It’s Abe writing again today. It turns out that even though some of us thought we would only have to write one blog entry, we (I) were wrong :). Today was our last day in the operating room. We had told Dr. Fekadu that we would like to work today as long as he would let us. He didn’t disappoint us at all. Dr. Sig and I started the day with a 19 year old male who presented with new onset of abdominal distention and palpable mass. He had symptoms of partial bowel obstruction. He also had associated bloody vomiting as well as significant weight loss. Complicating the picture was that he had been on empiric TB treatment for the last 6 months. His TB had been diagnosed with his complaints of fever and weight loss (no chest xray or TB skin test). In the US we would have definitely used a CT scan to help work him up for this partial bowel obstruction, but this was not available to us. We did have an ultrasound machine that we used. However, the mass seemed to just be multiple loops of small bowel. In the OR we found that our patient had disseminated TB and a significant inflammatory bowel obstruction. This diagnosis was a first for both Dr. Sig and I. The significant adhesions (scar tissue) was not amenable to surgical intervention; therefore, the patient will have to rely on broadening his TB treatment and parenteral nutrition. This case and a few others definitely reminded us the limit of resources here in rural Ethiopia and the blessings we have at home.
Our second case was a large thyroid goiter. Third was a large soft tissue mass on the arm. Fourth was a neurofibroma on the foot. And last was a cyst excision from the forehead. We were able to work until 7pm.
Part way through the day we were surprised by the local Ethiopian OR staff with a coffee ceremony. I thought it was actually quite funny when they stopped the OR and told our third patient of the day that she would have to wait for surgery while her surgical crew had coffee (especially because the ceremony takes about 30-60 minutes to complete). I thought to myself…what would we say if the delay in the OR couldn’t be blamed on anesthesia but rather on a coffee break back at home (I have no true hard feelings towards the anesthesia team 🙂 ). The coffee ceremony involves roasting the green beans (yes, they did this in the women’s changing room…and after the whole OR filled with smoke we realized there was no smoke alarm), grinding the beans, making some popcorn, steeping the coffee and then pouring it for everyone. The coffee is then steeped again and poured a total of three times. Each successive pour gets a little weaker, but I can testify from personal experience that my hands are a lot less steady after those three cups of coffee.
At the end of the day we all said goodbye to these new partners and friends that we have created during our time in Yetebon and Project Mercy. It was fun to talk about “what we would do next time” and “what if they could come see how we worked back in Wisconsin”. They asked us to come for 2 or maybe even 4 weeks next time. They also asked us to come with more surgical staff and residents so that we could have three ORs working instead of just two. We left with a “wish list” ~60 pages long that listed all kinds of surgical supplies and equipment that the hospital here would like to have if possible. It is humbling to see many of the items on this list that we use for granted and throw away after a single use back home.
We then headed down to dinner, our last game of cards here at Project Mercy, and bed before planning to leave in the AM for Addis Ababa. What a privilege this has been to care for these individuals and learn alongside such mentors.