Aira Hospital

To lose a leg is catastrophic. There is no supply of prosthesis around and without a leg you cannot do the farming which is the only way to survive for 95% of the rural population.

It is an old dream of mine to be able to supply our amputees with an artificial leg. Readymade prosthesis in different sizes left and right are available and can be purchased from abroad if only we had the money. Made of out of plastic they need only some heating to be adjusted to an amputation stump. No need of high tech equipment or trained staff - only money is needed.

Recently during the Swedish election campaign the country’s infamous Marxist-feminist nr 1 burned 100 000 Swedish crowns in public to get the attention of the media. She got it with the same success as when she urinated on the red carpet among dignitaries during a gala in Stockholm. This time however she was sober.

In the same election campaign various car companies pay 8 million crowns for free champagne to everyone.

One of our patients made an artificial leg for himself. A bit clumsy, but it works.

Others do not have that capacity and therefore we always do our outmost to save a limb.

This unfortunate man was as drunk as the Swedish Marxist-feminist NR 1 when she urinated on the red carpet. He fell asleep outside his hut and woke up in the middle of the night as a hyena was having a good meal on his leg.

In the operating theater all dead muscles and other soft tissues were cut away and the wound cleaned thoroughly (wound debridement and revision).

Not much was left. However the anterior muscles kept the foot in (dorsal) extension so there is a substantial chance of getting the patient walking on two feet

After some days the large defect was covered with skin graft.

It looked promising on the latest picture.

The patients disappeared although he was told to return for follow up.

Maybe a lucky hyena got a full and undisturbed meal later?

100 000 Swedish Crowns would pay for 500 cesareans saving 1000 human lives.

The free champagne could keep Aira Hospital going for 100 years.

Priorities are indeed different in this world.

Coffee is the main income source for many farmers around Aira. The coffee bushes are protected and guarded fiercely. Although the bushes grow wild they all have an owner and usually everyone knows and respects that - but there are exceptions. Many of our not infrequent “fighting cases” are caused by disputed ownership or direct theft.

One farmer was sleeping in the open air near to his coffee bushes which he was prepared to protect with his life. During sleep he was attacked – but not by somebody interested in the coffee. He woke up very abrupt as a hyena was taking a good bite of his left cheek before he was able to chase it away.

Wounds caused by any bite – human or animal – should never be closed directly due to the extremely high risk of infection. In this case closure was done after some days of wound care and antibiotics with the use of a local skin flap to cover the skin defect.

I hope you favour Ethiopian coffee. It is the best in the world – worthwhile to risk your life for! 

March and April months are traditionally a popular time for marriage. Count 9 months ahead and you understand why we are starting to have busy days (and nights) in the maternity department. Last night we did 5 cesarean sectios, one destructive delivery (craniotomy) for IUFD (Intra Uterine Fetal Death) and one evacuation of the uterus due to incomplete abortion. “We” that is me and my colleague, the gynecologist from the Swedish Rotary Doctors who came to support the hospital a week ago. The same doctor who was stranded with a broken car in the Didessa Valley on her way to Aira. I did the destructive delivery; she did all the rest while I had a good night’s sleep J

We also delivered three pairs of twins the recent few days.

The wards are crowded with mothers, babies, grandmothers and fathers. A mother after normal delivery stays only over a night. The Cesarens usually three days - longer time if there is plenty of room - shorter when beds are scarce. From the Video below you can get an impression of how the relatives take care of the newly delivered mothers and feed them by hand with a “gursha” (untranslatable for a lump of foodstuff which is fed by hand)

Maternity Ward Video   ← click here to watch video clip from maternity ward

The two patients with hyena bites are doing fine. The skin grafts took 100% at the first trial. As soon as they have finished the injections with antirabies serum they will be discharged. I have offered to make a plastic surgical procedure with lengthening of the amputated thumb, but the patient seems reluctant.

Further surgery means further sufferings - physically and financially. He was whimpering during the previous surgical procedure, so I asked him “who was the worst – the hyena or me?” I came only second!’

The regular reader of this blog has already noticed that on Sundays I always take time to talk with the patients. I am relaxed and usually in a good mood since I am regularly awarded a generous breakfast inculing two eggs every Sunday morning.

Every patient has a story to tell. All their different fates are material enough to write a book as voluminous as “War and Peace”

Today was an extraordinary peaceful and cheerful round, since all three newly operated fistula patients were dry (see page QORADA!). Two of them are primipara (first time pregnant), one had a stillbirth two months ago at home, the other had a life saving operation for ruptured uterus (see page RUPTURED UTERUS) in this hospital two weeks ago. I do not follow the old rule to operate a fistula only after three months waiting, but rather as soon as possible. This is according to the teaching of the highly estimated Nigerian based fistula surgeon Kees Waaldjik.

The third fistula patient is around 40, who had gone through 9 deliveries with 4 children alive. Only today at the round I learned that she was actually operated 12 years ago for a fistula at the famous Fistula Hospital in Addis Abeba. 5 years back she had a stillbirth at home followed by a new fistula. The one which was easily repaired this Friday.

I asked if she hadn’t been told at the Fistula Hospital never to try a home delivery again. “Well - my husband was not allowed inside that hospital, so I couldn’t decide to have a BTL (sterilization)” was the answer. In this country a BTL is a mutual decision between husband and wife. At Addis Abeba Fistula Hospital the staff is doing the nursing care, no relatives are allowed inside the buildings.  

Tomorrow she will have her BTL done, and on coming Friday she will go home.

Another interesting thing is that in the remote area from where she comes, far west near to the Sudanese border, a Christian NGO is running a “women’s project”. Part of that project is to collect women with fistulas and shuffle them all the way to the Fistula Hospital in Addis Abeba. I always considered “passing the river to fetch water ”being a rough underestimation to describe that part of the project. The NGO does it because the treatment in Addis Abeba is free. However nothing in this world is free, it just means that somebody else is paying. In this case generous donors from abroad are paying the bills.

Aira Hospital does actually also offer free fistula repair in principle, thanks to the hospital’s poor fund which receives donations from private institutions and individuals.

The same NGO brings women with uterine prolapse and other gynecological problems to Aira Hospital for repair. By mistake they included the fistula patient in a group which was brought to Aira Hospital for help. I am happy that the fistula - although a recurrent one - was easy to repair. It might be the case that will pave the way.

The two men with hyena bites are not showing any symptoms of rabies. They get a shot of 5 cc rabies antiserum, and the wounds are soaked and dressed daily.The wounds are clean, so tomorrow I am planning to close them with skin grafts, and at the same time fix the open fracture on one of the arms. 

I will be back!

Today was a most ordinary day. After finishing today’s program of 18 scheduled surgeries and screening surgical patients at OPD, it was time to go home and rest. Only to be called for an emergency cesarean in the evening. I thought that I had nothing to write on the blog except “today nothing new from the western Wollega”.

But then we got a message that the Finnish missionary couple on their way back to Aira with a Swedish surgeon for Aira Hospital had stranded in the Didessa valley with a broken car. That is definitely not an ideal place to be stranded. So Sr Sennait went away in our car to rescue the stranded people.

And later -around 21:30 (9:30 pm) - I was called to the hospital. Two men had been attacked by a hyena while they were taking the cattle home for the night. It happened in Yubdo, not far away - only three hours walk from Aira. They had severe bites on the forearms and legs and had to be taken to the operating theater for excision and revision of the wounds.

The most important thing was however to start treatment with anti rabies serum because the behavior of that hyena was definitely not normal. Rabies is not at all uncommon, and we regularly see patients with rabies. Not every month, but maybe a couple every year. They all die a terrible death. Nothing can be done when first the symptoms have started. Only treatment with antiserum before the debut of any symptoms will help. The best option would of course be to give vaccination, but that is simply too expensive to be practiced here. The nearer the central nervous system the bites are, the sooner the symptoms will start and the worse the prognosis will be. So in a way these patients were lucky that the bites were on the extremities only.

Something which people at home watch for entertainment on horror movies, these two men had experienced in reality. But none of the two made any complaints or showed any signs of anxiety. They even smiled after the surgical excision. No need of any crisis therapy or psychological support. That’s what you appreciate when working as a surgeon here. 

And by the way, they found a driver in the morning and the pharmacist brought home some thousand knife blades. Hallelujah!