oops

Hhhmmm not sure what happened to the giant photos in the last post. calum will tell you I'm a luddite with a terrible relationship with my computer. I blame that then. Still you get the picture - kind of....

HappyHolidays 2 - The Mighty Simien Mountains

After leaving Bahir Dar we headed north by road to Gondar. The drive is spectacular, and it was a really great chance to see just how different the north of Ethiopia is to our base here in Harar. This is the region of the Amhara people ( in Harar we have a mix or Oromo, Haraghi, and Somalis) and they really are quite different. Lighter in skin tone, the women wear their hair short and often uncovered which would be unusual in eastern Ethiopia. They tend to wear the traditional white dresses with embroidered borders and  matching scarfs. The majority seem to make their living from farming, but it is not chat growing territory. Instead they grow cereals and vegetables, and you will often see people out ploughing the fields with an old plough and oxen.

Gondar serves as the start point for most tours to the Simien Mountains although they are in fact a 3 hour drive north along a dirt road. The Chinese are currently putting in an asphalt road to make access easier. (The Chinese involvement in Africa is a blog topic all on its own...)

We had arranged our tour through a guy called Nega, who many other volunteers had recommended. To visit the mountains you need a chef, guide, scout/guard, mule men and camp hands and he co-ordinated all of this for us.

We trekked for 4 days and spent 3 nights camping in the national park which is listed as a UNESCO world heritage site due to being an area of outstanding natural beauty. It is also home to several endemic species including the Gelada baboons, Walia ibex and Ethiopian wolf. The trekking is absolutely spectacular and for the most part not too hard going, although it is mostly at an altitude of 3000-4000m above sea level. We noticed the altitude despite having been acclimatised to 2000m for the last 6 months so I can imagine that it might be really tough if you had just come from Europe. You also really need a head for heights to do this. Much of the first two days we followed a cliff top path along the escarpment and at times were less than a meter from up to 1000m vertical drops. Spectacular but also pretty scary especially when the altitude is already making you feel a little dizzy!

The camping here is pretty easy going. Each day our tent was packed up for us, packed onto mules and carried the shortest route to the next camp, where it was unpacked and set up again in time for our arrival. Three delicious meals a day were provided – with lovely things such as porridge, scrambled eggs or pancakes for breakfast, and a three course evening meal. We even had a bottle of wine on the last night. We had mattresses to sleep on and two sleeping bags each because once the sun went down it was really,really cold!

We saw loads of baboons which are amazing to watch and really not afraid of people at all. We also saw several Walia Ibex, which are apparently a relative of the goat family, but the males have the most enormous horns which look really spectacular. Photos to follow.....

A Good Week

Life in Harar has been pretty good since we got back from our holidays. I feel like I’ve had a really productive week which is great, as so often it takes forever to get anything done here and it can be really frustrating. So what have I achieved....? Pretty simple stuff really but it still feels good. The internet has been reliable enough to get in email contact with all the other volunteers and start planning a set of guidelines that can be used in neonatal units across the country, my neonatal admissions book, which is a record of all the admissions to the neonatal unit, their diagnoses and outcomes was received with great enthusiasm by my colleagues, and we had a visit from the director of VSO Ireland and a gaelic football player called Pat Spillane, who are about to do a VSO recruitment drive in Ireland and wanted to come and meet some volunteers and hear about their experiences. They seemed genuinely interested and impressed with what we are trying to do and it’s always so lovely to get a nice bit of positive feedback.

One of the things I’ve been mulling over a bit recently is what I can do to try and keep the babies warm. It seems ridiculous that this should be a problem in tropical Africa, where the average daily temperature is somewhere in the high 20’s, but it is. The problem is that all babies, and particularly those that are born prematurely or with low birth weight have real difficulty in maintaining their body temperature. The mechanisms which keep them warm are immature and they have less fat stores to burn to produce heat so they become hypothermic very easily. There is lots of evidence that in most cases getting cold is detrimental to both immediate chances of survival and long term developmental outcomes, so hypothermia is a real problem. The thing that frustrates me about it that the solutions are not particularly high tech. Yes a lovely heated humidified incubator would be great but these things often break or require maintenance and the support services are simply not in place to make that kind of equipment sustainable. We do actually have an incubator but as soon as you turn it on it just alarms and says it requires a qualified technician to service it, so it doesn’t get used much. The simple things we need to do are keep the babies dry, keep them skin to skin with their mother, and keep a hat on their head but this is easier said than done. There are no nappies of of any variety here, and babies are wrapped in whatever light cotton shawl the mother has spare when she arrives in hospital. They pass urine, the shawl gets wet, they get cold. The hospital doesn’t have nappies, or blankets or hats – we just use what the parents bring which is often not a lot. We have one radiant heater on the floor in the neonatal unit and we cram as many cots next to it as we can. So what is the solution? I have a few things in mind. I have been finding out about some simple incubators suitable for resource poor settings, that aren’t heated but protect infants from drafts. I am hoping that my neonatal unit admission book will help me prove what a common problem this is and we will be able persuade the powers that be to get some of these made locally. Secondly I will keep insisting infants are placed skin to skin as much as possible. Finally, I wondered if anyone reading this knows anyone who knits? And if so, whether they would like to produce some hats for my neonatal unit? We need as many as possible, in a variety of sizes with a circumference of between 28cm and about 38cm.... so can anyone help? If you think you might be able to, please comment on the post and I will email you. Oh and any suggestions for the nappy problem would be greatly received  Jo x

A few more Bahir dar Photos

 Sunset

Hippos

Bahir Dar Photos

 Hornbill at the ghion hotel

 Marabou storks

 Lake Tana

 Caromine Bee-eaters

Sunset silhouettes

Happy Holidays

The first instalment of our “Northern Circuit” was Bahir Dar, the so called Ethiopian Riviera. It’s approximately 500 km north of Addis, and we arrived on a Saturday afternoon after a very straight forward flight up from the capital. We had travelled to Addis the day before on the bus from Harar. The trip through the rift valley was no less spectacular than I remembered it although the novelty of 12 sweaty hours on a non air conditioned bus is now wearing off somewhat, and I think future Addis escapades will be done by plane. But that’s getting off track....

My first impression of Bahir Dar was the airport which is not exactly grand. It’s basically a shed, complete with corrugate iron roof. It does however have a proper conveyer belt to get your bags off – it comes in a hole in the wall of the shed and is approximately 2.5 meters long before it disappears out the of another hole. The area inside the circular belt is probably the size of your average dining table, and any bag placed on it would, I imagine, take about 20 seconds to make the full circuit. Needless to say I didn’t get to find out exactly how long it does take because when the little cart with our bags pulled up, they were just unloaded into the hands of their waiting owners and the little conveyer belt was bypassed completely.

Bahir Dar itself is a lovely town. It’s far more lush and tropical that Harar which has now become very dry and dusty. The tropical feel is thanks to the proximity of Lake Tana, the largest lake in Ethiopia and source of the famous Blue Nile River (it joins with the White Nile to make the Nile we’ve all heard of in case you were wondering). We stayed in the Ghion hotel which has a lovely spot on the lake shore, and amazing gardens full of birds. Now, I have never been much of a twitcher, but Ethiopian birds would convert the hardiest bird hater.  Pelicans, marabou storks, crowned cranes, touracos, paradise flycatchers, bee eaters, hornbills – the sheer size and variety, and the beautiful colours are amazing. The high light of our stay in Bahir Dar was an amazing evening boat trip with our guide Hailu, who knew where all the best bird watching spots are. It was magical to see them all at sunset, settling down for the night. And to top it all off we got a fantastic display from Lake Tana’s resident Hippos, when a mother and her calf had decided to emerge onto the bank unusually early to feed. It was a brilliant night.

While in Bahir Dar we also did the usual tourist attractions of the Island Monasteries, and the Blue Nile falls.  Although I’m glad we did these they were both a little disappointing when compared to our brilliant bird watching trip. We also caught up with a few other VSO volunteers who either live in BD or were passing through and ate some really amazing fish (well it might not have been that amazing but it was my first fish other than tinned tuna for 5 months).

So that was Bahir Dar. There are some photos (well quite a lot actually), but as Calum is still in Addis trying to sort out his visa and has the camera, I can’t load any up just yet... maybe with Happy Holidays 2 – the mighty Simien Mountains!

Ciao for now x

Hello Again

Hi folks,

Sorry for the absence of posting over the last few weeks. I had an unbelievably busy two weeks at work with medical student exams to write and give, and a resus training proposal to submit (project proposals and budgets have never been part of my job before), which coupled with rubbish internet access and then two weeks lovely, lovely holiday have meant a pause in the blogging. Hopefully I should be back to blogging regularly over the next few weeks, though, to fill you in on my holiday, and life and work in general here in Ethiopia.

I actually wrote the following entry before my holiday but owing to the lack on internet access never managed to post it.....

The pros and cons of a no appointment system

In Ethiopia very little is planned. You don’t get appointments for anything because for most people they can’t be reliably kept. There are a multitude of reasons for this, from things that happen at home to the buses that don’t have a timetable and just go when they’re full.

In some ways this is really frustrating. For instance, when Calum first arrived it took him nearly 4 weeks to be able to meet the president of the University and offer his services to the engineering department, because every time we went to see him, he had just left or was in a meeting or “in Addis”. He’ll be back later today, tomorrow, next week we were told. Can we have an appointment? It’s a possibility (everything is here!) but we don’t know when he’s free...

At other times though it’s a blessing.  Last week I went with Biftu, the dean of the college of health sciences, on a little fact finding mission for our planned newborn life support course. Our aim was to visit all 6 hospitals in Harar, as wel l as the Regional Health board to find out if they would be interested in further training for their staff in newborn life support, how many staff they need us to train and what facilities they have at present.

If at home you walked into a hospital unannounced and asked to see the medical director or head of nursing and expected a tour of the facilities then and there, you would get laughed out the door. And can you imagine knocking on the door of the vice president of the regional health board, and him not only being delighted to see you, but immediately summoning the person who has the information that you need. Well that is how it happened here. We were met with a very positive response in every hospital (except the army hospital who didn’t want any foreign nationals anywhere near their base thank you!) I am delighted although now just a teensy bit stressed about just how much we have taken on with this course. While I think it is desperately needed and will be so beneficial for the population here, it is going to be a huge amount of work and I hope we can manage to do it properly given how much we already have to keep us busy here.

Anyway, I’m off on holiday for two weeks as of tomorrow so I can not think about it until I get back. We will be spending time in Bahir dar, Gondar, the Simien Mountains and Lalibela. This means no blog entries for the next fortnight at least, but also lots and lots of blog fodder and photos when I get back.