Power cuts and water shortages

The past couple of weeks have passed much more quickly than the last, perhaps a sign that I am settling into a routine and feeling more familiar with my new environment. 

The students began to arrive on the main campus for the new academic year two weeks ago – the university arranges transport to bring them here from cities across Ethiopia so no weepy parents in sight!  The arrival of the students coincided with the onset of long power cuts (and consequently no internet access), significant water shortages and the absence of mobile phone reception.  Helen and I are very lucky to be living in an apartment block with ‘people of high position’ so seem to have had more electricity than most.  We have still spent a few evenings with the flat lit by candlelight and had several cold bucket washes in the mornings, sadly a situation that is the norm for millions of people across the world.  Water has also been a big problem – we are now familiar with the locations of the standpipes on campus and my headtorch has been very useful!  Much of eastern Ethiopia has been affected, possibly due to a problem with a dam which took longer to repair than anticipated.

Young boy looks on as the students arrive for the new academic year

Things are going well at the hospital.  The medical student final exams were held the week before last and I was asked to examine on one of the days.  It was interesting to observe the process and certainly brought back memories of my own clinical exams.  Each student had a ‘long case’, ‘short case’ and viva so I was able to see a range of children, some with pathology I have only read about in textbooks.  Several patients had severe malnutrition which is really sad to see.  I was pleased that a couple of the viva topics were subjects I knew something about – neonatal jaundice and diabetes care are stronger areas than the management of a child with smear-positive tuberculosis! 

At times things have been very frustrating and I have found the significant staff shortages particularly challenging.  However I feel that I have begun to establish positive relationships with both nursing and medical staff, and that some small things are slowly starting to change.  I have worked with the nurses to rearrange the furniture in the neonatal unit and am pleased that the phototherapy unit has been taken to be repaired.  The appearance of the Ward Sister with a brand new bucket labelled ‘neonatal unit’, together with a new bar of soap, was a definite step in the right direction.  I have collected and washed several small drinks bottles which I hope to fill with alcohol rub and tie to each cot so that it is easier for staff to clean their hands between babies.  The neonatal nursing staff highlighted ‘training’ as something that would help to improve patient care so I will start weekly sessions with them tomorrow. 

I have found working with the fourth year medical students particularly rewarding - it is great to have such an enthusiastic and motivated audience.  I started delivering bedside sessions and lectures last week, and both seem to have gone well so far.  Bedside teaching is fairly challenging with 22 students in each group (a lot to fit around one cot!) so I decided to split the groups into two, with half the time spent on clinical examination and half preparing a poster presentation.  The students are generally taught in a very traditional way and are given a fairly tough time in handover and ward round settings – they told me that they have never been asked to prepare posters before and that they have enjoyed the interactive nature of my lectures. 

I spent last weekend with four other VSO volunteers in Dire Dawa, Ethiopia’s second largest city.  The city is about an hour away by line taxi and lies several hundred metres below Harar so is much hotter.  We spent Saturday afternoon at one of the hotel pools – great to relax and enjoy a swim.  We had an excellent Indian curry at the hotel in the evening and met some other expats in the garden afterwards.  I really enjoyed a (cold) shower the following morning, so good to feel properly clean!  It was fun to visit one of the markets – known as ‘Taiwan’ because of the number of electrical goods available to buy.  I bought a scarf which I have used to tie back the curtain in my bedroom.  I wandered down to Bate, the village at the university gate, last Sunday evening to buy some vegetables and enjoyed a beautiful sunset as I walked back.

 

Women sell vegetables in Bate

Photogenic girls in Bate

Beautiful African sunset

This weekend has been spent relaxing in the sunshine on the main university campus.  I finished reading ‘The Secret Life of Bees’ by Sue Monk Kidd yesterday – I would certainly recommend it if anyone is looking for a good read.  One of the other volunteers had a party last night which was fun.  It is really interesting to chat to local university staff and makes me feel very privileged that I grew up in such an affluent and free society.  I went for a run this morning and ventured off campus for the first time – I saw some camels carrying heavy loads and was joined by a little boy for a few metres. 

I’m looking forward to the coming week and will be in touch again soon, internet-permitting!

Hungry hyenas

I met Helen and some  of the other volunteers in the old walled city of Harar after work last Friday evening.  After dinner we went to watch the ritual of ‘men feeding hyenas’, a slightly strange experience which I decided wasn’t for me!  Some of the others fed the hyenas meat skewered on a stick, and one or two people went as far as putting the stick in their mouth... 

Helen looks slightly apprehensive...

...whilst Daisy plays it cool

We explored our local town of Alamaya on Saturday which has a large market and a small supermarket.  I felt a bit of an idiot when I walked into the supermarket and asked for a basket, not terribly culturally sensitive!  We found some hooks in the market which Brian, one of the visiting volunteers (and over 6 feet tall...), used to help Helen and I put up our mosquito nets.  We had a housewarming party last Saturday evening which was good fun – we managed to feed ten people pasta with roasted vegetables, bought some wine in a bar in Alamaya and some beer on campus, and were treated to some Ethiopian music and dancing later in the evening.  Last Sunday was unusually wet so we played Bananagrams and Boggle rather than getting soaked outside.  The wet weather quickly disappeared though and the days since have been warm and sunny.  It is great to be woken each morning by sunlight flooding into my bedroom and for the temperature to have reached mid-high 20s by lunchtime.

The reality of the role that I have taken on has begun to hit me this week.  Senior university staff are keen that I work to improve neonatal care at the hospital so I have spent much of the past week on the Neonatal Unit.  There is currently a ten cot 'intensive' nursery, a room for less dependent babies and their mothers, and a room designated for Kangaroo Mother Care that is not used at present.  I am well aware of the statistics surrounding child mortality in the developing world but actually seeing babies die every day due to a lack of appropriate care and equipment is really hard.  Just three nurses provide 24 hour cover for the Neonatal Unit, and only three junior doctors work a rota to deliver 24 hour care to the whole paediatric department.  It is therefore perhaps unsurprising that the babies have only one set of observations each day and that documentation is minimal. 
 

The workstation and assessment area on the Neonatal Unit

The 'intensive' neonatal nursery

I am sure that relatively simple interventions, particularly those to prevent hypothermia, could make a big difference to neonatal mortality rates.  I know that Jo, the previous VSO paediatrician, worked really hard to try to prevent the babies getting cold and that many people in the UK sent her knitted baby hats.  I have discovered where these hats are stored and have been doing my best to encourage staff to use them.  I have also been able to talk to two of the neonatal nurses about what they feel they do well and what could be improved.  Following a discussion about infection control, one of the highlights of my week was watching a nurse find a bucket of water and some soap, and proudly show me how I could now wash my hands!  I just need to encourage everyone else to do the same....  I have put together a report containing my observations and ideas for the development of neonatal care which I hope to be able to discuss with paediatric and university staff soon. 

I also attended a 'follow up' clinic for children with chronic conditions such as diabetes, epilepsy and chronic liver disease.  There is limited availability of drugs for these conditions but the medication that the children receive is dictated by what the family can afford.  For the medics and nurses reading this, none of the families could afford short-acting insulin and the diabetic children had random blood glucoses between 15 and >30 mmol/L.  I have also been asked to review some interesting ward patients - with very limited investigations, the doctors are very good at piecing together the medical history and eliciting clinical signs to arrive at a likely diagnosis.  I have attended two ‘management sessions’ where medical students present recent paediatric cases and discuss the scientific background afterwards.  I have been impressed by the quality of their presentations and learnt a lot about malaria, not something I saw very frequently in Bristol...  I have agreed to deliver the neonatal topics in the medical student lecture programme and will begin this in a couple of weeks. 

I have found the days at the work tiring – I leave the main university campus at 7am and return just before 7pm, by which time it is dark.  I have enjoyed having some time to relax this weekend and to further explore the local area.  Helen and I took a ‘line taxi’ into Harar yesterday – the journey was quite an experience with 22 people, plus a baby, crammed into a minibus with 12 seats.  The two ‘ferengi’ (white people) seemed to be quite a talking point!  Many people on the bus were chewing ‘chat’, the leaves of a flowering shrub, for its stimulant properties.  The area around Harar is particularly renowned for chat growing and its trade certainly seems to be big business. 

'Chat' trade in Harar

Women sell nuts on the street in Harar

We had a wander through the market in Harar and found some aubergines and ginger which will add a little variety to our diet this week!  We then went for a walk around the perimeter of the walled city and back through the narrow, winding streets.   Unfortunately I missed the guided tour of the old city last Friday but will hopefully be able to do a tour soon, perhaps when we next have visitors.  I went for a run around the fields of the university campus when we got back from Harar.  Haramaya University has its roots in agriculture and the campus is very green with several farms.  Helen and I are meeting two of the other volunteers for breakfast on campus this morning, and plan to go for a walk later - we'll pack a picnic lunch, the Kindles and my frisbee!

Harar market

Laden donkeys on the street in the old walled city

The coming week will no doubt bring its challenges but hopefully some rewards too.  I’ll be in touch again soon with more news.