Addis Ababa, Ethiopia, April 2006
David Cho, MD
3rd Year Plastic Surgery Resident
Loma Linda University Department of Plastic Surgery
Every hospital in the world has a particular smell. The smell of Zewditu Hospital is a combination of African spices, dirty bed linens, bodily secretions, and the richest coffee in the world. Every morning I was struck by this odor, a reminder that I was in a different land with a special purpose to serve people less fortunate than myself.
I traveled to Addis Ababa, Ethiopia in April 2006 with Dr. Mohan Sehdev as my general surgery attending, and Drs. Erik Payne and Stan Brauer as team anesthesiologists. Our Loma Linda University team performed general surgery procedures for the patients of Zewditu Hospital.
"Enkirt" means endemic thyroid goiter in Amharic, the language of Ethiopia. Enkirt is a common medical problem in Addis Ababa. Iodine is easily washed away from the highlands with heavy rainfall, and those without iodine in their diets develop large thyroid neck masses. Patients without access to modern surgical care are left with their slow growing neck mass for many years. These unsightly masses are often kept wrapped in clothing. Some patients will tattoo the overlying skin in an attempt to camouflage the abnormality. During this outreach trip we were able to help many patients with Enkirt. A thyroidectomy (removal of the thyroid gland tissue) is usually curative with life changing results. For every Ethiopian patient who received a thyroidectomy, we received a wonderful "thank you" attempted in English.
Breast cancer is a worldwide problem; however, unlike in America, breast cancer in Ethiopia is not detected nor often treated in its early stage. Many women with breast masses are neglected in their village. I was told by an Ethiopian surgeon that "these women seek help from medicine men, but they are instructed that nothing can be done and that they will die from their disease." We met such a lady in Zewditu hospital who presented with late stage inflammatory breast cancer. She correctly knew that she could not be saved from her illness. Her chief complaint was that her ulcerated breast wound stained her shirt with blood throughout the day. Our surgical team performed a modified radical mastectomy for this lady. We hoped to buy her more time in life and reduce the burden of her bleeding breast. This 65-year-old woman beamed with joy when her gauze dressing was removed on the second postoperative day.
Educational exchange was an important aspect of this outreach trip. Our team was able to provide PowerPoint lectures and clinical teaching to the Ethiopian attendings, residents, and nurse anesthetists. Of particular note, the surgeons at Zewditu hospital learned to identify and preserve the key nerves and vessels of the thyroid and axillary regions. At the same time, our American team was taught how to remove enormous goiters (larger than seen in the American population), a valuable skill to possess for future outreach trips around the world. We were impressed with the ability of the Ethiopian surgeons to adapt and improvise with limited equipment and resources. I learned that you need very few tools to perform most surgical procedures and that frequent patient bedside visits are more valuable than expensive monitoring devices.
I am very thankful to Operation Good Samaritan for allowing me to participate with this trip to Ethiopia. It was an inspiring and life changing experience for myself and for my patients. It is a privilege to be a "Good Samaritan" and offer assistance to total strangers who live half way around the world. Operation Good Samaritan reminded me of why I became a doctor and has inspired me to participate in future outreach trips throughout my career as a plastic and reconstructive surgeon.