One would like to think that changes one makes are sustainable but sustainability is going to be hard work. I was struck on the ward round this morning that an 18 year old girl (probably 15 as they all say 18 so the government does not get involved) who had had a caesarean section for obstruction having been transferred after many hours in labour and a bus journey of at least 2 hours was now 2 days later unconscious, Glasgow coma scale responding to painful stimuli only. Catheter had been taken out and not put back in, pyrexia 38 and clearly not well. Not really looked at for 24 hours and closer inspection showed her to be very septic and after the appropriate blood test very neutropenic too. Not surprisingly the baby looked pretty unfed as well. Lots of shrugging and not a lot of action but have started some treatment and fiddled as much as I can with the antibiotics and we can but see, though not looking good. Thought a little prophylaxis for the baby might be no bad thing but unsurprisingly not really thought about. Do not really want eighteen year old kids dying on the patch but if, as usual hey are a. unable to spot if some one is ill, b. unable to do anything urgent about it when they actually realise that they are, life is difficult. I feel a little guilty as I was not on the ward yesterday having gone to a peripheral health centre with Karen but to be honest I can not be there every minute of every day – depressing though. Apart from dreary ante natal clinics, and I have always found ante natal clinics dreary, the day was enlivened by another labouring primip mother in the clinic with uterine inertia. Oxytocin stimulation in these clinics, which have very limited facilities, no running water etc. is not allowed but it seemed to me the better option (think of the 18 year old) than a long trip to the hospital, so I found some oxytocin, dextrose and a canula and set it all up and waited. Was gratified by a spontaneous delivery of a healthy boy an hour later, though the Health Officer could do with some remedial training on his delivery technique. Trying to deliver fetal shoulders in the transverse is doomed! But lets not bitch too much, all is well that ends well.
Our plan to travel back ently and possibly stop for a picnic of Bhuna (Coffee) and cinnamon rolls was stymied by agreeing to give lift to a weepy, in pain but actually normal primiparous woman with a breech and her husband, declining to take the rest of the family and some health extention worker who also wanted a lift and stopped in the village to pick up her daughter, who screamed with fright in the car and vomited copiously over the floor, Karen’s ultra sound wipes coming in useful here and the sucked noisily on an ample boob for the rest of the journey. Thank you (Galatoomi) does appear in our Oromo dictionary but not in common parlance as our various passengers drifted away without saying a word leaving me to wash the vomit stained and rather nausea inducing rubber mats. It is distressing how vomitus is able to find all the crevices in the mat and stay there. Particularly galling was the ability of our psychologically deranged gardener to hide the detachable tap from the outside stand pipe somewhere where I could not find it making mat cleaning even more difficult than it need be. Ethiopia is water metered (drought, famine and other biblical catastrophes being part of the culture, locusts any day now) and detachable taps are a form aqueous theft prevention I suppose, though apparently there is enough water at the moment. The cervical cancer program is gathering a little momentum despite the usual delays, this time adventist induced as they seem unable to get their act together to put a letter, electronically delivered onto the right note paper for circulation but then time in this country probably produces the ‘Ethiopian condition’ and certainly confirms the cynicism of your author. Never the less we managed to remove completely a large tumour and there is another booked but delayed for today. The delay is for an emergency ‘goring’ some chap having run foul of a bulls horn though in these parts not a matador just probably irritating it or being in the way at the time, health and safety is not high on the agenda here.
Perhaps we will get on this afternoon. Operation for Ca Cx went well but have a suspiscion that there was no cancer, though it did feel hard, one of the problems with clinical diagnosis I suspect. Having said that PCT permitting, she would in the U.K. have had a hysterectomy anyway, though perhaps with not the dissection she has had.
Just when I thought it was safe to get back in the water another 15 (18) year old has turned up from some distant health centre with a 2 day labour, obstruction and meconium. Well stuck in and an inverted T to get it out, she also appeared with a voucher though what this means I have no idea……given that they are supposed to have stopped.
Our other kid remains hypoxic, acidotic and thrashing about so I am very gloomy about her prognosis but hereabouts there is not much I can do.
Jabba news is that he is on I.V antibiotics and coughing and is going to spend the night here, Karen says sleep but I do not think that that is on the agenda. Abdi seems to have moved in too with his septic foot now with iodine dressings and my socks, will he be staying too? Sepsis all around me then.
I have been approached to chat to the senior Adventists after supper with boss Adventist here, prayers, water out of jam jars (living like Ethiopians?) and lots of lovely Injera. But moves are afoot with changing staff, an influx of Adventist physicians and surgeons, what is for sure is that the visiting gynaecologist is not an Adventist and there is going to be a change of guard.
There are lots of monkey attacks at the moment and they shut themselves into the chicken’s coop and then panic, so do the chickens who take refuge in our sitting room and cower (but still crap) on our feet.
Ah well, in for the long haul then.
You seem to be kept very busy there, I hope you are getting time to enjo y the music with Karen. Not Vagner but soothing I expect!
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