A team from America recently traveled to Ethiopia as part of a medical mission. The group of 18 on the trip included surgeons, anesthesiologists, nurses, speech pathologists, administrators and other volunteers, many of whom hail from the Hudson Valley.
By LAUREN YANKS
Manoj Abraham grew up in Sri Lanka during a period of turmoil.
The country had been plagued with ethnic tensions since it was granted independence from British rule in 1948.
“When I was 11, our house in Sri Lanka was attacked and our neighbors were killed,” said Abraham, whose family escaped the island south of India in 1983. “We fled to Nigeria, but there was a military coup.”
There were, in fact, multiple coups in Nigeria over four decades, the most recent occurring in 1999.
It wasn’t until he was 14 years old that Abraham’s family made it safely to the U.S. An uncle, who had moved to the country in the 1960s sponsored the family which, Abraham acknowledges, was “incredibly lucky.”
Today, he serves as the associate director of Otolaryngology at MidHudson Regional Hospital, and the president of the Dutchess County Medical Society. But, he hasn’t forgotten what it’s like to live in need, or in an area where high-quality medical care is not available.
Abraham last month traveled to Ethiopia as part of a medical mission. The group of 18 on the trip included surgeons, anesthesiologists, nurses, speech pathologists, administrators and other volunteers, many of whom hail from the Hudson Valley.
Manoj Abraham examines a patient during a medical mission to Ethiopia in January. The associate director of Otolaryngology at MidHudson Regional Hospital, Abraham was the … Show more COURTESY PHOTO
In addition to performing procedures, the group trained doctors who live in the region in surgical techniques and other care that can be applied in the future.
The surgeons were otolaryngologists, a specialty that focuses on the ears nose and throat, or ENT. Many of them specialize in facial plastic and reconstructive surgery, a field for which Ethiopia does not have a training program.
Over the course of a week, from Jan. 19-25, the medical group operated on 24 patients, many of whom required multiple procedures. Most of the procedures were to treat cleft lip and palates and Abraham, the lead surgeon on the trip, estimates roughly 50 procedures were performed in all.
Despite a rich cultural and religious history, Ethiopia is among the poorest countries on the planet, with 62% of its population of 105 million living on $3.20 or less per day, according to the World Bank’s World Development Indicators Database last year. Most Ethiopians lack access to safe water, sanitation and healthcare services. The country is located in west Africa, west of Somalia and north of Kenya.Get the Daily Briefingnewsletter in your inbox.
The trip was organized by Healing the Children Northeast, a volunteer organization based in New Milford, Connecticut, which provides free medical care to children in need. Supplies were donated by Westchester Medical Center.
Many on the trip were taking part for a second consecutive year; both years the team was based out of a public university hospital in Mekelle, the largest city in northern Ethiopia. The team plans to return next January.
Debbie Fritz, an operating room nurse at the Fishkill Ambulatory Surgery Center, said she takes part in two-to-three medical missions per year. She said the Ethiopia trips are unique in that both the local doctors and visitors learn from it.
“We share our knowledge and they share their knowledge,” she said. “In the U.S., we are always accustomed to having certain things. In Ethiopia, we have to learn to adapt and be creative, and they teach us that.”
Patients’ needs unique compared to U.S.
Many of the patients who came to be treated by the medical team traveled long distances, often by foot, and some with children on their backs. Some patients were meeting with the doctors for a second consecutive year, and some for reasons the doctors would normally not find locally.
Michile Niguse, a 10-year-old boy who greeted doctors with an infectious smile, lost his right ear to a hyena bite in September. He was walking from his house to bathe in water when he spotted the hyena. The animal chased him down and bit his ear before a man scared it away.
Part of the ear was recovered and, at that time, a general surgeon inserted the cartilage under the skin behind his wound. It stayed there until doctors from the mission harvested the cartilage and, using a skin graft, recreated the ear.
While that was among the more unique tasks for the doctors, many were faced with fixing cleft lips and palates, which are among the most common birth defects around the world. The tissues in a baby’s face and mouth usually merge in the second to third month or pregnancy; however, with cleft lips or palates there is only partial fusion or none at all.
Many experts believe they are caused by a combination of genetics and environmental factors. Depending on the level of severity, these children deal with a number of challenges. One of the most serious is feeding, as sucking can be a challenge and can lead to malnourishment. There may also be ear infections and hearing loss, speech difficulties and dental issues.
Fixing cleft lips and palates often require multiple procedures. For instance, many of the cleft lip procedures also required a rhinoplasty, and the ear reconstruction involved skin graft and cartilage reconstruction. Rhinoplasty can require a rib to be harvested, as well.
For the second year in a row, the team operated on Kedija Hashim, a lively 3-year-old girl who was born with a cleft palate. Last year, the team repaired her palate; however, the cleft had to be repaired again, so her mother brought her back. Her healing issues may have been due to malnourishment, which compromises the immune system and can impede the recovery process.
“Kedija was in better condition this time around because the initial surgery last year helped her to eat and drink more,” said Abraham. “Hopefully, the revision surgery this year will continue to help her more.”
Like many women from that region, Kedija’s mother married young and has four children. She and her families are refugees from Eritrea and live in a refugee camp. After Kedija’s surgery, her mother was thankful and said that if the team doesn’t see her and Kedija next year, it is because she has immigrated to another country in the hopes of making a new home for her family.
Another patient the team operated on this year was a priest. He was performing a ceremony when he was cornered between two fighting oxen and was gored in the face.
“It cut through the side of his nose,” Abraham said. “They took him to a local clinic, but it was misshapen and blocked his breathing.”
The priest’s daughter, a nursing student at Mekelle, heard about the mission and brought her father in. The team performed surgery on the priest’s nose, and he was so grateful that he conducted a blessing for the team on their last day.
“It was a wonderful way to end the week,” Abraham said.
A teaching expedition
Augustine Moscatello, the director of Westchester Medical Center’s Department of Otolaryngology/Head and Neck Surgery, said he’s “lost count” of how many missions he’s done, calling it “a nice way to meet people from different cultures, and it’s a way of giving back.”
As chairman of the Otolaryngology Department at the New York Medical College, Moscatello said he’s especially fond of “the teaching aspect” of the trip. “It’s an excellent model and should be the new way of doing missions,” he said.
As compared to missions in which doctors simply perform surgeries and leave, the medical team on the January trip worked directly with Ethiopian ENT resident doctors and other medical professionals, providing both hands-on training and specified lectures.
The program was set up by Otolaryngologist Joshua Wiedermann, originally from Silver Spring, Maryland. Wiedermann said after finishing his ENT residency, he became disillusioned by what medicine was becoming in his life.
“What felt most fulfilling to me was to provide care for populations with zero access,” he said. Wiedermann moved to Mekelle for a year and helped start an ENT resident education program. Abraham soon caught wind of it.
“Most people finish ENT training and get themselves a cushy job,” Abraham said. “For Josh to choose to go to a developing nation is an incredible story. And by connecting us to the residents, we were able to create an exponentially more effective model.”
There are only 25 ENTs in all of Ethiopia; after this residency program is complete, Abraham said there will be 16 more.
“It will have an enormous impact and reach so many more people,” he said. “We all look forward to fostering a long-term collaboration and creating a strong, sustainable program.”
Lectures this year included such topics as suturing, nasal fracture and anesthesia. In addition, the team included two speech and swallowing therapists. Many children born with cleft lips and palates struggle with their speech and swallowing, so gaining an understanding of these functions is important for the residents. When all the lectures were finished, Casey Saussy, Healing the Children Northeast’s volunteer mission administrator, collected the material and assembled it into books for each resident to use as a reference guide.
Ethiopian doctors benefit
The Ethiopian ENT resident doctors emphasized what a difference a dedicated, attentive medical professional can make in their country. The residents were in their late 20s or early 30s, polite and deeply determined. Some have overcome hardships to become doctors.
Dr. Dessalegn Berihu, or Cheula, developed an ear problem when he was 5 years old.
“I had discharge in my ear, so my father carried me on foot for three hours to an Italian mission,” he said. “It made a big difference.”
Cheula’s challenges were just beginning. Born in a small border town between Ethiopia and Eritrea, a war between the nations broke out when he was 7. His family fled their home with no money or food, and they were forced to hide in caves. Eventually, his father got a job as a day laborer. He always stressed to Cheula about the importance of education.
Cheula was thankful for the instruction from the mission’s doctors, especially in regard to lip and cleft palates and nasal surgeries.
“Most of our seniors are general surgeons, so we need more subspecialists in order to really grow,” he said. “ENT does not get any attention in Ethiopia, but it should.”
Filmawit Gebremeskel, or Fili, is a smart, self-possessed, 28-year-old resident who said “it has been my lifelong desire to be a doctor.
“I started studying when I was young and never stopped,” she said. “I was committed to doing whatever was needed.”
Like many of the others, the missions were Fili’s first experience with facial plastic surgery, and the first time she saw cleft lips and palates. In the operating room, she observed and assisted. She wants to do much more.
“I saw how such a small physical repair made such a big psychological difference,” she said. “I want the team to keep coming until we are confident to do it on our own.”
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