From: Biniam Haile \(SWE\) (eritrea.lave@comhem.se)
Date: Tue Apr 14 2009 - 11:55:32 EDT
Tuesday, April 14, 2009
HemOnc today - CLINICAL NEWS IN ONCOLOGY AND HEMATOLOGY
Manpower needed in Eritrea
by Paul Burress
Posted February 10, 2008
Fox Chase oncologist shares skills with patients, doctors in Eritrea.
When Mark A. Morgan, MD, chief of gynecologic oncology at Fox Chase
Cancer Center, accepted an invitation from the Stanford Eritrean Women's
Project to travel to Eritrea to perform vesicovaginal fistula surgeries,
his only desire was to help a country in dire need of medical
professionals who could perform fistula surgery.
Before coming to Fox Chase, Morgan was the head of urogynecology at the
University of Pennsylvania and was familiar with the surgical procedure
to correct vesicovaginal fistulas that occur as a complication of
childbirth.
It was his experience with vesicovaginal fistulas that made Morgan
believe going to Eritrea could make a difference to the large number of
Eritrean women in need of vesicovaginal fistula surgery. Eritrea is an
African nation near the Horn of Africa, bordering Ethiopia and the Red
Sea.
"Childbirth is supposed to be a natural process and more women in the
world, mostly in undeveloped countries, die from childbirth injuries
than from all the gynecological cancers combined," Morgan said.
In the last five years, Morgan has made eight two-week trips to Eritrea
that have provided him numerous technical and technological challenges.
"The equipment when we first started going was pretty rudimentary, but
we would bring our own things like suture material. You just have to
learn how to operate without having all the conveniences common in the
Western world like cauterization and suctioning," he said.
Progress in medical conditions
In the time since Morgan has been visiting Eritrea, numerous medical
improvements have been made, including a new hospital, Mendefera
Referral Hospital, in the Eritrean highlands, where he currently works
when in the country.
"During our initial visits, there were problems," Morgan said. "The
Eritreans have really worked to make changes and now have a new
hospital, so things like running water are usually not a problem.
Occasionally the electricity will go out."
Morgan and colleagues also have a system in place to work efficiently
with their Eritrean support staff.
"It still is not the same working environment as in the United States,
but it is much better than it used to be and much cleaner," Morgan said.
Because the technology that he is used to is not available and supplies
are limited, Morgan has been forced to become faster in surgery and
conscious of things like saving sutures.
"Although we have a bit finer technique, the Eritrean surgeons know how
to conserve supplies and combining our two strengths together works
well," Morgan said.
Since many of Morgan's patients do not speak English, translators and
counselors try to inform patients about what is happening to them and
what they might expect.
"We relate to the patients in more of a nonverbal way through
expressions and certain simple phrases that we have learned," he said.
Facing a language barrier, Morgan relies on more of an empathic bedside
manner to comfort patients and gain their trust, which was new to many
of his patients.
"The idea of someone being nice to them is a real change because, after
getting a fistula, they are really left by themselves with little care.
I think the patients definitely appreciate the display of caring and
empathy," Morgan said.
Need for doctors
When Morgan first started visiting Eritrea he and his colleagues would
see 75 to 100 patients, though in later trips the numbers have dropped
to about 40 or 50 women.
"The decrease in patients comes from the training we [the visiting
doctors] have provided to the local doctors in performing fistula
surgery as well as from the development of hospital postoperative care
and counseling programs," Morgan said.
Since local doctors have learned to perform the needed fistula surgery,
the problem is not educating doctors so much as not having enough
doctors to educate.
"The whole staff is a really good unit, but the problem is a lack of
manpower. People may say, 'go over to Eritrea and teach them how to
perform the surgery,' but there are not that many people to teach,"
Morgan said.
Morgan thinks for the near future many sub-Saharan African countries
will need doctors to come over and assist because properly trained
medical staff are needed.
Though his work in Eritrea is hard and he is often exhausted when he
returns home, Morgan said that the doctors in Eritrea have it far worse
than he does.
"One of the doctors that I work with is an OB-GYN and covers a half
million people. He basically works seven days a week, 24 hours a day and
never has a day off," Morgan said. "It is hard to feel sorry for
yourself when you see the doctors there working that hard."
Memories of Eritrea
Even though a great deal of his time is spent in surgery, Morgan has had
the opportunity to examine the Eritrean culture.
"It is a varied culture and they have at least eight different ethnic
groups and different spoken languages, including Tigrinya and Arabic,"
Morgan said.
Morgan seemed refreshed by the country's low crime despite its economic
troubles and constant tensions of war with neighboring Ethiopia. Violent
crime, Morgan said, is almost unheard of in the country.
When Morgan accidently left $500 in the pocket of his pants and sent
them to be cleaned, his money was returned within an hour of dropping
off the pants.
"Five hundred dollars would be anywhere from between a year to two years
salary for most of the people in Eritrea. They are honest even though
they are in a bad situation economically," Morgan said.
Another time Morgan left an old pair of shoes in Eritrea that he only
used when operating and was not going to use again. When he returned a
year later to the town where he left them, the townspeople, thinking he
forgot them, had the shoes there waiting for him.
"In America if you leave something in a major hotel and try to get it
back it's hard to do. In Eritrea, the people thought I left them. They
kept them and made sure I got them when I came back. It is a small
thing, but it is telling and says something about the people," he said.
Morgan hopes to continue helping where his skills are needed for as long
as he possibly can.
"If I finish up in Eritrea, I will probably go somewhere else to help. I
am 52 years old now so I will be at it probably another 10 or 15 years,"
Morgan said.
Morgan believes there is a lot that Western doctors can do to aid
developing nations, but they have to find the specific need that a less
developed country may have and try to fill it.
"This is where a person's sense of satisfaction will come from, if they
do a good job and provide people the help that they need," Morgan said.
- by Paul Burress
Posted February 10, 2008
Mark A. Morgan, MD, and Samson Abay, MD, from Eritrea
<http://www.hemonctoday.com/images/HOT/200802/46_image1.gif>
Mark A. Morgan, MD and fellow surgeons
<http://www.hemonctoday.com/images/HOT/200802/46_image2.gif>
<http://www.hemonctoday.com/article.aspx?rid=26175>
http://www.hemonctoday.com/article.aspx?rid=26175
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