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TODAY news for Thursday, June 29, 2006

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Operation Good Samaritan brings smiles to Ethiopians

Dr. Gabriel (center) brought smiles to the faces of children in Ethiopia.
The contributions of the Loma Linda University community led by Dr. Gabriel (center) brought smiles to the faces of children in Ethiopia.
This past spring, a plastic surgery team from Operation Good Samaritan journeyed to Addis Ababa, Ethiopia, to provide health care to patients and train doctors at Zewditu Hospital. The division of plastic surgery has been active in international outreach for many years, and for the past few years has partnered more closely with LLUAHSC entities to support a broad number of institutional global outreach initiatives.

According to Linda D’Antonio, PhD, professor and director of international outreach, division of plastic and reconstructive surgery at LLU, there have been significant benefits associated with that strategy.

“For example, in many locations in the world, a repair of a cleft lip is viewed as a miracle performed at the local mission hospital,” explains Dr. D’Antonio. “Plastics cases are also unique in that these cases are typically not emergencies and can be stored up for our periodic visits. Finally, fairly major quality of life changes can be accomplished with relatively low technology and infrastructure and therefore can be performed in very rudimentary hospital settings.”

Because of these unique characteristics, the outreach trips can bring significant attention to mission hospitals and assist them in increasing their visability and position within their communities.

“By coordinating with the LLUAHSC global outreach mission and with Adventist Health International hospitals we are able to lend the power of our surgeries and educational initiatives to help bring about long lasting contributions,” shares Dr. D’Antonio. “Our commitment to training local caregivers builds capacity at our partner institutions that we believe will then last far beyond our single visits.”

Editor’s note—the following stories are written by LLUMC plastic surgery residents about their Operation Good Samaritan experience in Ethiopia.

By Cherrie Heinrich, MD, and Allen Gabriel, MD, fifth-year plastic sur
The Operation Good Samaritan team helped many people with goiters by performing thyroidectomies
The Operation Good Samaritan team helped many people with goiters by performing thyroidectomies (removal of the thyroid gland tissue), which is usually curative with life changing results.
gery residents, LLUMC

Operation Good Samaritan in partnership with  Adventist Health International maintains relationships with hospitals throughout the world. One of the hospitals is Zewditu Hospital in Addis Ababa, Ethiopia. Built in 1974 by the Seventh-day Adventist Church, it is currently managed by the Ethiopian government, which has approached Adventist Health International to consider managing the hospital. At the hospital’s request, a surgical team was assembled to provide plastic surgery and train the hospital’s general surgeons in plastic surgery techniques.

Zewditu Hospital was the most modern hospital in Ethiopia in 1974. Since then it has deteriorated, but it still remains a very solid structure. Presently, the hospital is staffed with general surgery, obstetrics and gynecology, internal medicine, pediatrics, and basic dentistry. It also serves as a teaching hospital for residents from the main university hospital, Black Lion.

Our team consisted of two attending plastic surgeons, Andrea Ray, MD, and Norman Sogioka, MD; Mike Fischell, MD, attending anesthesiologist; and two plastic surgery residents, Allen Gabriel, MD, and Cherrie Heinrich, MD. In addition to the physicians, Debra Heinrich, MSN, registered nurse, and Shay Thomas, a surgical technician, brought an added level of support to the team. This was Operation Good Samaritan’s largest team in recent years.

Goals

The primary goal of this trip was to educate the local surgeons and residents in burn surgery and cleft care so they could continue to treat these complicated patients after our departure. The secondary goals were to provide care to the patients in Ethiopia and to provide us with experience in international health care.

The trip

On arriving in Addis Ababa, Ethiopia, Dr. Fekkede Gemechu, a retired general surgeon from Riverside, California, took us on a tour of the hospital where we would
The team members spent most of their days in the operating room after making their rounds in the ward.
The team members spent most of their days in the operating room after making their rounds in the ward.
spend the next two weeks. He had arrived the week before and had arranged for patients to attend our first clinic on Monday morning. From clinic, patients were screened and pre-admitted for surgery that week.

An average day began with ward rounds to evaluate patients prior to their surgery and to check on the patients who had already had surgery. Dressings were changed and wounds assessed. After rounds, we headed to the operating room, where we spent the rest of the day. In the late afternoon one resident would attend the clinic for screening additional patients that arrived daily.

The hospital had limited supplies and resources primarily for general surgery and gynecology procedures. In order to assist in providing plastic surgery care, we brought supplies and surgical instruments not only for our use, but to leave for the local surgeons to use. Most of their instruments were overused and they were ecstatic to receive the donated replacements.

Our patients

Each patient we treated while we were there made a lasting impression on us. Although individually unique and bringing their own story, they were all similar in their need for help. We were able to treat 25 patients and perform 60 procedures. This is but a drop in the bucket, but the education we left behind will echo for years to come.

Bati Mohammed is a 4-year old-boy who sustained a burn injury to his left hand. He had never been treated which resulted in his fingers scarring into the palm of his hand.

Misete Shafi is a 12-year-old boy with an incomplete cleft lip who lives 500 kilometers outside of Addis Ababa. He and his dad traveled for several days to reach the hospital. This was the first opportunity he had to have surgery on his lip.

Linger Liyew, a 12-year-old girl, had been burned by scalding water 10 years ago. Similar to many children, she was never treated and developed severe contractures. In the entire country there is only one surgeon who is trained in
Cherrie Heinrich, MD, and Allen Gabriel, MD, fifth-year plastic surgery residents at LLUMC, pose in front of Zewditu Hospital.
Cherrie Heinrich, MD, and Allen Gabriel, MD, fifth-year plastic surgery residents at LLUMC, pose in front of Zewditu Hospital.
burn reconstruction.

Personal reflections

One of the reasons that we both chose Loma Linda for our plastic surgery training is the strong emphasis on whole-person care that extends to providing medical care in developing countries. This experience is unique at Loma Linda as it is a formal part of our training. Both of us feel a strong pull to provide care to underserved populations as we each spent part of our growing years in developing countries. This instilled in us a desire to serve and donate our time and experience. The trip to Ethiopia made us realize how privileged we are to work in a modern hospital that has more than adequate supplies and instruments. In addition, we recognized how much we have learned during our residency. We gained confidence in our increasing ability to plan for and execute complex surgeries while working with limited resources.  

In conclusion, we consider ourselves very fortunate as residents to have had exposure to medical care in a developing country. Not only was this a learning experience for us, but we were able to share our knowledge and education with the surgeons and residents at Zewditu Hospital. The smiles on the faces of our patients provide all the reinforcement and constant reminders of why we chose plastic surgery. It was a life changing experience for both of us and continues to remind us that our worst day here at home will never come close to the best day in third world health care.

By David Cho, MD, third-year plastic surgery resident, LLUMC

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 halfway 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.

By Patricia Thio

TODAY news for Thursday, June 29, 2006