Professional Accountability

I saw a patient with the medical students last week who was 4 months old and only weighed 2.9kg, which is the smallish end of normal even for a newborn infant. The baby was the 10th child and unusually all of her siblings were alive and well. Her mother had breast fed all the other 9 children but for some reason on this occasion she didn't produce any milk. Not producing milk is pretty unusual, but this is also a very experienced mother who has managed to keep 9 other children alive and relatively healthy in Ethiopia, which is no mean feat, so I'm inclined to believe that she knows what she is talking about. As an alternative, she had fed the baby 1/3rd cows milk, 2/3 water boiled together and cooled, 3 times a day since birth. Not surprisingly, the baby had failed to gain any weight and was subsequently admitted to our ward with severe acute malnutrition.

This story is not that unusual here, but the thing that is frustrating is that this mother had taken her child to a private health clinic 4 times since it was born and they had clearly failed to act or give appropriate advice to this woman, with the result that her child has ended up with a life threatening condition. Unfortunately there is very little that can be done about it. There is no professional accountability here at the best of times. The doctors leave for a 2 hour lunch break often regardless of the state of the ward, and although someone is nominally on duty to be called in a emergency they will be at home which could be 30 minutes away.

If a child dies here, no body asks "why did that happen? Could something have been done to prevent this? What can we learn or do better next time?" It is just accepted as part of life.

I always used to get a little irked by endless clinical governance issues at home, but seeing a world without really brings out the importance of working in a enivronment where as a professional you must be accountable for your actions, and have a responsibility to remain up to date with the evidence for the best treatment for your patients.

Safe to say that any clinic or health professional who had not picked up the baby above sooner in the UK would have their practice scrutinised and measures put in place to ensure it didn't happen again, but here we will probably never know the true story and many more child will suffer malnutrition.

More baby hat action!

 This is the little girl from the last picture I posted. All snuggly and warm with her hat. Sadly her brother didn't survive. She's doing well but not out of the woods yet by a long way.

This little one was born the day after my second instalment of hats arrived. About 9 weeks early and born in the street! She was very cold on arrival so we decided to put her in the newly functioning incubator (as you can just about tell from the photo). It worked quite nicely and she didn't get cooked either!

Easter at Amaha's

 Some snaps from Ethiopian Easter at Amaha's house. The first one shows Jenny, Susan and Gary with Amaha standing in the background. This is a traditional but really quite nice Ethiopian House. And yes thats a Christmas tree which seems to stay up all year!

 Amaha's wife in traditional dress makes coffee Ethiopia style.

Susan, Amaha's son, Jenny, Amaha's wife, me and Amaha.

Melkam Fasika

This weekend Ethiopia celebrated Easter. It is the end of 55 days of fasting (ie vegan diet), and is the biggest annual holiday in the country. People spend it with their families, and eat a lot a meat (much of it raw) to celebrate. We were fortunate enough to be invited to one of the local teacher’s homes in Bati, the village at the university gates. We had a lovely meal, although it wasn’t the traditional Doro Wat and injera that we were expecting but an amazing spread of “ferengi food” prepared especially us.  I was only slightly put off by having previously met the goat they had slaughtered that morning. We also had some not quite so lovely Tela which is a local alcoholic drink brewed from Barley and that tastes like muddy ditch water –yuck!

The rains continue here. Intermittently, but still there never the less. On the whole it is very welcome, as everything is beginning to look green and lush again and it’s a good bit less dusty which is a relief. On Saturday, Susan and I went for a walk down to the eucalyptus woods at the bottom of campus. It had been raining earlier in the day and the smell from the trees was just amazing. I couldn’t decide if I was back in Australia or perhaps in a herbal essences shampoo ad!

I took ownership of the next consignment of baby hats today – this time courtesy of my cousin Sophie and the lovely ladies of Briston and Melton Constable WI. Thank you! They are really appreciated. I’ll take them in tomorrow and get a few more photos of them in use!

Work wise, things are slowly improving. We have managed to get our one non-functioning incubator working, which is great news, but the problem is none of the staff know how to use it. It’s not that high tech, but it requires close observation, and that is not part of the psyche here. Even the most critical patients are doing well if they get more than one set of vital signs recorded in a 24 hour period unless I’m there nagging. I can’t be there 24 hours a day though and I’m a little bit worried that if I put a baby in the incubator it might get cooked. Not literally, but it might overheat and I can’t be sure that any one will check its temperature or turn the incubator down, even if I leave explicit instructions.  I guess there is only one way to find out though..... hhhmmm might get that incubator out tomorrow.

Baronesses, Big thunder, Bowel trouble and Baby Hats

Back in Harar this week and trying to get back into the swing of things at work. My last week with Calum here was spoiled by a nasty bout of gastroenteritis, which pretty much stopped me from seeing anything of Hawassa, in southern Ethiopia, other than my immediate surroundings. The immediate surrounding were however lovely, and were quite nice enough to keep us occupied for a few days. We treated ourselves to a stay at the Lewi resort which is a lovely but expensive hotel on the shores of the lake. It has free boat rides, mini golf, table tennis, badminton and a lovely pool for its guests to take advantage of. There are beautiful gardens and trees full of very cheeky monkeys who spend most of their time spying on other people’s lunches from their aerial vantage points, and then mounting co ordinated raids on the unsuspecting diners below stealing what they can. Very amusing to watch – and we managed to keep all our food, only sharing a left over saucer of tomato sauce, which one young monkey came right onto our table and stuck his face into, ending up looking much like a toddler who had just fed himself a bowl of spaghetti hoops! Very comical.

Since being back in Harar, we have been visited by Baroness Blackstone, who has come with VSO on a two week parliamentarian scheme to see development work in action. She is also chair of the board at Great Ormond Street, and was very interested to see the paediatric ward at Hiwot Fana.

Every night we are having big displays of thunder and spectacular lightening forking across the sky and the small rains continue, although interestingly we seem to get the lightening most, often the thunder, and uncommonly the rain. The total opposite of Scotland where you get loads of rubbishy drizzle and occasionally a clap of thunder,  but rarely a good full on thunder and lightening display. I really like a good storm, it’s quite exciting and we get an amazing view from the full length windows in the living room. Being on the top floor of a 4 story apartment block has some perks!

Finally I have received my first instalment of baby hats from Calum’s Mum- thank you! They are beautiful. I was able to put 3 of them to use as soon as I got to work as we had a set of twins born 10 weeks early and weighing about 2.2lbs each who were so cold the thermometer could read their temperature (pics to follow) and a bigger full term baby, who’s temperature came up from 34.1 to 35.6 with an hour skin to skin and a hat on. She was still a bit cool but I’m confident that as long as she stays with her Mum things will continue in the right direction. The hats are massively appreciated -all of the mothers want one for their baby but at the moment I’m rationing to those that are cold or very small until we get a few more – so thank you, and do keep them coming!

An interesting few days

This week I have been in Addis Ababa, at the Ethiopian paediatric society meeting. It was really interesting, not particularly because of the content of the meeting (although the content was good), but because of the opportunity to network a little with other paediatricians in Ethiopia. The Ethiopian Paediatric society are doing really good work, developing national management guidelines, encouraging continuing professional development and accountability, and providing training for staff to help improve conditions in the country’s paediatric wards. They also made us as VSO paediatricians very welcome, and invited us out for dinner on both evenings, which  gave us really good opportunities to discuss some of the things we are trying to achieve in our placements, and work out just how we fit into the multitude of NGOs working in Ethiopia. I met representatives from the Ministry of Health, the world health organisation and other NGOs such as ICAP. We also managed to get ourselves invited to a meeting about improving neonatal health which is one of the main goals of many of the paediatric placements here. It’s is a bit frustrating that we hadn’t been invited before this, especially since it is a major reason for our being here, but we did get there eventually. Two of the doctors I work with in Hiwot Fana Hospital were also there, although I didn’t know they were coming. They were really enthusiastic about making some changes in our neonatal unit and I hope that we will now be able to work together as a team to improve things.

The other change in the last few days is that the small rains have come with a vengeance. The Ethiopian climate has two wet seasons: The small rains in Feb & March and the big rains in July, August and September. The rains are late, but very refreshing. Now instead of 25 – 30 ^oC and sunshine, we have cooler weather, a build up of cloud through the morning and early afternoon and then torrential rain and spectacular thunder and lightening in the late afternoon and evening. It’s the first rain Calum has seen since arriving in mid December! The arrival of the rains means we are likely to be in with a busy month or so at work and the incidence of malaria and water borne infections will rise significantly...