The International Hydrocephalus Association was here this week documenting the problems that children (and neurosurgeons) face in the treatment of hydrocephalus (build up of spinal fluid). Back home, children with this problem are treated from birth (or even before). Here, kids must wait at a minimum several months to be admitted and treated. It is a daunting public health problem in Ethiopia.

It has taken me some time to realize that if a patient's family has not donated blood, there is no blood available. Such was the situation this week. A patient had been admitted to the ICU with a severe head injury. I may have alluded to the fact that there is no CT at the public hospital. Consequently, if the skull x-ray is normal, we are left with a sort of guesswork as to the underlying problem. By contrast, back home, every person who has had any sort of trauma gets a CT scan of their brain (and probably their whole body). Now I cannot say that our system is necessarily the best either, but at least we have a better idea of what the problem might be.

So, before my eyes, I see our patient's pupil get bigger and he has stopped moving one side of his body (these are both grave signs). My natural instinct is to whisk him off to the OR and try to remove the blood clot around his brain that I imagine is his problem. The difficulty I find is that his family has not had time to donate blood. It is a very stressful situation to operate without the certainty that our patient can get blood if we get in trouble. But we try and find an enormous blood clot outside of his brain. In the process however, he bleeds profusely. Fortunately, we were able to stop the bleeding and return him to the ICU. I think the only right course of action in the future is to not operate unless the family has prepared blood. That is a difficult reality to accept when we think we can help someone.

Here is the view outside the former palace of Haile Sellassie. Regardless of your political orientation, it is indisputable that the man had panache.

The other major issue for children along with hydrocephalus is neural tube defects. This little boy had a mild case compared to those that we normally see in our clinic. Unfortunately, this boy was already paraplegic. But, we took him to the operating room and closed the defect that he had. Over the next week, we can hopefully get an idea of how many children are waiting to be admitted and treated for these problems. I imagine the number is daunting.

Fortunately in America, the number of babies with these problems has been dramatically reduced by improved education about prenatal care and prenatal nutritional supplementation. As the awareness and education of rural Ethiopian communities grows, hopefully a similar impact can be felt here.

Here is another girl that came to the hospital with a few week history of not being able to move her legs. The myelogram showed a mass at the T5 level in her upper back. She is only 14, an extremely young age to have such a problem. In surgery, we found a large mass inside the covering of her spinal cord (intradural). It seemed like another meningioma.

This week, I also received a computer which Sarah (my previous counterpart) had sent to be given to Abdysa at the orphanage. So off we went. When the computer is up and running, hopefully Abdysa can use it to get the internet, and increase his contacts to support his mission. In the week since I had visited him last, Abdysa has adopted another 3 children - so now he is the father of 21 children who would otherwise be without a home.

While we were there, we once again had a chance to enjoy the Ethiopian traditional coffee ceremony. Here, you can see one of the girls grinding the coffee beans which she had freshly roasted. The coffee here is truly the best in the world.