Wednesday, October 3, 2001/lk
Dr. Michael Hauty crossed a personal border this summer. It happened on a mission in Africa, and he's a better doctor for it.
Hauty spent the month of July volunteering in a remote medical outpost in Dubti, Ethiopia, working for Doctors Without Borders, an international medical aid group serving troubled regions of the world. Known globally as Medecins Sans Frontieres, or MSF, the group was awarded the 1999 Nobel Peace Prize. MSF provides 2,000 volunteer medical, engineering and other personnel to 18 countries facing poverty, epidemics, natural or man-made disasters, or armed conflict.
Hauty worked with minimal medicines and substandard equipment and staffing in the state of Afar, a region of 120-degree heat and pervasive poverty 400 miles from the nation's capital of Addis Ababa.
"I felt able to provide good surgical care and relieve a fair amount of suffering, in addition to recharging myself," said Hauty, 50, who took leave from Providence Hood River Memorial Hospital to serve in Ethiopia.
"It gave me an appreciation of what a great job being a surgeon is," Hauty said.
The experience was so rewarding to Hauty that he plans to go on an overseas mission at least once a year. He is considering returning to Ethiopia, a Horn of Africa nation that has experienced starvation, civil war and extreme political turmoil in the past 20 years.
"One of our core values is compassion and Dr. Hauty certainly lives out the mission and values by volunteering to provide medical care in places where it is a scarce commodity," said Jean Sheppard, associate administrator for PHRMH. "His commitment to help others at great personal risk and sacrifice is truly admirable."
"It is hard to state how primitive the hospital and the care was," Hauty said of Dubti. "We could do sophisticated surgery but nursing care and standards were primitive."
"This was my frst mission but the surgeon who had been there before me had been on a variety of missions and said that by far this was the most primitive he had seen."
MSF worked with regional government to develop Dubti as a district referral hospital, but Hauty fears that funding disagreements will mean MSF will have to pull out of Dubti.
Before the hospital was set up, "All they could do was send them to Addis Ababa but no one could go because of the distance and they had no way to get there," Hauty said. "So things weren't treated."
MSF works in two types of missions: "urgency" and "restorative." Dubti hospital was one of the latter. It was originally an infirmary for a cotton plantation that was nationalized by the Marxist Ethiopian regime of the 1980s. Soviet-era military equipment and even some Russian-language signs are still visible in the Afar region where Dubti is located.
Hauty said restorative missions are tougher because of the necessary interplay between local government and MSF. Dubti was intended as a "rehab of a hospital" so it could provide local care, but it appears it won't be continued by MSF due to funding diagreements with the local state government.
He worked with Ethopian nationals and local staff, along French doctors and nurses. Though medicine for tuberculosis and malaria were short, "we had a lot of staff -- a surgeon, nurse/anaesthetist and three scrub nurses," Hauty said.
The hospital provided obstetrics care and treated numerous trauma cases, including victims of severe car crashes -- despite the fact that there are very few cars in the region.
"There were no orthopedists so I got to do a fair amount of bone work," Hauty said.
Yet the hospital had no x-ray machine and no ambulance.
"Everyone travels on foot, and they only come to civilization under duress," he said. "Some had also been treated by traditional healers." Hauty said MSF admonishes providers to "appreciate and accept" native healers, but he had little direct contact with them.
Hauty expressed surprise at how many people still lead nomadic lives, and at the prevalence of mosquito-borne illnesses in such an arid landscape.
In addition to the malaria, tuberculosis was a problem due to "poor sanitation and squalid conditions," he said.
MSF provided medicines and supplies but he feared much of it, in particular the TB medicine, wound up in the black market.
"Sometimes, we didn't have any supplies," he said. "No drugs for TB or meningitis. Every bit of suture was used -- right down the needle. And the instruments were very old. But that's what we had and what we used to make it work."
Once the hospital lost water for five days.
"We had to truck it in, and ration it," Hauty said. "I would scrub up while an assistant poured water over my hands. They would send a driver 10 kilometers to fill up jerricans. A hospital needs a fair amount of water -- more than a Land Rover with a few cans in it can provide in a day."
One patient who made a particular impression was a nine-month-old boy whose mother was killed in a car crash; she was one of four wives of a Muslim man and no one claimed the child for four days.
"We were concerned that the child would be abandoned, because that's been known to happen. He was brought in by a neighbor, who left him, and for four days no one claimed him."
Another common problem was snakebites, many of which had gone untreated for days, months or even years.
"In many cases all we could do was amputate," Hauty said.
"The needs are overwhelming," he said. "Standard drugs such as antibiotics are losing their effectiveness."
The 150-bed Dubti hospital had 50 working beds, and it provided outpatient surgery where dentistry was the main need.
"A lot of what was done was pulling teeth," he said. "There are no dentists there."
He also saw "a lot of blindness," from illnesses transmitted by mosquitoes and unclean water.
"One of the hardest things for me to deal with was the amount of blindness, including a lot of young people," Hauty said. "We saw a lot of premature cataracts and glaucoma." Hauty said training in opthalmology would be helpful in future missions.
Temperatures reached 115-120 degrees during the day; even with fans and air conditioning it didn't get below 90 degrees.
"By the middle of the day we just had to stop working," he said. "I could hardly go for a walk during the day so I stayed in my room. I kept myself company by reading a lot of thick books and playing my guitar. I also brought my yoga mat, and my 30-odd years of practicing Bikram yoga (practiced in rooms heated to 100 degrees) made exercising in the desert easy."
The language connection was problematic at times. Hauty, who speaks French, had translators into the national language of Amharic and the local Afar. However, during night emergencies he sometimes resorted to handsignals in talking to nurses.
"They didn't always understand my written orders, but it sometimes didn't matter because their were no supplies anyway."
Hauty went to Ethiopia to answer some of his own questions about being a surgeon: he was growing weary of the profession, but was unsure whether it was the business part of medicine or the health aspects of being a surgeon that was burning him out.
What he accomplished in Dubti helped answer the question.
"It was a pleasure to tell that it was the business aspects," he said. "It was a privilege to go there and provide for these people. It was really exciting. There is nothing quite like it."
The human gratitude for healing touched the doctor.
Hauty helped at a direct observation treatment (DOT) center not far from Dubti, where there were 115 patients when he arrived, and 200 when he was done.
"With all the relatives, it created a village of 500-600 people, along with goats and camels," he said. "Families in some cases had waited three days to see a doctor. They were grateful for anything we could do."