Communication Failures

One of the persisting things in the Ethiopian psyche is being unable to answer a series of questions (you are likely to only get a half answer to one of them and never try a two parter, nor does it seem to part of the system to give clear and unambiguous information). So it was that my patient appeared in hospital fully dilated having had two previous Caesarean sections, something that I now believe is being encouraged in the ‘VBAC’ world of the west. Nothing ventured, nothing gained so I reached for the least battered looking suction cap but desisted (wisely it turned out as the swelling I thought might be bladder revealed blood on catheterisation) and subsequent laparotomy revealed dehiscence of both the scar and the bladder dome which was very adherent. Miraculously the baby came out crying and both are doing well. The moral of this story is not of course the advice she was given, which was ‘you need to have your baby in hospital’ but ‘you will need to have a Caesarean section’, which it seems would be far too unambiguous. Even better would be and’ you could be sterilised too. When asked why she did not come before the answer was, as it so often is, associated with transport difficulties, something that a ‘waiting house’ which is tax free might solve and an E-ranger (still in customs being wrangled over) might or might not depending where it and she were at the time. Simple solutions for simple problems are also not part of the psyche.

Despite general approbation from the clinicians in Surrey’s world of female genital cancer my request for limited funding to try and see if local clinicians could help local people with an otherwise fatal disease fell on deaf ‘lay ears’ with some surprisingly pejorative not to say ‘old testament’ remarks about the women in Ethiopia who, like their sisters in other parts of the globe have been challenged with oncogenic papilloma viruses but unlike many in more affluent parts have not been screened or offered preventive treatment or now vaccination. Whether by force of circumstance or choice, and it is rarely choice you have developed invasive cancer matters not a jot, the availability of effective treatment does. Here, of course there isn’t any and in Surrey wildly expensive minimal access therapy is, for the few that need it. From my time in the Surrey colposcopy clinics many of these could be termed ‘new Surrey women’ i.e. those from the Baltic states and eastern Europe whose life style and deprivation is probably broadly similar to that of the women I now see, but fill roles in wine bars, hotels and the service industry to provide the monied of Surrey with the services they aspire to. So it should be said are the stunningly attractive, if orthodontically challenged, young women of Ethiopia who regularly queue, for many hours at Immigration in Ethiopia for a passport so that they can head for the middle east and jobs in hotels, coffee shops and I suspect less salubrious employment where they will get exposed to oncogenic viruses and the cycle will continue. For those however, now in their forties and raising their children, death from renal failure, cachexia and chronic infection awaits, a death that might be avoided by a timely and skilled intervention. If anyone would like to help me help them to help themselves (Ethiopian psyche permitting) please let me know. This charitable concern comes with no overheads just the cost of the operation, around 2000 Birr a snip at £80.
For those of you who were distressed at the sight of the baby that tried to emerge into their troubled world face first I am pleased to report (see photo) that swelling has gone, feeding has been established and the traumatic emergence now the past – let us hope that the future is rosy. I am also amused to see that ‘attitude’ is alive and well in Ethiopia if tinged with ‘I must ask my husband’ which some would regard as a laudable trait in that a lady with quite worrying blood pressure is very reluctant to be induced or as they say in these parts ‘have the pregnancy terminated’ but I hasten to say that that expression does not have the western connotations that we would associate with it.

Happily she has now agreed, or more probably husband permitted, so termination is under way.

Yesterday was Ethiopian Christmas, a day that is as bad for cows here as it is for turkeys in Europe and there was much feasting. I do not know if it also bad for goats but there was a lone and vagrant goat eating in the garden and being male only good for eating or reproducing, perhaps it had wisely decided that it was an away day. We did our bit acquiring a slab of cow and with some difficulty as the knives are blunt and we have no sharpener, cutting it up, cooking it in the slow cooker and serving it with spagetti to our ever hungry youngsters and some Ethiopian friends with pancakes and the local equivalent of Nutella to follow (the latter ably produced by Clara). They all settled down to watch ‘Harry potter and the half- blood prince but I am not sure what they got out of it, more Shrek and similar movies probably required for this paediatric entertainment. One of the young men has infected feet which are being treated with antibiotics, like the gardener’s arm and I had that soaking for the afternoon. My only worry is that he has recently been bought some boots that look alittle large and more important military so I hope that I am not just treating trench foot with more infected salt water. Perhaps open toed sandals are what is required or that I am missing filiariasis or something equally exotic.

Baby 3 days after 'face presentation'

ruptured uterus pt day 2