Dear Editor,
I read your piece entitled “Could Tilahun’s death have been prevented.” Thank you very much for your inquisitive mind and thought provocative curiosity!
I would like to pass my deepest condolences to Tilahun’s family and to Ethiopia at large. Indeed, Ethiopia has lost a true son! A legend has passed away! We should celebrate the life of this legend in unison.
Tilahun is blessed in a way that he died in his Ethiopia, the country he loved and adored all his life. May the Lord bless his soul.
Having said that, I would like to put forward a professional opinion regarding your question.
Based on what I learned from the media, my impression of Tilahun’s medical case is the following.
A 68 year old legendary artist patient with past medical history of Diabetes Mellitus (most likely type 2), heart disease, status post right leg amputation likely due to complication of his diabetes or peripheral vascular disease, and history of slitting trauma to his neck. His chronic heart disease appears to have been most likely coronary artery disease as diabetic patients tend to suffer complications affecting blood vessels. Coronary arteries (arteries supplying the heart muscle) are some of the blood vessels which get affected by complication of diabetes. Coronary artery disease can lead to heart attack, heart failure, and arrhythmia (abnormal hear rhythm including ventricular tachycardia, atrial fibrillation).
The acute medical condition that claimed the life of our icon could be heart attack, arrhythmia and or acute heart failure with pulmonary edema (filling of the lung with fluid because if his heart was not able to pump blood properly). The symptoms that I heard he told his wife include “yelibe ametat tikikil ayidelem, liben yazign”. He likely had fast or abnormal heart rhythm. I also heard that he was short of breath. Indeed, Tilahun was acutely and seriously sick and he needed urgent medical help for him to have any chance of surviving the episode.
Certainly, there was a missed window of opportunity to potentially save the life of the legend. He survived long enough to make it to Betezata clinic. Per his wife’s report, he did not seem to have received any medical help other than advice to take him to another hospital. I would not comment on the level of care provided at Betezata clinic other than saying a Basic Life Support care should be available. The physician may have thought the patient would get a better care if he was transferred quicker. The level of care provided at the clinic may be limited. The physician could have limitation in his training. Tilahun’s case would ideally require a care by a heart specialist (cardiologist). But, what could a non-cardiologist physician have done to help him?
Given the limitations of the health care in Ethiopia, I would use the example of what a non cardiologist physician in the US could have done to help Tilahun. At least the following could have been done.
1) Check his vital signs (heart rate, blood pressure, breathing rate, and his oxygen)
2) Perform a quick and focused history and physical exam.
3) Give him oxygen supplement
4) Give him aspirin, nitroglycerin
5) Check EKG
6) Secure iv access
7) Draw blood samples for laboratory tests.
8) If Tilahun was noted to have no pulse or recordable blood pressure, he could have been given IV fluid. If he had abnormal heart rhythm he would have been given medications to slow the heart rate or electric shock could be given as necessary.
These measures could have stabilized the patient until he gets specialized care. Also, Tilahun would have been transported by an ambulance which would be faster and would be able to provide Basic Life Support (BLS) or possibly Advanced Cardiac Life Support (ACLS).
I will leave the judgment to the reader if the above could have been done at Betezata clinic given the rudimentary nature of the health system in Ethiopia.
I think it is wise and appropriate for Elias Kifle and all concerned Ethiopians to ask if Tilahun’s death could have been prevented. I do not think the government is directly involved in Tilahun’s death. That being said, who is responsible for the precarious health care system in Ethiopia? Who is responsible for the quality of physician training? Who is responsible for the absence of such a basic life support care in clinics in the nation’s capital? Who is responsible for the inaccessibility of health care to the people? Definitely, the government is responsible for the poor health system and its untoward effect. In fact, we may be suffering from the effect of an ill conceived health policy. Prime Minister Meles once said Ethiopia does not need doctors, remember? If he has this feeling towards doctors, do you think he would care for the quality of their training?
The big question is, if Tilahun, as legendary as he is, dies wandering to get to a hospital in Addis Ababa, can you imagine what is happening to the poor millions like Aba Biya in the village of Serbo in Oromia?
May God Bless Tilahun’s soul!
– Wase