Category Archives: Ethiopia

“Wisdom at the source of the Blue Nile” is the official slogan of Bahir Dar University.

Our CSI team, along with our Ethiopian surgical partners, were recognized by the president of Bahir Dar University, Dr. Baylie, and his leadership team at a farewell celebration tonight. It was a great way to end an exciting, productive and collaborative surgical week in Ethiopia!

Our team performed 33 life-changing surgeries on children from the region.

Hands-on training for ENT surgeries and post-operative nursing took place each day. Four Ethiopian surgeons have new skills, confidence and wisdom to serve the needs of their local community.

CSI volunteer Dr. Woubeshet Ayenew led six cardiovascular lectures for Ethiopian medical residents and initiated a diagnostic technique for endoscopy and cardiac imagery that the local physicians had the equipment for, but not the training.

More than 60 patients were evaluated for various medical concerns in our ad-hoc outpatient clinic.

Thirty-one children are on a waiting list for screening at our upcoming trip in April 2018. We performed initial surgeries on some of these children this week, and they will require an additional procedure at that time.

CSI’s goal is to make a lasting impact in the communities we serve.

• Performing a transformational surgery affects one child’s life, their families’ life, and thus their community.
• Refining and teaching new pediatric skills to local surgeons, nurses, and anesthesiologists affects children, families and communities for years to come.

Link to photos here!

Thank you to our dedicated team!

Dr. Woubeshet Ayenew
Haley Bye, R.N.
Mary Bye, R.N.
John Chauss C.R.N.A.
Dr. Siva Chinnadurai
John Erlandson C.R.N.A.
Cindy Halverson
Sarah Hartnett, R.N
Evan Keil
Tammy Lester, R.N.
Dr. Saira Mitha
Nolan Morice
Jodi Pelkey, R.N.
Dr. Jon Robitschek
Megan Sparks
Dr. Dave Tetzlaff
Dr. Zipporah Wagathuya
Norie Wilson, R.N.

A day in the OR.
Evan Keil, CSI Ethiopia team member

Transitioning from a nation of abundance to Ethiopia has not been easy. We are performing around 35 surgeries over 4.5 days. To accomplish this, many things are needed. At the forefront – collaboration and fluidity. These two stand out the most when walking around our surgical ward. Working through challenges with oxygen tanks, sterilization techniques, anesthesia, electrocauteries, recovery room beds and more, our dedicated team has found a way.

Each surgical day, the process for the patients begins in the pre-op room. Once cleared here by one of our pediatricians and our nursing staff, the patient is brought into the OR. From here, our OR nurses and anesthesia staff take over. They ensure that the patient’s vitals are stable and do the final preparations for surgery. Enter the surgeons: Dr. Siva Chinnadurai and Dr. John Robitschek (with their first names conveniently labeled with tape on their foreheads) begin their process. With headlamps glowing, gloves on, 15 blade in hand and a sterile field, the first cut is made. With decades of experience between them, these surgeries could be done fairly quickly. However, speedy procedures is not the focus for CSI.

At the core of our mission statement is promoting “self-sufficiency through professional training and support.” As mentioned in previous posts, four Ethiopian doctors (Drs. Wudie, Teshome, Birara and Sintayehu) are receiving expert training this week with the hope that they become confident enough to perform ENT surgeries that come through their doors. Each of these doctors come from different clinical backgrounds and thus require different training – something that our two surgeons have been addressing with each new day. They have each been making a lot of progress, and we still have two full days of surgery to go.

Check out all our trip photos here!

A special case for us today was 9-year-old Asnake. His surgery was a huge success that will have a dramatic impact on his life trajectory! Asnake’s large, complete cleft lip was a source of much shame for him, and he has been bullied and teased mercilessly. He constantly wore a scarf around his head and neck that he would hold over his mouth. Until tonight.   

CSI surgeon Dr. Chinnadurai and Ethiopian surgeon Dr. Sintayahu were able to repair Asnake’s nose and lip. He looked like a completely different person after surgery. His father tells us that as soon as they get home, which is a 90-minute walk to catch a 4-hour bus ride, Asnake will begin school because there will be no more shame. He now has a bright and exciting future living a full life with confidence.   

Meanwhile, exciting collaboration and training is happening in the cardiology area as well. CSI team member Dr. Woubeshet Ayenew gave another lecture to the cardiology residents. Today’s topic was focused on EKG Manifestations of Acute Coronary Syndromes (ACS). The students were engaged and had many questions.  With Dr. Woubeshet’s guidance, tomorrow they plan to see more patients and perform a TEE (transesophageal echocardiogram) for the first time ever in Bahir Dar. The hospital has the tools to do this, they just need the training, which Dr. Woubeshet is happy to provide. Lasting impact indeed!

See all our trip photos here.

Smooth Sailing on Surgery Day 2, and Happy Birthday to Trsit!

Meet Trsit – today is her first birthday, and today she gets to go home with her loving parents after having cleft lip repair yesterday. Needless to say, they were eager to get home. Just before their departure we were able to celebrate with cake and a wonderful rendition of traditional U.S. “Happy Birthday” by CSI nurses Haley Bye, Sarah Hartnett, Norie Wilson and Mary Bye along with pediatrician Dr. Saira Mitha. We are all very close and cozy in the same small hospital ward – patients, parents, CSI and local staff –  so everyone shared in the celebration. The kind staff at our hotel made the cake and even delivered it to the hospital.

Trsit’s family learned about CSI from an ad in the local paper. They arrived on our first day of surgery. Trsit was evaluated and promptly added as the final patient on our Day 1 surgery schedule. No matter where you live, two of the hardest things on surgery day are waiting and not being able to feed your baby. At one point, Trsit’s family was ready to give up and come back the next day. We encouraged them to stay, as they had come this far and were so close. “If it were my daughter, I would stay,” said a CSI team member.

So they waited. When Trsit wasn’t sleeping, cozily wrapped on her aunt’s back, her loving father comforted and entertained her. CSI team members played peek-a-boo and showed pictures to Trsit and her family. Lucky for us, Trsit’s father’s English is excellent; he even helped by interpreting for other families. We talked a lot as we waited. “I have learned many things today about how you serve the patient,” he said. “There is so much need in my country. Thank you for showing our doctors this.”

Along with singing and cake, there were hugs, kisses and tears of joy as we bid Trsit and her family farewell this morning. On to living life – eating, playing, talking and laughing and growing in her community.

Today, Drs. Birara and Wudie performed significant parts of surgeries alongside the CSI team. They got more experience with cleft lip and palate repair as well as the opportunity to remove a complex neck mass on 6-year-old Temesgen. Tonight, he and the other children are in the packed recovery ward room and hallway, resting with family and doing well. It’s 8 p.m., and finally time to head to the hotel for dinner and some sleep.

Enjoy our trip photos here.

Surgery day one complete!

We are off and running. It took a little extra time to get underway this morning – part of the process of getting organized. We arrived at the hospital early to find a courtyard full of families waiting for us. Some were those scheduled for today. Others were waiting for tests or confirmation about surgery. And still more were coming for the first time. Fifteen patients asked to be seen for the first time today after hearing that we were in town. They had a variety of inquiries – some things as simple as clearing wax from ears. We did screen five new patients, who have been added to the surgery schedule.

Today we performed six life-changing surgeries. Ethiopian Drs. Wudie, Teshome, Birara and Sintayehu were in the OR with our teams the entire day. Each doctor had a chance to work alongside CSI surgeons Dr. Chinnadurai or Dr. Robitschek. It was exciting, and they were clearly proud to complete some of the surgeries independently. By the end of the day, Dr. Birara was even coming from surgery to update the families – a practice that is not as common in Ethiopia.

While the children are in surgery, the families wait in the same outdoor corridor where we do our check-in and screening. The families are so worried and scared. Imagine what it must have been like to be the first mom who gave her child to the Americans for surgery Monday morning? That was the mother of 7-month-old Bizhayu. When she finally came out of recovery a few hours later, mom almost did not recognize her with her repaired cleft lip! Bizhayu was getting post-op care from CSI nurse Hayley Bye and the Ethiopian nurse interns, and mom was so relieved. “Biz” was breastfeeding and eating in no time. We expect her to go home tomorrow!

Ten-month-old Amanual was born with a bilateral cleft lip; it was repaired today. Mom and dad were so anxious and worried for him. We reassured them that the surgery often takes time, especially because of the teaching that is taking place in the OR, but that he was doing great! I’m not sure how much our reassurance helped, until mom had him in her arms. It’s scary to see the swelling at the site of the repair, and Amanual was (understandably) still very sleepy. It didn’t take long before he had porridge all over his face and was eating well! His mom was relieved.

Three-year-old Zenaw was so patient while waiting all morning for surgery. She is a beautiful girl with a large cleft palate. When Dr. Robitschek, along with Dr. Birara and Dr. Wudie, started the surgery, they discovered the cleft palate repair was more complex. With some extra time and the great skills of our collaborative OR team, she came through like a champ. Needless to say, she was not quite as bubbly immediately after surgery. She had some juice and fluids and was resting comfortably when we left the hospital at 8:30 p.m.

With six families in recovery, Dr. Saira Mitha and Haley Bye, R.N., did evening rounds with the local nurses, with lots of support from our friend and key CSI team member Dr. Ayenew. The surgeons, along with CSI anesthesia lead Dr. Gathuya and medical records volunteer Cindy Halverson, made revisions and additions to the full Tuesday surgery schedule and it is complete. We are ready to head back to the hotel for a late dinner and some rest.

We can’t wait for day two to see our patients and families from today and to help create lasting change in the OR for seven more children and this community.

View photos from the trip here. 

Screening day is complete!

Patient and loving families – flexible and creative volunteers – dedicated and enthusiastic staff.

This is the recipe that made today successful. After working through some space changes, our screening team got right to work. Thirty-six patients were evaluated for surgery, and we are expecting several more later in the week. Included in the group were babies, toddlers, adolescents, young adults and even some older adults. We saw a 27-day-old child with a cleft lip. Our surgeons, Dr. Siva Chinnadurai and Dr. Jon Robitschek are hopeful that in 6-8 weeks, when the baby is old enough, she can get this surgery from the local doctors – especially after the practice they will get this week.

While the medical records crew, floor nurses, pediatricians and surgeons were screening, the OR team was busy unpacking and preparing the operating room. The nurses and scrub technicians talked and readied the tools needed for surgery. The anesthesia team members also connected with their Ethiopians colleagues. CRNA John Erlandson shared some books and educational materials he brought from home. Our Ethiopian partners were excited and grateful.

In all, we screened 36 patients and plan to do 26 surgeries. CSI surgeons Dr. Chinnadurai and Dr. Robitschek worked alongside their three Ethiopian colleagues to prioritize cases, order the necessary labs for further screening, and set the schedule of the week. The plan is to focus on cleft lip and palate surgeries early, so by weeks’ end each Ethiopian doctor will have completed at least one surgery independently with consultation available as needed.

There is a little room in the schedule to accommodate some of the families we know are on their way. In addition, the team will get to help some patients with complex masses and other facial deformities that are keeping them from living their lives to the fullest. More on those patients later in the week.

After the long day of preparation, we enjoyed some time at the busy Bahir Dar market, where you can find spices, textiles, artwork and much, much more! Tomorrow we will have an opportunity to explore the community a bit, and have a Nile River experience.

It is a joy and privilege to work with this amazing team of dedicated volunteers – totally committed to collaboration and engaging our local colleagues in all aspects of patient-centered care. They are tremendous advocates and outstanding problem-solvers! The only thing more rewarding is to see the beautiful faces of these children and families, knowing we will be able to help them this week. The work we do to help our local colleagues build their skills means that the families who come next week, and all the weeks after we leave, will also be able to get the life-changing help they need.

See photos from the day here.

Our lengthy travels are complete, and we have arrived in Bahir Dar. Our partners from Bahir Dar University and the Felege Hiwot Hospital graciously met us at the airport. After they transported the team to the hotel we had a great lunch, where we met and got to know three of the ENT doctors that we will be working with this week.

Dr. Wudie and her team have prescreened 30 patients, and we expect more to arrive tomorrow on our official screening day. Our surgical focus this week will be on cleft lip and palate surgery and training. But when you get a bunch of surgeons together, they get very excited about the possibility of other cases as well, along with potential learning opportunities!

After our lunch, we had the great privilege to observe the Ethiopian Coffee Ceremony, or at least a shortened version of the ritual, which typically lasts more than two hours. We all had a chance to enjoy the delicious coffee, served with popcorn at the conclusion of the ritual.

Lastly, we held a short team meeting to strategize and plan for screening day on Saturday. We are very excited to get to work tomorrow!

View our travel photos here.

Today we finished procedures and spent the balance of the day investing in teaching and knowledge transfer at the nursing, medical student, resident and fellow level.

We started our day at 8 a.m. with a lecture on ASCVD prevention and transitioned to rounding that went into the early afternoon. We had the pleasure of rounding with very energetic and bright medical students and residents as they were going on bedside rounds with the cardiology fellows.

The center caters to the underserved, and there are 14 beds in each room. The excess we take for granted in the United States is stripped down to the basics, where even the curtain and some extent of privacy between neighboring patients is now down to a few feet between beds in a large open space. Yet with no TV, no patients talking on the phone and no monitors beeping, these large rooms with their 14 patients were quieter than most single rooms I round in while in the U.S. Most of what could be heard was our large team of providers moving from bed to bed and room to room discussing each case in detail and teaching residents.

While the MDs were enjoying these bedside rounds, our multitalented nurse Colleen gathered up the nursing staff and took them through a series of lectures pertinent to cardiac care. The staff created a makeshift lecture hall for her in the middle of the ICU by moving a couple of the beds out of the way so the wall became the screen. (See photo below.) The ICU nurses did not want to miss out on the lectures, so nurses from other areas came over to the ICU and the class was good to go. Improvisation at all levels is the way of life for folks here and a remarkable gift.

Dr. Ben Johnson will do the last in our series of lectures. He will talk about atrial fibrillation, which is a condition common in our patients with valve disease.

I plan on having a series of meetings tomorrow that will hopefully facilitate the smooth entry of our items into Addis/Bahir Dar on subsequent trips.

~Dr. Woubeshet Ayenew, cardiologist at Hennepin County Medical Center and CSI volunteer

Most of the CSI Urology and ENT team members have returned home after a successful week of teaching and completion of life-changing surgical procedures in Ethiopia. The cardiology team, including Dr. Ben Johnson, Dr. Woubeshet Ayenew, Dr. Ron Johannsen, Dr. Brinder Kanda, and Colleen Johanssen, R.N. continue their work in Addis Ababa. They are performing procedures in the cardiac cath lab that repair heart damage due to diseases uncommonly seen in the U.S.

Sticking with the CSI mission, the cardiology team’s goal is knowledge transfer at all levels of the cardiac care model. Every interaction with patients, cath lab nurses, ICU nurses, staff physicians and cardiology fellows has been leading to care enhancement for patients here in Ethiopia. Since rheumatic heart disease is very common in the region, we are also indulging in the local expertise on certain aspects of disease management. Colleen Johannsen R.N. gave a lecture on ECG interpretation this week to approximately 60 medical students, resident and fellows. They are so eager to learn!

Today I asked Ethiopian urologist Dr. Melesse what it has been like to work side by side with CSI surgeon Dr. Francis Schneck. “I have the opportunity this week to learn from a surgeon who is absolutely extraordinary; more extraordinary than I could have ever imagined,” said Dr. Melesse. He also praises having the CSI team at the hospital, saying, “The way you people work together, the way you are a team, the way you work together with our people, the way you help our people. It is a gift.”

Asked why he chooses to practice at this very poor public hospital, he says, “Because this is where I am from; this is where my wife is from; this is where our son lives; this is our home. You look down the hallways here and can see how very, very poor these people are. They are lying in the halls waiting for help. For most of them, there is nothing we can do for them. They have nowhere else to go.”

Our CSI team has learned so much from Dr. Melesse, and it is our hope that we have been able to share skills that allow him to provide even more comprehensive care for his patients.

The operating rooms are very hot, especially with the powerful lights on. OR nurses Mary Johnson, Jodie Pelkey and Dee Vander Pol are doing a fantastic job of keeping everyone well hydrated and everything as sterile as possible. They are also thinking about future missions here and determining if there is an opportunity to leave some of our CSI supplies behind for our next mission.

Everyday it is a hunt for some needle in a haystack, and none of this would be possible without CSI Logistics General Extraordinaire George Steiner. No request is too daunting for George. Yesterday he was dispatched to find a very small fuse to fit in a cystoscope for the urology team. The fuse blew as it was turned on, and the patient, a young man who had been in a motorcycle accident, had been waiting all day. We cried with joy when we heard “George found the fuse.” He was high-fived like he was carrying the flaming Olympic torch the final distance. Way to go, George!

We would like to take a moment to thank Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center and CSI volunteer. It was Dr. Ayenew who was aware of the serious cardiac issues of the children in Addis, and he was familiar with the hospital in Bahir Dar as well. He made the first overtures to Drs. Asnake and Melesse, who are now our main contacts here. This site is a dream CSI location.  Local physicians who not only want to offer free surgeries for their patients in dire need, but most importantly are committed and enthusiastic about learning to ultimately perform the surgeries independently.

The Cardiology team in Addis also had another great day, continuing to teach local cardiologists and nurses during three additional procedures. Their work is changing the lives of children and young adults. Here are some photos from their day.

By: Sally Lannin