land Cruiser travels

First an apology to some of my readers who have been involved in the events as they unfold, and who have found my words harsh or unjust or both. If I have offended or upset you I am sorry but in my defence I write what I see as I see it and as far as possible without reflection and I do understand that this can be seen as unkind or uncaring but do understand that the cynical detachment with which I write is because I possibly care too much. My partner in life whose considered position is so juxta-opposed to mine does worry about my needlessly giving offence but in my defence I am trying to describe life here, and the multiple agendas that surround it as I see it and I do hope that my distressed readers will see this not as gratuitously insulting but more as a distorting mirror reflecting back a different view than their own both reasonable and deeply held view. No personal insult is usually intended.

Having said that the on-going saga of the land cruiser import is an opportunity for gratuitous insult, and now a week and considerable cost on, an opportunity to vent my spleen. Where to start. We set off with the ‘researching Danes’ who want to produce and study the effect of mobile phone picture messages on health promotion in West Wollega back to Addis in a surprisingly new mini van, where I manage to bag the front seat but am exposed to Ethiopia top 10 for 12 hours as previously described. The lion’s den is as ever welcoming and the beef souflaki at our now usual watering hole the more so. I am introduced to a friend of the hotel proprietor who thinks that he can get the car imported through the Ministry of Health. He arrives, understands, as I subsequently discover, little of what I have said and departs with a fistful of photocopies with a planned trip to the ministry and a call in the evening. Predictably by now neither materialise and a phone call elicits the information that he is preparing a letter and will return at 12.00 next day. Phone call next day mean that he materialises at 4 pm with instructions that I have to be registered, though I have told him that I already am, and import of the car this way means that I am supposed to donate it at the end of the year – not something that is on. Internet news flash tells me that the car has now arrived in Djibouti and we elect to fly there immediately, ditching Sophie with a ticket to follow. This turns out not to be entirely sensible as we fly in on Thursday pm to discover, Djibouti following Allah that most of Friday and Saturday are devoted to local deities and offices closed. Our non-responsive guide, (she who puts the telephone down when she can not cope) spends a lot of time and non responsive telephone calls doing bureaucratic jumps about non negotiable way bills and bills of lading and takes away our pristine carnet. (This is subsequently returned a rather battered relic with staples missing but happily still seems to pass muster.) A period of total inanition and probably prayers follow and we collect Sophie from the airport, who has only been given a transit visa in Ethiopia and has trouble getting a visa at Djibouti as she does not know where she is staying. The hotel offered by the import agency, dark dank and unwelcoming with a Miss Haversham flavour about it has been declared unfit by Karen so we are off to luxury (at a luxurious price – Djibouti is the Switzerland of the horn of Africa) hotel family room. Enormous double bed for us and camp for Sophie and plan, though nothing is planned in Africa, our next move which turns out to be accompanying our guide to the shipping office being lead through the streets by a large malodorous pink galleon in Edna Everidge glasses where the appropriate forms despite her misgivings are all signed. Progress but predictably enough not until next day when after hassle getting insurance (3 months Djiboutian Insurance for 18 hours needs to be negotiated down and ‘international insurance arranged). Then off to the port where a cracking of seals, payment of the appropriate bribe and the opening of the door of the container reveals an unscathed land Cruiser that stars first pull having first set off the alarm. A few stamps later and we are on our way back to the hotel though getting comprehensively lost on route (this is going to become a recurrent theme as sign posting is not an African habit). The other problem that raised its head about now was getting a visa for Sophie as she had been given a transit visa at Bole airport and it was by no means certain that she would get a tourist visa at the border so a trip to the Ethiopian Embassy was in order and, as we were playing the tourist card, remarkably helpful, though with of course two trips – but remarkably in the day – a first for our dealing with the democratic Republic’s bureaucratic machine.
To diverge momentarily the hotel is a resting place for highly testosterone charged navy seals and other protection people who are on the high seas blowing pirates out of the water and generally trying to keep Somalia down so it is quite amusing watching Sophie and Karen being followed by lustful eyes as they swim in the bathwater warm pool. The showers actually produce water too though interestingly one morning there was no cold water at all-steaming loos!
An interesting interlude before we set off through the desert (sand, camels, rocks, hunter gatherers with little tents and no water) and the appalling discovery that despite my spending money in England – no air conditioning, boiling cheese in the fridge and generalised sweaty discomfort. It is understandable that there is not a car in sight but long lines of enormous lorries with trailers, inching their way up the hills and requiring you to overtake in ways that would have you returning to the test centre in more western climes. We are greeted very civilly by a man in a sarong and taken to a windowless hut with a desk that is concreted to the floor and whose post has two pairs of handcuffs attached to it. Its function becomes apparent as we finish as customs officer (though difficult to spot, sarong tee shirt etc. frog-marches some young smuggler (or illegal immigrant) in, waving a cocked pistol about in our (or more accurately Sophie’s direction) and puts the hand cuffs to use. The young man looks a little distressed and the companions are shouting. We are rather alarmingly asked to accompany the pistol waver who pauses to throw some stones at his interlocutors, only just missing us and who cheerfully stamps our papers (it turns out in the wrong place) and happily waves us off to cross back into Ethiopia.
The Ethiopian side is more formal but no less friendly, apart from pointing out inaccurate Djiboutian paper work on the Carnet which may cause trouble in the future, and only giving us a month which is when our visas expire, and despite the dire warnings we are through…surprisingly relatively painless.
Not so the drive as we battle past centipede like lorries in the boiling heat, passing herds of cattle and people trying not to be there (apparently you are not supposed to live in the national park but many do) in little tents-real hunter gatherer and camel herder stuff. Fifteen hours later we get comprehensively lost in Addis and arrive at our hotel and guess what the ‘Greek Club’. It is bad news to go there late as a little subsequent intestinal hurry testifies to. An amusing interlude on the journey was Sophie stopping on the Ethiopian side to buy a drink and speaking in French. Initially a positive result as she asked for a boisson, yes said the man and led her down the road past several likely looking fridges to a small shop that produced a tin of Tuna. Boisson not Poisson you tit!

As a life long non cola drinker I am finding cold cola the drink of choice (full fat) as it is ideal for long car journeys, giving you a sugar load, a caffeine jolt and a little fluid, I may end up living on the stuff, particularly when I am on my increasingly arduous on call.

Another marathon journey next day as we return to Gimbie, disastrously with a 4 hour dtour that we some how got wrong and the glorious country side turned into a bumpy ride through unsign-posted villages full of mutes with no apparent knowledge of where they were, particularly in relation to where we wanted to get to and the map we had bought appearing to be a work of fiction. Got very tired and grumpy but finally arrived. Employed the usual venal and dishonest hanging around men to help us unload the car, which was not wise as next day some one slipped into the house and stole my watch, case No 4 the bed linen and the hospital glucometer I was mending. Perhaps they were not happy with the price they were paid for portering? Sadly we will have to continue to use worn, see through and bed bug encouraging Ethiopian sheets. The car was absolutely filthy from its travels so I was looking for a hose to clean it with and the ever helpful (and tediously omnipresent) Hunde said he knew some where we could go so off we set down town toward the river where there was amusingly the local car wash. I was ordered out of the car by some under age driver who proceeded to drive the landcruiser into the river, approximately the same colour of the dust on the car where it was set upon by a gang of cleaners who did a tolerable job at a faranj price of course. It all seemed a little muddy but they did manage to drive it out though the front number plate fell off and I had to spend some time finding some washers. One of the windows would not go up afterwards but managed to dry that out and the number plate. All rather worrying at the time (Faranj super car washed away in river etc.) and probably not worth it as we have another balls aching trip back to Addis next week to take Sophie back-jeep bottom here we come! Karen is out visiting the community clinics, not in our beast accompanied by Sophie who is enchanting the local pre-school or probably no-school kids with songs and Karen pushing numbers up by scanning which ups referrals locally and keeps me up at night. We return to something of a political maelstrom as all is not well and this small community stuff is breeding tensions, I am trying to maintain a lofty distance but there are dangers of being sucked in. I am under pain of open testicular biopsy without recourse to analgesia if I reveal all but it will slowly creep out.
Back at the coal face, the usual litany of unmanaged labour, obstruction and dead babies is lightened by the arrival of a young girl with an Hb of 5, positive pregnancy test, no blood donating relatives, and a strangely distended abdomen. No prizes for guessing this one and suggest immediate laparotomy. Go to change and return to find her sitting (if rather wobbly) on the bench outside the O.R (as they now say post prolapse tourists) sans clothes apart from a torn gown, sans drip and sans oxygen which I manage to sort and she does surprisingly well – tough lot these Ethiopians. Left quite a lot of the blood in in the hope that she will absorb it and also it must be said that the sucker was crap. Talking of prolapse tourists I can say that their complication rate is 4% but the abscesses are slowly responding to drainage and anti-biotics.
I have been trying to extend the repertoire of the local gynaecologist and as there is a hell of a lot of cervical cancer here, in thin multiparous women I decided to attempt a Wertheim and teach him how to do it, a side each. I carefully demonstrate my side to him and show him how to dissect the ureter out, a bit of bleeding and suddenly his ureter is in two. There is one well past its use by date ureteric catheter suitable for an elephant and no cystoscope. Catheterising the distal end with the sharp bit proves difficult and causes a perforation at the insertion into the bladder so I end up re-implanting it, well outside my safety bubble but determined not to show it. Pity really as the specimen looks clinically as if we have got the resection margins. So far no leak but early days. I have decided that I am not going to do the glands as my memory is that this is for diagnostic purposes and in these circumstances who cares. However doing re-implantations with strange sutures is not for the faint hearted and I suspect I will have to face the derision of Gordon Williams when (or faintly possibly if) she leaks. I am not sure how I am going to get the ureteric catheter out yet-perhaps I could use an amnihook? If anyone has any suggestions comments please.
Karen’s birthday present included a third chicken, rather passive and named ‘Buttercup,’ though not for long as I found her dead with her nose in a corner this morning – I just hope the cause of death was not catching.
If it was not for my unalloyed good humour I would have to wonder what I am doing here struggling with little resource, hopeless clinical conditions, venal grasping locals and increasingly dysfunctional ex-pats, unresolvable local politics and sadly no watch or decent linen. Another Caesar calls, an induction dipping at 1 cm without any fetal monitoring is not my scene.
To be continued……….