By: Zergabachew Asfaw MD, FACP
Diabetes is a common metabolic problem that affects millions of people all over the world. More than three million cases are identified each year. More than 30 million Americans live with diabetes. It is the most common cause of non-communicable illness that leads to morbidity and mortality. It affects almost every organ in the body.
Diabetes is caused by relative deficiency or absence of insulin secretion by the pancreas. There are two types of diabetes. Type I is an early onset of diabetes and type II is adult-onset diabetes. The type one has genetic preponderance. The change in lifestyle has resulted in an epidemic of diabetes mellitus.
The diagnosis of diabetes is based on identifying the symptoms and checking laboratory tests. The symptoms include polydipsia- drinking water excessively and polyuria (excessive urination). Other manifestations may include fatigue, weight loss, or weight gain and generalized weakness. Morbidity from diabetes involve both macrovascular (atherosclerosis) and microvascular (retinopathy, nephropathy, and neuropathy) diseases. Intervention can limit end-organ damage, and therefore, patients with diabetes require initial and ongoing evaluation of diabetes-related complications.
Diabetes, if not treated, can affect every organ of the body. It can lead to blindness, renal failure, and a variety of cardiovascular disorders. There is not a single organ that is spared from the complications of diabetes. Therefore, early diagnosis and management are very essential to prevent those complications. The effect on the vision is called diabetic retinopathy. In addition, it can result in early cataract formation. The effect on the kidney is called diabetic nephropathy and when it progresses, it would lead to renal failure and the affected individual ends on hemodialysis. The impact of diabetes on the nervous system is multiple. It can cause peripheral diabetic neuropathy and damage to the central nervous system. The other impact is diabetic foot ulcers, which is also a major challenge to treatment.
Type I diabetes require insulin administration for treatment. We perform a history and physical examination two or four times a year to obtain information on nutrition, physical activity, reductions of cardiovascular risk factors, current management, and diabetic-related complications.
Initial treatment of patients with type II diabetes includes lifestyle change focusing on diet, increased physical activity, and exercises, and weight reductions, reinforced by consultation with a registered dictation and diabetic self-management education.
Glycemic control can minimize the risk of retinopathy, nephropathy, and neuropathy in both type I and type II diabetes. The goal of management is to reduce HA1C to less than 7% and maintain fasting blood glucose 80 to 130 mg/dl. To live the best life with diabetes, a comprehensive plan of diabetic care is necessary. Quality evidence-based diabetes self-management education and support service are fundamental parts of the treatment plan. To take control of your diabetes, you need to educate, empower, and motivate yourself.
Written by Richard Pankhurst
Adapted from An Introduction to the Medical History of Ethiopia
While diplomats, doctors, and other foreigners had been introducing modern medicine to ever-wider sections of the public, the first Ethiopian doctor, quite unknown to Menilek or anyone else in the country, had been obtaining his training abroad.
The story of this physician, variously known as Dr. Martin and Hakim Workneh, is most romantic. Born in October 1865 of a good family, he was not yet 3 years of age when his parents, along with other prominent people of Gondar, were seized by Emperor Tewdros andÂ taken with their families to his fortress at Magdala. On the arrival of the Napier expedition notÂ long afterwards, the child was found wandering away from his parents and was assumed by theÂ British to be lost. He was therefore annexed by Colonel Charles Chamberlain, of the 23rd IndianÂ Pioneer Regiment, who took him back with him to India and kept him at his home inÂ Rawalpindi. The colonel died in 1871, after which the boy was dispatched to the mission schoolÂ at Amritsar, the expense of his education being met by one of their number, Colonel Martin. TheÂ missionaries christened the boy Charles after the colonel who had brought him to India andÂ Martin after the one who paid for his education.
Written by Dr. Girma Abebe
Born in Wollo Province, Ethiopia, on April 27, 1900, Melaku Beyan was the son of Grazmatch (Lieutenant) Beyan and Woizero (Mrs) Desta. After his parents had transferred to Harar, their son, only a little boy, came to serve Ras Makonnen, the father of Crown Prince Tafari, who was then the Governor of Harar Province. Then young Melaku served the Crown Prince as his personal assistant in Harar and later in Addis Ababa for well over a decade. Palace life, which was competitive and terrifying, led Melaku to become disciplined and meticulous in his work. Wasting no time at the palace in Harar and Addis Ababa, Melaku immediately joined the elite priest school that attracted the cream of tutors famous for their cultural and historic knowledge of Ethiopia.
Written by Efrem Alemayehu M.D
After graduating from the Addis Ababa University Medical School, we (the present members of Hakim Workeneh and Melaku Bayan Society) left Ethiopia for North America in the late 70s and early 80s. We left our beloved Ethiopia to further our education because of political unrest and other personal reasons. We left Ethiopia during the rainy winter, or in the summer time, a season filled with plenty of sunshine and comfort. Global warming and environmental degradation have changed the climate of Ethiopia from what it was then. Many are dealing with harsh and extreme weather conditions. But I digress. We landed in various parts of the U.S. and Canada, in the scorching heat of the summer or in the bone-piercing cold winter. Because of the newness of the season, we accepted winter with excitement. Many of us who settled in areas with snow have winter stories to tell. Let me tell you mine, as it will give you a glimpse of my early life in Canada.
Written by Abebe Haregewoin, MD, Ph. D.
Every society deserves a character that is at the center of this story. Even the most conservative societies need someone who thumbs his nose at what is considered sacrosanct and sacred and out of limits to either derision or negative commentary from the vast majority. This is always a sign of a healthy society â€“ magnanimous toward eccentricity and tolerance toward members of society who sing to a different tune and march out of sync with the most common beliefs of most members of their society. In some societies such acts can have severe consequences, which may include stoning, or some such unpleasant acts by the conventional hordes in the belief that this will ensure the favor of God or the King or even other members of their society who are inclined to nod in approval at their outrage against the unlucky ones who end up being the individuals on whom society has to prove its point of, â€œThou shalt notâ€¦â€ In the modern age in the so-called enlightened societies the media may take its pound of flesh if such a personality is worth their time and ultimately their economic interest.
Written by Dr. Zergabachew Asfaw
This is a short introduction to the history of Ethiopian surgeons, those who developed the practice of surgery in a war-torn and fragmented nation. Documentation is sparse, but I hope this short depiction will motivate younger Ethiopian doctors to do more research and write about the early Ethiopian doctors, the trail blazers of this profession. After the Italian invasion of Ethiopia, the country embarked in a rapid growth of educational opportunities. Schools were opened and teachers imported; several young students were sent abroad for higher education.
It is a great pleasure to present Professor Edemariam Tsega as a pioneer in Ethiopian medical education. He single handedly introduced post graduate program in Internal medicine in Ethiopia and served his nation with great distinction for over forty years. He completed his primary education at Haile Sellssie I school in Gondar and his secondary education at Haile selassie I secondary school in Addis Ababa. He graduated from university college of Addis Ababa with bachelors degree in science in 1961 and then he joined McGill University where he got medical degree in 1965. He studied at London school of hygiene and tropical medicine in 1968. He did not want to stop there and even after becoming professor of medicine he eared PhD from Lund university, Malmo, Sweden. His qualifications are immense.
Written by Zergabachew Asfaw and Yohannes Endeshaw
Normal aging is associated with changes in all organ systems, and the following questions are intendedÂ to whet your appetite in the area of sleep and aging.
Written by Fassil Teffera
Many moons ago, I was assigned to work at Jijiga hospital. As it was customary at the time one GP is assigned to a hospital of whatever size, with some nurses and several Health assistants. I did the outpatient clinic daily and in patient rounds and minor surgery as well. I also did difficult deliveries though most of the deliveries were made by the competent Health Assistants who must have done thousands before I came to the scene.
I had a wonderful staff of Nurses, Health assistants, Lab and X-ray techs. We were supported by dedicated ancillary services and administrative staff. Of course, we had our dose of Political Cadres who carried their weekly indoctrination of the superiority of the Socialist mode of production over the Capitalist one.
One Friday, a giggling Health Assistant came and told me that a bride is coming to be seen by me, prior to her wedding night. I did not understand what it meant. She told me the Somali men bring their bride to the hospital prior to the anticipated wedding night. I still did not understand the whole idea. The Health Assistant noted my confusion and re assured me that everything will be fine and she will help me handle the issue as she had done with many others before.
Sure enough, there walked in a very handsome bridegroom and his beautiful bride with beaming smile in their beautiful weeding dresses. They got registered and the bride was brought to the OR by the nurses and Health Assistant, and undressed and put on an OR gown.
They all giggled saying that I will be the first man to see the bride even before the bridegroom. The lady was put on the table and the staff explained to me what to do. As it was customary in Somali culture all girls had sutures placed over their vulva thereby completely blocking the vagina except for a small whole for the urine to dribble thru. This was a protection from in inadvertent or deliberate pre marriage sexual performance.
After the lady was put on lithotomic position we figured out where the small hole was located, which was at the distal aspect of the vaginal opening which allowed only a small finger to be passed. The local lady sureon had done a good job of suturing the labia majora of a baby girl around the age of three and completly blocked and entrance or exit from the vagina.This was done to protect the girl and the family from future embarassment.
Written by Abebe Haregewoin
Ethiopians share with the rest of humanity that propensity for excessive preoccupation with oneâ€™s health.Â This condition is often referred to as hypochondria.Â The person who exhibits this syndrome is referred to as a hypochondriac.Â Â People with this condition are excessively worried about getting a disease, even after there is no supportive medical evidence.Â Such people often misinterpret minor health problems or even normal body functions as symptoms of serious illness. Since the sufferer does not have total control of their understanding perceived disease, it is usually difficult to dissuade them that their illness has no physical basis. An abdominal cramp for such a person is the beginning of a cancer in the belly, and a headache, the start of a brain tumor.Â It is a major feat of accomplishment for a medical person to convince the sufferer that they are in no immediate danger from any kind of illness.Â As a matter of fact the patient might lose confidence in their medical care giver, and as is often the case go shopping for a more sympathetic ear elsewhere or go to the witch doctor or other non-medical healer.
The symptoms a hypochondriac describes can range from general complaints, such as ill defined pain or excessive tiredness, to concerns about normal body functions such as breathing, change in eating pattern, bowel motion or urination.Â The affected person is obsessed with the selected symptom and really believes that it is the manifestation of a dire illness.
Written by Abebe Haregewoin
A very pretty teen age girl was brought to the emergency room at Fenote Selam Hospital in the middle of the night in a state of apparent uncontrolled shrieking alternating with strange gesticulations, shivering and writhing. Her hapless father with his eyes filled with terror was holding his daughterâ€™s waist and trying to restrain her restless hands and fists from self inflicted injury. The poor man looked totally exhausted from his struggle from this sylph of a girl, who seemed to have endless and uncontrollable power of an angry lioness. There was also a rope tied to her waist and gripped by her fatherâ€™s gnarled peasant fists, apparently to prevent her from running away and do herself grievous harm. It was apparent from the red and bleeding welts on her face and exposed chest that she has been scratching and beating her face and chest uncontrollably. A couple of scratches on the fatherâ€™s cheeks and nose revealed that he has also been a victim of her tireless nails and fists. Her poor mother, a scrawny little thing herself, was weeping uncontrollably from blood shot eyes. She was also making her own scene, by wailing for her daughter as if she was already dead. Her heart rending funereal tunes which were only interrupted whenever she frequently blew her profusely runny nose was the only respite from the impromptu mother and child tragic opera and drama.The trio was surrounded by bedraggled, younger and older siblings of the sick child, uncles, aunts and villagers of all sizes and shapes. Some were weeping and all looked miserable. From the bags of supplies they were holding it was apparent that they had travelled from a long and harrowing distance to come to the hospital.
There has been a health education program launched Â at St. Â Mary of Zion Â Church located in Â Yonkers, New York, attended by Ethiopians. Â The program has been going on for the last one year. The purpose is to promote wellness and health Â among the Ethiopian community. Â The Â teaching is given at least once a month by doctors and has professionals residing in New York. The topics covered include preventive health education and chronic diseases that include diabetes, hypertension, obesity, kidney disease etc. The program Â is coordinated by Helena Yigezu RN and Fassil Teffera M.D.
Ethiopian Medical History
Photo: Dr. Melaku Beyan. Dr. Melaku Beyan became the first Ethiopian medical doctor to complete his education in the United states in 1935 (Dr. Workneh Eshete became the first Ethiopian doctor to obtain a modern medical education in 1882)
The non-governmental organization, People to People, has just released The Manual of Ethiopian Medical History by Enawgaw Mehari, Kinfe Gebeyehu and Zergabachew Asfaw. The purpose of the publication is to teach the future generation of Ethiopian medical students and health care professionals about Ethiopiaâ€™s medical history.
Mekele University and Bahir Dar University have reportedly agreed to incorporate the study into their medical education curriculum.
Enawgaw Mehari, MD
Kinfe Gebeyehu, MD
Zergabachew Asfaw, MD
Senior Graphic Editor: Matthew I. Watt