The 15×10 Surgeons’ lounge adjacent to the two operation theatres at the Government Zewditu Memorial Hospital in Addis Ababa, Ethiopia, is buzzing with activity. The aroma of Indian vegetarian food fills the air as nearly a dozen doctors from India — Maharashtra, Uttaranchal, Punjab and Himachal Pradesh, are laughing and chatting. All of them top professionals in their specialties of General, Orthopaedic, Paediatric, Eye and Dental surgery, Gynaecology, Urology, and Neurology, with some heading departments in prestigious teaching institutions.
All of them are eating out of a tiny box a simple meal. While some have removed gall bladders through laparoscopy, the gynaecologists — Punam Maithani and Vineet Nagpal — have removed a twisted ovarian cyst, and the lone dental surgeon Dr Rupali Ashtaputre has performed some dental procedures. “Can you imagine they don’t even do fillings here, and simply remove the tooth,” she says. She has fixed two root canals for the next day.
Earlier, steaming cups of tea and mithai have been served by volunteer Poonam Gandhoke. Her husband, PDG Manpreet Singh Gandhoke, is busy assisting the Orthopaedic surgeon Rajeev Dwivedi and plastic surgeons Sanjay Dvivedi and Surinder Makkar in the other hospital. The fifth volunteer, Manmohan Manchanda, is busy clicking pictures.
“This is where Rotary lives and breathes, not in the five star hotels where many Rotarians meet,” says PRIP Rajendra K Saboo as he too tucks into the modest vegetarian roll and patties.
He has been the architect of Indian medicare missions to Africa since 1998 and this VTT (Vocational Training Team) mission, a global grant project, is his fourth to Ethiopia. So how many has he done in all? “Oh, I’ve lost count.” Pointing to the doctors he says, “They are the real heroes, they do the work and we bask in their glory. When we go to meet VVIPs our names come … that Raja Saboo led the mission. True I started it, but it would have remained only an idea if Indian doctors had not made sacrifices in their professional and other commitments, sometimes even closing their private clinics for the 7–10 days they spend here. I am only a volunteer.”
But the ‘volunteer’ is a tough taskmaster in ensuring that the work for which the 25-member delegation has come from India, gets done, and the maximum number of patients benefit in a country where medical facilities in several specialties remain where Indian health care was some 20–30 years ago.
The initial hitch
Almost in every medical mission there are hitches; “bureaucracy is there everywhere, it has no borders, and Ethiopia is no exception, but Rotary too has no borders,” says Saboo. So for two full days after landing in Addis Ababa the doctors and volunteers were “dejected and worried as all the medical and surgical equipment and medicines we had come with were held up at the Customs.”
Rotary also has at its disposal many a strings. So on the day I land, Nov 19, these strings have been pulled. That morning PDG of 9212 Dr Tadesse Alemu and Mohammed Idris, a volunteer who had helped Rotary with polio eradication landed up at 8 am at the Health Minister’s residence and got the necessary clearances. But the all-clear message was short lived; apparently each box would be opened and examined; another 24-hour delay.
Once again the duo got into action and ensured that the boxes reached the hotel in a few hours. And the surgeries began in the two hospitals!
But teething problems abound; for two days there are not enough patients screened and kept ready for these world-class doctors. Particularly considering that the “primitive status” of health care in such government hospitals. Private hospitals are much better but the expensive treatment is beyond the reach of the masses.
Backward by a generation
“Can you imagine that in the whole of Ethiopia there are only 5 paediatric surgeons for a population of nearly a crore, and all of them are in Addis Ababa,” says an incredulous Dr Milind Joshi, Professor of Paediatric Surgery at the Dr Ulhas Patil Medical College in Jalgaon.
Dr Madhav Maithani, a senior general surgeon, says general surgery procedures in this hospital are “one generation back. Laparoscopy and endoscopy which we had 20 years ago are missing. But we are training surgeons so it can be introduced here.”
Dr RS Parmar, a D 3132 PDG, is a senior general surgeon and a veteran in these medical missions. This is his sixth one to Africa. “The main challenge in this country is that local doctors are not trained in laparoscopy; so apart from doing the operations, we will also give local doctors hands on training.”
Medical Director of the Zewditu Hospital, Dr Daniel Ebebe, is extremely grateful to the Indian Rotarians for this project. The 45-year old, 230-bed hospital has 18 disciplines. “This was the first hospital in Africa where treatment for HIV/AIDS was started, but its incidence has now come down,” he says.
He is grateful to the Indian surgeons as the hospital has a backlog of over 1,200 surgical cases. With help from the Indian doctors, he wants to make this hospital a laparoscopic centre, and sheepishly admits that the “laparoscope donated by the Indian mission last time was not used. Your doctors are trying to repair and restore that equipment, which was almost thrown away. I promise this will not happen again, as we are very keen to introduce modern surgical practices here,” he says.
When I ask Saboo why some of these doctors cannot be trained in India on Rotary’s initiative, he says, “We are thinking about it. We had offered to do so two years ago, but did not get the right response.”
That in essence sums up both bureaucratic hassles and a modest number of patients at the two hospitals in the first few days, making you wonder at such a fantastic opportunity going abegging.
But this isn’t the case at the Debre Berhan Referral Hospital, which I visit on the third day, accompanied by Project Chair and PDG (D 3080) Arun Sharma, a veteran of many such missions, and host District 9212 DG Teshome Kebede. Providing an incredibly picturesque drive on surprisingly good roads — most of the roads in modern Ethiopia have been built by the Chinese — this city with a population of less than 100,000, was once the capital of the country.
At the camp site there are large groups of people, mostly elderly, waiting quietly, with incredible patience, and without any pushing or shoving, a sight common in Indian government hospitals. But even though there is orderliness, calm and near-silence, their anxiety is visible. Most of them have lost vision or are near-blind and by word of mouth know about this opportunity. Inside the operation theatre there are three tables on which the Indian eye surgeons Nishant Nawani, Ashworth Valentine and Pankaj Shah are performing mainly cataract surgeries at an admirably brisk pace.
Indian doctors sparkle
Dr Manoj Sharma, consultant urologist from Chandigarh and Dr Pamposh Raina, consultant urologist at the Indira Gandhi Medical College in Shimla, point out that Urology is in a very primitive stage in Ethiopia. “I have forgotten when I last made an incision on a patient for prostrate or stones; in India we do it all by laparoscopy and endoscopy, except in advanced cancers,” says the former. They are amazed that a city like Addis Ababa which has such modern infrastructure should lag behind thus in medical care.
As I step into an OT to take pictures, the doctors are doing a prostrate procedure, and are taken aback to find a huge growth being responsible for obstruction. As they meticulously attack it, I beat a hasty retreat!
While private hospitals do provide some advanced care, the treatment is very expensive, sometimes costing thrice of what it would in an Indian private hospital, says Dr Parmar. And prostrate medicines are five times more expensive than in India. The tragic result is that patients who can be cured by medicines often opt for surgery, even when not indicated, because they can’t afford the costly drugs.
Dr Abeye Gurnessa, a general surgeon at the Zewditu Hospital who is being trained by the Indian surgeons in laparoscopy, has 19 years of experience. So why are medical and surgical procedures so backward in his country, I ask. “Well, I am ashamed of it; it’s not due to poverty; it’s due to the attitude and mentality of the administration.”
Along with some other doctors he has been sent to China for training, but didn’t learn much because either they trained on simulators or operated on rabbits! “But this is hands-on experience. These doctors have taught me how to do a laparoscopic procedure on patients and now I am confident of doing it myself once the equipment is available.”
He is sure that within a few years both the Ethiopian doctors and the government will have to shed their apathy. “A time will come when people will demand better care and women will tell us we don’t want such big cuts and scars on our stomach! Then we’ll be forced to change!”
Dr Sanjay Dvivedi, a plastic surgeon from Dehradun says that the plastic surgeons were doing reconstruction surgery for patients with injuries sustained in burns or other accidents, and for birth deformities. “Many patients with failed surgeries have returned with complications and we are doing a variety of skin grafts.”
Dr Vivek Lal, HOD of Neurology at PGI, Chandigarh, played a very active role in giving lectures, taking classes for Neurology students, interacting with patients and changing their treatment patterns. “I found the students very keen to learn about neurological disorders caused by infections, stroke, headaches and epilepsy. Infection in the brain is the major cause of morbidity the world over, and TB of the brain is common in such countries,” he says.
Dr Milind Joshi operated on a 7-day old child, thanks to support from expert anaesthesiologists in the team. “He weighed 2.6 kg and had a half kg lump on his head, fortunately benign, and we removed it. “
As the patient flow improved, there were three more patients who wanted the doctors to operate on them, “but as it was a Saturday the hospital staff was not willing to stay back, so we’ve promised to do the surgery on Monday,” he added. The same day Dr Parmar did a “tough cholecystectomy, despite his back pain, standing for six hours.”
PRIP Saboo has switched base the earlier evening to assist the eye surgeons right from the morning. He can be seen in the thick of action, ushering in patients, and helping them onto the tables, waiting for the doctors to finish the procedure, complete the bandaging, after which he supports and escorts them out. With admirable efficiency the Rotaractors — Alef, Emma, Sam — are completing the several rounds of eye drops to prepare the patients for surgery.
The pace is so brisk that by lunch 25 surgeries have been done. Nawani says such a brisk pace can be seen only in camps, whether in India or Africa. For lunch, while I opt for a packet of rice and meat prepared in Ethiopian style, Saboo settles for a vegetarian sandwich.
“Only vegetarian? How do you manage for proteins,” asks Emma. “I’ve managed for 82 years,” is the cryptic reply she gets! Later he gives her a list of vegetarian foods, led by lentils, that Indian vegetarians consume.
He is a bit out of sorts, say other veterans of these missions, because spouse Usha, who accompanies him on almost all African medical missions, could not make it.
Disappointed volunteer opts out
That’s because she was diagnosed with herpes, and “was so disappointed when the doctor grounded her for three weeks,” he says. But from Day 1, she has been calling for status reports on whether the medical equipment and medicines have been cleared, or how many operations are taking place. “She has been calling every morning and evening; I give her a daily report but feel she would have been good for this camp as she is very good with eye patients,” he says.
Medical Director of the hospital, Dr Fiseha Tadesse, a Rotarian himself, says this 120-bed hospital is 79 years old and patients come here for treatment from long distances. “Today some of the people you see waiting so patiently have come from villages that are 100 km away.”
As Saboo brings out Beletech, a 60-year-old woman after surgery, holding her by the hand, her daughter is extremely grateful. “My mother was virtually blind for a couple of years; I am so grateful to the Indian doctor doing this surgery.” The next day the doctors operate on a two-year old boy with congenital blindness in one eye. His parents are delighted that the child’s vision will return in that eye. General anaesthesia is required for this surgery, which is organised.
Thanks to Dr Nawani — his father Dr Jayanth Nawani is the medical director of this mission — who has brought his own portable phaco equipment, many of the patients are able to benefit by this advanced procedure done without an incision. This costs around Rs 11 lakh and Tadesse, who is the incoming president of RC Debre Birhen, swears that during his year his hospital will have such an equipment. It is good to see that apart from training and surgical intervention, these doctors are also triggering aspiration for better medical facilities in government hospitals in an African country like Ethiopia.
“Phacoemulsification not only improves the quality of the surgery but also makes post-operative rehabilitation faster,” says Dr Nawani. Dr Valentine adds, “We’re seeing lots of patients with very bad or no vision thanks to untreated cataracts.” Dr Shah adds that each person is fitted with an IOL “so they go away happy.” But thanks to lack of general anaesthesia, the ophthalmologist are not able to do complicated cases such as retinal detachment.
For Arun Sharma this is his eighth medicare mission; his first being also to Ethiopia when he was D 3080 DG in 1999. He has been to Nigeria, Zambia, Zimbabwe, Congo, and his experience speaks in the quiet efficiency with which he ties up all loose ends, resolves glitches, deals with wounded egos … all this without getting a bit fazed! “Oh, I’m used to all this now,” he smiles at my question on how he keeps his cool. “We are very happy that our target of over 110 surgical procedures, 400 eye operations and numerous training sessions were achieved,” he says.
Saboo thanks Rajeev Sharma, originally a Rotarian from Delhi, who has now moved to Ethiopia to start a paper industry. “He is considered a leader among the Indian expats here, respected by the Rotarians of this country. Rajeev is the bridge between Rotary India and Rotary Ethiopia.”
Pictures by Rasheeda Bhagat