Gamechu was a two year old child that arrived at the rural Ethiopian hospital where I worked because of an abdomonial mass. Immediately upon examining him I noticed that he was severely malnourished and in his abdomen I felt a hard mass that I suspected to be a tumor.
We hospitalized him and strengthened him up so that he would be able to handle surgery. The mass was taken out and using the limited diagnostic means available in our hospital it seemed to be a lymphoma. Seeing that it was potentially curable with chemotherapy, after having completely resolved the malnourishment of the boy we sent him to the public hospital in the capital with a letter that explained our diagnostic suspicions.
The public hospital had in place chemotherapy facilities that ours did not have.
Three months later a malnourished child, disfigured by metastasi linfonodali arrived at our hospital. I recognized the father and realized the boy was Gamechu!
His father told me that they went to the hospital in the capital and even though it is officially free, they were asked for payment for the visits and the treatment to be received. Because he didn’t have enough money he brought Gamechu back to our hospital where the boy had received care with little payment.
I had to explain to him, with the help of an Ethiopian nurse to translate into the local dialect, that we didn’t have the necessary drugs, and that in any case, the disease had spread too much at this point.
He asked me what I thought he should do. I told him that the child should be taken home to live his last days surrounded by his family instead of in the hospital far away from his village.
The father of the boy showed incredible dignity in agreeing with my decision and we said an emotional good-bye.
It was a very difficult moment for me, not only because I had to explain that the disease was uncurable, but for the inaccesibility of care for the poor.
This experience has become for me an example of how, when bringing support to developing countries we have to make sure that our actions don’t just deal with the emergencies but encourage progress and guarantee access to health care by the most fragile members of the population.
In the pediatric ward of the Ethiopian hospital where I worked I happened to learn that the local nurses believed that the universal blood donor type was O positive.
My first reaction was to answer that they were simply mistaken and that the universal type was instead O negative.
While I was preparing myself to quickly resolve the problem in this way, I realized I had to stop and first understand why they were convinced of this, without imposing my answers on them and diminishing their education.
So we had a meeting with all of the nurses around a table and I started to explain blood compatibilty as it was explained to me, with drawings and practical examples: as if it were a university lesson.
At the end of the meeting we all got up with clearer ideas about the physiopathologic base of blood compatibilty. For me it was a lesson to not underestimate Ethiopian nurses and to explain to them in the same way I would have explained to an Italian colleague: doing it in this way, I didn’t have to force upon them my own point of view but rather we all came to understand the topic as a group.
I was certain that no one would make this mistake again because when an idea is imposed it is easy to become confused or forget, but when it is something grasped well it can be discussed and talked about.
THE COFFEE CEREMONY
In Ethiopia drinking coffee is a ritual: you stop everything, prepare the floor with a flowered rug, burn incense and drink three cups of coffee with your guest.
When I arrived I noticed that the nurses of the pedriatic department and the clinic would interrupt work every morning for a long, elaborate and ceremonious coffee break. At the beginning it seemed to me a waste of time: outside of the clinic there was a long line of children to see and the ward was completely full. Like any good European, it seemed wrong to take time away from the health care if I stopped, so I ordered that the break not take place or when it did I would continue working alone while the nurses stopped for coffee.
I came to understand that I had made a mistake.
The coffee break had an immense value in the working relationships: stopping to participate in the ceremony meant taking care of and deepening the trust we had between us and permitted me to enter into their culture. I spoke with the head nurse about it and apologized for my attitude explaining that I wasn’t necessarily against the break I just wanted to ensure the care of the patients.
Together we decided that both in the ward and in the clinic, the coffee break would be taken after having made sure that we had examined the worst cases.
Through my daily participation in the coffee ceremony I immediately became aware of a growing appreciation of me by the local staff as well as an improvement in our working relationships.