Merry Christmas

Christmas day in Ethiopia was lovely and sunny just like every other day so far. I’ve had sunny Christmas’ before in Australia (although that was actually disappointingly overcast and nowhere near BBQ weather as it turned out) It’s very strange being here because although we know what date it is there is nothing that makes it feel like Christmas. Ethiopians celebrate the birth of Christ around Jan 6^th, and their celebration is focused on the religious aspects of the day. They fast for 40 days before hand (meaning they eat vegan food) so there is a lot of goat slaughtering and feasting on the day but none of the consumerism associated with western Christmas. No decorations or Christmas trees, no Christmas adverts on TV, not even a Christmas film on FOX Movies. It could easily be mid summer-just not in Scotland as the weather’s too nice;-)

On Christmas eve, the University was celebrating Nations, Nationalities and Peoples day. Ethiopia is a very diverse country with over 80 distinct tribes each with their own cultures traditions and language dialects. So they had a huge parade with representatives from many tribes dressed in traditional dress and singing and dancing. The atmosphere was amazing and we took some great photos which I will hopefully get chance to post soon.

On Christmas eve night we went to a party and Marika and Mengistu’s house. Marika is Dutch and Mengistu is Ethiopian and they met while studying in Hungary. We made mulled wine which went down nicely and they had a BBQ (so I did eventually get to have a Christmas BBQ – just not on the beach). One of the things I love most about Ethiopians (sweeping generalisation coming) is that they LOVE to dance and they are amazing dancers. They dance to a mixture of western music and ethiojazz, and their dancing is likewise a melding of two styles – traditional and modern. Apparently, in traditional dance, the part of the body they focus on reflects the part of the country they are from, although it is I think happy coincidence rather than deliberate design. So in the north there is a lot of head spinning, so fast you think it might come off – or at the very least cause some sort of rotational deceleration injury when they stop. From the north of the central belt it’s all about the shoulder pop. I have no idea how they do this. I think there must be some double jointedness going on. It looks amazing though.  From the South of the central belt there becomes a bit of abdominal and hip movement which is pretty unusual for Ethiopian dancing, and from the far south it’s all about moving your feet as fast as you can. They all learn these dances from a young age and its brilliant fun to watch and try and join in with even if the chance of injury seems pretty high!

So our Sat night was spent in brilliant company, shoulder popping and fast kicking - I avoided the head spinning – that might be a step too far! Thankfully there are no apparent injuries and I live to dance another day!

We went for Christmas lunch at Pat’s. She cooked an amazing spread of fish, roast potatoes, and even some specially imported Brussels sprouts that she brought back from her trip to the UK in November and had kept frozen in the freezer ever since. All followed by Christmas pudding, so I certainly didn’t feel badly fed! All in all it has been a very lovely Christmas, and the best bit is we get to do it all in again in two weeks time with the Ethiopians!!

A welcome arrival

Last weekend I went back to Addis to meet Calum off his flight from the UK. I was a little apprehensive about how everything would work out but actually it was fine. I was able to get a University car to take me to the airport in Dire Dawa. My initial plan had been to get a line taxi down as my flight wasn’t until 12.20 with a 10.20 check in time but the weekend before, when I went to Dire to get the plane tickets, for the first time since my arrival here there was not a line taxi to be had at 9am on Saturday morning and I didn’t want to take the chance of that happening again. Ethiopian airlines are generally very good and had a very reassuring safety record, but they do tend to send flights at a completely different time to the one stated on your ticket and it’s not always late – one of my colleague’s flights was 45 minutes early! So getting to the airport 2 hours prior to departure is necessary. My flight to Addis was uneventful and following a short trek around the airport car park I managed to find my way our on foot and to a line taxi to Haya Hulett where the VSO programme office is. If you get a line taxi it costs 2.80 Birr, if you get a contract taxi its 100 Birr so it’s well worth the tour of the car park!

On Saturday night I stayed with Miriam, one of the Addis based volunteers, in her lovely lovely house. When I see other VSO volunteers houses it reassures me that we are not being excessively fussy about our accommodation here at Haramaya, because most of the accommodation VSO arranges is of a much higher standard than I initially expected.

On Sunday morning I took a line taxi back to the airport to meet Calum. After a small tussle with the guards at the airport (I resent having to pay 10 Birr to go and meet my fiancé) I was allowed in and we managed to find each other without too many problems. It’s a very surreal feeling to meet someone you know so well in a place so alien to you, but it is also really lovely to see him again and suddenly the last 14 weeks apart are completely forgotten.

We were able to check in to our flight back to Dire Dawa early, which meant we didn’t have to carry Calum’s bags around, and so it was off to the lime tree on Bole road for brunch. One of the things I hadn’t realised was just how central the airport is in Addis. Bole road is one of the main roads in Addis and it’s a bit of an ex-pat haunt as there are nice (expensive) restaurants and several embassies in the area. The Lime tree is a nice but hard to find place on the second floor of a nondescript office block but it does all you can eat brunch, with fresh fruits, yoghurts, eggs, pancakes, cheese, my first wholemeal bread since arrival in country(!)... the list is endless and it was delicious although at 125 Birr per person it’s definitely Addis prices. Still we ate enough to keep our flight grounded and returned to the airport sated.

And so after an only slightly scary sunset car journey home from the airport Calum has arrived at Haramaya in one piece. Hurray!!!

A chilling reminder (prepare for a rant)

Yesterday I met a five year old boy at work with complicated measles. He had pneumonia which in itself is not uncommon. He had been brought into hospital by his grandmother with a fairly classical history of fever, dry cough, and a rash that started on his forehead and behind his ears and spread down onto his trunk. Everyone here knows these symptoms as measles is endemic. I suspect most people at home of my grandparents generation also know these symptoms, as measles was endemic in the developed world until the start of vaccination in the late 60’s and early 70’s, but I wonder how many of today’s parents are so aware.

I have met many sets of parents in the UK who have chosen not to have their children vaccinated. All supposedly informed decisions. When I ask why, they give me a variety of reasons from concerns about Autism (which, for the record is now shown not to be in any way linked to MMR vaccine as was postulated) to my favourite “if you look after your children properly they don’t require vaccination”. I kid you not. Yes folks, the great news is measles respects good parenting!! On days like today I wish I could bring every one of these sets of parents here to Africa. The people here would love to have the health care system available to us in the UK. Most children are unvaccinated here but it’s because their parents don’t have the time, money or knowledge to access vaccination rather than a miss guided idea about potential harm. Consequently I have seen illnesses I have never seen in the UK such as tetanus. I am not saying all vaccines are completely without risk – there are side effects to many of them, but the risks are far outweighed by the benefits.

My 5 year old boy was lucky – he has recovered and was discharged home today. However his family are still missing two members. His mother and older brother both died two weeks ago, on the same day, of the same illness that he had. Measles is a killer, and not just in Africa. So if any of my friends who have recently had their own children happen to be reading this my plea to you is to make sure they are vaccinated (not that I think you wouldn’t for a moment) because we are lucky that we can’t all immediately diagnose measles, and I don’t want that to change.

(Slow) Progress

 It’s been a fairly productive week here in Harar. Since we finished the medical student exams a few week ago, I have been able to spend more time with my GP (UK SHO equivalent) colleagues, sharing ideas for the way the ward should be run. They have been very proactive in designing a new work plan for the ward, which has been made possible by the arrival of two new GPs from Addis and Jimma. The GPs are really good, with great knowledge and clinical acumen. By necessity they are very independent and manage most of the patients without any senior support which is just as well really because I’m all the senior support they have!! Sometimes I am really apprehensive that these relatively inexperienced doctors on their first and second years out of med school run the entire ward, but mostly I am seriously impressed by their abilities not just for patient management, but increasingly for the other managerial tasks they take on such as undergraduate training, chasing up UNICEF when we run out of F100 (special formula milk for the management of malnutrition that UNICEF provide), or reorganising the way the paeds ward is run to make it more efficient.  They have assigned leads for different clinical areas including neonates (me), critical care, the nutrition unit, and one for infection control!! Result- Now I know exactly who to bug about getting some facilities to wash your hands into the ward!

We still have a lot of work to do though. One of the things that frustrates me most about the neonatal unit is the number of patients (parents) who self discharge before their children are really ready.  I know it is difficult for them –  if members of the family are in hospital there are less people to look after the animals, do the cooking and house work etc. Also many families come for a long way away. They can’t afford accommodation in the city so they camp outside the hospital.  Every night in hospital costs money – not just for hospital fees and medication, but in terms of lost revenue at home. So if they see that their baby looks better, explaining the need to complete the antibiotics course to ensure any infection is fully treated is often difficult and for many families it’s a risk they have to take. With this is mind I often discharge babies long before I ever would at home but this is often still not early enough for the parents. Consequently the 900g 32 weeker we had a few weeks ago was taken home while I was away in Addis, at about 10 days old and weighing about 1kg. I’m really not sure if anyone tried to dissuade the parents . When I asked the nursing staff if she had been feeding prior to discharge they said she was trying but they didn’t think it was sufficient. Unfortunately there is nothing that I can do in these cases except cross my fingers.

PS 1002 page views woop woop!!

The Hamlin Fistula Hospital

As part our health workshop in Addis the VSO team arranged for us to visit the Hamlin fistula hospital.  It is a world famous hospital that specialises in the management of obstetric fistula. These are abnormal connections between the bladder, bowel and uterus which usually occur as the result of prolonged obstructed labour.  Essentially, if the baby isn’t delivered fairly promptly after labour starts, the pressure of the head on the bladder and bowel walls, inhibits good blood supply and the tissue thins and dies, and abnormal connections develop. The woman becomes incontinent and is often ostracised from her family because of this.  She almost invariably loses her baby too and it’s all made worse because so many of the women who this affects are actually girls having babies at 14, 15 and 16 years before their pelvis is fully developed.

So in 1959 two Australian obstetricians called Catherine and Reg Hamlin came to Ethiopia initially just for a 3 year period to help develop obs and gynae services in the country. They found such need that they ended up staying, and 50 years later the Hamlin Fistula Hospitals are the fruits of their labour. Their story is told in the book The Hospital by the River, which is a really good read about Ethiopia and obstetrics in general.

The hospitals (there are now 6 in total) are fascinating because they really are a shining example of how development work should be.  They started with the Hamlins operating on the few women that found their way to their hospital, but they trained some of their ex patients how to do the surgery, and things have grown and grown so that the 6 fistula hospitals now provide a comprehensive holistic approach to fistula treatment including the initial surgery, psychological support and counselling,  physiotherapy and rehabilitation, and the teaching of new skills such as handicrafts to the women so that when they leave the have a way to make money for themselves. The whole project is now run by local people and they train people from all over Africa how to do fistula surgery.

Our visit was really interesting. Unfortunately (but understandably) you are not allowed to take photos at the hospital so I can’t show you what it’s like. Instead I just have to say that I feel really privileged to have visited such a great place.

The Great Ethiopian Run

On Sunday the 27^th November 2011 I took part in the Great Ethiopian Run. What a buzz!!!!! I wasn’t particularly enthusiastic about the prospect when it was first suggested all the way back in In-country-training as my one and only previous 10k whilst an achievement I’m very proud of was not exactly easy, and the thought of training in Africa, with a million kids running alongside you (not nearly as fun as it sounds) in the heat and the altitude really didn’t make me think it would be a good idea. However after lots of encouragement from other volunteers who assured me they would all be walking I signed up for it and got my lovely t-shirt which is you race entry and medal ticket at the end.

I didn’t do much (any) training because of lack of time and, let’s be honest, laziness but instead made a firm plan just to walk it. However as there was no stratification based on your estimated time like you would expect at home I found myself worryingly close to the front of a pack of 36 000+ other participants of the day and as the starting gun went we just kind of got carried along by the crowd at a pace that was somewhere between a walk, a skip and a jog.

This is not a race you do to get a personal best though. This really is all about the participation. The vast majority are just there for the party and it really feels much more like a carnival than a race, with people chanting, singing, and conga-ing their way along the route. Every 500m there are either live bands or loudspeakers blaring out ethio-jazz and a crowd of runners who have given up running just to boogie on down to the tunes for a little break! So I danced, skipped, walked and jogged my way around the 10km in a time of 1 hour 45 mins and even got to the end in time to get a medal! Unfortunately some of our group missed out as the 36 000 medals they had produced ran out as many people without t shirts just joined in and even though you are meant to have a t shirt to get a medal they were just being handed out freely at the end.

Definitely one of the highlights of my trips so far!

Great Run Photos

 Kate and I before the run

Jo K takes a crowd shot

A weekend in Addis

Last weekend we travelled to Addis Ababa. Originally the plan was to attend the Great Ethiopian Run on Sunday, not because running 10km in the heat of Africa at 2400m above sea level really appealed, but because it had been suggested as a good excuse for a reunion with our entire volunteer intake. However VSO E decided to take advantage of the fact that so many volunteers would be in town to extend our stay for a two day long health volunteer workshop. This also means they paid for our transport and most of our accommodation making it really too good an opportunity to miss! So ensued a brilliant few days, with so much blog fodder I hardly know where to start.

Our trip began after work last Thursday when instead of heading back to Haramaya we stayed at the Ras hotel in Harar.  The hotel in clean enough although the beds are a little saggy and the water supply, as for all of Harar is temperamental at best, but it suited our purpose, which was to be close to the Salem bus stop as we had a 5.30 am departure to Addis the next day.

We had decided to take the Bus as our colleagues at Haramaya had recommended that the overland journey to Addis should be done at least once, and I think that is pretty good advice. We were unsure if the bus would leave anywhere near the allotted departure time, so it was a pleasant relief when we rolled out of Harar at 0540, only 10 minutes behind schedule. The bus itself is comfortable enough although there is no air conditioning which means it gets a bit hot and sticky later in the day. The scenery is spectacular, starting off with winding roads, shear drops and high ridges that are not for the fainted hearted (or travel sick!). Fortunately although I do frequently fall into that last bracket I had seat number 1 by virtue of being super organised and booking our tickets a whole 40 hours or so in advance of the departure, something Ethiopians never do.  This meant I had a good view of the road ahead, so that feeling queasy really wasn’t a problem.

After the mountains of the Eastern plateau, you descend into the rift valley – one of the major geographical landmarks of Ethiopia and Africa as a whole. It divides the continent into North West and South east and interestingly creates a boundary for diseases (such as trypanosomiasis ) as well as people. The landscape here becomes much more arid and quite stereotypical of African Savannah. Every so often you pass little gatherings of circular mud hut houses, where local villagers live very traditional lives. I kept expecting to see a pride of lions but sadly I was disappointed. I did spot the odd monkey and plenty of camels including some very cute baby camels (anyone know the name for a baby camel?)

Finally after the arid plains you hit the lakes full of ibis, flamingo, pelicans and storks. Around the edges of the lakes there are great black rocks that look like they must be volcanic in origin. It is spectacular and makes the 10 and ½ hours it takes to complete the 500km plus journey to Addis pass quickly.

And so we arrived in Addis,  a little tired and sticky but really excited to catch up with all our friends. It’s amazing how your perspectives change when you’ve been living in fairly rural Africa for 2 months. Addis Ababa feels like a cosmopolitan metropolis in comparison to what I been used to but I’m very aware that that wasn’t my initial impression when I arrived in September. We caught a line taxi from the bus station to our hotel near the VSO programme office in Haya Hulett and everyone was wearing a suit! Not only that, but there were only 13 people on it before it departed. Such a difference to being crammed in with 20+ other people, most of whom are traditionally dressed local farmers with numerous baskets or bundles of stuff, bags of chat, and goats (yes goats) in tow.

The contrasts continued on Saturday, as we went on a food hunting tour of Addis. It’s an accurate stereotype of volunteers that much time and conversation is devoted to reminiscing over our most favourite foods that we would love to eat, and we get very excited if accessing any of the valued delicacies becomes a possibility. So on Saturday we went en masse to the German church in Addis in search of gluwein and bratwurst at their Christmas fair. We were partly successful as it turns out even the hardiest of Addis ferengi still go mad at the possibility of gluwein and so even though it was only midday when we arrived it had all been sold out. Still the bratwurst were still there and were washed down very nicely with a pint of beer in the sunshine while listening to cheesy Christmas music.

We also went to the NGO fair,  a craft fair, where a variety of local charities sell stuff to rise funds and awareness of their work. It was in the heart of the embassy district, just of Bole road, and you just had to follow the strings of white NGO 4X4s to find it. It was interesting but decidedly over priced on the whole and very much seemed to cater for “the ambassador’s wives” and the like. It’s strange to think how many foreign people live “normal” lives on “normal” salaries in Ethiopia, even those who are supposedly volunteering or working for charities. The disparity between what other “volunteers” and NGO workers get and what VSO get was something Shona who had volunteered in Sierra Leone had warned me about prior to departure so it isn’t a surprise, but its so much more obvious in Addis. To give you an idea, an Ethiopian farmer earn around 4000 Birr a year if they farm cereals, 8000 Birr year if they also farm chat (this is a whole other blog post that I keep saving for a week when I can’t think of anything else to write about). As VSO volunteers, we get 2750 Birr per month. The peace corp and ifesh  “volunteers” (US charitites) apparently get in the range of 15 000 Birr a month ie double the average Ethiopian farmers annual salary......need I say more.

The other thing I notice related to money when visiting Addis is how expensive it is. It isn’t really, but I’m comparing it to Harar where I wouldn’t worry about only taking 50 Birr (about £1.70) for the day. On my last night in Addis I had my most expensive Ethiopian meal ever – 165 birr each for possibly the best Chinese meal I have ever had (or maybe I’ve been away to long already!). It seems like a fortune at the moment but in reality it was only £6 pound including beer – not so bad after all!

So those are some of my thoughts about Addis. I haven’t even started to talk about the Great Ethiopian Run or our health workshop which included a fascinating visit to the world famous Addis Ababa Hamlin fistula hospital, but I think maybe I will keep you in suspense and post about these in a few days time. After all I’m getting very close to the one thousandth blog view!!!

The neonatal unit

being premature in Africa

Something we are getting very good at in the UK is keeping increasingly premature babies alive. When I work at home, being asked to go to a delivery of babies more than 30 weeks gestation ( ie 10 weeks early) hardly gets the adrenaline going at all. After all, we now expect the majority of these infants to survive, hopefully with either no or only minor disability, and I know I have the skills and support to provide the necessary treatment to make this happen.  We have NICUs full of incubators, monitors, ventilators, phototherapy units.... the list is endless.

How different things are here.

At the end of last week, I went into the neonatal unit to find a 24 hour old premature infant who weighs 900g. She was born after 7 completed months of pregnancy and clinically 32-33 weeks looks about the right gestation, but she is tiny even so. We don’t have an incubator here, so she was hypothermic (33.5) with a very slow heart rate (44) but responsive and with reasonable respiratory effort. I put her skin to skin with her Mum which is really the only way of warming up a baby here and crossed my fingers. She was on iv fluids initially as she is too immature to suck, and iv antibiotics as infection is a common reason for preterm delivery and can be rapidly fatal if not treated.  But this is about as much as I can do for her. If she has significant ventilatory problems there is none of the equipment that I am used to – not even a mask small enough for her tiny face. If she becomes jaundiced there is no phototherapy – we use a normal light bulb, but if we expose a tiny baby like this she will become hypothermic again.

Our neonatal unit is basically a room full of cots with a heater on the floor and an oxygen cylinder in the middle. Nothing more.  We did have an incubator but it is broken and no one knows how to fix it. We keep suggesting to VSO that hospital technicians would be a really useful addition to the health team. Someone who can fix these instruments and teach local staff how to maintain and fix them would be worth their weight in gold. Just giving equipment without training staff is a common fault of international aid and really doesn’t help at all.

Sometimes though I think it is just as well we don’t have more facilities, because Ethiopia is really no place for a child with disability. At least this way only the very strongest babies survive.

Our preterm baby is now 6 days old and doing remarkably well all things considered. She is tolerating expressed breast milk and really only had a minor amount of respiratory distress all things considered, with no oxygen requirement (well she’s not obviously cyanosed- we don’t have a saturation monitor). Here heart appears to be normal on examination and so far she is behaving as I would expect from a neurological point of view. She has even put on 50g! She is certainly not out of the woods but she does appear to be a little fighter – and since we have no facilities to put central lines in her chance of secondary infection should hopefully be less!

Revenge of the rats – the straw that broke the camel’s back

My last post was written while Susan and I were sitting in the morning sun eating our usual breakfast of porridge with banana and honey, and debating what to do with the weekend. Shortly after I’d finished typing I mentioned the large number of bites I seems to be getting and couldn’t quite work out where they were coming from. Was it perhaps worth putting the blankets out in the sun just in case we hadn’t completely got rid of the fleas? So we did, and sure enough as soon as the sun hits the blankets there were fleas hoping everywhere... well that explains the bites then.

So ensued a morning of taking all the bedding out and hand washing it, putting the mattresses in the sun and steeping the really thick blankets to try and drown any fleas that weren’t killed by the sun. Having done this all two weeks previously it was getting a bit tiresome but needs must so we ploughed on.

On Saturday night I shivered in bed wrapped in a million layers of clothes as the flea infested blanket was not yet dry. It actually gets pretty chilly here at night and the locals keep telling us that over the next 2 months it will drop below freezing after the sun goes down, so sleeping without a blanket , especially in a house where the windows don’t shut properly, is not a pleasant experience.

On Sunday morning, I was in the shower when Susan shouted for me to come as there was a rat in the kitchen. Sure enough there was a very large black rat with a long tail right in the middle of the kitchen floor.  It was one of those slightly-groggy-rub-the-sleep-out-your-eyes-am-I-seeing-things type moments. The rat was obviously slightly groggy too, having eaten some of our poison, as it didn’t move. Susan went to get the guard while I went to get some clothes and by the time the guard arrived the rat had hidden behind the fridge. The guard made several unsuccessful attempts at getting it out by bashing it with a broom handle, which didn’t work and the rat managed to find a hole in the back of the fridge to crawl into and disappear/die. Not great. Over the next few hours as the sun got hotter, the smell of dead rat got stronger and stronger and our resolve to stay and beat them got weaker and weaker.

We were debating our next move, when like a guardian angel, one of the housing guys appeared with the news that there was another apartment we might like instead. It has 3 bedrooms but it’s a bit of a mess he said. Still they would paint it and get new curtains and mattresses for us. Would we like to see it?

The new place is in even more of a state than the old place was. But at least there are no rat droppings and very few soft furnishings to become flea infested. So we said yes please, we would like it very much and in the mean time we would move into the guest house while they get it ready. Very optimistically they reported that it would be ready by the end of the week but having seen the state of it I’d be surprised.

So back at the rat infested dump, we pack up out stuff and cart it all to the guest house at which point Susan find her new bed covered in cockroaches. This was the straw that broke the camel’s back. There followed a minor flipping out and thankfully Jenny and Pat have taken pity on us and let us have their spare room for the last two nights. Don’t get me wrong, cockroaches are definitely part of African life, but on top of the two weeks of cleaning, the fleas and the rats it was all just a little too much. Still I am now recovered and planning to head back to the guest house soon.......

Too much water, not enough water

Okay so I wrote this on Saturday (its tues today) but I hadn't had chance to post it and things have changed a good bit since then. Still I'll post it now and try and updaet you all soon.....

Too much water, not enough water.

So another week has passed in Ethiopia and we have now managed to experience the extremes of water in Africa. When I first arrived it was the end of the rainy season and it seemed so strange to me that while it was raining daily, and there was no running water in the hospital, nobody seemed to be making any effort to store or conserve the water seeing as it was obviously such a scarce commodity.

Since then the dry season has well and truly started and for the last 5 weeks or so it’s been clear blue skies and not a drop of rain, at least until Thursday. On Thursday we stayed in Harar in the evening to go out for dinner. It has emerged that the University has evening classes on the Harar campus and that there is an evening bus leaving at 8pmish to bring staff and students back after their classes so transport home was sorted and dinner out was a possibility.

We have also had another VSO volunteer, Jaq, visiting this week. She is helping Susan and Pat deliver a VSO sponsored medical ethics course for the nurses and midwives at Hiwot Fana hospital.  Many of the things that we take for granted at home such as patient confidentiality don’t really exist here – oh you have HIV, well everyone needs to know so they can’t catch it off you etc.....

So our perfect excuse for dinner out – a visitor and transport home – pizza here we come. Our dinner was lovely and we were back at the campus waiting for the bus home. It had been over cast all day and was just beginning to spot with rain. Unfortunately I had a sudden attack of Ethiopian Delhi belly and headed off to the lovely campus loos with Susan in tow to make sure I didn’t get jumped on by any random students (not very likely but VSO scared us all witless at induction so we err on the side of caution). On the way back the heaven opened. With torrential rain, thunder and lightning with very little warning. It was quite spectacular and we were absolutely soaked within seconds and then spent the rest of the bus ride home shivering. I was so relieved to get warm and dry and tucked up in bed listening to the rain drumming on the roof – reminded me a little of Scotland.

So following the torrential rain any water shortage must be eased for a few days, right? Wrong. We have had no water at the house for the last 24 hours. And like the Ethiopians we have become complacent in storing water because despite the dry spell for the last few weeks it hasn’t really been a problem.  We had even had our boiler fixed and were able to get warm water out of the shower! So our one bucket in the bathroom hasn’t really lasted very long, especially with my ongoing dehli belly equivalent. Thank goodness for dry shampoo and wet wipes!!

Well at least we will learn from our mistakes – when or if the water comes back on we will fill as many storage containers as we can get our hands on. Don’t know how Calum’s going to cope when he arrives though – last time we discussed it he was averaging 4 showers a day!! I did suggest he should try and wean himself off a bit so that Africa isn’t quite such a shock to the system.

Anyway think that’s all for now. I will try and post a few photos of the mansion later.

Jo x

Smallish and Bigger Triumphs

This week I had what I think can only be described as a very African experience at work.  For a number of reasons which I will try to expand on now:

1.       The Paeds ward is normally run by the consultant, Dr Fricerte and four GPs (our SHO equivalent). You already know that as soon as I appeared Dr Fricerte used the opportunity to go off and do a Masters in Public Health at the University and so is no longer around, leaving the paediatric ward in the admittedly fairly capable hands of her SHO’s (and I suppose me but my hands are still feeling somewhat less capable). Well this week 3 of the 4 GPs left to go to a diabetes conference in Addis leaving Me + one other who hates paeds and has been trying to get out of working here in favour of radiology as he has now been accepted onto post grad radiology training. There are health officers as well who are trained health professionals with decision making and prescribing abilities but they tend to have less in depth knowledge that the medical staff.  So we had to muddle on through. But the students still expected teaching and sadly this seems to be more of a priority on the ward than patient care and they are generally not very flexible on changes to the schedule or the teaching style.  I did make a point of at least seeing the neonates before I did the bedside teaching and interestingly seeing me make some decisions and be taken seriously by the nurses seems to have improved my standing in the eyes of the students. Small triumph.

2.       As Susan and I were heading for the Bus on Monday evening the head of the health sciences campus walked with us (insisting on carrying the massive Nelson’s textbook I was lugging home in order to have some ammo for the students, because Ethiopians just do things like that). He was asking for our help organising a VSO sponsored medical ethics course, something which is a great idea and which I had heard vaguely about already. “ I was hoping to here from VSO today” he said, “because the course is due to start next Monday!” So follows the mad rush to organise an entire 3 day training course in one week flat. Can you imagine ever trying to do that at home? Not in a million years. I have to say i quite like this about Ethiopians – no need to plan just crack on and do it!!

3.       The scariest bit of the lot..... When I was contemplating doing VSO I spoke to another Paeds volunteer called Shona quite a bit. She was in Sierra Leone. I remember her describing a situation to me of a patient arresting on the ward round and saying this was really quite common. I didn’t really believe her but it happened to me on Thursday morning. I was in the neonatal unit  doing a round. I had seen one patient already and come to the next cot to find the baby apnoeic (not breathing) and bradycardic ( slow heart rate ie almost but not quite dead). There is no monitoring so no one really seemed to be aware that he was quite so sick. He didn’t respond to stimulation and after much searching someone managed to produced a bag and mask out of a locked cupboard with which I was able to give him some ventilation breaths, and some chest compressions. Amazingly his heart rate improved and after a minute or two he started breathing again. We put him in recovery position but he stopped breathing so we turned him over and started again, and again he started breathing. He had neonatal tetanus – something I have never seen before coming here but am now a bit of a expert in. It can make him stop breathing by paralysing the diaphragm and resp muscles, and we treat it with massive amounts of sedation with diazepam (valium) which can also cause respiratory depression. I think he had too much valium on board and had just stopped breathing, because I don’t think he would have started again if it were resp muscle paralysis due to tetanus toxin. So I halfed his dose of sedatives. I didn’t really expect him to be alive the next day – but to my amazement he was and not only that, he looked considerably better, much more awake, less secretions, breathing much less obstructed. Big triumph!!! The only slight niggling doubt in the back of my mind is whether he will be brain damaged from lack of oxygen as I have no idea how long he had stopped breathing for. Ethiopia is certainly no place for a disabled child so fingers crossed.

In other news this week, the war on the rats is progressing well. We won the first battle as the poison was gobbled down and the sightings, new droppings and roof top rustlings stopped pretty quickly. However they are now getting their revenge by dying and decomposing under our kitchen cupboards and in the roof spaces and making the whole house stink. Susan pulled two dead rats (they are defiantly rats) out from under the kitchen sink – yuck!!  So glad I wasn’t here for that. There must be more – we can smell them, but we can’t get to them. Still better dead and smelly than alive. Definitely!

Think that’s all for now. Off to Dire Dawa today so hopefully some photos to follow. Also there are photos on facebook of me in action courtesy of the Canadian CUSO-VSO team who came last week.

Jo x

Welcome to Paradise

This weekend Susan and I finally moved into our own house. We have been given the house of the academic vice president of the university who is currently on a year sabbatical. It is one of the nicest houses on campus and all our Ethiopian colleagues keep telling us how lucky we are to have it. And we are lucky. It’s a lovely villa in its own garden with a huge living/dining room, two very large bedrooms and a kitchen and bathroom. It has running water and electricity (most of the time), and it’s even meant to have internet access, although that part is not working at present.

The bad thing is that it’s filthy and rodent -infested. There were droppings everywhere and we saw two very large mice or small rats (we’re not sure) on our first night alone. Now I’m not actually phobic of rats or mice but I really, really don’t want to share my house with them.  So we bought some poison in the market yesterday and we have declared war.

We have also scrubbed the house all weekend – so much so that we managed to run the water tank dry on Sunday afternoon. The kitchen and bathroom are now pretty clean and our rooms are habitable – the mattresses have been left in the sun to kill any fleas that may or may not have been lurking in them,  and the blankets VSO gave us had the same treatment. Two of the four blankets were actually jumping with fleas when we laid them out in the sun and even though the sun seemed to do the trick and there were none visible after a few hours we didn’t like the idea of having them on our beds last night much. I therefore tucked myself up in bed in my sheet sleeping bag with a pashmina, fleece and hoodie and a cardigan spread around for warmth all under the mosquito net, of course. I was also upside down with my feet to the head of the bed  a there were some very strange rustling noises coming from the ceiling above the head of my bed which we put down to some very large rats in the roof space and I didn’t much fancy them falling on my head on the off chance the ceiling should give way in the middle of the night.

So passed a not very restful night. When I wasn’t woken by rustling rats in the roof it was barking dogs in the back yard or a wailing imam from the local mosque competing with the Ethiopian orthodox equivalent for business from those faithful enough to be contemplating getting out of bed at 5 or 6 o’clock on a Sunday morning. As some one said- welcome to paradise!!   And so our villa was named.

One of the things that surprise me is how quickly news spreads here about what the ferengi are up to.  I had just drifted back to sleep when the Imam finally gave up at 7am when there was some frantic knocking on our door. We had been in the house for less than 24 hours but it was one of the local women asking if we would require the services of a maid. While this is something we are considering, the answer given at 7.20am on a Sunday morning after a restless night was probably not the one she was hoping for.  Later on, we had a visit from a local man, who had walked from the nearest village with two references from previous employers offering his services for the collection of eggs and milk, laundry and gardening. How he knew where to find us and when is beyond me. It’s all a bit bewildering. On one hand I am loathed to give out money unnecessarily for things I can easily do myself as despite the big house and there appearances of being rich ferengi the money we get  from VSO is significantly less than the local lecturers, and I will need to be a little careful  if I’m not going to spend my wedding savings long before the big day arrives.  On the other hand in comparison to many people here we are extremely wealthy even on our Ethiopian VSO salaries. Many people earn as little as 300 Birr a month (roughly £100) or less and an extra 10 Birr here for collecting your eggs, or 30 Birr there for doing a week worth of laundry by hand makes a significant difference to them and it does make my life much easier too. They are also for the most part very hard working honest people and I have been pleasantly surprised many times by the fact that people on the whole don’t see the colour of your skin and try and bump the price up too much. It does happen from time to time but just as often there will be a complete stranger sitting beside you on a line taxi, or in the market who will make sure you pay the right price for your journey or half kilo of bananas, just because they want to help you and make sure you have a good time in their country and that is very humbling and makes me feel bad about every time I‘ve been a little too defensive in response to the bombardment of attention you get being white skinned here.  

An exciting few days

It’s been an exciting few days here in Playa del Haramaya! Firstly we are almost ready to move into our mansion!! Well it’s not quite a mansion but we are reliably informed that as the university’s academic vice president’s house it is one of the nicest on campus. Said vice president is off on a year sabbatical so we get to live in his house in the mean time. It is certainly big – two large double bedrooms, big living/dining room complete with 4 piece suite of the variety your grandmother would love, kitchen and bathroom.  The bathroom appears to have a leak and although the toilet flushes and there is some water in the sink there is more water on the floor than in the bath/shower and the boiler seems to be broken so I think we’ll be on cold bucket baths after all. The kitchen is also pretty grotty at the moment and we are just waiting to get in there and give it a good clean. We do have a fridge which works and a cooker / oven but only one of the four rings works at the moment. On the plus side we have functioning broadband and satellite TV!

Then we have a visit from some Canadian volunteers – a photographer and journalist who are recording volunteers stories and experiences to use as promotional material to encourage more volunteers. Hence lots of photos of me in action with African children and medical students. I have been promised a copy of them so I’m looking forward to that. It was really nice to have some new people to talk to and we had a good laugh with them (not that are fellow volunteers are not lovely and great company of course!)

Then there was the arrival of my rescue packages – dairy milk, almonds, dried fruit, hand sanitiser... all the essentials! Was really brilliant to go to the post office and find a little yellow slip in the box telling me there was a parcel for me – especially when it actually turned out to be three parcels and a card, courtesy of my folks and Calum (thanks a million) I am down one bar of dairy milk as it was demolished with a lot of help for my friends here last night, but very very worth it. Yum! (plus when it’s shared i don’t feel so guilty).

Finally I am now the proud owner of an office – hurray. I’ve never had a office or a desk just for me before. Very exciting!!! Photos of all of the above to follow (except perhaps the dairy milk).

Jo x

Haramaya flowers

Last week I took a wander around campus with my camera. There are so many beautiful flowers here in every colour of the rainbow. I have no idea what most of them are but it makes it easy to see why the rastafarians think Ethiopia is Zion.

Happy Birthday to me

Happy Birthday to me! Well I had a lovely Birthday weekend. The planned trip to Dire never materialised as Susan was sick with tonsillitis, and I wasn’t that fussed so we decided to delay until she was better. Instead we went into Harar again for lunch and a few beers, and a bit of shopping. It was a really nice day. In the evening we went to Jenny’s for wine and nibbles. My standards when it comes to red wine are definitely dropping and the Ethiopian gouder wine is now becoming quite pleasant (desperate times). Apparently though, some French winery has bought up a whole lot of Ethiopian land for vineyards so you never know. Ethiopian wine could be the next big thing!!!

On Sunday I spent the morning by the pool reading my book which is a brilliant way to spend any birthday. Then in the afternoon our friend Rozina gave a coffee ceremony for me. This is Ethiopian tradition and happens when you have any guests to your house. All Ethiopian women know how to do it. It starts with roasting the coffee beans on a metal pan of sorts, traditionally over a charcoal stove, then the beans are ground in a mortar and pestle before being put in an Ethiopian coffee pot with water and heated to produce coffee. There is incense burning and the coffee is served with pop corn. The first round of coffee is the strongest and therefore considered the best. It is served in espresso sized cups usually with copious amounts of sugar. More water is then added to the pot and it is reheated for second and third rounds of coffee. I had seen coffee ceremonies before during in country training but it was nice to have it described in detail for you.

On Sunday evening we took a walk down to the bottom of campus to see the hyenas that live wild here. I’m told we are completely safe as they are scavengers, but it’s still a pretty hair-raising experience to see them in the flesh. Apparently, Gary one of the other volunteers didn’t know there were any on campus and the first time Gary saw them he got such a fright he climbed the nearest tree then sat there wondering what to do next!!! He won’t thank me for telling the world that on my blog, but to be honest I think I would have done the same thing had I not been expecting to see them.

The best bit of birthday news was that Susan and I finally have a house sorted and should be able to move in at the end of the week. It belongs to the vice president of the university who is away on sabbatical for a year, and so it is rather grand indeed! We saw it for the first time of Monday and it has a huge open plan living/ dining room, two enormous carpeted bedrooms and big bathroom with bath and shower, and a big kitchen. It’s a little dark and dusty as its been empty for 3 months but it has so much potential. It also has a lovely little garden and a reasonable amount of private outdoor space for sitting and exercising in. Can’t wait to move it! Photos will follow.

The Art of Clinical Diagnosis

Well another week is almost done and the more time I spend in hospital the more things slowly start to make sense.  I had a very nice morning this morning, attending a lecture on rheumatic fever given to the medical students by the paediatric consultant, then a bit of bedside teaching for the students on malnutrition, something which in just three weeks has become bread and butter. The initial dread of being put on the spot doing bedside teaching on patients I know nothing about with the wildest pathology I have ever seen is beginning to subside a bit and I am well aware that teaching this stuff is making me learn huge amounts too. I can’t help but feel that in the UK we have become over reliant on investigations instead of clinical skills. Here there is no option to send any murmur that sounds vaguely pathological to a cardiologist for assessment /ECHO. There is no cardiologist, and no ECHOcardiography.  Just my ears trying to decide whether this patient just has mitral regurgitation or whether there is a mitral stenosis murmur too (trucks on cobble stones anyone?) and 22 eager medical students awaiting the verdict.

There is still wild pathology. This week I have seen a three day old baby who was born at home with a huge spina bifida lesion, present with fever and almost certain meningitis.  He is currently better from his meningitis although there is absolutely nothing we can do for his spina bifida, and it may have been better not to treat him at all. Along the same line I have also see a 14 month old present with on lump on the back of his head present since birth. Sounds innocuous enough until you realise he has severe developmental delay(no head control, can’t sit), macrocephaly (abnormally big head) and the lump is almost certainly an encephalocele of some variety ( ie spina bifida of the head rather than lower back for want of a better description). Again absolutely nothing we can do – not sure why they waited 14 months to see a doctor but then there wouldn’t have been anything that could be done 14 months ago either.

So what is available in terms of diagnosis? Well I’ll give you a list. The investigations are so few and far between that listing them is possible: Haematocrit (but no Hb), WCC and differential, platelet count (not done routinely), blood film, ESR, urea, creatinine, bilirubin, SGOT/SGPT (transaminases I’ve never heard of before), alk phos, blood glucose, wider test(typhoid) wiflex test (typhus), Hepatitis serology,HIV antibody test, urinalysis, microscopy of most fluids, xray, ultrasound.

That’s it.

No electrolytes, no blood gases, no albumin or bone profiles, no clotting studies, no cultures (of anything), no ECG, no EEG, No CT or MRI (not that I was expecting those really).

No nebuliser or spacers (subcut adrenaline for acute asthma anyone?)

No neonatal resus equipment, or any equipment for resus at all. (But there wouldn’t be much point in the latter when there is no ITU either)

No phototherapy units. No incubators (well one, but it’s broken and no one knows how to fix it)

No water.

There. I’ve managed to thoroughly depress myself with that, but it’s really not all that bad. We have a few small triumphs – in fact I’m amazed at how resilient some of the children are. Two in particular cheered me up today: A girl who came in with high grade fever, diarrhoea, purpura everywhere, bleeding nose, bleeding gums, unwell but alert.  Haematocrit 17%, Platelet count 9. She was treated as ITP+infection with antibiotics, steroids and blood transfusion. She looked a million times better today. I still think she probably has leukaemia but it was nice to see her looking better. Secondarily, a boy with acute hepatitis B who had been to see a traditional healer which is common practice here. He had been given a herbal remedy which turns out to be pretty toxic to the liver and came in with jaundice, massive ascites looking decidedly encephalopathic (ie bad for the non medics reading this). Transplant not being an option he was managed with iv fluids and multivitamins and was wide awake again and looking much better today. Hooray!  The herbal remedy seems to be really bad stuff. I haven’t seen so much ascites since I worked on the alcoholic liver disease ward in Glasgow Royal Infirmary as house officer!

Anyway. I think that is all for now. Apologies for the very medical content of this post – not so interesting for everyone. I’m off to Dire Dawa this week end so the next post will almost certainly be full of touristy stuff and photos.

Jo x

A kind of routine

So another week has passed in Ethiopia and a kind of routine is starting to form. During the week the days start early at 6am when I get up and go to catch the bus into Harar campus at 7ish. I say 7ish as that’s what time it meant to go but to date it has never departed at this time. Pat, one of the other volunteers initially told us that we had to be there by 0645 to be sure of catching it, but so far the earliest it has departed is five past 7 and so our presence at the bus stop is a couple of minutes later each day. The latest the bus has left is 0730 which then makes me late for the lectures I give, but this seems to just be part and parcel of Ethiopian life. The bus itself is for staff who live on this campus and work on the other, but the drivers pick up a whole bunch of other local people on the way including most of the local high school kids who travel from Baty, the village at the University gates, to Alemaya, at the bottom of the road where the high school is. The bus tends to play badly tuned in Ethiopian music very loudly on the radio, and that combined with the crowded nature of the bus means that any hopes of a 45 minute snooze are completely dashed. At least the people on this bus don’t mind having the windows open too much. When you take a line taxi, they are really stuffy and crowded and many Ethiopian people seem to have a morbid fear of moving air thinking it carries disease or something, and so choose to swelter with the windows shut rather than risk opening a window.

Once I arrive in Harar I usually head down to the hospital which is a 15 minute walk from the bus. On Tuesdays and Thursdays the medical students currently doing paeds and obs and gyne get paediatric lectures and on Mon and Wed they get obs and gyne lectures. This week I gave the paeds lectures on growth and development. I had been pretty apprehensive about this but thanks to some great tips from Jenny one of the education volunteers, things seem to have been going pretty well so far. One student even came to say thank you for such a good lecture on Thursday which felt like a real triumph. After the lectures they head to the ward for bedside teaching for at least an hour which I find much harder. I have very much been thrown in the deep end with the teaching as most of the pathology is very different to what we see at home, and because you don’t know what you are going to see and have no time to prepare its real challenge to the clinical skills to be put on the spot and expected to teach in detail about a patient you have never seen before.

I am beginning to understand a little more of the routines for patient care. In Ethiopia the doctors in the first two years out of medical school are called GPs and there are three attached to paediatrics who seem to do the bulk of the clinical work seeing most of the patients between them on most days.  One the whole they seem to be pretty good. There is still no water and no hand washing although when I arrived on Wednesday last week someone had mopped the floor! That said we went to see a patient who had been admitted with reduced conscious level and was not improving despite 3 days of treatment. When I arrived at the bedside with the consultant, one of the GP’s was teaching some students. He was talking about the importance regular recording of vital signs (obs). This patient did have an obs chart taped to the wall above her bed and in 3 days had had 3 sets of obs recorded. He quite rightly said that this wasn’t enough and banged the chart with his hand, at which point several cockroaches emerged from behind the chart and ran down the walls – lovely!

At lunch time I head back up the health campus in Harar for lunch with Susan and Pat, we try not to eat out every day as doing this quickly gets through the 80 Birr (£2.50) a day budget. Instead we buy bread and peanut butter, and fruit.

The afternoon is usually quieter, with time to prepare lectures. Sometimes I  get a line taxi back to haramaya campus, other days I wait for the uni bus. If I wait for the bus I don’t get back until 6.30pm which is a pretty long day. Just time for dinner, a quick check online and bed!

PS think you should now be able to write comments on the blog – would be good to hear any thoughts!

Harari Ramblings

Lovely day today. We went into Harar on line taxi, for lunch before doing a guided tour of the old city with Binyam, a guide who the other vols had used several times before. He showed us the old walled city of Harar, the various mosques and churches and a couple of museums of Ethiopian and Harai culture and markets. He knew his stuff and was very friendly and approachable. Wandering around with him meant we felt a lot more relaxed and could take photos without worrying we were offending people as he kept us straight on what was acceptable and not. One of the nicest things to see was a traditional Harar house, a lovely cool airy place, with seating on 5 levels depending on how important you are, beautifully decorated with pots and pans and vases.. It was really nice to finally see the touristy bit city we are working in.
Lovely day today. We went into Harar on line taxi, for lunch before doing a guided tour of the old city with Binyam, a guide who the other vols had used several times before. He showed us the old walled city of Harar, the various mosques and churches and a couple of museums of Ethiopian and Harai culture and markets. He knew his stuff and was very friendly and approachable. Wandering around with him meant we felt a lot more relaxed and could take photos without worrying we were offending people as he kept us straight on what was acceptable and not. One of the nicest things to see was a traditional Harar house, a lovely cool airy place, with seating on 5 levels depending on how important you are, beautifully decorated with pots and pans and vases.. It was really nice to finally see the touristy bit city we are working in.

 Harar old town gate

 Susan and I in a traditional house

 Tailor in machine street

 Black Kites at the meat market - ultimate thieves

 Table football

 Mosque

 Church

 Markets