New technology for the Emergency Room is now in use.

I first visited Tikur Anbessa Hospital one year ago to work with colleagues from the hospital and Addis Ababa University.  My partners are exchange fellows with UW-Madison, and we are working together to develop healthcare quality improvement efforts in the hospital.  These are some of the most talented and well-trained health professionals  in the country, and I have had the privilege of  collaborating with them through shared work and study in both Madison and Addis for the past two years.

The Hospital, whose name means Black Lion in English, is a large public hospital and faces the problems you would expect in a sprawling African city with a high rate of traffic accidents.  This hospital receives those trauma patients, and serves as a referral hospital for the more difficult cases seen in other hospitals, ranging from emergency obstetrics, to pediatrics, to multi-drug resistant tuberculosis to HIV/AIDS, to advanced cancers.  So just about everything is happening here….

There are visible changes since my last visit.  Last year the pediatric emergency ward was really in disrepair and creating very challenging con!ditions for health care providers, patients and their caretakers.  There was talk that a new pediatric  was in the works.  As several people described it to me,  I looked at that patch of ground they were pointing at, trying to imagine the new building, and worrying that this “six month” project might take years…. Well, the good news is it did not take years!  I peered into the windows this afternoon!  It is nearly finished with the ribbon cutting soon (maybe this week?) and patients will be moved from the temporary ward early in 2012.

A 24 hour pharmacy is now in place in the ER.

The other wonderful development was hearing about how the QI program is moving forward and maturing.  There was no building to point to, but as I sat at the table with my colleagues, who shared their successes and honest appraisal of the things that had not worked, and how they would keep trying new strategies,  I realized that the reality of what they had  “built,” terms of improved care was just as impressive.  They have developed and implemented a functional triage system and are sharing it with other hospitals.  They have made huge strides in infection control.  While we can’t see the cases of infection that have been prevented (always a problem for successful prevention programs!),  the cleanliness is evident on the wards in the adult emergency room, and plans are in place to replicate this in the new pediatric emergency ward.  They are also improving drug distribution in the hospital (imagine yourself in one of the beds and then think more effective treatment and better pain management), and are improving a number of registration systems that will lay the foundation for better information for case management and planning at the ward and hospital level.  In addition to all the projects, they have developed their own capacity to train others and, appropriate to their role as a national teaching hospital,  they are looking toward sharing experience and skills with other hospitals around the country.

One of the really special aspects of this project is that it is a Twinning Program, (see,  which means that we work through mutual partnerships and exchange.  It is  really joyful to walk the grounds of the hospital, and see the familiar faces of the fellows who have shared experiences with us in Madison.  In addition to being part of the valuable medical exchange,  we have walked the Lakeshore Path together, and some have visited my home.  During one visit the  fellows experienced snow, and another visit coincided perfectly with the peak of tulip season, so we skipped out of class to visit a local tulip garden!  This week  I am on the other side of the Twinning the equation– in my visits to Ethiopia I have begun to experience the beauty and hospitality and incredible history of this country, and I hope to return many times myself, and with my family.

Everyone gets their daily fix of hope and inspiration in a different way I guess, but for me today it came from revisiting this hospital, and seeing what is needed, what is happening, and what is possible.  It was a visceral  reminder to me that small changes matter. Perhaps we don’t have to develop complex   plans  to  “scale up change.”  I don’t want to scrap that idea entirely because it is the  topic of the talk I am supposed to give at the ICASA Conference next week (!), but I am beginning to believe that the most important thing we can do is to let the reality and possibility of the tangible changes that are within our reach capture our imaginations, befriend us, get out of control, and enable us to work together to change the world around us.