Killing Time

Byron Bay Bluesfest Stall

Reverse culture shock didnt seem to trouble me so much when I returned to Australia from Ethiopia this time. I stayed for a few days with Zoe in a lovely new apartment overlooking a marina in Melbourne, where we were visiting Rankine but I also wanted to visit the Melbourne Gaol and the State Library of Victoria to learn a little more about Ned Kelly - I had now read three books about him and was becoming a little bit obsessed with it all. His suit of armour is on display in the Library, along with his death mask, and one of the boots he was wearing when captured at Glenrowan in 1880. The boot is damaged by bullet holes. At the Gaol we watched a monolog from a woman dressed in period costume and speaking with an Irish accent, pretending to be Ellen Kelly, Neds mother. She passionately recounted from her perspective the story of his life, while 20 feet above her was the trapdoor and the very beam from which he was hanged on November 11th the same year.

Ned Kellys Helmet

The following week  I was at a course in Sydney with Medecins san Frontieres (MSF) - "Doctors withour Borders" I had been to an interview with this amazing international aid organisation some months before, hoping to do more voluntary medical work but this time with a large organisation as part of a team, and they had offered me a place. The course was in preparation for a mission they had offered me in Nothern Nigeria. There were 15 other participants and we all had different missions to prepare for, but much of the course content was about things common to all missions, things such as security, ethics, cultural awareness, our roles as members of MSF, crisis management, what to do if kidnapped! - and how to behave at checkpoints and under fire! - media relations, international humanitarian law...it was a fascinating course. We had to fill out "Proof of Life" forms - a list of questions that no-one but ourselves - and now MSF - would know the answers to. In the very unlikely but not impossible event of our being abducted, to prove we had not been killed negotiators could seek from our captors answers to those questions. Being asked those questions would also be a signal to us that help was on the way! It was stressed to us that road accidents and malaria were much more likely than kidnapping!  At the end of the course I had my final briefings and was given my ticket to Nigeria. I was going to leave from Auckland in a weeks time, after visiting my family.

Team New Zealands 72ft Cat : One last NZ attempt at the Cup

About this time, the French decided to mount a military offensive against the Islamic insurgency in Mali, a country close to but not actually bordering Nigeria. A few days later local health workers giving vaccinations were murdered in Northern Nigeria, and a little later several foreign workers were abducted and murdered in the same region. Being  French, MSF became a target as well - I received an email telling me the entire MSF mission in northern Nigeria was to be closed down after several years of great work : my mission was cancelled! I was really disappointed. However they said a new mission would be found, and at the moment I am expecting to be sent to South Sudan, but not until mid June - and there was news yetserday of a major outbreak of fighting and killing in that regions as well so I will try not to get too excited about going there just yet!

 

In the meantime I had an extended stay in New Zealand and then managed to find some locum work in Australia which I hope will get me through to the beginning of the sailing season, when I will go sailing and wait for the call to the Sudan.

At the moment I am returning to Sydney from a Locum in Northern New South, on a sort of Easter Holiday Road Trip. I managed to get a ticket to the opening day- everything else was sold out - at the famous Byron Bay Bluesfest, an annual music festival with a line up this year that includes Carlos Santana, Paul Simon, Joan Armatrading, Ben Harper, Iggy Pop and Robert Plant (Led Zeppelin). I listened to Ben Harper and Joan Armatrading and Chris Isaak, and several other groups I had never heard of and had a great day that didnt end till midnight.

The Pictures will do the Talking

Young man from Mursi Tribe

I was going to write about being back in the "Civilised" world. What I really mean is the "developed" world where we have Internet access and clean running water - all that stuff - but reading again about whats still going on in Syria, or in relation to Gun Control in the US, or being revealed in the Corruption Inquiry right here in Sydney where scumbag politicians and so called "businessmen" are being exposed as lying greedy thieves, - OK so whats new you may say! -  I decided "Civilised" was overdoing it a bit.

"Generation" Tree in Konso Tribal Village

Our tour into the southern parts of Ethiopia was  brilliant. The contrast with northern parts couldnt have been more stark, as we visited several different tribes over nine days in the lower Omo Valley.

Couldnt resist a quick Snap of this tourist being helped up a bank by the Omo River!!

Amazingly crooked canoes that work really well crossing the Omo

Hamar Men wear lots of jewlellery and have complicated Hair-do's

The single most vivid impression I have come away with is of the women down there - I couldnt believe how hard their lives are, how incredibly tough they are, how hard they work and how vital their roles are in all these tribal societies, and yet how passionate they seem to be about their lives and their culture and their families. I was at first heartened to hear that baby girls are prized over boys - up north its the other way round -   but then was told that this is because they attract a dowry of many cattle and sheep and goats, the ultimate status symbols of wealth and influence. In some places up to 15 or 20 head of cattle are exchanged for a young bride!

Children of Dassenach Tribe posing for Photos

Watching cattle being assembled for "Bull Jumping" Ceremony, Hamer Tribe

Karo Tribes people who live on the Omo River are renowned for Body Paint

Inside tiny smoky hut of Mursi Tribe

Outside Butcher shop in Jinka

Mursi Women famous for their Lip Plates

Out Walking

A couple of weeks ago the now dead head-high grass surrounding all the hospital buildings had finally dried out enough to be cut down and stacked, and later carted  off to be used, I think, as thatching . I had been waiting for this to be done ever since I arrived because the  tall grass blocks the view from my front door of the row of village houses and all the animal and human traffic that passes by on the other side of the hospital fence 10 meters away. A common sight now revealed again, one that put me off my morning coffee was children squatting down not far from the fence to poo on the open ground . But my eye was always drawn to a distant upward  sloping horizon across which on market days could be seen a steady stream of tiny figures creeping slowly toward town, and in the evening back again along a country trail. I often wondered where they had come from and what was over the horizon - until yesterday when I at last got to walk there.

Villagers on the road

This track turned out to be the path to a waterfall that I had been hearing about, that other volunteers here had visited , and which I decided yesterday afternoon I also should visit, and I set off at about 5 pm with Shewaye and Anna , a volunteer midwife who arrived last weekend. She has been here before and had already visited the waterfall but was keen to go again. In the end, because of fading light we stopped short of the waterfall but had a good view of it from a distance as the sun was going down behind us. The walk across the fields had taken us out of the town, past one of those lovely circular churches, and near a small cluster of homes.

Heading home

On our return we were invited to drink “‘tulla” which is home brewed beer, and given some flat home cooked bread to eat by a group of people working on a huge heap of recently harvested teff. They were extracting the tiny seeds by spreading the teff stalks across a circular sort of arena, then having their cattle walk round and round on it and lifting off the depleted stalks with an angled stick, leaving the tiny seeds and lots of chaff on the ground. Later the seeds and the chaff would be further separated by throwing it high into the air in a light breeze. They had no doubt been working there all day long and seemed glad of an opportunity to crowd around and have their photos taken – they were lovely friendly people, and obviously very poor .

Looking at their Pictures

 

As it got dark and we headed back to Motta, half an hours walk away, we started to hear the noise of the town and see the dust rising from the road as a bus rumbled past, a few lights – Motta suddenly seemed like a big place! And then my phone rang and we quickened our pace to get back and see someone the midwives were worried about. Its tempting to get misty eyed and sentimental about the sort of simple village life we had just glimpsed – and I think if you weren’t old or sick, or in labour in such a place,  there would be times when it could probably provide  just about everything you could want. Certainly the kids seemed happy.

Ragged clothes worn till they fall off

Back in Motta, we quickly sorted out the problem and then had dinner. Since Anna got here last week we have been sharing the cooking, and it was her turn and we had a pasta dish with local spinach and the first cheese Ive had this year because Anna had bought with her a big ball of lovely dutch cheese. The previous night she had made a tasty salad to supplement fish cakes that I had made. 

Today is Saturday but I wont be going to the market. Instead, I am packing up my stuff and leaving for Bahar Dar, as my two month spell comes to an end. In an hour or two my replacement should be arriving – I hope they are sending her in a more reliable vehicle than they one that was supposed to bring me here – otherwise she might end up on the bus and not get here till 8pm. However  I am not leaving Ethiopia for another two weeks, as I am going to have a holiday with Ewin who flies here in a few days – we are going to tour the southern parts of Ethiopia. Not sure how much internet access I will find down there but the next few days I will be in Addis.

Shit Happens

Builder at Motta Hospital

There are proper toilets in all the buildings at the Motta Hospital, and a shower is included in several of them but because for  many years there has been no running water all of the toilets and showers are “non functional”. In the unit that I stay in, the toilet is still connected to some sort of septic system, so I can flush it by tipping half a bucket of water in, but the shower isn’t usable. To have a shower I heat water up on the stove and use it to warm up another half bucket and tip the water over me from a small plastic jug.

In recent months  parts of the hospital  have reacquired running water to a few taps and a couple of showers : these are the Maternity Unit, and the Operating Theatre, which apart from being the place where young men get circumcisions, is almost exclusively used by the Obstetricians for caesareans. These select areas have running water only because a few months ago a guy called Brad, the husband of one of the Farenji  volunteer midwives from Australia, decided to make himself useful while here and get it all working again. I take my hat off to him: to get something done like that, which included digging out the half filled old hospital well and getting a new pump installed and connected is no mean achievement in the culture that exists here. His contribution has made a huge difference to hygiene and the  general state of cleanliness in the Maternity ward, which for years previously  used water from  a single large plastic water container that required refilling from a tap 100 yards away every morning.

The new Hole

The toilets themselves have been non-functional for all these years as well, and instead patients use a smelly rickety tin shed in the nearby field with squat toilets over a deep hole. There is no lighting to it and the path is just a worn track through the grass. The deep hole must be getting near capacity because over the last few weeks a new one has been dug and a new toilet facility is being erected over it. The new hole, 20 feet deep was dug by several men with picks shovels, a bucket on a rope and a ladder, and it took about a week. It is lined with narrow eucalypt tree branches, which have all been chopped down locally and trimmed to size with axes and adzes whose handles are appropriately shaped limbs of a tough tree. Walls, the roof and doors are all corrugated iron nailed to a frame of more tree branches set into the earth, but as yet the flooring consists entirely of more tree branches’ laid across in two layers at right angles – somehow I think concrete  will be laid on top of them to make a floor.  Its been quite an education to see this structure being literally hand made and using branches and tree trunks rather than dressed timber

New Toilet nearing completion

One wonders what sort of budget the hospital must be managing on if this is the sort of construction method employed for something as important as toilets, and there was never enough money to re-establish the water supply.  But then, I discovered the other day that there is no Electro-cardiograph machine in the hospital – this is a fundamental piece of equipment used in the investigation of all manner of cardiac diseases and would be regarded as  essential in any western hospital. An ECG machine is not an expensive item, but apparently it also is too expensive for Motta. I also learned they would not be able to afford locally trained Ethiopian Obstetricians like myself – when one was employed to cover an unexpected gap in the supply of volunteers last year, he agreed to come only if the Barbara May Foundation paid him the equivalent of more than ten times the salary of the local General Practitioners, who by Ethiopian standards are already well paid!

Brads was not the only water project in the area : when I was here a year ago I would often run into a charming guy down at the Wubet Hotel who was a manager of a huge water project for the town. It was funded from overseas to the tune of something like a million Euros. His team had been drilling for water and planning a reservoir somewhere nearby, had a couple of nice white Toyota Landcruisers, mobile phones and requirements for lots of meetings and travel in conjunction with the Project. Enquiring about how the Project was going this year, after having realised this guy was no longer around, I was told most of the wells were dry, the guy in charge had been moved on and had apparently been rorting the finances by such devices as claiming wages for fictitious employees, and the project was probably going to be abandoned as the funds were nearly all exhausted! Even the hospital water scheme wasn’t spared this sort of scam : poor Brad was asked to send a large sum of money to pay import tax on a new pump he sent from Australia after he got back, but the person asking for it had nothing to do with the hospital and simply pocketed the money and left the pump at the airport in Addis. In contrast, somehow I don’t think the poor hardworking guys building the new toilets are finding much to rort. The irony is that in poverty stricken countries where  the temptation to help yourself to seemingly limitless Farenji  money is too great for some, the crooks are usually in the ranks of the  comparatively well off – the really poor don’t have the education or the means to participate in rorts and scams, other than perhaps asking a bit more for their onions and cabbages at the markets.

The Spice of Life

Tea and Coffee Pots

Ive often wondered why it is that for most of us in the west we have almost the same thing for breakfast every morning, but insist on almost never having the same thing for dinner two nights in a row. Ethiopians don’t seem to have this problem – they eat injera at almost every meal, and the range of spices and sauces and vegetables they eat with it is quite limited, but they are, to a man – and woman – incredibly enthusiastic about the stuff. Whereas  we in the west are mostly quite curious about the foods of other nations, and we like to try it – Japanese, Chinese, Thai, Malaysian, Spanish, Italian, Mexican, Indian - anything really - Ethiopians – well the ones around here - seem not to be, and  for them, gastronomically, variety is NOT the spice of life : Injera is. They seem never happier than when upending a dish of spicy sauce onto a plate of fresh injera and using the right hand tearing the injera into pieces and scooping up the sauce and vegetables a mouthful at a time. 

"Scrambled Injera" is Injera with Injera on top

I have grown accustomed to Injera and some of the ways its served;  I had some today with cooked diced meat and onion and spices at the Wubet  Hotel for lunch, and enjoyed it, could probably live on it of I had to, but I know what I prefer to eat, though mostly what I prefer  is not available here. What IS available is a limited range of vegetables –tomatoes, onions, cabbage, green peppers, potatoes carrots and beetroot – banana, limes and bread, as well as many spices, ginger, eggs and pasta in a couple of shapes, spaghetti and rice. There are also the scrawny chickens, and in the little stores I can buy small tins of shredded tuna fish swimming in oil, and fancy biscuits which are very small and manufactured with some sort of drying agent which turns each tiny biscuit into about the most drying and water absorbent object known to man – it makes the inside of your mouth feel as if its been wiped dry with a handful of dust, so must be ingested with coffee or tea on standby. So these are the supplies I have been keeping stocked up on, and from which I make my meals.

Dabo and Mus = bread and bananas

Typically I have coffee and a bread roll with a small banana inside for breakfast. Sometimes its just coffee.  At morning tea time I have a tiny cup of sweet tea and a sambusa  from the hospital kiosk, and for lunch more bread roll with tomatoes and green pepper , or another banana or  slices of beetroot – a cup of tea and a packet of those tiny biscuits – there are 6 and they cost 12 cents a packet! I also buy lollies at 1 birr each – the same as a nice banana but I have to indulge my sweet tooth somehow.

Everything chopped up in a pan, with Rice or Pasta

For my dinner I typically chop up tomatoes, onions cabbage and ginger, fry them in a little oil, then add a tin of tuna fish, perhaps some tomato paste and water, juice of a lime and then  eat it with rice or pasta. I usually have some left over for breakfast or lunch the next day when I might supplement it with scrambled egg which is made with NZ powdered milk. I can also make a kind of soup with all the same vegetables chopped up and boiled for ages with two cups of split yellow peas or lentils, and I eat that with bread. The chicken pieces I thaw to use instead of the fish, but have only had four such meals as I gave some of my chicken to Shewayes famly for Xmas. And sometimes I just have all the chopped up vegetables and rice with a bit of local spice added. A couple of times I have made fried fish cakes from mashed up potato and the same tinned tuna, but essentially I seem to be living on bread, tomatoes and onions, tuna, cabbage  beetroot and eggs. I was really hungry a lot of the time in the first two or three weeks, but I think my stomach has shrunk to match the reduced volume of food I am eating, and I know I eat a lot less than I used to but nowadays I hardly ever feel hungry. I think my more or less vegetarian diet may be good for me – but the food I think about most when imagining being home again, is a juicy medium rare salty lamb chop cooked on a BBQ. 

Tuesday : Part Two

Clothes drying in the sun

 Uterine rupture is one of the most feared labour complications because it frequently results in the mothers death. The midwifes call brought an abrupt end to my relaxing afternoon, and I hurried over to maternity, where I found a desperately ill young woman with the classic sign of uterine rupture : the so-called “Bandl’s Ring”.  What you see in a woman lying on her bed is that her abdomen, instead of rising up to a smooth hump then down again, has two humps instead of one, the trough between them being the “Ring” where the uterus has split apart almost into two pieces. I wanted to take a photo of it but there was no time – she had unrecordable Blood Pressure, was barely able to open her eyes and her pulse was 150 beats per minute. The baby of course was long dead.

 We started fluid resuscitation, gave her what antibiotics we had available and I inserted a catheter into her bladder – pure blood came out and nothing else. We sent relatives to see if any had compatible blood but none did and then we had to try to decide what to do. It was suggested we should send her to Bahar Dar – blood would be more readily available there – but I was in no doubt – she would be dead before she got there.  “no” I said “She is too sick to send away”  And later I found out that the hospital vehicles are still non-funtional, so we wouldn’t hahve been able to send her way even if had wanted to.

 My anaesthetist hesitated once we got her down to the Operating theatre – her pulse was 170 – he mentioned that in Ethiopia it is regarded as a particularly bad thing for someone to have died in the Operating room – better that they die with the family. Should we just send her back? Her blood pressure was still too low to measure and nothing else had appeared in her urine bag apart from blood. It was tempting – the surgery was going to be complicated and even if technically successful it seemed she may not recover – there was no blood, we coudnt get all the antibiotics we needed, her kidneys seemed to have shut down – was this perhaps one of those moments when instead of blundering on and doing heroic surgery that wouldn’t affect the outcome, it would be better to face reality and allow her to die with some sort of dignity, rather than just mutilate her and return a corpse to the family tearfully waiting in the dark outside the operating theatre? Once before I had faced a dilemma like this – it was a year ago in this same theatre when we began surgery for a ruptured uterus and found such damage to the uterus and the bladder I was urged to give up, to not even try to repair the mess. But then I reasoned there was nothing to lose by trying, so I did, and ultimately my Heath-Robinson bladder repair and ureteric reanastomosis saved her life – I was as surprised as anyone, having never before even observed let alone actually performed such surgery. It is a horribly difficult dilemma to face but I decided again that I would not give up without making some sort of attempt to save her. “OK” my anaesthetist said, “Can start” and he put her to sleep

New, still empty homes on the outskirts of Motta

Half an hour later, the operation was over. But it wasn’t the operation I had been expecting to do because on opening the abdomen to our shock – and relief – the uterus was not ruptured though it was close to doing so. The lower of the two “humps” visible externally turned out to be a swollen oedematous and badly traumatised lower segment of the uterus and  bladder, and so all I needed to do was a straightforward caesarean. I extracted the dead and putrid baby, removed the placenta and closed everything up again. Bleeding had been minimal. She woke slowly – we all felt a surge of hope and excitement – she would probably survive.  Thank goodness we hadn’t just sent her back to die!    

 

Tuesday Part One

That Church

Yesterday was interesting for its contrasts. It was a beautiful warm day with hardly any wind, and at about 4pm, very little having happened all day, I decided to go for a walk back to that lovely church among the trees. I had prints of the photo of the guard and the half blind nun to give them, and also sad news that there were no immediate plans for an Eye surgeon to visit Motta.

 I remember his visit last year when I was here : literally hundreds of people turned up one morning, near blind elderly men and women and family members looking after them. They sat on the ground all round the hospital, were eventually all assessed and the lucky few, probably 20 or 30 with the worst cataracts were operated on over the following day or two, and again they sat around outside after their surgery with a patch over one eye. I couldn’t find out why this obviously much needed service isn’t operating any more, but continuity and reliability in terms of service delivery in this part of the world can never be counted on – whether its to do with funding or some other vagary I have no idea. A case in point from yesterday – we needed some critical IV antibiotics for the woman I will describe later – but the Pharmacy had none left! Today, investigating this ridiculous situation I discovered there are actually THREE Pharmacies in this hospital – one for Inpatients, one for Outpatients and one for Clinic patients – and they don’t appear to communicate with each other because I discovered the antibiotic we needed was still available at one of the other “Pharmacies”. I suppose it keeps people in jobs if you have three of the same thing in one tiny hospital but how wastefully inefficient, and how hopeless that the Inpatient one not only allowed its stock to run right out but had no idea that the drug was available at the other “Pharmacy” about 20 meters away! Meanwhile my patient is receiving inadequate treatment, maybe even dying because of office inefficiency.

 So, as usual I set off by a different route to the Church. Ive noticed the further away I get from the hospital the less irritating the children are – the ones near the hospital have recently started throwing stones and dust at me and sneaking up behind me to poke me with a stick. This no doubt is the result of a couple of changes in my own behaviour – for one, nowadays I mostly ignore the chorus of “Hi” “Faranji” “Give money” etc etc that are yelled at me by every kid under about 12 that sees me, even if I am 100 yards away they scream out at me and expect me to turn and wave or call back – which I used to do but eventually one wishes for some peace and quiet when walking the streets, to be left alone with ones own thoughts and not have every ragged kid regard me as some sort of mobile entertainment centre. The other thing that happened was when walking alone one evening recently I spied twin baby goats and their mother nestled down among some small trees in the late afternoon sun : a beautiful picture waiting to be snapped, so I quietly approached and was quite close, getting my camera out when suddenly the cry went up “Faranji, Faranji” ( it means Foreigner) Within seconds a horde of screaming children started racing across from around a nearby corner, “Faranji, Faranji, Hi Hi, give money…” and of course the startled goat stood up and so did her twins, the moment was lost, destroyed by this damn snotty filthy rabble…I was infuriated and lost my patience, and when I lost it and turned towards them and shouted back “Go AWAY, leave me alone” and rushed forwards a few steps towards them, as I expected they all turned on their heels and ran like hell in the opposite direction – they are often quite afraid of Faranji! One poor kid, in blind panic turned and ran straight into a tree, reeled back howling and then took off again!

So the further away I got from the hospital, the fewer were the shouts and cries going up alerting the neighbourhood to my presence, till, after crossing a rickety wooden bridge over a near dry creek. I was walking past animals and kids and houses in almost blissful silence. People still said Hi as we passed on the track, or they said nothing and withdrew inside their gates to watch me wander by. The closer I got to the church the more enjoyable, even uplifting the walk became, and once I passed though the gates again it was so peaceful and quiet I felt almost as if I had come home. I found the guard and he embraced me like a long lost friend, and beamed from ear to ear nonstop as he looked back and forth at the several photos I gave him. I didn’t see the old nun but, with the help of another man who turned up with rudimentary English, asked the guard to give her the photos and the news about the eye surgeon. I wished I had bought my Kindle with me because it would have been so nice to linger under those trees in the late afternoon sun, read and rest for a while.



Days End

Back outside, not far from the church gate there was a collection of animals feeding on  leftover stalks of teff , most of which was stacked up in two huge piles. Standing with them in the warm sun were several men, so I went and stood with them too, and we watched the ox and the donkeys and mule, hardly talking, just enjoying the peace at the end of the day. A little over an hour later it was nearly dark as I got back to the flat and put the kettle on for a cup of tea. I felt relaxed and resored  by my walk and was looking forward to that cuppa, but I didn’t get to drink it till much later because the phone rang and Melkam said “Doctor there is one lady for ruptured uterus” 

 

(…to be continued)