SAO Spring 2016 Annual Report

Spring 2016

Volunteers, Donors and Other Supporters:

First, a quick recap for those who basically already know that because of your generosity, SAO has been able to continue our work:
— teaching vascular access surgical technique to Ethiopian physicians (vascular fistulas are needed for hemodialysis (“HD”).
— making significant strides toward establishment of an outpatient peritoneal dialysis (“PD”) program in Addis (if successful, this will not only be the first outpatient PD program in Ethiopia, it will also be one of the first in Africa)
— with the Ethiopian Federal Ministry of Health on the development of a national center of excellence for renal care. We are deep into the design phase of this building. Two volunteer healthcare architects from Seattle, Stephen Manthey, KMA Architects and Lee Ajayi NBBJ, spent a week in Addis doing site evaluation and design work for this new building. They are collaborating with local volunteer architect Yoseph Bereded in Addis.
–continue on-going training of orthopedic surgeons, anesthesiologists, otolaryngologists, audiologists, nurses, and others. This has traditionally been SAO’s core work and we remain committed and active helping improve these resident training programs at Addis Ababa University.

** For those of you willing to wade through the tall brush some additional details and highlights appear below. For all of our donors, thank you so much for your support. None of this could have happened without you.

RENAL CARE

Chronic kidney failure (known as End Stage Renal or “ESRD” herein) is a highly treatable condition in the United States and throughout the developed world. For most Ethiopians, however, it is a death sentence. The only treatment option currently available, hemodialysis, is scarce (available only at a handful of locations) and extremely expensive. In a country where the estimated average per capita income is $70.00 per MONTH, the average monthly cost of hemodialysis is $900.00. Individuals and their families must bear 100% of this cost: there is no source of governmental or sustainable charitable funding for those who cannot pay.

SAO has been involved in a number of different initiatives aimed at ameliorating this grim reality:

At the request of kidney patients in Addis Ababa, organized under the rubric of the Ethiopian Kidney Failure Dialysis Charity Organization, SAO helped KDFCO to build out an operating suite in a small building located on the grounds of the Zewditu Hospital in central Addis. It is also in this building that the Ethiopian government is installing 6 hemodialysis machines to begin offering HD to an obviously small number of kidney patients. It is a significant start, and it is expected to open in the summer of 2016.
SAO volunteer physicians, nurses and technicians have made multiple trips to Addis, in order to teach Ethiopian surgeons the techniques for creating (and repairing) the vascular fistulas required for hemodialysis. In particular for several years, Seattle vascular surgeons Swee Tan, MD and more recently Kaj Johanson, MD have been training a local surgeon, Abeje Branu, MD to do this procedure – as well as doing the procedures themselves. One local surgeon (even an SAO trained one!) can’t hope to meet demand. This Fall we will begin training a second group of 4 Ethiopian surgeons in vascular access surgery. We have far more interested surgeons seeking training than we can accommodate.

At the same time SAO has worked to help expand charitable hemodialysis options in Addis, SAO has recognized that the reach of hemodialysis will almost always be limited. There is one simple reason: cost. Hemodialysis is expensive everywhere on earth. HD has to occur in an inpatient or outpatient healthcare setting, with access to super-purified water, high-tech equipment and intensive nursing support. In contrast, peritoneal dialysis (PD) is low-tech, and for the most part is conducted in a patient’s home or at work. Moreover, as demonstrated in countries like India (where PD was the treatment of choice for some 20 years) and Thailand, PD has proven to be a safe and cost-effective treatment option for ESRD. In the US, the mean survival for HD and PD patients is the same. For these reasons, SAO has also worked diligently to get a peritoneal dialysis program started in Addis.

In the past, the problem with PD for Ethiopia has been (and for most countries in the developing world the problem continues to be) access to the copious amounts of special fluid needed for this procedure. Because it is largely water, the fluid needed for PD is very bulky, and very expensive to ship. As a result of SAO’s early efforts, however, an Ethiopian company, Pharmacure PLC, has not only agreed to begin producing PD fluid in Ethiopia, it has stated that it will make this fluid available to Ethiopian patients at a significant discount. Pharmacure has a way to go, as it gears up its factory and secures necessary governmental approvals for the manufacture, sale and distribution of PD fluid within Ethiopia. However, SAO is very gratified by this development and the personal support pledged by the company, its owner, Sheik Al Almoudi, and (especially, on a personal level because of his kindness to me), his associate, Abennet Meskel. This will be truly life-changing (and saving) for ESDR patients in Ethiopia and adjacent countries.

If all goes according to plan, Pharmacure will begin sustainable production of PD fluid in the Fall of 2016, and SAO will continue to gear up for initiation of a PD Pilot program. Bernadette Thomas, MD , UW Department of Global Medicine and Adam Omidpanah were instrumental in designing this pilot study. Meanwhile, SAO volunteer nephrologists Sandy Watkins, MD and Sangeeta Hingorani, MD from Seattle’s Children’s Hospital continue overall direction of the entire PD project. Nurses from Northwest Kidney Centers and Valley Hospital (Nancy ) have been to Addis and will return this Fall to continue the nurse and family education necessary for safe PD. This group developed bi-lingual (English and Amharic) nursing and patient/caregiver manuals for PD technique. Nothing is more key to successful PD than education of nurse teachers and patients. Our nursing team has been dedicated and has won the loyalty of their students. This has been particularly encouraging as these students will ultimately direct this program. We are hoping that within 24 months of completion of the pilot, 100% of this PD initiative will be directed by Ethiopian professionals.
Sangeeta and Sandra have initiated IRB review to allow transparent reporting and study of this pilot. It’s hard not to assume a successful pilot, but it’s important to note that the SAO suggested protocol calls for clear attainment of certain benchmarks for quality and efficacy prior to expansion of the PD initiative. We all want a successful and sustainable program!

As the involvement of SAO in all things dialysis in Ethiopia has deepened, so has our understanding of the difficulty of marshaling even the few available resources available in that country to assist kidney patients. There is no existing institution or organization facilitating communication among Addis’s nephrologists (currently, numbering less than 8, for a city with a population estimated to exceed 5 million, and a nation with a population estimated to exceed 100 million). There is scant and inconsistent support for the work of these nephrologists. If possible to imagine, there is even less for the support of physicians (no nephrologists) and nurses providing care outside of Addis. With the initiation of the PD program, the Ethiopian Federal Ministry of Health and SAO hope to improve this situation through establishment of a center of excellence for renal care (the “Addis Ababa Renal Care Alliance” or “AARCA Center”).

SAO is working with the Ministry of Health and others to develop the AARCA Center, not just as a building and center for the delivery of renal care, but as a center for renal education, both medical professional and patient oriented. As currently envisioned, the AARCA Center will provide training in the management and treatment in all aspects of kidney disease, particularly including ESRD, to physicians, nurses, administrators and other health care professionals, patients and their families/caregivers. It will offer vascular access and catheter placement surgery and repair, renal biopsy, and related lab services. It will be a home for the country wide PD program.

SAO hopes that the AARCA Center will be guided by a coalition of Addis Ababa’s nephrologists. Addis’ current nephrologists have agreed to participate, and future nephrologists and others involved in and committed to the improvement of access to and the quality of renal care in Ethiopia will be encouraged to participate in the AARCA. Seattle SAO volunteers, Bahiru Egziahiber and Nuru Tuku have spent countless hours writing the proposal for the development of AARCA and the AARCA Center and have met with many Ethiopian officials — determined to make AARCA a reality.

In the spring of 2016, SAO volunteer architects Steve Manthey, KMA Architects and Lee Ajayi, NBBJ architects, traveled to Addis to meet with representatives of the Ethiopian Ministry of Health and Zewditu Hospital (assumed site of the AARCA Center), and Ethiopian architect Yoseph Bereded as well as other Ethiopian engineers, and healthcare officials, to begin planning for the AARCA Center. As a result of their work the AARCA Center is starting to take real shape and form. The design has been launched. Hopefully completing construction within 18 months.
All participants in the first design exchange for the AARCA Center were excited about the potential for creating a truly state of the art, buildable and—that word again—sustainable center of excellence for renal care.
Significant hurdles remain. Design for the AARCA Center is pending further development of the program for that building, and of course, there is the matter of funding. Yet, the Ministry of Health’s has been unwavering in its commitment for this center and for Ethiopia’s growing ESRD population. Patience and persistance…

ENT

Okay, enough about kidneys! From its very first trip to Ethiopia, ENT care (under the superb guidance of volunteer Sandra Skovlund, M.D., who is based in Minneapolis) has been an important component of every trip SAO has made. In 2015, Sandra and her team made two trips, including in the Fall, one that was focused on providing training to Ethiopian ENT residents and audiologists in hearing care and aids, and in the Spring provided a workshop on ENT surgical skills (mastoid drilling).

Sandy quietly and consistently organizes these ENT training trips, recruits for them, begs equipment and supplies needed, pays her own way and uses her own vacation time for these trips. She created the SAO agreement with the residency program at the University of Minnesota which allows the chief resident in ENT to come to Addis with SAO on every trip. This training assistance for ENT residents is quietly allowing opportunities that do not exist for Ethiopian ENT doctors. It is extraordinarily practical training to enable basic ENT services to be delivered in a country where they are otherwise largely unavailable. It is work at the heart of SAO’s reason for existence.

ORTHOPEDICS

Similar to Sandy’s work in ENT, SAO volunteer orthopedic surgeon, Alexis Falicov, M.D., has made numerous trips to Addis Ababa to train Ethiopian orthopedic residents in all aspects of orthopedics. Alexis does daily rounds with the residents and staffs numerous OR cases. While in Addis, none of us put in longer hours than Alexis.

ANESTHESIOLOGY

SAO assistance for the anesthesiologists and residents at AAU continues. This is one of SAO’s longstanding efforts. In general the department is doing much better than several years ago when it was close to collapse. We continue to supply limited equipment when possible. SAO volunteer Wyn Strodbeck, MD anesthesiologist from Virginia Mason made two trips with SAO to Addis in the past year. Wyn is a terrific speaker and has given many seminars to the anesthesia department as well as daily attending in the operating rooms.
This year SAO sponsored the summer educational meeting of the Ethiopian Society of Anesthesiologists in Addis.

THANK YOU

In closing, let me thank you again for all of your support. SAO is comprised solely of volunteers; 100% of the organization’s expenses are paid by participants and donations. We are particularly proud that such a small group of volunteers has been able to instigate some dramatic improvements in an extremely overburdened country. Your support is making a tangible difference.

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