Landing in Addis Abba brought back a flood of memories of my former time spent in Uganda and Gabon: the terracotta earth, the roadside food stands, the hot African sun. It was a strange sense of familiarity as I debarked from my plane in a place half way around the world. After a very long and bumpy car ride to Soddo, located a little more than 300 Km from the capital city, I finally arrived to Soddo Christian Hospital where I spent a month long rotation with former VCMC grads, Drs. Kavi Simpson and Michelle Yates. My time in Soddo was spent primarily among the pediatric ward and on the postpartum wing, caring for kids with a variety of medical diagnoses and looking after many newborns in their delicate fight for life. I don’t think I could have ever fully prepared myself for the many lessons learned while being abroad on this trip, and I was so grateful to share that space in the company of those who became such heartfelt friends.
Learning started for me the day following my arrival to Soddo, as I spent my first morning on rounds and was quickly inundated with a list of differential diagnoses I had never directly encountered in the States: things like pyogenic cerebritis, Pott’s disease, Grade IV intraventricular hemorrhage from a Vitamin K deficiency, rickets, acute rheumatic fever, and many other exotic infectious diseases. The list, in fact, went on and on. One of the first girls I met in the ward was being discharged to home after six weeks of IV antibiotics for her brain abscess that had initially brought her to the hospital with complete left sided hemiplegia. After hearing her story, I teared up watching her walk and talk normally since her treatment had taken effect, and her focal neurological deficits had entirely resolved. I quickly felt a thirst to read and think broadly about our patients on the peds floor, and I spent the coming weeks reviewing presentations and treatment for many tropical illnesses, reading WHO guidelines for nutritional management, calculating formulations for IV fluids and engaging the nurses and local general practitioners in team based care. But learning in Soddo was not simply confined to the acquisition of medical knowledge.
One of the more dynamic lessons I learned over the last month was the importance of educating and training local physicians and nurses to take a primary role in patient care and decision making. In doing so, I learned the importance of walking away. Not just leaving the hospital at the end of the day for a sense of personal boundary and emotional health, but walking away for the equipping of local doctors to take on leadership roles and be empowered as providers. Learning how to walk away is hard for many reasons. It means that there are still patients lined up outside the ER waiting to be seen. It means the labs we ordered in the morning might not get completed. It means there might be physical exam findings or historical points that will get missed on new admissions. But walking away also creates space for dignity on behalf of Ethiopian practitioners, as they learn to own their responsibilities in patient care. Because when we walk away as one-man operations, we leave nothing in our place. The hope is that one day Kavi and Michelle will walk away from Soddo with a self-sustaining and thriving local community of providers. And that is a direction, I think, that’s truly worth walking towards.