The following is a story of a single patient treated at Mekelle University’s Ayder Hospital where I was the Head of Neurosurgery. You can multiply the saving of this one life tens of thousands of times to recognize the work of our hospital. Originally written in 2018 in an international neurosurgery forum before the Ethiopia Tigray conflict. It was a time of hope. I have altered the writing for a different audience here to show how life was improving in Tigray. That we could bring something new to Tigray and help the farmers whose lives had seen too much killing and death in the past. I pray these days will come again. Advocates for blockade of Tigray which denies medical care to the people of Tigray try to paint them falsely as less then human. Instead the reality is that most of them are poor farmers living a hard life.
A Day in the Life of a Neurosurgeon at Mekelle University Ayder Hospital
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. The MRI of the brain showed a 10 centimeter tumor in the fourth ventricle which was highly vascularized. This is the type of case neurosurgeons dream of, a mix of danger and hope. Besides giving sophisticated medical care we were building capacity to continue this care for future generations by training surgeons, anesthesia professionals, nurses, and others to serve more than a 7 million population.
The residents and fellows do the initial opening until the back of the brain is exposed which takes the first hour of surgery. Through the donated microscope 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. A wrong move could kill or result in crippling paralysis.
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.
He left the hospital fully functional and returned to his farm. I pray he has survived the war. One precious life saved and the building of hope for a better future.