This week has been a bit slower around the SCOPE office for Sheldon and me, so we are taking the opportunity to see and learn more about the Ethiopian healthcare system.

The SCOPE intervention is all about prevention- trying to both prevent problems that might require urgent care, and also trying to make sure that health issues are taken care of before they become emergencies.

Shortly after we arrived, we had a very illuminating conversation with one of the members of the SCOPE board, Dr. Shitaye, who warned us that many people avoid the health care system until their problems are extreme. Sadly, this means that many diseases such as cancer and heart problems are not diagnosed until they are terminal.

I kept this in mind as Sheldon and I were provided with the tremendous opportunity yesterday to shadow the emergency room team at the University of Gondar Hospital. This was particularly meaningful for me- many years ago I did a nursing school rotation in Seattle’s own Harborview Emergency Department. I was eager to see how the staff in Gondar’s ER worked with considerably less space and fewer supplies.

The emergency room is divided into zones- red for the most critical patients, then orange, yellow and green. All of the rooms in the emergency department are painted with wide, colored stripes around the walls- a constant reminder of how sick the patients are in that room. The rooms are large and open, each holding about a dozen patients. We started in the red room, what would be considered critical care or the resuscitation bay in the US.

The physicians and residents were very systematic, reviewing each patient’s history, physical exam, labs, etc. But I was immediately reminded of Dr. Shitaye’s words- many of these patients appeared to have had little treatment prior to ending up here in the ER in critical condition. Several patients had been diagnosed that day with serious, likely terminal conditions such as cancer with metastases and kidney failure requiring long-term dialysis. It was clear that most of these patients also hailed from very rural areas- places where even very basic medical care may be many miles’ walk away.

I left the Emergency Department very impressed with the work ethic and thoroughness of the physicians working and training there. But it also reinforced in my mind the great need to focus on prevention and care at the local health center level. Travelling to a city center such as Gondar must represent an enormous effort and expense for many of these families. An accessible, culturally integrated health center, supported by local institutions such as the Ethiopian Orthodox Church, has the potential to address many of these issues before they need high levels of care.

I am looking forward to beginning the rural Health Center visits in the next days and weeks. Having seen the urban teaching hospital in Gondar, I am eager to complete my “picture” of the health care system here. And ultimately, I am eager to contribute to the prevention work that I believe is so very important.