Doctor Brings Expertise and Gains Insights in Ethiopia



Dr. Gordon, BCM-Osher-JDC Medical Fellow

in Ethiopia, hosts a teaching session with

medical students from University Hospital, Gondar.

Photo: medshare.org

 In an effort to improve medical education, clinical care, and research in Ethiopian pediatrics, JDC has teamed up with the Baylor International Pediatric AIDS Initiative (BIPAI) and Gondar University Hospital (GUH). Over the past two years, BIPAI pediatricians placed as fellows have been formally integrated into every aspect of medical education at GUH, contributing invaluably to both the education of the local medical professionals and the care of the hospital’s patients.

David Gordon, M.D., M.P.H., is the current BCM-Osher-JDC Medical Fellow in Ethiopia. He trained in pediatrics at the University of California in San Francisco, holds a Masters in Public Health from Boston University, and has worked in India, Lesotho, Kenya, and Turkmenistan. David shares his insights on medical miracles, mind-bending local challenges, and the importance of cardboard toys for malnourished children.

JDC: Can you share some details about your personal background? When and how did you initially decide to go into medicine?

DG: I was born in Walnut Creek, California. I wanted to be an aerospace engineer until 1992, when on a whim I joined a program called Amigos de las Americas, run out of Texas. I raised money by selling grapefruit door to door, and paid for a ticket to Ecuador as a "community sanitation" volunteer. I was placed in a small village high in the Andes, where I worked with the local health department to construct latrines, give health-related presentations to villagers, and do what I could to develop the local infrastructure. It was my first time seeing poverty like that, and as a kid coming from suburban California it made a big impression on me.

I went to college, where I studied international development through the geography department, to figure out why people in Ecuador were so poor. At some point, I recognized how integral a population's health was to its economic productivity: people become sick because they're poor, and they become poor because they're sick. I became interested in public health, and in medicine by proxy. The rest of my education fell into place from there.

JDC: You've worked in such a wide variety of places, including India, Lesotho, Kenya and Turkmenistan. In what ways is Ethiopia a unique place for you to be working? What issues do you see transcending national boundaries?

DG: Ethiopia is like nothing I've ever seen. Its landscape, with green plateaus and rocky outcroppings, is stunning. Its culture, practically untouched by colonial hands, seems pure in a way I can't fully describe. And its people are friendly and respectful of me in a way I've rarely seen in my travels. As wonderful as Ethiopia is, it presents many challenges to providing medical care. First, there are local customs that threaten the health of children, and as a physician it's difficult to understand why these customs still exist. Holy water is used for everything from ear infections to the treatment of HIV, a practice which considerably delays a patient's presentation to allopathic care.

Second, the pathology that I see here is unlike any I've seen elsewhere. Ethiopia aspires to become a middle-income country, but it is still extremely poor. It has the world's 7th highest incidence of tuberculosis; it is one of just three places on earth endemic for a parasitic disease called visceral leishmaniasis (or kala-azar), which hits children here quite frequently; seasonal food security continues to be a problem, and severe acute malnutrition accounts for the bulk of our admissions; and countless rare diseases, including endemic typhus (the last place in the world this condition can still be found), abound. The wards are as much a classroom for me as they are for our medical students and interns.

Third—and this has more to do with me than with Ethiopia—this is the first time I've worked as a fully-credentialed pediatrician in another country. My status as a physician affords considerable legitimacy, and I have been able to connect with colleagues faster and accomplish much more than I was as a Peace Corps volunteer, a medical student, or a resident. The willingness of my Ethiopian colleagues to collaborate with me in this way has made my experience here more gratifying than any I've ever had.

Many of the same problems that weaken medical care in the US can be found in Ethiopia, too. Interns are severely overworked, and everyone (including me, sometimes) expects them to be miracle workers. Systems of delivering care break down constantly, as they do in the US, and fixing broken systems takes time and energy above and beyond what we're already putting into the job. And in a busy ward, with everyone dealing with the same problems, it happens too often that providers fail to relate to patients as human beings: we know what needs to be done, we need to do it quickly, and the human side of delivering care is undermined by the machines we have to become. Fighting all this is just as difficult here as it was in San Francisco!

JDC: Can you describe your typical day, if there is such a thing?

DG: I wake up at 5:45 and go for a run along the main road, usually getting warm greetings from passersby who yell "Gobez (well done)!" One child runs out to me, pumps his arm up and down several times, and yells "YES!" The latter happens just before a large hill that brings me home, and always recharges my energy. I drink a cup of buna—or coffee—at a cafe across from the hospital, where the owner often brings his 4-year-old son for me to evaluate for one ailment or another.

At eight, I join the department for morning conference, where we hear from interns about patients that were recently admitted and help them learn the essentials of pediatrics. Truthfully, I probably learn as much as I teach, since the pathology in Ethiopia is so different from that in the US!

After conference, two days a week, I teach medical students at the patient bedside. One student presents information about the patient, and I spend two hours making corrections, expanding the list of possible diagnoses, and reviewing the basics of physical examination and therapy. On the remaining three days, I work on "quality improvement" and research.

At noon, I walk across the street to a restaurant, where I fill my stomach with local cuisine for the equivalent of 50-75 cents. From two to four, I do rounds with interns on actual patients, hearing about details and making corrections to their management. I usually spend an hour at the end of the day reading about conditions I've seen on the ward and making sure my team's management is in agreement with international standards of care.

In the evening, after five or six, I like to walk around my neighborhood. Some children near my house teach me Ethiopian games; some families ask me to come inside to see a sick child and then sit me down for coffee or tea; and beyond my community, in the lush farmland, I like to walk and clear my mind for the night. Then I cook dinner, work on small projects or watch a TV show, and go to bed around 9:30; most of my friends call me an old man, but I can't function without a good night of sleep.

JDC: Do you work in tandem with the other Fellows in the program? What about local medical professionals?

DG: Currently, I'm the only BIPAI representative in Gondar. Usually, there are three of us, and two more will be joining me soon. We all work on our own projects, but lean against each other heavily: we consult each other on clinical cases, discuss good approaches to getting projects accomplished, and point out resources when we find them.

More commonly, to make our work sustainable, we partner with other physicians in our department. Six general practitioners, two residents, and three Ethiopian "senior consultant" doctors contribute significantly to our work, and without their involvement nothing would get done. We hope that when BIPAI leaves some day, we can leave behind a team of providers that can keep our interventions going into the future.

JDC: How do you cope with the difficult things you encounter so regularly? Have you seen any "miracles"?

DG: I wish there was a secret to making the sight of a suffering or dying child easy, but it never is, and I hope it never will be. I've seen students and residents visit this hospital for a one-month attachment and give up after two weeks, practically in tears; it makes me wonder if I've lost some element of sensitivity somewhere along the way.

I do two things when something bothers me. First, I run. Sometimes I run really far. And I always feel better when I come back. Second, I do something about the problem, even if it's small. Of all the cases I've seen in the past year, the malnourished kids have been the most heart-wrenching for me. They lie there, and they don't even have enough energy to complain. After my first week on that ward, I came home and made five toys out of cardboard, plastic bottles, and old magazines. Kids that I thought were lost forever smiled for the first time, mothers started playing with their children, and for a while the quietest ward in the hospital became the loudest.

Surviving here, I think, depends on feeling like you're moving forward, and on believing that your presence means something. A realist would probably die here, but as an idealist I'm thriving.

Honestly, every healthy discharge feels like a miracle, since kids come to us really sick and we care for them with so little! But other miracles happen, too. Interns who seem too busy to improve their practice sometimes take my advice to heart and surprise me with improvement. Medical students who I think aren't paying attention in lecture approach me afterward and ask appropriate questions, even asking for more reading material to augment their learning. If I look for miracles, I find them.

JDC: How does your Public Health background play into the work you are doing in Ethiopia?

DG: As a physician in general, moreover, I think it's important to think like a public health practitioner. One sees disease in a broader context if one is trained to think at the population level. It's easier to recognize clusters of disease and ask why they're occurring; it's easier to include environmental adjustment in a child's discharge plan; and it's more likely that a patient's family members will be recruited for testing when an infectious diagnosis is made. I've heard some people say public health (which focuses on communities) and medicine (which focuses on individuals) are mutually exclusive. On the contrary, I think public health and medicine can and should work very well together.

JDC: What are some of the biggest challenges you've faced in your time in Ethiopia so far? What are some of the most unexpected surprises?

DG: I always find technology frustrating, and technology in Ethiopia is no exception. So much of what I do requires 1) a source of electricity, 2) a source of internet, 3) a computer that works, 4) a cord that connects a computer to the internet and another that connects it to electricity, and 5) a printer that works, has electricity, has a cord that connects the computer to the printer, and accepts my flash drive. This may sound logical to you, but in Ethiopia you would be AMAZED by how rarely all these components actually co-exist.

The same is true for lectures in powerpoint—at least one of these components is almost always missing, no matter how prepared you are. Ethiopians deal with this by shrugging their shoulders; admittedly, I deal with it by getting really angry. I want to do good work, but I feel like the universe is working against me. I'm becoming more patient with time here, and I think I'm becoming a better person.

I've been surprised by how far we get with such few resources. A child with a newly-diagnosed neurologic disease in the US would get an MRI and blood work very quickly. Here, I have to re-learn how to interpret physical findings in context, knowing that the only data I'm going to get will come from my ears, hands, eyes, and nose. It's validating to know we can do so much with so little, especially having trained at a US tertiary care hospital where any question was answered with a sophisticated test. I'm also surprised by both the heroism and the greed of providers here. My fellow pediatricians and internists voluntarily stay long hours to care for their patients and are meticulous when educating medical students. In other departments, however, senior physicians often shunt the poorest patients into private clinics to earn more money from their care; equipment is stolen from the public hospital for use at private facilities; and, incentivized by more competitive salaries, many leave practices serving the poor to work abroad or for international NGOs that may or may not provide comparable services. I really do feel like I see the best and worst in people here.

JDC: What do you think you'll do once you complete your current service?

DG: I have absolutely no idea what I'll do after this. I've wanted this job, more or less, since I was sixteen years old, and it frightens me to think that I have to set new goals now. I have an interest in policy, and may pursue a career with the WHO or one of the US-based health development organizations. Alternately, I could continue practicing pediatrics for an underserved community in the US and focus on community development. After this experience, it will be difficult to ever let my interest in international health go. I'm open to ideas.

Shabbat in Addis

By Naomi Van Dinter

Naomi is an international development worker currently working on a large project that brings HIV care to over 500,000 people and treatment to over 200,000 people in ten countries while training and empowering local organizations to gradually assume management of the project. The central funding for the project is ending in an effort to bring the management and funding to the country level, and directly to the local partners when possible. Naomi traveled to Ethiopia to help the country program apply for direct, continued funding.

I arrived into Addis Ababa, Ethiopia during the day. I had transited through Addis previously, but only saw the city in the late evening and the early morning. I have traveled through most of Eastern and Southern Africa, yet I was especially eager to take in the sights and sounds of Ethiopia. The country has maintained a private, homogeneous culture with great pride in its traditions and roots.

I was greeted by a welcoming people that were enthusiastic in sharing their unique culture. Every person with whom I spoke wanted to talk about my impressions of Ethiopia and explain a different piece of how their heritage fit into the modern way of life. The cultural restaurants showcasing traditional music and dance, usually reserved for tourists in other African countries, were dominated by the locals – proudly enjoying their country’s food and distinctive dance while relishing the incense from the coffee ceremony at the conclusion of each meal. Along with their deep cultural roots, many of the Ethiopians are deeply religious people who choose to live their religions without judgment or evangelism.

My purpose in visiting Ethiopia was to write a proposal to continue funding for an HIV care and treatment project, however my additional personal interest lay in connecting with Ethiopian Jewish population. Prior to departing, through a contact at the Associated [Jewish Community Federation of Baltimore], I was linked with the American Jewish Joint Distribution Committee (JDC) who recommended I contact their Country Director, Dr. Rick Hodes. I learned that unfortunately I could not visit the remaining Ethiopian Jewish population as it was too far from Addis, however I received a lovely invitation to spend Shabbat with Dr. Hodes.

Dr. Hodes has become well-known for his work with the local population through the Missionaries of Charity, as well as for caring the Ethiopian Jewish population (through JDC). However, it wasn’t until I arrived at his house did I realize that he truly lived his work.

I arrived at Dr. Hodes house at 6:30PM with a dozen roses in hand, braced for an elegant dinner in one of the large mansions in which high level expats usually live in Africa. Instead of a guard answering the door at the gate, a sweet teenage boy with a severe spinal irregularity welcomed me into the courtyard of Dr. Hodes’ modest home. There, I met a young man who had lost a leg to cancer, another girl who some physical difficulties, and the list went on. There were about 15 children who were all patients of Dr. Hodes, and I presume also orphans, as Dr. Hodes had taken them all in.

The younger ones were attending school and living in small dormitories in the back of the house, while the older children who had graduated were living in another house off-site. Despite the challenges they faced , the children had a warmth and sense a peace around them that I have only experienced in an ashram that I visited many years ago. I imagine that this came from the nurturing of a stable home and a parental figure, and security about their next meal -- all assets that had previously eluded them.

In addition to the children, a group of physical therapy graduate students from the US were socializing in the living room while waiting for Dr. Hodes to arrive. A few Jewish stragglers living in Addis were also in attendance. At around 8PM Dr. Hodes came in and quickly began Shabbat. He asked all of us to form a large circle around the living room and threw “kippot” to all of the men. These kippot were hats of all kinds: jester hats, skull caps, hats with Hanukah lights and such. Dr. Hodes and his children led the group in a rendition of the ‘The Hammer Song.’ He then said a blessing over the bread (skipped the lights), dipped each piece in salt and through it at each person to catch. To honor the Ethiopian Orthodox (Christian) fasting season that many of his children were observing, we all enjoyed a vegan Ethiopian meal.

The evening included a blend of people from different cultures, religions and socio-economic strata that were brought together in respect for a person who was living in solidarity with those he served. I was humbled by the warmth and inclusive atmosphere that I experienced during the Shabbat in Addis. To me, it personified what the core of religion is about: recognizing and honoring the piece of G-d that is living within each of us.

On the Job in Ethiopia - University of Washington Hillel Short Term Service Program

Students from the University of Washington Hillel recently traveled to Ethiopia on a JDC Short Term Service program to volunteer their time in support of JDC's humanitarian assistance programs in the country.  This marked the first time in the 27 years of field work in Ethiopia that such a group has traveled there for this purpose. 

Read about their time in Ethiopia by clicking on the links below, or visit JDC: In Service, JDC's Short Term Service program blog.

Working hard to get medicine to the visitors of JDC's clinic in Gondar.

First Day of Service in Gondar

Teaching girls from a local village “Mary Had a Little Lamb”

Day 3!

Helping carry water from the local water source

Gondar--Addis

Changing the Future in Ethiopia

Check out this moving video showing JDC humanitarian assistance programs in Ethiopia, 2010, funded by the Mary L. and William J. Osher Foundation, in partnership with the Jewish Federation of Greater Houston.

Interview with Rick Hodes on NY1

The official premiere for the documentary profiling Dr. Rick Hodes, Making the Crooked Straight was held on April 13 at HBO's headquarters in Manhattan.  New York local news channel, NY1 interviewed both Dr. Hodes and filmmaker Susan Cohn Rockefeller during the party. 

Watch the interview and read the accompanying article at NY1. 

Learn more about JDC's work in Ethiopia.
Official website for Making the Crooked Straight.

Dr. Rick Hodes Taking Center Stage

For more than 20 years, Dr. Rick Hodes has provided comprehensive medical treatment in Ethiopia.  As JDC's Medical Director, his programs have served tens of thousands of people through two medical clinics, immunization, nutritional support, family planning, and community health. He was instrumental in ensuring the safe immigration of Jews to Israel during Operation Solomon in 1991, the historic airlift of over 14,000 Ethiopians to Israel in 48 hours. Dr. Hodes works with people suffering from heart disease, diseases of the spine, and cancer.

Dr. Rick was inducted into the Medical Mission Hall of Fame and was selected by CNN as one of its CNN Heroes in 2007.  He is now the subject of a new documentary film, Making the Crooked Straight and a new book, This is a Soul: The Mission of Rick Hodes. 

Watch on Wednesday, April 14, at 8:00 pm (EDT) when Making the Crooked Straight will debut on HBO. 

The official trailer for Making the Crooked Straight


The official film WEBSITE
HBO's web page for the film
Photos from the film premiere in New York from WireImage

This is a Soul: The Mission of Rick Hodes by Marilyn Berger is available for purchase HERE. Read an excerpt from the book HERE as well as a wonderful article about the author in the New York Times.

You can watch an interview with Dr. Rick and Marilyn Berger with ABC News HERE.


Learn more about JDC's work in Ethiopia HERE and you can hear from Dr. Rick about his work in these clips of his presentation to the JDC Ambassadors Circle.


Video clip from Dr. Rick Hodes' presentation at the JDC Ambassadors Circle Global Symposium on May 19, 2009.



During his presentation to the JDC Ambassadors Circle, Dr. Rick Hodes shares the story of his involvement in Operation Solomon in 1991, where Dr. Rick was in charge of the medical care for over 14,000 Ethiopian Jews who were airlifted to Israel over a period of 36 hours. 

Dr. Rick Hodes Featured on CBC News

Canada's CBC News recently interviewed Dr. Rick Hodes, JDC's Medical Director in Ethiopia about his work, his life and the documentary film by Susan Cohn, Making the Crooked Straight that has been a Jewish film festival smash across North America.

To watch the interview on CBC News that also includes footage from the documentary film please click on the picture below.





In this video clip, Dr. Hodes speaks to participants at the JDC Ambassadors Circle Global Symposium on May 19 about JDC's current programs in Ethiopia as well as his own work in the areas of cancer research, spinal deformities, tuberculosis and other medical conditions.

Bringing Wells and Wellness to Residents of Rural Ethiopia

Azanaw Musaw Tegegne, an eighth grader, says that before JDC installed the fresh water tap in his village in Gondar, Ethiopia, most people drank water from a nearby stream. Like hundreds of villages around rural Ethiopia, Gondar’s Gabriel kebele (area similar to a neighborhood) had no access to potable water for drinking, bathing, or cooking during the region’s extended dry seasons and draughts.

Ethiopia is one of the poorest countries in the world. In rural parts of country, only 11 percent of the population has access to clean water while just 7 percent has access to adequate sanitation facilities. During the rainy season, the population’s water supply is procured from nearby springs, streams, and shallow wells. When the dry season comes, these water sources dry up, forcing villagers to collect water from sub-standard, often polluted, wells and streams.

The health hazards are enormous: 90 percent of all preventable diseases such as malaria, cholera, yellow fever, hepatitis, typhoid and diarrhea can be attributed to underdeveloped and ill-protected water supplies. Waterborne diseases claim the lives of hundreds of thousands of Ethiopians each year.

Limited access to safe drinking water not only results in poor health, but also causes serious developmental problems. Collecting water is back-breaking work that drains precious energy and restricts involvement in productive activities and community affairs for many women and children in every village. On average, rural villagers spend four to six hours per day collecting water from sources that can be as far as 10 kilometers from their homes.

Over the last 25 years, JDC has built dozens of potable water wells throughout Gondar and the surrounding countryside with guidance from the Ethiopian Water Works Construction Authority and the local government in Gondar. Funding for this effort has come from international NGOs, as well as private donors and foundations. The Ground Water Development program has produced hand dug wells, protected springs, taps, micro-dams, and latrines.

JDC originally built wells in areas that served large numbers of Jews (the Felas Mura population awaiting immigration to Israel) but also supplied water to the non-Jewish villagers. By 2008, as JDC constructed a dozen wells across Gondar through its International Development Program (JDC-IDP), new water projects served 100 percent non-Jewish populations.

As JDC-IDP’s larger goal is to provide assistance that will leave communities stronger and self-sustaining in the long run, each project engages and is facilitated by local village water committees, who solicit local manpower for some labor and materials used in the construction process. JDC-IDP also provides the villagers with training on the importance of drinking the clean water and encourages behavioral change to improve overall health. Whenever possible, in addition to building the wells, JDC-IDP constructs communal latrines to facilitate a safe, sanitary human waste disposal system (as open air toilets are widely known to contaminate the town’s clean drinking water). Community education and involvement contributes tremendously to the success and long-term sustainability of these projects.

With safe, fresh, local water sources for drinking, cooking and sanitation available in his village for the first time, Azanaw Musaw Tegegne no longer needs to travel great distances to collect water. Freed of this chore, he will now be able to finish eighth grade at the newly built JDC-IDP school in his hometown of Gabriel, Gondar—one of 10 schools JDC-IDP has built in the region in the past 18 months.

That last fact is important, as Ethiopia has an adult literacy rate of barely 36 percent. Azanaw will be one of the just 23 percent of teenage boys and 13 percent of teenage girls enrolled in secondary schools. (Only 55 percent of all boys and 47 percent of all girls are enrolled in primary schools; 38 percent will not reach the fifth grade.)

Committed to making a difference in the development of Ethiopia’s educational system and securing a future for some of the most vulnerable people on the globe, JDC-IDP has been repairing and building schools for some of the poorest Ethiopian children across the Northern Gondar region since 2000.

At a celebration in appreciation for JDC-IDP’s donation of a hand water pump to one local village, the Chairman of the Gondar City Council, Asmamaw Yosuf, said, “Really, you have reached at the [root] of the problem. The people have no words to appreciate your donation. [We have] seen the enthusiastic dances praising to your organization.”