1/10: a busy and different kind of day

A sad and frustrating to the start of the day. We operated on a huge tumor last week, probably benign. I thought the surgeon did a wonderful job. Ran into the resident who was assisting on the way to rounds early this morning and learned the patient had died. I was shocked and angry, particularly when I heard the description of events and the management of them. Details are technical and frustrating.

The usual 6 or 8 trauma cases over the weekend are reported. Some make it and some do not. We have our morning tea and I then learned the Norwegians have arrived. We were expecting them tomorrow.

More than 2 hour meeting with the dean, 4 of the six neurosurgeons in the country (80,000,000 people), 3 Norwegians (more about them later) and I.



They are here to determine whether to renew a grant from the norwegian peace corps to our hospital. Most of the funds will go for scholarships for residents and nurses to spend 3 months in Bergen, Norway. Remainder for some equipment. There is an unbelievable amount of construction going on in Addis and the entire country; however health care does not seem to be a priority and the hospital actively seeks help from Norway, turkey, etc. U.S. Does not seem to be much of a participant here at all except in providing AIDS drugs and care .

After much planning and rehearsal, and thanks in no small part to my being here (which really impressed the Norwegians), our proposal seemed to be very well received and my impression is we will get the money ( sounds like more than $100,000).

After the meeting we tour the hospital with them and then go to the other hospital, Zudetu, just 5' away.

The Norwegians then invited us to a lovely old world Ethiopian hotel dining room. I was fortunate to sit next to the recently appointed chief of neurosurgery from Bergen and we had a very informative discussion. The other norwegians were an anesthesiologist and the head nurse/administrator of their 70 bed neurology/neurosurgery unit.

Norway is a country of only 5,000,000 people with purely socialized health. Taxes are high, but essentially all health care is free, except for $25 for every visit to a g.p. the neurosurgeon said he makes a good salary and both he and his patients are grateful for their system. Yes, the doctors periodically wrestle with the government over salaries, but overall he feels their system is far better than ours and he knows our system well.

There is no such thing as malpractice except for egregious acts. Normal complications are expected and accepted, If the patient has a complaint they go to an ombudsman, who seeks a review and opinion from experts in the field. If the patient was injured by other than a known complication and the doctor was at fault, some money may be awarded but it is reasonably related to the injury and very rarely as much as 6 figures. Usually the hospital pays, as the employer of the physician. Egregious demands are never made; documented pain may be compensated but not "suffering" which is the usual huge award in our system.

All in all a wonderful day with very intelligent, highly motivated and caring, blond and bright blue eyed (all three of them) Norwegians. They were very impressed that the King of Norway rented our house in Vail a few years ago.. I had forgotten, but Gabriel, the Norwegian/Ethiopian neurosurgeon reminded them.