Warmer babies and a weekend in Awash

Time is flying by here and it is now only about three months until I plan to return to the UK, ready to start work back in Bristol at the beginning of September. 

Life at the hospital has been really busy over the past couple of weeks.  The rain brings disease and has led to increased numbers of children requiring admission, including several with severe malaria.  One of the doctors kindly checked that I am taking my doxycycline properly!  The number of admissions has exceeded bed capacity so cots and mattresses line the main corridor on the paediatric ward.  The 4^th year medical students had their clinical exams last week so we spent three days assessing their history-taking and examination skills.  The increased workload, together with staff shortages, has meant that I have found it hard to escape from the ward to work on other projects.  Amongst other things, I plan to work with the Head of Paediatrics to develop standards of paediatric care and basic neonatal management guidelines.  I hope that I will have more time to work on this over the coming week.

It has been great to see that some of the changes (medication charts, neonatal monitoring charts, neonatal referral forms) that I have introduced at the hospital have become part of routine care and I hope that this will remain the case long after I have left Ethiopia.  I have also been really encouraged by the results of a repeat audit of neonatal temperatures.  You may remember that when I arrived I was really struck by the number of hypothermic (cold) babies on the Neonatal Ward.  I decided to undertake an audit of the temperature of the babies on the daily ward round over a two week period and found that 49% had a low body temperature.  Following this, I raised awareness of the dangers of hypothermia by training the nurses and medical interns, arranged for repair of the overhead heater and wrote a guideline about managing hypothermia which was translated into Amharic.  I have been reinforcing good practice on ward rounds, including making sure every baby is given a hat to wear and that we use Kangaroo Mother Care whenever possible.  I recently re-audited the body temperatures of the babies and was really pleased to find that there was a significant reduction in the number of cold babies - decreased from 49% to 23%.  The number of very cold babies (temperature less than 35C) had reduced from 22% to 2%.  I am really pleased with these results and will present my findings to a departmental meeting soon.  It is clearly vital that the good practice continues and I will encourage the doctors to identify other areas where audit could be used as a driver for change.

Improved patient monitoring: one of the medical interns records the vital signs of a baby

Another way in which I have highlighted areas for improvement in clinical care is through individual case review.  I recently presented the cases of two babies with bowel obstruction to a joint paediatric and surgical meeting.  Both babies died after their operations, one after two days and one after eight days.  After the deaths, the local surgeon said he that was reluctant to operate on any more babies as he had concerns about the way that they were looked after post-operatively.  I suggested that we looked at the two cases in detail to identify what was done well and what could be improved.   The presentation was well received and it was great to see local doctors identifying gaps in clinical care and making suggestions as to how practice could be improved.  Poor documentation was a consistent theme and I plan to develop a training session for junior medical staff across the hospital about the importance of recording the care that they deliver.

Helen and I are now the only VSO volunteers at Haramaya University but feel well supported by our Ethiopian friends and colleagues.  My salad leaf, basil and coriander seeds have grown well on the balcony and I have been enjoying the fresh produce over the past week.  It was ‘Fasika’ (Ethiopian Easter) last weekend so Helen and I took advantage of the public holiday and spent three nights in Awash National Park which lies about 300km along the road to Addis.  The park takes its name from the Awash River which forms a series of beautiful waterfalls as it flows into a deep gorge.  The gorge then carves through the savannah landscape and reaches a depth of 150 metres in places.  We stayed at a lodge overlooking the falls – the dining area was positioned such that you could watch crocodiles basking on the rocks in the river below.  We were very lucky to meet some expats who had their own vehicle and invited us to join them on a couple of game drives and a trip to Mount Fantelle, a nearby dormant volcano.  Although there are reported to be large mammals in the park, it is rare to see any of the ‘big five’.  The area is rich in birdlife and the park is reported to be home to 450 species.  We saw dik-dik, gazelle, oryx and baboons on an early-morning game drive and spent a very pleasant evening watching hyenas and warthog leaving their den to go out to hunt.  Last Sunday morning I climbed about 1000m to the top of Mount Fantelle and was rewarded with stunning views of the surrounding Rift Valley and a 350m deep crater ‘lake’.

The entrance to Awash Falls Lodge

 

Enjoying the view over the waterfalls



Hyenas and a warthog go out to hunt at dusk

A crack created by previous eruption of Mount Fantelle

 

View over Lake Beseka from the top of the volcano - it was a steep climb!

 

The reach of the mobile phone - overlooking the crater at the top of the volcano

I will travel to Addis in a couple of weeks for a VSO ‘leavers workshop’ and am looking forward to catching up with some of the other volunteers.  I’ll be in touch again soon with more news from Ethiopia.