume of patients as here in Ethiopia. Therefore it is an excellent way of learning and getting experience - enjoying a good time in luxurious surroundings at Sheraton hotel as well.

Not leaving any equipment or knowledge is an excellent way of keeping this country at status quo – in ignorance and dependency for always.

So dear friends – watch out! The bigger organization and the fancier brochures – the more your money will be wasted!