Christmas is coming...

In many ways it doesn’t feel like December but Helen is compensating for the general absence of Christmas by making sure we have plenty of festive cheer in the flat.  Our bookcase has been turned around so that we can create a fireplace (!) and Helen has been busy making snowflakes and paperchains, photographs to follow...

Daisy, one of the VSO volunteers based in Dire Dawa, visited last weekend so we went on a tour of Harar’s old walled city.  Binyam, our guide, was very informative and expertly led us through some of the many narrow cobbled alleyways.  Around 30,000 people live in the 1 square kilometre walled city which contains over 80 mosques.  We visited the home of the 19^th Century French poet, Rimbaud, as well as a traditional Harari house and a very peaceful Catholic church which sits on the same site as a school and orphanage.  I bought some of Harar’s famous coffee from the city’s small factory and have been enjoying it this week with milk from one of the farms on campus.



Showa Gate, one of the six entrances to the old walled city

Inside the walled city

 

Donkeys bring wood to the city



Local butcher...



View over the surrounding countryside

Another of the gates to the walled city


It was ‘Nations and Nationalities Day’ last Sunday so many of the university students dressed in traditional costume and took part in a parade on campus to celebrate the nine different regions of Ethiopia.  Later in the day Helen and I went for a walk with Gary, one of the other volunteers, through the eucalyptus forest on the edge of the vast university campus.

Students in traditional Harari costume take part in the nations and Nationalities parade



Sunday afternoon stroll with Helen

Life at the hospital continues to be busy.  I have now presented the findings of my short audit on the temperature of newborn babies, as well as the data I collected about admissions to the neonatal unit during October.  Keeping babies warm is a very simple but effective way of improving neonatal outcomes and an area of practice that I’m really keen to improve during my time here.  My audit showed that 49% of babies on the neonatal ward had a low body temperature.  I have now developed a guideline for temperature control in neonates which has been translated into Amharic, and I am encouraging staff to promote the use Kangaroo Mother Care (skin to skin contact of mother and baby) to keep babies warm.  I think the doctors were surprised by how high the neonatal mortality (28%) and self-discharge rates (44%) were during October.  The importance of regular monitoring of babies and effective communication with families (including managing expectations – the same all over the world!) cannot be overestimated.   I introduced a new observation and fluids/feeding chart to the neonatal unit last week and hope that this will help to improve monitoring of the babies.  I have also worked with one of the doctors to develop a prescription chart (currently medication orders are written in the medical notes and there is no documentation of drug administration) which we plan to introduce this week.

I have been really encouraged by the presence of the new medical interns on the ward and am sure that they will make a big difference to the quality of care given throughout the hospital.  I delivered a session on emergency paediatrics as part of their induction programme and included revision of the neonatal resuscitation that they were taught by Jo, the previous volunteer paediatrician.  I hope to run a similar session for the medical interns working on the maternity ward to try to improve the care that newborn babies receive.  I now spend two afternoons each week working with the interns in the paediatric admissions area so that I can share my skills in acute assessment and management, including the role of effective leadership and teamwork.  I also continue to enjoy my regular bedside teaching sessions with the 4^th year medical students.

I will be in touch again with more news and photographs, including progress with the Christmas decorations!