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

Haramaya campus shots

 Vultures!

 Campus buildings

 A walk around campus

End of ICT

Ethiopian coffee ceremony

VSO Ethiopia Map

Me and fellow vols

Ruth from the program office in traditional dress