Teaching Times

The return of my Ethiopian ‘oppo’ allowed me a night out, which was spent in part feeding the 5,000 (actually 5 orphan boys of prodigious appetite) but allowing me the privilege of a barely cold St. George beer. Remarkably and a first the beer was bought for me by an Ethiopian rather than the other way round – he was a bit boozed up and as he had wanted to borrow the car for a wedding I am glad we said no. This became slightly guilty as sitting there I was accosted by the most Adventist Adventist of them all (drinking wine is an offence to Adventists of blogs passim) and to cover I offered to do a teaching session for her midwives which was eagerly accepted. Thus this afternoon found me with 10 keen souls (I am sure that they too are all Adventists or pretending to be Adventists) and one patient who had no idea why she was there to teach a bit about pre-eclamsia.
When I picked her up I was amused to see that she was sitting up by her bed and that her husband was fast asleep in it, this is after all the Ethiopian way. Anyway best described as keen, shy and ignorant but hopefully by making a story of it we managed to impart a little that might help when they come across a that situation but we had a great deal of difficulty with treatment. Good luck to the hypertensively challenged pregnant women of West Wollega and others who come under midwifery care hereabouts. I repeated this teaching episode a couple of days later with the ‘male midwives who the feisty feminist alcohol abhorrent Adventist midwifery tutor tells me bully the little ladies. If I was worried (which I was) about the ability of the ladies to recognise and cope with a little pre-eclampsia I would be a good deal more concerned about their male equivalents. I am begiiining to understand more and more about the challenges facing this country and although I rail about the inadequacies of what we do here it is Queen Charlottes nor the equivalent to what happens in the deep rural areas…see below.
It seems that I loosely promised (and failed to keep) to get a camera case for someone and he is now haunting me and I do not quite know what to do. Karen says that I have to learn to say no but I am always caught on the hop.
Academic challenge. You wish to change some dollars for birr, and go to a bank which insists on putting your dollars through a machine that rejects most notes, when put through multiple times (usually around 10) Do you doubt the money or the machine……the money of course, but you can bring them back tomorrow and try again..! logical positivism at its best. But I did though with different notes and it worked
Yesterday’s night on brought with it another tragedy in the shape of a 17 year old girl of extremely short stature and odd facies who had been labouring at home for at least a day before transit to a health centre and on to here. Undiagnosed twins, the first a dead brow and the other about to expire. She acidotic and with an oxygen saturation of around 86% (not good) and with massive abdominal oedema and very confused. Sadly fluid resuscitation, caesarean and oxygen failed to improve her and she died an hour later despite our best endeavours. What is so tragic is that the treatment is free, be it here with a voucher or at the Government hospital which has a very competent obstetrician but that for what ever reason or reasons there was a failure of ante natal care (she did not get any) a failure to recognise that she might be at risk (very small very big bump) and a failure to recognise that she might be in trouble until she was an irreversibly septic mess. Even then she had to catch a bus into hospital. What one wonders were her parents thinking and what were the health advisors thinking or were they punishing her for under-aged sex –who knows…though some of the answers to Karen’s questionnaire about preparation have the response that ‘God will provide’ but he does work in mysterious ways. Perhaps it is a blessing that this time no orphans.
Those of you who have been following the cervical cancer project will be pleased to know that word is getting about but sadly a disappointed customer as my colleague tried to slip one under the net. I grant you that menorrhagia with fibroids is very uncomfortable and the lady is disappointed as the operation will not be free but this is not open season for hysterectomy (and being Ethiopia not the U.K. not much else is on offer) so with our limited budget she will have to save some money (about £100 which is quite a lot in these parts).
My first academic offering from Ethiopia is now ready for submission and has the approval of my trusty literary editor (Vasanth) but not yet that of Karen, who in true academic style has it on her desk in the’ I will read it when I have time mode’ thus in my dotage I am given less priority than her MSc students. The unsurprising findings are that predictors of dying from a uterine rupture are taking more than 24 hours to get there and rupturing your uterus in your first pregnancy which chaps is not as rare as you might think. Will it make BJOG which is up I see for a new editor? Meanwhile I am pleased to say that her birth preparedness study runs on apace and if she can find a way of stopping small 17 year olds getting into trouble it would be a very good thing.
Slight concern as new medical director has arrived (Dutch Missionary recently in Malawi, and no he failed the paper work test at the first round) as I was asked to show him our house in which he and his wife were very interested….five months would be an eternity in alternative accommodation in the housing stock available here so may have to put up the barricades though currently am assured not..but long stay Adventists are I suspect thin on the ground.

I am failing miserably in my medical treatment of the most appalling pustular folliculitis of the vulva and am trying to get a four month course of roaccutane for her but prescribing difficulties in the U.K. are making this difficult as is internet cost. If anyone has any lying around or can lay their hands on some my niece is coming out at the end of this month and a young Ethiopian would be very grateful.
So, as the middle classes of Gimbie arrive for their elective sections and repeat scans the rural community awaits virtually ineducateable midwives uneducated health workers and a grizzly and preventable death, teaching times maybe, learning times I fear probably not.