Training New Doctors for International Service

By Zachary Steinberg | March 18, 2007

My colleague Jeremy Berman and I began our organization, Students for Medical Action (SIMA), over three years ago when we were first-year medical students. Since that time we have sent dozens of second-year medical students and George Washington University (GW) faculty to Ethiopia, linking them with Ethiopian medical students and medical professors. This year we have organized SIMA's first fourth-year medical student rotation in Ethiopia, and I am currently writing you from a small internet cafe off the bustling streets of the Piassa in downtown Addis Ababa.

Our core group, six fourth-year GW medical students, arrived over one month ago and have since undergone a wide variety of activities designed to change dependent on who the visiting GW physicians were. The trip is essentially several rotations within a six-week timeframe.

For the first few weeks of our stay, we were accompanied by the GW emergency room's two top wound care experts, Jim Marinucci and Amy Keim. Jim and Amy were specifically selected by the team given SIMA's past experiences at Mother Teresa's Mission of Charity (MTMC), a community-based clinic with a large outpatient population and little to no physician support. Every Saturday and Tuesday MTMC opens its doors to literally dozens of indigent community members in order to provide basic medical services. About 95% of these people have debilitating acute and chronic wounds ranging from broken bones and large lacerations, to abscess and burns, and the list goes on. Up until one month ago these wound care needs were met with soapy water and an ACE bandage. During their two week stay, Jim and Amy trained us on a wide variety of wound care management techniques including suturing (stiches), debridements (removal of dead tissue to allow healthy tissue to regrow), abscess drainage, and nerve blocks to allow for pain free procedures. Our help there has been greatly appreciated and we have begun to train some of the permanent staff on some of these techniques. We have started to to create a wound care manual that we intend to publish and distribute at a variety of local clinics in Ethiopia, including MTMC. We hope this will be the begining of much improved heathcare at these sites in particular.

During the other days of the week, students have been rotating with GW's Internal Medicine Department at the Black Lion Hospital. This includes morning educational conferences in which residents and attending physicians discuss difficult patient cases and plans of investigation/treatment, morning rounds in which one attending physicians leads a group of residents around the hospital to provide a bedside analysis of each hospitalized patient, afternoon conferences which focus on specific disease processes and recent literature on the topic at hand, and several informal patient evaluations with the medical students and residents.

There has also been an emergency medicine component to our participation at Black Lion Hospital. As Ethiopia lacks a formal Emergency Medicine Division, George Washington University, through past SIMA activities, began a program that hopes to introduce the specialty to Black Lion Hospital as the prototype of Ethiopian Emergency Medicine and a well run emergency room. As a continuation of GW's commitment to this project, two GW Emergency Ed physicians joined our group during the first two weeks. Drs. Kate Douglass and Elizabeth Fihe spent their time in Ethiopia assessing Black Lion Hospital's outpatient facilities that serve as their emergency room. In addition, and with the help of Jim and Amy, they conducted a three-day emergency medicine course at the hospital focused on acute wound management, burns, emergency intubations (placement of breathing tubes), and a general introduction to emergency medicine. Their target audience included approximately 20 physicians (surgeons, obstetrician/gynecologists, internists, pediatricians, and anesthesiologists) who will eventually constitute the core of the hospital's emergency medicine faculty.

Last week, SIMA students spent time in the northern city of Gondar on a more rural rotation. Led by Ethiopian physician Asefa Mekonnen who practices in the U.S., the group rotated through Gondar's major teaching hospital. While Gondar's population is only 200,000 (making it Ethiopia's second largest city), it services a large expanse of rural areas including various mountainous and tribal regions. As such, the hospital is said to provide medical care for millions of people. This largely rural population provided an opportunity for us to see a wide variety of infectious diseases including malaria, leischmaniasis, and schistosomiasis (parasitic infections). We also learned about some of the medical issues surrounding the diet of many Ethiopians. For example, one of the drought resistant grains in the north of Ethiopia carries small amounts of a debilitating neurotoxin. During drought years, people consume heavier quantities of this particular grain and, in so doing, accumulate toxic levels of the neurotoxin. In addition to learning about these more unusual ailments, we also learned of the poor hospital resources in this region. For example, Gondar has no access to a CT scanner or MRI machine. In addition, they have not one single working ventilator, and even basic electolyte labs are beyond the technology of the hospital. Each of us came away from this experience with ideas of how to bring these very basic medical staples to this hospital.

As we enter into our final week here in Ethiopia we look forward to continued rotations at the Black Lion Hospital in Addis Ababa. This week we are joined by Professor of Gastroenterlogy Dr. William Steinberg, Pulmonary Critical Care expert Dr. Asefa Mekonnen, and Pharmacopyschiatrist Dr. Melvin Stern. These physicians have been linked with Black Lion specialists and will provide various lectures to the hospital faculty. In addition, we plan to meet with the Minister of Health and the country's head nutritionist.

We have been very grateful for the opportunity to return to Ethiopia and continue what we believe is very valuable work. Over the past month SIMA has conducted several meetings with the deans and medical department heads of Black Lion Hospital in order to formalize our relationship with them and link SIMA medical students and Black Lion Hospital more closely. We have also begun to brainstorm about the potential solutions to the lack of necessary medical equipment in the country. We firmly believe that the most effective solution will come through focusing our efforts on building friendships abroad.