On a recent trip to Ethiopia, eight doctors, two nurses and one physical therapist from the Hadassah Medical Organization in Jerusalem traveled on a weeklong medical mission to the city of Mekelle, in the African country’s north. Led by Dr. Josh Schroeder, a spine surgeon at Hadassah and Dr. Allon Moses, the chairman of Hadassah’s Department of Clinical Microbiology and Infectious Disease, the Israeli medical team performed five surgeries at the Ayder Comprehensive Specialized Hospital, which serves some 8 million patients but does not have a spine surgeon.
Their journey told in the three parts below involved patients who are all aged 18 and under, and had spine deformities so severe that they were causing potentially lethal complications. Watch the video here.
Ethiopia: Day One
For 11-year-old Nazria and 16-year-old Fano, the doctors and nurses from the Hadassah Medical Organization who flew in to Ethiopia from Jerusalem are their last hope.
Both have been brought to the Ayder Comprehensive Specialized Hospital in Mekelle, hundreds of miles from their farming villages. Nazria’s frail frame reveals a back twisted into the letter s. Displaying a shy toothy smile, she shows the doctors she can walk. The middle child of five, she nearly died last year from pneumonia, which was exacerbated by her spine malformations. Fano, the youngest of eight children and very handsome, is the only one of his siblings to be born with a back full of hills where plains should be. The doctors examine this boy and girl as well as other patients on a wooden bench in a waiting room open to the hospital courtyard in the crowded hospital.
This March 19th-23rd medical outreach by Hadassah to Ethiopia, entitled Hadassah’s Scoliosis Surgery and Education Campaign, is the first mission to Ethiopia to undertake complex spine surgery. Ethiopia has very few spine surgeons and most of them deal with trauma, not pediatric congenital diseases. Mekelle, located in the center of Ethiopia’s northern Tigray region, is home to the Ayder regional hospital that services some eight million people.
Ties have existed over the last decade between Hadassah and Mekelle University, which includes schools of medicine, nursing, pharmacy, and public health. Expert in Infectious Diseases Prof. Alon Moses has been involved in joint investigative studies with Mekelle, and four Hadassah medical students do a rotation there every year.
Mekelle physicians and nurses were among those professionals who took part in the successful “Train the Trainer” program, led by Hadassah Hospital to combat HIV AIDS. Additional contacts initiated by Hadassah Spine Surgeon Dr. Josh Schroeder, coupled with donations, have brought the dream of the scoliosis surgical campaign to reality. “Somewhere in my mind,” says Dr. Schroeder, I have always felt we need to share our expertise with the neediest populations. When I was an intern, I volunteered in Africa. Now, as a trained surgeon, I have more to give.”
In addition to Dr. Schroeder and Prof. Moses, Dr. Leon Kaplan, head of Hadassah’s Spine Unit, joined the mission. They were accompanied by Anesthesiologists Drs. Yuval Meroz and Galel Yakobi, Spine Fellow Dr. Hananel Shear-Yashuv, and Intern Dr. Nadav Moses. Hadassah nurses as well as physical therapists are playing a critical role on the team. Reuven Gelfond, who was a leader in Israel’s aid missions to Haiti and the Philippines, took on the role of preparing and organizing the operating room, as well as bringing critical equipment. Deputy head of Hadassah Hospital Mount Scopus’s recovery room, Tsheay (Orna) Tadoses-Solomon, who was born in Ethiopia and speaks Amharic, will head post-operative care. Hadassah Hospital Ein Kerem Operating Room Nurse Ammar Farhat will work with Mr. Gelfond and the surgeons. Amir Maymon Shapira, a Hadassah nurse who is now Vice President of Medtronics, a medical supply company that contributed equipment to the mission, and Sagi Gudes, a neurophysiologist, will monitor the surgeries.
The multidisciplinary team spent this first day readying the operating room, examining patients, and planning the complex surgeries, slated to begin on Day Two.
Ethiopia: Day Two
As Day Two begins, Mebrat’s mom and dad don’t yet know about the success of her back surgery. They live in a farming town far from Mekelle with no phone or electricity. To convey the news, her brother-in-law Girmay will phone someone who lives closer and he will make his way by taxi or donkey to their house. Mebrat has been living with Girmay and her oldest sister Gidana in Mekelle for two years, ever since her back started to hurt so much. Also, the schools are better in Mekelle and Mebrat likes to study. She’s 16 and a tenth grader. But in the last half a year, the curve in her back went from a 45 to 70-degree angle, with fears that she would be 90 degrees bent over. She hid the deformity in loose clothes. She didn’t have a boyfriend and she knew it was unlikely to get married. Soon she would be at risk for life-endangering bouts of pneumonia because her back would interfere with her lungs.
Not a surgeon in Ethiopia could fix it.
But the good news for Mebrat was the arrival of the Hadassah spine surgery team. In four hours of surgery, using the equipment they had brought from Israel, layer by layer they exposed the twisted spinal cord. Screw by screw they chose the angel of repositioning the vertebrae. Working in tandem on two sides of the teen, spine surgeons Prof. Leon Kaplan and Dr. Josh Schroeder—long-experienced at doing surgery together-- placed the screws. The anesthesiologists overcame challenges of an underperforming lung and an unsteady oxygen supply. At last, nurse Ammar Farhat handed Dr. Schroeder a titanium rod. Dr. Schroeder cut it to fit Mebrat’s size, and grimaced as he bent the metal so that it would rotate and straighten her spine. Then the two surgeons worked quickly to attach hanging clips to hold the rod in place. “The last screw is in,” said Dr. Schroeder. A beat of silence and relief went through the operating room. All that was left was to close up her back. Fellow Dr. Hananel Shaar-Yeshuv did the sewing. While he worked, Hadassah nurse Orna Tedesu-Solomon coached the staff in the recovery room to ready a bed, sterilizing the area. Tedesu-Solomon is the deputy head nurse of recovery at Hadassah Mount Scopus and a specialist in minimizing pain. “My life’s dream was to be a Hadassah nurse,” said Tedesu-Solomon., who was born in Ethiopia. “I am so proud to being able to come back to Ethiopia for the first time in 27 years as a nurse and to be part of the team that helps this girl have quality of life.”
Mebrat, whose name means light, will begin physical therapy tomorrow and will be up walking soon. She’ll be straight and she’ll be at least two inches taller. All she can talk about is the surgeons whom God sent her way.
The surgical team had originally planned to do only one surgery on their first day working in Mekelle, but two emergency cases came up. A 21-year old young man who wasn’t wearing a seat belt and who flew out of a car, severing his back. The surgeons were on hand to fuse it back together.
This is the first time in Ethiopian history that scoliosis back surgery was successfully completed in Ethiopia. Other programs have sent these children abroad to be operated on, but the Hadassah team knows how much better it is to allow a child to be treated in a supportive home environment.
Ethiopia: Day Three
The Hadassah Medical Organization surgeons urged caution about celebrating this surgery until it was over. They were performing an extremely complicated spine repair on a 17-year-old who had a 110-degree back deformity. His twisted back was full of hills and valleys. The surgery would take many hours under anesthesia.
And so they began, slowly and carefully exposing layers of his back. Reminiscent of the Great Syria-African Rift, his back was lined on both sides by surgical screws with what looked like a pulsing river—his spinal cord--running through. The placement of the screws was just the beginning. Four metal rods needed to be cut and shaped to support his back. His rib cage, long distorted by his curvature, needed to be re-shaped. This process required literally hundreds of pieces of equipment, handed to the surgeons by Nurse Ammar Farhat. Surgeons Dr. Leon Kaplan and Dr. Josh Schroeder were again on two sides of the youngster, working in long-practiced tandem. “We don’t have to speak much,” said Prof. Kaplan. “We understand what the other is doing.”
A third set of surgical hands belonged to Dr. Hananel Shear-Yashuv, who is doing his Spine Fellowship at Hadassah. At each step, Anesthesiologists Dr. Yuval Meroz and Dr. Galel Yacobi gave the nod forward, helped by Operation Manager Nurse Reuven Gelfond, who hurried to roll in a new tank of oxygen when one unexpectedly ran out. Sitting near the operating table was Sagi Gudes, monitoring the patient’s neurological capacity. Key muscles and the brain were attached to a computer monitor to make sure no muscle function had been compromised. At many intervals, he shouted “Hakol b’seder” (All is okay)! and the surgeons went on to the next step.
It was a symphony of hammers and drills with the scent of cauterization frequently filling the air. The room was hot. The surgeons, working without air conditioning, frequently needed their foreheads wiped and water tubes pushed under their masks. But they never took a break. With the back reshaped, they needed to deal with their patient’s rib cage. Five ribs were manually cut out to make space for the ribs to heal over the new back. The metal rods now need to work together with the boy’s bones to protect this young man.
And who is he? This is Fano, a countryside boy, the youngest of eight children, who can now face the future with hope.
For the Ethiopian staff who took part in and observed this surgery, the bar was raised high to show the level of surgery that could be accomplished right in their own operating rooms. For the Hadassah team, it was an achievement to demonstrate that the high level of surgery they are famous for can be exported to the neediest of patients.
Post-surgery, Fano was moving all his limbs. He will be sore for a while, but he will walk straight.