Stories from Africa

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Stories of Africa Erica J Zima, MSN, CRNA
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Health Volunteers Overseas is a private,
non-profit, non-sectarian volunteer organization
founded in 1986 and headquartered in the United
States.
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HVO MISSION

• To improve the quality and accessibility of
  health care in developing countries through
  training and education
• Focus on local pathologies developing local
  capacity
• Place emphasis on local materials

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Divisions of HVO

• Anesthesia Overseas
• Dentistry Overseas
• Dermatology Overseas
• Hand Surgery Overseas
• Internal Medicine Overseas
• Nurse Anesthesia Overseas

• Nursing Overseas
• Oral Maxillofacial Surgery Overseas
• Orthopaedics Overseas
• Pediatrics Overseas
• Physical Therapy Overseas

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Health Volunteers Overseas
Improving Global Health Through Education
1900 L Street, NW Suite 310 Washington, DC
20036 202-296-0928
www.hvousa.org info_at_hvousa.org
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A brief history of Eritrea

• On the eastern coast of Africa, covering 121,000
  square kilometers
• Bordering Sudan to the north, the Red Sea to the
  east, Djibouti to the southeast, and Ethiopia to
  the south
• Six Zobas Dubub, Central, Southern Red Sea,
  Northern Red Sea, Gash Barka, and Anseba
• Nine separate tribes

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History of Eritrea

• Official languages are Arabic and Tigrinia
• Equal division of Christian and Muslim religion
• Economy relies on agriculture
• Currency is Nafka 15 to one US dollar
• Capital city of Asmara
• Population of 400,000
• 7,700 feet above Sea level

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The Political Struggle

• 1889 Eritrea is defined as a nation state and
  colonized by Italians
• 1941 WWII Italy is defeated in Africa and Eritrea
  is ruled by Great Britain
• 1952 Eritrea is federated as an autonomous state
  within Ethiopia
• 1960 Eritrea is annexed by Ethiopia declaring it
  as the 14th province
• 1961 Beginning of the war for independence by the
  EPLF
• 1976- 1978 Liberation movements take control over
  most towns and countryside
• 1991 Eritrea is officially liberated from
  Ethiopia by the EPLF and a transitional
  government is established- an estimated 50-70
  million had died
• 1993 UN referendum for independence held- 99 in
  favor of independence
• 1998 the second of the two wars begins over a
  claimed border dispute in Badme
• 2000 December a UN sponsored cease fire, the
  Algiers Agreementand the introduction of the
  UNMEE peacekeeping force

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Need for Assistance

• Ratio of MDs to general population is 3 per
  100,000 citizens
• To serve a national population of 4 million there
  are 40 Anesthetists, 23 of which are in Asmara
• Training need
• 99 of anesthesia services provided by nurse
  anesthetists, the remaining 1 by Cuban, Chinese,
  Italian, and Egyptian MDAs
• As of Jan 2005 the Orota School of Medicine
  recruited its first class but no formal
  anesthesia program has been identified

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Nurse Anesthesia Training

• Eritrea
• 3 year nursing school (diploma)
• 2 year mandatory National Service
• 3 year clinical practice
• General nursing/TOEFL exam
• 2 year Anesthesia training and residency
• Written and Oral Certification Exam
• No CME requirements

• USA
• 4 year BSN
• 2-3 year Critical Care experience
• 3 year MSN with residency
• Certification Examination
• CME requirements for recertification

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Kessete Teweldebrhan

• Born in Feb 1946 Haren, Akeleguzzai
• 1967 Nursing and Nurse Midwife Diploma from Menen
  School of Nursing, Asmara, Eritrea.
• 1967-1971 Charge Nurse Mekonnen Hailesellassie
  Hospital, Harar, Ethiopia
• 1971-72 PACU Menen Hospital
• 1972-1974 Senior Midwife, Menen Hospital

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Kessete Teweldebrhan

• 1974-1976 WHO/ Swiss government sponsored
  anesthesia training
• School closed after first graduating class of 18
  due to political situation
• 1976-1982 Assistant head nurse of anesthesia
  services Black Lion Hospital Addis Ababa,
  Ethiopia

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Kessete Teweldebrhan

• 1982 Founder and Director of School of Anesthesia
  for Nurses, Black Lion Hospital
• August 28, 1998 Deported from Ethiopia with over
  259 state employees
• All identification, belongings, and family left
  behind
• Three days in camp and an eight day border
  crossing into Eritrea

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Kessete Teweldebrhan

• After suffering from starvation, homelessness,
  lack of identity, and a stroke. Finally given
  the opportunity to again start an anesthesia
  training program- this time, from scratch
• Program currently has its third class
• 9 students, 1 female/ 8 male

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teacher Erica

• Class for 8 hours (two hour lunch/nap of course!)
• The students struggled not only in trying to
  learn anesthesia, but also because they were
  learning in English
• Very curious about the U.S.