Illusions of sustainability

There is a glimmer of the illusion of possible sustainability on the horizon with an offer by one of the nurses, almost spontaneously to put down a nasogastric tube on an eminently salvageable 2Kg 32 week old neonate with no suck reflex and a rather bruised head from her backward entry into this world. A number of problems had to be overcome first however such as the availability of a tube even on the second hand market (there is a flat tin with various coils of damp plastic, but no 5F tubes). Apparently none in the hospital despite various calls – was a salvageable baby going to succumb or aspirate for the sake of a tube. Despite much energy being expended on inventories, this was at variance with local knowledge of a cardboard box to the right of the door, in the store which might contain what was needed. Finding the key had its difficulties as being quarter to five all had gone home (no guesses as to standard day finish) and the local key was held by a case of D&V who was reluctant to leave the home facility but needs must. Entry achieved to the locked room and indeed tubes available, sufficient for me both to keep a spare myself and sequester one in the room for another eventuality. A sugary regimen and we are away. It is up to you now mum, milk production or death.
On joining the ward round yesterday, (something I avoid unless I have to conduct it for its sheer tedium, I now know why it is so difficult to get an SHO on to the post-natal ward) I was struck by the large piles of human poo around one of the beds and was not immediately aware of its source until I spied a toddler, sans clothing below the navel and a mother (suffering a miscarriage I think) confined to bed. The high roughage diet is clearly high poo volume too, but why no effort to clear it up. The answer of course is that there is nothing to clear it up with – there are no paper, or come to that any towels, so nothing to scrape the offending ordure up with, so there it stays, and many do not have shoes. This was brought home to me by a visit to the Government hospital today to chat to their very nice obstetrician, who I watched – I kid you not – dry his hands on a piece of paper from the notes. This is not as bad as you might suppose as the paper is of low quality and is very absorbent, the only thing you can write with is non- absorbent biro, rendering me even more illegible than usually the case. Lest you be worried the O.R has reusable towels as with everything else, but the soap is running out I notice. Here, you wash your hands then someone pours an evil smelling alcoholic solution onto them, a smarting experience if you have a small cut.
The usual diet of obstructed labour and fetal distress has been broken recently by ectopic pregnancy, one a bit tachycardic and the other a chronic mess with the appendix buried in it and a radical hysterectomy which I am pleased to say went really well. This has inspired me to look at developing a service for early stage invasive disease – so do take the trouble to read my plug in the next blog which immediately follows this.
The absence of wheels and dependency is increasingly tedious and is being used a less than subtle form of control together with petrol costs and per deums (eating costs for the driver, and sleeping costs if we go to Addis). I am plotting ways of trying to get the car back as Karen now feels secure here, I feel claustrophobic and am looking for ways to put myself in danger or expanding my horizons. I think Aber Minch has possibilities but I suspect that there will be quite a lot of leg work both with the authorities and on the home front. Although the compound is a safe(ish) haven, bar the endless stream of people who call at the door, wanting a chat, money, both computer access or more time consuming computer lessons or feeding. While waiting rather endlessly outside the government hospital for my lift I noted people being carted in on stretchers and rather a lot of quite friendly looking people in Khaki smiling a lot but toting AK 47s with hollowed out shoulder rests and looking quite new. Why I wonder do the manufacturers bother with fake wood on these automatics? Feeding has its moments as Adventists develop sudden narcolepsy just before food and start muttering (probably to some deity) and marvel at the amount of Ribena we seem to be drinking from a box without offering any to them though we keep a supply of apple juice now for such visitors. The chickens have become very noisy and toxic trying to find a place to lay we hope, but have to keep chasing them outside and off chairs – they almost seem to like being picked up now, very worrying ,as is their incontinence. Lack of eggs culminated in me buying some from the village, Karen simultaneously buying some up country while walking back from a health post as there was the usual delay in transport, so with an egg glut – two eggs from our two. Egg mayonnaise sandwiches for lunch then. Karen has constructed comfortable looking but so far ignored egg laying boxes but they prefer the outside world as do passing stray dogs or the chickens themselves. Eating your own eggs probably does not amount to cannibalism and as not fertilised infanticide, but what I wonder?

Off to Aira hospital tomorrow, transport permitting, a haven of German Missionary efficiency where I hope to both discuss my cancer project and borrow a cystoscope so I can take stent out.
In the meantime the endless supply of lentils which ensures no bowel obstruction, and the peoples of this area, which ensures pelvic obstruction will continue. It is a far cry from St. P, but that does not sound that much fun at the moment either….
To be continued if anyone is reading………….