Addis Interlude

So after an extremely muddy and slippery ride we find ourselves in Addis, obstensively to celebrate my birthday but more importantly for some relatively gourmet experiences, the power of excessive lentils having finally taken us to make the journey, which is longer than that from London to New York.  Not as gourmet as you might think as we have endured a Chinese meal of such oiliness that my fat free diet of the last few months has now been blown and it was served in a wind tunnel that actually blew the mosquitoes at you.  Karen is also paying the price of some other meal with intestinal hurry which adds another layer of discomfort to her intermittent febrile illness.  Discussions in the car and over coffee reveal that the Gimbie rumour mill has credited us with all sorts of sexual misdemeanours and proclivities that might be rather fun if they were true but are laughable as they are not.  The source of the gossip is the local ‘bad adventist’ drinking club at the ‘Green Bar’ a small all male group but transmitted by farangi gone native with much to be gossiped about.  Our consciences are entirely clear but there is much rustling of bed covers and much else in our little microcosm.  Our charity is melting down with the imminent departure of the project leader to pastures new (a BBC charity probably as loosely organised as this one) a farangi shoe in temporary replacement and a deeply dysfunctional local work force.  The hospital too is in turmoil as bankruptcy threatens, the work force has not had a pay increase and is in mutinous mood and inevititably the patients (such as can afford to come) are even more ignored than before.  The employment situation however is such as there are no other jobs, they have all been there for years and are far too frightened of moving as that would require effort, so they will just go on bitching and pilfering as before.  Even, sadly the new medical director has had enough and will depart in December, though his wife given half a chance would be gone yesterday, and the Adventist hierarchy is in turmoil, such that the church elders want to sack everyone and the seemingly terminally arrogant head of Adventist Health International is due to fly in on the equivalent of a ‘needs assessment’ visit. I say this merely on hearsay but this is on good authority, I have never met him and probably not being of the faith never will.  There is of course lots of needs assessment but little in the way of needs met.  As news of our impending departure filters through so do the visits of vultures to our doors to see what we might leave behind for them and the requests for clothes, sponsorship and money all become more urgent.  I have it mind to say we are going a week later than we really are and then ‘steal softly into the night’.

A visiting and very enthusiastic medical student has joined us, and virtually moved in.  this may be to escape from a bunch of first year, innocent and barely coping Adventist girls from America and we have set her to work trying to find out what happened to various women who have delivered in the health centres.  What is revealing about this is that all though the notes have covers with numbers written on them (seemingly random as men seem to have babies) the papers inside are bare of writing, the only note that I have seen is in my hand!  What is so sad is that the care offered in the health centres is so poor and so rudely and arrogantly delivered that the women vote with their feet.

Faranjis (us) with portable scanners and a smile get 60 odd women coming and we are able to give some sort of advice about where to have babies etc.  As an example of how sad  it can be, I saw some wretch who had attended 4 times, thought she was term and had a 22 week sized dead baby which had clearly been that way for some time and gone undiagnosed, despite gifts of sonicaids and all the rest.

Somebody also turned up with a fistula of about 4 years duration but they at least get free treatment and free transport.  The fistula hospital which I am about to visit is also in turmoil however having also been the subject of something of a putsch, though more of this later.

The two are probably not related but my departure coincides with a flurry of cancer patients and hopefully the skills passed on to the Ethiopians I have been training will bear fruit but I think that they will be scared of doing them without their hands being held.  However both I think will be on the move having learned what they can and also with the prospect of me going do not fancy being on duty one in one.  This may be a good thing though as I am encouraging them to build cancer teams and that might make a difference.  Screening too may in some nascent way become a possibility as someone wants to do pap smears.  So if there are any old Aylesbury spatulas and fixative about do save them.  What of the cancer?  The operations are possible even with big tumours, and can be achieved with relatively little morbidity, mostly wound infections, which I do not entirely understand as the caesars are relatively unscathed and so far reasonable clinical clearance.  I have found it difficult to persuade the pathologist to look at the vaginal edge and I am not sure that the formalin is a s strong as it could be given the slightly putrid smell that accompanied us to Addis with the last four specimens.  This mixed uncomfortably with the smell of vomit which always seems to occur when charity dictates that we fill the car with indigent freeloading Ethiopians piling in the back for travel to Addis or elsewhere.  We have tried to contain this with aircraft sick bags but they will not use them, merely steal them.

On a brighter note, having got the fetal monitor to work after a fashion, there is a lot of noise, I have achieved vaginal deliveries with inert primips pouring meconium, with the judicious use of oxytocin and a lot of patience.  More gloomily however the Adventists are getting more toxic about abortion, despite desperate pregnant unmarried teenagers who may well do themselves damage by going off to the back streets or abandoning their probably hypoxic and brain damaged babies, once they have delivered themselves at home.  Few misoprostol tablets and all would be safe, but then we move in strangely contradictory circles.