Global ENT Outreach: Taking Ear, Nose, and Throat Treatment and Surgery Techniques to Ethiopia

Article excerpt

Africa is a destination for only 2 percent of the 24 million Americans that travel outside the USA annually, and the majority who venture to the African continent go for safaris in Kenya or for a visit to the beautiful cities of Capetown or Johannesburg in South Africa. So why did this American physician go to the hidden empire of Ethiopia on the Horn of Africa? Answer: Because there were eleven children who could not breathe because of respiratory papillomas blocking their airways, and they had been hospitalized for years. My mission and my desire was to get them back to their homes and families!

The disease, called juvenile respiratory papillomatosis, is what affected these eleven Ethiopian children. It is transmitted to the newborn during the delivery process as the child comes through the vaginal tract that is infected with condylomas, a wart like growth. The condylomas harbor the human papilloma virus (HPV), and the transfer from the mother to the child occurs via inhalation into the upper respiratory tract of the newborn. Once in the upper respiratory tract, the virus can remain dormant or grow to the point of causing airway blockage requiring emergency tracheotomy, the placement of a metal tube in the neck to bypass the blockage in the larynx, or windpipe. In developed countries or countries with substantial resources, lasers and/or mechanical debriders are used to remove the viral growths before they block the airway and require a tracheotomy.

An otolaryngologist and the Director of Global ENT (Ear, Nose and Throat) Outreach, I traveled to Ethiopia, a country of 77 million people, in 2004. In this region of the world, a lack of resources and skilled physicians resulted in these eleven children, ages three to eleven, being hospitalized, some of them for years. All of them had tracheotomies, because there was no means to remove the blockages, let alone provide the needed care to keep the tubes clean from the build up of secretions. The hospital lacked the needed portable suction machines, sterile water, cleaning kits, as well as home health services and respiratory therapists, that are required to allow patients to go home with tracheotomies.

With the help of Medtronic Xomed, USA, a manufacturer and distributor of surgical products for ENT specialists, and the government of Ethiopia, I mounted up resources that allowed me to take new technology to the Black Lion Hospital in Addis Ababa, the capital. The debrider, which is a mechanical shaver that removes surface growths, was introduced into Ethiopia at the time of my visit. Within one week, nine of the eleven children who were operated on had their tracheotomies removed and were allowed to go home. The remaining two children required numerous procedures and were hospitalized for an additional week before going home. Some of the children had not been home for years and had received schooling and daily care from the Black Lion Hospital, the teaching arm of the University of Addis Ababa School of Medicine.

As a nation, Ethiopia is faced with poverty, malnutrition, internal political strife, and an active dispute with Eritreria on its northern border. To the southeast is Somalia, a country run by Islamic militants and considered to be a haven for terrorists. To the west is the Sudan, which is plagued by civil war and a starving refugee population. Needless to say, unrest abounds in Ethiopia, and only nine ENT physicians are found in the entire country. All of them live in the capital of Addis Ababa, a city of 5 million people and the home of the African Union. The monumental task of treating the 11 children mentioned earlier was small compared to the new challenge I took on of teaching ear surgery to two of the nine

ENT physicians in Ethiopia. Hearing loss affects close to 10 percent of the world's population and is a major and under-recognized global health problem that has enormous social and economic impacts, limiting the education, employment, and social participation of what would otherwise be healthy people. …