Clinic Day

Clinic day is always a crazy day. It is Tuesdays. The waiting room is overflowing with patients – they spill out into the hallway. There are crying children, there are moaning women.  Some are limping, others are blind. Many patients are accompanied by one or more family members – several have to be quite literally carried in to the offices. There seems to be no clear organization to the clinic. All patients arrive by 9am when the doors open. A huge stack of charts is divided into 3 piles – one for each of us who will be attending (Dr. Mersha – the other attending here and one of my former students, Azarios and myself) and we start seeing patients.

Before clinic starts today I apparently am running my own “private” clinic – patients who were sent in specifically to see me. I am not quite sure how this has happened – and no one else seems to know, or care either. There is a young girl with a potential neck injury that Dr. Tadios, the former chairman here who has just retired, has sent in for me to evaluate. One of the attending radiologist is also here – with a herniated lumbar disc and an MRI – seeking my opinion. Before I have a chance to speak to her, however, she steps aside to give way to a somewhat distinguished looking gentleman.  I think it is a cultural thing – a woman giving way to a man, although, as it turns out she is higher up in the pecking order than he.  He is a health officer – a nurse with extra training that acts as a physician extender. He comes with an MRI in hand as well. He has been going blind in his right eye. It turns out he has a brain tumor. Like most brain tumors I see over here it is large, very large. And it is deep, wrapping precariously around important blood vessels at the base of the brain and putting pressure on the optic nerve and chiasm– and hence is blindness.

The good news for him is that it is a benign tumor, slow growing. The bad news it its size and location. He ask me what to do. I try to explain the situation for him. His English is excellent but still Azarios helps to translate. Like most Ethiopians he doesn’t want me to explain or give him options he wants me to tell him what to do. Given the size of the tumor and his progressive symptoms surgery would be the best, although even in the most well-equipped north American center this tumor would be a huge challenge and surgery would not be without substantial risk. I ask him where he wants to have treatment. His answer surprises me.

Most wealthy and well-connected Ethiopians fly “abroad” for treatment. Depending on their financial reserves this could mean anywhere from Kenya or India to Europe.  Occasionally some venture across the Atlantic as well. In his position, he planned on being treated here, in Addis.  I recommended he try the Korean Hospital. It is a private hospital subsidized by the Korean government. Patients have to pay for treatment there  – it is too much for most but “affordable” for those who have some means. There, the equipment is far superior than at the public hospitals. That alone helps improve outcomes.

Finally with my “personal patients” aside we start attacking the plethora of patients stacked up in the waiting room. I think in the past I have referred outpatient clinics as neurosurgical textbooks of pathology. Today is no different. We see children with hydrocephalus, patients with tumors in every possible location, all way larger than almost any we see in north America and a surprising number of patients with back pain. My favorite patient of the day had to be an old retired army major. Many years ago he had been shot in the arm and suffered at that time an injury or his median nerve, one of the nerves that supplied both sensation and movement to the hand. He is now complaining of a new tremor in his right hand whenever he writes.  Other than the old issues with his median nerve I can find nothing else wrong. I refer him onto a neurologist. He is upset that I can’t fix him. He is 79 years old.  For Ethiopia he 30-years past the average life expectancy here despite the time spent in active combat. I smile as he leaves, I think he is doing pretty good……………………….