Sunday, 24 June 2012

18th-24th June 2012

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.

Sunday, 17 June 2012

17th June 2012

Most mornings now we start the day with ‘no light’. It seems that the electricity cables or posts are just not strong enough to withstand the nightly rain storms. I have, however, managed to get out to the health posts and the health centres and so the work continues, which is just as well as the women keep flooding in. I saw 49 women at Ganjii and many of these women had never had any antenatal care in the whole of their pregnancy. I’m not quite sure why so many new women turned up but suspect that my conversations with the Health Extension Workers (health workers who are based within the villages) last week provoked further discussions with women in the far away villages. Some women had walked 2 ½ hours to come and see me. I hope they were happy with the service they got. The exhausting day ended on a bit of a low as a woman in her first pregnancy was found to have an intra-uterine fetal death. I was really sad for her and thankfully had a very kind Ethiopian with me who translated the news sympathetically.
It must be strange for a woman to see her baby on the screen when she probably doesn't have access to a mirror and so doesn't even see herself on a regular basis.

There are always children trying to peep through the clinic window

 The road back to Gimbie from the health centres

Jaba continues to be well, which is something of a relief given that 1 in 17 children here die before the age of 1. We took him to the police station to register him as ‘abandoned’ – something the hospital are supposed to do when the event actually occurs. This is the second time I have had the need to visit Gimbie police station (previously had to go when Makabe was robbed) and it was just as amusing this time. There were quite a few people waiting to tell their troubles to the 2 policeman in the hut and so we waited amongst the bare necked chickens for our turn.  The necessary information about Jaba was entered into an A4 lined notebook and various signatures were obtained before we were sent on our way to the office of women’s and children’s affairs. Here we again told our story and registered him as abandoned and gave them a letter from the hospital confirming the story. Now all we have to do is apply to the court for a hearing, bring three witnesses along with us and he is legally ‘abandoned’.

And boy does it rain.....

No, the dog isn't ours..... 

Colobus monkeys playing on the roof of our veranda 

Friday, 8 June 2012

8th June 2012

Another week of heavy rain and the roads are now becoming very slippery indeed. Yesterday, I tried to get to the Ganjii antenatal clinic but when we got to Haru, just 30 minutes out of Gimbie, there was a huge lorry with a trailer stuck in the ditch and unfortunately blocking the road. Since it was still raining, the driver had relocated himself to a dry place, leaving us and the bus waiting for………..what?? Nevertheless, in good Ethiopian style, we did wait – for an hour – and then we decided to find the traffic police as they should be dealing with the situation. We brought the rather unperturbed policeman to the scene of the road block but by the time we arrived, the driver had returned to his vehicle. The policeman also returned to his post, leaving a team of locals helping to dig out the lorry. After about 30 minutes, however, all ‘tools’ were downed on the basis that nothing could be done but to wait for the sun to dry out the mud. Well, this was clearly going to take a very long time as the sun was firmly hidden by numerous rain clouds. So after 2 hours of waiting, we decided to return to Gimbie, having achieved nothing other than got cold and wet and a bit muddy. I clearly felt bad about the women who will have walked to the antenatal clinic and so was relieved to hear from the head of the health centre that it was also pouring with rain in Ganjii and that very few women had turned up to the clinic. He also added that there was another lorry blocking the road there, making any form of access impossible. What happens in an emergency, I wonder? They are totally cut off from any hospital care.

Positive aspects of the rain: 1) it provides lots of water for washing and drinking; 2) the crops will grow well, providing essential food for the country and animals; 3) the roads are no longer dusty; 4) it provides a new source of amusement for children who play in the puddles.

Negative aspects of the rain: 1) it wakes me up most nights as it falls on the corrugated iron roof; 2) The roads are muddy and often impassable, leading to relative isolation; 3) the power lines fall down, leaving us in darkness and without a fridge; 4) all clothes remain damp after washing.

I guess that on balance, the lifeline that the rain provides for many outweighs the inconvenience it causes.

Once the rain had settled, after getting various bits of paper signed and stamped by health officials, the hospital staff made a big bonfire to burn all of the expired drugs. The task was considerable as the hospital get many drugs donated from the government – only one catch though; they have just 3 months of use before expiring, which means their disposal becomes a task for the hospital rather than the government. Not such a generous gesture after all.

Having heard that there was a sick baby on the ward, I spent the morning in the hospital. The 2-day old baby had been fitting on and off over the past 36 hours, having presumably been pretty hypoxic during the delivery. He also had pretty rapid breathing and a high temperature, which suggests meconium aspiration. He had been started on the usual 2 antibiotics available here and had received one dose of phenobarbitone 36 hours ago. Despite being directed into his eye rather than his nose he was on around 30-40% oxygen, delivered through an oxygen concentrating machine (oxygen cylinders are too expensive to get refilled and have to come from Addis). Since he was still fitting, I asked whether he could have some more phenobarbitone and perhaps some phenytoin as these drugs are generally available here. So we stood there watching the baby continue to fit whilst the relatives went to get the prescription of drugs. Drugs have to be collected form the pharmacy on the next floor, where the relatives will need to queue and pay for them. After an hour, the relatives returned with exasperated expressions explaining that the drugs were not available anywhere in Gimbie. One of the nurses asked if we had any ‘in your house’ and so I had to explain that although it sometimes appeared like we ran a pharmacy – or indeed an entire hospital supplies unit - anti-convulsion medicines wasn’t something we ran to. Eventually, we managed to find two tablets on the male ward, which I then had to take home to crush and mix into a solution. No pestle and mortar sitting in any drug cupboard here. Actually, no drug cupboard here.

After an hour or so, the baby looked a bit better and the convulsions lessened. He’s still a pretty sick baby but perhaps he has a chance……

I have just looked outside our veranda to find an enormous hole just inches away from the house. It seems that the old cesspit used to be here and the heavy rain has shifted the corrugated iron covering, leaving the earth on top to cave in. I am told that someone will come to fill the hole and rather hope that this will happen before the veranda – and house – slides into the crater.