About Seattle Alliance Outreach

The Mission of Seattle Alliance Outreach is to provide support for the improvement of medical care in developing areas of the world. Seattle Alliance Outreach has no religious affiliation.


SUPPORT FOR THE ANESTHESIA DEPARTMENT AT ADDIS ABABA UNIVERSITYIn 2008, doctors and nurses working at Seattle’s Swedish Hospital established the nonprofit organization Seattle Anesthesia Outreach (SAO). The founders had earlier participated in medical missions to Central America, South America, and the Caribbean, but had grown frustrated with the limitations of these short-term humanitarian service efforts. The main problem: while these surgical missions delivered much-needed aid to those patients treated, there were no sustainable benefits to the population. The medical skills and knowledge involved in these efforts left the countries when the volunteer doctors and nurses flew home.
In response to this shortcoming, the SAO founders decided to broaden their volunteer-driven program in ways that would provide training, equipment, and ongoing support to struggling medical facilities. Now, having pursued its expanded agenda for nearly four years, SAO has gained the experience and the insight needed to implement a successful knowledge, skills, and equipment transfer model. Long-term, SAO’s efforts will help establish sustainable medical capabilities and services that can flourish locally on their own. As important, SAO’s partnership-based services model is one that other organizations could adopt and expand in like engagements throughout the world. To develop its sustainable aid methods and to and prove their merits, SAO approached Black Lion Hospital in Addis Ababa, Ethiopia in 2009 to explore a collaborative aid effort. Black Lion is the principle public hospital in the Ethiopian capital city of about 3 million people, and also serves as the main training facility for the medical residents of Addis Ababa University. Despite its critical role as the dominant health care institution in the capital city, however, Black Lion faces a daunting array of staffing, equipment and facilities challenges. The hospital welcomed SAO’s offer of assistance in large part because the volunteer organization was willing to fine-tune its engagements to address Black Lion’s self-identified needs. By pursuing this collaborative approach to Black Lion’s problems, SAO broke from the model of many medical aid initiatives. Rather than coming in and dictating its own agenda, SAO worked closely with Black Lion’s administrators and medical staffs to jointly identify and address the hospital’s areas of greatest need. Following two organizational trips in 2009 and 2010 to Addis Ababa, SAO sent 26 volunteers – including anesthesiologists, nurses and biomedical equipment technicians –to Black Lion Hospital for four weeks in October 2010. SAO followed with two other trips in February and October 2011, again bringing a multi-skilled group of 24-26 volunteers each time.
During these initial trips, the SAO volunteers helped train anesthesiology residents and attending physicians, assisted in surgeries, helped build and equip the hospital’s first Post-Anesthesia Care Unit (PACU) and initiated an epidural service for laboring patients in the hospital’s obstetrics ward. SAO also coordinated the delivery of thousands of pounds of donated or SAO-purchased medical equipment and supplies (everything from bed sheets to anesthesia machines). To transport the equipment and supplies, SAO enlisted the support of Boeing and Ethiopian Airlines, both of which donated their services in support of the SAO effort. On its October 2011 trip, SAO for the first time added six surgeons to the mix of five anesthesiologists and other medical personnel participants who traveled to Addis Ababa. The volunteer team continued the training work it began on the earlier trip, painted, rewired and equipped Black Lion’s pediatric operating room and laid the groundwork for ongoing alliances in general surgery, colo-rectal surgery, and ENT surgery.
To date, all of SAO’s funding has come from two Seattle-area fund-raising events, which together raised approximately $60,000. Despite its relatively modest amount of funding, SAO has been able to accomplish much through the frugal management of these donations and the generosity of its own volunteers. SAO used the donated funds to purchase equipment and supplies (more than 25 tons of purchased and donated material delivered so far) and to help pay for the volunteer nurses’ and biomedical technicians’ airfare, lodging and food (nearly 100 individual trips supported to date). The volunteer physicians have paid for their own airfare and local expenses, and have also helped subsidize the other participants’ expenses as needed.

Ethiopia Statistics (from CIA World Fact Book – July 2011 estimates unless otherwise noted) • Population: 90.9 million • World’s 13th largest country by population

  • Population: 90.9 million
  • World’s 13th largest country by population
  • Age Structure:
    • 0-14 years: 46.3%
    • 15-64 years: 51%
    • 65 years and over 2.7%
    • Population Growth Rate: 3.194%: World’s 8th fastest
    • Birth Rate: 42.99 births/1,000 population: World’s 6th Highest
    • Death Rate: 11.04 deaths/1,000 population: World’s 37th Highest
    • Infant Mortality Rate: 77.12 deaths/1,000 live births: World’s 17th Highest
    • Life Expectancy at Birth: 56.19 years, World’s 196th ranking
    • Health Expenditures: 3.6% of GDP, World’s 170th ranking
    • Physicians density: 0.022 physicians/1,000 population (2007), World’s 187th ranking
    • Hospital bed density: 0.18 beds/1,000 population, World’s 182 ranking
    • Children under the age of 5 years underweight: 34.6% (2005), World’s 10th highest


The largest hospital in Ethiopia and one of only two university hospitals in the country, Black Lion Hospital is administered by Addis Ababa University and provides teaching for about 300 medical students and 350 residents every year. Black Lion has 800 beds and offers diagnosis and treatment for approximately 370,000-400,000 patients each. Black Lion faces a wide array of challenges, ranging from shortages of key medical personnel to lack of critical medical equipment to an aging and dilapidated physical building and infrastructure. One indication of the facility’s dire needs: there is no hot water available anywhere in the hospital. Much of the medical staffs’ activity consists of a never-ending succession of triage efforts, identifying patients with the most immediate needs and attempting to address those needs with the hospital’s very limited means. There is little coordination or planning and, by Western standards, the process of educating and training medical students and residents faces serious problems. Meanwhile, lack of training combined with equipment and facilities shortcomings has kept Black Lion from performing even basic medical procedures adequately, even something as critical as sterile processing.

Despite its many problems, Black Lion is the only hospital available for many of Ethiopia’s citizens. Among Black Lion’s core challenges:
  • Limited and inadequately trained medical personnel – When SAO began working with Black Lion, the hospital had just four anesthesiologists. That compares to more than 90 anesthesiologists at Swedish Hospital, which is just one of many major hospitals in the Seattle area (a metropolitan area with a smaller population than that of Addis Ababa’s). There were no signs this situation would soon improve: In the four years prior to SAO’s engagement, Black Lion had been unable to attract a single resident to its Department of Anesthesia. Meanwhile, many medical procedures and techniques that are routine in Western hospitals weren’t being practiced at Black Lion. One example: there was no epidural service for laboring patients in the hospital’s OB ward (nor was there any such service in the entire country). Exacerbating these and other challenges are staggering patient loads for each physician. “I’m forced to see 40-45 patients in one afternoon. You can imagine the quality of care that I’m giving,” Dr. Abebe Bekele, thoracic surgeon at Black Lion (and one of only four thoracic surgeons in all of Ethiopia).
  • Lack of medical equipment and supplies – In a dynamic common to many hospitals in poor countries, Black Lion has become something of a dumping ground for medical equipment and supplies sent by wealthy nations and hospitals. Although many of these donations are made with the best intentions, much of the equipment sent is outdated, broken or impossible to use. When SAO first arrived at Black Lion, the volunteers found numerous rooms overflowing with broken donated equipment and obsolete supplies. There were shortages of everything from operating room tables to patient monitors. Of particular concern to SAO: there were only two dated and barely functioning ventilators in the hospital, and virtually all of the existing anesthesia equipment was in major disrepair.
  • Dilapidated building and infrastructure – When Black Lion was built more than 40 years ago, the hospital had a functional water supply system with hot and cold water and drainage, a central oxygen system, a central suction system and many other hallmarks of a well-equipped medical facility. Today, all of these critical systems are in disrepair and largely nonfunctional. Among the problematic hospital systems is its electrical system. Most of the hospital’s operating rooms have few, if any, electrical outlets and inadequate lighting, meaning that even if Black Lion obtains much-needed equipment it often has no way to power it. “Their systems are so far deteriorated that any week, any month, this hospital could have to shut down completely,” says anesthesiologist Richard Solazzi, one of SAO’s founders.

Forming the foundation for all of SAO’s work with Black Lion hospital is the cultivation of ongoing relationships with hospital and medical school administrators, medical and teaching staffs and – when appropriate – Ethiopian government officials. SAO views its association with Black Lion as a long-term and multi-faceted association, and understands that its efforts can succeed only if they are planned and conducted in close partnership with the hospital’s key players. In addition to scheduling month-long stays twice each year at Black Lion, SAO’s physicians and nurses communicate regularly with the hospital’s administrators and medical personnel throughout the year. SAO’s work to establish strong and positive relationships has created a culture of trust and respect between the nonprofit’s volunteers and the Black Lion community. “[SAO’s work] has really brought a kind of insight to our potential [and] has also motivated us to make major changes to the operation theater – the way it should function, the way you should manage it, the way it should improve, said Dr. Be-ede, chief of surgery at Black Lion. “And this has really changed our attitude toward the operation theater. And this, I believe, is the most important thing. The thing that may last for years to come, what we have received from the SAO.” Given its approach of responding first and foremost to the hospital’s self-determined needs, SAO must be flexible and adaptable in the range and type of services it provides. To that end, SAO volunteers have done everything from scrubbing hospital floors and walls to training residents and attending physicians in much-needed anesthesiology and surgical procedures and techniques. At the end of 2011, after three comprehensive mission trips, SAO can point to an impressive number of accomplishments. Among them:

  • After SAO worked with residents, attending physicians and medical students during its February 2011 trip, 11 medical school graduates applied for residency positions with Black Lion’s department of anesthesia. The department accepted five of these applicants, who began their residency training in the fall of 2011. Again, this surge in applications followed four years in which not a single graduate applied for an anesthesiology residency.
  • Black Lion had no post-anesthesia care unit (PACU) for surgical patient recovery. During the February trip, SAO volunteers built a PACU (including wiring it and putting up walls with help from U.S. Embassy personnel that SAO recruited), equipped it with beds, oxygen lines, and patient monitors, and trained nurses to run it.
  • Also during the February trip, at the request of the OB/GYN, SAO initiated an epidural service for laboring patients on Black Lion’s obstetrics ward. Several Seattle OB nurses and obstetricians helped train the hospital’s OB nurses and OB residents on the effects of epidural analgesia on laboring patients. This highly successful service continues and is the first OB epidural service being offered by any hospital in Ethiopia.
  • One critical and ongoing activity that SAO conducts each trip is tackling the piles of donated medical equipment and supplies that Black Lion was warehousing in 3-4 storage rooms. SAO volunteers work with Black Lion staff to sort through the material, disposing of broken equipment and outdated supplies and organizing what remained for easy access by hospital staff.
  • During the fall 2011 trip, SAO volunteers placed particular emphasis on improving the hospital’s pediatric services. As part of this effort, the team painted, rewired and equipped Black Lion’s pediatric operating room with stainless steel cabinets, lighting and other needed equipment.
  • Despite having only limited funds, SAO has purchased and solicited the donation of thousands of pounds of much-needed medical equipment and supplies for Black Lion. Among other items, this material has included 10 anesthesia machines, 16 operating room and ICU monitors, 20 recovery room beds, four transport gurneys, a dozen anesthetic vaporizers, surgical equipment such as cautery units, 300 new bed sheets, 50 medical textbooks and a collection of electrical wiring and transformers. All told, SAO has shipped more than 25 tons of material to Black Lion, most of it sent for free on air cargo flights that Boeing and Ethiopian Airlines contributed to support the SAO effort.
  • Given the known problems associated with introducing and maintaining sophisticated medical technology and equipment, SAO has included skilled biomedical technicians on each of its trips. As a result, SAO is not only training nurses and physicians in the use of the equipment, it is also training hospital staff in how to maintain and repair the equipment. To support the effort, John Fluke company generously donated $40,000 in new electrical testing equipment. In one early sign of SAO’s success, one of the new patient monitors broke down after the SAO team departed, and Black Lion’s personnel were able to test and replace circuits and successfully repair the monitor.
  • SAO anesthesiologists and surgeons conducted a number of teaching labs and presentations for Black Lion’s residents, attending physicians and medical school studentsSAO’S ONGOING EFFORTSAO is under no illusions about the many difficulties it faces as it works with Black Lion to introduce much-needed and sustainable solutions to improve the hospital’s services and the experiences and outcomes of its patients. SAO views this as an open-ended initiative that will span many years, if not decades. In addition to the educational, equipment and facilities hurdles SAO and Black Lion face, there are cultural barriers and attitudes that will take time to overcome. With their respectful and humble approach, SAO volunteers have already made impressive progress in establishing the strong relationships needed to make progress toward its many goals.Through its regular and extended trips, its combination of experts in many critical fields and specialties, the many services its volunteers provide, and the tons of equipment it donates and trains upon, SAO has already become a highly valued Black Lion partner. At the same time, SAO recognizes that it is far from the only nonprofit or agency seeking to deliver various types of aid to Black Lion hospital. To that end, one of SAO’s goals is to work with other aid groups to coordinate the various efforts and make them as effective as possible. SAO, for example, has formed working alliances with a group associated with the University of Toronto and also with a group associated with the University of Bergen to ensure that each team’s work complements the other’s.Ideally, SAO’s founders hope that the collaborative and sustained approach they are pursuing with Black Lion will establish an aid and education model that other groups can emulate. Individual U.S. hospitals, for example, could form “twinning” relationships with poorer hospitals around the world, with volunteer physicians, nurses and biomedical technicians at these other U.S. institutions delivering the same type of skills and knowledge transfer that SAO’s volunteers are providing to Black Lion. More broadly, regional communities of medical facilities and corporations could organize around the SAO model to deliver not just medical knowledge and skills, but also help needy hospitals upgrade everything from their medical equipment to their buildings and support infrastructure.
    A sweeping vision, and a daunting road yet to travel. But SAO’s efforts have already had a powerful – and lasting – impact on Black Lion’s capabilities and on the outlook and attitudes of the hospital’s medical students, nurses, physicians and administrators. With its ongoing commitment, and with increased funding, SAO could have a profoundly positive effect on not just Black Lion, but on the established approach to delivering medical knowledge and aid worldwide.
    Perhaps SAO’s most impressive accomplishment to date has been its ability to affect real change and improvement at Black Lion Hospital despite the limitations imposed by SAO’s self-generated – and shoestring – budget. With a secure and steady source of funding for volunteer transportation and lodging, as well as for equipment and supplies purchasing and shipment, the good works already achieved by this all-volunteer organization could be even more transformative and far-reaching,