Venalmalignancy

For much of the time I have assumed that the Ethiopian condition is brought about by incompetence but I fear that the combination of grasping venality and cynical manipulation suggests that something much more malign is about.  This thought struck me as I saw various off white coats and our new (but shortly to depart as he cannot stand it) medical director down by the incinerator hut burning boxes.  The smell of cardboard mingled unhappily with that of plastic which I was to learn was that of many blister packs of just post- date drugs that would now no longer be able to help the needy.  These drugs it would appear are actually provided free at the point of use by the government but delivered, with the usual mountain of paper work when they are about to expire.  That is to say with only two months to run and as they know when they are about to expire they can come and do random checks, and hey presto the hospital is in trouble and a nice big hefty fine.  Meanwhile, blood transfusion sets (ones with filters) have run out and there was a plan to refuse blood to the seriously anaemic because of this.  I explained that the odd small clot would just block the cannula and not the vein but they were not happy.  Given that the planned recipient was about to die, (or expire as they say in these parts) with a haemoglobin of 2 gms I felt that this was the least of her problems but they were still being difficult about who was going to pay.  Currently too the charity to whom I am increasingly loosely linked is handing out free drugs (bought from the same government warehouse) to the local health centres in an effort to redress the imbalance set upby something called the 30-70 rule.  This seemingly sensible idea is that only 30% of a charities money should be spent on administration the rest given over to good works.  Problem is that ‘training’ is administration and readers of this blog will know that all our particular charity wants to do is train, so in order to redress the balance give a few sell by date drugs but only the sort that have the going cheap stickers that you see in super markets and that allows you more on your 30%, get the picture.  It also turns out to be a nice little earner for the health centre, or at least their employees too as might be expected they are sold on to the punters.  The antibiotics are probably useful but not many actually need the methyl dopa for their blood pressure and without careful monitoring actually probably counter- productive. (Venal and malignant?)  As the effort goes into training so the available funds for care fall away and there are now few health centres that have vouchers which does at least mean that my nights are less disturbed but the Government hospital takes the strain but only limited resource (this remember is going to health centres).  The result of this and probably chronic lack of planning was that there was an urgent call for cord clamps of which the charity store revealed 3, the result of some calamity when there was nothing in the government hospital to tie a new-born cords (not it seem even the apocryphal shoe lace), so a gauze was placed over the cord as the unfortunate bled to death, incompetence of an astounding malignancy in probably a very overcrowded area.  The local obstetrician who is competent and nice is clearly at his wits end and there are plans to expand, but need has to be shown.  How many have you got to allow to die before you show need and how many would receive at least some care if they were given a voucher, but no education is all so an institution with facilities and capacity is starved of funds and will probably close. (To be fair there are a lot of problems as well) while the institution down the road will drown and the punters will feel it more sensible to deliver at home and some will rue the day as they turn up too late (malignant planning, forcing disaster before change or just incompetent planning?)

This particular institution is particularly cash strapped at the moment, made worse by falling maternity income, but the employees who would otherwise vote with their feet work in an area of chronic unemployment so just have to stay, stay demotivated or beg (never borrow) or steal to survive (venal?).  Certainly the begging is increasing and the theft will certainly rise the former certainly and the latter probably as the date of our departure approaches.

Intra partum care now is largely care in the second stage and the combination of hypoxic encephalopathy and meconium aspiration is difficult particularly when useful drugs like phenobarbitone for neonates is not available which makes treatment difficult.  Not insurmountable though as you can take an adult tablet dissolve it in dextrose and pop it down the nasogastric tube.  We are getting a bit of explosive diarrhoea though but at least there is some breast milk.  The meconium aspiration, well we do have a little way to go.  If she had come in earlier and maybe that was cost it would have been a different story. (Malignant choices?)

A safe place of birth for the majority is I fear a distant fantasy.

 We seem to be running short of wine, now that is definitely a malignant change!