Real-life Medical Care
My little SIM clinic protects me a bit from the real lives of so many poverty-stricken people living in Addis. All my ex-pat patients have insurance and if medical care becomes necessary beyond what is available locally they can leave the country and be treated in better developed settings – South Africa, Kenya, Dubai, India, Europe. Ethiopians employed by SIM (who form the majority of my workload) although often living in difficult circumstances at least have a job and an income, however inadequate. And SIM will pay for a certain amount of medical, dental and optical care for them and their immediate family members. Dealing with how much care will cost and having to restrict what I can do based on available funds is anathema to me when face to face with my patients - 30 years in the NHS saw to that, where necessary care is available when needed without recourse to discussions about money.
However for the last two weeks I have spent several days in a very different environment. SIM Ethiopia's AIDS Care and Treatment (ACT) Project brings teams of clinicians from the USA several times a year to run medical clinics for the beneficiaries of the project (all of whom have a family member with HIV/AIDS) and for the communities around. This time they were short of a doctor, so I joined them to fill the gap. A church or a community centre would be used; tables and chairs are set up for consulting; benches are provided for the patients to wait on, and somewhere a mattress is placed to allow examinations beyond what can be done in public.
Bilingual nurses are brought in from the main Addis Ababa hospital to translate for us. People are booked in to a maximum number although this failed on Friday morning when the planned 36 people turned into 52 as word went around the local community that there were doctors available.
One day last week we went to a centre for children with learning disabilities run by a protestant denomination were they can get education, physiotherapy, food and above all, love. I spent the morning being hugged and kissed by children with Down’s syndrome.
This is primary care at its most challenging. People who never access medical care because they can’t afford it come with high and often unreasonable expectations. They have multiple and sometimes long term problems, and as we provide just a one-off consultation there is often little that can be done. No continuity is possible; frequently treatment is a best-guess; many leave disappointed.
Let me tell you about two children I met.
Sara was a little 2 year old with Downs syndrome. She has a serious heart defect that needed operating on long ago to rescue her from the consequences. (For you medics this was an AVSD). She’s been seen by a cardiologist who has said the surgery she needs is not available in Ethiopia. her mum presented me with her test results and asked me about why Sara was getting out of breath so easily and why she wasn’t growing. The test results said it all – the blood pressure in her lungs is way too high. I examined her, heard her heart murmur, and Sara gave me a big smile. In my heart I knew she has only a short time before heart failure sets in. With no money and no hope of ever having surgery there was nothing I had medically to offer. Sara left my table with her mum – Gizaw will pray with her and talk to her about Jesus before she leaves.
Selamawit was 3 years old although she looked the size of a one year old. Her large head, and the fact that she was carried in on her mother’s back revealed all – spina bifida. Selam had had an operation to close the defect on her lower spine when she was a baby, but she has no nerve supply to anything below her waist. her legs were tiny flaccid spindles. She had almost no muscles but some of the ligaments were stiffening – I couldn’t fully straighten her tiny knees. Mum’s request? Was there anything we could do to help Selam stand? Explaining the facts was heart-rending. This gorgeous little girl will never walk; will never have bowel or bladder control; will probably have a very short and difficult life. We offered to pray with her but mum left before it was possible. She disappeared into the crowd.
I’m sure there were many we helped in the course of these clinics and many will have had an opportunity to hear about Jesus. I’d like to say I enjoyed the last couple of weeks, but while I was delighted to have the opportunity to help and I met some wonderful people coping in the most difficult of circumstances it was an emotionally challenging and draining experience. Of all the things I have done here this is the hardest – seeing people suffer and die for want of basic medical care that I have been used to providing in the UK. I feel helpless. And it makes my heart ache.