The Prisoner

So, return to the ‘parish pump ’politics and tittle tattle of small community living with the added bonus, now being virtual prisoners being sans car and almost sans everything. The added frisson is that access to the Maternity Worldwide car is being controlled for reasons as far as I can ascertain for reasons of wear and tear. Life is taking on a rather down market version of ‘The prisoner’ for those of you who remember the Patrick Magoohan saga set in the faux village of Port Merion on the Mid Wales Coast, but who is No. 1, I certainly do not want to be No 22 or wear a blazer with ribbon on it. The local uniform is more international ‘scrub cast offs’, the Danish ones all Any pandy with elasticated trouser bottoms and rather absurd short sleeved white coats, the American with embroidered names and the U.K almost saying ‘stolen from’. But life does have that rather surreal quality to it, particularly as we have a self confessed ‘Bad Adventist’ in our midst who has taken up with our midwife but has also charmed the Equadorian nuns into letting have access to their dodgy wheels, something that we have tried to emulate but for us it requires the permission of the priest and the bishop, all is well then in this Marxist state, yes control is here.
Meanwhile, news is filtering out of withdrawal of financial support by Maternity Worldwide and our thoughts (and at the moment they are just thoughts, of our moving to pastures new) and this is causing muted distress both in the greater European community of maternity Worldwide and in our own parochial world. Even the very minimal contribution from charity sources to our presence here is under discussion but we shall see. Having said that initial enquiries to other charity agencies have met with enthusiastic response but, having been done over in Kenya Karen finds the relative security of our open prison comforting, I on the other hand, now being free of the NHS do not want and rankle under the control that this wheel free environment now has.
The other news with interesting repercussions is that the temporary surgeon is no more as he has returned to Addis with a swollen leg, and the hospital has been under the ‘emergency provision’ of the Government hospital surgeon, though nobody at the time told me when I did my next night on.
Apart from the now common diet of obstructed labour, dripping meconium and rescue surgery for the very small of stature I was summoned to a sick patient who came to me by virtue of the fact that she had some regular light monthly vaginal bleeding that was occurring at that time. She also had an unrecordable blood pressure, a tachycardia and an acute abdomen. The lab technician was unavailable, it being night and Sunday, but she did not look that pale. She also improved a bit with some crystalloid, all that is available in these parts. The absence of a local surgeon, and also no knowledge of an alternative, the concept of a hand over is unknown in these parts, made me realise that laparotomy was required. This revealed a belly full of pus and on extension of the laparotomy a perforated gastric ulcer. It is a very long time since I last over-sewed an ulcer and put on an omental patch but surprisingly she is doing reasonably well, has not leaked and her aspirates are falling but well outside my area of expertise.
I am surprised by how sanguine one gets about obstetric emergencies too. Found ruptured membrane with a beating cord under the head so just took her through and did a section – none of this supporting the head nonsense but did put her into knee elbow position. Alarmingly she had a crash induction that consisted of a slug of ketamine, no airway protection but clearly some form of laryngeal response by the strange noises she made throughout the procedure. Happily neither she nor her offspring seem any the worse for their experience at the time of writing, let’s hope that ketamine has an amnesic effect and does not just give you a bad trip – this one would be real though.
The aftermath of the ‘prolapse tourists’ live on with a neuropraxia treated locally with Ibuprofen. The unfortunate sufferer had been prescribed ibuprofen by my colleague and turned up at the clinic (he having developed severe man flu) saying that they could not afford it. The advice that it probably would not do a lot of good so not to bother did not go down well. I can see how the desire for pointless poly-pharmacy develops.
The other rather taxing thing at work at the moment is the total absence of any method of delivering babies vaginally by suction. All the overused Kiwi cups have now stopped any thought of vacuum and the silastic cup suction apparatus is U.S too, the hand pump requiring a fit pumper and so far they have failed to maintain adequate negative pressure, and the electric version not sucking. As I was called one of the midwives/trained birth attendants/less trained birth attendants/no training but good adventist (being an adventist is a requirement for a job in the hospital) was trying to deliver a baby with a silastic cup and failing miserably, but the unrecognised catch was that the usual spray of blood and other body fluids as the cup detaches was not apparent – pump not working! (Subsequently, when I took it apart it was apparent that the filters were all wet and blocked and when dry there is a negative pressure but I doubt that it is enough to effect a vaginal delivery.) I was reduced to using the one pair of Wrigley’s that is available and then a strange device with large metal spoons that did not fit easily. Both these deliveries required episiotomies, one of which extended and made for an interesting suturing experience as the light was not working, and head torches which require you to bend your head and bi-focals which require extension leads to difficulties and eventually a stiff neck.
However adaptability is as they say ‘the key’.
The return of the star feature of the ‘Maternity Worldwide’ winter news letter to the U.K means that we are surrogate entertainers and feeding station for the local motherless band of actually quite polite reprobates, but their need for sustenance far exceeds mine so they are welcome to faranj bananas, fruit pastils and mandarine orange juice. The purchase of schoolbooks and supper is on the horizon later today, together with clothes a football and Man U

shirts on our return to the U.K.

So life now consists of being a registrar, surrogate parent to an infant and supervisor of assorted rising stars of an Ethiopian football team (Gimbie Wanderers?), however lack of wheels, lack of sleep and probably lack of any meaningful infra-structure or support takes its toll. However there is also a growing stream of the indigent poor with unaffordably treatable prolapse, and the middle classes with uninvestigatable infertility beating a path to my door (two mixed metaphors in a single sentence). Shelf pessaries or clomiphene for all?
I am not a number, I am a person. I am number 6, you are number 22, but who is number 1?