Meanwhile having thought that the financial changes and withdrawal of funding would mean undisturbed nights of sleep I was rudely shocked by a night of registrar activity which included sedating a young lady who subsequently died as a combination of stroking out with her eclampsia (probably but being at home not really clear) and her sepsis, a sad and squalid end in the open ward, the other patients weeping quietly. Other activities included a breech delivery on a pre-eclamptic lady who laboured quietly in the ward, two retained placentae, an emergency section for a breech that looks strangely Down’s syndrome like and to round the night off a shoulder and cord presentation at full dilatation! I remain unclear as to where they all came from, whether they were paying for themselves or did they come bearing vouchers which will soon be rejected. Although wearying for the aging obstetrician manqué it does restore my faith, albeit temporarily, that I am possibly doing something useful. One of the worrying features however is that people come either when it is too late, preterm delivery at home and brisk bleeding having had two previous caesarean sections, and another fully dilated with a very low fetal heart rate. The latter is doing O.K. but the former baby does not look that great. I suspect they hang on in the hope that they can save the money and this may reflect the lack of a voucher, but I do hope not. The new MWW rubric is educashun and as part of this there are chats to women’s groups and worrying stories that either suggest education failure or male dominance of a degree that even disturbs this bastion of male domination. Women ruptures her uterus at home and kills baby, uterus sutured, has next baby at home, surprisingly ruptures uterus again, kills baby has hysterectomy and now ‘quote’ @must bear this burden. Failure of education, understanding or permission of husband? Who knows but goes some way to explain the Ethiopian condition. Not so though the trip to Gueliso I was conned into taking together with the ‘Adventist team, which was recruited patients for free prolapse operations, yes time to herald the return of the prolapse tourists, this time a slightly different team but still due to arrive any day, so some punters might get an operation and they can sort out the mesh erosion that popped up last week. Happiliy I will be away for a good portion of their time here so will not get too irritated I hope. One of the reasons, falsely it turned out, for going was to see if there were any cancers about but none came forward. Histology so far has shown resection margins clear but out into the parametrium so hopefully a slightly longer life. We await more punters but I suspect that the other hospitals, though not offering surgery are jealous of their trade.
So as we move into the final third of our trip here (3 X 4 = 12) but actually slightly over half as we are doing 10 months it is an interesting time to take stock. I have I think been a little over harsh on the Ethiopians, not because of what they do but why. There is no government net so they rely on local support and a sort of Marxism rules in that if you have and they have not you are expected to share, the more you have the more you share (and thus presumably you have less) but faranjis always have more so start there.
Do they care, they certainly stand and stare and invade your space, there is relatively little in their lives so anything is a free show and they are clearly trained to remain expressionless until there are episodes of collective joy (singing at marriages etc.) or collective grief (ululating at funerals) but they do turn up in their multitudes when there is illness but whether to help or watch I do not know. The occasional happy smile is a sign that they do have feelings and when you do get to know them you will get some idea of these. Though if you do piss them off this may well last for ever. If you live small parochial lives (and mostly they do) you get small parochial views and it only those with satellite TV that are ever likely to move away from this.
Will they steal anything from anybody even their friends, if you are the street kids yes, the top to my memory stick has been nicked from the table outside where it was left for 10 minutes during a recent visit – irritating as useless to them and quite important to me. This adds to the list of trivial nicking, which includes for the second time one of the outside bulbs, doubly irritating as it lights my path when summoned to the ward in the wee small hours. The kids sadly, and this goes for the vast majority, are bored feckless destructive, begging bastards, whether it writing on the car with stones, shouting obscene requests for money while being vaguely threatening (Teenagers) or if ‘orphans’ taking faranj hospitality and gifts while outrageously upping the ante, more expensive food and drink when being entertained, and lording it about in football kit that they only just manage to keep clean, though to be fair when given a tub of water they did wash their clothes followed by each other. I suspect that their life consists of intermittent neglect and then the showering of treats when what they really require is tough love and life lessons.
Life here is hard and in the main brutish, with low living standards, little in the way of facilities and a government service which is more in what they say they do rather than what actually happens. There is a lack of care and in a strange parallel with our own health service it is more about measurement than delivery, and that which is delivered ain’t that great. Despite this they are survivors, but with only a little help, and a little real thought rather than the parroting of what they have been told, they could make great strides, but that would require initiative and sadly, in the last analysis that is what is missing
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