Nancy Alonso

I found a surprise note on my desk after the morning clinic. It was a busy clinic with patients of various kidney and electrolyte problems including a challenging case of hypokalemia or low potassium.

At first it didn’t click. I read the note again,

Please call Nancy Alonso at———- she is in Miami waiting for your call.

It sure was her, her voice still strong.

We were a bunch of 18 year olds sitting in one of the new lecture halls awaiting to see the famous Cuban physiology professor. It was twenty six years ago in what then used to be called Jimma Institute of Health Sciences, one of the only three medical schools at the time, located in South West Ethiopia.

A sharp, intelligent and telegenic Cuban professor would walk in that morning and every morning for a year to lay the foundation for our education in medicine. There is no medicine without human physiology. There was no better professor than Nancy Alonso, in South West Ethiopia, where we had scarcity of educational materials.

She brought the complex human physiology in a way we could grasp and enjoy it. I still do.

It was a very volatile time in Ethiopia. The Cuban professors including Nancy had to leave after a change of government leaving a vacuum in the medical school which fortunately was temporary. With a strong foundation in physiology, most of the class of 89 went on to finish medical school. Some of us had the opportunity to pursue sub-specialty medical training in Ethiopia and beyond working now in private practice and academia, teaching the next generation of health providers. Among us are US board certified internists, cardiologists, endocrinologists, nephrologists, surgeons, to name a few.

I drove to Miami to pick her up. We were both thrilled to meet again.

She was dressed in an Ethiopian outfit and carrying a present for us, berbere, Ethiopian hot spice, and Teff, Ethiopian super grain, that she got in one of the Ethiopian stores.
After a cup of strong Cuban coffee, we drove to our house to spend the afternoon with my wife and daughter.

It was easy to see that Nancy Alonso’s two years in Ethiopia from 1989 to 1991 had left a lasting impression on her about the country, its people and culture. She told me that her experience in Ethiopia played a role in her becoming a writer. She also told me that she has an upcoming collection of short stories reflecting Africa. Most of her works are in Spanish but some are translated in to English.

We are testament that people like Nancy who travelled the world to teach did make a difference in the lives of many. Unfortunately some may not even know the impact they had on other’s lives.

This is a thank you note to Nancy Alonso, the Cuban biology professor and writer, for her contribution to our early education in physiology and medicine and for who we are today as a person.

Posted in Memoir | 1 Comment

A life matters !

“Doctor, doctor, doctor,” she said, with a Spanish accent

“Look at me doctor,” she said again grinning

“Look at my face, I am happy now, I am happy now, my life is back”

Her eyes welled up with tears
This was a mother who had suffered from chronic illness
For too long
That many physicians in the Americas missed
Because they were looking for common things
Even after her vital organs, like the kidney and liver
Started to fail

I remember the day I saw her
I could tell her body was on fire
Of inflammation
That alluded many

Until we made a diagnosis of the rarest of rare diseases
Almost a decade after her initial symptoms

When I look back, it is not because we are genius
Or it is not because we had an eureka moment

It was because we opened our eyes, scratched our head
And looked for rare diseases

Because a life matters!

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Until I had my own

“Her heart is beating at 172 per minutes. Do you have fever?”

That question from the obstetrician threw chills in our bones in otherwise a routine visit. My wife quickly turned and looked at me but I wasn’t able to reassure her; I was afraid.

No she didn’t have fever. We kept our routine of freshly squeezed juice for her and a cup of black coffee for me and rushed to make it on time for the 8:30 appointment. There was nothing alarming; the baby was moving as usual. She was overdue so we had prepared everything ready from hospital gowns to baby clothes, snacks, toothbrush and paste.

“Well, your baby’s heart rate is high so I don’t think we can wait any longer. I will send you to the labor ward. Will start induction.”

The labor ward at the Memorial Hospital was only a short walk from the obstetrician’s office. By the time we arrived there, the midwives had all the information. They were nice to us, easing our fears. So that was how it all started. Slipping in to a hospital gown, intravenous lines, monitors for the baby’s heart rate and my wife’s contractions which began about an hour after the oxytocin was initiated. Baby’s heart rate settled in the 160s, which was not alarmingly high. We waited for the labor to progress anticipating a normal deliver but knowing that we were in good hands if she needed surgery.

A loud bang on the front door. Again and again.

“Doctor, wake up. Doctor, wake up. There is a pregnant mother in labor.”

I was the only intern in the compound at the time. This is back in the early 90s, in Asendabo Health Center, a small town in the outskirts of Jimma, a major city in western Ethiopia. I was completing medical school then but part of the requirement for graduation was to do internship in local health centers. There was no electric light at the time. I quickly lit the candle and checked my watch. It was about 3 in the morning. A tall and muscular man in his 50s was standing at the door, profusely sweating.

“Hurry up, hurry up, she is in labor. You are the only one I could locate. The mid-wife and physician are out of town. The health center’s only car is broken. Please hurry up.”

It was the security guard.

Fortunately the outside was lit by a full moon. We rushed to the health center. There I was, a young ambitious intern, with just a pen light at hand, at about 3 or 4 in the morning, in front of a young mother, perhaps 15 or 16, exhausted from hours of horse ride and in labor pain. Her husband, extended family, neighbors were all crammed up in a small dark room.

My wife’s contractions started to peak up as the dose of oxytocin was escalated. Our baby’s heart rate remained stable. About 2 hours in to labor, my wife finally requested epidural to ease the pain. It helped. She was able to take some rest, caught a nap.

I drifted back to Asendabo.

I soon realized I had no time to waste. Everything happened very fast. We explained to the family to stay outside. I made a quick evaluation. The mother’s vitals were stable. I picked an old pinard horn fetoscope and tried to listen and count the baby’s heart rate. It was fast, perhaps around 170. That made me nervous. The closest hospital for surgery or any major complication if needed was hours away and to make matters worse the multi-purpose car that also substituted as an ambulance was broken. Fortunately, the head was down and the cervix was fully dilated. All what she needed was a push. I got myself well situated holding the pen light in between my teeth, ready to deliver, with no other help.

Take a deep breath and when I count down to three start to push down.
One, two, three…

They both pushed, taking few breaks in between, separated by time and location but united by the same being.

Celebratory gunfire erupted outside the health center in Asendabo the moment the baby cried. Word was out that I was able to successfully deliver her, both mother and baby doing well except that I was socked in the amniotic fluid and blood, unbeknown to me, until sunrise.

Two decades later, across the Atlantic Ocean, I stood mesmerized …as my own baby was delivered at around midnight. I was frightened when I first saw the cord around the baby’s neck but it was loose … she cried… relief and joy and tears of happiness.

I didn’t realize until now what that moment in Asendabo meant for her parents. Until I had my own.

Posted in Memoir | 3 Comments

Renal rounds: Christmas gift

We were shopping for Christmas when the call came through. It was a big shop with Christmas decorations all over the place. It was noisy and crowded. We left the house early to spend as much time as we can to hunt for bargains and make it on time for my dialysis, something I do three times a week for three and half hours. My dialysis days were on Monday, Wednesday and Friday but the schedule was changed so that we can spend Christmas day, which fell on one of my dialysis days, at home. My two younger brothers didn’t expect much from me, they knew I only worked part time but it made me happy to get them something for Christmas. I also didn’t want them to see me as disabled because I was not.

My kidneys failed when I was young. I had no idea why I was feeling weak and tired. There was blood and protein in my urine. I even had specimen taken from my left kidney for testing. The doctors said I had IgA nephritis, a common kidney disease that causes inflammation of the linings of the blood vessels inside the kidneys. My parents had no idea what it was and how to treat me. The doctors said it was too late to help me, that’s until we moved to the US. I recall how I persuaded my parents to apply for the green card lottery. They were hesitant to do it first. I remember the joy when we got the visa but it was the beginning of a long journey.

It took us almost a day including the connection flight to Detroit where our host family was located. They greeted us in the airport with flowers. I wasn’t feeling well. I was weak and nauseated. I had twice vomited during the flight from Ethiopia. My younger brothers were deep asleep on the car to the house. My parents were very anxious; they knew I was sick. That night, I would end up in the emergency room of Detroit Receiving Hospital. If it wasn’t for the swift care I had there I would have died. My potassium was dangerously high, which is one sign of my kidneys failing.

Kidneys are not only filtering organs but they regulate key electrolytes, I recall the kidney doctor saying to the medical students, interns , residents and fellows all taking turn to hear the “rub” on my chest. I was in bad shape. The toxins that my failing kidneys were unable to remove were causing inflammation in the linings of the walls of my heart, what they termed as uremic pericarditis. That was how I started dialysis. It was new to me. I was fascinated by the science that my blood would circulate in a filter attached to a machine the size of our old black and white TV set to separate the good and the bad. While the people I later met in the dialysis unit were afraid to start dialysis, I was thrilled because I felt better with each dialysis treatment but as time went by it took a toll on our family. The boys started school. I picked up a part time week-end job in a nearby coffee shop. It made me proud to make the best coffee for each customer, I wanted to give back coming from the birth place of coffee, Ethiopia.

Four years went by until the call came through… on Christmas Eve…it was the transplant coordinator from the hospital.

“We have an organ for you.”

I didn’t hear her first, was I in shock?

“If you take the offer we want you in the hospital as soon as you can.”

We dropped everything and rushed to the hospital. The boys joined us later once they heard that I am having a kidney transplant.

The surgery went well. My new kidney immediately started working.

That was one hell of a Christmas gift !

Posted in Health, Short story | 1 Comment

Kidney Transplant in Ethiopia

Let’s us congratulate the team at St. Paul’s Hospital in Addis Ababa, Ethiopia and the Transplant Team at the University of Michigan, and every one involved, for performing the first kidney transplants in Ethiopia on three people who received kidneys from living donors in September 2015.

Here are some facts about dialysis and kidney transplant to give you a perspective

-Dr. Willem Kolff is considered the father of dialysis. He constructed the first dialyzer (artificial kidney) in 1943 working at the University of Groningen Hospital in the Netherlands.
-In 1946 the first successful use of “peritoneal irrigation” which would later advance to peritoneal dialysis, was reported in the US. Several physicians/scientists were involved.
-After World War II ended, Kolff donated the five artificial kidneys he’d made to hospitals in London, Amsterdam, Poland, and New York City (the Mount Sinai Hospital) which is where the first human dialysis in the United States was done on January 26, 1948.
-The first dialysis machine built in Africa was in South Africa in 1957. It was used in 2 patients with acute renal failure.
-In 1958, dialysis was also used in Cairo to treat a woman with kidney failure.
-Cairo and Johannesburg University hospitals used dialysis in the early 60s followed shortly by Tunisia, Algeria, Kenya, Nigeria, Sudan, Libya, Zimbabwe, and Morocco.
-8 African countries had the resources to achieve-sustained national program capable of 100 dialysis patients per a million populations fully covered by the government in state hospitals and partially cover the cost in private dialysis units. These are Egypt, Libya, Algeria, Tunisia, Morocco, South Africa, Mauritius, and Gabon. Sudan and Mauritania have reached 75 dialysis patients per million.
-Peritoneal dialysis accounts for 10% of dialysis population in Kenya, 20% in Uganda, 34% in Zambia, South Africa and Senegal, 41% in Sudan, 56% in Democratic republic of Congo, and 60% in Rwanda.
-There are now 13 countries with kidney transplant program in Africa: Algeria, Egypt, Ghana, Kenya, Malawi, Mauritius, Morocco, Nigeria, Rwanda, South Africa, Sudan, Tunisia and now Ethiopia.
-It is estimated that there are less than 2000 nephrologists in Africa for a population of over a billion.
-Formal nephrology training programs are currently recognized in 5 countries: Egypt, South Africa, Morocco, Tunisia and Nigeria.

The situation in Ethiopia

-A kidney unit was opened in Tikur Anbessa ( Black Lion) Hospital, Addis Ababa in 1980 with the assistance of a Cuban team from the Institute of Nephrology in Havana.
-The first peritoneal dialysis was done in Ethiopia in April 1980 and the first hemodialysis was done in June 1981
-The first private dialysis unit opened in Ethiopia in 2001
-Two public hospitals offer hemodialysis for acute renal failure
-A transplant program has just started at St Paul’s Hospital with the help of the transplant team at the University of Michigan

Reference
Am J Kidney Dis. 2015; 65 (3):502-512

Posted in Current events, Health | 1 Comment

A trip to Addis

I started to be nervous on the final decent of the Ethiopian Air Lines Boeing 777. The last time I was in Addis was the day I left Addis itself. That was 15 years ago although it felt like 150 years. Then, I was an ambitious young man in his mid-20s. I was going back with some gray hair and few extra pounds, thanks to the burgers in Mid-West, from Detroit to Cleveland, where I spent almost 12 years.

The airport was filled with many people but almost a third were my parents, siblings, nieces, nephews, and friends. It wasn’t until few days later that I realized how emotional I was to see family , friends and Addis itself, after a decade and half. The cameras and iPhones had captured the moment.

Addis has changed in many ways. It’s sky line is dotted by tall buildings. There are glamorous coffee shops, restaurants, hotels. The recently completed train tracks have given it another dimension to its growth. Driving by my old neighborhood, Sengatera, I witnessed the high rise condos in place of once a shanty neighborhood where we grew up playing soccer.

Pure and simple, Addis is a city in renaissance.

And that is until you take a ride to some of the remaining downtrodden neighborhoods. The shortage of electricity and water can be frustrating. Poverty was not new to me. I saw it up close in Detroit and East Cleveland but what worried me the most was the gap between the rich and the poor, as wide as imagination itself.

One Sunday morning I took my nieces and nephews, who were excited to put name and face together of their uncle, to a nearby building with play stations for children. This was unheard of back in 2000 when I left Addis. That was when the people of Ethiopia were 65 million, before the 30 million or so new faces were added. It was a four or five story building with gym, coffee shops, playing stations for children. The owner was as surprised to see me wondering around how this business was transforming the neighborhood with healthy choices such as gym and kid’s games among its business unlike the many bars I witnessed. In the 15 years I called North America home, an old friend and his business partner had toiled day and night to build this business. I was so happy to see one of my own making a change. From there we went to one of the cultural dining halls in the city center. It was lent. The vegetarian dish everywhere I went was amazing. We feasted on injera, lentils, greens, you name it. We danced to the beats of Amarigna, Tigrigna, Guragigna, Oromigna and other cultural songs. My nephews and nieces were so good at all the cultural dances that the band invited them on the stage. I was delighted to see them happy.

In another day at St Paul hospital, one of the teaching hospitals in Addis, I witnessed how a dedicated young physician was trying to help the far too many patients that were lined up. I visited the dialysis unit, the upcoming transplant center, met the many energetic and ambitious physicians who are trying to improve the lives of patients with kidney disease.

It was hard to finally leave. The children won’t stop crying. They thought perhaps they won’t see me again in another 15 years. They perhaps don’t realize how much they helped me re-connect, ask myself on what tangible things I have contributed to their future. What have I really given back to Sengatera, to Addis, to Ethiopia?

To those of us who call both Ethiopia and the US home, it was a wake-up call to do more…

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When your doctor leaves

When your doctor leaves
Where do you go ?

You saw him, yes you did
Unshaved, dressed in a hurry
Dirty old glasses
On his face, a patch of dermatitis

“So what brought you here ?”

Isn’t that what he said

I bet he knew
How come he asked you about star fruit
If he didn’t know that you had calcium oxalate in your urine

He took away chocolate, greens, salt
All the good things and yet
You still liked him

Now after so many years and many doctors
Do you remember what you saw in him ?

It wasn’t appearance or being on time or the science
Nor his manner or the tone of his voice
Infact he had accent, which was hard to place
Didn’t he even say not to call him again in the middle of the night even if your stone is stuck in your pelvis ?

Did you like him because you felt that he cared ?

But you never cared for him
You called him every week, refills, this and that
You saw him gain weight, unshaved, dirty old glasses
Of blue stripe, the same three ties
You didn’t bother to ask him where he came from or what he left behind

Where do you go now
That he is leaving ?

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