Aira Hospital

Elephantiasis is a disease which can be treated conservatively with good result (see page “ELEPHANTIASIS”)

We know all too well that the result of surgical treatment is not promising in the long run – something which I am being reminded repeatedly by people engaged in the podoconiosis programs around.

But what do you do when a young man turns up at the OPD with a huge deformed leg asking for an amputation? Just chop it off?

I personally cannot resist helping and trying to save his leg. The surgical treatment is rather simple but time consuming.

The principle behind the surgery is very simple:  if there is no subcutaneous tissue there will be no subcutaneous edema. So cut away all subcutaneous tissue! The method was described by Dr Thompson and the procedure carries his name.

Start to harvest skin from the leg with a handheld dermatome.

Excise all the affected subcutaneous tissue from the leg down to the fascia.

Then transplant the skin back on the bare fascia and elevate the leg in traction with a pin through the calcaneus

The result might not be cosmetically the best, but the patient is happy and relieved.

The special form of elephantiasis called podoconiosis which represents almost all of the cases seen here in Ethiopia is caused by small mineral particles from the red soil which penetrates the skin and blocks the lymphatic system in people walking barefooted. It could be easily and simply be prevented by protecting the feet with shoes. Poverty prevents that.

The problem caused by podoconiosis is enormous. There are a lot of patients suffering from the disease, but except the beggars in the street you do not see them easily. They usually hide as it is considered a shameful condition - a curse. 

One researcher has calculated that the overall financial lost in Ethiopia from this disease widely overshadows that caused by HIV/AIDS!

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”