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