A Travellerspoint blog

My typical day


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My typical day starts with a formal handover and ward round at 0830. We firstly go through the notes of every patient who has been in hospital over the previous 24 hours and discuss any issues. We then visit all inpatients and make a plan. Just like any hospital, there is pressure on the beds and the need to discharge patients quickly and efficiently to make space for more. I then get a coffee break!

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At 10.30 I start 'consultations'. The patients are seen by a midwife in the antenatal clinic. If they require medical advice or an ultrasound, I am consulted. I sit perched by a bed in front of the ultrasound machine with a midwife to translate and assist.

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My ultrasound skills are somewhat rusty (I now start to regret not doing routine unnecessary scans on my private patients for practice!) but passable. Several midwives are competent at scanning and I'll often let them take over to give me a break. I'd like to think I'm teaching them but it's probably more the other way around.

At lunchtime I wander back to the house and have a home cooked meal waiting. Today, a tasty fish goulash and salad.

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At 3pm I return for afternoon consultations. It was quiet today. I saw several women late in their pregnancy with no antenatal care and no idea of their due date, I diagnosed twins on ultrasound at 25 weeks, arranged 2 inductions for women at 42 weeks, treated syphilis and amoebic dysentery. There is no such thing as Down Syndrome screening and no anatomy scan.

I do another round after the consultations, then again at around 9pm. In between times the midwives call me if there are any issues or deviations from the clear protocols that they follow. It is all very well organized and the midwives generally run a tight ship. I've think I've been lucky in the last couple of days with relatively few calls.

I have discovered the universal language....Candy Crush!! I was sitting waiting for a patient and started to play the (much maligned by my children) game.

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All of a sudden I was surrounded by multiple staff who had heard the music. They whipped out their phones and all started playing and bragging about which level they had achieved. My respect skyrocketed when they discovered I am on Level 1344 (see kids, I'm not a loser afterall!). Then they realized I had an updated version and the excitement escalated. Did you know there is an app for transferring other apps by Bluetooth? Neither did I....but I do now! I was instructed to download this app via my internet connection. Everyone then turned on their Bluetooth and I was able to transfer the most up-to-date version to them all. The wonders of modern technology in the middle of Ethiopia!

Fun fact: Ethiopia has its own unique calendar. This is very confusing, particularly when dealing with obstetrics. The calendar is made up of 12 months of 30 days and a 13th month of 5 days (6 if its a leap year). The new year starts on September 11. Today is the 28th day of the 10th month 2008!

All the patients and the hospital run on this Ethiopian calendar. But the (non-Ethiopian) ultrasound machine and all the obstetric wheels obviously use our Gregorian calendar. It is impossible to translate one date to the other in your head but fortunately there is a conversion chart (and an app!).

And just when you get your head around this, the time is also different! Ethiopians start their day at 6am (or when the sun comes up) so everything is around 6 hours ahead i.e. when they say 2pm, they actually mean 8am. Very confusing. Fortunately the hospital sticks to standard time!

Finally, a big thank you to all those who gave me sympathy and advice regarding my bowel issue. I have cut back on the coffee and fruit as suggested. You will be pleased to know that things have improved and I still have all my lovely soft loo paper in storage. I will keep you posted........

Posted by gunny64 10:49 Comments (3)

My first official day


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Today started well. The electricity was on and I got my wake up coffee!

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Marjolein was here for the morning so we did a round together and I managed to extract even more information from her. My short term memory bank is now full to capacity! But no doubt there will be plenty of unexpected problems. She has kindly left her email address in case I get stuck - but I'm not really sure that will help when I have an emergency situation at 3am!

I know there are a lot of you dying to hear some of the gory details? Be patient! I am making a list of the obstetric issues I come across and will do specific dedicated blog posts over the next few weeks with a disclaimer for my non medical/nursing friends. I will also eventually post photos of the hospital. Once I've settled in I'll be more comfortable getting the camera out.

We had another traditional Ethiopian meal for lunch. To make up for the meat last night, we had a vegetarian dish. I haven't quite got to the bottom of it but there seem to be certain days you are unable to buy meat. They also have specific 'fasting' days when no meat or dairy are eaten.

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Injera is the traditional Ethiopian flatbread made from a grain called teff. The grain is mixed with water and then fermented over 3 days making it very labour intensive. It is like nothing else! It's thick and spongy and slightly sour with a pinkish tinge. It is not immediately likeable and has very little taste but I suspect it will grow on me (not that there is any choice!). The injera is layered on the plate then the rest of the meal is placed on top. You eat with your right hand, tearing the injera and scooping up the spicy meat or vegies. No knife and fork!

Ok it's my own fault for bringing it up in the first place so I can't back away from sharing the details now given how much I've banged on about it. My bowels! Those of you who are squeamish or uninterested may like to skip over the next paragraph - you have been warned.....

I officially have diarrhoea! I am certainly not surprised but I'm irritated that it's happened so soon. Fortunately I feel totally well and I've easily been able to eat and keep up my fluids. I took myself off to the shop this afternoon with an empty toilet roll to indicate what I needed. Worked a treat! I'm saving my 4 rolls of extra soft, double ply for when it's really necessary! If I get really sick I've been instructed to take a specimen into the hospital where they can test it for amoebic dysentery or Giardia. OMG let's hope that isn't required!

So ends my 1st official day. The sun is down, the rain is falling, the mosquitoes are buzzing and the nearby mosque is blasting out its evening prayer. Goodnight Ethiopia!

Posted by gunny64 09:51 Comments (1)

Calm before the storm

storm 21 °C
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Today I woke up to no electricity. This apparently happens often, especially if there is heavy rain overnight. It usually returns within a few hours but at 9.30 it was still off. So, no hot shower and no coffee!! Marjolein is even more addicted to her morning coffee than I so, after the hospital round, we went hunting for a cafe with power. I will talk about coffee in detail some other time but OMG. They drink it black, STRONG and heavily sugared......it is amazing.

Marjolein took the opportunity to walk me around the area and show me important places such as 'bowel safe' restaurants, cafes, bank, supermarket, Internet cafe and even somewhere to have a pedicure! It was good to get my bearings as the streets all look alike and do not run parallel. Fortunately there is a tall hotel and a mosque with spires nearby so, if all else fails, I know to head towards one of these.

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It was decided I should have the day off in preparation for my 2 weeks of continuous on-call starting tomorrow. I spent the morning reading! It has been a very long time since I have sat and read a book without being interrupted or feeling guilty. For those who are interested........

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With some trepidation, I ventured off on my own in the afternoon. Barhirdar is quite a big tourist town due to it's proximity to the lake. It is quite pretty with a wide tree-lined boulevard running down it's centre. Once again I was the only white face in sight. However, I attracted more attention than in Addis and kids kept coming up to shake my hand or 'high five' me. I managed to make it back to the compound without getting lost which was very exciting.

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Marjolein catches up with an Ethiopian friend every Sunday night at a local restaurant and they very kindly invited me to join them. Luckily I'm not vegetarian! The meal was a traditional dish consisting solely of spicy deep fried beef kept sizzling hot over smoking embers. It was served with injera which is their staple 'bread' (I will explain this another time). Not a piece of cutlery in sight! The meat was tender and juicy.

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This meal is considered a luxury because of the amount of meat and therefore out of the price range of most locals. Including my 2 Sprites, I paid $5!

Tomorrow it gets serious! I have absorbed as much information as possible regarding the hospital and asked Marjolein about every potential scenario I can think of. I am as prepared as I believe is possible under the circumstances. I will rely on the the midwives, my experience and some good old common sense.

Here's hoping the power stays on despite the current thunderstorm and that I manage to start my day tomorrow with a coffee.......

Posted by gunny64 11:13 Archived in Ethiopia Comments (2)

A twist!

sunny 30 °C
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I have now been in Barhirdar for 48 hours. Just as I have started to settle in, there has been a rather interesting twist. Apparently the rules have suddenly changed and Immigration will now no longer extend business visas. This means that Marjolein is having to leave Ethiopia on Monday, return to Holland, apply for a new visa and return. There will be a turnaround of about 2 weeks, during which time I will be the only doctor here. Eek!!

However I am thankful that a) she was here to show me the ropes when I arrived and b) I managed to get my own visa in time to come (as otherwise there would have been no one here for 2 weeks). I will be spending the next 2 days sucking every bit of information I can from Marjolein!

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The hospital has been incredibly busy in the last 48 hours. There have been 27 babies born - all alive and only 1 (elective) Caesarean. The midwives have handled almost everything without the need for medical assistance.

I delivered a set of twins. This also would normally be managed by a midwife but there was thick meconium and the vacuum wasn't working. I was therefore called to deliver them with forceps. The first was born very flat and required CPR but survived at 1.7kg. The 2nd was healthy and 2.8kg. Everyone is hopeful that the little one will quickly learn to breastfeed and thereby stay alive.

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In amongst the chaos I was treated to a welcome 'coffee ceremony' All the staff came along. Biscuits, popcorn and lollies were supplied by the organization and an enormous cake-like loaf of bread was produced.

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The floor was scattered with grass and we sat down to a cup of extremely strong and sweet coffee.

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It was also an opportunity for the staff to be praised for the incredible job they have done during the last exceptionally busy month.

I am paranoid about mosquitoes! As the sun goes down, the irritating little insects appear, and by dusk they are everywhere. I have been taking my medication, dressing appropriately and lathering myself in DEET. Although initially a bit claustrophobic under my mosquito net in bed, I have quickly adapted and now love the security it provides. Rarely do they get close enough for me to hear them buzzing at night.

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Today Marjolein tells me that a) it is not malaria season and b) most of these irritating mosquitoes are not the ones that carry malaria anyway. She wears no protection and is very blase about the whole issue. I was reassured for a short time (she is a tropical medicine specialist afterall) but then she went on to tell me she's had malaria 4 times!! I think I'll just continue to play it safe.......

And finally for today.....a cute photo!

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Posted by gunny64 09:46 Archived in Ethiopia Comments (2)

Barhirdar

overcast 25 °C
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The trip to Barhirdar was an experience! My first problem was getting into the domestic terminal. The security guard at the entrance thought I was lost and kept trying to convince me to go to the International airport. I obviously didn't look like someone that should be flying to rural Ethiopia! I managed to get past him, through the multiple security checks and found my gate. Even then it wasn't straightforward. After many announcements that I didn't understand, I followed the herd onto a bus and we were transported to a plane parked at a different gate. I was seriously wondering where I might end up, but once the doors closed, everything suddenly became normal, off we flew and 1 hour later landed in Barhidar.

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I was met at the airport by Solomon the ambulance driver who then proceeded to speed through the streets as though he was transporting a patient having a heart attack (which I almost was by the end of it!), stopping only to pick up his wife who needed a lift to the supermarket. We arrived at the compound just in time for lunch.

Marjolein is a Dutch Tropical Medicine doctor who has been to Barhirdar several times and for extended periods. She is the perfect person to show me the ropes. We ate a hearty savoury rice lunch before heading off to do afternoon rounds.

I am staying in a very small compound about 100m from the hospital. The house has 3 rooms and a kitchen/dining area. To my delight, there is a toilet and shower in my room and even intermittent hot water. Luxury!!

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There is a high brick wall topped with barbing surrounding us and a heavy lockable gate.

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At night there is a security guard who stays in a small hut inside the compound. Apparently he is not necessary but it is reassuring to have him there. I certainty feel safe!

I will spend more time on the hospital and post some photos in the coming week. Suffice to say, it is not what we would normally class as a 'hospital'. It is basically a large shed with 12 beds (10 all in one big room and 2 in a small separate room for 'high risk' patients). Antenatal, postnatal and labouring women are all intermingled, along with their family members. Once fully dilated, the women are transferred into a separate room for delivery. There is a small nearby 'operating theatre' and a separate Antenatal Clinic.

Yesterday at the afternoon round, all beds were full and there were several women in labour. There were 3 Ethiopian midwives managing everything. They have clear protocols to follow and are confident, experienced and capable of dealing with almost any problem. If all is straightforward they will even just go ahead and do vacuums, deliver twins and manage breech births. The problem is that if they call for a doctor, it is for something serious!!

We were not needed so Marjolein took me for a walk down to the nearby lake. We found a restaurant and ate dinner (fish goulash and chips) before rushing home just ahead of the nightly thunderstorm.

Oh, I was excited for a minute when I complained that I'd forgotten the vegemite and Marjolein told me that someone had left some when they left recently........bugger!!

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My first impression is good! This is a well organized, highly efficient hospital offering a very high standard of care despite basic resources. I feel so honoured to be here and help however I can. It is inspiring to be working with these hard working local midwives. I think this is going to be an amazing experience!

And for those who have been expressing their concerns regarding my bowel function......so far, so good!

Posted by gunny64 09:16 Archived in Ethiopia Comments (2)

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