31st October

I'm afraid to say that last night we ate the cockrel! Thankfully, we didn't have to prepare him as there is a Danish couple here who have a farm back in Denmark and are familiar with dealing with such things. So we cracked open a few glasses of red wine and had quite a feast between the five of us. Actually, there was hardly any meat on him but the taste was good. Just as well, because the choice for lunch today was orange or brown lentils and a bread roll – I chose orange. Such excitement over calorie intake is more than most people can stand. I think if I could stomach the injera, this would also be an option and probably a bit more filling as well.

I have been looking at various studies on the funding options for maternity services. The evidence is not great and basically seems to suggest that the more money you give people, the more they will participate in the preventive health services. Well, I think that most people could have worked that one out for themselves. The problem we face is trying to ensure that whatever the charity does is sustainable. So throwing money at health workers to encourage them to provide good maternity care in the health centres and the hospitals, or at women to encourage them to attend their antenatal appointments, is really not going to be something that can go on forever. However, in essence, this is what happens over many developing countries. NGOs have money to spend and they need to meet the targets set by world leaders. So when the Millennium Development Goals state that there needs to be a 75% reduction in maternal mortality, it’s little wonder that all efforts go towards making this happen. So what happens after 2015 when the target date is reached? Perhaps some new targets........

Today, as well as being without internet, the electricity went off, followed by a huge downpour of rain. Now the garden has had a good watering, we should be well on the way to getting some food growth. Mind you, the gardener, who seems to dig barefoot, asked Jeremy to look at his clearly fungal infected feet today. As luck would have it, the previous residents of the house left some anti-fungal cream behind and so he is now applying this – assuming that he has access to water to clean his feet first.

29th October

Yesterday, I went to two more health centres to set up my obstetric risk screening project – This went well as there were a couple of pregnant women at the centre and so I was able to show the head of the district health office how useful the portable ultrasound could be. Indeed, he wants me to go out with the Health Extension Workers when they do the outreach clinics, which is exactly what I need to be doing so all in all it was a very useful day. We stopped off at a darkened room for lunch, where I was ordered chilli scrambled egg with injera (the grey coloured pancake that has the texture of a wet flannel) and bread. They had to run to another place to get the bread as this isn’t something that Ethiopians have for lunch. Mind you, they don’t have eggs either but since there are always chickens running around every household I guess this wasn’t such a problem.

 Lunch place

After lunch we were taken to the health centre that had dealt with the breech presentation pregnancy a few nights ago. It turns out that having induced her, they realised that they were not going to be able to deliver the baby as it was breech and so told her to make her way to the hospital. This she did having waited 4 hours for a bus to take her on the 2-hour journey to the hospital. The head of the district health office was not impressed with what had gone on and is going to set up a meeting with the nurses to discuss the case further.

Stretcher, otherwise known as a 'foot ambulance' or the helicopter, used to bring women to hospital or health centre 

Having checked up on baby Jaba (I have named him this as it means ‘fighter/strength and he is going to need a lot more of this), who is now absorbing his feeds fairly well, we set up for what has become ‘Friday film night’. We invite the 3 other expats and Ethiopians that we work with to come to our house for popcorn, pizza and soup and we show a film from the collection that we have on our external hard drive. We are able to project it onto a wall and the picture is really pretty good. So far, the film night has gone down well, although I’m not sure that all the Ethiopians always get the gist of the story. Still, the pizza, despite having just a scraping of cheese on top, is very nice.

 Baby Jaba

We were given 3 hens yesterday and were told that one had started laying and the other two should do so fairly soon. So you might imagine my surprise when there was a distinct cock a doodle doo coming out of the chicken house as the young, allegedly laying ‘hen’ was trying to communicate to other cockerels in the neighbourhood. Needless to say, he has got to go. It’s bad enough having the orthodox priest wake us up every morning without having to listen to a rooster as well. Jeremy seems to have been plotting with a Danish couple here to prepare a meal of Coq au vin for tomorrow but I’m not so sure about this. It is very possible, therefore, that he has just had the last supper!

Note

Sorry, forgot to add that Baby A is doing well. Quite perky and taking an interest in his surroundings. Mind you that's not such a good thing as he resides in the labour room and so has to listen to the wails of labour all day long.
He still doesn't like the Nan milk much but absorbs more of it now. Just put him up to half strength milk and hope that he doesn't vomit this overnight.
He also now has some rather large clothes to wear, which is more than can be said for most babies here.

27th October 2011

Yesterday, a woman from a village about 3 hours drive away was induced at the nearby health centre (not sure why they did this). She was pushing for 18 hours but getting no-where. Eventually, at around 2am she arrived at the hospital, where an emergency caesarean section of a breech presentation baby was performed by Jeremy (he was on call). This classic situation would have been completely avoided if they were performing ultrasound scans at the health centres to determine the baby’s presentation. I am therefore heartened by the fact that one aspect of my project – to introduce scanning into the health centres – will be of value. Both the mother and baby survived their ordeal, but this was largely because they had access to rapid transportation. For the majority of women, this is not the case and so either mother, baby or both, could easily come to an unpleasant end.
Despite having had quite a disturbed night, I left to visit the village health centres at 07.30 this morning. Again, the views across the country are amazing and you almost forget the level of poverty that saturates this beautiful country. Driving along, you are constantly plagued by goats, donkeys and dogs, all of whom have their place in the road. Kume, the driver told me a classic Ethiopian 'joke'; There was a driver who picked up a goat, a dog and a donkey to take them to the next village. When they got there, the donkey paid his fare and left the car. The odg paid his fare but didn't have the right money and so wanted some change - but the driver didn't have any change and so couldn't give him it. The goat did a runner without paying. So now when you see the donkey in the road, he stays still in the road because he thinks he owns it - he paid his fare. The goat always  runs away from the driver as he is scared he will get caught. And the dog always chases the car as he still wants to get his change form the driver. And this is exactly how it is when driving along. A complete hazard of animals - not to mentio the chickens, cows and humans that simply rin out in fromt of you. You get thrown in prison if you run over a human.
The health centres were very interesting and I made some excellent contacts with health officers and heads of the health centres. They were all interested in working with me on my project and so things are moving ahead really well. I am going to go out with some of the nurses who run the outreach clinics (these are run in the villages - often under a tree). Here I hope to start work on my project to screen women for low, medium or high obstetric risk.
Wjilst at the health centres, word got around that we were there and presumably, they were interested to see a faranji there. So we ended up having 4 women turn up for an ultrasound scan - this was great as I could show the health centre staff how useful the scan was for telling the baby position, how many babies were there and also the position of the placenta. So, all in all, a very successful day.

On the way home, we stopped and bought about 50 bananas for £1.00 from a woman selling them at the side of the road.

Jeremy consulting in the corridors of Ayra Hospital

Two women waiting to give birth at the waiting house near the hospital

26th October 2011

Over the past few days we have not only been cut off from the internet but also had no phone network for hours on end and then been without electricity for a few hours. So all communication has taken place down the ‘Green Bar’, a little place just 10 minutes walk away, where you can get a good cold St George’s Beer and shout above the clinky clanky music that booms out non stop. Mind you, this is a great improvement on the Orthodox Priest’s singing every night as he call everyone to prayer from the bottom of the valley, to which we are the recipients at the top.

 It has been a busy few days working at the hospital and also going out to a hospital around 25km away, which is also supported by Maternity Worldwide. It took us about 2 hours to get there but the drive was really amazing as we drove up over the pass and were above the clouds.

 It was a really interesting visit as they had a Waiting House just outside the hospital and I was able to chat to women there who were ‘waiting’ to have their babies. The idea is that those women who are considered to be at a high risk of needing a hospital delivery are advised to wait for the last 2 or 3 weeks in the Waiting House. It’s a nice idea and I am trying to set up some evaluative work there with one of the nurses to see how many women actually end up needing a hospital delivery. They don’t have an obstetrician in the hospital as they can’t recruit anyone, although there are 5 pretty competent nurses and a general surgeon to do caesarean sections.

 Baby A has had a harrowing time over the past few days, largely because his mother has abandoned him, leaving him without any milk. He was doing really well and absorbing her expressed milk (well ¾ strength anyway) and had been taken off of the oxygen. But then yesterday evening she crept out of the hospital without anyone seeing her go. I’m not sure whether she just headed off home to her village or not but this was at least 4 hours walk away and it was pitch black.

So I had to introduce Baby A to powdered milk. It is at least baby milk but is designed for term babies rather than very premature ones. He doesn’t get on that well with it and has had quite a few episodes of vomiting. Last night, it looked as though he had aspirated vomit into his lungs as he went very blue and needed oxygen again. His lungs were also quite noisy. So I went to bed feeling rather disheartened by it all.

 However, this morning, much to my surprise, he was off of the oxygen and was quite perky – well as perky as a premature baby gets, I guess. So now I have him on ¼ strength Nan (powdered milk) and make the rest up with Dioralyte and glucose – I have managed to calculate his requirements for glucose and electrolytes and can just about make the right solution up. However, I run out of Dioralyte tomorrow and they don’t have any here in the pharmacy so I will have to re-think things a bit. Perhaps he will take more milk.

This evening, after I fed him, I dressed him in the only baby outfit that we have here – a knitted top. We don’t have nappies so it will be wet fairly soon but at least it’ll keep him warm for a while. As I tucked him in, I removed the cockroach that landed in the cot...........

We have now employed a gardener at 20 Birr a day (80p) and so he is helping us to prepare the ground a bit for the vegetable patch. We inherited a caged in area so it is money proof. We have also started a composting system – might as well as all the rubbish goes into the garden anyway.

 Tonight we had a delicious meal of Jerusalem artichokes and rice – you may not think it such a treat but I can tell you that it made a very welcome change to beans and lentils.

23rd October 2011

Apologies for the slight pause in blogging but believe it or not, I've been rather busy. A few days ago, a woman gave birth to her 28week baby in the toilet at the hospital. She thought is wasn't alive and so left it there and then came to report at the outpatient department (actually, just a small dark room). Having reported this story to Jeremy, through translators, one of the nurses was asked to go and look at the baby. A few moments later, she came back with him wriggling but as you might expect very cold. So the baby was taken to the 'female' ward and the mother, who by now was looking very shocked and did not have a recordable blood pressure, had to walk (no stretcher) to the 'female' ward where she was started on some intravenous fluids.

So the next few days have been spent trying to keep the 1.5kg baby alive. As you might imagine, there aren't any incubators or facilities for respiratory support and so he had to be a tough thing to get through this. The biggest challenge has been trying to maintain his temperature with just two hot water bottles; the second one only arrived on day 2 after much persuasion to seek out a further bottle. We also used empty drinking water bottles filled with hot water - thankfully they are tough enough to withstand the heat. The second challenge was to get the nurses to feed him 5ml of 10% dextrose through his nasogastric tube every hour. For the first 24 hours, I had to administer the feeds much of the time because everytime I went to the ward, he was very cold and hadn't been given any fluids. I'm not sure whether this was because they simply didn't see the point in caring for him as I guess they felt that it was futile - after all, a 28 week premature baby in the UK is going to have some challenges ahead despite all the available equipment and therapies. After a while though, the nurses joined in and I was able to leave them to feed him and keep him warm.

The situation was slightly compounded by the arrival of another 28 weeker the next day after baby A was born. So now a 1.4kg baby boy was placed in the cot with the other one. At least they could now keep each other warm! In some ways, it was easier to have the two together as it was easy to get into a routine for feeding and temperature readings. However, unfortunately, baby B died yesterday. I think we never really got on top of his fluid balance and therefore also didn't manage to keep him warm. It may also be possible that he was septic, as his mother was quite unwell, although we will never know this.

So I've just come back from seeing Baby A and he is doing remarkably well, all things considered. He is absorbing the fluids and is peeing - well, the blankets are wet so I assume he is. They don't have nappies. His mother is visiting him in in his temporary home, the labour room, which is attached to the female ward.

It has also been busy in the house as we have been trying to sort out the garden and make a start on the vegetable growing. We have also had to arrange to have a bed moved in to the spare bedroom here and given the steep and narrow stairs, this was no easy feat and involved taking the bed apart nd putting it back together upstairs. Still, all sorted now. Oh and the monkies are being total hooligans and have even popped in through the open door of the house and pinched a couple of bananas from the table.

I shall now go and roast some coffee beans and make some banana porridge - now a regular breakfast activity.

19th October 2011

We have now employed someone to do the cooking and cleaning and I think this will make life a great deal easier, not just because it will save us a huge amount of time, but also because she knows how the various systems here work. It seems that the household rubbish has to be emptied in a hole in the garden (we all appear to have our own personal rubbish holes) and then this has to be burnt. So I am sitting at my desk enjoying the waft of burning rubbish. The other real advantage is that she also does the shopping. Yes, I know there’s not a great deal to choose from but she gets a much better price for things that we do and also knows where we can find things. Shops aren’t shops in the same way as in the UK. Here, there is a small dark opening in a crooked mud and hay walled building that is the entrance to the ‘shop’. So you have to either know what is being sold or you have to go to every doorway and see if you can spot the item that you want to buy. Since most things seem to be ‘out the back’ it is really quite hard to know what is on offer. Indeed, when I went to the shops with Makaabee yesterday she took me into a meat shop, where behind the counter was what looked like beef hanging amongst the hundreds of flies. Here we bought 4 bottles of beer.

So for lunch today, Makaabee made us a casserole of mixed beans from the market and some cabbage with green beans and onions. We had this with a lovely bread roll that she made yesterday. There’s no waste of food here, so anything not eaten at one meal gets heated up for the next one. A great bonus is the fact that this is a big coffee growing area and we buy fresh coffee beans to roast and then grind. It’s often better to have the coffee black, although you do get used to the powdered milk, even if it is very expensive.

Hmmm, after eating ALL of the mangos off of the tree, this delightlful chap and his hairy friends departed from our veranda, looking for bananas in our trees.