The Cost of Living

The Shopping

Thursday was December 25^th but because Ethiopians believe Jesus’ birthday was December 29^th, which is monday, it was just another day at the Offiice. Saturday, as usual, was Market Day and just as in the West, the last big shopping day before xmas was really busy. Everyone from everywhere seemed to be crowded into the market, but there didn’t seem to be anything special to buy, just more sellers and more people buying, in preparation for Xmas when they can all break their month long fast and gorge themselves on eggs milk and meat. I bought eggs : 1 Birr each (6 cents) and to get them home intact placed straw around them in one of the little plastic bags that I carry to the market for that purpose. I also bought a kilo of tomatoes for 42 cents, a small cabbage for 12 cents, 6 small carrots for 12 cents, a nice beetroot for 12 cents, 6 bananas for 1 birr each, 3 small limes for 1 birr, and it was around 50 Birr ($3) for a kilo of macaroni, a kilo of rice, half a kilo of raw peanuts – which I hadn’t ever seen for sale before - and a small mound of a local hot spice. The most expensive item by far was a tin of New Zealand Milk Powder - called “Me and My”for 100 birr ($6). I have seen places where fresh cow milk can be bought but I am not too sure if it would be safe for me to drink – my guts hold up pretty well, and Ive eaten local food that’s been offered to be polite wondering if I would suffer for it and haven’t so far, but I think local milk might be pushing it.

By the time I got back to the flat I had been walking out in the really harsh hot sun for about three hours - I always wear a hat but you still get very hot and dry and thirsty. Sitting down I noticed I had a really bad headache and so I had a couple of glasses of cold orange flavoured water. Later I still had a headache, and then I started to wonder if I was coming down with something. I remembered when I was squeezing through the crowded market an old woman turned to her side and sneezed right in my face – and the other day I noticed I had forgotten to take my malaria tablets – I checked my pulse – it seemed ok – I wondered if they would be able to treat meningitis here, or what was that other disease I saw a young woman die of last year – relapsing fever? It was only 3 in the afternoon and I felt tired – maybe I should go to the hospital and ask them to screen me for Malaria ? I checked my pulse again – 78 – and had another drink then lay on my bed wondering what to do. I had never been worried about my health before, never. In the end I fell asleep, feeling anxious.

I was woken maybe an hour later by the phone ringing – it was a midwife “Doctor, cord prolapse patient is arrive” “Is the baby alive?” I said – “Yes, alive” she replied. “Ok I will come quickly” And forgetting about my headache, hurried across to maternity. In the west “Cord Prolapse” is one of the few reasons for what we used to call a “Crash Caesar” meaning you do a Caesar as fast as you possibly can because with cord prolapse the baby often dies very quickly- the problem is that the umbilical cord has fallen down in front of the baby and will get so squashed as the baby squeezes down the birth canal, that blood wont be able to flow through it bringing vital oxygen to the baby from the placenta – and without Oxygen the baby will quickly die. We had already had one case like this earlier but the baby had died before the mother arrived in the ward – her labour continued and she eventually delivered a dead baby and went home shortly after. The midwives said they wouldn’t show her the baby“for psychological reasons” – the same reasoning we use back home for doing exactly the opposite! And probably the correct behaviour in both cultures…

Prayer at the Church Gate

However this time the baby was still alive. We cant do “crash” caesars here – theyre only possible in big units that are staffed 24 hours a day – but as the baby was alive and the heartbeat was strong , by acting quickly it was certainly possible that we could save it. So everyone was called in, we prepared the woman for the operating theatre by taking blood, giving medication, inserting a catheter and an IV line, all the while  checking on the babies heart beat. In half an hour we were almost ready to take her down to the Theatre building next door, where my anaesthetist and the theatre staff were rapidly getting everything ready. All that needed to be done was for the woman to sign the consent form – her name was Misa – but she wouldn’t. She wanted to talk to her family who were outside – several came in, there were lots of words exchanged between staff and family and the patient, but no, they decided, better to let the baby die – she doesn’t want a caesarean. The heart beat was still strong, there was still time to get it out safely but no they were afraid Misa would die. Talking went on for some time – their minds were made up, the baby would have to die.

I recognised and understood their reasoning – hurrying across to Maternity when I was first called I was wishing it had died already because there were reasons why I didn’t really want to do a caesarean – for one thing, this was the young womans first pregnancy and there would be many more – and having numerous pregnancies after a caesarean creates some special risks, complications that could conceivably kill the mother. Secondly, even though she stated she was “Due” she had not received any antenatal care at all and we had no proof that this baby was really “Due” – it could be premature and if so, unlikely to survive whichever way it was born. I did a quick set of measurements with the ultrasound machine and the baby measured small, about  the size of a 6 weeks premature baby, meaning if correct it was unlikely to survive even if born alive – but it could have been a small and undersized baby only 1 or 2 weeks early – there was no way of being sure.  So a doubly bad outcome was possible – no live baby and a caesarean scar to complicate the whole of the rest of Misas childbearing future. The families’ reasoning was brutally logical.

 

I sent the theatre staff home and asked the midwives to try and be especially kind to Misa. Her first pregnancy was about to end in sorrow.