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