My first day at work

Today was my first proper day at work. I got up early and caught the bus from Haramaya campus down to the health campus at Harar. The bus leaves between 0645 and 0730ish and takes around 40 minutes to reach Harar. We didn’t have time for breakfast before leaving and so Susan and I headed over the road to the coffee shop for chai and a very yummy donut-like thing for breakfast. Then at 9am we met the Dean of the medical school, Dr Tekame, who took us over to the hospital for a tour.

Haramaya uni has only recently opened a medical school, to help with the government expansion of health workers and so far only one class has graduated. The hospital only became affiliated to the university last year and so the training of staff which has now become a massive part of their life is new to everyone. The one paediatrician is, I think, called Dr Frikurta (I have been introduced to so many people and the names go in one ear and out the other). Her name apparently means love, and she does indeed seem lovely, and very glad to have an extra pair of hands which is a relief.

The paediatric department is a mass of contradictions, some bits seeming to be impressively organised while others lack basic necessities completely. The good bits are the structure for medical student training - they get two 12 week paediatric attachments in their clinical years which is almost 5 times the amount of clinical paeds I got to do as an undergraduate, and the weeks in principal are very structured. Each day begins with two hours of lectures from 0815 to 1030. Then teaching rounds and bedside teaching where cases are presented and discussed. Each student has their own patient who they clerk, and manage under supervision. Every Wednesday the students present a topic they have researched, last week it was vaccinations, this week it will be diarrhoeal disease. If (and in Africa it’s a big IF) this goes to plan I think we should churn out some very well trained students.

Other good parts are the paediatric labs, which are separate from the main labs, and appear clean, uncluttered and well organised with well labelled draws, plenty of sharps bins etc. The lab staff take as well as processing all the samples (which I think is a brilliant idea- can you imagine if that happened in the UK? No more repeating “insufficient samples” that you know fine well were not insufficient). Also there is a maternal child health unit run by a lovely midwife who seems stunningly competent at first impression, who co-ordinates antenatal care, HAART therapy for HIV + women, the prevention of mother to child transmission programme, does all the vaccinations and whacks in implanon, and coils as well!

But there are also bad bits, and they hit you between the eyes as you walk in. Harar as a whole is short of water, and the hospital is no exception. It’s dark and grimy. There are very few sinks, and half of the ones that are there don’t work. There is no hand gel and hand washing seems to be none existent. There is one squat loo for the whole ward, and no bathrooms or places to have a wash. Needless to say it stinks and there are flies everywhere. I asked Dr Frikurta, how many beds they have and she shrugged her shoulders “it doesn’t matter – if the beds are full we put them on a mattress in the corridor, or on the floor between beds”. This is the only paediatric ward for miles and miles and there is no where else for them to go. The ward is not that busy today –paeds in Ethiopia is just as seasonal as in the UK it seems. They have 2 nutrition rooms – one for babies, one for older children. Malnutrition seems to be a huge part of the workload. There is a critical care unit, which today was the most crowded of all, with around 10 beds and 4 cots in a room that’s about 5m square. In the centre of the room is the single oxygen tank which they share between those who need supplemental oxygen. There is a tetanus room (thankfully empty today)– a small dark 3 bedded room for treating those with tetanus. The size and darkness is to try and keep it quiet, as the slightest noise can provoke painful spasms in tetanus. I confessed to my guide, a young GP who is going to Addis to study radiology soon, that I had never seen a case and he assured me that I will be well versed in the diagnosis and management soon. The neonatal unit is warm and clean but with no incubators (there is one donated by UNICEF in another room but it doesn’t work).  They look after preterm babies, those with neonatal asphyxia and infection, and those that have been abandoned, which is apparently common place.

After a hour or two of orientation I was sent away to return tomorrow, at which point Dr Frikurta will give me a list of early morning lectures so that we can decide which ones I should give. Having been one of the things I was most concerned about – standing up and giving a lecture for a couple of hours now seems like safe ground in comparison to ward work!

I therefore got a line taxi (by myself for the first time which is another story) back to campus and have spent the afternoon reading up on malnutrition, practising my Afan Oromo, and  writing this.

Haramaya 23/09/11

We finally left the Red Cross compound for the last time yesterday morning to travel to Haramaya. Our last two days on ICT were really good. On Tuesday we had the last of our language lessons and a really interesting work shop on cultural norms in Ethiopia before heading into central Addis Ababa for the dreaded scavenger hunt. This involved being divided into teams of three and sent off with a list of tasks to get us using our Amharic and negotiating our way around the city with the safety net of someone knowing roughly where we were going and when we should be back. We started out getting a line taxi to the stadium district. Line taxis are the safest form of public transport and the one VSO recommends we use. They are essentially blue and white minibuses that crisscross the city on set routes. There is a boy who collects the fares, who hangs out the window yelling the destination at the top of his voice. When you hear the one you want, you flag it down and jump in along with everyone else. When you reach your destination you shout WERAJ and they let you out. They looked pretty scary but once you’ve done it its actually okay.

Once in the Stadium area we had to buy a newspaper and ½ a kilo of bananas (gamash kilo muz in Amharic!), get a shoe shine, meet some old volunteers in a cafe, find out how much to swim at the Ghion hotel, and make our way back to the VSO office. All of this was remarkably easy, and almost everyone we asked in broken Amharic replied in English. We were really impressed just how helpful and friendly all the locals were, and it was a really nice experience.

On our last night we had a cultural night at the Red Cross centre, with traditional music, dancing and a feast and we got to sample some local wine which is probably best described as unreliable. I had three glasses of red, each from a different bottle. The first was okay and very light. The second was actually pretty good and the third still seemed to be fermenting and was pretty, much undrinkable. It was great fun and a really good way to say goodbye and good luck.

So the morning found us up at 0540 to leave a 6 for an early flight. You have to make sure that you are in good time in Ethiopia (even though no one else is) as flights will often leave early! We flew to Dire Dawa in the east and immediately the difference is noticeable. It’s much drying and more barren looking and even though the rainy season has just ended most of the river beds are dry. It’s beautiful, much cleaner and more tropical than Addis and we had a really nice drive up to Haramaya Uni which is about an hour from the airport. Haramaya is up in the hills again at about 2000m above sea level so a little cooler than Dire Dawa. The campus is huge and really beautiful, with amazing birds and huge flamboyant trees with spectacular red flowers. There is an amazing outdoor pool! Our accommodation isn’t ready which wasn’t a huge surprise, so in the mean time we are being put up in the resource centre in fully catered luxury and I had my first proper hot shower since arriving in Ethiopia. Last night Pat, one of my fellow health volunteers cooked us an amazing ferengi meal and then today we met the University President who gave us his car to visit Harar campus which is a 35 minute drive away. The health campus is a bit of a building site by comparison and the “classrooms are small and crowded with nothing but a few desks. I managed to meet the head of the medical school who will take me over to the hospital on Monday and introduce me to everyone there. I will get a few days to orientate myself, get a feel for how things work and then we’ll meet to discuss exactly what my role will be..... should be interesting!

Orthodox church in the Entoto Mountains and Views back to Addis Ababa

Images of Addis

Addis scafolding!

VSO Addis office, cookery lessons and supply boxes

Images from Ethiopia Red Cross Centre

Meskrem 8 2004

In country training

I have now been in Ethiopia for a week and finally we have been allowed out of the Red Cross compound. On Saturday we went to the VSO office in Addis for the first time where we had a cooking class and learnt how to make the local shiroj which is chickpea powder which gets fried with oil, spices and onions to make a curry type thing. We also had a demonstration of how to use the supplies provided by VSO including water filter, kerosene stove and mosquito net. Then we went shopping in small groups with some existing volunteers, to the market to buy pots and pans, bed sheets and anything else we may need on arrival in placement, and to the posh ferengi supermarket for olive oil, baking powder etc all of which are apparently hard to come by outside of the capital. Ferengi is the Amharic word for foreigner. There are actually loads of us in Addis as there are so many NGO’s all trying to do their bit so you don’t get too much attention, but out with the city ferengi, ferengi is apparently a common cry from the local kids (often followed by money, money)

When not shopping we have been having intensive Amharic lessons – I can now order food,  get directions, tell the time, get a taxi,  talk about members of the family etc. We’ve also had some really interesting talks from a variety of people about the politics of Ethiopia and the state of the health care system and their plans for development which fill you with a mix of hope and trepidation due to the massive size of the task ahead. To give you some idea of the figures (2005data):

Population 82 million growing at 2.6% per annum = about 1.6 million extra people/year

Maternal mortality rate: 871 per 100000 live births = 25000 pregnancy and childbirth related maternal deaths/year

Under 5 mortality rate 101 /1000 ie 10% of children die before their 5^th Birthday

Infant mortality 77/1000 ie most children die in the first year of life

Life expectancy is 54 years. 46% of the population is 15 years old or less.

These figures are now 5 years out of date and the 2010 results, due for publication in the next few weeks are meant to show significant improvement. However in Ethiopia it only became a legal requirement to register a birth 4 years ago and it is still not a legal requirement to register deaths. Add to this the fact that 85% of the population remains rural, and I have no idea how accurate any of this can be.

Ethiopia operates a three tier health system. Small rural health posts staffed by health extension workers do health promotion and basic health work. They feed into a health centre. Each health centre supervises around 5 health posts. The health centres provide primary health care similar to a large UK GP practise, but without doctors. The health centres refer on to district general hospitals and tertiary speciality hospitals. In the last 5 years there has been a massive expansion of the health sector in order to try and reach the millennium development goals. 76 health posts have become 14000, 150 health centres have become 2200, and 87 hospitals have become 197. Unsurprisingly, this has resulted in a real shortage of trained staff and people are therefore being rushed through training. In Ethiopia you don’t chose what you want to do after school, the government looks at your grades and directs you to medicine, nursing, midwifery etc. Most of the midwives currently in training are male. The result is a huge number of people doing courses they are not really interested in, and although they work hard, their goal is to get a higher degree so they can apply for work at an NGO or leave the country. It’s sad but not hard to understand and I’m not sure what the future will hold.

First Impressions

First impressions of Ethiopia.

My first impression of Ethiopia is that it’s very green. I expected a dry dusty, brown country but from the air as you arrive Addis is lush and tropical. It is the end of the big rains and so this is as green as it gets. Although our experience today is that they aren’t quite over yet. We were out in the bus and the clouds came in, the heavens opened and within 20 minutes the roads had turned into torrential rivers.  However another 20 minutes later we were back at the Red Cross training centre and things are drying up again.  The temperature has not been hot, between 18 and 22 degrees I would think but the sun is fierce and 15 minutes in it is enough to pick up some colour.

Last night we went to a champagne reception at the British Embassy courtesy of the British Ambassador. The embassy is a beautiful colonial building in the centre of Addis with huge walls, three massive gates / barriers to get in. No cameras allowed so you will have to believe me when I tell you about the giant tortoises that roam the grounds (seriously) and the tropical gardens.  It was lovely if slightly surreal and I can’t help but feel a bit awkward given the surrounding poverty.  Certainly no signs of recession in the little bit of Britain, although there were no chocs, just yummy canapés.

Ethiopia is of course poor, and we still haven’t had much chance to get out and about on the streets. My impression from the bus windows is that its bad, but perhaps not quite as bad as Delhi. Everyone including the ambassador has told me that Haramaya Uni and Harar are some of the nicest bits of the country so I’m really excited about getting there and getting stuck in. We still have another full week of in country training before leaving to go to our placements – by which time I will be semi-fluent in Amharic (not). I have been told that my accommodation is so nice that I have broadband and sky TV (hardly roughing it) so I haven’t bought an internet dongle after all. This means probably no skypeing until after I get to Haramaya. There is wireless here with good speeds and I’ve even mastered enough IT skills to get myself connected to it but it is so intermittent that typing everything on word and copying and pasting is all you can do.

So while I wait for my next window I will tell you something about the food. Injera, the local traditional food is alright. It’s like giant pancakes in texture and comes in cardboard grey and  cardboard brown colours. It has a slightly sour taste which is balanced by the stews, some of which are totally delicious. They are kind of like Dahl, or meat stews. They also do great veg – mostly cabbage (probably the best cabbage ever), carrots, beans yum. Anyway internet up must post fast.... Jo x

I wrote this yesterday

Arrival in Addis. 1^st Meskrem 2004 Happy New Year.

So I arrived in Addis without too many problems. Most of us came in on the same flight and had started talking long before the plane left Heathrow. The flight was okay, although there wasn’t much time for sleep so I’ve been a  bit of a zombie all day.

We’re staying at the Red Cross Training Centre in Addis Ababa, which is a really nice compound in the South east of the city. Its been a very gentle introduction to Ethiopian Life so far, as everything has been organised in a most impressive way for Africa and we haven’t really had chance to mix with the locals other than a couple of the VSO Ethiopia staff. Just a had short introduction this afternoon to what to expect over the next 10 days of in country training, and a session on communications ie mobile phones and how to get them ( VSO staff will buy a SIM for us) internet dongles (again taken care of). There is a wireless service here is Addis but because it’s a holiday today (New Years day 2004 – brings back a few memories) it’s not working. So back to full working order tomorrow then....

On Wednesday we have an Ambassador’s reception at the British Embassy (cue lots of thoughts of fererro rocher!) although in reality I’m told its just plenty of nice wine – hard life this volunteering!

Hugs Jo x

T -2 1/2 hours

Well departure day is finally here and I have no idea where the last year has gone. So much planning and it just seems to have gone so quickly. I am fully packed but have there are serious doubts whether or not I'm within my 30 kg limit. Guess I'll find out soon. Had a sucessful trial skype with the folks this morning so it just remains to be seen if Ethiopia internet speeds will be good enough. So really there is just time for a last "good" cup of tea before heading to the airport..... I'll see you in Addis!!!

Ethiopian Time

Just found this on the 'know before you go' section of VSO's Ethiopia website. I had read it before but thought I would share it with you:

Time
One of the many things that makes Ethiopia so different is its unique way of counting time. The
Ethiopian day runs from 6am to 6pm (European time) and the night from 6pm to 6am. The
following times therefore apply:
7am European time= 1 o'clock Ethiopian day time
8am= 2 o'clock
Mid-day= 6 o'clock
1pm= 7 o'clock
2pm= 8 o'clock
6pm= 12 o'clock
7pm= 1 o'clock Ethiopian night time
8pm= 2 o'clock
12pm= 6 o'clock (midnight)
6am= 12 o'clock
It's not as difficult as it might sound, but it is important to make sure you and anyone you are
making dates with are both talking about the same time. Different areas of Ethiopia tend to use
Ethiopian and/or European time to a greater or lesser extent but it is always worth checking.
The Ethiopian calendar is equally different as it runs to the Julian calendar. There are twelve lunar
months (each of 30 days) in the year, and also a short one of five/six days at the end. The months
do not coincide in any way with the European/Gregorian calendar e.g. 11th September 2009 is 1st
‘’Meskerem” (September/October) 2002
Ethiopia is three hours ahead of Greenwich Mean Time and two hours ahead of British Summer
Time.

Right then!