Part Two: Medical Malpractice Suits and Long Showers

There are many things that keep me up at night here, other than the persistent itching of mosquito bites and constant barking of my seemingly nocturnal dogs. One of these things is what I would do if I got really, really sick here. The thought of needing immediate care terrifies me, not because there are no doctors or hospitals in Gondar, but because of the quality of the medical care— my friends who are doctors here say that even they wouldn’t go to the hospital if they were ill. There are a number of issues with the health care system here, but since I am not deeply involved with it, I will only go into a couple of the issues that I know about.

First is the issue of accessibility of care, both in terms of the existence of care and the ability to afford it. This is not an issue that I would not have to face should I get sick, but then again, I am not at all representative of the population of Ethiopia. In rural areas, the only medical knowledge and remedies available might very often be limited to traditional medicine, such as bathing in holy water.  JDC has recently started an innovative rural health outreach program, in which Ethiopian doctors from Gondar (as well as myself) travel to schools in rural areas and treat children who have no access to modern medical care. Last visit, the most common cases the doctors saw were epilepsy, vitamin A deficiency, and chronic ear infections, which can lead to death, blindness, and hearing loss, respectively.  One or two of the eighty kids seen were referred for medical treatment at Gondar Hospital, but otherwise, the rest were treated with simple medication. Yet, without this medical intervention, which many adults and children do not receive, serious impairment and even death is likely.

Whenever I go on one of these weekly rural health outreach visits, I am always so touched by how caring the doctors are and the attention that they give to each and every child who comes to see them. However, I wonder if these doctors are an exception, as I know there are serious issues in the hospital with the care given by doctors and nurses. On rounds with residents, I watched as corrections given to each patient’s care by the senior doctor went unnoted, an issue that I have heard also goes for nurses, which infuriates visiting doctors and nurses and leads to issues with patient care. I also listened as residents and interns discussed diagnoses and treatments they had already prescribed, which senior doctors pointed out as incorrect, and in some cases, harmful to the patient.

While I know that in the US there are issues with inattentiveness to detail and mistakes made by doctors, American doctors are also liable for these mistakes, which is not the case in Ethiopia. If one of the patients incorrectly treated by one of the interns, or any other doctor, dies from the mistake, the doctor is not legally held responsible. The same is true for nurses. This lack of liability can lead to serious problems within the medical system. A visiting doctor told me a story of patient who was in serious distress one night at the hospital, but the only medical professionals the family could find sent the family away, saying they were on break. The patient died. This is not to say that medical malpractice causes responsibility and that it is not abused in the U.S.; rather, the hope is that this morality exists already and that medical malpractice is a means of holding those responsible for gross negligence and malpractice.

A student getting a vaccination at the school where I teach, a very positive relationship between the healthcare and education systems

Even if all the doctors were as attentive as those who take part in the rural outreach program, doctors here face serious problems in terms of medical supplies. Also while on rounds in the hospital, I frequently heard that certain medications and tests were either not available or had run out. Some of this was temporary and these medications and tests would be available in other places, but some supplies are truly unavailable. One American doctor told me that she had to resort to using a very old version of a medication that causes side effects almost as serious as the issue being treated. Yet, as the newer version of the medication, used in the U.S., is not available in Ethiopia and the issue needed to be treated, she had no choice but to use it. Not only do doctors here face issues never seen in the U.S., but they must also develop treatments with little testing and outdated and limited medications. Combine this with limited access to any medical care, lack of public knowledge of when to seek treatment, and issues of accountability among healthcare professionals and you have a serious healthcare crisis that often keeps me awake late into the night.

There is often one simple cause for many of the medical issues that we see in rural areas, something so basic that in developed countries, we hardly ever give it a second thought, even as we waste it in abundance –water. We are 14 years into the 21^st century –Amazon is proposing drones to deliver packages, high-end cars can drive themselves, and computers can do just about anything. Yet, around the world, there are 800 million people who do not have access to clean water. The concept of not having water, coupled with such large numbers, can be difficult for those of us who guzzle bottled water every day to comprehend. Driving around in a cab in Manhattan last year, I saw this PSA from charity:water come on the taxi’s TV, and was struck by how simply it depicted a developing world problem with a developed world perspective. The idea of not having water might not seem so bad at first thought – just not being able to shower, right? But try not using the water in your house for a few hours and you will see what a big part water plays in our lives – we drink it, bathe in it, keep our homes clean using it, keep our pets hydrated with it, cook with it, and constantly wash our hands with it.

Many people here do not have close access to water, and the water they do have access to is not clean. The country seems over-run with water during the rainy season, but after those four months, river beds dry up and water is hard to come by, even in a house with (occasional) running water like mine. This means that people who no longer live by water have to walk every day just to get the most basic necessity, water.

A girl washes her face and drinks from a stream at a site where JDC is building a well for the community

When I go to visit the wells that JDC builds in rural areas, I hear from people what their life was like prior to having a well. They tell of suffering from dehydration, of sending their kids to school in the heat without water, and of having to walk for an hour each way just to get water, only to find that water cruelly betray them, giving them intestinal parasites and bacterial diseases because it is unclean. Yet, with no clean water available, what choice did they have?

Even with access to clean water from a well, they can only bring home as much as they can carry. Along roads in rural and even urban areas, you see women and children with yellow jerrycans (plastic containers of all sizes), often not much smaller and certainly heavier than their bodies, roped to their backs as they walk home. If they’re lucky, they will have a donkey that will carry extra water. This container of water is all they have for the consumption of an entire family (which we usually estimate at 5 people) –for drinking, bathing, cooking, cleaning, and on top of all of that, for livestock as well. Imagine having to take care of a family, of a home, of livestock, and on top of all of that, walking long distances every day or every few days for water.

A woman loading a jerrycan of water on to her back so that she can carry it home

With so little water, families often do not bathe or wash their clothes often. This, combined with a lack of knowledge of sanitation, leads to the many scalp and eye infections that I see when I am in rural areas. Water also accounts for many of the intestinal parasite cases that we see during the rural outreach program. It is not surprising that lack of water leads to deaths, but that water itself also causes deaths is much more difficult to imagine.

All of that is to say this: it is 2014, a time of so much development, yet, there are millions of people who do not have access to a nearby water source, let alone a water source that is clean. I cannot think of a better example of the great economic divide that exists in our world than the fact that there are people who, without thinking, guzzle $40 bottled water (it exists, I’ve seen it), swim in pools of purified water, and spend extended periods of time under their six shower heads in a shower with mood lighting while there are people who have to walk two hours to get water that will in turn dehydrate them from the diarrhea it will give them. If you stop to think about it, it is truly mind blowing that people are still struggling every day to attain the most basic necessity of life.

Now that your mind has been blown, I want to say this: the purpose of these two posts was not to make you feel bad for what you have, or to pity those here who do not have. Rather, the purpose of this post is awareness, as being here has opened my eyes to how truly lucky I am to have been born in a developed country. At the start of every new year, we are so focused on ourselves –what can I do in the coming year to lose weight, find a partner, get a promotion, etc., and perhaps in this holiday spirit and new beginnings, we lose sight that there is more outside our little bubble. No, taking a shorter shower will not mean that people in rural Amhara will suddenly have clean water, just like not buying those cute winter boots won’t bring shoes to someone here. But take a few minutes to read about what life is like in other places around the world, in places like Ethiopia, India, Myanmar, and so on. Read the UN’s Millennium Development Goals to understand statistically how much of the world lives. I could easily list dozens of links to sites with more information on these topics, but sometimes the best way to understand a situation is to look into it yourself. Maybe you’ll find a great organization like JDC that helps people in need and decide that you want to support it. Maybe you’ll start your own initiative at your church, synagogue, workplace or school. Or maybe you won’t. Maybe you’ll just feel a little more grateful for all that you have. Maybe next year, you won’t need Thanksgiving either.