Busy times

Life continues to be busy and will no doubt remain so during my last few weeks here.  It has been great to have visits from three sets of VSO volunteers over the past month or so.  They have all been very impressed with our accommodation at Haramaya (having a hob and an oven is a definite luxury in Ethiopia!) and have enjoyed visiting the colourful city of Harar.  I am really looking forward to my sister and her boyfriend visiting in a couple of weeks.  It will be lovely to show them what I have been doing over the past few months and to explore the sights of northern Ethiopia together. 

Helen and I continue to have weekly Amharic lessons and have even begun to master the past and future tenses.  Knowing a small amount of the language has certainly helped with day-to-day activities and seems to impress the locals.  My daily 10 minute walk to and from the hospital includes a chat with several people – there aren’t many ‘ferengi’ (white people) in Harar so after nine months I remain somewhat fascinating!  I often buy bread for lunch from a small kiosk near the hospital and bananas from a lady who has a stall next to the hospital gate.  I’m certainly going to miss being able to buy a kilo of mangos for 50 pence when I get back to the UK!

A well-stocked corner shop!

Bananas at the hospital gate

 

The paediatric ward at the hospital remains full and there are still mattresses lining the main corridor.  Many children are admitted with malnutrition or have diseases such as TB meningitis and rheumatic fever which have largely been eradicated at home.  There has been a recent measles outbreak with many children presenting with severe complications, perhaps useful experience for my return to the UK…  The number of babies with congenital anomalies is also really striking.  Over the past couple of weeks I have seen a baby with a cervical meningocoele (a protrusion of the fluid surrounding the spinal cord from the back of the neck) and two babies with encephalocoeles (a protrusion of the brain from the skull). 
 

Mattresses line the corridor in the Paediatric Ward

A couple of weeks ago I saw a five month old baby who was admitted to the Neonatal Unit back in January with severe breathing problems.  He had some immunisations at the hospital last week so his parents brought him to see me.  It was really lovely to see that he is thriving and developing well.  I was also very pleased that two babies stayed to complete three week courses of antibiotic treatment for meningitis and another premature baby weighing 1.4kg has been receiving Kangaroo Mother Care over the past ten days.  The neonatal nurses are becoming more involved in the monitoring and care of the babies, and I am sure that this helps in encouraging the families to stay to complete treatment.

I continue to teach the 4^th and 5^th year medical students, and helped to assess the 5^th year medical student clinical exams last week.  I’ve also completed the evidence-based neonatal clinical guidelines which provide an operating framework for the neonatal unit as well as guidance on the management of common neonatal conditions.  The guidelines were printed on Friday ready for introduction and implementation this week. 

Medical record-keeping is an area in which practice could certainly be improved at Hiwot Fana and was identified as a major weakness in the care of the two surgical cases that I reviewed recently.  Together with a colleague, I have recently audited the standard of recordkeeping across the hospital and developed a two hour training session about medical documentation.  We delivered the training to 24 medical interns last week and will assess the impact in a month or so.  The interns are working really hard currently (night duty every two to three days in addition to normal working hours) as half of the group are completing community-based attachments.  I attended the final presentations from the first group of community-based interns a couple of weeks ago.  It was interesting to hear how they have been identifying ways in which they can improve health outcomes (such as improving attendance at antenatal clinics and administration of vitamin K to newborn babies) and have been delivering health education to various target groups.

I really enjoyed my trip to Addis for the VSO Leaver’s Workshop at the end of May.  It was great to catch up with several other VSO volunteers as well as a couple of friends from Haramaya who are now living in Addis.  A change of diet and a glass or two of decent chilled white wine were very welcome too!  I also had my first set of blood tests for viruses after my needlestick injury and was really relieved to know that everything was negative.  I’ll have another set of blood tests in August.  I flew to Addis again today for a workshop reviewing the VSO Child Health Programme in Ethiopia.  Currently there is no funding to replace me or the other two VSO Paediatricians who leave in August.  The workshop will be attended by representatives from the Ministry of Health and UNICEF, and I have been asked to present my experiences and to discuss the case for ongoing funding.

I’ll be in touch again soon with more news and photos.