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 11^th September 2004 and the time is 22.10. In the UK it is 19^th 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!!