Global ENT Outreach (GEO) Middle Ear Mission in Butajira, Ethiopia
Kavita Dedhia, MD Humanitarian Travel Grantee Raj C. Dedhia, MD As husband and wife, we had the unique experience of traveling together from Pittsburgh, PA, to Butajira, Ethiopia, in early June to take part in a surgical mission for patients with chronic ear disease. The trip was made possible by the collaboration of Ethiopian physician Nega Kiros, MD, and leader of Global ENT Outreach (GEO) Richard Wagner, MD. Dr. Wagner assembled an international team including himself, Marta Sandoval, MD (ENT-Spain), Pedro Benitez, MD (ENT-Spain), and Victor Estevez, MD, (Anesthesia-Spain) on the “Butajira Middle Ear Program.” Dr. Wagner founded GEO in 2000. The organization has flourished during the last 13 years and now serves more than 10 countries. Dr. Wagner successfully established two temporal bone laboratories, one in Peru and the other in Cambodia. Apart from the chief goal of providing patient care, there was a strong emphasis from the attending physicians on educating both Ethiopian otolaryngologists and us, residents from the United States. Two of the three microscopes had teaching arms allowing for attending oversight during cases. Additionally, one of the microscopes was hooked up to a projector system. This allowed the surgery to be viewed by a larger audience to allow better visualization of the procedures. We met in Addis Ababa on Sunday, June 10, and traveled by car to the small town of Butajira. That afternoon, we evaluated nearly 100 pre-screened patients in clinic for surgical candidacy. While they patiently waited outside to see if they were to have surgery, we spent the next few hours triaging the group. We scheduled a total of 51 surgeries during the following five days. We set out to complete roughly 10 complex cases per day including tympanoplasties, mastoidectomies, and tympanomastoidectomies with and without ossicular chain reconstruction. We used one large operating room, which was divided into three sections to maximize our efficiency by operating on up to three patients simultaneously. The majority of cases were performed under monitored anesthesia care (MAC) while younger children received general anesthesia. Our day started with team breakfast at 7:30 am with an 8:00 am operating room start. We typically finished cases by 6:00 pm. Following dinner, we reviewed each of the cases from the day and reviewed surgery that had been recorded on one of the microscopes. It provided an excellent opportunity to reflect on our operative mistakes and learn from the experiences of others. Teaching the Ethiopian residents and physicians was the central goal of this surgical mission. From June 11 through 15, we completed 51 otologic surgeries without notable complications. We provided care to an area that is profoundly underserved. To give perspective, the ENT nurse in Ethiopia stated that there were roughly 10,000 patients in Butajira on the waiting list to be seen in our clinic and possibly require surgery as sequelae from chronic otitis media. Ethiopia has a limited number of otolaryngologists, and of the otolaryngologists few are adept at providing complex otologic care. There are also virtually no supporting services such as trained audiologists and speech therapists. All of these factors increase the burden of ear disease in Ethiopia. It is the hope of Dr. Wagner and the GEO to continue to train Ethiopian otolaryngologists (roughly 20 ENTs in a country of 84 million) in complex otologic surgery. In particular, the GEO is attempting to build an Ethiopian partnership to house a temporal bone laboratory in Addis Ababa and raise awareness for the devastating impact of middle ear disease. We would like to thank the Academy for its generous support in providing Kavita the Humanitarian Travel Grant and allowing us the incredible opportunity to give back to the global community.
Humanitarian Travel Grantee
Raj C. Dedhia, MD
As husband and wife, we had the unique experience of traveling together from Pittsburgh, PA, to Butajira, Ethiopia, in early June to take part in a surgical mission for patients with chronic ear disease.
The trip was made possible by the collaboration of Ethiopian physician Nega Kiros, MD, and leader of Global ENT Outreach (GEO) Richard Wagner, MD. Dr. Wagner assembled an international team including himself, Marta Sandoval, MD (ENT-Spain), Pedro Benitez, MD (ENT-Spain), and Victor Estevez, MD, (Anesthesia-Spain) on the “Butajira Middle Ear Program.”
Dr. Wagner founded GEO in 2000. The organization has flourished during the last 13 years and now serves more than 10 countries. Dr. Wagner successfully established two temporal bone laboratories, one in Peru and the other in Cambodia.
Apart from the chief goal of providing patient care, there was a strong emphasis from the attending physicians on educating both Ethiopian otolaryngologists and us, residents from the United States. Two of the three microscopes had teaching arms allowing for attending oversight during cases. Additionally, one of the microscopes was hooked up to a projector system. This allowed the surgery to be viewed by a larger audience to allow better visualization of the procedures.
We met in Addis Ababa on Sunday, June 10, and traveled by car to the small town of Butajira. That afternoon, we evaluated nearly 100 pre-screened patients in clinic for surgical candidacy. While they patiently waited outside to see if they were to have surgery, we spent the next few hours triaging the group. We scheduled a total of 51 surgeries during the following five days.
We set out to complete roughly 10 complex cases per day including tympanoplasties, mastoidectomies, and tympanomastoidectomies with and without ossicular chain reconstruction. We used one large operating room, which was divided into three sections to maximize our efficiency by operating on up to three patients simultaneously. The majority of cases were performed under monitored anesthesia care (MAC) while younger children received general anesthesia.
Our day started with team breakfast at 7:30 am with an 8:00 am operating room start. We typically finished cases by 6:00 pm. Following dinner, we reviewed each of the cases from the day and reviewed surgery that had been recorded on one of the microscopes. It provided an excellent opportunity to reflect on our operative mistakes and learn from the experiences of others. Teaching the Ethiopian residents and physicians was the central goal of this surgical mission.
From June 11 through 15, we completed 51 otologic surgeries without notable complications. We provided care to an area that is profoundly underserved. To give perspective, the ENT nurse in Ethiopia stated that there were roughly 10,000 patients in Butajira on the waiting list to be seen in our clinic and possibly require surgery as sequelae from chronic otitis media. Ethiopia has a limited number of otolaryngologists, and of the otolaryngologists few are adept at providing complex otologic care. There are also virtually no supporting services such as trained audiologists and speech therapists. All of these factors increase the burden of ear disease in Ethiopia.
It is the hope of Dr. Wagner and the GEO to continue to train Ethiopian otolaryngologists (roughly 20 ENTs in a country of 84 million) in complex otologic surgery. In particular, the GEO is attempting to build an Ethiopian partnership to house a temporal bone laboratory in Addis Ababa and raise awareness for the devastating impact of middle ear disease.
We would like to thank the Academy for its generous support in providing Kavita the Humanitarian Travel Grant and allowing us the incredible opportunity to give back to the global community.