The machine that goes ping

It's been a while since I posted anything but a lot has been happening.

Last week I went to Addis to help my friend Tom (an anaesthetist with VSO) with a project. His hospital has a very nicely set up neonatal unit (made me a bit jealous) and had recently been donated a pile of second hand equipment by a US charity. They were keen to set up a neonatal ventilation service and had asked Tom to help, who in turn asked me to give him a hand (in his words 'I can do the ventilators and you can do the little people').

In the equipment room was a bewildering clutter of medical machinery including cardiac monitors, an autoclave, a defib, spirometer and 3 neonatal ventilators attached to air compressors.

The first ventilator we tried seem to work ok (once we managed to shut off the ear piercing alarms) but something seemed to be not quite right. Eventually we established that something was deeply and unfixably wrong when we realised that the PEEP dial was controlling the rate. The next ventilator we plugged in briefly alarmed then died and filled the room with the smell of electrical fire. At the point of despair we did manage to get the last ventilator to work consistently. Currently the plan is to use it as CPAP driver for a few weeks to test it for reliability and familiarise staff before trying to ventilate any babies. I'm hoping to make a follow up visit at the end of the month to see if this is feasible.

It felt very odd yet strangely reassuring to be back in the 'comfort zone' of a neonatal unit surrounded by incubators and alarming machines (several friends have long standing sealed orders to shoot me if I ever consider a career as a neonatologist) but the experience turned up several issues and dillemas for me. Back in Bahar Dar we can't even administer effective phototherapy and have had several deaths from kernicterus (brain damage due to high levels of jaundice) and I'm not sure that establishing a ventilation service should be a priority when the basic standard of neonatal care remains so poor. There is also no provision for supportive medical, financial or social care in Ethiopia for any babies who may be 'saved' by the service (the sick and premature babies who survive ventilation will have a very high risk of developing often severe disabilities). And there is also the difficulty of safely ventilating babies without the facility for blood gas analysis, although this will hopefully change. It will be a challenge to safely and fairly develop this service, only the second or third I believe in Ethiopia.

The charity who donated the equipment obviously did so with the best of motives. However 'dumping' a pile of old medical equipment with no support in setting it up or using it and with absolutely no ability to service it locally when it inevitably malfunctions is at best a questionable gift.

Back home things are going well. Ruth and I planted the first phase of my vegetable patch and the salad and beetroot have already germinated (pictures with next update). Seeds for phase 2 have been purchased, carrots, tomatoes, cabbage and chard and I'm also seriously considering getting some chickens! Best of all there has been no sign of the rat for the last 3 weeks, the low tech measure of sticking a large rock over the drain in the shower seems to be keeping the bugger at bay.

At work the big news is that I finally managed to get a delivery of the therapeutic milk used to treat children with malnutrition (since we ran out several weeks ago we could do little more than watch them get worse as their digestive system is unable to cope with normal milk or food). Still not sure where the issue in the supply chain was but ferenjii pestering power managed to get around it. This week was exam week and it was fun to take part in the short and long cases. I wasn't as soft a marker as I thought I would be!

Time to go I think. Here's some photos I took during a trip to Gondar, the old capital of the emperors, a few weeks ago (where I spent my final year elective at medical school).