The first of its kind medical service

04 Sep 2017

 

Dr Mekonen Eshete is a consultant Plastic and reconstructive surgeon. What is more, he is an associate professor at Addis Ababa University, Surgical Department. He is as well the vice president of the Plastic surgery society, Ethiopia and the site director of the Partners in Cleft Training in Africa. Dr Mekonen has been elected and served as executive committee member of the Pan African cleft Lip and Palate Association and served as a chair of the local organizing committee of the 2009 Pan African Cleft lip and Palate congress which was held in Addis Ababa UN hall.

The American Plastic Surgery Educational foundation and Smile Train recognized him as an educational affiliate providing compassionate care to the world’s citizens.

The Ethiopian medical association awarded him for the 2003 best scientific paper. Adventist Health International, Smile Train and Loma Linda University, USA also awarded him for the best scientific paper. The plastic surgery foundation recognized him as the 2013 Smile Train International Scholar. Recently Smile Train gave him recognition as the 2016 Smile Train Global leader in cleft care.

He participated in many surgical campaigns organized by the Surgical society of Ethiopia, Federal ministry of Health, AMREF Ethiopia, AMREF Kenya and Smile Train and helped many patients who needed his expertise. Moreover, he started his medical carrier as a general practitioner in the southern part of Ethiopia in Konso Bekaule town it is now called Karat town. He worked as a health manager and general practitioner.

When did your interest in General Surgery and subsequently in Plastic and Reconstructive surgery was born?

My interest in General Surgery and subsequently in Plastic and Reconstructive Surgery was born during my practice in Konso. A patient who has got stub injury to his left chest and who developed haemopneumothorax presented to the health center where I used to work. It was not possible to send the patient to Arbaminch Hospital, which was the nearest health facility, which could provide surgical treatment.

Haemopneumothorax is a condition, which requires immediate surgical treatment otherwise the patient, will die from respiratory failure. I was able to manage this patient together with the medical staff at the health center with the available equipment. This was my first successful independent surgery and it created an interest in him to study surgery.

From that day on wards, I decided to study surgery. After serving at Bekaule Health center for one year I was transferred to Arbaminch hospital and worked at the surgical department where I got a lot of opportunity to work with Expatriate Norwegian Surgeons, which further inspired me to be a surgeon. Then, I joined the surgical training at Addis Ababa University medical faculty and graduated as a general surgeon.

After graduating as a general surgeon, I went back to Arbaminch Hospital where I worked as a general surgeon and head of the surgical department. During my practice as a general surgeon I observed that many patients were losing their limbs because of inappropriate traditional healers’ treatment (tight splinting without anaesthesia). I decided to change this and together with my other colleagues and the support of Gamogofa zone health Bureau, Arbaminch Hospital and Arbaminch rehabilitation center educated 112 Traditional healers not to splint an injured extremity tightly and was able to change this and the number of patients losing their legs and hands were significantly reduced. In addition, I educated health workers practicing at health centers and Clinics on proper splinting of an injured extremity. I presented this work on the 2003 Ethiopian Medical association Annual conference and got an award for this work. I received a gold medal and a certificate, which says award for the best scientific paper of the year 2003. This work was presented at international conferences and received recognition.

What is all about being a Plastic and Reconstructive Surgeon in Ethiopia?

Plastic and reconstructive surgery is a unique surgical subspecialty. In contrast to other subspecialties it is not restricted by patient, pathology or anatomic sites, rather it is driven by surgical techniques challenging surgeons to be amenable to each new clinical situation. It is performed to correct and restore form and function, which is affected, by congenital anomalies, burn injuries, other traumas, infection, tumors and other diseases. It also helps to improve patient’s body image and self-esteem. In developing countries, plastic surgery is usually considered a nonessential subspecialty service because it is commonly correlated with beauty surgery.

The history of this specialty in Ethiopia can be divided in to two: before 2000 and after 2000 GC. Before 2000 there were only two plastic surgeons for the whole country. In 2000 a sandwich type-training program started in collaboration with Addis Ababa University and Haukeland University Hospital Bergen, Norway. Norwegian Plastic surgeons who are real friends of Ethiopia initiated the training. Norad financially supported the program. It is now fully runned by Addis Ababa University.

I am one of those who trained under this program and now I am one of the teachers. Since then 14 plastic and reconstructive surgeons trained and almost all are practicing in the country and teaching. Currently, there are 18 Plastic and reconstructive surgery residents and fellows all together. To be a plastic and reconstructive surgeon in Ethiopia is both an opportunity and a challenge. The opportunity is, it is a new specialty, which is on the rise in our country, and it is a pleasure to be part of this development and contribute. There are many trainees who need your teaching skill and expertise. There are also a lot of patients who needs your companionate care and it gives you a pleasure to help those who are in need. As stated above it is a new specialty with considerable challenges.

What are the challenges?

To mention some of the challenges: there is scarcity of needed consumables and equipment. There are not many importers who are engaged in importing delicate equipment and consumables which are needed for nerve and vessel repair. There is a huge load of patients who need the service, which includes emergency patients. This discrepancy between need and supply is a big challenge for the caregivers and policy makers.

What are the common conditions, which require the expertise of plastic and reconstructive surgeon in Ethiopia?

We have all the problems, which require plastic and reconstructive surgical skills. The main ones are: Burn from different causes, in fact there is a change in the epidemiology of burn injury, some years ago the main cause was flame burn from open fire and ground level cooking. At the moment because of the booming of building and expansion of electricity in the absence of proper training and safety measures for the workers we see a lot of electric burns. Because of the same reason we see a lot of trauma cases, which require reconstructive surgery. The other conditions, which require plastic and reconstructive surgical skills, are congenital anomalies, of different types, which are also on the rise. Cleft lip and palate, hand anomalies leg anomalies ear anomalies etc.

You stated above that congenital anomalies are one common conditions which require the involvement of Plastic and reconstructive surgeons, what is the commonest Congenital anomaly which needs the expertise of Plastic and reconstructive surgeon

Almost all congenital anomalies in any part of our body require the expertise of a plastic surgeon. Since it is impossible to discuss all let me discuss the most common congenital anomaly, which occurs in the head and neck region in which I am also deeply involved, cleft lip and or palate anomaly. Cleft lip and or Palate literally mean an opening in the lip and palate (roof of the mouth). It commonly involves the upper lip it could be on one side where it is called unilateral or both sides where it is called bilateral. This is one of the commonest congenital anomaly in human being. It is also common in Ethiopia. Approximately one out of the 600 children born in Addis Ababa will be born with this anomaly. It is not life threatening but requires major corrective procedures, follow-up and rehabilitative care. In addition to appearance the problems associated with cleft Lip and or palate are multiple which include feeding difficulties, recurrent ear infection to the extent of hearing loss, speech problem, dental problem and psychosocial burden to the affected child and the family.

At the moment, these patients receive full rehabilitation free of charge at Yekatit 12 Hospital medical College with the support of the hospital, transforming Faces and Smile Train by a team of health professionals. This Cleft Management Team Includes Plastic and reconstructive Surgeons, Speech Therapists, Social Worker, Nurse Coordinator, ENT Surgeons, Orthodontists, Dental technician, oral hygienist and pediatrician. The treatment of these cleft victims’ starts with counseling of the parents. It is a big trauma to give birth to a child with any type of defect when you expect to have a normal one, so the first thing to do is to provide psychosocial support for those families. The psychosocial support will include demonstration of feeding techniques family group discussion and later peer-group discussion. It will be followed by surgical treatment evaluation and drainage of ear canals (Grommet tube insertion) by ENT surgeon if needed.

When did this multidisciplinary care exist in Ethiopia?

This multidisciplinary care did not exist in the country until 2003 when it was started at Yekatit 12 Hospital Medical College and ALERT center in Collaboration with Addis Ababa health bureau, Federal Ministry of Health, Addis Ababa University and Haukeland university hospital Bergen Norway with the support of Norad.

At the beginning of this program, it was run by Norwegian plastic and reconstructive surgeons and speech therapists. In addition to the clinical activity they also thought Ethiopian professionals and now all the health professionals in the cleft management team are Ethiopians. The Cleft management team at Yekatit 12 Hospital Medical College was awarded as a 2016 Smile Train Global Leader in Cleft care.

What is your take on the Government’s bid to churn out competent health Professionals that back up the goals set in GTP II in improving service delivery and medical education?

In addition to the clinical service, I am involved in many areas like teaching (capacity building) team coordination and creating external contacts. I am involved in the teaching of undergraduate medical students, general surgical residents, Plastic and reconstructive surgeons at Addis Ababa University, and General surgical residents and orthopedics residents coming from different universities in the country and abroad. I also mentored the plastic and reconstructive surgery residents at Jima University. I organized and thought at different national and international workshops. I involved in training of supportive staff from different health sectors in Addis Ababa in burn care. I am working as a site director for a program called partners in cleft training in Africa which is run by Kuamsi, Ghana, Midugri, Nigeria, Seattle Children USA. I am also working as a cleft management team leader at Yekatit 12 Hospital medical college for Transforming Faces, Canada and Smile Train USA.

Finally let us talk about your research experience.

I believe that research is very important in developing and improving knowledge and practice. I think it is only through research that one can evaluate the activities he carries on. I myself have done many researches and involved in many areas of research activities. Some of my research works were published in national and international peer reviewed journals. Two of my works won an award. Currently, I am doing a number of scientific researches; some are under review for publication.

BY ADDISALEM MULAT

 

 

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