So we are into our final week and although I remain fairly
laid back the ‘so much to do and so little time to do it’ pressures bear down
relentlessly. The car is stalling a lot
and intermittently producing volumes of
black smoke adding to the growing hysteria.
The internet sites to are producing dire warnings of the difficulties of
obtaining Djibouti visas, which has had the added frisson of requiring a letter
of support from the British Embassy, an
organisation that is dedicated to leaving British subjects bereft of any help,
if it actually deigns to open or publish its rather elastic opening hours. There may be a little help on the horizon as
a phone call to the Djibouti authorities suggested that all that was required,
other than the usual multiple photographs was $140 in cash per person. African exploitation is alive and well here
in the horn of Africa. Our trip to Addis
last week coincided with the exit of the medical director’s wife, who could
stand no more and was back to the home state of Malawi. They required dropping off at some guest
house, of which they had only a scanty knowledge of the geography, sticking
another 2 hours on the journey, and when they arrived decided that it was
unsuitable so travelled on with us.
Sadly Lion’s den, the usual hostelry has been declared unsuitable,
uncomfortable beds, crap showers poor breakfasts etc. and we have been moved
away from the Greek Club, nice ambiance, splendid salad and wine by the
glass. Instead we were installed into a
guest house which was newly opened and a little disorganised but comfortable
enough if in the Addis equivalent of Twickenham. This may have something to do with Camilla
joining us as this is clearly where she feels at home. Addis itself was fairly trying as the African
Union was in town so roads were blocked off everywhere and we were not allowed
to stop, so much so that I was forced to abandon Karen and it took the best
part of an hour to do the back doubles to get her. (You will understand from
this that we are now beginning to understand the local cartography a little
better.) Also in need of rescuing was
the aforesaid Camilla who was either abandoned or escaped and found wandering
down (or was it up) the Bole road as we were going for supper, before picking
up our guests. Unusually for this part
of the world they arrived early (mid meal) so we had to send off a greeting
party which was nice as they were able to join us, though Adam has been laid
low since. Buying all that soft paper
seems to have been a good thing. Sadly
attempts to buy a picture to take back with us continue to stall, through lack
of agreement and the somewhat touristy nature of the ones I like (vague shapes
of priests in rock hewn churches).
However as Karen has had enough there may not be the need for many
memories but we shall see.
Our long planned trip to Addis coincided with my oppo’s need
to register his wife on some course the other side of Ethiopia so with these
priorities the population was abandoned for a few days to a visiting
obstetrician on call from the hospital down the road. I arrived back to taking call and sorting out
the hypertension of many days. Some poor soul had ruptured her uterus and lost
the baby but was a least alive to tell the tale. Nasty moment when she said she was leaking
urine but happily this turned out to be retention issues so will not need the
trip to the fistula hospital. However I
continue to be on call and there is as yet little sign of returning Ethiopian
obstetricians though I live in hope and look forward to a gin and tonic. Visiting 16 year old is embryonic doctor, so
with only one fainting episode has been joining
the group that moves around with me. Jen, all bouncy enthusiasm, has
declared the bus ‘impossible’ and required a lift to Asosa to catch the plane
leaving Emily who has taken Adam under her wing and shows promise as an
embryonic missionary doctor, she even beats him at table tennis pointing to a
past of travel or youth clubs.
So back at the coal face it is business as usual but with
some surprising cost savings as the hospital at Nejo (clearly the relevant
doctor has gone away) had the wit to put two women with obstructed labour in
the same car so they both arrived simultaneously producing the potential of
some interesting ethical dilemmas, particularly - labour lasting some time – as
both babies were not reaching their happiness potential, but as luck would have
it one was deliverable vaginally.
This was duly pulled out with a second or third hand KIWI
cup which is not something I will miss as they invariably break suction at the
critical moment and spray unmentionable fluids at you which you are ill dressed
to cope with. The baby inevitably needed
resuscitation which was managed with much greater competence than hitherto
which was pleasing and when not sucking as a little shocked, they spontaneously
put down a tube and gave sugar followed by breast milk. Progress in deed. Happily the shortly delayed a Caesarean
produced a meconium stained (well they all are here) but otherwise very fit
baby.
We went off to Aira Hospital to look at the labour ward book
and pick up an Ethics letter and it was very muddy, causing me to put the land
cruiser in the ditch at a rather perilous angle, there being a very deep hole
in the middle of the rather narrow track which I had been trying to avoid. Lots of sliding cursing a diff lock but with
the directions of a helpful minibus driver and Karen we managed to extricate
ourselves with nothing other than a few scratches (to the car not us). Predictably
none of the documentation we required was readily available and the only way we
could get the required letter was to track down the administrator who was doing
a conflict management course (I kid you not) in some local but not easy to find
school. Permissions granted though with
some suspicion, we were able to look at
the relevant books but were upbraided by a belligerent doctor who thought we
were spies. Bureaucracy delay and
paranoia remain part of the Ethiopian culture and will I fear take a long time
to change. As I very gingerly did the
return journey later I was given the evil eye by a larger bus driver who could not understand what the fuss
was about. Next day was not so
successful as we failed to get the car up a steep and muddy hill with a
precipice off left so after the usual extrication, go back, we had to abandon
the trip. Our last mud extravaganza now
is the trip to Addis.
So as we pack up and the stream of Ethiopians to our door
for rich leavings grows ever longer, what have we achieved? Hopefully we have shown that warm fed dry
babies survive even when small and certainly they try much harder and this
small development may be the best we have achieved. I have demonstrated that oxytocin in
primigravid women can work as well as a caesarean even (horror of horrors) if
there is meconium about though at some personal cost as initially I had to sit
there for the rest of the delivery. We
have tried to persuade the women with real risk to come to hospital with some
result and a few have survived their obstruction, anaemia and even sepsis, for
these individuals a result but for sustainability, well that’s another
day. I hope that I have also shown at
least two individuals, that targeted radical surgery can certainly bring
symptomatic relief at little cost and for probably the majority an improved
survival if not cure and that the surgical practice of a different generation
is what is right for the facilities available.
We probably have to resist the siren call of the instrument companies
who are selling laparoscopic equipment and I equally, though it would be fun,
have to resist the temptation to teach laparoscopic surgery to the private
practitioners queuing to service the burgeoning middle classes of Addis. Personally despite the downs the fatigue the
squalor and the lack, a great adventure – possibly one that I would repeat, but
would I have company?
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