Sunday, 25 March 2012

25th March 2012

A quieter week has passed, although it may simply be that I have completely adjusted to life here.  I haven’t been out to clinics much but have at least had the opportunity to enter my data. I’ve seen a total of 394 women now, although following them up to see what actually happens at the delivery is a mission in itself. The increasing incidences of petrol shortages will undoubtedly make it more difficult to run around the countryside finding the women I saw in the antenatal clinics. No-one ever said it would be easy…..

Car park at the 'restaurant' in Guliso

Jaba is now 5 months old and we have started to introduce ‘solids’. I know it’s a little early but milk is not easy to get and we’ve run out of the Cow & Gate brought over from England. So what do you wean an Ethiopian baby on? Well, it appears that there is a light brown powder, containing some 14 ingredients that you mix with water and give as a ‘soup’. The ingredients are written in Amharic and so I’m not totally sure what it really contains but it looks incredibly similar to the Shiro that we eat. Makabe tells me that it has things like wheat, barley, corn, and teff in it and is also drunk by mothers after delivering their babies or if those who are unwell. Apparently, some salt or sugar is added, presumably to make it more palatable. It tastes a bit like sweet tea but this may be simply because it was warm and sweet. It’s probably reasonably nutritious and presumably easily digested. I also gave him some strained apples, although he won’t get this very often as they are at least 20 Birr each (80p) and we only get them from Addis. He certainly enjoyed it; but to be honest, he seems to guzzle down most things.

 Jaba is rather fond of Mr LaMaz, the colourful bear

 The DVDs are being put to great use!

Amidst the smoke from the burning rubbish, I noticed two men digging a hole in our garden this morning and asked the gardener what they were doing. He said that the men worked for the hospital and were digging a hole to bury the babies who die on the ward. So our back garden that I look out onto every morning is in fact a neonatal cemetery. I wished I hadn’t asked!

Talking of babies, the little baby boy whose young mother died a few weeks ago was visited by the man who runs the orphanage. There is undoubtedly various bits of paperwork that has to be completed before he will go to the orphanage, but by the sad look on the nurses’ faces (they have become rather attached to him), it won’t be long before he is on his way. Alas, there is another very small baby in the ward, his mother went into premature labour at home and delivered what can only be a baby of about 28 weeks gestation – his eyes are barely open and he weighs just 1.2Kg. Worryingly, he doesn’t absorb any of the 10% glucose I gave him down the nasogastric tube – he simply vomits it shortly afterwards. We are trying to warm him as this may improve things a bit but I fear he is unlikely to survive. He’s just a little too small to survive with the care that we can offer him. His mother is also a little unwell, having presumably lost a considerable amount of blood. She should be OK though as she can be given a blood transfusion, using one of her relative’s donated blood.

I was asked a while ago why it was that so many of the orphans are boys and not girls. This does indeed appear to be the situation and is an interesting question that I have been trying to answer for some time. From what I am told by various people, girls are more useful than boys. It is the girls who carry the water, cook the food, wash the clothes, clean the house etc etc. The boys, generally play in the dirt, are noisy and don’t do anything to help around the house – according to Ethiopian culture, this is clearly woman’s work. As they get older, boys will cost more to keep as they will be more likely to be sent to school than the girls and when they marry, the family will have to pay the prospective wife’s family a sum of money for the daughter – usually around 10,000 Birr (£400). So it would seem that when a child becomes parentless, there are three options; either a family member will take on the child; or someone in the village may offer to look after him/her; or thirdly, the child is left to fend for itself. Given that girls are more useful and cheaper to keep than boys, it would seem that the third option is more likely to be on offer to the boys. I’m not sure how close to reality this situation is but I’ve heard it said by a few people now and it sort of makes some kind of logical sense. Some people also say that girls should not be left to fend for themselves and therefore it would be harder to leave them on the street.

Carrying on with the theme of gender differences, I was struck by the surprised look on our Ethiopian guest’s face last night when I served him with food before anyone else. He was astonished that Jeremy, because of his age, didn’t get to be served first. He was really quite surprised to learn that in the UK it should be ladies first and then the gentleman but always the guest first (female guest before male guest). In Ethiopia, he explained, men are always served with the food first and the older men are served before the younger men. Women, it would seem, are always last to get the food. Indeed, I have often commented about this in a restaurant – on such an occasion that I eat out – whereby I always seem to get my food after Jeremy, even though my dish clearly takes less time to prepare than his. So although the girls are better off when abandoned in childhood, they have to make the most of this advantageous position, as it certainly doesn’t last for long.

We have finally managed to book a trip to Gondor and Lalibella, which are the key tourist areas of Ethiopia. It seems, from the guidebooks, that there are reasonably nice hotels in both places and as I have selected only those classified as ‘top end’, I am hoping that there will be plenty of hot water and reasonable food. We leave for Addis on 7th April, fly to Gondor on the 8th and then fly on to Lalibella on the 10th for a couple of nights before flying back to Addis. 

Bird eating the insects form the banana plant

Pesky chickens are still refusing to lay any eggs

The following day……

I am not sure when I will be able to get this blog on the net as we are amidst a season of restricted electricity supply and non-existent internet access. Indeed, we were caught in the middle of a huge storm yesterday evening when we slipped out for a St George’s beer down at the Churo bar. The rain, thunder and lightening continued through the night, turning the dusty roads into deep red, thick mud. Apparently, the storm has brought down the power supply cable in Gimbie town and so many of the local men are busy trying to repair it this morning. The nice thing being that there is a great sense of community spirit – the community need electricity and so the community will repair the cable. They can’t really telephone the ‘electricity board’ so they just get on and fix it themselves.

There was competition between the megaphoned man that calls people to prayer (he, by the way, unfortunately has a petrol generator) and the all too familiar sound that flows from the hospital fence when someone has died. It was particularly loud this morning so I went to investigate, only to find hundreds of people congregated along the fence seeing off a Isuzu truck, overflowing with white shawled people, and I am guessing, the deceased body. It’s interesting to observe how people in Ethiopia deal with death. Firstly, everyone in the village will be involved in the ‘ceremony’, which means there is generally a large group gathering around the place of death. When news of the death reaches the village, people flock to be near to the family and to offer their condolences. This is done by howling and wailing loudly with the family until the grief or sadness is released. From what I have seen, it seems to last for about 15-20 minutes, after which, everyone appears to know that it is time to move on and they return home. I think the family take the body back to the village with them and I guess the local funeral is then arranged for either that or the following day. Everyone gets buried in the village graveyard.

By the way, for all of you who have been following this blog over the past 6 months, you have now read over 35,000 words!

And after the rain, came millions of termites…………..

I don’t think we are officially in the ‘wet season’ yet. I’m told that there are the ‘small rains’ and then the ‘large rains’, so assume that we are currently experiencing the small rains. The downpour of termites that follow the rain is much more of a worry than the rain itself and I seriously hope that this is not a taste of things to come. The photos below give just a glimpse of the military invasion across the hospital campus last night. Actually, forget across the campus - the invasion was largely based along the illuminated path to the hospital, which you may recall, leads directly to our house. Yes, the electricity came back on around 6pm, creating the perfect termite landing strip. So last night, just as we were finishing the cheese fondue (was a great need to use up cheese as power cut meant no refrigeration), we suddenly became surrounded by flying insects heading for the living room and kitchen lights. Each second, dozens more arrived, frantically circling every light inside and outside the house.  Thousands more were banging desperately against the closed windows and doors, making a sound similar to the rainstorm of the previous evening. It took a several minutes to work out that the port of entry to the house was a 2cm gap under the patio door. It took several minutes further, plus a short power cut, to realise that the best strategy to deal with them was to turn off the lights. However, being surrounded by large flying termites in the dark is not a happy prospect for anyone, let alone someone who is constantly plagued by a crawling sensation on her skin!

Thankfully, termites fly madly for around 45 minutes, drop their wings and then scuttle off in search of soft mud with which to build their home – hopefully, not the mud you have used to build your house.

A happily 'full' toad leaving the scene

Sunday, 18 March 2012

17th March 2012

Another hectic week has passed and over a hundred pregnant women have been screened for obstetric risks. The usual mal presentations, twins, women who have had over 4 pregnancies (at times this rises to 7 or 8), and those with previous stillbirths have all been given advice about where it would be safe to deliver their baby. Interestingly, having previously seen very few women with high blood pressure and symptoms that suggest pre-eclampsia, I came across 3 women this week who were certainly heading for trouble. All of them had blood pressures around 190/105, which was accompanied by oedematous feet and protein in the urine. One also had bilirubin in the urine, suggesting that something was going on with her liver. None of these women had any idea that they had a problem with their pregnancy, despite one woman having had 2 stillbirths in the past. The problem is that women simply will not have heard about the risks associated with pregnancy unless someone tells them. There is a move to try and provide health education in this area and to be honest, the messages do appear to be seeping through to some women. However, many remain uninformed of the risks and are therefore very surprised when I tell them that they need to be taken to hospital. They go though and I have certainly found that women are very receptive to the advice that they are given.
One of the clinics I went to was really out in the sticks and I had to do some very clever off-road driving in order to get there. The staff at the health centre, who came with me were suitably impressed with my driving skills and said that I was now eligible to drive anywhere in Ethiopia. Another very interesting clinic was held in a remote area where they are mining for gold. I’m not quite sure how much this benefits the villagers who live there but one bonus was that the mining team have 4x4 cars and will always take a pregnant women to hospital in the even of an emergency and she will not be charged for this. This is really an important service as there is no other way to get to hospital other than to walk for about 6 hours.

 The long and dusty roads to health centres
The faranji visit always creates a source of amusement

The woman that was pregnant with twins (see 11th March) has now delivered a health boy and girl (1.7Kg and 1.9Kg). she had a caesarean section as one was breech and the other transverse but all went very well. Since I was going back to Ganji on the day she was ready to leave hospital – 4 days after the CS – I took both her, her husband and the twins back with me. This meant that she didn’t have to catch the bus home and also that she didn’t have to walk the 3 hours from the bus stop to her house, something that would be a little painful after a CS. Mind you, it’s what most women have to do but if you can make it easier for some of them then it’s a bonus. I’m going to visit her in a few weeks time to give her a copy of the photo I took. She was really keen to have this as she said that she wanted these children to know the story of the Faranji who came to Ganji and how she helped them in so many ways. They were a really lovely couple and so very appreciative of the care that they had received.

1 hour old twins from Ganji

A happy ending for the twins and their parents who are now back home

The faranji returned to Ganji

Having been out and about so much now, I am beginning to feel like one of the locals. Despite the distances that I travel, I now recognise many of the people in the villages and we exchanges waves as I drive through each day. I don’t know exactly what they think about me but they’re very welcoming and it’s nice to see a familiar face in the morning. Actually, it’s nice to be able to see anything as I am driving along the roads – the dust/sand is really very thick now as it hasn’t rained for so long and I feel terribly guilty as I look in the mirror at the plumes of dust that fill the air following the car. What must it be like for people to be constantly covered from head to toe in dust? How can they ever keep things clean? I see people washing their clothes in the river and then hanging them on the dusty bushes to dry and gather more dust. The rainy season is apparently on its way, although for the past month now, everyone tells me that the rain comes in 2 months time.

The 'car park' outside Ganji Health Centre

I don’t really go to the hospital very much now as I tend top spend most of my time in the community health centres and health posts. I did, however, pop in last week to see various people and could help but notice the all too familiar brown cardboard box that sat on the floor outside the labour room. I must have been staring at it for a little too long as one of the nurses looked at me with a smile and nodded to confirm what I had suspected. ‘The young girl with the ruptured uterus?’ I asked. ‘Hmmm’ she muttered, looking towards the box and then back to me. It feels quite bizarre sometimes to be standing in the corridor having these conversations but word gets out about the tragedies here. Jeremy had told me about 2 young girls, both of who had ruptured their uterus. Since labour will have been going on for some 2 or 3 days before the uterus finally slits open, the babies don’t survive. Thankfully, the mothers seem to be pretty tough and many of them do make it to the hospital in time to have the uterus sewn up, possibly allowing just enough time for it to heal before they are pregnant with their next baby. Hopefully, they will automatically come to the hospital for the delivery next time.

Baby Rabina; sadly his mother died from sepsis shortly after childbirth

I have joined a group Oromifa lesson now as I have got to the stage where I need to be able to have a little more communication with the people I work with and the women that I see in the clinics. So far, this is going well, although I don’t find it a particularly easy language to master. I don’t suppose it will be of much use in the future either but it would still be nice to learn a bit more. My next lesson is on Tuesday so I will do some homework over the weekend.

 I will be out and about in the community over the next week, although I have no idea exactly where this will be. I am bound to be somewhere remote. It’s bound to be very dusty and numerous people are bound to ask me for a lift in the car, clearly wanting to avoid the arduous walk to the next village. My priority is always to take the pregnant women and since I generally need to take one or two back with me I reserve any spare seats for them. Interestingly, despite there appearing to be very little in the way of dairy products here, my Ethiopian passengers always smell faintly of milky, buttery vomit.

Jaba 5 months and very happy

Showing a keen interest in toys

Note the England football outfit

When I came home one evening, a toad was happily sitting on the door step. No idea where he came from but he was gone in the morning - probably wise, since I imagine he would have ended up as dinner for someone........

Sunday, 11 March 2012

11th March 2012

As has become the routine now, we had Jaba for the day yesterday. He’s doing well – feeding like it was his last bottle of milk and putting on plenty of weight. I couldn’t help noticing that he had a few bed bug bites on his head but I guess that’s par for the course here. I sympathise with him.

 A couple of days ago, a woman came to the clinic to see Jeremy. When asked what the problem was she replied; “the faranji came to Ganji and told me I have to come to the hospital to have my baby”. I think this should be the title of a song! I did indeed see her in Ganji (a village that is about 2 hours drive away) and since she was pregnant with twins, had one stillbirth before and was 145cm high, I told her very firmly that she must have these babies in the hospital. So seems she was listening. She will have a caesarean section today so I hope all goes well for her.

Update on the baby with spina bifida; she had the hole in her back closed the day before yesterday and is doing really well. This is really very good news as I was pretty sure that she would have to go to Addis to have her surgery and it was very unlikely that the family would be able to afford this and so her future was not looking great. Thankfully, there is a surgeon from Addis here for a month and he was happy to do the operation here, despite having limited facilities, not least of all very basic anaesthetic drugs.

Update on rodent presence in the house; two small ‘mice’ with fluffy tails have taken a nosedive into the washing up bowl, which, since they clearly couldn’t swim, ended in their demise. Thank goodness Makabe found them and dealt with it.

Thursday, 8 March 2012

8th March 2012

After yet another exhausting day at the health centre yesterday, I am relieved to be spending the next 2 days at home. Actually, I wouldn’t be able to travel anyway as there appears to be a complete absence of fuel in Gimbie. Indeed, yesterday we had no electricity, no phone network, no water and no fuel. The good thing is, when it gets this bad, you know there’s nothing more that you can lose and therefore, no further disappointment.
My peaceful day, however, will be affected by the need to clean the car as it is covered in dust (both inside and out) and to my great annoyance, one of the women I brought back to the hospital with me vomited all over the back seat. This was despite my telling her and her daughter, who was holding her newly born baby with spina-bifida, that they should let me know when they felt sick so that I could stop and open the door.  Car sickness is a common problem amongst rural Ethiopians who have largely never travelled in a car before and so I always make sure that they understand the need to tell me if they feel sick. Clearly, this didn’t work.

Update on the theft; the police have only managed to recover 180 Birr from the 4000 stolen. The woman who was allegedly given the money has never returned. The 15-year old girl has been 'sentenced' (ie a decision was made by the police) to 6 months in prison. Apparently there is a prison in Gimbie.

This woman was seen at the risk clinic a couple of weeks ago and deidied to deliver her baby in the health centre. She was in labour for 13 hours, with no analgesia and delivered a healthy 3.5Kg baby girl. She walked home (an hour away) later in the afternoon.
Note the knitted jumper Angie! I can't explain the pink hat being given to her rather than a matching one but they certainly appreciated having the clothes.

Jaba (4 months old) getting tubbier by the day and seemingly developing a lazy eye!

The long, dusty and deserted road to a health post. It takes women 3 hours to walk from here to the health centre.

A long and dusty walk back home after bringing their babies to the vaccination clinic.

6th March 2012

Last night brought a whole new experience to my time here. Around 10pm Makabe came to the house to ask if I could help her. She was clearly upset and it seems that earlier on that day, a 15 year old girl, who had been drinking coffee at Makabe’s house had decided to steal 4000 Birr from her bedroom. Now this is an enormous amount of money (approx. £160.00) and represents at least 4 months salary for most people. Yes, you have to ask why she had the cash in the house but I think she hadn’t been to the bank and all salaries are paid in cash here (her husband – who is currently in Addis - had been on a week camping to help the UK bike riders and so will have been paid extra money for this). So by the time I was asked to help, there were 10 people gather around the end of the pathway to our house. I think some of them were workers from the hospital but I didn’t know many of them. In the middle of this crowd was the young thief, looking pretty nonchalant and not appearing to be remotely upset to find herself in what I would imagine is a rather tricky situation. So she was marched off to the car, where a further 6 people piled in, making very sure that she could not escape. I drove them down Gimbie town to pick up Ashabere’s (Makabe’s husband) sister, who is apparently a police woman – or at least works somewhere in the police station – and we headed back to the town, down a very dark unmade road and to the police station. There we all waited while a policeman questioned the still dispassionate girl, occasionally waving his AK47 around just to remind her that he was indeed the law enforcement agent for the town. She firstly insisted that she had not taken the money, then that she took just 1000 Birr (why she thought anyone would believe that she’d leave 3000 behind, I don’t quite know). Her denial continued for at least 40 minutes, whilst I was given regular translations form the crowd that I had brought with me. The policeman seemed to be getting nowhere fast until the door was shut and presumably, the girl was searched.
Apparently, the thieving girl finally admitted that she did take the 4000 Birr but that she had then taken it to a friend in Gimbie. Indeed, the police search revealed that she currently only had 128 Birr on her. So now we all had to get back into the car, with the addition of the policeman, to find the woman who was allegedly in possession of the stolen cash. Back into the dark night and up Gimbie high street we went to what was later described as a cave rather than a home. Unsurprisingly, the woman was not in and the money was no-where to be seen.

Back we went to the police station where the girl was put in prison for the night. As we walked away at midnight, I heard shouting from the other prisoners and was very glad to be leaving.

More investigations today revealed nothing further, with the woman supposedly holding the money still being very much ‘out of town’. So the girl goes back to the cell and the police do further searching tomorrow.

After a heavy day at the health centre, a woman brought her new-born baby in to be treated by the faranji. The girl’s husband had died during the pregnancy and she had delivered the baby boy after many hours of labour at home. He was now 3 days old and sadly moribund. As I unfolded the cloth wrapped around him, revealing a buttered leaf stuck to his forehead, it was clear that this little chap didn’t have long in this world. After paying 5 Birr for (20p) for an ampule of 40% dextrose, I drenched my finger in the sugary liquid and let the baby weakly suck on it. I’m told that high levels of dextrose have some kind of analgesic effect, presumably working on the immature brain in some way. Anyway, what else could I do but try and make him comfortable before giving him back to his mother to hold whilst he died some 30 minutes later. All very avoidable if she had had her baby in a health centre or hospital instead of having prolonged labour at home, which probably meant that the baby was a bit compromised when born – or maybe aspirated meconium. Who knows?!?

Saturday, 3 March 2012

Some thoughts so far.......

Having been here for 5 months now, I feel that I am able to draw together something of a coherent idea about some of the difficulties here in Ethiopia. I am of the view that many of the problems experienced here stem from a lack of cognitive development in childhood. What I am arguing is that important aspects of brain functioning need to be developed in early childhood, and presumably in the West, this happens through the massive stimulation that children get. In the UK and other western countries, new born babies are provided with colourful and tuneful mobiles and surrounded by people who chat away and make funny faces and sounds in an attempt to get some reaction from their otherwise non-responsive offspring. From just a few months old, the baby will be sat in a bouncing chair with toys strung across, which when bashed produce an entire range of sounds. The cooing infant will also be bathed in warm, bubbly water, which is also likely to have the odd rubber duck floating around. As the baby gets older, there are further bouncing apparatus that allow them to test out their legs before they can walk and clumpy walking frames that create havoc in even the largest of living rooms. The toys continue to stimulate cognitive development by teaching the child how adults cherish them getting the correct wooden shapes in the holes, matching up the right colours, and even being able to make the correct sounds to various farmyard animals. My point is that these babies are constantly stimulated with exercises that develop the problem-solving part of the brain.
Contrast this to Ethiopian babies who have no colourful, musical toys, and since the women are busy carrying water, wood and cooking, they don’t have time to coo and cluck over their new born. So the baby is placed inside the dark, often windowless, one or two-roomed house whilst the rest of the family work in the fields or look after the household needs. She or he rapidly gets used to this under stimulated lifestyle and throws out little objection to this isolation, only crying out when s/he needs food. Once the baby can sit up unaided, s/he is placed outside of the house where s/he watches the world go by. As you drive around the Ethiopian countryside you will see many small children sitting, often alone, outside the houses. They seem to sit for hours ‘playing’ in the earth. So even at this young tender age, they lack any impetus to object to their isolated existence. They are accepting of it, presumably as they know of nothing else.

So the western 2 or 3-year old may be a complete handful and I’m sure that everyone can cite times when their toddler throwing a tantrum in the local supermarket was a source of enormous embarrassment. But at least this child had the drive to object to something. At least this child knew that there was something better on offer. At least this child had the cognitive ability to work out that screaming and shouting got at least some response – even if it wasn’t the response they wanted. The Ethiopian 2 or 3-year old is much more passive. Yes, they cry but this is largely because they are hungry or they have fallen and hurt themselves. They may even cry out if they see something that they want, but on the whole, there is little for them to yearn for.

By the time the western child reaches 4-5 years, s/he is shipped off to school to face yet more challenges, developing further and more complex problem solving skills. Their critical thinking skills may even be aroused, although this tends to come a bit later in life. What is important is that these children, and later these adults are constantly facing problems that they are stimulated to solve. It’s an integral part of our education system and something that we largely take for granted.

In Ethiopia, due to a lack of schools, children go to school for either the morning or the afternoon. They are taught to remember as many facts as can be packed into the limited time they have at school. The emphasis, however, is on ‘more knowledge is better’ rather than ‘deeper understanding is better’. So it is little wonder that the nurses’ response to ‘why has the baby not been fed?’ is a nonchalant shrug and ‘no milk’. I think that they simply don’t think about finding a solution. Their cognitive ability does not provoke a problem solving response and instead, they adopt the only response they know; to shrug and accept the situation. So what I’m suggesting is that you need to develop the brain at an early age and if you don’t do this, vital aspects of cognition remain embryonic through to adulthood. I am unsure as to whether these parts of the brain can be developed later on in life or whether they need to be stimulated in early childhood. If the latter is true, there is little hope for the Ethiopians here today, although a radical change in child care and education could rescue future generations.

This is just my take on things and clearly there will be exceptions to what I have described. Some children are stimulated and some adults do have the ability to think critically. The scene that I have described above, however, reflects a large proportion of the population that I have observed. 

1st March 2012

I’ve had an exhausting week. Sunday saw the arrival of the 17 bike riders, who despite a few illness along the way, all managed to arrive in Gimbie in one piece in time to go to the reception that we had arranged in Green Bar B.

Monday I went to a health post in Ganji, where I saw 32 pregnant women for a risk assessment and Tuesday I went to Homa health centre, where I saw 49 women for risk assessment. Homa has a set of weighing scales where I always weigh myself and was a little concerned to see I am now just 52Kg so now I am treating myself to regular rations of chocolate.

So why are things in the clinics getting so busy all of a sudden? Well, I think that word of the risk assessment clinics has reached women living out in the more remote areas. The women that are now coming for antenatal care live in many different villages, often far away from the health centre. This is, of course, excellent news as these are the very women that we need to reach, as they have often never seen a health professional throughout their pregnancy. Interestingly, they tend to have had more children than women who live nearer to the health centres, with some women having 8 or 9 children and now onto their 10th. Thankfully, there aren’t too many of them. In fact, when I first came here I was quite surprised at how much women were planning their families as many chose to have just 2 or 3 children, despite the fact that it is not unusual for one or more to die before the age of 5 years.

The little boy that I mentioned last week – the one that was abandoned by the family when the baby’s 15 year old mother died – is still in the hospital, although we have prompted the hospital to start the process of getting him to the orphanage, where he will hopefully be adopted by a loving American couple. He is certainly better off in the orphanage at the moment as he is currently being deprived of adequate supplies of milk. Yes, the same problem arises again; the nurses don’t think about sorting out the nutritional needs for the baby but instead they give a large shrug and mutter ‘no milk’ when asked why the baby hasn’t been fed. The frustration of it all is deeper than you can imagine. The trouble is it is so difficult to understand why people don’t have the motivation or inclination to resolve problems. There is a clear problem; a baby needs milk and doesn’t have any family to buy the milk. It turns out that the hospital will provide the milk BUT for some curious reason they need to be informed of the situation. Now you might think this is obvious but here, this is far from obvious to many people. So the baby doesn’t get the milk until some faranj buys it. However, now that we have managed to work out what the hospital policy is – something you might think the nurses would already know – we can make sure that they inform the admin staff when a baby needs some milk. Do I believe that they will do this next time? What do you think? Am I becoming just a little cynical?

Wednesday I went to an incredibly remote place called the Green Lake clinic to look at the facilities there and help with an assessment of these. The clinic is set in the middle of a large flat plain (unusual for Ethiopia) with the nearest town being 3 ½ hours walk away. The clinic doesn’t have any running water or electricity, although this was something that the people I went with were looking to resolve. Being so remote, there is little food available and so we ate injera and lentils for each meal. I drew the line on the sieved bean soup for breakfast though, deciding that 3 cups of tea would be just fine – I brought my own teabags. At night, we made a camp-fire and since we were still hungry, we were very grateful for the bag of Bombay mix that I had brought along.

Typically untidy clinical area at the health centre

An unsuccessful health education message

My bed for the night

The faranjis arrive at Green Lake

Having heard that there were fanjis in ‘town’ there was a queue of people to see the ‘doctor’ the next morning. Well, as it turns out, there aren’t any doctors here but instead an Ethiopian nurse who has been here for 18 years and is probably a little jaded and now a fresh out of school nurse who has virtually no experience in symptom recognition and diagnosis. So, although I also don’t have the skills of a General Practitioner, I thought it would be helpful for me to work with them. It was certainly an interesting experience, although not reassuring to see a young man complaining of headaches, neck stiffness and a dry cough being diagnosed as having pneumonia. He wasn’t examined in any way, let alone having his chest listened to. I couldn’t help but intervene – even I would raise an eye at headache and neck stiffness – and decided to use the clinic as a teaching/learning experience. I was relieved to see 3 pregnant women as this, at least, is something I now know quite a bit about.

I returned from the clinic on Thursday evening totally shattered. I woke in the night, however, feeling something crawling in my hair – it felt like a mouse or something like that but we couldn’t find any evidence of it. So now I am wondering whether I imagined it – perhaps I am becoming psychologically disturbed by the bugs and the fact that we seem to have at least 2 resident rodents. Jeremy placed a piece of orange matchmaker chocolate on two traps that Makabe bought but these don’t seem to work as the chocolate went and the trap didn’t go off. Actually, I was quite pleased about this as I didn’t fancy coming down to a dead creature in the morning. Mind you, I also don’t fancy it being in the bed either. Anyway, as part of my ‘therapy’ I am collecting a photographic portfolio of the bugs and animals that live in the house. I will post it on the blog when complete.

Last night, we were settling down for a nice bowl of baked pumpkin, potato and tomato, made hugely better by the grated mature chedder sprinkled on the top (good idea to bring the waxed chedders from Christmas Sue), when I thought a nice glass of chilled white wine would set the whole meal off to a treat. I was a little concerned to find that the wine had disappeared form the fridge, and even more alarmed when it occurred to me that Makabe must have done something with it – the thought running through my mind was ‘perhaps she thought it was water and has used it to make up Jaba’s milk’. Makabe uses the water that we boil and filter in the house for Jaba’s feeds and so it isn’t beyond the realms of possibilities that she could have taken the wine, cleverly decanted into a water bottle so it could be chilled, by mistake. Once she came round from her sleepy state (it was only 9.30pm but people go to bed early here), we managed to sort out that she had thought it was tap water that she had chilled when she had a headache and she didn’t want us to drink it as it hadn’t been boiled so she tipped it down the sink. Now this may seem trivial to those of you who have easy access to supplies of wine but we have to buy ours from Addis and we are running very low! Oh well, another enforced health improvement comes our way.

 A game of Bingo on the veranda

Connect four championship