Melkam Addis Amet or Happy New Year 2003 September 2010 Update

Greetings from wet and muddy Addis Ababa, where we hope the rain will stop by the end of the month. I’m writing this on September 11th, which is Ethiopian New Year. The Julian calendar is still in effect here, so I get to relive 2003!

The last few months have been incredibly busy with medical teams back to back to back from mid-June to mid-August. We saw a lot of patients, gave out a lot of medicine, did lots of counseling with patients and saw spiritual fruit with some people making decisions for Christ. Many thanks to Medical Campus Outreach from Augusta, GA, Highland Park Presbyterian Church from Dallas, Cedar Springs Presbyterian Church from Knoxville, and Covenant Presbyterian Church from Nashville. It was great to get reacquainted with some old friends and meet some new ones. One particular patient from our June medical team has kept me busy and challenged medically. This is her story.

Weusene is a 12 year old girl from down-country (outside of Addis), who was sent to a distant relative here at least a year ago in order to get medical treatment for a rash involving her cheeks, nose and mouth which she had had for at least 2 years prior to coming here. She was sent by the Kebele (local government office) to one of our outreach clinics in June.

I didn’t see her initially, but was asked to follow her after the team left, because they had put her on Prednisone, which needed to be tapered. Normally, we don’t follow patients we pick up at our outreach clinics, but this was a special exception. We had an “iffy” diagnosis of mucocutaneous leishmaniasis, which Teddy, our project manager made. So, between the end of July and early August, I was treating her for bacterial infection and tapering the Prednisone. At the beginning of August, we had a pediatric infectious disease specialist from Vanderbilt, who came with a medical team from Nashville. I sent him a picture of her face ahead of time and he was pretty convinced that this was mucocutaneous leishmaniasis. And what is mucocutaneous leishmaniasis? Well, it is a disease caused by the bite of a sand fly which affects the skin and mucus membranes (lips, nose, inside of mouth). There is also a visceral type which infects the liver and spleen and can be quickly fatal.

So how does one find treatment for this disease???? In the US, the drugs can only be gotten through the CDC in Atlanta. So I talked with a pharmacist here, who referred me to another pharmacist, who referred me to Médecins Sans Frontières Holland (Doctors Without Borders.) They are one of the few groups in the world that actually treats this disease (other than the US military). So Teddy, Weusene and I went off to their office in order to find out what the possibilities were for treatment. Initially, we were going to send her north to Gondar, where an MSF representative would meet her and her older sister, and take her to their treatment site on the Sudan border.

That was the plan, until their doctor in Gondar told them there was treatment available in Addis, at the Black Lion Hospital, which is essentially in the neighborhood of our main office. So they made us an appointment at Black Lion and off we went. We were taken to the Leishmaniasis Lab, where a swab was taken of Weusene’s mouth and told we needed to go to Alert Hospital where a biopsy would be done. So we got in Teddy’s car and went to Alert, where we met an Ethiopian dermatologist, an Ethiopian PhD student in Microbiology and a PhD researcher from Switzerland/London, who were all lovely. They took a biopsy of her face (ouch) and told me that this was classic mucocutaneous leishmaniasis, though they might not be able to see the parasite in the biopsy. There were no Dermatology beds available at Alert and no way to treat her at Black Lion, so they asked if I would treat her. After being significantly invested in this little girl, I couldn’t say no, and Teddy agreed. Then we all, including the two researchers, piled back into Teddy’s car and went back to Black Lion to get the medicine.

The treatment is with a drug called sodium stibogluconate, which is Antimony, a heavy metal–remember this from Chemistry?? Neither did I!!! It can be given by IV or intramuscular injection and is given daily for 30 days. It is a very painful injection, regardless of the route of administration. And because of the volume of medicine to be injected into muscle, it needs to be given in 2 injections.

Weusene has faithfully come to all her appointments, both before and since we started the treatment. She is very brave, considering that she knows that she is going to get 2 very painful injections everyday. After about a week, she had a lot of swelling in her face, which is a local reaction to the drug. However, at about two weeks, we started to see improvement in the swelling and the ulcerations on her lower lip started to heal. September 15th will be the last day of treatment. We go back to see the team at Alert Hospital on Sept. 20th, to see if she is really done or will need additional treatment.

So what happens to her after the treatment is done? That’s the question I’ve been asking myself. If she goes back home, she will likely become someone’s houseworker and never get an education (she’s functionally illiterate as it is) or be married at 15 or 16. If she is to stay in Addis, she will need financial support, as the distant relative she lives with has told us several times she needs to send Weusene back home because she can’t afford to feed another person, so I’ve been helping them with food each week. I’ve been praying about whether or not to support her here in Addis so she can go to school and have a future that is more promising than she might have otherwise. Teddy and I will need to talk with her, once a decision is made about her treatment to find out what she would like.

I’m going to Namibia from September 14-18 to attend the Africa Palliative Care Conference. Palliative/hospice care has long been an interest of mine and we are expecting that sometime in the not too distant future, we will need to start doing more palliative/hospice type care in our project, as less funding is available for AIDS drugs, first line treatment fails and second line treatment becomes less available. Another nurse from SIM, our partner mission here, is going with me.

Once back from Namibia, it will be a busy time until October 15th when I leave for a 3½ week trip to the US. I’m looking forward to seeing many friends, family and supporters. It will be a busy time there, as I squeeze in doctor’s appointments, visits with friends in MD, visits to NH and MA, shopping for things I can’t get here and a few days in Chattanooga at the Mission to the World Global Missions Conference.

Again, many thanks to you all for your faithful prayers, financial support, care packages, emails, snail mails, and Facebook messages. Here are some more prayer and praise items.

Praise:

  • Good summer medical teams
  • A new Amharic language tutor, who is excellent
  • Progress in Weusene’s treatment

Prayer:

  • Safe and productive time in Namibia
  • Preparations for trip to US
  • Income generating sewing project with ladies in our project
  • Continued financial support to be able to be here another 2 years.
  • Complete healing for Weusene and how to help her in the future

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