Thursday, 31 May 2012

30th May 2012

The entire Ethiopian phone network – yes, there is only one network – has been switched off for 48 hours in a desperate attempt to stop cheating in the grade 10 exams. Apparently, everyone has been passing the exams as they have all had the answers texted to them. I am told that it is not the students who initiated the cheating but rather the teachers. As soon as the exam scripts are opened, a teacher passes a copy to another teacher, who then completes the paper and sends the answers around by phone to some syndicate of teachers who then somehow inform the students in the exam rooms.  So for 3 million Birr, the government are able to buy ETC silence and we are yet further dislocated from the world. As it happens, and I don’t know if this is linked, the internet has also been off for the past 24 hours, making any form of communication rather difficult.

I am beginning to dread Wednesdays as this is the day I visit the largest health centre to provide antenatal care and it is really busy. 68 women turned up, all of whom wanted to have an ultrasound scan. Who said women do not want antenatal care?? The latest figures released form the government state that only 46% of women in Ethiopia have any form of antenatal care. Well, I can safely say that we have managed to improve on that in this area. Many women come back two or three times, having walked some 2 or 3 hours to get there and often having to wait most of the day to be seen. It is just impossible to see everyone in one day and so I have told 30 of them to come back on Friday, when I will do an extra clinic. We try to see those who have travelled the furthest first, but the system breaks down as women push their way to the front, having no concern about their queue jumping.

The husband of a woman who had a C-section in the hospital last week, came to see me, asking for help for his wife who was apparently at home with a gaping wound and unable to move from the bed. He said that her wound had burst open and that she couldn’t be moved. Well, what was I suppose to do? Given the torrential rain over the past few weeks and the increasing difficulty driving on the ‘main’ road to the health centres, I asked them where they lived. Having only just got the car back from the garage, I was not in the mood to find myself sliding off the road and into some ditch. ‘Oh it’s OK, they are just 5-10 minutes on the main road’ I was told. Being considerably experienced in Ethiopian inability to tell you the truth, I checked this information at least 3 times. Yes, I was told, it is definitely on the main road and yes, her wound is gaping open and yes she is unable to travel.

In order for me to get back to Gimbie before dark, I need to leave the health centre at 4pm. You really don’t want to travel in the dark as there are no street lights and assorted animals belligerently lying on the road. If you kill a cow, you have to pay 10,000 Birr (£375.00). A sheep is 4,000, a goat is 3,000 and a donkey is 3-4000. If you kill a person, you get 17 years in prison – not a nice thought at all. So I closed the clinic at 3pm and we set off to see the woman in her home. You probably won’t be surprised to hear that; 1) the road was anything but ‘main’ and due to the rain, it was rather muddy/flooded; 2) it was a 25-30 minute drive to the house; and 3) the wound was not gaping but rather, there was a slight infection causing minor breakdown of the edges. Having placed a dry dressing over the wound to stop the dozen or so flies getting to it and prescribing some Amoxycillin, we left the house as quick as possible to get back to the health centre, where a pregnant woman and her husband were waiting to be taken to the hospital.

We made it back just before nightfall and I vowed, once again, never to believe the story I am told. Whilst frustrating, I am beginning to see the funny side of the things that happen – probably because I know that in a short while, I will be walking away form all this. If this is your life, however, you must totally despair. Perhaps that explains some of the attitudes here?

I often wonder how this little chap will turn out. He is going to have to deal with a lot of frustration over his lifetime. At least for now, he’s happy……..

Friday, 25 May 2012

25th May 2012

The lady who bled, had an eclamptic fit and a blood sugar that went off the scale, survived and has now gone home with her healthy looking baby and one unit of my blood.

After a long day at the health centre, I was approached to ask me if I would take an 11-year old boy back to the hospital as he had fallen out of a tree whilst picking mangos. This is quite a common accident at this time of year and sadly, a boy died in Gimbie just last week having had a similar mango tree incident. I explained that my priority was to take the pregnant woman back with me but I would see whether we could take both. There are a few problems that always arise when giving a lift to people; 1) most Ethiopians are not used to car travel and so they vomit after an hour or so; 2) everyone wants to bring an assortment of relatives with them and they get cross when you won’t overfill the car (and I really mean overfill); and 3) you never quite know whether the person will go into to labour along the bumpy journey – or in the case of a sick person, whether they will die along the way. Now no-one, not least of all a faranji, wants to be caught with a recently deceased Ethiopian in their car. Try explaining that to the police, or worse still, the angry mob brigade that rule the villages when the police can’t do anything.

So I wasn’t really too happy about the prospect of transporting a sick child who had broken his leg and smashed up his face. On examination, he looked OK, although in considerable pain. They had bandaged his leg up but this didn’t seem to provide a great deal of support. His face had swollen up like a balloon and I think his teeth had been bashed out. I asked whether they knew if he had sustained a head, or perhaps worse still, a neck injury. ‘It’s just his leg’, the nurse replied. Hmmm, so why is his face swollen then? ‘Did he hurt his neck?’ I asked. ‘yes’ came the reply – ‘but it’s his leg that’s the problem’ he added. I did try to explain that his neck might be a little more important if he had broken it as he might stop breathing. “oh no” says the nurse as he pulls down the blanket from his chest. “look, he is breathing fine”. Oh dear oh dear. What’s the point, I wonder. I asked whether there might be any form of protection that I could have for his neck for the bumpy journey but as you might imagine, this request was met with a negative response. No such thing as ‘assume the neck is broken until radiological evidence has proven otherwise’.

Now the really annoying thing is that some bright spark had decided to take it upon themselves to send my pregnant woman off home as now the boy was taking priority. Whose priority??? In Ethiopia, women are placed fairly low down in the importance list and certainly appear to be lower than a male boy. I was, as you might imagine, really cross that they had made decisions about my transport. Unfortunately, she had already left, having been waiting all day for my lift to the hospital.  Grrrrrrrr.

My answer to whether the boy’s neck was broken was soon answered as the family carried him, neck hanging down, to the car. If it was broken, that would have ensured instant death. So I bumped him along, trying to ignore the occasional scream of pain, to the hospital. He made it there and presumably received appropriate treatment. The moral of the story is that fruit is not always good for you.

The good part of the above story is that the pregnant woman did manage to get transport the following day and turned up at the hospital. She’s going to be induced today as she had previous 2 stillbirths and is very short.

 In my role as ambulance driver I often take women back home from the hospital. This was the lady with placenta praevia - lucky to have been spotted using my super duper portable ultrasound scan 

I arrived back at the house this morning, having picked up our leg of lamb from a friend’s freezer, to find two hospital gardeners chopping down our banana trees. The trees now have considerable fruit on them and presumably they felt that they had the right to take it. Well, as you might imagine, I thought otherwise. After much talking through Makabe as translator, it turns out that they have some agreement – with whom, no-body could quite establish – that they chop the bananas down, give the hospital a pittance for them and then someone sells them at a profit outside of the hospital. Since we pay for the gardener who tends them with our metered water, and since they are in our garden, we decided to object to this. I asked whether they felt they had the right to chop any hospital resident’s fruit trees down. ‘oh no’ they say, ‘we only chop the faranji’s trees down’. Well I was now very annoyed by this level of faranji abuse and so decided to call the hospital administrator to sort things out. They weren’t taking any notice, however, and continued to chop until Jeremy shouted at them. Yes, he can shout when he wants to and it had the desired effect. They have now been sent on their way by the administrator and been told that they cannot take our fruit for their own gain. Apparently things will be looked into further as there is also some dodgy dealing going on with the hospital garden, where the vegetables are being taken, and presumably sold, instead of being brought to the kitchen. It’s the complete lack of understanding of what is acceptable and what is not that is so mystifying. I asked Makabe whether they would take her fruit from her garden. ‘Oh no, definitely not’ she replied, adding that it was not acceptable for them to do whet they did. The only words for it is ‘faranji abuse’.

Tuesday, 22 May 2012

22nd May 2012

There hasn’t been any internet for a couple of days and it doesn’t look like it will return for some time so I’m not sure when this blog will be posted. We’ve also increasingly been having power cuts, probably due to the heavy rain storms that appear most days. It’s still hot for much of the day though so the ground remains pretty dry. The afternoon sun also means that the fruit on the tress continues to ripen but along with this comes ever-increasing numbers of monkeys. I was hoping that our mango tree might give us just a few mangos but sadly, the monkeys got there first.

Despite the changing weather, we are still managing to enjoy morning and afternoon tea on the veranda. However, a couple of days ago, there was a worrying sewage smell wafting past as the regular 4pm afternoon wind whipped up. I am hoping that it wasn’t coming from our cesspit, which by the way, is just a hundred metres down the garden. I have no knowledge about cesspit management and wonder whether the heavy rain is causing some kind of overflow. It is, of course, more likely that the aroma is coming from next door’s latrine, which is housed in a metal sheeting building and adds to the view from our veranda.

I’m pleased to report that the car is on its way back to us tomorrow. Possibly more important, the Ethiopian gynaecologist working with Jeremy will also be on his way back from Addis along with the car. It has been a tough week here for Jeremy as he has had to be on-call for the whole week day and night. At times this isn’t so bad but for some reason it has been incredibly busy, requiring him  to be up for large chunks of the nights. I am trying to help out where I can and so assist in the outpatient clinic by doing the ultrasound scans. Interestingly, the women of Gimbie are much richer than the women I see in the more rural areas. For a start, they all seem to have underwear here and they don’t seem to mind at all when you tell them that they need to come back for a further check up.

I even donated a pint of blood this evening as a woman arrived pretty shocked and near dead, having had a massive bleed after she retained her placenta following her fifth child being delivered at home. She was fitting on arrival, which suggested that she may have had an eclamptic fit, although her blood pressure wasn’t high. Interestingly, she also had sugar and protein in her urine, suggesting that she was eclamptic but that she also had diabetes. To have 3 pathologies (diabetes, eclampsia and retained placenta) at once is pretty impressive and certainly presents a few tricky problems for her management. Her family also donated 2 pints of blood, which was just as well as she had a further bleed later that evening.

Along with our car comes some food supplies from Addis so tonight I shall push the boat out and make some tuna fishcakes and a tomato and avocado salad with balsamic and olive oil dressing. I’ve also just filled the 7-up bottle with white wine from the box and put this in the fridge to chill (fingers crossed for continuing electricity supply). It’s amazing what you can do when the rations from Addis arrive.
I'm feeling more positive about things now, although I am increasingly thinking about being back at home. Below are a couple of pictures of women who both had 2 previous stillbirths but having been brought to hospital, both now have a live healthy baby.  One also had terrible pre-eclampsia and is lucky to be alive. I'm taking them back to Ganjii with me tomorrow so a nice success story to end this blog entry on.

Saturday, 19 May 2012

19th May 2012

The past week has been marred by the continuing lack of transport, along with the news that return of transport is going to be at a high cost. I’ve still managed to get to the health centres, although relying on others to accommodate my needs does not make for a peaceful time. I have also been feeling a bit demoralised by the situation here and perhaps this is related to the need to rely on others for transport. Or perhaps it results from being here for so long and more recently, being here without a break away from it all.
Everything is just so difficult. Nothing quite works as it should do. People never tell you the whole truth about anything. OK, so maybe I am seeing things in their extreme but this is how it feels. Some examples;

-        A woman turns up at one of my rural clinics. She has had a previous C-section and has a fistula as a result of the previous obstructed delivery. I tell her that in 6 weeks time, she needs to come to the hospital for her delivery. She will be about 37 weeks pregnant by then and should not come to any harm in the community before this. The following week, she somehow turns up at another clinic I am doing, some 1 ½ hours walk away as she has “an economic situation” – so I learn from the translator – and can’t afford the bus to hospital. Naturally, the health centre staff direct her to me as, being fanji clearly means that you operate as a free ATM machine. She is desperately poor and so I give her the 100 Birr (£3.75) for her and her husband to come to hospital when the time is right. She also gets a voucher for free hospital care. But the following day, she turns up at the hospital, with her 3-year old son, to be admitted for her delivery. So now what do we do? She shouldn’t be here for another 5 weeks. She should have her husband with her and not her child. She has no clothes other than the very tatty and rather smelly one she stands in. We can’t send her back home or we won’t see her again and she may well die during childbirth. She smiles, happy to see the faranji that was nice to her in the clinic.

-        The ‘team’ arrange to go to Ganjii on Wednesday as I needed to get to the clinic in this area. This is great for me as it means I can continue with my work. Having been told that they will be stopping for lunch, I don’t bring any food for myself or my translator. However, at lunchtime, I learn that they decided not to stop at the health centre where I was working as they were in a hurry – it is on the way. 45 minutes later, when Hunde looks like he is about to faint, I decide that we have to walk to the town to get food. It’s a fair walk up a steep hill but needs must. Not only were the team still there, but they were going to be there for a considerable time as their appointment in the afternoon had actually been cancelled. Why did they decide to leave us without lunch? Why did they not give us a lift back? Having wasted at least 45 minutes walking, we then couldn’t see all the women who turned up and had to send them away.

-        Our car is kindly taken to the garage in Addis by the hospital driver – he has to go to Addis anyway and so suggested that he takes our car and then he can either stay there and drive it back if it is going to take just a few days to repair or he can come back and then return to Addis if it is going to be along time. All sounds sensible. Well it would be if we could be sure that we were going to be told what was actually going on. We are continuously told that the car would be ready in 2 days time. Oh yes, now another 2 days actually as we need to fix some ’plastic’ thing, which no-one seems to be able to define. We are told that the workman are very busy but could be persuaded to work over the weekend if paid overtime – yes we say, good idea. After the weekend; Ahhh yes, it should be ready in the next couple of days….. but actually, it isn’t now. Finally, I phone the garage manager, only to learn that he is surprised to hear that we have been told that it would be ready by Friday as there is no way as far as he is concerned that this will be the case. So the hospital driver has been in Addis for 14 days now, each day requiring a per deum payment. Why are we unable to get the full story at the start?

-        One of the women I referred to the hospital for a placenta praevia (a life-threatening condition where the placenta has positioned across the cervix. When the baby’s head starts to descend, the woman has a massive bleed as the placenta is pushed away) was advised to get her relatives to donate a few units of blood as she would probably need them when she has her C-section (they tend to bleed quite a bit). There is no such thing as a blood bank. The C-section is booked for Friday but on Thursday evening she has a massive bleed and needs to be taken to theatre for an emergency C-section. Is there any blood for her? No. Why not? Her relatives were going to come on Friday to give it. Bit late. She survives but largely due to Jeremy’s prompt and competent treatment. Had she not been in hospital, she would most likely have died.

-        A man turned up at the house asking me to treat his wife as she had pain in her abdomen. I told him that he needed to take her to the outpatient’s department to see the doctor. Ahhha but I don’t have any money. So that was why he was at the house. I asked Makabe to explain that it would be slightly ridiculous for me to give him money so that Jeremy could treat his wife, for which he was not getting any payment. I don’t think this was understood by either Makabe or the man so I went back to my usual statement about there being many people in Gimbie, and even more in the areas around, that couldn’t afford treatment and couldn’t possibly pay for them all. The trouble is, once you say yes to one person, the whole town will come knocking at your door. People rarely keep quiet about any donation you give them. On the contrary, they tell everyone to make them jealous that they were successful in obtaining money.

-        Having started the follow-up work for my project I come to realise that the names of many of the women in my sample change according to who is actually writing it down. Worse still, the medical record numbers are often duplicated resulting in record numbers that should relate to women in my study belonging to men or children. I want to scream when I see this but it’s so hot in the tin roofed medical records room that I simply don’t have the strength. The record keeping generally is pretty poor, making it really hard to find out what happened to a woman who died in labour or a child that is born dead. When I ask the staff, I am faced with that familiar blank faced, shoulder shrugging action that I have come to dislike so much.

-        Both the date and the time is different in Ethiopia – so today is 11th September 2004 and the time is 22.10. In the UK it is 19th May 2012 and the time is 12.10. We are 2 hours ahead of the UK and so it should be 14.10 but the beginning of the day here starts at 0600 (ie this is 00.00 if you are Ethiopian). Anyway, the end result of this is that you haven’t a clue whether anyone is arranging a meeting in Ethiopian or Western time. Not that they would be on time anyway.

-        I am done with shiro and injera and fail to understand how people can eat this every day. The thought of it makes me lose my appetite but since it is either this or tibs (some kind of meat in some kind of sauce/gravy), there is little choice.

 To make matters worse in my world of gloominess, I was looking forward to a nice relaxing evening watching the Girl with the Dragon Tatoo and the following 2 films, only to find that they are all in Swedish! No subtitles and no, I don’t speak Swedish.

Ending on a more positive note; we are planning a roast lamb lunch for next Saturday. Oh yes, this is possible if you make an enormous effort. Some friends arranged for a team of people, who I’m told know about selecting a lamb, to go on a hunt in Gimbie for a suitable animal. They had to get it from someone who cared for animals a little better than the average person ie they needed to find one that had been fed and thus had meat on it rather than being all bones. Then arrangements had to be made for its slaughter – the only way to be sure of fresh meat. They wanted to do this on campus but it was felt that this was a poor idea on account of the flies. We can make the mint sauce as we have managed to grow some mint in our garden. We can get potatoes for roasting and hopefully, some reasonable vegetables. Another friend has been sent some Paxo stuffing so we can use this as well as her Bisto gravy granules. We may even stretch to apple crumble (apples from Addis and not sure about the crumble yet) and custard. This meal will take the best part of 2 days to plan and we shall undoubtedly talk about it for at least 2 days afterwards. If there is a power cut, however, there will be deep gloom!!

Sunday, 6 May 2012

6th May 2012

What a week! It is never dull here that’s for sure, although at times, I really wish there were fewer events in my life. Last Wednesday brought the busiest health centre clinic so far. Around 50 pregnant women turned up to be seen, many of whom actually had considerable problems and required further interventions. Time was marching on and by 11.30, it became obvious that we would not be able to see everyone. The last 20 women to arrive were therefore told that they would have to return on Friday, which is when I would provide an extra clinic. I felt bad about this as for some of these women, this would mean another 1-2 hours walk back to the village and then the same again on Friday. But there’s not a lot that can be done in a health care system that is totally devoid of any form of appointment system. I guess, there’s little point in giving appointments as the notion of time and days of the week are really rather pointless here.
Even having split the clinic into two days, we still didn’t manage to leave until gone 4.30, meaning that we only just got back in time before it got dark. I am particularly concerned not to be driving at night here as not only is my night vision poor, but there are so many hazards on the road that make driving in the daylight a great challenge. In fact, earlier in the morning, I had to take the car off road to avoid a live (well, I assume it was live) electricity wires that had fallen across the road when the pole came down. I’m pleased to say that we managed to identify 2 very sick pre-eclamptic women, both of whom I took back to hospital with me and a further woman who had a placenta praevia, where the placenta had grown across the cervix. This is rather hazardous for the woman as delivering the baby would bring about enormous haemorrhage and almost certain death. So she is also now in the hospital, where she will get a caesarean section. There was also a woman who had previously had 4 babies, 2 of which had died on delivery and one who had a breech presentation – both of these women have been told to come to the Hospital for delivery in a few weeks time. I have been collecting data about what the women’s plans are for their delivery and so it is interesting to know that none of these women had planned to deliver in hospital and 4 of them would not have even gone to a health centre (not that unusual as 90% of women deliver at home).  So this was all good work, with positive results for all concerned.

The 2nd clinic on Friday was also pretty hectic, not least of all because we had to break in the middle to drive to Lalissa Dibbee, a little village around 2 hours walk from the health centre, where, by the way, every woman seems to be pregnant. You may recall that a woman who delivered twins lives there and she has been having some problems with her C/section wound and, more recently, has apparently been bleeding and getting considerable pain. As Jeremy was able to come with me to the clinic, we decided it was easier to drive to the village and take her to the health post for examination. Yes, easier said that done. Having navigated our way along the rocky road, by which time Jeremy was getting agitated by the whole palaver of it all, we finally found the 12th tree on the left by the corn field on the right and the earth mount that marked the way to her house. The two nurses with us went of in search of the family whilst we stayed with the car, which within 10 minutes was surrounded by every person in the neighbourhood.

We piled the woman, her husband, the twins, and the 2 nurses into the car and set off, now to a private clinic, as it turned out that the health post was closed. Once more, within seconds of our arrival, the entire village joined us, pushing through the clinic doors and jumping up at the ‘windows’ to see what we were doing. Try examining someone with that lot going on. Anyway, despite having considerable pain, it would seem that there was nothing seriously wrong with the woman so after giving her some diclofenic and iron tablets, we took her back to her house and then headed back to the health centre to see some more patients. On the way, however, we spotted a very pregnant, sweaty woman walking up the dirt road, heading to the health centre. Having put her and her husband in the car, examined her at the health centre and finding out that her previous 2 babies died during childbirth. As she was full term, she was advised to head to Gimbie hospital the following day.

Having given the boys pizza and a viewing of the Lion King later in the evening, I collapsed into bed, totally exhausted. Saturday morning came too quickly and I was up early to have Jaba for the day. After just 30 minutes he vomited all of his banana breakfast over the floor and my jeans, which should have been the first sign that this was not going to be a good day. On my way back from dropping Jaba off at Makabe’s house, I heard an almighty bang and the smashing of glass, followed by what sounded like hundreds of people screaming. I headed off to wards the noise with Makabe only to find that the commotion was created around the place where we park our car. You have to know at this point that our car is reversed onto a steep incline for parking. Having reached the parking spot, I looked up the hill to see that the car was now parked backwards into – and I mean ‘into’ the mortuary wall. The story goes like this;

We were meant to be going to a wedding and so Jeremy decided to take the boys along to wash the car – it was pretty dirty from all the journeys to the health centres. He asked one boy to wash the windows from the inside and another was then placed into the boot to wash this area. It seems that the boy doing the windows decided to play with the gears – which, being an automatic means the park, drive, neutral etc controls. Having found that he could move the stick, he placed it into neutral and the car proceeded at a great speed to roll back down the hill and into the mortuary wall. The trouble was, Jeremy was standing right behind the car, having just helped the other boy to get into the back of the car. He was knocked to the ground but thankfully managed to get himself in the middle of the car rather than under one of the wheels, which given the weight of it, would presumably have crushed him pretty badly.

By the time I arrived, Jeremy had managed to crawl out from under the car but looked rather confused and his head and face was covered in blood. There was also about 50 Ethiopians gathered around and many of them, including Makabe, were hysterically screaming. After much persuasion, I managed to get Jeremy to agree to go to hospital as he had a large and quite deep cut on his head and I didn’t know what other injuries he might has sustained. Having made sure that all of the boys were alive and uninjured, and phoned all the people I could think of who could be of use, I headed off to the operating department, where they were examining Jeremy and suturing up his head.

Thankfully, he’s fine; a few bruised and possibly cracked ribs, some nasty grazes and bruises in various places and a nicely sutured head wound. It wasn’t a great night for sleeping as I had some rather unpleasant thoughts about what might have happened – it could have all been a very sorry tale indeed.

The road to Lalisa Dibbee

The road to the twin's house

Remote villages

Always a crowd when the faranji and her car arrives

One of the twins - boy

The twins and parents - 8 weeks old

Jaba enjoying Robin Hood

Jaba - 6 months and teething

The car rolled into the mortuary - perhaps symbolic

Very much jinxed car

The mortuary; minus a wall

Sutured head injury