A Taste of Medicine in Africa

Last week was my first (rough) introduction to medicine in Africa. It began with the death of a baby and ended with the successful amputation of a man’s arm. These stories illustrate the limits and challenges of the work we do here. They are not easy to read or tell. The baby died after his mother unsuccessfully labored for two days at home before traveling to our clinic—a common occurrence here. The nurses and the mother accepted this fate without noticeable emotion…or commotion, for that matter. But after we strived unsuccessfully to revive the baby, I realized that this is the first perinatal death I have ever encountered… and it certainly will not be the last.


Before having the opportunity to process this event, another critical patient arrived at our clinic on a stretcher fashioned out of sticks and banana leaves. The 60-year-old man had been cutting down trees when one fell on his arm, snapping his humerus in half, and leaving the remainder of his arm mangled and deformed. Upon initial examination it was clear that the arm hung onto the shoulder by some muscle fibers and skin, and two tourniquets were necessary to limit the blood loss. Also clear immediately was (1) this man needed immediate medical attention or he would die, (2) that this arm needed to be amputated, and (3) that we were entirely unprepared to do the job. A call to the closest district hospital was discouraging—they did not have surgical capacity at that time to do amputations. The next option—a drive to the nearest university hospital more than three hours away—was also impossible. It was getting late and the roads are not safe after dark. Before I cracked open my surgical book, there was one remaining option—Dr. Wodajo. Ok, well he isn’t actually a doctor… and he doesn’t actually work at a clinic, but he is an extremely well-trained health officer (similar to a physician’s assistant) with a private surgical practice in town. Within a few minutes of calling Dr. Wodajo, we had our patient in Dr. W’s “OR.” This OR consisted of a single bed in an unlit room with no additional equipment. I hurried back to his OR with tetanus antitoxin in hand to find that the surgery had already begun. Dr. W and three assistants were gathered around the patient… one man focusing a single dim flashlight on the wound so Dr. W could operate. I quickly handed Dr. W my headlamp and the surgery proceeded. With local anesthesia, two flashlights, and a rubber glove for a drain, Dr. W removed the patient’s entire humerus, amputated the arm, and neatly stitched part of the wound. A few days later the patient is not out of the woods yet, but he is healing well and we hope he will make a full recovery.

The craziest part of this story is that the surgery almost never happened. The man almost didn’t receive the care he needed, which would have almost certainly led to his passing. The thing is, Dr. W’s fees are extremely high. He charged about 300 Birr for the procedure… an amount that the patient couldn’t conceive of affording. It was only with Lalmba’s emergency fund that we were able to pay for the surgery and save this patient.

The US dollar equivalent of 300 Birr? It’s less than $25 dollars.
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