doubleplusungood

I've had to move my blog over to wordpress, at least for the time being:
http://idiotwindblowin.wordpress.com/


Given my links with VSO it is probably inappropriate to discuss why in too much depth.

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).

The Ethiopian Riviera

Time moves on and I've been in Bahar Dar now for over 2 weeks and for better or worse am starting to get into a routine. I've been meaning to post something new for a while but have been too busy finding my feet.

Life at home has been improving steadily but unfortunately the poison has not entirely deterred the rat and I've had a few face to face meetings. I missed my best chance to rid myself of my murine intruder when it ran to hide behind a chest of drawers giving me a good shot with a broom handle but I missed and (s)he escaped. My currently enacted plan C is to seal up all possible entry points and so far it seems to be working. Plan D would have cravings for fish and go miaow.

More happily I'm now pretty much equipped for day to day life but am holding off doing anything more adventurous than make porridge or sandwiches until I am rodent free. Tea and whisky supplies remain healthy but marmite supplies are approaching critical – reinforcements have been requested but their ETA is 3-4 weeks. I also now have a (mostly) working sink and am munching away on bananas and papaya from the garden. When I moved in there was a dirt track outside the front door but the town is currently in the process of turning into a tarmac road. I'm sceptical I will see the end result before I return and it is currently a muddy rubble strewn mess. A lot of building projects seem to get started and then peter out long before completion. BD is littered with concrete skeletons of buildings, many surrounded by decaying wooden scaffolding and sporting enough plant life that they are starting to resemble woodland.

The roadworks seem to be having a bad effect on the water pressure and the only tap that reliably works is in the garden. It's amazing how refreshing a cold 'shower' from refilled water bottles can be after a hot dusty day! It's now been 3 days since I last refilled them though and I need water soon!

On Sunday Ruth and I went to the Blue Nile falls, about an hour outside of BD. I visited them once before in the dry season and was disappointed but Sunday was truly spectacular. It was also lovely to get out of town and see some countryside – fields of tef, chat and millet. We also went on a brief boat trip on Lake Tana itself and visited the Zege peninsula. Besides from the amazing birdlife we saw hyrax, vervet monkeys and a huge monitor lizard.

More photos 

I've been taking things slowly at work, mostly just observing and getting a feel for the system. Felege Hiwot is one of two referral hospitals in Amhara state covering a population of around 10 million as well as serving as the district hospital for the BD region. There's a slightly complicated political background in that the university and most of the medical staff are under the authority of the federal government but responsibility for the hospital itself is down to the state government. The staff are great and the medical students are incredibly keen and knowledgeable (I'm afraid they put UK students to shame). The hospital itself has a number of structural and institutional problems and feels like it has been neglected for some time. The children's ward is filthy and badly under equipped, especially the neonatal unit. There's a major lack of nursing staff and also supply problems with vital medication and nutritional supplements. The degree of pathology is harsh, TB peritonitis & pericarditis, rheumatic heart disease, liver failure, horrific pneumonias, all underscored by the 3 horsemen: HIV, malaria and malnutrition. I will go into this further with my next post.

The noises in the roof

My worst fears confirmed this morning regarding the noises I had been hearing in the roof at night.
In the bathroom my bar of soap had large gnaw marks on it and next to it was an unmistakable rat dropping.

I'm pretty live and let live about these things and was fully aware that there would be rats around but I'm not prepared to live with them in the house! After much frantic signing and failing to communicate ( although I learnt that Amharic for rat is ayitt) I managed to find a shop selling rat poison. Now the roof space is well baited I'm hoping the current noises above are rodent death throws. Sadly more humane methods, I'd prefer traps, were not forthcoming and I'm afraid I've had to throw my principles out with the soap!

In happier news that is only exciting to me today I managed to buy a fridge after persuading the shopkeeper that I was not going to pay the ferenji price of double the sticker. It is now humming away reassuringly, inside are a few bottles of water and a St George's beer to take my mind off the rats (I fear the singular is unlikely).

On Friday I had a brief look around the hospital and met many of those I will be working with. That deserves more than this quick update.

Bahar Dar

Today I said goodbye to the red cross centre that has been my home for the last 11 days. It's been useful and fun, I've met a lot of great people but I was starting to feel institutionalised and am glad to move on. Addis is an exciting town but I was also keen to leave the dust and smog behind.

After getting up at the unreasonable hour of 4:30am we were driven to the airport with a ludicrous amount of luggage. To add to me 2 large bags I had acquired a huge box from VSO full of vital equipment such as water filters, electric cooking plate and a paraffin burner. After manhandling everything to check in I was a mere 40kg over my limit, no Ryanair like excess fees though - an entirely reasonable 240birr (just under £10).

Bahar Dar is set on the southern shore of Lake Tana, a vast freshwater lake in the north of the country and is one of Ethiopia's most pleasant cities. We were met at the airport by the vice-dean of the medical school and given a quick tour. We stopped for coffee in a lovely hotel on the lake and were surrounded by weaver birds and parrots in the trees.

I have a huge house all to myself with an entirely empty spare room (perfect for visiting guests) and a small garden complete with banana and papaya bushes. It could do with a spring clean and the plumbing needs some TLC but I'm happy and it's great to finally unpack. Tomorrow Ruth (a consultant obstetrician) and I visit the hospital...

More photos - training in Addis and new house

Tena yisTilign

Time for a first blog update. I'm not labouring under the misapprehension that I have anything interesting to say or that I can write well so updates may be sparse to none existent.

I've been in Addis now for just over a week and I depart for Bahir Dar in 3 days time.

We have been staying in comfortable seclusion at the red cross training centre. Each day has been packed with a combination of adminstrativa, political and cultural education on Ethiopia and Amharic language training. The latter is brining back bad memories of high school French lessons, only more so. So far I can (just about) count to 100, buy fruit and vegetables, order at a restaurant and talk about my family. Hopefully tomorrow we won't be learning to talk about what we did during our summer holiday!

One of the most bizarre experiences was a trip to a private clinic to get a mandatory health check in order to be licensed by the ministry of health. After a cursory but friendly once over from the doctor I emerged clutching a sheaf of coloured pieces of paper for tests which to my surprise included an ECG, CXR, fasting lipids and ESR. Some might say this was a bit over thorough (cynics may have other explanations).

The weather in Addis reminds me very much of home, cool and rainy with lots of clouds. There are even beautiful roses growing in the garden here, not something I expected so close to the equator! Only during brief breaks in the cloud cover does the strong sun remind you that you are in Africa.

This week I've also been reacquainted with two old friends. It was lovely to catch up with Million who was a schoolboy in Gondar when I last met him, now he has graduated university and works for a tour company in Addis. My other, not quite so positive, reunion has been with injera, the staple carbohydrate in Ethiopia. Made from teff, a local grain, it resembles an old grey flannel or pancake, has the texture of a crumpet and a vinegary taste not unlike sour dough bread or perhaps spoiled milk.

It's been a busy and very useful week but it has also at times left me feeling a bit like I'm imprisoned behind a bubble with only brief glimpses of the real Ethiopia. I'm looking forward to heading off and starting my placement. Next stop: Lake Tana.