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Sunday, November 27, 2011

Changes

Stacks of Teff
Ive been here eight weeks now and for the first six was the only foreigner in the hospital, but now I have been joined by Myrte the volunteer midwife from Holland and things certainly have changed.. We have been very busy with difficult patients and complications, but there has also been time for the introduction of a plan to make the place better that I had been working on before Myrte arrived  I had written it up as a  Power point Presentation and after working on it with Myrte I presented it to the midwives and the 14 student midwives a few days ago. Essentially we wanted to improve communication and organization within the unit, quite simple changes which we felt would enhance the care and the outcomes women would receive. My idea was that we would outline the plan and then work steadily on implementing its  eight points over the next few weeks. Myrte however had other ideas - she was expecting it to all be implemented right from Day One, something I felt would be too much to expect. One of the changes we wanted to make was for every patient to have their vital signs recorded  and entered on a bedside chart every morning at 8am, and then for everyone to meet and do a “Round” of all patients together at 8.30. I also wanted to assign individual students to particular women, to give them some personal interest in the case and take on some of the responsibility for caring for her. In the “west” these activities have been a normal part of hospital practice probably since Florence Nightingale and hardly seem revolutionary but here, they are foreign ideas which my predecssors have also tried to introduce but without success. The practice of  midwifery here is largely  what I call “reactionary”, that is to say nothing is anticipated or prepared for , nothing is done until something else happens to prompt it – and this is true for things like running out of stationary and batteries, and for managing labour in someone for whom it could easily be anticipated that there could be problems.
The morning after we made our presentation, to our amazement every bedchart was filled in by  8.30 and every midwife and student  was present for the ward round. After the round they split off to do the tasks needed for their assigned patients instead of milling round like a mob of confused sheep getting in the way, and later still, when the work was all done Myrte gathered them all together for a discussion about care of the newborn. She has got tons of energy and is full of enthusiasm for midwifery and for improving the lot of the women here, and that I think is why our little plan just might succeed.


Cutting the Teff
Meanwhile, the fields of teff have been harvested. The rocky track to the Hospital passes through the middle of  one of these fields which cover the rolling hills in all directions around Motta, so it was easy to watch the harvest. I was amazed at how quickly a line of 17 men with small sharp curved sickles moved across and cut it all down,  in a sort of self induced frenzy, shouting and yelling encouragement to each other , then stacking the bundles to one side as other men with pairs of bullocks ploughed up the ground where only hours before  fields of golden teff had been growing. The tiny seeds from the teff are the base ingredient for Injera, the staple food of Ethiopia. It was the failure of these crops because of drought – and also because of inhuman Government policy, including massive expenditure on arms instead of health in the 1980’s - that led to devastating famine in the region. It was the trigger for the first “Live Aid Concert” and that catchy “Feed the World” song. The famine currently happening in the “Horn Of Africa” is affecting  mainly neighbouring Somalia , as there clearly isn’t a crop failure in Northern Ethiopia where I am, but its easy to imagine, seeing how poor and on the edge people are here, that crop failure would rapidly see famine re-emerge.

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