'We have a 40-year-old male here with rectal pain and a fever," Ronald Lett bellows at a group of shy Ethiopian medical students scribbling meticulously in their notebooks. The heat is so intense that it's hard to tell if the budding doctors are focused on making a diagnosis or just trying not to keel over.
As the patient rubs his upper thigh and moans, Selamawi Kidanu, the student examining him, looks down with a boyish smile and checks the man's blood pressure. Sensing that an abscess could be the problem, he recommends a course of antibiotics to keep the infection from spreading.
But moments later, the Alberta-born Dr. Lett is tapping Mr. Kidanu on the elbow and coming across like a frantic nurse: "Doctor, he's becoming short of breath! Look - he's getting a rash!"
In fact, every mistake seems to have dire consequences. When one student forgets to ask about allergies, the patient has one. When another doesn't get his assistant to help with a tool, he is told that his dithering has doomed the baby he was trying to resuscitate.
But it's all pretend, part of a role-playing exercise that is meant to provide young Ethiopian doctors with the skills they will need when thrown into one of the country's disastrously overstretched public hospitals, explains Dr. Lett, director of the Canadian Network for International Surgery (CNIS).
During the five-day CNIS workshop, the students will work on plastic torsos, perform colostomies using animal intestines and pilot chest tubes toward the stiffening lung of a freshly slaughtered sheep.
"In the ideal set-up, the students should do everything on the model before they go to the patients," says Ethiopian surgeon Mulugeta Tena, one of the workshop's three instructors. "But that hasn't been happening."
MASSIVE WORKLOAD
A city of 125,000, Hawassa is a few hours south of Addis Ababa, the macchiato-crazed capital of a country infamous for its famines, droughts and on-again, off-again border wars with Somalia and Eritrea. The hospital here serves an area with 15 million people - 50 times the population served by a hospital in North Vancouver, Dr. Lett says.
The austere white building overlooks a city suburb where steel-roofed, one-room houses mimic the uniformity of suburbs in the West and the dust from passing taxis settles slowly. Women travelling on rickety donkey carts wipe the dirt from their foreheads with white, cotton handkerchiefs and stern-faced 10-year-old boys, driving herds of horned cattle, press their lips together so that the windswept sand doesn't enter their mouths.
Originally from Grande Prairie, Dr. Lett has practised medicine in Manitoba, Quebec and British Columbia, as well as Africa, and founded the CNIS in 1995 in a bid to improve surgical practice on this continent.
Although he often grumbles over the slow pace, and throws his hands in the air when the class is forced to wait outside the lab for "the man with the key," he is determined to increase the capacity of local health-care systems.
He is also quick to point out how much his approach differs from that of the high-profile agencies he competes with for funds - the ones that focus on infectious diseases.
While HIV and malaria make easy headlines and inspire celebrity-driven campaigns, the grim state of public hospitals in countries such as Ethiopia does not. Here, health-care workers are "begging the government for sterilization machines, antibiotics, even gloves," Dr. Tena says.
Hospitals are also in desperate need of manpower. According to World Health Organization statistics, Ethiopia has 2,000 physicians for a population of more than 80 million - three doctors, in other words, for each 100,000 people. The shortage is only slightly more severe than that in most countries in the region - but jaw-dropping in comparison with Canada, which has 214 physicians for each 100,000 people.
