Tastes like chicken



Do-it-yourself KFC

Getaneh is the young man who brings me my water - he is not the same one who was here last time, because Moges has graduated from school and is apparently now at a University down south. Moges was a splendid guy, tremendously honest, always happy and hardworking, he lived in a concrete room about 12 feet square and slept on the floor beside a pile of school books. The guy who used to kill chickens for me has also gone from the hospital – he was also a charming guy but apparently he was trying to charm money out of the foreigners and was asked to move on. I’m told he failed his exams in Road Construction, so now he hangs around the coffee shops down town – believe me that sounds  a lot more glamourous than it really is – theyre nothing more than really dingy dusty run down little stalls with cracked cups and filthy chairs and a couple of wobbly tables. Whenever I pass he hails me and we have a chat, and he runs his latest scheme by me, tries to talk me into giving him some money, I pay for the coffees and  that’s it till next time. No hard feelings apparently. Actually I feel a little sorry for him because about 18 months ago a middle aged American photographer was in town working up a series on poverty or something for her Portfolio back home , and she seems to have become completely infatuated with this young guy – hes about 24. I know this because she has a Blog and she wrote the most adolescent sort of stuff on it about his dreamy eyes, and how her days lit up whenever he appeared, and how she longed to see him every morning – well she took her photos and headed home without him of course but made a big fuss on her blog about buying him a Gabi which is a traditional cloak sort of wrap everyone wears round here – they cost about 300 birr for a reasonable one –  less than 20 bucks! My poor pal read on her Blog her declaration that even though she was leaving Ethiopia she was taking him back to the USA in her heart. His  English is better than most but still poor, and the metaphor escaped him : when I met him several months later he was still waiting for her to send for him. He showed me the Blog to prove it was really going to happen – I tried to break it to him gently!

Chook Market

Anyway, the new water boy has almost no English but he still managed to get 100 birr off me the other day with some story about an exam he has to sit – I agreed to give it to him when he agreed – or so I thought – to kill a chicken and chop it up for me this weekend. So I duly went to the market with Shewaye, and got the chicken yesterday for 80 birr. Things got a bit busy in the hospital and there was no time to do it yesterday, and when I saw him wandering past late in the afternoon I called him into my flat and showed him the bird, legs tied, standing in the shower recess, and asked if he could do it in the morning “no , me fasting” he said, much to my disappointment – but then it was Sunday after all. “OK, Monday then” I said “Oh no, fasting to december 29” “So you cant do the chook till 29 december?”His face lit up “yes 29 december” “Good grief!What next” I thought!

Fasting here doesn’t mean the same thing as it does back home – there are various modes of fasting, all of which include eating food, but it mustn’t contain animal products – so no meat, eggs or milk, and for some they eat nothing at all during the day. After December 29 they can eat meat again!

So I lay awake long into the night steeling myself for the task I was now going to have to do myself – slaughter the chook that I was feeding and giving water to in my shower recess. I considered giving it away. Could I find someone else to kill it – but I had already paid Getaneh !!  And I was hungry and had been looking forward to some meat at last! It seemed like a massive problem, but it turned out to be a massive misunderstanding. He was just saying he couldn’t eat it – because he turned up in the morning all set for the kill!

A Poor Woman

What a Cute kid !

Work has been quiet the last few days, but there have still been some memorable incidents. The first, late last week was in the midst of a busy afternoon of births that for the most part were progressing well - suddenly a great crowd of people appeared wheeling in a woman on a trolley who had been sent by ambulance from a village two hours away. She had given birth at home to her sixth baby at about 9am, had arrived at a village "Health Centre" four hours later with a retained placenta and bleeding, and there was given a drip and rushed to Motta, arriving some seven hours after she had given birth. Everyone was calling for me to quickly attend to her and I did - and the first thing I noticed was how cold she was. And then that the bleeding had stopped.And so had her breathing. And there was no pulse - her heart had stopped as well - she was dead! I found out later she was barely conscious when they put her in the ambulance.

 

Surprisingly, she was the first dead mother I had ever seen. The only woman that I looked after who died when I was here last time was taken from the hospital near death,at the families request and died at home from overwhelming sepsis. I had seen lots of women here I thought would surely die, or who were near death but in every case they were so tough that they didnt. But this poor woman exsanguinated while desperately trying to reach help, and expired in the back of a dusty 4WD. She was a typical poor country woman, filthy from head to toe, the standard ragged and filthy green dress with the zipper pocket across the front, very short hair with a black wrap tied around her head, and bare feet with thick cracked souls and  hard yellow nails. She was the archetype of the poor ethiopian woman, something like one in 12 of whom die, and most often in this exact way, from post partum bleeding after having had a large family. Probably her youngest is only two, but now all her children are motherless. I asked what would happen to the newborn baby - was there anybody who could breastfeed it? The answer it seemed was no, the idea of a relative feeding the baby seemed out of the question, and therefore to compound the tragedy, it would seem the newborn baby will die too. No one would be able to afford baby formula,and in any case even if they could its use usually results in fatal gastric infections because proper sterility is impossible in homes of mud that are warmed by fire.

 

So I filled in the paper work, declaring her Dead on Arrival. And then as I watched, the midwives prepared her dead body to be returned to her family. I wanted to take a photo but didnt - but it was interesting to watch as they firstly cut her dress off and then covered her face with a big wad of cotton wool. A long strip of ribbon gauze was then wrapped around her head to hold the cotton wool on, and then it was continued around her body to hold her arms folded across her chest, then down around her legs to keep them together and lastly, to keep her feet together, the two big toes were tied to each other.She was then wrapped in the blood stained shawl she came with and laid on the floor of the ambulance, which immediately left. They dont have death certficates here.

 

The other incident of interest was a scary moment for me when I thought a woman with twins was going to die when her anaesthetic went awry. She was scheduled for a Caesarean because  the first twin was a breech - coming bum first - and I wasnt intending to have a repeat of the ghastly situation that developed last year when I was here, when twins became locked and both died! No Thank you! After she was put to sleep it proved impossible to get the breathing tube down and she started to go blue. Fortunately we hadnt started the operation so we just ventilated her in a very simple way with a Bag and Mask and a basic airway until she started breathing for herself again. After she woke up and recovered, we sent her to Bahar Dar for the caesarean, as she was too high an anesthetic risk for Motta, but that couldnt have been anticipated until we tried to give her one.

 

Next time I shall think of something a bit lighter to write about.

 

First Returning Thoughts

The Road down to the Hospital at Motta

I remember that when I left Motta after my first spell here, in January this year, I doubted there would be any lasting improvements in the way the Maternity unit was run – it seemed despite repeated attempts at instilling some basic principles of maternity care, nobody seemed to really get it. Since then the continuing series of volunteers coming here all seem to have reached similar conclusions as they came to the end of their time here, expressing the same frustrations and disappointments I did. In fact what I have found on my return, to my surprise, is that things have definitely improved: the rooms are cleaner, there is no actual mud on the floors any more, the stench from the toilets has disappeared, women are no longer lying on beds with filthy sheets  or even no sheets or blankets, Midwives are more often writing on the whiteboard and keeping it up to date, they are doing regular observations and updating the bedside charts, and, thanks to the husband of one of the midwives who came here from Australia there is running water to several taps in Maternity and the Operating Theatre.

I wouldn’t want to create the impression that things are all wonderful here now – far from it – in fact someone coming here for the first time would probably regard what goes on as appalling, and could hardly be worse – but if they had been here a year ago, they would realise that it has been worse and that now it is better, albeit not by much, but definitely better. The truth is that the cultural differences between us are so huge that bridging them will take a very long time. This I think is the lesson I learned last time.

Take medical records for example : much of our record keeping in the west is for “medico-legal” reasons, and we are almost obsessional about it – a midwife in Australia will usually note the exact time that she rings me to come and asses a labouring mother that she has concerns about, and record the exact moment that I get there as well – how has that got anything to do with managing the current problem? In fact it is recorded by the midwife to protect herself in the event that there is an adverse outcome and an investigation. Much of modern medicine is what we call “defensive” medicine – that is, we do things to protect ourselves from medicolegal consequences of adverse outcomes. It doesn’t  matter that an adverse outcome may have been unavoidable - if a lawyer can find a test or an observation or an investigation that could have been done but wasn’t, even if in the judgement of the clinician it wasn’t an appropriate test, or it  was so unlikely to affect the management that it seemed inappropriate to waste money on it, the clinician may then be found negligent. So we order all the possible tests without much reference to their appropriateness, and we do them again if they are slightly borderline, and document all this in the Medical Record.

My Op Notes from Caesarean Birth on Thursday night : note the Ethiopian Date should be 2005 not 2004!

Here in Ethiopia of course, there doesn’t appear to be any such thing as medico-legal concern – if a patient dies, the Doctor is presumed to have been doing his best and is praised for trying. This is a two edged sword of course – it means Doctors can be lazy and careless, they can fail to truly uphold the ethical standards of the medical profession and yet because nobody is any the wiser, continue to receive respect and be honored for the role they play in society. I am afraid I have witnessed this sort of behaviour here. The reality is that Doctors are people too, and subject to the same frailties, and the Legal profession plays an important role in maintaining standards in the west – but many of us feel sometimes it goes too far. In Ethiopia people more readily accept that “shit happens”  than they do in the West – perhaps because of their religious beliefs? In the west when something isn’t perfect  the tendency is to look for someone to blame.

In any case, getting back to medical records, though we obsess about them, my Ethiopian colleagues must wonder why – after all if the woman comes in and has a baby, why do we need to record at what time she arrived, at what time the baby was born exactly, exactly what the babies weight is, or how much blood the mother lost? Surely its enough to record she came and had her baby and went home?

There is more to it than that though – some of the information we collect in the west helps us manage a womans future pregnancies, it gives us information that when collected and audited can be used to improve and fine tune standards and outcomes that benefit all women . But here in Ethiopia we only have the resources for basic care – fine tuning is an unaffordable luxury for now. And in any case the filing system is so hopeless old notes are rarely found or of any use even if they are. Just today I saw a woman who had a stillborn baby when I was here last time – we did find her old notes but amongst the jumble of dusty paper I could find only one with my writing on it, and that was written on the day of her discharge from hospital – the preceeding page or two that would have had all my – yes, obsessional – notes were missing! 

So good note keeping is pointless if there isn’t a decent filing system, and pointless if no use is going to be made of all the information they contain, and not needed for any sort of medico-legal purpose either. So why do we hassle the midwives so much about doing it? The answer is because that’s what’s appropriate in the culture that WE come from. But what about THEIR culture?

For the time being, as far as note keeping is concerned I just would like them to get into the habit of writing something.  Its too big a jump to go from writing almost nothing to writing and recording almost everything!

Getting to Motta

The Bus arriving in Motta

To get to Motta from Sydney I flew with Emirates  firstly to Dubai, a 14 hour flight which was rendered hellish by a shrieking toddler that didn’t sleep one minute the entire way. Its parents regularly lifted it up above the level of the seats so its whining penetrated the headsets of everyone tin the cabin and at one point a heavyset bloke not far from me yelled out something in a foreign language, no doubt expressing what everyone felt, that the damn kid would shut the hell up! The flight left Sydney in the evening so all we really wanted to do was sleep. However I did watch a great documentary about the life, music and tragic early death of Bob Marley.  We had a four hour stopover in Dubai, a place that just seems wrong to me – the ostentatious wealth, the massive skyscrapers in the desert, exploited foreign workers, women covered head to foot, those ghastly artificial islands crammed with luxury villas…..I never feel comfortable there.

And then four hours away is the Bole International Airport at Addis Ababa. There are wrecked and rusting planes and helicopters off the runway and the terminal itself is an almost empty shell of a building with a tiny Duty Free Kiosk selling cigarettes and not much else. Security and Customs are unsophisticated, so pretty soon I was dragging my one suitcase out the front door and along a rough concrete path to the Domestic Terminal, an even more worn out building where I tried to sleep on some plastic seats while waiting four more hours to catch my flight north to Bahar Dar. By the time I got there it was 8 pm local time, and dark. I had been travelling and had hardly any sleep for 36 hours. The Summerland Hotel courier van took me to the hotel and I slept well in a bed that sagged massively in the middle.

In the morning after breakfast of two fried egss coffee toast and jam I walked to a nearby Bank and got some Birr, then walked further along to meet Birhanu, the local co-ordinator for the BMF. These crowded streets area familiar to me now, the beggars in the dust, the people praying along the wall of the local church, the women wanting one Birr to weigh you, the shoe shine boys, the rubble of still unfinished building sites spilling onto the road… Birhanu took me for a tour of the BMF maternity service provided at one of the government run  Health Centres and showed me an overgrown courtyard surrounded by half fallen down buildings which are going to be removed and replaced by a new two story Maternity Ward, funded by donations to the BMF. I wouldn’t be surprised if there is a huge tangle of red tape and official obstacles to negotiate, and if they prove greater hurdles to clear then the fund raising.

I expected that next he would be bundling me into a mini van or a 4WD and sending me off down the rocky and winding 150km road to Motta, to there get a brief  “Handover” from Dr Rien  who would then return with the same vehicle to Bahar Dar. That’s whats happened in the past, so there is continuity of cover at Motta. However this time they had decided to do it in reverse – Dr Rien would come to meet me in Bahar Dar and then I would go back to Motta. It worried me that there would be half a day without cover but that was what had been decided – so be it.

Dr Rien and his wife and the midwife, Julie , arrived at lunch time so we met them at “Kariftu” which is an elegant and luxurious hotel on the edge of Lake Tana. They had all decided to splash out and stay there for a night – they deserved a special treat I am sure. We had a nice lunch and discussed what was  happening at Motta and then the driver arrived and I farewelled them all and we headed for Motta. Soon after we were bumping rolling and weaving our way round great clods of earth and rocks on a stretch of road that was undergoing repairs, when a loud peculiar scraping sound attracted our attention from the rear of the vehicle. The driver stopped and was outside poking round underneath for a while then returned saying we would have to return to Bahar Dar as the wheel bearing was damaged. I phoned Birhanu so he could arrange alternative transport but there was none available at this time of the day he said, and I would need to return to the Hotel and wait till the next day when hopefully the vehicle would be fixed. This stressed me out somewhat because now Motta wold be without cover for a day or more, and a day in Motta is long enough for a disaster or two, events I was meant to be there to help prevent.

We started back to Bahar Dar at about 5km an hour. A battered and overloaded bus approached, also bumping and weaving between the holes and the rocks – “Is it going to Motta?” I asked the driver – “Yes, Motta” he said “Shall you go on the Bus?”  “yes” I replied and he stopped and flagged it down. I scrambled aboard and squeezed into one of the seats near the front with two grubby poor women and a baby, my bag on the dusty floor , and off we went. I was relieved to be on my way albeit slowly and uncomfortably, but after a couple of hours one of the ladies got off and it wasn’t such a squeeze after that.

We arrived in Motta in the dark, about 7pm. Birhanu had already phoned ahead so someone who knew me was waiting when I got off – it was Shewaye the schoolgirl who had done washing and cleaning for me last time I was here. It was lovley to see her friendly smling face. I was tired and dusty and thirsty, so went into the Wubet Hotel nearby for a quick drink – we had just sat down  and I had a mouthful of beer when another familiar face appeared – Melesse, one of the Doctors, and after warm greetings and embraces  he told me there was a woman with an obstructed labour in the hospital, the midwives said she would need an emergency caesarean and they had sent a driver down to get me! So off we went, straight to Maternity where I asked someone to take my bags to the flat and I went in to see the woman whose baby was stuck. I was greeted  again with huge smiles and big hugs by Simagnew, the only midwife still there from when I was here a year ago, but we had to save catching up till later. When I examined the woman in labour there certainly were signs of obstruction, the skull bones of the baby so squeezed together they overrode one another like plates sliding one under the other to an extent one never sees in Australia – this is called moulding and is normal up to a point but this was extreme. However the head was well down the birth canal and I decided to try and deliver it with forceps rather than by caesarean section. The forceps went on OK and I moved the babies head around to a better position and then with about three almighty heaves dislodged it and brought him out in surprisingly good condition. Even the babies out here are tough! 

I was back. It felt good.

The Three Lucys



Lucy and the Concrete Croc

Ive stopped working for money again, after my fifth locum at the Royal Darwin Hospital. Once again it was challenging work made more interesting by the large indigenous population in the Northern Territory – they have a fascinating and ancient history, culture and languages, but as in many other places in the world, invasion by colonising powers has left many of them reeling and suffering at the bottom of the heap. I find Australian aborigines impenetrable – they often seem indifferent to the concerns we have for their health, and as hard as I try I don’t think I have ever managed to make any sort of emotional connection with a single one of them: they’re too absorbed in their own culture and family and world of dreaming to be bothered with me and mine. I think disinterest in much of western culture and values makes sense so I see in Australian aborigines a deeper wisdom at work, and I can’t help admiring them for it, but as I said, I really do find them impenetrable. The tragedy is how awfully western culture has degraded their proud traditions.

The Northern Territory is sometimes regarded as “Redneck” because theres a tradition of barramundi fishing, hunting and beer drinking, but theres more to it than that, quite apart from the indigenous art and culture. I went with a friend from work to a play about dementia and family secrets one night and on another we went to a stand-up Comedy performance by Australian Judith Lucy :according to one reviewer: ‘‘Lucy’s blend of venom and cheery condescension… is a joy to behold.’ A couple of years ago she went on a Spiritual Journey that was made into a funny but also insightful TV series, and she wrote a book about it called “Drink, Smoke, Pass Out”

Speaking of Lucy, my sister, another Lucy came to stay and ended up doing all the cooking and cleaning and washing for me. We went to Katherine for a week, 3 hours by car south from Darwin where there is a small regional hospital that needed Specialist back-up, and on another weekend, back in Darwin we did the Jumping crocodile cruise. We also visited Litchfield Park and had a swim at the Florence Falls. There were great markets to visit on the weekends and we went to the Museum and Art Gallery. It was very hot during the day and as the Dry Season was ending it started to become humid as well. 

And this is a rather weak seque I know but from Darwin I am returning to the home of another Lucy, the famous hominid discovered in Ethiopia that had a small brain but walked upright. These 3 million year old fossil bones are kept in the National Museum in Addis Ababa, but what you get to see in a pokey downstairs display case are replicas. I really had been looking forward to seeing the real thing. 

In my Sydney Hotel room, sorting out what to take to Ethiopia



A Video - at Last!

This video was made on my usual camera, the Panasonic Lumix.  But my Panasonic Toughbook which is now more than 5 years old didnt seem to want to download it properly or replay it. I decided eventually to get a new LapTop and preserve the Toughbook for use on Sapphire - theres a docking station on the boat for it, and Ive got my Sailmail and my Navigation software loaded on it. So now I have finally bought a new LapTop - its a Sony VAIO, cost $800 at JB HiFi. And then it took me ages to get the video uploaded to You Tube.

 

But at last, here it is. I am 25 miles from Vava'u, the wind is about 22 knots and we're probably making 6.5 knots +/- .5knots. I remember this morning well - it was one of those great days of sailing made more exciting by the imminent arrival in Tonga. Departures always have me dry mouthed and anxious but arrivals are usually the adrenalin high that might be why we keep going back for more.Its such a tremendous feeling to succesfully complete an ocean passage. Later this day I sailed across the northern end of Vava'u where there are massive cliffs, I saw a Douglas DC3 aeroplane fly past heading to the airport, a whale surfaced ahead of me and then I entered the passage between several islands that leads to Niafu. At the commercial wharf near Customs two boys fishing took my lines and helped me tie up. I cleared customs in the morning then moved to a swing mooring.

Approaching the passage to Niafu

The Actual and the Virtual Family



Kanoa

I had a busy and fun filled week in New Zealand, firstly driving south with my sister to visit one of my daughters with her 10 day old baby, my granddaughter Kanoa. I learned of her birth via sailmail message when I was  sailing south of Fiji somewhere, and was really looking forward to meeting her. Of course, she was adorable.



Mount Tongariro

The beauty of the New Zealand countryside was breathtaking as we went further south through the middle of the North Island past Lake Taupo and Mt Ruapehu and Mt Tongariro to visit my other sister. She has a sort of Hobby Farm with a big vegetable garden, calves and sheep and chooks and two super friendly big Poodles. We also visited  a niece  I hadn’t seen for a couple of decades, and learned in a former life she had lived on a yacht and sailed right round New Zealand! Now she lives on a farm and they milk several hundred cows twice a day seven days a week. Bloody hard work!

Our road trip then headed back up to Whangarei where I have two friends called Hilton, one of whom Ive mentioned here before – we are old school friends. The other Hilton and his wife Melva run the Riverbank B&B, near Whangarei, having been live-aboards for years before that, sailing all over the Pacific. We met when Sapphire was in Tutukaka in 2010 and because their yacht Spindrift was so like Sapphire in size age and design, they have been able to teach me an enormous amount- Thanks guys! I also met Gary, a man who has been following my Blog for a while and making the occasional Comment. He and his wife invited me to their place for dinner where I learned that Gary is an architect, yacht designer and remarkable sailor whose adventurous life included among many astonishing things a circumnavigation in "Alice" a lovely timber yacht with no motor that he designed and built himself. Garys current project is “Mason Bay” a venerable and classic old timber fishing boat that he has been restoring and transforming into a beautiful and practical launch, a process I have been following on his Blog, and which is close to completion.  He gave me a guided tour the following morning and I was left in awe of not only his engineering and boatbuilding skill, but also his appreciation of beauty, and his imagination and enthusiasm for life.



Mason Bay approaches Whangamumu

Mason Bay at Great Barrier Island

Later I reflected on how unaware I had been when I decided to learn to sail that I was about to stumble into an amazing community of remarkably talented and fascinating people,  the community of men and women who love sailing and the sea. I also reflected on the fact that without the Internet and Blogging I would never have met most of the people who have helped and encouraged and supported me, or been able to learn much of what I have managed to learn that got me out there.  Its been amazing. Ive been so lucky and I am glad to be living in the Internet Age.However, to quote a T-Shirt I saw yesterday

 "No, I am not on F*#%*ing FaceBook"