Visiting Times

Despite protestations to the contrary the ward seems very quiet to me and the only thing different is that the clientele are predominantly rich and normal (this of course being a relative term), apart from a run of gross hydramnious and sadly even more gross abnormalities, most of which I suspect would be prevented by a little folate in the flour that makes the ever present injera, as would the goitres by some iodine in the salt. However agencies that are about education and the improvement of peoples lot are about to take a hit as the NGO office has now decreed that charities can only spend 30% of their income on admin. Not a bad thing you might think when you see all the local NGO officers swinging about in their land cruisers with fading U.N. signs on them (not surprisingly the U.N. which is what everyone aspires to work for, lots of dosh, super perks and a diplomatic passport is exempt) most of them achieving little as most of the resources never hit the ground, and a very good model if you are building dams and roads but not good if you are delivering education or medical services. The infrastructure cost also includes transport, so the 30% cost has to include getting educators, doctors or whatever out to the rural areas, ergo it will not happen and our local chap is thinking of investing in bicycles. Talking of bicycles the charity cyclist have now arrived in Addis so assorted lycra clad and sweaty cyclists will be starting their journey through Gimbie and back to Gimbie for their charity run complete with tents cooks support team and crutch rot medicine. The police have told them that they cannot take photos of local housing stock and kids but views are all right so it will be interesting to see what the instamatics produce. There is an assumption that the local organising committee (now us as everyone else is travelling support) will fix a grand welcome, orphans with flags, tee shirts and probably more useful coldish drinks. The fridge still does not work well so cold is not an option. My original plan was to serve Pimms on the veranda but this is in doubt as there is a simultaneous visit by senir Adventists looking for signs of lack of spirituality as mentioned before so plan B is beer and cheeseless pizza in green bar B, but less mess for us to clear up. We also seem to be doing the leader of the gangs laundry for him and for reasons that I have yet to understand I found myself folding someone else’s boxer shorts…….
The week generally has been one of ceaseless politicking with general bitching about cyclists, teaching local midwives to do abortions (I kid you not, it is called Manual vacuum aspiration and it is to allow local midwives, health officers etc. to do evacs but it is but a small step to significant income generation dealing with unwanted pregnancy. Thus twice this week I have found myself teaching a variety of future abortionists to suck green gunge (ripe advocado) out of infant feeding bottles without going through the top of them as a reasonable proxy for a uterus. Such is the life and calling of the do-gooding expat retired obstetrician, what is it you might say all coming too. This yesterday was witnessed by our other visitors, a Christian financial services consultant (yes they get everywhere too) and a Berkshire GP into good works who seem to run some sort of health facility in Uganda and who and with whom the cycling leader is trying to form some sort of partnership. This has meant even more entertaining and worryingly ,if not disastrously the complete quaffing of our remaining supply of Drotsky Hof red wine, even more sadly without my help as with vestigial feelings of responsibility (there being so few deliveries) I was on call and thus on the water. There are vague promises that this will be replaced but then how much can you balance on a bicycle. We have been given (bizarrely) a bottle of Baileys which I hope will keep but we did serve this with pancakes, yes pancake day was recognised, but what to do with the rest? The visitors, who like all business peoples and do gooders seem to regard themselves as good judges of characters (which makes me wonder what they think of me as I probably seem a nice gentle boxer short folding sort of chap superficially, and a cynical bastard if and when they get to read this) did the rounds of local NGO organisers and hospital administrators and spent the next few hours discussing their impressions.
One of the afore mentioned sits with his legs akimbo waving his arms about while being increasingly disingenuous and dissembling madly, the other being more and more cautious, careful and less openas he tries to balance budget constraints and the competing demands of his impossible 30-70 split, the battles of his surrounding faranji and Ethiopian colleagues and ever changing and developing relationships (no I shall say no more). Relief from all this is clearly required as further inroads into the remaining red wine resulted in a middle class Ethiopian all male dancing group with much shoulder waving (this being the difficult to reproduce by nonindigenous local dance style) and by the look of it rather sore heads next day. Ethiopians have no lesser difficulty coping with the results of rough red wine than their faranj counterparts though we were excluded from this group on this occasion and I have had to rely for this on second hand reports. So healthy exercise and deprivation is being replaced by red wine and late night dancing, what would the Adventists say if they knew – let’s hope that this blog is still locally blocked. Quite what our visitors think of all this as they cope with their ill advised restaurant meals, judging by the frequent trips to the facilities and the need to stock up on rolls of soft if grey paper and whether we will be merged into some greater charity, remain to be seen. However the offer of an exploratory trip to Malawi and a further trip to Uganda are there and may prove exciting new adventures if accompanied by politically correct report writing and much less politically correct blogging.
Our other Faranj visitor, a current student from my old alma-mater, but really a bit more ‘Royal free’ seems to have enjoyed her time in the visitors dorm despite being surrounded by evangelical Adventists and being groped by Ethiopian male nurses (who clearly do not have the sexual proclivities of many of their U.K. counterparts) and whose ruse of wearing a wedding ring has not proved useful. She now returns to the north of England, her boyfriend a medic destined for Epidemiology and a desire to make babies from the safe haven of general practice, her taste for developing world medicine now being sated. Perhaps, when the boredom of the worried well, the demands of the western overindulged young and the understanding that she has ability dawns, she will return to something that is actually quite fun. The need to grasp the opportunities that arise from career change, failed relationships and the lack of ties would not be wasted on others too.
Looking back from a career, which consisted of taking clinical risk from safe jobs and bearing the intermittent opprobrium and eventual grudging respect of safety conscious WHO safety list toting colleagues, makes one wonder whether really you could have had more fun, though certainly most of it has been quite amusing. Would I have done it differently, probably not apart from tedious management roles, which have only really produced enemies and being party to change that was not really to the benefit of anyone other than bean counters, certainly not our patients.
Meanwhile back here, management bean counters have stopped the money flow that brought women in need to a place where there was facility and driven them to a place where there is undoubted clinical competence but limited facility, no sheets or anything useful like that and sadly very few beds to put them on, poverty means that needs will need to be assessed, time taken for them to be agreed to be met, and even more time before they are even partially met, so suffering all round. What happens to those who do not make it to any facility, well some doubtless ‘Adventist or other factional’ god only knows.