Outcomes

Poor but Happy

Since returning from Ethiopia I have been quite surprised at how many people have told me they found what I wrote about Motta almost too confronting to read. I was told it sounded so awful nobody would want to volunteer to go there to help, it would be just too depressing and too sad. This impression is mostly a fault of my writing, though I don’t think I overstated what a grim place it can be for women in general and especially for women wanting to have a baby there. In fact those 14 weeks were the most extraordinary and unforgettable 14 weeks of my life in medicine, without doubt. It was hugely challenging, it was frustrating, it was exhausting and at times heartbreaking – everyone got that message! -  but I agree, I didn’t write as much as I could have about the  many wonderful moments of joy, of immense satisfaction, of the rewarding and warming interactions with exceptionally supportive and friendly Ethiopian doctors midwives ancilliary staff and patients and their families, or of the fascinating village life where tradition and the technology of every day existence is centuries old and happening right in front of you. Utterly unforgettable.  Nevertheless, as I wrote at the time  I left feeling quite despondent, as everything seemed to have gone wrong at the end, but since then a couple of things have happened that have helped dispel the gloomy mood.

The first was  remarkable news about the poor woman I had expected would die a few days after I left, the one whose ureters I reimplanted into a reconstructed bladder – a complex operation I basically made up as I went along – well, against every expectation she recovered and went home. She is going to need further surgery at the Hamlin Fistula Hospital in Addis Ababa but that will be free and be done by one of the worlds foremost urological reconstructive surgeons. I found this out just before Zoe and I left Ethiopia when I phoned my replacement at Motta to see how he was getting on  - “Good save” he said.. I emailed this news to Myrte who was ecstatic, saying that her survival against the odds, on its own made Myrtes time in Motta worthwhile.  I was left in awe of the resilience and toughness of these incredible women, who, given half a chance seem to be able to prevail against the most appalling odds. It was definitely only half a chance that I had given her.

                                                                                             Heading to Market

The second tonic I received was when I looked back at what all the Volunteer Obstetricians and midwives  had achieved at Motta in 2011. It had been the first full calendar year with specialist obstetric cover at Motta. For comparison purposes. I brought back statistics from the hospital records for 2009, the last of the many years that Motta had been functioning without any Obstetricians. The 2009 figures were incomplete but it is thought that of the 750 women who went there in 2009, about 70 died. No caesareans were done because no one there knew how to, and about 20% of the babies also died. By contrast, in 2011  the death rate for babies was halved to 10%.. For mothers the figures were even better : there were 88 caesareans, 4 caesarean hysterectomies and 11 destructive deliveries – all of these women would otherwise have died or survived with the dreaded urinary fistulas that render them outcasts in their own communities. In fact there were only 5 maternal deaths even though the number of women givng birth there increased by  almost 50% to 1009. This  reduction in maternal death rate  from 1:10 to 1:200 means that in 2011 about 95 womens lives were saved at Motta Hospital.. It made me feel good to have been a small part of that.

Back at work in Australia

 

The tiny Leigh Harbour, Little Barrier beyond

My great friend Alex, a Professor of Tibetan History sent me an email the other day and asked me a question that really surprised me: “Hows your culture shock?” he wrote. And thinking about it, I realized Culture Shock is exactly what I am suffering from : heres  the Wiki definition :

 “Culture shock is the anxiety, feelings of frustration, alienation and anger that may occur when a person is emplaced in a new culture”  

But scrolling further down the page I came to this :


“Reverse Culture Shock (a.k.a. "Re-entry Shock", or "own culture shock") may take place — returning to one's home culture after growing accustomed to a new one can produce the same effects as described above. This results from the psychosomatic and psychological consequences of the readjustment process to the primary culture. The affected person often finds this more surprising and difficult to deal with than the original culture shock”

So it would seem I have been suffering from “Reverse Culture Shock” and according to another link, I “don’t have to feel ashamed because it happens to nearly everyone” – actually that was in relation to Culture Shock which apprently progresses through four phases : Honeymoon, Adjustment, Negotiation and Mastery, and eventually you become either a “Rejector” – and go back to where you came from, an “Adopter” and never go back to where you came from, or you create your own unique blend of habits derived from both cultures, and you are described as “Cosmopolitan” – which I rather like the sound of.

I certainly remember experiencing the Honeymoon Phase – back in New Zealand I found everything delightful and marvelous, from roads that werent just paved but had beautiful concrete guttering that was neat and clean, cars that were modern and clean , and mostly seemed almost brand new, people had lovley clean  unpatched clothes and shoes without a single mark on them, clean haircuts and shiny healthy faces, and I understood every word.. In the musical ambience of  a Supermarket I walked about grinning from ear to ear, so impressive was the variety and volume of goods on display.  I was especially impresed by the fruit and vege department where the  nutritious vitality of every fruit and vegetable seemed to leap out at you. The carrots for example were all a fabulous bright orange and perfectly tapered from one end to the other and all about three times as long as the gnarly worm eaten ones I had been used to in Motta. Similarly, the tomatoes too were all perfect in their unblemished  and bulging redness. I was surprised at my own delight in such a simple activity but realised the thrill probably wouldn’t last. What a pity that all too readily we take for granted the incredible richness and privilege and ease of life in the developed world! I cant name a more privileged and more beautiful country than New Zealand – and, actually I think in the main Kiwis are aware of it. It was so good to catch up with so many of my friends and family there. 

My Family

So now I must be in the “Adjustment” or “Negotiation” Phase. I had a voracious appetite for junk food when I first got back but now I have regained my ability to say no to all the cakes and sweets and snacks that in short order replaced 3 of the 7kg I lost in Ethiopia., Having identified what was  “wrong” with me has been useful, not that I think theres is actually something “wrong” and I certainly don’t intend to dismiss all the questions and anxieties and anger in my head as mere “readjustment process”  And, after seeing on the Blog stats how many people are continuing to look for new posts from me I have decided to keep going with the Blog.. I had been wondering if I would. The Next Beginning.