Tag: Ayder Hospital

A day in the life of a neurosurgeon in Tigray, Ethiopia battling a deadly brain tumor

The author assisted by a Mekelle University neurosurgery resident performing microscopic brain tumor resection at Ayder Hospital in 2018

The neurosurgical team of Mekelle University’s Ayder Hospital struggles to save the life of a poor farmer from a deadly brain tumor. A critically ill patient who faced death unless he underwent emergent brain surgery.  An intense multi-hour confrontation with a brain tumor.  This became an almost everyday occurrence for our team. 

I had come to Ayder Comprehensive Specialized Hospital in Mekelle, Ethiopia in 2015 to start a neurosurgery program. This was a federal teaching teaching hospital  and part of a university medical center serving about 15 million people. We wanted to create a sustainable medical service that also train neurosurgeons. 

As the family said goodbye to him he left the ICU for the operating room. He had been intubated and resuscitated in the emergency room where he presented with coma. A young uneducated farmer from a remote primitive area who had been deteriorating for a year and half. Tumors in this part of the world are large and angry because they present so late.

A large 4th ventricle tumor next to vital structure would be difficult to remove

The MRI of the brain showed a 10 centimeter ependymoma in the fourth ventricle which was highly vascularized. This is the type of case neurosurgeons dream of, a mix of danger and hope.

The residents and fellows do the initial opening until the back of the brain is exposed which takes the first hour of surgery. I can see the tumor erupting to surface with very swollen blood vessels around it. Instead of the ependymoma (an easier tumor to remove) this was going to be hard. I begin working a millimeter at a time. Gently dissecting tumor from brain, isolating and separating scar bands and blood vessels. Using directed light and magnification for the next 8 hours I cannot take even a 5 minute break. Removing the tumor means there is constant blood loss. The brain receives more blood than any other organ. Tumors cause extra blood vessels to grow into them. As you control one bleeder another 2 start.

By the fourth hour into surgery he has lost 5 liters of blood and his blood pressure is fragile. By the sixth hours there is still about 20% of the tumor left which is covering the cerebral aqueduct. This must be removed to allow flow of cerebrospinal fluid. We are millimeters away from vital areas that cannot be damaged.

Another 2 hours goes by and there are times when the blood loss starts again and pressure gets low even with another 2 units. After 8 hours from the beginning of my part of the surgery the tumor is completely removed. The patients blood pressure is holding thanks to high dose epinephrine (a drug to raise blood pressure in critical patient). Now comes the hardest time. Will the patient wake up? He goes to the intensive care unit and we wait. After a few hours he begins to move in a way that suggest he will emerge from coma.

This is the life of neurosurgeon. Fighting to stay on the brink of life for hours at a time.

Neurosurgical consult for snake bit in Ethiopia

Artist rendition of Ethiopian puff adder about to bite the leg of a passer by. His CT of the brain upon presentation to Ayder Hospital, Mekelle University showed multiple sites of intracranial hemorrhage. 
 
A case from 2019 in Mekelle, Ethiopia at Ayder Hospital. A neurosurgical consult for snake bit (not too common) causing brain hemorrhage.
 
This 21 year old man was bitten in the foot by an unknown viper, we latter determined it was most likely an Ethiopian puff adder, three days before being referred to our university hospital for sudden onset of coma after two days in a local hospital without antivenom. On arrival he was bleeding from all orifices and the intravenous site. Platelet count showed no countable platelets and bleeding time was not measurable. On seeing him he had no brain function but agonal respiration. We could not save him.
 
There a few case reports in Africa of similar nature usually occurring on the third day or so after the bite. I had not seen this in Ethiopia before but many people often do not seek treatment and assume they are going to die. It is imperative that victims of viper snake bit seek treatment at a university hospital with antivenom and advanced capabilities. He came too late for us to save.

Medical Director gives witness of Mekelle bombing and severe shortages in Tigray

Medical Director of Ayder Hospital in Mekelle , Dr. Kibrom Gebreselassie Desta Source: Facebook

The following is a copy of the account given by Dr. Kibrom Gebreselassie Desta, Medical Director of Mekelle University Ayder Hospital of the bombing of the kindergarten in downtown Mekelle as documented on his Facebook.  The horror of injuries and death was magnified further by the Ethiopian government’s siege of medical supplies which rendered severely limited what medical care could be given to survivors.

 

It was noon.

Staff were leaving the hospital for the midday break.
 
I locked my door and sat in the couch. I didn’t want to go home for lunch. I know I have no prepared lunch at home. It has been more than a year since I got my salary, like any Tigrea government employee. Every commodity that you can get in the market is at least 10 times more expensive than its pre war value. But this too is if that commodity is available. Eating once a day is a routine thing for someone who can afford it. For someone who is the director of the biggest referral hospital in the entire region. For someone who had spent two decades in medical school, a subspecialist in Cardiovascular and Thoracic Surgery like myself. For the common people imagine how hard life is.
 
Our friends and family members who live abroad send us money sometime when the have means to do it. Dealers will cut a minimum of 35% of the cash and they give you at an exchange rate which is too low than the bank rate. You should be grateful as this is your only hope to see the sun rising the next day.
 
Photograph of the kindergarten bombed in Mekelle on August 26, 2022  Source: DW
 
While dozing in silence I was started by the sharp noise of an Ethiopian military jet. It was followed by a deafening explosion. I thought my hospital was the target. I run to the emergency room. Everyone was alert and ready to receive the victims. The head nurse told me he saw smoke in the neighbourhood which was at least one kilometre away from our hospital.
We heard the siren of an approaching Red Cross ambulance. It brought an injured elderly woman and a dead boy, at least 17 years old. He had a big hole in his chest. His heart was blown out. An instant death for the kid, but a lifetime horror for the woman who had to endure the scene in the entire trip. Soon more ambulances brought dead and injured children of the air strike. The target this time was a kindergarten. The children’s Amusement Park was completely destroyed. The area is a quite neighbourhood with no military installation or camp. Ethiopians, like their Eritrean allies are known to target market places and schools. They did hit their target once again. We in the receiving end of their two year long atrocities, it is another day of sorrow and bitter sadness.
 
In a hospital which has no budget in a year, with a staff who haven’t received their salary in 16 months, with no electricity (our sterilisation department, the operation theater, imaging department are not functioning because there is no fuel for generators. NGOs like WFP, USAID, UNICEF, WHO and OCHA were asked for help, none of them could help us. The treatment we got from UNICEF was the most painful. The guy there laughed at us when he heard neonates are dying of hypothermia. USAID and WFP opted not to respond to our quest. The others at least shared our pain.) or telecommunications services, here we are to treat our wounded. The emergency physician approached me and asked for more intravenous fluids. Her tears were visible. She knew the hospital has no fluids nor antibiotics. All I can do is shed my tears with her.
Such is our life in Mekelle, Tigray.
This too shall pass!