By Casey Farrar | The Keene Sentinel

PETERBOROUGH, NEW HAMPSHIRE (USA) – On Dr. Fletcher R. Wilson’s first trip to Ethiopia, he decided he wouldn’t let it be his last.

Wilson, an obstetrician and gynecologist at Monadnock OB GYN Associates in Peterborough who lives in Hancock, traveled to Ethiopia the first time more than a year ago to adopt his now-3-year-old daughter.

During the trip, he was shocked to see the condition of medical care available in the country and contacted Wide Horizons For Children, the Massachusetts-based nonprofit organization through which he was adopting that has also built schools and clinics in the country.

By April, Wilson and another local doctor, Dr. Steven W. Coffman, a surgeon at Monadnock Surgical Associates in Peterborough, were headed to Ethiopia on a fact-finding mission to assess medical needs in the East African nation of 82.5 million people.

“They (Wide Horizons) had money and wanted to build hospitals and health clinics, because they have a humanitarian aid arm,” Wilson said. “But they didn’t have medically trained people to guide them. So that’s where we fit in.”

The country lies in a region of the African continent that is a hotbed of instability — bordered by Kenya, Somalia, Djibouti, Sudan and Eritrea, which it was embroiled in a border war with until signing a peace treaty in 2000 — but is relatively peaceful.

It remains, however, an impoverished agricultural nation that suffers from frequent droughts, with more than 1.5 million people infected with AIDS or HIV. The average life-expectancy is 55 years old, according to the Central Intelligence Agency’s World Factbook Web site.

Wilson, who said he’s been interested in practicing medicine in developing countries for years, enlisted Coffman’s help because the surgeon had extensive experience on international medical trips, having been to Haiti, the Philippines, Cambodia, Laos, Brazil and Peru.

The doctors are planning to start a project in Ethiopia that will focus primarily on promoting women’ and children’s health in Ethiopia, especially expectant mothers and infants, although Wilson said an influx of medical care and improved facilities will benefit the general population.

The ultimate goal is to decrease the need for adoptions by making child-birth less risky in a country where two-thirds of mothers die in labor, Fletcher said.

Because of the malnutrition that plagues the country, many women’s bodies are not fully developed when they become pregnant, and often they are too small for a baby to pass through the birth canal.

“It was just staggering to see,” Wilson said. “Only about five percent of births take place in a hospital with trained professionals.”

In one region of the country, women who need Cesarean sections, or surgery to remove the baby, are sent to walk 27 kilometers, roughly the distance from Keene to Jaffrey, to the nearest hospital for treatment.

If they are too weak to finish the trip, they will return home and die after days of unsuccessful labor, Wilson said

Fletcher’s own daughter was orphaned this way. As the youngest of nine children, when her mother died in child birth the family gave her up for adoption because they could not support her, he said.

When Wilson and his wife, Holly, adopted her, their daughter was more than 2 years old and weighed only 17 pounds.

In a report detailing their findings about the country’s medical care that they submitted to Wide Horizons after their visit in April, Wilson and Coffman say they hope to bring at least two ambulances into the country to relieve the necessity of walking to medical care.

Not surprisingly, Wilson said, what they found during their April trip, and a second visit earlier this month, was a lack of available medical care in rural parts of the country. But the reality of the situation was much more sobering than the doctors had expected.

In the southern part of the country Wilson and Coffman visited two hospitals and a clinic recently built by Wide Horizons. In a the southern-most hospital, which serves about 2 million people, there were two surgeons, two obstetrician and gynecologists, an eye doctor, a nurse anesthetist and 10 general doctors.

But conditions in the north, a rugged, mountainous area were more desperate, Wilson said. At one of the region’s two hospitals, one doctor serves about 1.5 million patients.

Seeing how much need there was in the country encouraged Wilson and Coffman to continue their work there.

“This was one of the most rewarding trips I’ve been on because of the need,” Coffman said. “I’ve never seen anything like it.”

When they returned this month, along with Dr. Joseph V. Lupo Jr., an anesthesiologist at Monadnock Community Hospital, and his wife Mary Jo Lupo, a post-surgical nurse, the doctors performed several surgeries with their Ethiopian counterparts and taught them some new procedures.

Wilson and Coffman say that type of training will be a major piece of their project.

They plan to focus on teaching lower-level medical professionals to do basic procedures such as sewing vaginal tears, which are common in natural childbirth.

Part of the problem they face is that it is hard to retain doctors at hospitals, since they can find better paying jobs with international nonprofit agencies, Wilson said.

Doctors in Ethiopia make a salary of about $200 a month, or about $2,400 per year, but they can make close to $10,000 working for a nonprofit agency in the country, according to Wilson.

“It’s understandably a draw in a country where people are so poor in general,” Wilson said.

Hospitals and clinics are also staffed with mid-level health care providers who do daily inpatient care, similar to the work of a nurse practitioner in the U.S, and “field surgeons,” who receive only three to nine months of training and learn how to do basic surgeries, such as appendectomies and Cesarean sections.

Most women deliver babies at home with the help of traditional birthing aides, who, unlike mid-wives in the U.S., don’t have standard training and are not regulated by the government.

Wilson and Coffman hope to design a program in Ethiopia that can be managed by a local doctor or administrator. They plan to make four trips a year back to the country with other doctors to perform procedures and train local medical professionals.

“I think that by teaching the doctors and professionals there we can begin to see things turn around,” Wilson said.

Casey Farrar can be reached at 352-1234, extension 1435, or [email protected].