Background

Having spent since October 1971 in the NHS it is time to move on and with the pension due, new pastures, or possibly waste lands beckon.  Having researched quite hard we have decided that Ethiopia sounds very exciting so we are off to explore the possibility of working in a hospital in Gimbie West Wollega Ethiopia for a year, both looking at the delivery of health care and also possibly doing some good.

  Maternity care is limited with a catchment area of 120 square miles and little transport in a country with a limited infrastructure.  So, the first problem is, if you get into trouble having your baby how do you get help, assuming it recognised you are in trouble.  Once you get to help, how long does it take to get it, and probably most important does it help.  This is referred to in the literature as the 3 stage model but it begs a lot of questions.  We are told that the population of Africa is steadily increasing, yet the maternal death rate is very high (extra-ordinarily so compared to the western world), suggesting that there are a lot of orphans about.

 If you want to get into trouble having a baby in the west have 4, your 4th is likely to be associated with some bleeding but in the west we are both quite good at stopping it, and if it does go on a bit giving you some replacement blood-both the skill and means of stopping bleeding are in short supply in the developing world (the politically correct expression). If you do bleed you will have to rely on your hopefully disease free relatives to give you some blood. Hopefully you will not get anything nastier than maleria, which though fatal untreated does have the chance of being cured-which is more than some of the diseases on offer.  A big issue in Africa is Caesarean section (the 25% rate in this country) may be very unhelpful in Africa when an operation for one pregnancy may lead to a disastrous rupture of the uterus in the next because a second operation is not available in your village or kebele.

 The other big problem is your babies head pushing hard on the skin between the bladder and the pubic bone leading to death of the tissue there and breakdown so that you are no longer continent-difficult with minimal sanitation.

 These are just some of the problems and we will explore more as this blog develops.  We will also look at our own trials as the trip develops.  We are very keen to have wheels and a big discussion is whether to drive out (big adventure) involving crossing dodgy regions with kalashnikov carrying locals and strife or whether we should buy some well used wheels there and be left with a lot of birr (local currency) at the end of our trip.  Our other problems we will look at in more detail and will fill you in when we return from a preliminary trip in February, not least what the accomodation is like and what are the problems working in an environment with scarce resourse.  The actual organisation we are travelling with are called Maternity World wide and you can check them out on the Web.  They too seem to be in a state of change.

 One of the things we are keen to do is to look at the effects of interventions and make sure that they are useful to the population. there is bound to be a tension between this and working at the coal face.
Regular updates can be expected, so stay tuned.