more nights of joy

I had hopes of it being quiet, but no such luck. We fed the jabba the hutt and set off for bed but as soon as 12.20 struck so did the irritating jingle on my Ethiopian phone ( I have to learn how to change this as it is beginning to get to me ) and as communication is so difficult you have to fumble into your clothes and go take a look. I find a lady with two previous sections in labour as with no dates no elective caesareans and arrange her operation. The scissors are unbelievably blunt and I am reduced to dissecting down the bladder with a rather fearsome scalpel blade before a successful delivery and happily savaging of the fallopian tubes. As I go to the theatre the guards arrive with an abandoned, cold and hungry baby, probably a month or so old and looking rather wild eyed, so I arrange warmth and milk though when I return from theatre I find one of the nurses suckling it, not perhaps the best strategy when HIV status is not known but too late now. Very sweet and bouncy looking baby and now a rival for Jabba’s dwindling supply of milk. Clearly some Ethiopians live in desperate times. No sooner am I back in bed do I get another call. The para three (no I have no idea of names) ain’t making progress, is making an extra-ordinary amount of noise and the midwife cannot feel a head. It is very high and curiously I am unable to feel a single suture. When I keepher still for a minute the abdomen is a funny shape. Yes you have guessed it we have a brow and a fair amount of meconium. From the last update you may appreciate that I am a little sensitive about meconium, so back to theatre we go. The husband (they are both older and all powerful in these parts) initially fails to approve the thought of tubal ligation but while in theatre on the news that it is a boy relents, so hopefully she will not be back.
I sleep in a bit and then pop up to the ward to hand over the keys of office (the key to the ultra sound machine) and find the usual chaos but in addition Heidi struggling to replace an inverted uterus –para 5 delivered at home – and we manage to partially replace it hydrostatically but all not quite well so EUA needed. Problem, the prolapse tourist team are inhabiting both theatres and deep into lengthy abdominal repair procedures without much thought for the need for emergency space, words required later, but mange to clean an old delivery bed, carry it into recovery as it no longer has wheels and get a spinal in there which allows us to finish the job, and yes another sterilisation, there will be no intact tubes in Gimbie by the time I finish.
Have words with helpful (at least verbally) prolapse team and explain the problem that we are in danger of compromising the safety of emergency patients while they spend their donated $20,000 on re-suspending sagging denizens of the environs of Gimbie, each of whom I am told are sent home with a new dress and pair of shoes. This goes some way to explaining why the corridors and outside spaces of the hospital are thronged with would be prolapse sufferers.
We have acquired an Oromo tutor, who had been translating for me a few days ago. He soon launches into his hard luck story and how he and various hungry if not starving members of his family are dependent on him and he hopes us as he tries to draw us into his web of need. We are however happy to pay a reasonable rate for his teaching time but not become the welfare state.
This confirms my growing understanding of the malaise of Ethiopia which, thanks to western aid is now entirely a hand out culture with no sense as far as I can see of any entrepreneurial endeavour apart from trying to rip off the faranj (us) on any purchase we try to make and expecting people to do things for them which they are capable of doing themselves. Such is the desire to get free things, a pupil midwife followed me in to the theatre changing room to try to remove the crumpled jeye cloth that serves as my theatre hat as she wanted it and that was before the operation. I understand that it is possible to apply to the government for various things but that it is so much effort it easier to beg from the charities who provide masses of equipment, much of which if our exploration of store cupboards is anything to go by remains stored and unused, possibly of course because no one knows how to, but that is another story. The pointlessness of offering a training to the mass of people who either do not want it, think they do not need it or are only interested if they want more money will be the subject of further discussion, provided of course if I am not stopped before, ther is an ugly rumour the local state tries to screen all outgoing electronic traffic – could this be why the net is down as much as it is……paranoia strikes and kafka remains alive and well.