Have pension will travel. Took the lump sum in June and now doing my locum till end of this month and my successer appointed-good luck looking after the women of Surrey- Shaheen as we hopefully set off for Gimbie on 6. October. Why hopefully, well although we have got the airline ticket we yet to have a work permit, a combination of bureaucratic obduracy and charity incompetence or probably more charitably ignorance. Despite having had a number of volunteers it is apparent that they have never had the correct paper work in place. work permit requests to the Ethiopian Charities agency start with the expression 'We humbly beseach........' do we now (!) and require a fistful of documents-certainly enough to tip you over the starter pack cheap deal in DHL. Your original degree, not anything useful or relevant like GMC registration needs to be found (trip down memory lane in the attic) and this needs to be notarised, then legalised by the Foreign and Commonwealth Office and finally stamped and signed by the Ethiopian Embassy before being sent to the Agency. Do you want me to notarise everything else that goes with it, such as supporting certificates health certificates, job offers etc.? No no not necessary until you send the stuff over, wait interminably for it to be picked up and then turned down as 'job offer not notarised. Snake-start again, so not there yet! other little money earner is length of work permit-should be s ix months but try and get more than three-so more trips to Addis I suspect-12 hour journey will be nothing as we will be able to buy food and more important wine so perhaps not a bad thing. Work permit is probably good thing as web site says work without work permit = gaol, not a pleasant prospect anywhere-specifically one suspects Ethiopia. Now this presents us with another snake-no work permit no permission to take a car into Ethiopia for personal use without paying mega bucks in tax, and car essential for escape from Gimbie and indeed to carry out projects etc. Alternative is to take it out on a 'Carnet', as a tourist but this has its own problems as entry may be denied as not coming in on a tourist visa-all great fun if you are not the one in the middle. With obstruction at every turn, I wonder if any 'volunteer' has ever had a work permit-certainly not in the charity we are going with. The 'truck' itself is another story of potential venality if not incompetence as it required buying a left hand drive land cruiser in Belgium with very little guarantees that it would arrive and delays, evasions and failed phone calls to the level that you seriously wondered if it would...avoid internet dealers offering purchase of left hand drive cars. When it arrived the tyres were shot the car unloved, suggesting a long time in a dealership and the paper work missing. one understands that cars from Belgium have to have the Belgian equivalent of an MOT-this one did not. However some conversions later it is probably ready to go though I have not seen it for 6 weeks and when I phone to ask most things are about to be done, so we will see. with all the extras it is now of course outrageously expensive so tax on admission to Ethiopia would pay for lots of mothers and babies to have care. this is of course the main reason for going though on the basis of what is happening would seem to be what they are trying to prevent. maybe, politics being all they are the wrong babies in the wrong place.
While we were out visiting we copied a year of the delivery book and have, with the help of the redoubtable Hazel been analysing this, a snap shot of the world of hospital obstetrics in West Wollega. there are 1,500 deliveries a year of which 40 odd percent are paid for by the charity and probably represent the tip of the iceberg of the deliveries in the region. Appropriately the majority are primips as most primips even in the developed world, with their untried pelvis, are probably best delivered in a institution that may but I hope that this is not a reflection on the care they get and their reluctance to return. The Caesarean section rate is around 22% but mostly for obstruction and with a worrying number of dead babies. Being a twin is also bad news, it is rare for both babies to make it. Four mothers, all under 25 died in the year, one of eclampsia and the others of blood loss-preventable and unnecessary. These statistics though, sadly are some one's child, sister, partner and their loss will be keenly felt. How much more carnage, the result of a normal process, is going on the community is any ones guess. We would like to do something sustainable to stop this loss of life, damage to 'parts' and suffering, perhaps a triage system to direct the appropriate people to a safe birth place-even one that is vaguely nice to people as well would be nice- but such triage systems have not been shown to be robust in the developed world, though they might offer some hope in the developing world. This together with Education is what we will be trying to do-work permits and car permitting of course.
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