I have posted before about our first day in the hospital on our first spell overseas. An introduction to Life in Africa The establishment had a large complex of programs run by a Christian mission. It was on land given by the Emperor’s daughter and it’s distinctive feature was that it was to have a large leprosarium. This was in a period where the concept for many including the government was to keep people suffering from leprosy (Hansen’s disease), certainly those with the infectious variety, apart from the general populous.
The government gave a grant to the mission to help treat 700 patients residing on the land already granted to them. Nearby there was another parcel of land given for the mission to produce food to feed the leprosy patients living on the leprosarium.
The mission took this work very seriously and expanded way beyond just keeping lepers off the streets and treating them in the relatively limited ways available at that time. The work of Drs Cochrane, Brand and Fritschi, basically in India, with their teams had made much progress but treatment was not as available nor efficient as it is today. India was much more developed. I had some time in India with Drs Cochrane and Fritschi on my way to Africa.
The local tribal language was what is now called Oromepha. The greeting was ‘Nega, fiya, urga’ roughly translated ‘hello, how are you? It’s nice to smell you.’ The last bit sounds nasty. But the verb really had broader meaning, including to sense, and I think the intent was something like ‘it’s good to sense your presence’. But because of the use of rancid butter smeared on clothing to make it waterproof, added to smokey fires in houses without chimneys, there was often a fairly powerful smell. When I had been working in the operating room where, in addition to the above, we used a lot of ether for anaesthetics, I personally collected some of the odour. Many times when I got home to greet my wife, with a loving kiss, I got told ‘You stink, go and have a shower.’
Early in our stay, I remember introducing my young son to a lovely bright young man who had come to visit me. The man knew good English. The boy greeted him politely then turned to me and said ‘Dad, do all Ethiopians smell like this?’ The guy was very gracious saying something about kids being like that everywhere!.
The compound had 2 parts. That devoted to leprosy treatment and that for general service to the surrounding community. Today I’ll write about the leprosy part of the work. The general service to the community aspects were almost as extensive!
The Leprosy work:
- A 50 bed hospital for the acutely ill leprosy patients. It had an operating complex which was also used for general patients.
- A leprosy outpatient clinic which serviced about a thousand sufferers who were not on the grounds but had chosen to live nearby as well as being used by those living in the leprosarium kraals when necessary.
- Many kraals for people living on the compound to receive continuing treatment.
- A group of huts devoted to caring for about a hundred patients with severe lower limb ulcers and infections.
- The farm which provided much of the food to feed those patient living on the compound.
- A machine shop for the farm equipment with an attached shoe shop to make appropriate footwear and artificial limbs for those with deformed feet.
- A school to teach the children living on the leprosy part of the compound.
- A church for leprosy patients if they chose to come.
When working in the leprosarium in India, surgery had been a large part of the workload. People were concerned with cosmetics – they wanted their fingers straight for the greetings; they wanted to walk without an obvious foot drop; they wanted replaced eyebrows and straightened noses. In Ethiopia these things didn’t matter to many. They wanted strong hands to handle ploughing, whereas if you straightened fingers you lost some strength. In Ethiopia people presented later so we had many more severe ulcers on feet and hands. People couldn’t feel normally so they didn’t get concerned in situations which with normal sensation would have been excruciating painful. Thus we spent considerable time removing pieces of dead infected bone or even amputating and then having the shoe shop make peg-legs.
Soon after my arrival I was asked to assess all the inpatients. I thought that about half of them were capable of living in the community. As the mission was paid depending on the number of patients on the compound they were distressed by this. In discussion with them and the government we agreed to keep the finance as if they had 700, but the money would be used to run an outpatient service covering about a sixth of southern Ethiopia.
10 outpatient posts were setup and people reviewed there each month by a rotating team and given their required medicine for the next month or brought to the main leprosarium if necessary. It serviced about 10,000 patients and was overseen by an Ethiopian man who had been trained in Canada as a chiropractor. He did a magnificent job.
My duties also included being the surgeon/doctor to the general hospital.