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Notes from Ethiopia - Dr. Jason Ghodasra

A CALL TO ACTION

In 2013, Orthopaedic Institute for Children Foundation funded a joint team from OIC and UCLA to explore ways to help orthopaedic surgeon Duane Anderson serve the injured in Ethiopia, Somalia and Eritrea. Led by Dr. Nicholas Bernthal, the team’s cross-cultural exchange of ideas during that first visit inspired an official partnership between OIC/UCLA and Soddo Christian Hospital. Philanthropist Jean-Marc Chapus, a UCLA Medical Center—Santa Monica board member, was moved when he learned about the initiative and offered to generously underwrite the project for four years. Since then, OIC/UCLA residents have made the trip to Soddo, Ethiopia.

MEET DR. JASON GHODASRA

Jason Ghodasra was born and raised in Dalton, Georgia. He received a B.S. from Duke University and subsequently received a combined M.D./M.S.C.I. (Master of Science in Clinical Investigation) from Northwestern University. He is currently a 5th year orthopaedic surgery resident at UCLA. After completing his residency this summer, he will be completing a 1-year hand surgery and microsurgery fellowship at the Curtis National Hand Center in Baltimore, Maryland. In his free time, he enjoys hiking, tennis, golf, and skiing.

 

BLOG POST #1: OVERCOMING LIMITED RESOURCES TO PROVIDE THE BEST ORTHOPAEDIC CARE IN THE COUNTRY 

The journey to get to Soddo, Ethiopia was long. From Los Angeles, it first took over 20 hours of flying. Once I landed in the capital of Ethiopia, Addis Ababa, a driver from Soddo Christian Hospital picked me up and we drove 7 hours to a city named Soddo in the southern region of Ethiopia. Immediately from the drive down to Soddo, I found out that things were going to be different. The road was a shared means of transport for motor vehicles, bicycles, pedestrians and animals alike with little concern for right of way and direction of travel. Many times, we had to stop in the middle of the road without warning for a large group of pedestrians or goats crossing the road. Furthermore, the roads towards Africa’s Great Rift Valley were winding and scattered with potholes. On my bus ride down, my first introduction to Soddo Christian hospital was speaking with Mark, a “retired” obstetrician/gynecologist, and his wife, Allison, from Michigan who moved to Soddo, Ethiopia 7 years to help those in need by providing medical care. When I learned she had recently suffered an ankle fracture and asked her where she had surgery, she replied of course at Soddo Christian Hospital. I quickly learned that although medical equipment and resources are very limited throughout Ethiopia, it did not stop Soddo Christian Hospital from providing some of the best orthopaedic care. After a long and nerve-racking bus ride to Soddo, we finally arrived. After a quick dinner, I headed to bed because jetlag was still a factor and I knew I had a long day ahead of me.

The following morning, I met Dr. Duane Anderson who I would be working with for the next 2 weeks (Photo 1). Also a “retired” general orthopaedic surgeon from Idaho, he has given the last decade to providing and improving orthopaedic care in Ethiopia. I quickly learned that he was the reason why Soddo Christian Hospital has become the respected tertiary referral center for orthopaedic care in all of Ethiopia. We headed over to the orthopaedic surgical ward which consisted of about 12 rooms, each filled up with up to 5 patients. The census on the orthopaedic service typically was around 50 patients everyday with a long waitlist of patients awaiting an open bed. Furthermore, the number of complex patients was vastly more than anything I have previously seen. Typically, our orthopaedic services at UCLA and OIC will have at most a handful of complex injuries or infections; however, over 90% of orthopaedic patients at Soddo Christian hospital had a complex issue. In photo 1, Dr. Anderson was treating a patient that suffered a pedestrian vs. automobile accident and had bilateral lower extremity injuries but the patient was not able to make it to Soddo Christian Hospital until 3 weeks later making treatment significantly more difficult. Moreover, the orthopaedic team had limited resources to treat these patients with. Not only do the patients that come to Soddo Christian Hospital have limited to no financial resources, but also medical equipment and supplies are very limited or not available in Ethiopia. For patients that needed longitudinal traction, a simple rope was tied over the edge of the bed to an empty paint can that filled with cement (photo 2). In the operating room, certain medical equipment including bovie cautery and tourniquets were cleaned, re-sterilized, and used again and again until they no longer worked. In the United States, both of these items are used for single surgery, disposed of, and replaced with a new one for the next patient. The operating suite only had a limited number of operating rooms. In order to keep up with the demand, one operating room was utilized by 2 surgical teams to treat different patients at the same time. While operating, the staff often did not have a surgical instrument or medical equipment that I asked for. However, that rarely stopped Dr. Anderson and the orthopaedic staff from providing some of the best orthopaedic care in the country of Ethiopia. Some patients travelled for days to Soddo Christian Hospital because of their reputation. Accordingly, in my first 2 days here in Soddo, I was able to partake in some of the most complex orthopaedic cases that I have seen during my orthopaedic residency. With my first 2 days already being a whirlwind of complex orthopaedic cases, I look forward to what the next week and half has in store.

 

BLOG POST #2: "PRIMUM NON NOCERE"

On the first day of medical school, I took the Hippocratic Oath which included the concept of “Primum non nocere”, meaning “First do no harm”. While the idea is simple, understanding its implications is more complex. As my first week in Ethiopia comes to an end, I have been able to help take care of a number of patients who were first treated by traditional healers known as Wogeshas. As one of many different healthcare providers, they treat a variety of injuries including fractures and offer a range of different treatments. At Soddo Christian Hospital, I helped take care of a 6-year old boy nicknamed “Abe”. While playing outside one day, Abe fell and suffered a supracondylar humerus fracture, an injury that we see and treat at OIC almost everyday. Abe was first treated by a Wogesha who wrapped his arm tightly in bamboo leaves and sticks. Unfortunately, he developed compartment syndrome of the forearm and hand, which was not treated until after he arrived to Soddo Christian Hospital several days later. What began as a routine elbow fracture in a child became a devastating injury after initially being “treated”. As healthcare providers, I recognize the amount of trust patients and their families place in you and the importance of “Primum non nocere”.

In the last 5 days, I have had the opportunity to work with a lot of the staff at Soddo Christian Hospital. While everyone has been very welcoming, working with the Ethiopian orthopaedic surgery residents has been a highlight so far. There are currently four 4th-year orthopaedic surgery residents from Black Lion Hospital in Addis Ababa who I have the opportunity to work with in the wards and the operating room. With significantly different training experiences, we are able to work together and use our strengths to help each other. I am able to teach them about procedures such as total joint arthroplasty while they share their vast experience on malunions. Operating together (Photo 1), we are able to combine our strengths in the operating room table and learn new techniques and tricks from each other. During a complex patient with a hip fracture, the residents taught me about making the most of limited orthopaedic implants and intraoperative imaging capabilities. While Soddo Christian Hospital does have one of the few c-arm fluoroscopy machines in the country, 2 of 3 orthopaedic operating rooms here do not have one, and instead we must rely on other intraoperative tools and techniques to adequate reduce and fixate fractures. The orthopaedic residents have a number of tricks up their OR gown sleeves that I have never seen before.  Accordingly, working with the residents has been one of the many highlights of my first week in Ethiopia.

 

BLOG POST #3: "THE BEAUTY AND DANGER OF ETHIOPIA"

After a busy week at work, I had the opportunity to explore more of southern Ethiopia. After rounds on Saturday, I visited Arba Minch, a city located south of Soddo in the Great Rift Valley. The city sits atop a hill overlooking Nechisar National Park and the two lakes on either side of it, Lake Abaya and Lake Chamo. With the company of a couple of employees from Soddo Christian Hospital, we took an afternoon boat ride on Lake Chamo. As we headed out on our small motorboat, a number of fisherman on the their makeshift boats made from only a few tree logs were headed back to the shore after a day’s work (Photo 1). As we made our way onto the lake, the scenery was serene. On one edge of the lake, there lie the densely packed forest of Nechisar National Park. On the other side, the vast water of Lake Chamo stretched as far as one could see. However, what lay below the water’s surface was far from tranquil. After only a few minutes on the boat, we saw a number of Nile crocodiles emerge. We even got within several feet of a crocodile resting along the edge of the lake (Photo 2). Other wildlife we were able to find included hippos, pelicans. Further inland in Nechisar National Park we saw zebras, baboons, and gazelles.

While enjoying the stunning beauty of Ethiopia on my trip to Arba Minch, I could not forget one of the patients back at Soddo Christian Hospital that we were taking care of. Nicknamed “Kyle”, he is a 40-year old who has been working as a fisherman his entire life. While working on a makeshift boat similar to the ones we saw on Lake Chamo, a crocodile attacked him. Kyle suffered an open both bone forearm fracture with significant skin tissue and permanent nerve damage (Photo 3). He told us he was lucky to survive and did so by using his fishing sphere to hit the crocodile in the eye, which gave him enough time to escape and get back to shore. By the time Kyle presented to Soddo Christian Hospital, he had developed an infection on top of an already devastating upper extremity injury. Fortunately, Dr. Anderson and the staff at Soddo Christian Hospital have vast experience with treating a range of infections with limited medical equipment and no antibiotic irrigation fluid systems available. By developing an inexpensive, yet effective sterile diluted bleach solution (Photo 4), Dr. Anderson is able to treat and prevent infections. After successfully treating Kyle’s infection, we were able to stabilize his forearm by placing rush rods in both the radius and ulna. Although he has more surgeries to go and will remain in the hospital for another week or two, he’s already on the road to recovery.

Kyle’s story is one of the many juxtapositions in Ethiopia, a place often known as “the land of contrast”. Lake Chamo with its wildlife is a spectacular site to see. However, the beauty is accompanied by the perils they pose to the people.