A goat and a hyena

The weeks now seem to be flying by.  It’s just over two months since I left the UK and I am certainly becoming more used to my surroundings.  Every now and again, however, I am reminded that I am a long way from home.  The day that I saw a goat wandering around the children’s ward and the morning that a hyena stared from the roadside as we left the university campus served as such reminders!

Life at the hospital is busy and I am becoming more involved with the various activities of the paediatric team.  The fourth year medical student exams were held last week so I spent two days examining the students on ‘long cases’ (students take a history, perform a physical examination and then report their findings and management plan) and another day examining the respiratory station of the OSCE (Objective Structured Clinical Examination).  The OSCE consisted of a circuit of eleven stations, some involving clinical contact and some requiring the students to answer questions related to photographs.  I was asked to develop two questions on developmental milestones and newborn classification.  Forty four students are attached to the ward at any one time and watching them each spend six minutes examining a child’s chest felt like a bit of a marathon!

The first intake of medical students graduated from Haramaya University last month and started work as interns today.  Thirteen of them will be attached to the paediatric department for ten weeks.  I have worked with the paediatric doctors to develop an intern induction programme and suggested that it would be good for them to each have a clinical mentor.  I attended a meeting about the proposed roles and responsibilities of the interns at the medical school last week which was very interesting.  Professional accountability and continuous professional development have very different profiles here and at present there are no postgraduate examinations.  The medicolegal system is very much in its infancy but I am sure that things will be very different when the new doctors approach the end of their careers. 

My clinical contact continues to be mainly focussed on the neonatal unit.  I have been delivering weekly training sessions to the neonatal nurses but at times feel very frustrated by the lack of basic care.  I reviewed the log of all admissions to the neonatal unit during October and identified a mortality rate of 28%.  A further 44% of babies leave the hospital without medical agreement and I know that many of them will not survive.  At times things do go well though and it was lovely to see a preterm baby whose Mum brought her back to the ward for a ‘check up’ last week – she looked really well and was gaining weight which was great.

A happy Mum returns to the Neonatal Unit with her thriving preterm baby

I have been struck by the number of babies with congenital abnormalities here – many women do not have any antenatal care and few have antenatal ultrasounds scans.  I have seen three babies with no anal opening (fatal if not operated on), two with severe spina bifida (one who was born at home and didn’t come to hospital until he was three weeks old) and two with encephalocoeles (herniation of brain tissue through a defect in the skull) – more than I have seen in over six years of paediatric practice in the UK.

Helen and I continue to enjoy our Amharic lessons, and I helped at Saturday Club again last week.  I enjoyed pottering around Harar at the weekend – the market was really lively on Saturday afternoon and I managed to fill the fridge with quite a range of vegetables.  Green beans, lettuce and cucumber have become quite exciting!  I also located the alcohol shop so was able to enjoy a gin (with lemonade...) at an Ethiopian friend’s party on Saturday night.

I think I will have a busy week introducing the new medical students to paediatrics and delivering some of the induction programme to the interns.  Susie (VSO midwife) and I plan to visit the other government hospital in Harar tomorrow afternoon to arrange some refresher neonatal resuscitation training for the staff there.  I will be in touch again soon with more news.