Tuesday, November 24, 2015



After our worthwhile introduction to Dr. Boachie's Focos Orthopedic Spine Hospital for just a couple of days, we bid farewell and caught our flight to Addis in the afternoon.  Dr. Boachie intended to join us on our flight, but due to a young patient emergency he decided to postpone his trip to Ethiopia by a couple of days.As I still had no real transparency into when I may receive my missing piece of luggage, the clothing items that Dr. Boachie kindly lent me were still coming in handy, though I was looking forward to laundering my own single set of clothing when I get to Addis.

On arriving in Addis the night of Nov. 3rd, I was pleasantly surprised to see that my tour operator friend Million had also brought Tesfaye to the airport to greet me.  It was very charming and amusing to see him wearing a t-shirt with my image on it that my son Justin had made a few years ago, together with a small bouquet of lovely roses.

                                                       NOV. 4TH CLINIC PATIENT EXAMS WITH DR. RICK
Our first full day in Addis we were spending most of it at one of Rick's spine clinics at his own relatively new JDC clinic, but we first had breakfast at our hotel. Naturally, on his way to meet me and my two spine docs from Vancouver, Chris Reilly and John Street, Rick saw a young man with a severe spine deformity on the street, so he picked him up and brought him to the Sheraton to find out the story. He was told to come to the clinic that afternoon, and we did see him there later.
I always find the clinic days seeing patients to be very interesting, though each case and story is as tough as the next. Because of so many extreme cases continuing to find their way to Rick, Focos hospital in Accra being the main outlet for corrective surgery,and the ongoing funding needs, it is necessary to make tough decisions about prioritizing the wait list and who to "invest in". Lots of factors to consider, e.g., age, severity,risk, available family support after surgery (or possible paralysis), etc. The old list of ranking from 1 to 5 had a new level of top priority created called 1*, but now there is even a need for a 1** level.
It was good to see the new permanent clinic set up for Rick. It became apparent that there are some information management improvements that can (and will) be made to make Rick's life a little easier in terms of managing and digitizing the patient records more efficiently. Each clinic day has a steady stream of old and new patients, and, of course, being in Ethiopia you have to also deal with the intermittent power outages and making do with natural light or firing up the noisy backup generator.

After coming from seeing Dr. Boachies' surgery setup at Focos hospital in Ghana, this was a good
"welcome to Dr. Rick's world" introduction for doctors Chris and John. With all the cumulative spine clinic time I have been exposed to over these years, I have learned more than I ever thought I would about spine disease.
At the end of the day Chris and John took in some of the streetscape while waiting to depart, and when we briefly stopped in at Rick's house I had the chance to say a quick hello to my old friends Balem Gebeyehu and Zemene Tiget.
Later that evening had a very pleasant dinner joining Rick as a friend, supporter and JDC Board member, with a very nice couple, Nick and Susan, that are supporters of JDC and Rick's work through a Foundation that Nick chairs.

THURSDAY NOV. 5TH was a “no patient” day. First I did some schedule rearranging on the fly for the two doctors Chris and John, and then I caught the tail end of a presentation Rick made to the local French chapter of Rotary International, which included slides of Tesfaye, Fanteye and Justin with the first school he initiated back in 2008. Rick introduced me to the group and I sat through a one hour lunch conducted in French.

Afterwards I sat with Chris and John discussing with Rick the anticipated steps for starting the research project on why there seems to be so much bad spine disease in Ethiopia, utilizing Rick’s 2000 patient records dating back to 2006, but the bulk of them from 2010 onwards. Using a general North American rule of thumb, the docs figure that based on Ethiopia’s population of around 100 million, you might expect at least anywhere from 20,000 to 50,000 spine cases, and Rick and Dr. Boachie have teamed up to fix about 500 of them. We talk about the need to catch the problem spines at an early age, but the challenge is getting to them in the countryside villages where 85% of the population lives. To do this we must train the rural health officers and educate the parents. Many villages don’t deal with bad spines as they feel the person is cursed and should be shunned.

Early evening I went by taxi to see Tesfaye’s new rental place, and when I arrived there the area was experiencing a typical power outage.  Tesfaye met me on the  street, and after cautiously weaving our way across the street through the dense traffic we walked up the dirt hillside path to his place with me illuminating the way with my phone flashlight app.  After entering their place in the compound I was warmly welcomed by Fanteye, Aselefew (another former spine patient they have been sharing a place with for 6 years, and Atsede, a 14 year old girl whom I first met in 2008 after returning from heart surgery in California, followed by spine surgery in Ghana; Atsede recently started living with them as her sponsor from the States could not continue supporting her at this time. They had candles going and made traditional coffee and popcorn, and I looked around their place, which has better features and is more spacious than their last rental I visited.

We had a nice time for a couple of hours until just as the power came back on I was picked up to go to the Airport to finally pick up my missing luggage.  After not having my suitcase for the first 5 days of my trip, we were happy to finally be reunited.


Chris and John spend the morning at Black Lion Hospital to meet with the surgical group and I went over to join Rick’s patient exams taking place at Cure Hospital, with Dr. Boachie  in and out between a few scheduled spine .  From time to time I step out and interact with crowd of waiting adults and children, and I seem to be an amusing distraction for them with my repertoire of Amharic phrases and tricks for children.

After attending so many patient exams over the years with Rick, I feel pretty accustomed to the various spine issues; as I say to Rick – “variations on a theme”.  Nevertheless, a number of cases present with extra complications, including polio cases that tend to have higher associated risks. 

Though the kinds of cases Rick sees are all very serious, given the sheer number of cases and the given capacity constraints at Dr. Boachie’s Focos hospital in Ghana, category 1 (out of 5) top priority cases have had to be divided into urgent subcategories of 1+ and now 1++. Lots of tough decisions.  One 14-year-old boy with all kinds of extra complications had a huge twisted “omega” spine that presented as a very high risk for surgery, but at the same time if not operated on then means a high risk of dying within 2 years.  He was a very sweet boy, an only child whose father had died recently.  At one point after examining another difficult spine case Dr. Boachie turned to me and said “you have got to find more money…these cases are endless”.

Friday night I attended Rick’s for one of his famous Shabbat eve dinners, and it was great sharing it with Tesfaye and Fanteye and seeing the whole gang of kids, many of them my old buddies.  As usual, with everyone wearing the colourful funny headcoverings we started with a few of the traditional Sabbath prayers, followed by Rick’s custom of everyone joining hands for the non-denominational group rendition of “If I had a hammer”.  I was exhausted and tried to leave early enough to pack and get a reasonable amount of sleep before catching the next morning early Saturday flight to Lalibela with Tesfaye, Fanteye, Chris and John. (see Lalibela trip highlights post above). Note: as usual, I didn't succeed in getting enough sleep.

Monday, November 23, 2015

My exhausting and exhilarating Ethiopia/Ghana trip Nov 2015

Dr. Boachie leading a case conference at Focos Hospital, Accra Ghana
NOVEMBER 1 - 3, 2015 

As I sit here back at home in Vancouver, Canada reflecting on (and recovering from) my just concluded, wonderfully intense trip to Ghana and Ethiopia, in chronological order I am going to try to give a sense of the fullness of the many experiences. For me there were two equally important elements to the trip: the chance to spend some quality personal time back with Tesfaye, his sister Fanteye, and other members of my Ethiopian family; and, the philanthropic "business" purposes of the trip, including visiting Dr Oheneba Boachie-Adjie and his FOCOS Orthopaedic Hospital in Ghana, launching the long-planned research into Dr. Rick Hodes' extensive collection of bad spine cases to see if there are ascertainable reasons for it, exploring opportunities to build more sophisticated spine surgery capacity in Ethiopia,reviewing the various current JDC programs in Ethiopia and deciding on strategies going forward, and touching base on the UBC Branch for International Surgery partnership with Gondar University Hospital relating to improving the trauma care systems and procedures.
Forgetting about the fiasco with my personal luggage not showing up for 5 days, after our long flight to Ghana through London our first couple of days passing through Ghana represented a visit to a new country for me and a very enlightening visit with Dr. Boachie and at his private Focos spine hospital that he built. Prof. B is a world renowned spine surgeon recently "retired" from the Hospital for Special Surgery in New York; though he may have retired from there, he is far from retired. Dr. B now is fully entrenched in a high pressure spine deformity surgery treatment program at his hospital in Ghana, taking on a steady stream of very complex spine deformities, many of them coming from the extraordinary relationship between him and Dr. Rick Hodes established almost 10 years ago. Together these two are "saving the world one life at a time" -- Dr. Rick is finding, without advertising, a seemingly endless number of severe spine deformity cases and Dr. Boachie operates on them after prioritizing them in terms of severity and urgency based on a number of factors. What a beautiful partnership between this devout Christian and observant Jew -- an example of what can be accomplished if people of different beliefs set aside their differences and join forces for the greater good .
Drs. Boachie, Reilly and Street

Leticia, Hospital Administrator

At Dr. B's Focos hospital he has the highest number of pre-surgerytraction patients out of anywhere in the world. It was very interesting for me and the two Vancouver spine surgeons that accompanied me on this trip - Dr. Chris Reilly from BC Childrens' Hospital and Dr. John Street from Vancouver General Hospital - to see Dr. Boachie's setup, observe patient conferences, tour the facilities, and interact with the patients and high calibre staff at FOCOS. 

It is amazing how comfortable the kids get with their traction, which often is done for four months; they are smiling and racing around the premises much of the time.  A lot of lives are being changed at Focos.  I the the new Focos hospital facility with its sophisticated equipment and ICU had been around back in 2008, they likely would have decide it was safe enough to operate on Tesfaye then and there.  How different the course of why life and Tesfaye's over the last 7 years or so would have been!  Chance, or meant to be??