For my second day at Ayder Hospital, I woke up ready. I knew what to expect, and I knew what had to be done. I mentally prepared myself through my morning routine – wash, brush, dress – and ate a hearty breakfast before catching a bajaj. Ayder is barely a ten-minute bajaj ride from my guesthouse, so I easily arrived on time at 9AM. Today, I was bringing drafted medical charts of my own creation for Dr. Judy to inspect, and hopefully use in the coming weeks. I walked through the front doors, flung wide open, and was greeted by a teeming crowd of people from both Mekelle and the rural areas. I braced myself for the smell, swallowed hard, and told myself that this will get easier.
I met Judy in her office on the first floor, where I showed her the ideas I had come up with for the charts. Luckily, she really liked them! We printed them off and she dubbed it the “experimentation phase,” where we would try to educate all of the nurses about keeping proper records and the logistics of SAM treatment. She told me that she wanted me to create a PowerPoint presentation to give to the nurses for a full day, mainly on proper nutrition and severe acute malnutrition. I felt a bit under pressure, and vowed to start doing more research, as I could hardly classify myself as an expert in the subject compared to Judy. If anything, it’ll be a good excuse to commit all of that information to memory and hopefully use it for future jobs opportunities.
After expressing my keen interest in obstetrics and gynaecology (which is what I’d like to specialize in if I become a nurse, or possibly apply for midwifery), Judy took me up to the second floor where there was a room full of new mums and their tiny babies. Some of what I saw was difficult to see, and some of it made me angry. First of all, all of the nurses were congregated at the nursing station on their phones. We walked by, with Judy making sure to loudly say, “Salam,” to which they merely nodded in acknowledgment. The audacity?! Or is it just me? Trust me, it’s not like they’re without work. There is plenty to be done. There just so happens to be a room full of incubators directly across from them, with no one checking or attending to them.
The first bed we visited was a mother who had just given birth to her fourth child. She was barely paying attention to the baby, and the women and her mother seemed disinterested and saddened by the birth. Judy told her that her baby is beautiful and asked, “Happy?” Sadly, the mother could barely convince us of her joy. The baby was apparently four days old, but it seemed as though he hadn’t yet been bathed since delivery. I made a mental note that there was no sink or running water on this ward, or any place to wash a baby for that matter. He had what I thought was afterbirth residue on his skin, so Judy fetched some bottled water and helped the mother clean him. That’s when we discovered his deformity, and perhaps the reason for their disinterest. Both of the baby’s feet were clubbed. Medically diagnosed as talipes equinovarus, clubfoot requires intervention of some sort soon after birth to prevent difficulties walking later on. While the prevalence varies across cultures, it predominantly afflicts male babies (at a 2:1 male to female ratio). I’m only assuming that the mother is now thinking about how difficult his life will be or if he’ll be able to walk. After reading up on it a bit, I saw that there are many different methods to try and correct the clubfoot, requiring a combination of casting and bracing to take advantage of a newborn’s flexibility. For treatment in developing countries, I’m not sure what method they use.
I saw another seventeen-day-old baby too, but this time I’m quite certain she weighed less that three kilograms. This baby was even tinier than the one I saw on Monday, with even looser skin hanging off its poor body, where fat stores normally should be. Another mum eagerly showed me her newborn, who happened to be in an incubator. I’m assuming the baby was jaundiced, as its eyes were covered from the therapeutic light and it didn’t seem to be hooked up to any other machines. I saw a lot of sick babies in a few short hours. The mothers and babies on this ward weren’t being monitored; there were no charts for either, and absolutely no direction or guidance being given. Given the situation, I assumed that the nurses should be helping the mothers to initiate breastfeeding, washing the babies, or getting a consult for more serious cases. I saw none of this, so Judy made a note that we need to come give talks to new mothers about nutrition for themselves and proper infant feeding care.
Next, we stopped at the pediatric ward. This time, Judy showed me Ward B, which was designated for children over five. A fifteen-year-old boy with a badly broken leg was in the orthopedic room, and we were told that he had lost ten kilograms during the two weeks he had been at Ayder. At one point, we tried to move him to change his bed sheets and he yelped in pain. It was difficult to watch. He clearly needs surgery or a cast or something, but instead he’s immobilized in a hospital bed with no support. I think that Judy is going to pay close attention to this boy, and feed him back to health in the same way that she did her burn patient that I met on Monday.
On Pediatric Ward A down the hall, for children under five, we saw a new mother and her twins. This woman was from Afar, and these people are considered to be the most primitive of all Ethiopians. Judy spent time some time in the Afar region before settling in Mekelle, and said that it is not uncommon to see babies abandoned in the desert. In their culture, the weak are tossed aside because they only value the healthiest of children. Today on Ward A, it was no different. One twin was considerably larger than the other, looking healthy and breastfeeding normally. The woman was giving all of her attention to this baby, and I noticed behind her that the second twin was tiny, sick, and weak, with an IV in his head. He was bundled up and she made no move to try and breastfeed the child, or give it skin-to-skin contact that is essential for a newborn. This was shocking to me, and I wanted to grab a doctor or a nurse and shake them. Why can’t they encourage this woman to feed her second twin? He’s surely going to die if that dynamic persists. What was touching, however, was when Judy spoke in what little Afar she knew to this mother, and the woman was moved to tears. Typically, Afar is only spoken by people living in that region of Ethiopia, so she must have felt comfort in hearing her native tongue and being understood for the first time since coming to the hospital. In fact, her eight-year-old daughter that had accompanied her rushed up, grabbed two colorful, traditional-looking blankets, and wrapped them expertly around Judy. The two proceeded to dance in the traditional Afar way, and it was a hilarious spectacle to watch. Everyone in the room laughed, and it lightened the mood for a few minutes, providing a much-needed distraction from reality for the women and their sick babies. During all of this, I noticed another woman had her teeth filed into points. In some regions of Ethiopia, they do this as a sign of beauty.
Across the room, two young women attended to a baby who lay almost motionless on the hospital bed. This baby had a N.G. tube, but was still incredibly malnourished and listless. We discovered that this baby had been abandoned at the hospital, and the two young women who were here today had taken it upon themselves to stay with the baby during its treatment. I was happy to hear that the mother’s plan to leave the baby for dead hadn’t worked, but what is it’s future now? Will these women take the child in as their own, as an extra mouth to feed? Or will it get sent to an orphanage, where I’m sure the rates of malnutrition and disease aren’t any better? I hate playing that game in my head, where I volley back and forth between what is simply the least worst outcome.
Even though I’m seeing a lot sick and dying children, I’m learning a lot. I feel like Judy’s personal medical intern, following her around from ward to ward in the hospital and consulting with patients as her equal. Aside from all of the negative, it’s extremely interesting for me to see each condition or disease in every new patient. Judy fields all of my questions, and carefully explains everything to me in terms of diagnosis, treatment, and potential outcome. I’m gaining so much from her everyday; my brain is like a sponge, as I take mental notes of all that she says. Unless I work in developing countries full time, I’m not going to ever see cases like these in the hospitals back at home, but it’s important for me to still see these cases anyways and get this type of experience. We’re also meeting loads of people along the way; from nurses to doctors, everybody loves Judy and they all welcome me graciously to the hospital.
On a happy note, Judy’s burn patient, Haftun, was cleared for discharge today! His recovery has been remarkable, considering over seventy percent of his body was burned from an accident in his rural village, where he used to work as a sheppard. I can fully attribute the boy’s recovery to Judy. She treats him like she would her own child, and fed him back to health using her “food is medicine” mantra. It’s an emotional day, since he has been on the ward for seventeen months, and everyone has become quite attached to his presence. There are tears, laughter, and lots of pictures as Haftun is wheeled out of the hospital and into the ambulance, where he is gladly being taken far from the hospital. It’s incredible to watch, as he hasn’t been outside in a year and a half. Everywhere he looks, it’s like he’s seeing people, buildings, and the usual bustle of Mekelle for the first time. His dutiful brother, who barely lets Haftun out of his sight, is also incredibly loving and caring. Since Haftun’s accident, his brother has slept on the floor by his hospital bed for the entire duration of his hospitalization. Even though he was needed back home, he refused to leave Haftun’s side. I’m relieved because he clearly has a supportive family member, so I know that he won’t have to endure these final months of recovery alone.
It was certainly another exhausting, but rewarding, day at Ayder. There is so much to done, so much to be learned, and so little time left in my internship. Judy, as welcoming as ever, invited me to her house that night for a dinner party she was throwing. Her good friend Monica, who works in Barcelona on of the best burn units in all of Europe, is visiting for three weeks to help her at Ayder. Judy also connected with a young twenty-year-old couple from Madrid. They work in Wukro, where two Spanish priests do mission work with children. They traveled to Mekelle for the day to visit, and I had a really nice time chatting with them. They’re both university students, studying business and law. I love the Spaniards; they are so loving and welcoming and generally happy people to be around. The language is oddly comforting as well, as it reminds me of years and years of vacationing in Mexico. That is one language that I’d love to be fluent in; it seems to come easier to me than French does. Of course, the power went out and stayed out for thee hours, but when it finally decided to come back on again, we dined on a delicious meal of freshly-slaughtered goat, vegetables, and bread. Since I haven’t had the opportunity that often to connect with other expats in Mekelle, it was really nice to be welcomed into this little Spanish community of very genuine people. It made me realize how isolated we are, as it’s typically only me, Naomi, and Dr. H on a day-to-day basis. I still miss all of my friends and family back in Canada (and Denmark and France and Austria and Budapest and China) almost everyday, but it really helps to make meaningful connections with people here to get me through these last few weeks.