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...

A tough day

Well another week has passed and time continues to accelerate here. Monday was a tough day in the neonatal unit, even by Ethiopia standards. Three babies died, and I am fairly certain that at home they would all have survived. The reasons for this high death toll are multiple. There is the obvious lack of intensive care facilities and skilled staff, but there are also major issues with the infrastructure and systems that underlie how things are done. The first baby was admitted on Sunday night, but had really difficult venous access and no one was able to site an intravenous line.  He was therefore given an intramuscular antibiotic injection and left overnight without feeding or fluids so that by the next day he was dehydrated, with low blood sugar, and very sick. I was able to site an umbilical line the next day but it was really far too late. There is no system or protocol for the staff to get help in these situations. IV access is almost exclusively done by the nursing staff here, and in general it is only the paediatric specialists who can do umbilical lines, and there is no paediatric specialist on call. It’s not clear who was called for help and whether the on call doctor was even consulted, and it never will become clear because there is no procedure to be followed following the death of a patient to review the cause of death, and see if there are any lessons to be learned.

Equally one of the other babies really needed a blood transfusion, but there was no blood.  Blood transfusion is a risky business here at the best of times as the blood is often not matched to type, let alone cross-matched for antibodies that may cause an adverse reaction. One unit is shared between many patients, and it is kept far longer than it ever would be at home. Amazingly I haven’t yet seen any bad reactions to blood transfusion, which surprises me given the high level of care and documentation taken over the decision to transfuse blood at home. Sometimes we try and persuade family members to give blood that can be given to their relative, but that costs them money for the equipment, and in this case would very likely have taken too long and probably been futile.

I find this really frustrating. Things are the way they are for a whole multitude of very complex, interlocking reasons and that makes it very hard to know where to start. I am always conscious that I don’t have all the answers, just a different way of doing things that may or may not be better than what is in place in the context of what’s available.

Happy Holidays 3 Lovely lalibela

After our amazing few days in the Simiens, we returned to Gonder, happy but tired, and very, very dirty. Possibly the dirtiest I have ever been, in fact. Our clothes were actually black (even the underwear!)  because of the fine dust blowing around the mountains which gets into everything. We stayed in the Goha hotel for a few days relaxation and luxury, but unfortunately the Ethiopian food had finally caught up with Calum ( I’m amazed it didn’t get him sooner actually) so he got well acquainted with the toilet, while I sipped Gin and Tonics on the terrace!

In Gonder, I visited the royal enclosure and Fasilada’s baths. Gonder was previously the capital of Ethiopia and a the rulers lived here in the 17^th and 18^th century. The royal enclosure has been preserved by UNESCO and is in remarkably good condition.

From Gonder we flew to Lalibela, which is only a couple of hundred kilometre east, but very difficult to get to by road. Lalibela is the spiritual home of Ethiopian Orthodox Chrisitians. It was built by King Lalibela in the 12^th century. The story goes that Lalibela was poisoned by his sister and in a coma for 3 days. While in a coma he was spoken to by god, who ordered him to build a second Jerusalem in Ethiopia, and so construction of the rock hewn churches commenced. There are 11 in total, all carved out of the rock and surrounded by a myriad of passage ways and tunnels that allow easy access from one church to the next.

At the time we visited, the orthodox Christians were fasting prior to Easter. This means eating only vegan food and for the strictest not eating anything before 3pm in the afternoon. The churches were full of people praying, and it was touching to see the depth of their faith. The whole atmosphere here is really hard to describe unless you’ve experienced it, but for me there was a deep sense of spirituality in the people which I found fascinating.

Another highlight of our trip to Lalibela was a visit to Ben Abeba restaurant. This restaurant is newly opened, and is housed in a unique building on the hill with spectacular views. It is run by an Ethiopian man and a Scottish woman who initially came to Ethiopia as a volunteer. The food is lovely, the views spectacular, the prices very reasonable and the welcome exceptionally friendly. Oh and they are so proud of the cleanliness of their kitchen that they give tours (definitely a first in this country).

So that concludes our amazing trip up North. Unfortunately we didn’t have time for Aksum, the oldest Ethiopian capital, and supposedly home of the Ark of the Covenant, but this just means the chance for a return visit. I was impressed by the friendliness and the diversity of the country and although Ethiopia has a way to go to reach standards of tourism expected in the West, or even India and SE Asia I would definitely recommend it to anyone with a sense of adventure....

 Royal Enclosure Gonder

 Ben Abeba restaurant Lalibela

 Rock hewn churches

 Faith

 Priest

St georges