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Monday, November 28, 2011

Icebergs

Myrte, Dr Merawi and Kipur
The day before yesterday walking away from maternity ward I saw a small boy with a shaved head and baggy pyjamas walking slowly along the covered walkway by himself. As I passed I looked down at the top of his head and saw it was covered in horrible sores and pustules – “no wonder he's in hospital” I thought to myself. Today I met him. His name is Kipur, he is 11,he was infected with HIV at birth, he has Tuberculosis and the reason he came to hospital – if all that wasn’t enough! - was because  a month ago, when he was admitted to the childrens ward, he was starving to death : he weighed 12.5 kg, the average weight of a 2 year old in Australia! Underneath those baggy pyjamas he is just skin and bones, the skinniest human being Ive ever seen, his arms feel like twigs you could snap with two fingers. And to think that only yesterday I wrote that the famine wasn’t affecting these  parts of Ethiopia.

I also wrote that the people here are living on the edge and he illustrates how close, because with an immune system depressed by HIV, even though he receives the anti HIV medication, infection has been robbing him of the little nourishment he gets at home and he has been slipping further and further behind. In addition to being fed, Kipur is getting antibiotics for his infections, cream for his infected scalp, and 3 packets every day of PlumpyNut, a chocolatey sweet and nutrtitious nutty paste specially formulated for the treatment of malnourished HIV +ve patients. Beside his bed is a standard razor blade for slicing open a corner of the PlumpyNut packet so he can squeeze it into his mouth like toothpaste. Hes been here a month and can now walk again, and has put on 4kg. It’s worrying to think that even though he was in a fully funded programme for HIV positive people, apart from dishing out medication no-one seems to have been monitoring his health. Its also worrying to wonder about how many other kids are out there like him ; there are probably hundreds, maybe even thousands…..but I don’t think anyone really knows.
Like superstrength Peanut Butter
The reality seems to be that in Ethiopia the organized health services treat only a very small proportion of the total need, the merest tip of a massive iceberg of disease and disability. In the pediatric ward today, for example there are 4 children, an absurdly low number even just for Motta township, reputedly home to 40,000 people – there are undoubtedly many many more sick kids out there, and many are dying – the question is why aren’t they in hospital?

As far as women having babies are concerned, its been estimated that our hospital is the nearest one to a population of over a million people, and if that’s true something like 30,000 women are giving birth in our area every year, but we only see 1200,  about 4% of our potential work load. The sad implication of that statistic is that even if all our mothers were to have perfect outcomes, and all their babies were to survive and be healthy, the effect of all our efforts in Motta would not be noticed in the ghastly statistics that describe the outcomes for mothers and babies in this region where the huge majority of births occur out in the country, out of sight, out of mind and out of contact with anything that resembles modern medicine. Having seen the misery and horror of the few who manage to drag themselves in  to Motta, I shudder to think of the scale of  suffering and of injury and loss happening hour by hour  as near as perhaps 30km away but who may as well be on the far side of the moon for all the help we can be to them.

Ive heard that plans are afoot to seal the road between here and Bahar Dar beginning as early as next year.(next year, 2005, starts in September in the Ethiopian Calender) If so it will dramatically improve the ability of huge numbers of people to access health services, and potentially have a much greater impact on Maternal and child health outcomes than any  piece of modern equipment, drug or foreign volunteer doctor programme. However, the services  currently in place will be completely overwhelmed and utterly unable to cope unless huge improvements in hospital infrastructure and  especially medical manpower are in place in time for when the road is sealed. Discussing this with Myrte the other day I said “ I am starting to feel what  I think the iceberg might have felt when it saw the Titanic heading for it”

I am not really discouraged by the fact that a road will have a bigger impact on health than all my efforts, or that my contribution wont make even the tiniest blip on the statistics, because I always knew I wasn’t going to be changing the world. However every now and again here in Motta something I do makes a big difference to the life of one poor family, a difference that might not have happened if I wasn’t here, and that’s enough for me.

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