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.

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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