Ethiopia 2019 Blog

In November I had the opportunity to accompany Drs. Politis and Moses on an international teaching effort in Jimma, Ethiopia, at Jimma University Specialized Hospital (JUSH), sponsored and organized by Operation Smile International (OSI). Operation Smile has been involved in Ethiopia for nearly 15 years, originally providing service trips to address an enormous backlog of cleft cases.

Over the past 8 years, OSI has been providing educators to teach surgeons and both physician and non-physician anesthetist trainees during “educational rotations”. Those educational rotations have had many similarities to traditional OSI service trips that bring equipment and medications, with the main difference being that cases are limited to 3-4 per table per day (for training purposes) and OSI team members work side by side with JUSH trainees. We were part of a transition from that approach to one called visiting professorships. The focus of our efforts was education in all disciplines, including surgery, anesthesia, and nursing. Drs. Moses, Politis, and I planned full integration into all the ORs (not just the plastic surgery OR) and into the ICUs at JUSH. The goal was for Jimma physician and non-physician anesthetists and their trainees, surgeons, and nurses to take primary roles, and we would serve as consultants and educators while preparing for and administering patient care. Our plan was to use their equipment and medications, and all or their usual resources in their own standard anesthetizing locations and ICUs. We also intended to closely observe practices in the JUSH ORs and ICUs, including teaching of anesthesiology residents, in order to conduct a “needs assessment” and be able to make formal recommendations to their program and hospital administrators.  The anesthesiology residency training program in Jimma is relatively new, having opened 5 years ago, and has expanded to 26 residents, yet has only three faculty. That rapid growth has led to some serious growing pains, and as can be imagined there are difficulties training so many physician and non-physician anesthetist trainees when instructors and case load are severely limited. The material resources available in the JUSH ORs and ICUs are very different from what I have become accustomed to in a US teaching hospital. It was a learning experience for me to support the Ethiopian anesthetists and their trainees in drug selection and approaches because I didn’t always have my standard options available. I was impressed with how much they accomplish with such limited resources. We worked in all the ORs, with Dr. Politis focusing on pediatric general surgery, pediatric plastic surgery, and ortho-trauma, and Dr. Moses focusing on adult cases. We helped manage some remarkably challenging cases such as a 2-year old with Ludwig’s angina who was about to lose her airway, and a 4-month-old with a choledochal cyst that bled 75% of his blood volume during the procedure. Ultrasound guided regional anesthesia has taken off in Jimma, and we therefore spent a lot of time supervising and teaching blocks.

Time spent in the ICUs was equally interesting and challenging. Dr. Politis rounded most days in the PICU, while Dr. Moses rounded daily in the SICU and made contributions in that unit throughout the day. To his chagrin, the SICU often doubled as a PICU extension. Resource deficiencies and types of patients in the JUSH ICUs were as challenging as what was encountered in the ORs. We helped manage two ICU patients with tetanus, and witnessed that Jimma patients commonly die for lack of resources that we take for granted. I had the great opportunity to spend some time in all areas working alongside Jimma anesthesiology residents.  Each day was different.  One morning I would be bouncing room to room teaching ultrasound guided blocks, later I would be helping to manage an unstable pregnant patient undergoing removal of a large mass, and other times I would be teaching TTE in the ICU. We also ran a weekend workshop with the anesthesiology residents, which included lectures by all of us and hands on use of ultrasound directed by Dr. Moses. The residents are very eager learners and have an excellent grasp of the book knowledge. Many of the residents were initially very quiet and reserved. We are accustomed to the Socratic teaching method, but it seemed as though that is not commonly used for Ethiopian residents. As the trip progressed, they became much more interactive and inquisitive. By the end of the trip they had so many questions that I felt like I was in a Dr. Littlewood oral board exam, but I was missing 2/3 of the resources.

The entire anesthesia department was exceptionally inviting and were great hosts, particularly Dr. Yemane (Department Chair/Program Director). I will have great memories of his wife’s cooking and the incredible hike he took us on up the mountain outside of town. Our hike even included Dr. Politis enjoying jumping rope with local children. Overall it was an eye-opening, rewarding experience, and I hope that my two weeks there made at least a small impact on the education of the staff, and the care for the patients in Jimma.