Faranj, you,you you Give me money

So here we are back in Gimbie, with the timeless rhythm of calls to labour ward, previously undiagnosed malpresentation and unresuscitated haemorrhagic shock and incomprehensible problems in outpatients, most of which are uresesolvable. This is interspersed with people asking for sponsorship, the latest being a sister doing computer studies, some one wanting to give away her 2 year old so she can continue her studies and general impolite demands for Hori (money) as you walk the streets. One of the troubles with having got the land cruiser over here is that it marks you out as rich and therefor deserving of even greater efforts to extract cash from you. The fridge, despite having spent the day outside with various ‘experts’ working on it is still at least room temperature, but then who cares as dried beans seem to keep for ever.
The two chickens, having recovered from the loss of their new play mate but now resolutely not laying again, have been allowed out and even wandered into the sitting room today. Perhaps with their new found freedom they will find secret places to lay eggs so as to ensure that the thought of a fresh egg is a thing of the past.
Splendid banana and raisin cake for Karen’s birthday which was celebrated with orange juice, a trip to the green bar and spaghetti napoletean, washed down with South African red.
I decided that a spare tyre on the roof of the cruiser was a temptation too far and have now with the help of Abdi (semi orphan in as much as his mother is a maid in Nekempte some 200 Km away and never sees him so he lives in a house with 5 others and does not have sternum which means you can see his heart beating through a thin membrane and I think causes him some anxiety, it would me) who shot upon the roof and helped me down with the tyre and to put the spare in the boot and did not ask for a Birr. He was rewarded with coke, cake, pencils and a rubber and seemed to trot off happy. Meanwhile we get shouted at from behind the compound barrier which is a little tedious.
As a welcome change from beans, we had cooked by Sophie Thai red curried pumpkin and rice, washed down by me with a dwindling supply of orange squash as I was on call and by others with beer (St George) or red wine according to choice. Pumkin itself like so much on the menu here is a little bland but the curry was a welcome change of taste. As above I spent the night playing registrars.
We had a successful skype link with the charity AGM in Brighton but were only able to see Adrian and they only silhouettes as lighting bad here and we were able to talk about our nascent projects in a generally upbeat way, but as is the way in Ethiopia nothing is certain except the undoubted need to go to an office somewhere and get another stamp. There is a round of this coming up when we do the hellish journey to Addis later this week.
Jabber continues to do well with intermittent high quality care and intermittent neglect but looks quite cute if drowned in his new western clothes. What though of his future? So far my implantation seems to be holding up. This is despite a serious bout of infection having found her on the ward unrousable – apparently from some time earlier but probably regarded as just sleeping, it being well known that 60 year olds with urinary trauma and who have been allowed to lie completely flat for some days regularly have no blood pressure, no urinary output laboured breathing and complete unconsciousness. It is apparent that my attempt at major surgery is about to pop her clogs, and more important cost her relatives a small fortune. It transpires that she thought she had a prolapse and was due for the free dress shoes and neckless, not a nasty cancer and lots and lots of complications. In passing you should know that there are no reagents in the laboratory and all we have to go on is no urine an improbably high blood sugar and an improbably normal white cell count – she is a little hot but the thermometer is missing. ITU time but no ITU so we improvise with some out of date dopamine, an oxygen concentrator and having raided our dwindling supply of batteries an oxygen saturation monitor which is not giving good news. An added difficulty is that our ITU expertise (Karen) is up in the boondo some where and dosages were never my strong point. (You try working out 2.5.micrograms per kilo per minute when the solution is 8 mg. per ml. and god knows how much a drop is, but then when finally in range we get the answer - 30 drops per minute). (The patchy telephone coverage by the way suggests that the richly funded (they hope) Danish project may be dead in the water.) With many visits now 10 days on she has actually survived all this and is actually sitting up in bed a bit. Discussions with Gordon (of Fistula hospital fame) suggests that we can get the stent out in 10 days (surprised?) as if they do not leak by then and she has not leaked as yet they will not do so. There is however a paucity of equipment with which to do this.
The land cruiser, predictably is becoming a disaster area with now only two weeks to run and the various officials becoming ever more unhelpful with the smiling helpful faces with which they impart this information which is as ever, ever changing as the sand and sadly the sands of time shift not in our favour although some say that our fully insured carnet paid etc. car can theoretically stay. The desire to stay and help the venal dishonest and donor recipient culture we have entered is now wearing a little thin so we may, rather sadly from my point of view (deep down I must be some sort of medical masochist) be moving on which means that I will be deserting my garden and chickens. The latter rather irritatingly, having become very free range have started laying around the garden rather than sensibly in their nice house but we have had so far a nice local omelette from them.
Ethiopia remains sadly an outstandingly rigid and closed bureaucracy and is unable to help itself. Their credo is summed up by the shout you hear all the time on the street- faranji, you, you, you give me money. They deep down do not want to change their poverty, ignorance, unquestioning culture or the fact that nobody can be seen to fail when failure is the norm, but that failure is never anyones fault and did not happen anyway. The important thing is we go on getting money from faranj, big faranj for big projects (Chinese for roads, Bharanians for flowers and any old Brit you can con as apparently we are big aid givers on the big scale and any old visitor on the small scale. I have recently finally cracked and given £5.00 so my erstwhile Oromo teacher whose translation is not what I hear going on around me can have some rotting sugar cane infected dental stump pulled out, though I am not supporting his sister through computer school and I have set my face against new glasses for a nurse and continuing wasted educational support for the whole of Gimbie.

Not quite sure what we will do with the automobile but Karen has set her face against admitting defeat and putting back in a container to the U.K and her anti Ethiopian Officialdom and grasping culture is high so we may take it down to Kenya and move there ourselves which I see as something of a defeat but she a new adventure, however things there are gloomy but not decided, surely they will in due course be recorded. What I do not want to do however is teach laparoscopy to the fat cats of Kenyan private practice in Nairobi.

One of the reasons why this blog has not been updated for a while and if I have any followers I apologise, is due to the travels to try and sort out the car and lack of access to internet or time to record the immediate thoughts and record them so I can share with you. So much happens and is so immediate that the immediate absurdity is lost so quickly so will try to make amends. I return to be greeted with parting Danish doctors returning to bacon cheese butter and other luxuries having imbibed precious commodities such as wine and departed with our Ethiopian resident leaving me in sole responsibility so dear registrars I am you with no respite and if I am good no recourse to alcohol for the next week. In addition to the endless vaginal repairs with their slightly septic look and grey re-used packs looking a little yellow and giving off volatile sulphur compounds like a mouthful of crowns there is now a steady trickle of serious obstetric mishap either happened or about to happen from Asosa some 200km due west, desert and the home of 200,000 souls and no obstetric care. On the ward is a 22 year old who has been fitting for three days, delivered by forceps on arrival of her surprisingly alive baby but deeply unconscious, with fixed dilated pupils an complete renal shut down being treated with fluid restriction. On my arrival on the ward it is apparent that she is brain dead and within a few minutes, sadly just dead. This to my surprise produced a temporary show of emotion from the midwives with wet eyes, the only real emotion I have seen since arriving. Such is the social scene hereabouts, it appears the mother of the recently deceased has a child of one that she is breast feeding and has produced some milk for the baby and will probably take it on, so out of disaster there may be some resolution however sad. Equally sad is that she failed to get simple and indeed free medication that might have saved her life. Later another fitting proteinuric refugee arrives but this time delivered and with malaria-is it cerebral malaria or eclampsia – transfer to physicians after some Mg SO4 and so far no further fits so their problem.. In ‘House of God ’terms this is what is called a slough!!. However 3 days on she still looks pretty blotto to me and is just lying there but no more fits. Although this sad this is medical sad so really have to keep my distance.

So life for the rest of this week when not worrying about the car and not being able to make contact ( I write this off line as the internet is down) I will do ward rounds on my own punctuated by gynae clinics mixed with obstetrics extremely dodgy scanning and obstetric emergencies, there is quite a lot of obstruction around here. Life does not change, those of you in theatre will know as my trousers seem to want to fall down, no longer pushed down by bulk but by being a bit loose! Karen says I was virtually baring all while suturing some tear I had caused having abandoned the multi use no suction kiwi cup for a pair of strange looking forceps with no fenestrations and finding that there was no scissors to do an episiotomy and the baby was not very happy there being loop after loop of cord around the neck. Some of you may know that Ethiopians do strange dancing that involves swaying a lot and I suspect that this happens in utero too giving rise to multiple cord problems. Perhaps dancing is an instinctive trait like chickens following their mothers? Remarkably I delivered a baby today without any meconium. Interestingly also saw an 18 year old with a three year old fistula which is high and close to her cervix, her pelvic floor being largely intact. In another place this would make a very interesting laparoscopic repair and here would do well at laparotomy but should probably go to Addis and they get the bus fare from maternity World Wide for a while at least. Also asked to see a 10 year old with a history of sexual assault, though happily did not looked damaged to me. I suggested that an HIV screen might be appropriate and as my note had to be typed it came back as tasted for HIV rather than tested, but I think like many they struggle with my hand writing.

So as I survey my garden, freshly sprouting greens and increasingly bold if largely barren chickens, obduracy of Ethiopian Authority means that we are likely to be on the move which is sad for both the research, which may well bear fruit and the adventure but equally I am sure that further if possibly tamer adventures wait. A little flexibility would be a wonderful thing.