For many years the rulers of Ethiopia were from the Amhara tribe. Their religion is orthodox Christianity and they changed other tribal names of towns and areas to suit their desires, often to Biblical names. With the several changes of government over the last nearly 50 years many names have been reversed to their former names and Nazret (Nazareth) is again Adama. (The Oromos use a lot of doubling of letters to show how long a letter is to sound. They spell it Adaamaa). Is that of significance to this post? Well, yes it is. With the rise of tribalism, local people were put into positions which had previously been filled with Amharas, that is members of the then ruling tribe – not that they either were always a perfect fit for their posting. The replacements were not always well qualified. Thus the CEO of the Nazret hospital was now from the Oromo tribe. The young surgeon who wanted me to come was an Amhara. The Oromos are an Islamic tribe in the main. So when I was brought before him, the question was why he should allow this foreigner into his hospital at the request of an Amhara. There was not open hostility but below the surface suspicion.
My friend had told me that the boss had had several unsuccessful attempts to have a large umbilical hernia repaired. The hernia was visibly bulging through his shirt. So, somehow or other, it became the conversation piece. Eventually I persuaded him , if I could get a nylon mesh imported from Australia, to allow me to repair the hernia again. I promised him a 98% success rate. He agreed, and I was allowed ‘in’ to help my friend. His operation went well.
Note – in fact promising 98% sounds good but for each individual the outcome of a complication is either zero or a hundred percent. You get trouble or you don’t. He didn’t, so everything was okay for me after that. He was a happy, now cooperative, customer.
In fact it hadn’t been easy for me to make the decision to go there. Prior to meeting the CEO my wife and I had gone down, on a public holiday afternoon, to inspect what was involved. The wards were much like most Ethiopian hospitals; the surgeon was obviously trying his hardest without a lot of administrative cooperation. Not that they were against him but they had no real understanding of how to run a hospital.
But, as a surgeon, I was particularly interested in what the operating rooms were like. And seeing what we saw it was a hard choice to agree to work in them. There had been a procedure done the night before. The room had not been cleaned up; there was dirty linen on the floor and a considerable amount of blood about. A window was broken and there were flies feasting on the tasty morsels which they could smell and easily find. So in choosing to go I undertook to do and to get done quite a bit before my first operating list.
The school at which I taught part-time Because of Bilingual Canada had a rule that the year 10 students had to have a civic experience in the community for a couple of days during the school year. That year I bought some materials, and the students with the day workers from the school all came down and the windows and screens repaired, a decent setup for pre-operation scrubs put in place, the OR complex was painted and an emu parade performed over the hospital grounds to clean up the very messy area. Thank you, school.
Adama has a population of about 500,000 and an elevation of just over 1,700 metres (nearly 6000 feet).