Closing debates

One of the things that Ethiopia’s poorly trained rural health service has been foisting on their local populace in an effort to keep the population down and to offer treatment for miscarriage is something called MVA which stands for manual vacuum aspiration and is basically a vacuum curette attached to a 50 ml syringe and I have even been persuaded to teach these locals how to use it using ripe avocados (quite enough of that) though personally I am not sure it has much to offer over some misoprostol under the tongue, but never mind there we are or were when I got the usual summons but this time to a 40 something old who had had this procedure some distance away and was not well, barely conscious in fact and very septic with a reported white cell count of 39,000 (normal range non medics up to 12) and a large abscess in her pelvis. After such resuscitation as is available a trip to theatre where I planned to just drain the abscess until I saw the state of her uterus but this was trick and the combination of blood loss and acute sepsis prompted sadly her demise which sadly is the way with overwhelming sepsis.  Of course she leaves 5 children, some of who were big enough to give her some blood with a little arm twisting but was her grubby initial surgery really necessary and could she not have got access to appropriate treatment before it was too late.  Probably not, this is after all rural Ethiopia and sepsis is the biggest killer but I still wonder if I had just drained the abscess she might still be ill but also still with us. 

I tell you this story as I despair of the health planning.  There are hospital but they are basic and cost but yes we do save lives.  There are health centres, they are very basic and theoretically free, but the staff are poorly motivated badly paid and by and large very poorly trained.  They are there because they have to be there and have no choice.  They are serving time before hopefully getting a desk job cooking the figures for the government and they care little other than to flog the odd free drug to increase their income.  Their rudeness to the patients is staggering and you might think that this is the lot they put up with, but most of the punters vote with their feet which is why there is so little take up of the service.  The pity is of course that if the service was taken up more things might actually get worse not better as the off the wall treatment is often worse than no treatment at all and the two things that might actually save the odd maternal life, misoprostol and magnesium sulphate are not allowed. My only contribution has been to persuade them that 5% Dextrose run fast can produce enough energy to start people contracting again and get the odd vaginal delivery, but things I am sure will soon slide back.  Simple things like welcoming your patients, giving them advice pertinent to them and exploring with them how they will get to hospital in reasonably timely manner if things do not work out well will go a long way to tackling MG5 (maternal health) which is nowhere near there but I am sure that the book cookers will sort that.  Investment into some sort of transport infra-structure would however be the biggest contribution.

Last Monday was a bank holiday here, celebrating the fall of the ‘Dirge’ (the communist lot) but as one Ethiopian wag pointed out (and Ethiopians with an overt sense of humour are rare) what they are actually celebrating is the change from overt to covert communism and you do have to ask what us NGO workers are doing, and more importantly what is our government doing, pouring so much resource into an environment that really just squanders it, but then it is probably more to do with the bigger political picture, it does after all contain the Somalis to the coast where the American Seals can blow them out of the water if they get too close to a ship.  Meanwhile the government here continues to bully, humiliate and despise the NGO workers, what they really want is the money not the people and probably they should get neither, but Chinese and others would come rushing in to fill the gap so we will doubtless just go on giving them the money -   A mad world indeed.

Meanwhile the organisations for which we volunteer seem to be going through one of their periodic convulsions about which I shall have to be careful as a local reader would be mighty cross if I was to tell all, but promise all will be revealed on or about 07 August.  Suffice to say many are looking for new jobs or may even have got them, some relationships are closer than they should be or is healthy and others are very strained indeed. Happily ours is not included but we are dispensing tea and sympathy while blithely pretending all is well.  The Adventist too, have their problems both with paper work and a general desire to maintain the status quo at all times.  I am told that when the work force come for discussions with their faranji counterparts the translating big wig Ethiopians who are all related start by saying that they are going to be told off but it is alright as they will protect them.  The problem however is bigger than this as the hospital is failing and there is a rival (probably equally failing but government supported) up the road and the withdrawal of safe birth fund funding means that a great proportion of the populace remain unsupported and the government hospital has not the resource.  MG 5 is indeed a long way off.

NB For those of you who do not believe in disproprtion see below!