Reporter's Notebook: A Not-So-Grand Tour Of Ethiopia's Top Hospital

Aug 14, 2014
Originally published on August 14, 2014 11:25 am

When you sign up for a reporting fellowship to learn about the health of newborns in Ethiopia, you expect things to be a little different from what you're used to in the U.S. To be perfectly honest, a little worse. But Ethiopia actually surprised me, even before I took off.

I did my research, and it turns out that Ethiopia's health care system is getting better — significantly better. It's meeting international goals, winning awards from the United States and, more important, babies are living longer and fewer mothers are dying in childbirth.

This is great news. Maybe Ethiopia would be better than I expected. I got some shots in the arm, popped a few anti-malaria pills and hoped for the best.

It was worse. Now, to be fair, all those things I said before are true. More babies are living through childbirth. Infant mortality has decreased by 39 percent in the past 15 years. But one in every 17 Ethiopian children still dies before turning 1, and one in every 11 children dies before age 5. There's a ways to go.

Once I arrived, it took me awhile to figure out what was actually happening with Ethiopia's health care. I was more involved in recovering from the jet lag that woke me up at 1 a.m. every day and avoiding mosquitoes like the plague. I was honestly a little mosquito obsessive. I covered myself and each of my belongings with every repellent known to man: cream, spray, patches, bracelets, small mechanized devices. I needed all the help I could get — the little critters are hopelessly attracted to me.

Because I was having some trouble breaking out of my self-obsessed bubble, Ethiopian health care didn't seem too bad at first. We heard from Save the Children about all the improvements the country had made. We visited a private maternity/abortion clinic whose "waiting room" was a bunch of plastic chairs set up under a tarp outside.

I talked to the doctor there. He said the last fatality at the clinic was more than a year ago. The facility seemed clean and well-organized, and the doctor voiced confidence in his clinic. The care seemed to be adequate.

It was the visit to Black Lion that put things into perspective.

I'd heard about the hospital before. The Ethiopian press reported a blackout in 2005 that left seven patients in intensive care dead; in 2013 there was a seven-hour outage. It didn't sound good. Then there's the name, conjuring a massive feral beast that chews people up limb by limb.

Ethiopians have a different perspective. For them, the hospital is pretty much the most important in the country. Whatever you come down with, wherever you come down with it, if doctors can't treat your ailment where you are, they send you to Black Lion. There are fancy private clinics that cost more money, and some can provide better care. But for most Ethiopians, the Black Lion is as good as it gets.

I visited in the morning on a typical day. I was greeted by a broken front window, a hand-painted directory and crowds of people. Whole families were camped out under the trees outside the main building, and a thick stream of people were trying to move through the halls, some with bandages and crutches, others just trying to get by.

I was immediately aware of one problem: cleanliness. There are people whose job it is to keep the hospital clean. They do their job, but they're no match for the people getting it dirty. What's more, windows are open, doors are open. It's very open-air. That's great for a market, bad for a hospital. The Ministry of Health doesn't collect statistics on hospital-acquired infections, but several isolated studies have been done and the number hovers around a 20 percent infection rate. In the U.S., the rate is 4 percent.

The first place I visited was the neonatal unit on the sixth floor of the eight-story building. With 40 patients and 40 beds, the place was full. Well, I thought it was full, but head nurse Berhena Mulat said they could usually treat many more. Three to a bed was capacity.

Mulat was the first person I met at Black Lion. She'd seen a lot of patients — and a lot of journalists, visiting to report on the state of Ethiopia's health care. I asked her one of the questions we journalists ask when we want to know what's wrong. "What are you missing?" I asked. "What do you need here to do your job?"

"You're a journalist," she said. It was true. Mulat had a pretty good idea what journalists do — and what they don't do. They don't hand out money and supplies to hospitals. "If you don't help me, why do you ask me?"


Once I recovered from the punch in the gut, I realized what she was saying. Other journalists had been here before. They hung around, asked some questions and then left, never to be heard from — at least by her — again. And Black Lion stayed the same.

Being the tenacious journalist I am, I did convince her to answer my question — eventually. And so I became aware of Major Problem No. 2: a shortage of basic supplies. Here's a shopping list:

Equipment to measure infant oxygen levels

Oxygen, or at least a steady supply of it

Baby scales


Generators for when the electricity goes out.

Infants who are not too small or who have a case of jaundice — that's who Black Lion can help. But for anyone who requires surgery, Mulat says, "The outcome isn't good."

Downstairs in the pediatric unit, parents were pushed out on the sidewalk, in the garden, corralled behind metal bars, waiting. It's hard to even squeeze into the hall to talk to people, but I managed. That's where I met Zelem Abdissa. He was a little easier to spot, a full head above the crowd. He's one of the main pediatric nurses.

Kids come to Black Lion from all over the country, he told me. Abdissa does his best to help them, but sometimes he can't: "If they can't afford, it's difficult to help."

One boy came with a collapsed lung. Abdissa says that's just one of the problems Black Lion can't fix.

And if Black Lion can't help, there is no other option. The boy with the collapsed lung was referred abroad, but his family couldn't afford the expense. After two years in the hospital, he died, alone.

A lot of patients have been let down by Black Lion, Abdissa sadly admitted. He went through some files and steered me to another example.

Alizar Haile Gessesse lives with his sister, his wife and his two children across the street from Black Lion. Literally across the street. His sister met me outside the hospital and walked me over. I met the whole family at his house. It was small, modest, but kind of lovely.

Seated, Gessesse looks tall, strong and very handsome. But when he gets up to move from one room to another or even one chair to another, his strength fails him. His legs just won't cooperate. He has some muscle control but not enough. His condition requires him to rely on his family for everything, even going to the bathroom.

He met me with a pile of papers in his lap. He showed me all of them: whole files that documented all the blood, urine and tissue he volunteered with the hope that Black Lion could at least tell him what was wrong. In exchange, he received blood chemistry results, total protein counts and these papers — papers that even now, 10 years later, he still doesn't fully understand. He has learned one thing about his condition, though: "This is more than our level, more than our capacity in Ethiopia to diagnose." Black Lion has no CT Scan, no MRI.

Gessesse told me he has spent $15,000 on his treatment. He was once an electrician; when he first got sick, his parents were alive and they could help. A board of doctors told him to go abroad for treatment. That was 10 years ago. He still can't afford the trip. He's been across the street from Black Lion, his condition deteriorating, ever since.

After Black Lion, I did some traveling around the country. I saw some other health care facilities — fairly miserable hospitals where garden-variety bugs commingled with patients.

A little farther out in the country, I saw smaller clinics with one or two health care workers who were distributing birth control and teaching women about breast-feeding. Those were the successes. That was where Ethiopia was improving.

Oh, that was also the place with the highest rate of malaria infection, and of course I forgot my anti-mosquito medication. Sigh. Those little buggers penetrated my repellent fortress. Two bites right under my fancy anti-mosquito bracelet.

But I knew I was going home. Hopefully, I won't get malaria, but even if I do, I know I won't be treated in an Ethiopian hospital, which makes me a little happy and a little sad at the same time. As a journalist, if I can't help, why do I even ask?

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A few years ago, Ethiopia's health minister noted that there were more Ethiopian doctors working in Chicago than in their own country. That country has long had a weak health care system, and now some Ethiopian doctors are heading back with big ambitions. They want to build a state-of-the-art hospital, a place where people can get advanced brain surgeries and cancer treatments - treatments that are not available now. But even if they get the hospital built, it might take years for Ethiopia to see the benefits. Amy Walters has the story.

AMY WALTERS, BYLINE: Ethiopians practicing medicine abroad - it's kind of a thing. I met Fassil Teffera at a groundbreaking ceremony for the new hospital in Addis Ababa, Ethiopia. He flew over here from the Bronx where he works as an internist.

FASSIL TEFFERA: I just left the country when they had the coup, and all my friends were killed. My brother was killed, and I just left with my shirt. I never planned to immigrate.

WALTERS: That 1989 coup attempt failed, but political tensions forced a lot of Ethiopians out of the country, including doctors. Then, it was the economy that pushed even more out. Ethiopian doctors live on one of the lowest medical salaries in the world. So there's only 5,000 doctors left. Ethiopia has 80 million people. It's not enough doctors.

TEFFERA: So I'm going to be the first one moving. So I'm going to be the Moses. So I'm going to bring all the Ethiopians back here.

WALTERS: That's what Teffera hopes, at least. He's joined with about 200 other Ethiopian doctors from the Diaspora to build the biggest, best medical center this part of Africa has ever seen. It'll include neurology, orthopedics, cardiology, even a five-star hotel for the families to stay during their medical treatment - a center of excellence. That's the official term. It's a kind of facility Emun Abdu, one of the doctors - a brain surgeon from Tucson, Arizona - is accustomed to.

EMUN ABDU: I deal with brain aneurysms through the interventional route where you go in through the groin and access the brain vessels. And you can do whatever you need. If it's a stroke, you can extract clots. That option is not there at all in this country.

WALTERS: So the only way you can get this procedure - a lot of procedures - is to leave. Hospitals in Thailand advertise in Ethiopian Airlines in-flight magazines. This new medical center could save lives.

ABDU: My parents live here, and I am worried to death that if they had, like, a mini heart attack or a mini stroke, they would not have the appropriate care and would die.

WALTERS: But here's the thing - most Ethiopians make around $400 a year. They're not going to be able to afford this hospital. It's for an elite few in Ethiopia and around Africa to keep those patients and their money here. Most Ethiopians end up someplace like this.

It looks like the door just came off the hinges there.

This is a typical public hospital in the Northwest of Ethiopia. Natnesh Assrat is lying down with a tiny baby - 2.9 pounds - on her chest. She's careful to explain the water droplet on her left cheek is sweat, not tears.

ASSRAT: (Foreign language spoken).

UNIDENTIFIED TRANSLATOR: She's having a kind of sweating.

WALTERS: When a baby's premature here, they keep it warm and close to food by resting it on the mother's chest. That's their version of an incubator. They did just get a new incubator, though.

BERKANU WEBSHET: Very recently.

WALTERS: Berkanu Webshet, one of the doctors here, explains the last incubator arrived three years ago. It broke one month later. There aren't enough beds, x-ray machines, thermometers, even hospitals. You can't rely on electricity or clean water. So building a state-of-the-art medical facility here isn't going to be easy. But the technology giant GE has pledged help and so has the government. Tedros Ghebreyesus, Ethiopia's foreign minister and the former minister of health, was a guest of honor at the hospital groundbreaking.

TEDROS GHEBREYESUS: And we will help them in any way possible like what we have been doing. This project is part of the bigger strategy plan.

WALTERS: What they're all hoping is that if they get enough rich people coming to this new hospital, it'll give a boost to the Ethiopian health care system, overall. The doctors want to help train local doctors, and there'll be a foundation to help some Ethiopians who can't afford the services. But it's not clear if they'll raise the money needed to build the hospital or if the medical tourism plan will take off and then, if it will even help average Ethiopians. But Ghebreyesus is undeterred.

GHEBREYESUS: Ethiopia can be a very good hub for American tourism - you know, the whether - it's the best? I know you will tell your listeners that.

WALTERS: Well, the weather is pretty good, but they might need more than that. For NPR News, this is Amy Walters.

GREENE: And we should say Amy Walters traveled to Ethiopia as a fellow with the International Reporting Project. Transcript provided by NPR, Copyright NPR.