Morning tea was somewhat disturbed by the arrival of two men at the bottom of our garden, carrying that familiar cardboard box. I guess this means that the baby of the eclamptic woman, who has been sick over the past few days, didn’t survive. Indeed, there have been a few ‘boxes’ buried in the garden over the past couple of weeks, which, were we not leaving soon, would have caused me some concern as the cemetery gets closer and closer to the house.
The Wednesday clinic was busy as usual and we saw a total of 52 women. Luckily, Jeremy came with me and so we were able to set up 2 simultaneous clinics. We saw 3 women with twins, all of whom were rather shocked to hear the words ‘mucha lama’ , which simply means two babies. You will notice that my Oromifa hasn’t improved greatly, although I just about get by at the clinics, much to the amusement of all the women. It’s odd enough to see a white face in the village, let alone one that can speak some of the language.
I also saw a woman who claimed to be 9 months pregnant with her first baby, but clearly looked rather small for this. On examination, her abdomen was quite hard and when I scanned her, the 5 month-old baby was without a heart beat. Given that she was sure of her dates, it is likely that the baby had been dead for about 4 months. What makes this story even worse is that she had attended the health centre on 4 previous occasions and despite her small size, none of the nurses had thought to listen for a fetal heartbeat. Why? …you may well ask.
The government struggle to increase the proportion of women attending for antenatal care and put considerable resources into new health centres and health posts and even increase the numbers of health care staff by at least fourfold. However, what they haven’t managed to do – and we all struggle with this – is to motivate staff to provide a high quality service. This seems to be a particular feature of the male dominated health centres. So when a woman comes to the health centre, she often gets a cursory check-up, with little more than a few questions being asked about why she has turned up. Yet, they are supposed to be delivering what is termed ‘focused antenatal care’, where the woman receives fairly prescriptive, but effective care. So the challenge for all of us is to find a way to alter attitudes – not an easy task. Yes, you can offer financial incentives; and this is what many people seem to want but this just spirals and quickly becomes the norm. Interestingly, many NGOs (non-government organisations) have fallen into this trap and have been paying health staff considerable sums of money to attend training sessions. Now, of course, you can’t get someone to attend a training session unless you pay them. This is certainly a ridiculous situation, especially when you consider that in the UK, we all have to pay to receive any form of training. So it’s easy to make mistakes and find yourself in a worse situation than when you started.
I don’t have the answer – I would be a very cleverperson if I did – but I do think that there is a need to introduce some form of accountability into the health system. So if we take the scenario of the woman with the intra uterine fetal death that I just mentioned, you would have some kind of mechanism whereby this is followed up. Clearly, the woman received inadequate care. What can she do about this? Who does she report this to? What kind of complaints system is there? Well, you won’t be surprised to hear that there is nothing she can do about it. There is no-one to complain to. Indeed, you would be lucky to find anything written in her notes about her 4 visits to the health centre.
I could write a whole book about all of the difficulties (don’t worry, I won’t post this here) as it really is a fascinating and incredibly complex situation. On a positive note, one of the nurses (female) at a health centre managed to deliver twins in a woman who had a previous caesarean section. The woman turned up in the night, having been driven for the past 2 hours on her way to hospital. She was not able to complete the next 2 hours of the journey as she was having rapid contractions – indeed, when the nurse looked, she was fully dilated and the head was popping out. So she delivered one baby and then started to deliver the placenta, only to find another baby emerging. The woman had no idea that she was pregnant with twins. Both babies and the woman survived the whole ordeal and although the nurse was a little shaken by it all, she performed extremely well.
We heard that the government had banned the use of Skype here, which you might appreciate, is rather troubling for us as it is one of our few communication channels. Apparently, they were worried that ETC, which by the way, is the only telecommunications organisation, were losing vital revenue because people were using Skype. The response was to ban Skype and try to pass a law that stated you would get 15 years in prison for using it. I am told today that, due to international pressure, the decision has been reversed.
I’ve been a bit unwell over the past couple of days, with what I am mildly concerned might be malaria. This is now the 3rd time that I have had a sudden onset of high temperature, headache, neck stiffness and feeling generally rough. I had my blood tested last time this happened and it came back as negative but I’m not so sure that the tests are that sensitive. Anyway, I think I will have a check up when I get back to the UK to see if any amoebic rogues are lurking around. It’s a bit of a nuisance though as we are now in Addis and I want to enjoy the food. It’s Jeremy’s birthday and so we felt that we needed a treat – some food. Actually, I have had to go out and buy some new clothes as I am now a size 8!! I am a little sad, however, that my new jeans have just lost a button. Such small things are upsetting when you haven’t had any new clothes for at least 8 months.
Booked in to have a hair cut and a facial at the Boston Spa – hoping to look a little better than I did after the last hair cut. I don’t think that the concept of ‘layers’ and ‘shaping hair to fit the face’ has arrived here yet though.
Women get to do much of the heavy labour - carrying wood for the fire
Men, however, also have to do some heavy work - carrying a woman to the health centre on the 'foot ambulance'
Waiting for antenatal check-up
Kids at the local school.