Caring for the health of strangers is a discussion most of us engage only from a perspective of public policy. The health care reform that was passed last year in the United States inflamed the passions of almost anyone who was paying attention. Working professionals in the field like Heidi and her friends in residency at OHSU, or the nurses and paramedics I am honored to fly with, know the question from a much more intimate place. They approach every ailing stranger with a determination to affect a positive outcome, and they must temper the feeling with a sense of what is possible.
Science and medical technology, and some might even say fate, draw the ultimate line of how positive the outcome can be. But along the gradient of what is possible, the resources available to a people, and the policies that systematically distribute those resources to a community, provide limits of medical possibility that fall well short of the ultimate line. Doctors like Heidi bare witness to this disparity every day of their professional lives, and must reconcile the feeling as human beings. And the rift becomes much larger in a developing economy like Ethiopia.
Science and medical technology, and some might even say fate, draw the ultimate line of how positive the outcome can be. But along the gradient of what is possible, the resources available to a people, and the policies that systematically distribute those resources to a community, provide limits of medical possibility that fall well short of the ultimate line. Doctors like Heidi bare witness to this disparity every day of their professional lives, and must reconcile the feeling as human beings. And the rift becomes much larger in a developing economy like Ethiopia.
I only managed to visit Heidi once at the hospital over these past weeks. At lunch, I went to the piazza to hale a bajaj, a ubiquitous taxi-like pod built on a motorcycle chassis that travelers the world-over often refer to as a “tuk-tuk”. On this day I opted to simply hop in and declare my destination, armed with the rare knowledge of the unwritten market price for the trip to the hospital, and therefore able to avoid the negotiations that inevitably leave a foreigner paying more than what is fair. The ride took me five minutes out of town through winding, paved streets lined with leaning tin structures, eucalyptus trees, and streams of tangled people weaving random, individual lives into the same tough fabric.
I arrived at the front gate of the hospital campus, paid the bajaj driver the two birr ($0.12) for the 3km ride, and thanked him in Amharic with a grateful and reciprocated smile. The entrance to the hospital is a node of simultaneous stillness and turbulence. Crowds of people clot together outside waiting for perhaps a bus or bajaj, or maybe just to watch the time pass by in the heat of the day, while others pulse in and out of the small valve that is both entry and exit. They come and they leave with the same hope... that someone knows their pain, and that something can cure it.
Ethiopian medicine provides very limited answers to this question. The hospital in Gondar was built years ago with an intended service area of under 300,000 people. Today, it serves a catchment of over two million. Lab testing capabilities, a fundamental diagnostic tool to western doctors, are prohibitively expensive and often unavailable. And the pharmacy carries only a basic bench stock of medications of questionable quality. Doctors here rely heavily on the physical exam to learn what ails their patients, knowing intimately the shape and texture of a pulse and the sound of the heart. To touch the patient like this rather than subject her to a sterile series of lab tests and technical analysis is perhaps a positive on a deeply human level, but as medical science goes, doctors here are dealing with a very limited data set.
Heidi met me inside the gate on the main street of the sprawling hospital campus. The street was lined with single-story, cinderblock enclosures that served as the various departments of the hospital. There was the emergency room, windows agape, allowing an easy view of the patients from the outside. Some lay on crowded beds, while many more spilled into other pockets of the open bay, laying on the floor or sitting against a wall. Heidi walked me through the campus pointing out similar scenes in identical buildings labeled by different names; in-patient wards, surgery, pediatrics, and the rather ominous multi-drug resistant tuberculosis ward.
It’s difficult to avoid sounding melodramatic when describing this scene. Infectious disease, no doubt, is well incubated and easily spread by the hygienic conditions of not only the hospital, but the country as a whole. As a doctor, Heidi says it has been an excellent learning experience to work in Gondar over these past weeks. Simply put, she has seen diseases and ailments come into this hospital that either don’t exist in Portland, or have been well managed in the population with preventative medicine and vaccination. On a scientific level, it has been good to expand her knowledge in this way.
This journey, however, has not been exclusively about the pursuit of science. Living here for almost a month now, and knowing people that we will count as friends after we leave, Ethiopia has become an extension of our own, global community. The line of medical possibility here has been drawn well short of what we’ve known in our own country by circumstances that extend far beyond the gates of the hospital. To know the depths of such a rift inspires a deeper struggle with human empathy than we knew before embracing this larger community. It also inspires respect and humility for the amazing good fortune of our own circumstances, and instills a desire to continue to close these rifts.
