Embracing Change in an Ethiopian ICU

Nov 27, 2018

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Not long ago, the concept and importance of ICU nursing was wholly misunderstood and underrecognized in Ethiopia. This is changing.

Mark Stambovsky

As ICUs gain acceptance and recognition in Ethiopia, the country’s critical care nurses and hospitals are experiencing growing pains. At the helm during this era of change is Mark Stambovsky, head of nursing at St. Paul’s Hospital Millennium Medical College and instructor at the School of Nursing. Faced with inadequate supplies, cultural barriers, hiring challenges and shoddy construction, Stambovsky often fights an uphill battle to establish world-class ICUs. Yet, his tremendous passion for the work and his love for the Ethiopian people shined through during his speech at NTI 2018 titled “Trials and Tribulations of Transforming a 3rd World ICU Into a 1st World ICU.”

What is your position and where do you work?

I am the nursing director in the adult ICU at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. I am also the ICU clinical coordinator and instructor in the School of Nursing, a St. Paul affiliate.

How did you get started in nursing?

I was originally a music teacher but was laid off after the State of Massachusetts cut the school system’s music program budget. After doing some traveling and writing, I decided to take the advice of my sister — an ICU nurse — who suggested, “Hey, why don’t you go into nursing?” Sometimes, it’s good to listen to your little sister.

Describe your decision to move to Ethiopia.

After 16 years working in the ICU at Baystate Medical Center, I needed a change. I arrived in Ethiopia at the end of a trip across Equatorial Africa. I was immediately struck by the warmth, cordiality and gentleness of the people. They are also extremely forgiving, which is very comforting when you find that you’ve screwed something up … not that we nurses ever mess up, right? I decided that taking a position in a hospital would open the doors of change I had been looking for.

How easily did you adjust to your new life in Ethiopia?

There is certainly variation between the world’s third- and second-world countries. But my earlier travels through South America and Asia essentially inoculated me against any cultural and/or economic shock.

How do you deal with issues such as supply shortages, transportation and staffing needs?

Shortages of disposables remains a big issue. I’ve stressed time and again the need to create commercial pipelines for essential ICU items, but bureaucratic wheels here move slowly. The same goes for staffing. The hiring process of new nurses is excruciatingly slow but, fortunately, the local supply of nursing manpower is sufficient to satisfy our needs at the moment. Transportation is improving. The hospital provost is supporting the initiation of an ICU van service that will essentially eliminate transportation issues.

In your previous life, you’ve taught music, been a writer and rehabbed houses. Have those skills been useful in your new role?

Happily, most of those skills have played a role in the evolution of my position in Ethiopia. While the primary language here is Amharic, many formal correspondences and documents are written in English. My ability to edit and economize the language has come in very handy.

During the design and construction of our new ICU, my real estate rehab skills provided much-needed guidance when we were faced with the shoddy workmanship typical of government construction. The construction contractors were thrilled, and management celebrated my guidance.

And you’re now a father. Tell us about that incredible story.

A young girl named Kokeb came into the ICU with renal failure and pulmonary edema. We had to extubate her three times during her 15-day stay in the emergency department due to repeated episodes of severe stridor. Every night, Kokeb’s sister, Selam, was right by her side. Kokeb remained on dialysis for a year before I could successfully arrange for Selam to donate a kidney. Throughout the long and arduous process, the sisters’ sweetness, courageousness and caring quickly stole my heart. They had been abandoned by their parents when they very young and materially had nothing, but obviously deeply loved each other. We became a family — Kokeb and Selam have brought joy, laughter and great purpose to my life. As I said in my speech at NTI, “I saved Kokeb’s life, and she saved mine.”

What was speaking at NTI like?

Speaking at NTI was my chance to present a compelling story to like-minded or curious nurses. My gut said I was ready after mentally practicing and rewriting the talk for months. Ten minutes before my talk, though, the butterflies were partying like 2099. I momentarily froze at the outset of my first session and choked up at the end when showing a slide of my Ethiopian girls, but the standing ovation and throng of well-wishers that approached me afterward pretty much confirmed that I did OK. I was fortunate to have had a fantastic audience of ICU nurses. I was off my game for the second session, because an upset stomach kept me up most of the night. It went well, but I thought it lacked the punch of the first.

What do you see for the future of nursing, especially in countries such as Ethiopia?

Not long ago, the concept and importance of ICU nursing was wholly misunderstood and underrecognized in Ethiopia. This is changing, as the Ministry of Health has embraced the importance of ICU nursing. The formal acknowledgment of our craft gives me great hope for the future of ICU nursing in Ethiopia. In contrast, hospitals in the USA are micromanaging nursing practice for greater profitability. I remember being mandated to do an ever-increasing number of tasks while being expected to provide the same level of safe care, all performed in the same amount of time. Something had to give and, in my observation, it was often nurse morale. While such change is notoriously difficult to quantify, I felt that some of the rewards and joys of the job were being slowly siphoned away. In Ethiopia, such pressures do not yet exist. I hope it remains this way for a very long time, and I’m glad that I’ve positioned myself to help lead this wave of change in the country.

How do you maintain a healthy work/life balance?

During the first couple of years, I spent inordinate amounts of time either at the hospital or taking care of Kokeb. I am now essentially still on call 24/7 because of my proximity to the hospital, but the skill level of the nurses has improved to the point that I can stay away an entire weekend day without worrying that everything will fall apart. I work out at a local gym every other day, and Kokeb, Selam and I always eat dinner together and typically watch a movie before bedtime. I’m planning on taking my daughters to see the ocean for their first time with a trip to either the Seychelles Islands or beaches of Zanzibar.

Why do you love being a nurse?

A patient who I thought would never survive, beat the odds. Months later, she suddenly walked into the ICU. She smiled broadly, reached for my hand, looked into my eyes and said, “They told me you saved my life.” Best job I ever had!