Calum and I in India last year
Sunday, 29 January 2012
Friday, 27 January 2012
The power of white
One of the things that I can't get used to here is how grateful the patients are and what huge expectations they have of me as a ferengi. Not all of them, but the majority. They are very keen for me to see their children, to offer a solution some how. I have been told on several occasions "thank you for coming", "thank you for bringing your medicine". In actual fact I'm not sure that I have brought much at all.
The thing is I still feel like a bit of a fraud here. I am learning huge amounts about the multiple pathologies the children have, and I'm beginning to get my head around the intricacies of managing conditions that I've really only read about such as malnutrition and tuberculosis. However the bulk of the day to day work is still done by the GP's, and more often that not they are advising me how to manage the baby with neonatal tetanus, or the child with massive hepatosplenomagly and ascites secondary to TB. When I think I don't know what to do I have to stop and think - what would I do with this at home - and often the answer is a battery of tests or a specialist consultation. For example, the baby with the encephalocele, well they need an MRI scan of their head and then a neurosurgical consultation, neither of which are available here. They are available in Addis but thats a 500km, 12 hour public bus journey away and there are no ambulances. Still with no viable alternative thats what we had to do. Sometimes I feel a little bit like a wizard without my wand. I know what would make so much of what is here better, but without the ways to make it happen I'm virtually useless.
Despite this the parents still think I have the answers, and they like me to see their children. Whether it is the white coat or the white skin or probably the powerful combination of the two together they seem to believe I will make a difference. So I do what I can. Right at the beginning of medical school I remember some one showing me an axiom of medicine: to cure sometimes, to alleviate often, to comfort always. So if nothing else I try to offer the latter, by explaining what's happening -albeit through an interpreter - and often that seems to be enough.
There are so many basic, basic things here that I would like to be able to change here, but encouraging the medical and nursing staff to communicate better with the patients is probably top of the list and it should be do-able. I can't plumb the water into the ward, but I can lead by example with communication and I think its beginning to rub off -slowly!
The thing is I still feel like a bit of a fraud here. I am learning huge amounts about the multiple pathologies the children have, and I'm beginning to get my head around the intricacies of managing conditions that I've really only read about such as malnutrition and tuberculosis. However the bulk of the day to day work is still done by the GP's, and more often that not they are advising me how to manage the baby with neonatal tetanus, or the child with massive hepatosplenomagly and ascites secondary to TB. When I think I don't know what to do I have to stop and think - what would I do with this at home - and often the answer is a battery of tests or a specialist consultation. For example, the baby with the encephalocele, well they need an MRI scan of their head and then a neurosurgical consultation, neither of which are available here. They are available in Addis but thats a 500km, 12 hour public bus journey away and there are no ambulances. Still with no viable alternative thats what we had to do. Sometimes I feel a little bit like a wizard without my wand. I know what would make so much of what is here better, but without the ways to make it happen I'm virtually useless.
Despite this the parents still think I have the answers, and they like me to see their children. Whether it is the white coat or the white skin or probably the powerful combination of the two together they seem to believe I will make a difference. So I do what I can. Right at the beginning of medical school I remember some one showing me an axiom of medicine: to cure sometimes, to alleviate often, to comfort always. So if nothing else I try to offer the latter, by explaining what's happening -albeit through an interpreter - and often that seems to be enough.
There are so many basic, basic things here that I would like to be able to change here, but encouraging the medical and nursing staff to communicate better with the patients is probably top of the list and it should be do-able. I can't plumb the water into the ward, but I can lead by example with communication and I think its beginning to rub off -slowly!
Friday, 20 January 2012
The hyena Man of Harar
On Sunday, we decided to join the tourist throngs in Harar again. We had a VSO volunteer from Arba Minch (South Ethiopia) visiting and Calum hasn’t done the touristy stuff yet, plus Susan and I have yet to see the famous Hyena man so it was the perfect excuse if one was needed.
Hyenas are common here. We see them all the time around the university campus, in the early mornings and at dusk. They generally don’t cause too much trouble except that the dogs tend to chase them in the middle of the night and cause a racket with all their barking.
There were reports recently of the hyena attacking people in the local village of Bati. According to locals, a hyena had fallen into a pit that had been dug for building works and couldn’t get out. Rather than risk trying to rescue an angry hyena they decided to bury it alive. The subsequent attacks were revenge from the hyenas mates! More likely I think, is that the amount of building works being done here are disturbing their habitat and changing their behaviour. Whatever the explanation we were all being a bit more cautious of the hyenas than we were initially.
All except the hyena man that is. He has been feeding the hyenas every night on the outskirts of Harar for the last 50 years or so and invites any brave tourists along to watch the spectacle. So on Sunday night a group of us piled into some bajaj (little vehicles like India tuktuks) and headed out to see him do his stuff. It’s pretty spectacular. The hyenas are big up close, bigger than your average dog with enormous haunches and very large teeth. The hyena man has named them all, although the only one I can remember is Jambo – the name of the local beer! He feeds them bits of meat off a stick and then he invites you to feed them, even putting the stick in your mouth and letting them take the meat off the other end. We all had a little go and the photographic evidence follows.....
Thursday, 19 January 2012
Time passes quickly
Wrote this last weekend but haven't had reliable enough internet access to post it yet (again!)
So another week is over in Ethiopia. It’s amazing how quickly time can go here. Calum has been here for 4 weeks already. For me it hasn’t been the most eventful week ever, but I’ll fill you in on the highlights.
Last weekend was Ethiopian Christmas. As I’ve said several times Christmas here is not like the European version. It’s predominantly a religious festival, where people go to church and spend time with their families. Orthodox Christians fast for around 40 days prior to Christmas – that is to say they don’t eat any meat or dairy products. The fast is broken after they go to church. So on the final couple of days before Christmas several of our neighbours had live goats tied up on their balconies, bleating away. The bleating all stopped early on Christmas morning though, and apart from the odd hoof lying around there has been no sign of them since. We joined some of our Ethiopian friend for a big camp fire / BBQ on Christmas night (and of course the essential dancing) which was really good fun. I must be getting old though – I find partying 3 weeks in a row exhausting, let alone 3 nights in a row!
I spent the week at the University and hospital in Harar. I am still giving two lectures a week to the fourth year medical students covering all aspects of paediatrics, followed by 1 ½ hours bedside teaching in the hospital 4 days a week. On the morning that I’m not teaching I do a ward round with one of the GPs and they usually ask me to see patients they are worried about. I am still amazed at how advanced the pathology and clinical signs we see are, and often still baffled as to what the underlying diagnosis is. The thing is that very often we don’t have the facilities to make a diagnosis – it’s more of a best guess scenario or a worse case scenario as the case may be. For example everyone with a cough, fever and fast breathing gets diagnosed and treated for pneumonia. Many of them won’t have a bacterial infection, and would get better without antibiotics, but we can’t investigate or observe them closely enough to tell the difference, even if they are in hospital, so they all get antibiotics. It’s frustrating at times but it is the best option with the resources that are available.
Thursday, 5 January 2012
Internet alle!!! woop woop
Thats amharic for "there's internet!!". The last week we have had internet yellum (translation: no internet) boooooooo
So here is a multitude of blog posts, written over the last week, including the one below. You'll gather I was getting a little frustrated!
So here is a multitude of blog posts, written over the last week, including the one below. You'll gather I was getting a little frustrated!
Chewing the Chat
So here is the long promised post about chat. Brought about by lack of internet for the last 4 days meaning that I have played as much solitaire as I can stomach and have taken to writing a store of blog posts to pass the time.
The lack of internet highlights just how dependant I am on it. It’s not that I have nothing to do but rather I am limited by the lack of internet. I can’t check or send the emails necessary to organise the next stage of the neonatal resuscitation training Susan and I are trying to arrange. I can’t skype friends and family. I can’t research the trip to Northern Ethiopia we are planning in February. And of course I can’t actually post this blog entry either. So at least by the time you read it you will know that the internet is functioning again.
It is at times like this when I wish that I was back in a country where life was easy. Where having a wash didn’t require 30 minutes spent frantically filling buckets in the one hour a day that we have running water, followed by 15 minutes boiling a brand new but never the less leaky kettle, so that the water is warm, and 5 minutes mopping the floor afterwards as there is no shower curtain and the cubicle is tiny. Where you could go into the supermarket and buy a bar of chocolate or some fish and not have it cost the earth because it’s imported. Where internet connection is fast and efficient....
Anyway this is meant to be about Chat. When I first arrived I looked up Chat on Wikipedia and I will try and tell you what I remember, as I can’t check it (no internet in case you were wondering!!). Chat is Ethiopia’s second biggest export after coffee. It is a stimulant plant native to this area of Ethiopia, with similar effects to caffeine but slightly more addictive. People here LOVE it. Almost everyone chews, although some more than others. You can tell they’re chewing by the green froth around their mouths and a slightly manic glint in their eye. In the afternoons, especially on a Friday, very little work is done as everything stops for chat.
Aweday is the town between Haramaya main campus and Harar. Pat calls it chat city, with very good reason. Apparently it is one of the richest towns in Ethiopia because it is the centre for Chat production. It’s a fascinating but slightly scary place and I have only been through on a bus. Not somewhere to go for a walk around. There are whole rows of shop fronts that seem to be given over to chat. They are mostly entirely empty except for a carpet of disused chat leaves (apparently the big ones are not tender enough to chew!) and a few chat-heads (not an official term) lying round chewing.
Chat really is a lucrative crop though, even if the money is not evident on the streets of Aweday. Most of the families we see in hospital make their money from farming, and many of them farm chat. As part of their history taking, the medical students generally ask about household income, which always seems a little inappropriate to my very British sense of privacy, even if I can see the relevance to little Ashu’s nutritional status. However it provides fascinating information for the nosey part of me. Apparently, farming cereals such as sorghum, maize and tef, gives an annual income of around 4000 Birr, or £150 for those who work in sterling. Add chat into the mix and that doubles to 8000 Birr /year. Not really surprising then that many of them farm chat. The problem with this is it’s a very thirsty plant that tends to steal water from other plants. If you look at google maps to see where Haremaya is, there is a large lake called Lake Alemaya nearby. In reality this is more of a giant puddle, no more than 6 inches deep across its entire surface area, and this is down to water being taken for chat farming. In a country with drought and famine in living memory (if not currently if you count the Somali border areas) it’s a bit of a worry to say the least.
So that is the low down on Chat, or as much as I can remember of it at least. Will I chew while I’m here, maybe, and if what they say is true that should result in several more particularly long blog posts!
New Year New Pad, the photos....
My room
Susan's room
5/1/2012, Part 1 New Year New Pad
02/01/2012
We received the keys for our new house on boxing day, almost exactly 3 months after our arrival in Haramaya. It’s a lovely spacious apartment on the top floor of a block of staff accommodation. We have two small bedrooms downstairs, one of which is mine and a big open plan mezzanine level above the sitting area which Susan is using as her room. We have double height windows beside the sitting area so the whole place is flooded with light and in the late afternoon when the sun comes in through these windows it heats up like a greenhouse. At the moment the weather is still cool enough that we’re glad of this, but we may change our mind come June! The whole place was painted sunshine yellow before we moved in and so it feels really cosy. The electricity seems pretty reliable and we have internet connection – although that is decidedly less reliable. Water comes on 1-3 times a day for about an hour each time, so in between times we store water in buckets. Unfortunately there are no hot showers, but a couple of kettles full of hot water in a bucket allows for a pretty decent bucket bath when you need one. It’s amazing how little water you actually need to keen clean!
We had a flat warming / New Years party on Saturday night. For all Ethiopians it is still 2004, and their New Year is celebrated in September, so like Christmas it’s a bit of a none event here. Still we made more mulled wine, and every brought some food, and we had music and of course dancing until about 2AM. It was great fun. Again I have been amazed at the generosity and thoughtfulness of our Ethiopian friends. Gift giving doesn’t really come into the celebrations here, but they know it’s part of our culture and so many of them brought us gifts, even though we had nothing for them or each other. Consequently I am the proud owner of a CD full of Christmas tunes, a lovely new bangle and a beautiful brightly coloured scarf. So kind and thoughtful.
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