Rainy Season

East African countries like Kenya and Ethiopia (where we are visiting for two weeks) don’t have seasons like we are used to in the U.S.  The mention of summer, fall, winter or spring to a Kenyan or Ethiopian only brings blank stares of confusion.   There is no snow here; no fall colors on the trees, and the flowers just keep blooming.  However, we do have some variation in weather patterns manifested by two seasons, rainy season and dry season.  Rainy season reminds me of late spring in Michigan, just not as cold.  Weeks of overcast gray go by with a mixture of thunderstorms and drizzle.  Everything is wet and muddy.  Then, just when you think you can’t take it anymore, the clouds will break and you will get a few rays of warm sunshine before the next storm rolls in. 

It’s rainy season in Ethiopia now, and today was a rainy season at the hospital.  Overall our family has had an enjoyable time here and have gotten a good snapshot of what Soddo Christian Hospital is all about.  However, some days are cloudier than others.

I sloshed my way down the wet path to the hospital this morning to meet the Ethiopian PAACS surgery residents for morning rounds. I knew there would be at least two patients near death in the ICU; we had admitted them yesterday.  I asked my post call resident how the rest of his night went and he responded in a tired despondent voice, “It was a rough night.  Let me show you.”  We commenced with rounds.

Bed 1:  empty.  Our patient who had been assaulted and robbed a few days back died in the night.  He was a normal guy employed as a guard when he was attacked and robbed.  His head injury, bilateral pneumothorax (dropped lung) and rib fractures were a bad combo for a place with no ventilators. 

Bed 2:  22-year-old man who had gotten into a fight with his brother (not sure why) and had just arrived a few hours prior to rounds.  His pupils were fixed and dilated, and I could tell by the way he was breathing that the tall guy dressed in black waiting in the corner holding a scythe was there for him.  He died 5 minutes later and the 20 family members outside the ICU began their mourning process with wailing and screaming audible throughout the whole hospital. 

Bed 3:  55 year old male I had admitted the previous day with another bad head injury due to a motorbike accident.  I was surprised to see that he was still alive, as he showed signs of brainstem herniation yesterday.  I spoke to his family, and updated them on his grave prognosis

Bed 4: 14 year old girl brought in by her family overnight from 3 hours away.  She too was a victim of the transportation system here in East Africa, where cars, motorbikes, pedestrians, and donkey’s share the newly paved roads.  She had been hit by a motorbike and sustained an intracerebral hemorrhage (bleeding on the brain) that put her in a coma (GCS 5).  After ensuring that she was getting our best supportive care, I told her family not to go anywhere today or tonight.

Bed 5-9 were made up of orthopedic patients with open fractures of various long bones.  Most were polytrauma from road traffic accidents and most were younger than I. 

Road traffic accidents are maiming a generation in the developing world.  Over 1.2 million people die each year from road traffic accidents, and an estimated 50-60 million people worldwide suffer disabling injuries.  Over 90% of these injuries happen in low to middle income countries like Kenya and Ethiopia.   A careful analysis of current trends yields the prediction that road traffic will be the third leading cause of death and disability worldwide by 2030, up from ninth place today (WHO 2009 Global status report on road traffic safety).

At Tenwek, our orthopedic service is overrun with fractures due to careless and untrained motorbike drivers, and devastating head injuries are far too common in our ICU.  Now, I’m at a different hospital, in a different developing country, and I’m seeing the same thing; another busy orthopedic service trying to keep up with the constant stream of open fractures, more head injuries with minimal supportive care options, and young people in the prime of their lives being robbed of their mobility and mental capacity.   What about the hundreds, perhaps thousands who never even make it to the level of care provided by Tenwek and Soddo? 

And what about the patient’s ability to hear the gospel...their only hope of eternal life?  Head injury patients are especially tough for me.  We can treat their body, but due to their mental status changes they aren’t able to hear and comprehend the eternal healing message of the gospel. 

Later in the day I was in the OR lounge when I heard the familiar sound of a family screaming and wailing, mourning yet another death.  I made my way over to the ICU thinking it was one of my patients, but it was a patient from a different service.  More gray skies, and the rain kept falling.  I checked on my head injury patients, and both were still hanging on. 

After the day was over, I began the walk home.  The path was dry now, as the literal rain had held off for the day.  I walked past the hospital’s pet sheep, (that are kept for phlebotomy to make blood agar in the lab) and around the corner toward our house.  In the distance Alex was playing, and when he saw me he screamed for joy, “Daddy’s home!!” and it echoed throughout the compound.  He ran over and gave me a big hug.  Tucker trailed behind, and Cooper materialized from a tree to welcome me home.  Cole came running out from the house and said he had been waiting for me.  The clouds from my day had broken and a few rays of warm sunshine were holding onto my legs.  I enjoyed the evening in the sun, not sure when the next storm will roll in.