Day 3

The day started bright and early and thankfully my phone and watch synced to the normal date and time to alarm me of the correct time to wake up. We had a 7:30 bus to catch to the hospital. Now although that sounds silly (first world problems with my Apple Devices not keeping up) but Ethiopia is in fact quite confusing. You may think it’s January and the year is 2019.....but not here. We found out quickly when we got to the hospital, and looking over their medical records that they go by a completely different calendar. Yes, it is in fact the year 2011, not 2019.  The month I believe is April, and don’t even get me started on the time. When I started writing down 12pm

And they were telling me it’s 5, I thought this was some sort of trick on wanting to go home early. Well if we are going by that calendar I’m down. I am 23 if that’s the case, so let’s roll with it!

The hospital was a sight to see indeed. They have a lot of natural light, as windows everywhere are kept open and courtyards and open walkways to the elements are abundant. We started out our day with a brief tour before breaking up into different groups. The clinical team with our PACU/ER nurses, speech and language pathologists, and administrators went to set up a screening room to triage the ENT patients while my OR team with the surgeons, OR nurses, and ENT residents from Mekelle University went on rounds to see the patients we would be operating on today as well as some post op patients. We started with a bunch of children here for cleft lip and palate surgery, and screened them to be done early in the day given their age. Adult patients followed which consisted of a second stage paramedian forehead flap recon, 2 post op patients from total laryngectomies (one of which was the laryngectomy induced hyena bite) and a post operative pituitary mass that underwent a transphenoidal approach. The lead ENT attending at Mekelle is a fellowship trained pediatric otolaryngologist from the United States who is one incredible human and physician if I do say so. His range of expertise goes far beyond pediatrics (he is doing total Laryngectomy induced hyena bite flap reconstruction and TSA pituitary excisions mind you!!) and these pituitary masses aren’t USA standards. They are grapefruit sized masses that have ripening for many many years. 

So without continuing my awe and appreciation for this ENT surgeon who is literally the biggest badass (pardon my  Afrikans) for not only providing  ENT related medical aid for those in the region of Tigaray but also being the foundation for the ENT residency they have started at Mekelle University Hospital. Our goals even on this medical mission is to not only operate and help the population but pass along our expertise and teach their residents so they can continue our model once we have left. I’ve been here a day, and I can say the learning experience has been AMAZING. I love teaching their residents, and am so honored to be working with them. 

So after rounds I went down with their residents to the OR. They are extremely strict on dress code for the OR, where we had to change out of our hospital “clothes” (aka other scrub pants that I wore that look like cargo pants, and my team Ethiopia shirt) to another pair of scrubs and their personal OR shoes they provide for us. I only brought one pair of sneakers with me so my first thought was naturally “wow I am so screwed if someone steals my sneakers, I’ll have to haggle some off of someone if they do.” I took the closest clog size which was 2 sizes too large, but hey TIA. They worked, I could walk in them, and the type of surgery we started out with can be quite a back breaker so anything that takes your mind off your neck aching is great to me. Plus there is now no chance blood will get on my sneakers now! I’m a glass half full kind of person! After grabbing my new shoes, and went to the ladies locker room to change into my scrubs. Found a broken chair with no seat to balance my backpack on so I could then proceed to balance myself one one foot and gracefully take my clothes off to change into my scrubs without falling into one of the many mysterious bodies of water on the ground. Again, I like that we have OR shoes, and my sneakers are safe and clan. I’d also like to thank my parents for all those years of figure skating lessons. My balance as impeccable as I changed and no clothing or body parts of mine touched any of the mystery water. What a success! 

I ate breakfast and had a small coffee in the morning but I have to admit I did dehydrate myself today. I was warned of the hospital bathrooms more than once and it was enough to somewhat scare my bladder (and THANK GOD bowels) into a shock like state. It’s a small stall (I cannot confirm if there is an actual door yet) with a hole in the floor. It apparently requires not only impeccable balance but quad strength to strike such a stable position. I can only attempt one balance thing a day (and friends I know you are going to say I work out enough to be able to do this but I just wasn’t ready!) 

So finally after all the adventure of just getting there is was the best part of the day OPERATING! We started today light since the morning was filled with getting up to speed, triaging, patients and unpacking our equipment. As well as introducing ourselves to the hospital and the doctors, nurses and teams they have working there. Ethiopia like many counties that medical missions go too have very prideful people, and we aren’t there to butt in but to help out, and making that noted takes time and appropriate introducing. 

Our first few cases were cleft palates, followed by a cleft lip and a pediatric airway of an obstructive mass that turned out to be an interesting pallisading neurofibroma. The cleft lip and palate kids did fantastic and looked amazing once they were done. It is such an incredible and rewarding surgery. The last case of the day was an elderly gentleman who underwent a paramedian forehead flap for a large maxillary defect eroding though the orbital floor and anterior wall of the maxilla. After divide the pedicle there was debunking and flap rotation and advancement to be done to reposition the eyebrow to its natural location and achieve a favorable aesthetic result. For me I was very pleased with his results but it was his reaction that did it all. He was so appreciative and emotional looking at his newly reconstructed face. And that is why these trips mean so much to me. It’s all about the patients and the impact we have on their lives.

After the OR we sat down for a lecture series given by one of our own surgeons on cleft lip and palate that was interactive, fun and very useful for their residency program. The bus driver to take us back to the hotel initially decided to not show up (people really are not about overtime or working even a minute past their hour to go home) so it took some time to get another ride. 

We had another traditional Ethiopian dinner tonight (although I had to skip the injera, as I am losing interest in it) that was very nice before laughing to all the stories from today and heading to bed. Tomorrow is 

Disclaimer throughout this blog: One I have terrible wifi, so please forgive me if I mispell some Ethiopian cultural things I have picked up through word of mouth, and haven’t been able to properly look up to correct  (I will try to correct once I get back)

Second, I am writing the majority of this in my spare time on my iPhone notes app. My phone hates medical terms and will autocorrect to what it thinks is best which is not necessarily correct. And I write on the fly, so I’m not checking grammar or spelling meticulously.