A nurse applies a bandage to a very unhappy child. (photo: Asrat Habte Mariam)
Sister Mitsui and Dr. Alem makes their rounds in the TB ward. (photo: Asrat Habte Mariam)
Dr. Joseph inspects the eyes of a patient. (photo: Asrat Habte Mariam)
Desperate villagers await treatment from behind Bushulo’s gates. (photo: Asrat Habte Mariam)
A patient with tuberculosis waits for the doctor. (photo: Asrat Habte Mariam)
Dr. Theresa checks the heartbeat of one of her patients. (photo: Asrat Habte Mariam)
Tap tap tap on the bedroom window.
Doctor, Doctor, equerta, tinish chiggera wedda delivery room. Doctor, Doctor, theres a little problem, please go to the delivery room.
So, at 1:30 A.M., in response to the petition of the night nurse, Dr. Theresa rises from her warm bed. Dressing quickly, she rushes to the delivery room.
Doctor, says Almaz, the night nurse, the Red Cross ambulance brought this woman in at 12:30 A.M. She is at full term, started labor, but stopped. And the mid-wives who were assisting her said she would have problems.
Dr. Theresa, a 35-year-old medical doctor from Italy and a member of the Salesian Lay Institute, works at the Bushulo Major Health Center in southern Ethiopia. She looks at the patient, reaches down and strokes her forehead. She speaks to the woman, who is about the same age, in flawless Amharic:
Simi, simish mano? What is your name? Fekerta gives her name. Fekerta, is this your first child? Did you have problems during your pregnancy?
Dr. Theresa interviews Fekerta while checking her pulse, blood pressure and other vital signs. She then leaves the delivery room and consults with Fekertas husband to confirm the information she has received. Dr. Theresa paces the length of the hospital veranda to give herself time to make her decision. She returns to the delivery room and gives instructions to the nurse regarding medications they will induce labor.
Two hours later, Dr. Theresa returns to her cold bed having delivered a healthy baby boy. Had Fekerta not been rushed to the hospital, and had Dr. Theresa not been summoned, both Fekerta and her baby boy would have died.
At 5:45 A.M., Sister Rose of the Franciscan Missionaries of Mary, seated on a mat in the chapel, prays before the Blessed Sacrament. She begins her day with prayer; she knows this will be her last opportunity for quiet time until after the sun sets. Morning prayer for this community of seven, led by Sister Rose, begins 45 minutes later. Finally, at breakfast, the seven sisters who run Bushulo eat, chat and conduct a little business to organize the days activities.
Dr. Alem, an Eritrean staff doctor, begins her rounds in the TB ward and checks with the nurse on duty at 8:00 A.M. Poor nutrition, dirty water and crowded living conditions have contributed to the rapid spread of TB in rural Ethiopia. Comparing notes with the staff nurse, Dr. Alem checks several patients and gives instructions to change the medication for a few of them.
The Ministry of Health has designated Bushulo as the TB treatment center for the entire population of the greater Awasa region, located some five hours south of the capital, Addis Ababa. The region includes some 320,000 people. A team from the hospital travels systematically to various site clinics and gathers statistical data to determine the number of registered TB patients. Bushulo regulates the distribution of medicine and checks the progress of the patients. Lengthy reports are prepared by the Bushulo staff and sent to the Ministry of Health. Periodically, the Ministry of Health sends teams of inspectors to examine the program at Bushulo.
While Dr. Alem reviews the status of her patients, two doctors and one registered nurse begin seeing patients in the outpatient department. They will see about 120 patients in the course of the morning. Most are very poor. However, to respect their dignity, a modest registration fee is charged and medicines are sold, but at a highly subsidized price. Bushulo is supported by a number of funding agencies, including CNEWA. Additional funds from private donors are deposited in the poor box; these funds are used for the destitute. Amazingly, the poor box never goes broke!
As work with outpatients begins, another staff doctor makes the rounds. At the same time, Sister Helen, the hospitals Irish-born administrator, opens her office.
A group of people waits for her. One is a nurse who has come to report that she cannot work today: a relative has died and she must take part in the traditional mourning rites, which last for three days. Bushulo Major Health Center, located just under four miles from the nearest town, Awasa, was built for the country people. The professional staff, however, all live in the city and they must travel by horse-drawn carts or the hospital transport system. If Bushulo is so far from Awasa, why did not the nurse call to explain her absence? Simple: the phone was broken.
Several years ago a single phone line was run from the town to the hospital. But often enough the phone is out of order: a branch falls and breaks the line, a wind off the lake blows down several of the wooden poles or a thief cuts and steals the copper wire. It takes days for this single phone line to be repaired.
After Sister Helen finishes with the nurse, an attendant reports to her after having been sick for one week. It is not unusual that workers in the hospital, attendants, nurses, doctors, sisters, take ill. The crowded conditions of the hospital and the variety of contagious diseases take their toll.
The hospital has 75 beds, but last night there were more patients than beds a malaria epidemic has hit this lowland area. When the beds are full patients are put on stretchers; when they are full, the benches in the waiting area are called into service.
One of the saddest displays is the sight of four plastic tubes hanging from one IV stand; two for each bed. Today, four little tykes, lying toe to toe, are nourished and medicated by their own drips. The children are fighting typhoid fever. Many youngsters who would not have made it otherwise walk feebly out of Bushulo; they have conquered this highly communicable disease.
Sometime between 10:30 and 11:30, doctors, nurses and staff escape from the frenzy to have a cup of tea. The staff cannot afford coffee, so tea, heaped with sugar to give instant energy that will be called upon shortly, is the beverage of choice.
On her way back to the outpatient department, Dr. Theresa is interrupted by a nursing sister she knows. Sister Clare works in a clinic located in a rural area, a one-day drive from Bushulo. After speaking with her, Dr. Theresa walks over to Sister Clares ambulance. Sitting silently, head tilted, eyes closed, is Father Gino.
Father Gino has been in Ethiopia for 21 years. He came as a newly ordained priest, but now he looks much older than his 48 years. Father Gino lives in the mountains in a small parish with 12 stations. Each day, in his battered Land Rover, or on his motorcycle, or trusty mule depending on the quality of the roads Father Gino heads out in a different direction. He celebrates Mass, hears confessions, anoints the sick, gives marriage instructions to a few engaged couples, baptizes a few infants, chats with the elders to catch the latest gossip, and then heads back to his parish.
From time to time his body goes on strike, this time with relapsing fever. But over the years Father Gino has suffered from malaria, hepatitis, typhoid, typhus and a variety of amoeba.
Dr. Theresa and Sister Clare help Father Gino out of the ambulance and lead him into the doctors office. The doctor examines him, takes a blood sample, sends it to the lab and tells the attendant to admit the patient.
Lunch is a rushed affair: each person catches what he or she can.
At 2:00 P.M., Sister Mila, a native of Spain, and Sister Mitsui, who is from Japan, climb into their 18-year-old Land Rover with three other workers and head off for Finchawa, a nearby village. There they set up a mother-and-child clinic once week.
For more than 45 minutes, they bounce along the track until they arrive at a clearing. This spot is chosen because it is more or less in the center of five villages; village women and children may easily walk to this site. Tables and chairs are set up under a huge fichus tree a great place for a picnic on any other day.
One attendant gives out registration cards to the gathered women. Two attendants weigh and measure the children; two nurses begin seeing the mothers. The clinic lasts for more than three hours. After all the patients have been seen, staff members share a cup of tea, chat with the people, load up the car and head back.
While the mobile team is out bouncing along the track, Dr. Joseph reviews the results of the blood tests that have been sent from the laboratory. He checks the six samples for HIV, the virus that causes AIDS. HIV/AIDS is an enormous problem. In Africa it spreads primarily through heterosexual contact. In Ethiopia, one may track the spread of AIDS by the march of warring factions during the civil war, by the routes of a very migrant trucking industry and by the movements of the government work force. These factors have left Ethiopia with an explosion of HIV/AIDS.
Bushulo is one of the few nongovernment hospitals in the country that is authorized to test people for HIV/AIDS. Several years ago Bushulos doctors, most of them young and unprepared for the AIDS onslaught, asked the medical director to arrange for them to receive training in counseling skills. They believed they could cope with the disease, but they did not know what to say to the patients and to their relatives. The medical director was able to arrange for a counselor from Addis Ababa, some five hours away, to travel over a six-month period to share with the doctors skills to help them cope with the emotional crush of this killer disease.
The night shift staff arrives at 6:30 P.M. to relieve the day shift folk. There is now a mood of quiet in the wards. Visitors have left and only a few cries from the childrens ward may be heard. Meanwhile, the doctors, nurses and attendants walk slowly to a waiting car, which will take them to their homes in town. They chat quietly, joke and tease one another. All of them are very tired, but all carry with them a sense of accomplishment.
After evening prayer and supper with the sisters, Dr. Theresa walks back to her house. As she walks, she ponders the days events and the marvels of the seven sisters American, Indian, Irish, Japanese, Pakistani and Spanish all living together in harmony, all here in Bushulo to serve the poor. Dr. Theresa writes a few letters to her family, researches some medical questions she encountered during the day. She then takes a few quiet moments to say good night to the Lord and goes to bed. In a few minutes she will sleep soundly.
12:30 A.M. Tap tap tap on the bedroom window.
Brother Vincent Pelletier, F.S.C., is the Director of our Addis Ababa office. Sister Isabel Arbide, F.M.M., a doctor at Bushulo, also contributed to this article.