Week of Noma

So my first week of 4 has flown by and I haven't been able to post due to the extreme slowness of the internet connection at my brother's house... I can't even get the blogspot page to load much less think about creating a post. This morning I am at the cafe at the American embassy making the most of the high-speed connection to share some pictures and stories of my first week.

Typical Addis streetscape.

Andrew and Kayo's house: the lap of luxury!

I have split my time so far between the diagnostic labratory of a private hospital called Bethzatha and a place called the All-African Leprosy and Tuberculosis Education, Rehabilitation and Training Center (ALERT). Dr. Yohannes, the doctor with whom I am working and one of about 20 pathologists in all of Ethiopia, works at both places. I could not be luckier having him as my teacher this month. He has a great sense of humor and is passionate about what he does. He spent 20 years in France so we have been having fun communicating primarily in French. After 20 years of practicing in Ethiopia he is heading to Guadeloupe in 2 months for a more lucrative position with the French Government for a year or two. The car he drives is the same age as me... he wants to at least earn enough money to buy a car.

Dr. Y on the left and the long-time lab technician at ALERT

A pathologist's job in Ethiopia seems to consist mostly of doing cervical lymph node FNAs and bone marrow aspirations (Dr. Y does all sternal aspirations). This week we did about 6 a day. However, he is a jack of all trades. He also grosses in all his own surgical pathology specimens, which happens on Tuesday and Thursday afternoons. He stains his own slides. He writes his own reports. He does an amazing job of explaining the FNA/bone marrow aspiration procedures to anxious patients. Dr. Y at the microscope.

This week I also spent time with a plastic surgeon at ALERT. He was equally inspiring. He makes a total of $360 a month and does totally life-changing surgeries on leprosy and noma patients. I had never really heard of noma before coming here. It is a flesh-eating and disfiguring infection that can occur on the faces of malnourished children. There are currently 5 noma patients at ALERT that are undergoing reconstructive surgery to give them new lips, cheeks and noses. Most of them are in their 20s and have had their deformities since childhood.

Me and Dr. A the plastic surgeon.

Operating on a noma patient with Dr. A.

This is a noma patient's oral region before skin grafting.

The facial reconstruction happens in stages. The picture above shows an intermediate stage: a flap of skin and subcutaneous tissue from the clavicular and deltoid regions gets brought up to the cheek, attached with sutures and left there for 3 weeks so that it can form new vascular connections with its new environment. The flap is then cut and grafted tissue is revised to form new lips/cheek/nasal tissue for the patient as needed. One of the noma patients we operated on literally has no nose and no upper lip. It's absolutely devastating and I don't feel comfortable posting my pictures of him to this blog.

To end things on a positive and cute note, below is a picture of my nephew Nicholas, only one of the cutest babies ever to grace the earth.