Arba Minch Photos Part 2 - Nechisar park

Arba Minch Photos - part 1 Dorze Vilage

 The view

 Traditional Dorze House

 Spinning Cotton

 Making Enset bread

 Weaving

 Pottery Lesson

 Important Game of Marbles

Dorze Lodge

cream teas Croc and Catholic Priests

Cream teas, crocs and catholic priests

Calum has just left after his two week trip to Ethiopia, which is means two things; firstly I have lots of exciting holiday type stuff to write about and secondly I’m on the home leg with only 6-7 weeks left in Ethiopia.

We spent the first few days of Calum’s trip here in Haramaya, catching up with friends and enjoying life on campus. I was also able to take the equipment Calum had bought down to distribute to the hospital. I have had 3 Life boxes, which are oxygen saturation monitors designed for resource poor settings donated by Little Lives, an Edinburgh based children’s charity run by one of my colleagues at Sick Kids. They help the help to detect hypoxia earlier than clinical signs can and are especially useful for patients undergoing anaesthetic. Initially I wanted all three from the paediatric ward but after discussion with the medical director we decided to put one in the OR, one in “intensive care/ recovery” and one in paediatrics. I made them promise to reassess how much use they are getting and redistributed if they are not being used, although whether that will happen is anyone’s guess. Calum had also brought 24 child/neonatal ambu bags with masks courtesy of Dr Morrice (also back in Edinburgh) and which will go into the labour ward paediatric ward and also to some other hospital and health centers so that the staff should have no excuse not to put into practise all the brilliant resuscitation skills we’ve taught them. They are desperately needed – only the week before I found another apnoeic, bradycardic baby on the neonatal unit. I asked the nurse to get the ambu bag, but she couldn’t find the usual one so appeared with another old thing but said she didn’t think it worked. I decided to give it a go but when I squeezed the bag the baby almost got a mouthful of cockroaches instead of a lungful of air. Needless to say we abandoned that particular ambu bag pretty quick.

Our original plan had been to stay in Haramaya for a full week, but then we were invited to the British Embassy to a garden party to celebrate the jubilee. Since we had been planning to fly to Addis anyway on the Saturday we decided to bring the flights forward to Thursday and go to the party that afternoon. It wasn’t so much the patriotic need to flag wave the attracted me, more the pull of pimms, proper wine and pastries. However there was to be no cream tea for me as we were bumped off the flight at the last minute in favour (we think) of the US ambassador who’d been at Haramaya the day before to open a radio station. Gutted is not the word. Still we ended up with some extra time in Addis and filled it very nicely by swimming at the Sheraton in their lovely heated outdoor pool, and spending the night watching Ethio jazz at the Taitu hotel which was fab.

From Addis we flew to Arba Minch which is in the South of the country. It’s totally different to any other part of Ethiopia, set in the heart of the Rift Valley with two great lakes which almost meet, separated only by the “Bridge of God” a narrow, but mountainous piece of land which forms the Nechisar national park. On the other side of Arba Minch from the lakes there are mountains covered in lush vegetation including enset and banana plants and mango trees. Its very green and tropicl feeling in comparison to other parts of the country which generally are looking much more barren at this time of year.

In Arba Minch we stayed with Father Paddy at the Catholic Mission. It was recommended to us by other volunteers but I have to admit to being a little apprehensive about it as my previous impression of the Catholic church has been one of a slightly intimidating, stuffy, out-of-touch institution. Would they mind that Calum and are were not yet married? Absolutely not! Father Paddy and Father Dennis are so hospitable and great company. They (and the fridge full of beer) really make you feel at home, and I think between them they could definitely convert the masses. Apart from the great accommodation and food they also generously provided us with use of the mission’s 4X4 to visit Dorze Village up in the mountains and Nechisar park, where we saw the biggest crocs ever! (Photos to follow). They also took us to visit Arba Minch Prison where they do a lot of development work, improving the inmates accommodation, and health care services, and providing workshops and equipment to allow them to learn a new skill and keep occupied while in prison. They were visiting the prison that day with a group of Irish Musicians on a fund raising visit, and the plan was to put on a concert. After a couple of tunes though, it was felt the locals didn’t really get the Irish music and maybe some irish ceilidh dancing would help, except they only had 3 people and needed 4. Next thing I know I’m being dragged up to do my first ever Irish ceilidh dancing in a Ethiopian prision cheered on by 2000 inmates. Thankfully they totally “got” the dancing and were very enthusiastic in their applause! It was a brilliant experience.

Thats all for now. More photos later.

Thoughts turn to Home

Oops - its been a while. Another period of dodgy internet access I'm afraid. the joys on living in Africa!! Wrote this post last week......

Last week I travelled to Addis Ababa for the VSO leaver’s conference. This is a one day work shop held to inform anyone whose placement ends in the next 6 months about the procedures and paperwork necessary before you leave. There’s quite a lot to do but it all seems fairly straightforward and I still have at least two full months to get everything finished off.

The workshop also gives you a chance to reflect on the highs and lows of volunteering and what you have achieved in your placement. It was interesting to hear everybody’s stories, good and bad. It seems that although most people have had many challenges and frustrations along the way, no one has regretted making the decision to volunteer with VSO. For me it has been a brilliant year and I am so pleased to have had the opportunity to do it. It has been incredibly tough at times, especially at the start when I really missed Calum and had no permanent accommodation which made getting settled so difficult. However I know that if I hadn’t come to Ethiopia I would have always wondered what it would have been like and wished I’d been able to find out. I have also learnt a huge amount. Not just about paediatrics in Africa (which is  an entirely different job to paediatrics in the UK in every way imaginable) but also about things that have never been part of my job before, like writing project proposals, preparing and managing budgets, running training courses, and implementing changes and new protocols. I have had a huge amount of teaching experience and have discovered that I actually quite like it and maybe medical education is something I’d like to explore more when I get home. So on the whole a year well spent. There is still sooooo much to do here though, and I will never be able to change all the things I would like. The good news is that there may be someone following in my footsteps so hopefully a new volunteer will help keep up the momentum.

After the leaver’s conference Susan and I headed West of Addis to the town of Ambo. We had a brilliant night out on the town and then went to visit Wenchi crater with a whole gang of VSO vols. Wenchi crater is an extinct volcano with a fresh water lake, and it’s absolutely beautiful. We walked the 1 ½ hours down to the crater lake then took a boat to the island in the middle on which there is a monastery. Afterwards we rode horses back up to to summit where our minibus was. It was so lovely to get our in the country side and there was hardly any hassle so it was a really relaxing way to spend the day. Photos to follow......

Mission NLS complete

The last two weeks have absolutely rocketed past. We have been super busy with our NLS course, running another 3 rounds, and training 80 people in total. The courses seemed to get better and better and it was really lovely to have our local trainers on board, able to translate into Amharic. I’m sure it really improved the understanding of some of the participants who really didn’t speak much English.

I particularly enjoyed working with the local trainers because most of them were young women, and women still have a pretty subservient place within Ethiopian society. There are very few women in positions of power here and the traditional culture is for the wife to serve her husband. Consequently a lot of our female trainers were really apprehensive about the idea of standing up in front of colleagues to give presentations. However with a bit of encouragement and the reassurance that we wouldn’t have asked them to do it if we didn’t think they would do a really good job, they all did us proud and seemed to really relish the opportunity, to make things a bit better where they work. A lot of them seem to have gone back to their hospitals and health centres really motivated to improve things which makes me feel like we’ve achieved our aims.

We have already visited one of the hospitals at their request, and made plans to spend an afternoon there, making sure staff are confident to use the equipment they have that was not covered in the NLS course. The Helping Babies Breathe newborn life support posters which were donated by UNICEF Ethiopia and given out at the first course were proudly displayed in frames on the walls about the newborn resuscitation station just as they should be so some things are working!

The next step will be to ensure all the senior staff have been trained. This was requested by one of our local trainers, who said that she was delighted to have learnt about newborn resuscitation, but had come up against some resistance from senior colleagues at work who still think the best way to resuscitate a baby is to swing it upside down by its feet (seriously!). We’ll need to tread carefully with this one so as not to cause offence and are working with the University to devise a plan.

Finally I’d love to be able to persuade the regional health board that they should fund this training to be run every few months with local staff so that all the health care workers who regularly deliver babies update their skills every couple of years. This might be a long shot be we’ll see what we can do.....

NLS success

Every now and then I get a day when all the difficulties of volunteering seem worthwhile. This week I’ve had a whole week! It has been brilliant and it’s great to finally feel like you are doing something that might actually make a real long lasting difference.

When Susan and I first started working in the hospitals, one of the things we noticed is the complete lack of confidence most of the nurses and midwives have in resuscitating a baby who does not breathe at birth. This is a really critical part of a midwives job, but our direct observations were that it was done badly or not at all. Partly this is due to inadequate staffing, space and equipment but also it’s due to a lack of awareness and training. More than the basic resuscitation, we also found that the care of the newborn was often really poor.  The babies who are admitted to the neonatal unit are frequently hypothermic, and they may not have been fed for hours and hours.

We decided that this was something we had to try and improve, and so since Christmas we have been preparing a newborn life support course for the nurses and midwives working in Harar. We applied to VSO for a grant to fund the project, and spoke to the regional health bureau who asked us to train health centre staff as well as hospital staff, and agreed to ensure that the government institutions have the basic equipment necessary. Then we prepared the course material we wanted to teach, based on UK newborn life support guidelines but also adapted to the WHO/ Ethiopian Paediatric guidelines.   As well as basic newborn resuscitation we have includes sessions on ethics and document keeping ( as the quality of note keeping here is generally pretty appalling), and essential newborn care which covers how to support mothers in breast feeding and keeping babies warm amongst other things. Finally we persuaded UNICEF Ethiopia to donate the neonatal resuscitation training equipment in the form of 4 neonatalie complete kits!

The course is happening in 2 stages. The first stage started this week and we had participants from every hospital and health centre attending. We did two days training on the theory and practice of newborn resuscitation and then a final day discussing methods of learning and teaching, and asking our participants to think about how they would take what they have learnt back to their place of work, share it with their colleagues and put it into practice.

The course was really well received and all our feedback was extremely positive. On the 3^rd day we asked our participants in groups to prepare a micro-session explaining and demonstrating a particular aspect of newborn life support, and it was so lovely to see them demonstrating what they had learnt and explaining it to colleagues. The candidates who we thought were strongest we have asked to come back and help as instructors in phase 2, when we hope to train another 60 of their colleagues by running 3 more similar courses but without the third day.

The final part of the plan is to speak to the regional health bureau about setting up an annual professional development programme, where they run similar training regularly throughout the year so that all of the staff here get the chance to update their skills on a regular basis.  Even if the final part is not successful we will have around 80 better trained health care staff working in Ethiopia and if they put their new skills into practise that alone will be a year well spent!

 Progamme and all improtant "ground rules" agreed by participants

 Susan and the participants

 Hands on practice with "neonatalie"

 Susan leading a scenario

 Caroline leading a scenario

Participants helping each other

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.