A Travellerspoint blog

Hippo Hunting

storm 20 °C

Firstly, sadly, my phone is dead. It's insides have been totally cooked by what I assume was a power surge and I have probably lost all my photos (apart from the ones saved for this blog). However, Marjolein has kindly loaned me her camera so I will try to take as many photos as I can in the next few days. The logistics of getting these pictures onto my blog is tricky however, so everyone will just have to put up with words for now!

Today I had a big adventure! It was my day off and Marjolein insisted I get out and explore. She directed me to a lakeside walk. I found a surprisingly modern pathway right up against the lake's edge. I left quite early and it was cool and peaceful. Along the way were occasional 'drinks stands' as well as goats, chickens, sheep and one Japanese tourist. Intermittently I would come across a laundry area where the locals were scrubbing their clothes in the lake and then hanging them out to dry on the rocks. Other places were obviously bathing areas with mostly naked men washing and shampooing and frolicking around having a great time in amongst the worm infected reeds. As you know, I have pushed my boundaries somewhat here in Ethiopia but I was not tempted to join them!!

After my long return journey, I was just about to leave the path when I came across a young Ethiopian who wanted to chat. As previously discussed, this happens quite a lot and I would normally not converse long, but this particular fellow was a young university student who had arrived only yesterday in Barhirdar for 'summer school', seemed very genuine, spoke excellent English and wanted to sightsee. He was also a history student and full of fascinating fun facts. After much discussion, he convinced me that we should go hippo hunting together!

I was already exhausted from my walk, so after a short time, I decided we needed some other form of transportation. He hailed a minibus and in we hopped together, scrunched up amongst the locals, for the grand sum of around 5 cents each. An interesting, albeit claustrophobic, experience! Finally we arrived at the Blue Nile Bridge. It hadn't quite dawned on me that this was the actual NILE RIVER so I was pretty excited. We hunted around for hippos but sadly it was probably too late in the day and they had moved on. Even if we had been lucky, unfortunately it is illegal to take photos of, or from, the bridge (my friend asked the machine gun carrying soldier on my behalf and was clearly told NO so I wasn't going to even try!). We then hopped on a tut tut (which cost slightly more but was worth it!) for the trip home. Being a poor university student, and having provided me with an unforgettable experience, I decided to give him a small amount of money to buy a textbook. He was pretty chuffed!

It is impossible to know what will happen next in this place! I arrived home to find my housekeeper had cooked a full Mexican meal including guacamole and homemade tortilla. What a bizarre thing to be eating in Ethiopia. Very tasty though!

The hospital has been very busy in the last few days. Apologies to the non medical/nursing people among my readers. We have had a Para 7 (6 alive) with severe preeclampia at 36 weeks. Her BP was 200/125 and she initially refused to stay. Via her husband, we eventually convinced her to have some treatment - only to find we had no hydralazine. After a frantic search of the town, some was discovered in another hospital and we managed to control the situation before she fitted. All her other babies had been born at home so she was rather suspicious about us wanting to induce her, but finally relented and a good outcome was achieved. That afternoon someone else had a retained placenta. Unlike at home, this is sorted out on the labour ward without analgesia - a somewhat traumatic (but successful) experience for doctor and patient. She was off home after 6 hours like everyone else! We had 13 vaginal deliveries in the last 24 hours including a successfully induced VBAC. 160 births for the month so far, with one week to go. Currently a 4.4% caesarean rate!

I cannot believe I only have a few days left in this amazing place. I intend to make the most of it........

Posted by gunny64 05:56 Archived in Ethiopia Comments (1)

An inspiring man

overcast 27 °C
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Over the last 2 days, I've had the privilege of spending time with the most inspiring man I have ever met. Andrew Browning is the gynaecologist who has worked here in Africa for many years; setting up this hospital in Barhidar, as well as several others scattered throughout Ethiopia and Tanzania. His passion and commitment are palpable and I am blown away by his humility. Andrew has dedicated his life to improving women's health in Africa. I wonder how many women and babies this man has directly or indirectly saved; not to mention the lives he has returned to those many women who have had a fistula repaired under his care?

I can't believe my luck at being here for this visit. Andrew is in Barhirdar for just 3 days to check on the hospital (including the new one currently under construction) and meet with the Board. On Thursday he is spending the day in Addis and catching up with 2 other amazing people - his aunt Valerie May Browning and the famous Catherine Hamlin. Oh, to be a fly on the wall at that meeting!

Today Andrew took me to visit the fistula hospital here in Barhirdar. He started up this place about 10 years ago but it is now under different management. It was one of the most emotionally overwhelming experiences of my life. Andrew was treated like royalty. All the staff - nurses, cleaners, kitchen staff - came running out to hug and kiss him. Many of these women had themselves been fistula patients and Andrew had operated on them years before. We then had a tour of the hospital. I was (somewhat embarrassingly) totally overcome by emotion seeing firsthand the difference he has made, and continues to make. A formal 'coffee ceremony' ensued which is a very complex and prolonged procedure starting with the roasting of the coffee beans. I'm sure the entire hospital staff turned out to show their respect. I'm am still struggling to hold back the tears as I recall the experience.

Unfortunately, just before we left for the fistula hospital, my phone totally died. I suspect there was a power surge which has cooked its insides. One of the locals has taken it off to be looked at but I am not holding much hope. Sadly this means there are no photos and there may not be any more from now. I hope the ones I've already taken are still safe as I haven't backed up for a week or so! It also means I have no phone, clock, torch or internet. Very, very inconvenient. My computer is still functional and I have found good wifi at the nearby hotel. However, future blog posts are likely to be few and far between......

Some other exciting news has been the return of Marjolein. She's back from Holland with wonderful goodies including wine, cheese and chocolate (for the midwives). Having been on call continuously for 2 weeks, it is a relief to get a break. She was very impressed that the midwives and I kept the hospital in good order without any major disasters. I had told her the caesarean rate at Murdoch so I think she expected to find I'd cut everyone open during her absence. Actually, I had done only 5 (all necessary!) caesareans thereby keeping our background rate of less than 10% (actually it is currently 5% for the month!!).

And......breaking news.......I passed my first solid stool since arriving in Ethiopia. Happy days!! Looks like I'll be able to donate my 2 remaining rolls of luxurious toilet paper to the hospital!

Posted by gunny64 07:56 Archived in Ethiopia Comments (2)

Breasts!

sunny 27 °C
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It has been a rather stressful 2 days. I awoke yesterday to find a message from my boy Alex telling me he was 'safe'! This obviously raised a few questions and concerns. After a quick Google search, I learnt about the terrorist attack in Nice and then slowly the story unfolded.......

Alex's waterpolo team were in Nice at the time. They were enjoying the evening in a cafe close to the main strip where the attack occurred. The boys were luckily not in the line of sight but could hear the shooting and then people starting running into their square. Alex and his mate, Jake, rushed to the cafe, collected the boys and took them safely back to their hotel. It was fortunate that Jake had been living in Nice this year and knew the area well. The boys were apparently 'shell-shocked' but OK and last night flew onto Budapest for the second last leg of their trip. Another terrible tragedy for the people of France but I am so thankful that Alex and his boys are safe.

Something like this reinforces my isolation. I have no access to normal media. There is no TV or radio that I can easily reach. The internet is 'patchy'! The one saving grace was that social media access had been mostly restored on Friday, making communication with Alex and home much easier. Also I now have some contacts here who could have helped me quickly arrange the 5 hour flight to France had it been necessary.

Now onto breasts.....I know my LC friends will have been waiting for this. Sorry no photos for this topic!

I have seen a lot of breasts in the last few weeks! On one of my first days, Marjolein mentioned that breasts here are not considered sexual - they are purely functional. This seems so true. Women are not embarrassed or sensitive when it comes to feeding. Their babies are carried on them everywhere and breastfed whenever, and wherever, they desire. I am yet to see a baby being fed with a bottle. Formula is expensive and inconvenient. I'm told that donor milk or 'wet nursing' is rare or unavailable due to the HIV risk.

As I've previously mentioned, the whole process of getting the baby out is pretty quick and mothers are back in their ward bed within 30 minutes of delivery. The baby is then immediately offered the breast and most just latch straight on. The baby co-sleeps and demand feeds. Discharge is usually 6 hours later and the midwives make sure the baby is sucking well before it is allowed to leave.

Like at home, doctors play little part in this process, but I've certainly made a few interesting observations. Firstly, there seems to always be an abundance of colostrum and the milk comes in very quickly. Secondly, most babies suck strongly immediately. It is so rare for women to stay or be readmitted with breastfeeding issues (apart from mastitis). There is a breast pump hidden away in the storeroom but I am yet to see it used. There are no lactation consultants, nipple shields, breast warmers or supply lines. Unlike at Murdoch, it doesn't seem necessary to add Motilium to the water supply! It all just seems to work!

Another fascinating use of the breast is during 2nd stage. As we know, contractions often diminish at this time. Here it is routine to perform nipple stimulation to 'hurry things along'. It is somewhat comical - one midwife (male or female) either side of the woman, nonchalantly tweaking her nipples while discussing their social life between contractions. It works! Not sure how it would go down at home though?!

Today I was really brave and tackled the main drag of Barhirdar. Being a Saturday morning, it was packed and chaotic - possibly not the best time to avoid being pickpocketed. However, it was lively and atmospheric, and worth the risk. There were many amazing photo opportunities but it somehow didn't feel right to snap away at these people going about their business. I did, however, ask permission of this gorgeous little chap herding his sheep through the streets. He was particularly proud of his little lamb.

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I accidently discovered a supermarket. It was not clearly marked (well not in English anyway) and I only went in because there was a picture of a chocolate bar. Inside was a haven of neatly packed shelves filled with (somewhat) western food. Chocolates! Biscuits (sadly not Oreos)! Fresh bread rolls! But no vegemite or butter :( Needless to say I left with a bag full of goodies! The chocolate bar didn't even make it home..........

Posted by gunny64 06:35 Archived in Ethiopia Comments (4)

Half way

sunny 21 °C
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It is hard to believe but I have now been in Ethiopia for 2 weeks and I am halfway through my adventure. What an amazing experience so far! Who would have thought that I'd survive? Let's face it, I'm not designed for hardship - I hate dirt, disorder and discomfort. Despite all 3, somehow I have managed to last for 2 weeks and haven't felt the urge to scuttle back home to my comfortable life.

Having said that, there are some things it has taken a while to accept (in no particular order):

1. Sudden, random loss of electricity, expecially in the middle of making coffee or during a Caesarean
2. 5.30am wake up every morning by the 'call to prayer' blaring via a loudspeaker from the nearby mosque
3. Lack of water for 12 hours (a difficult situation if one has irritable bowels!)
4. Cold showers
5. NO internet for an entire day
6. Mosquitoes (especially the one every night that manages to somehow squeeze through the net and buzz near my ear)
7. No butter, vegemite, cheese or Grill'd
8. Repairing a perineum by the light of a smartphone torch
9. Mud!

On the positive side, I've learnt a lot about Ethiopia, obstetrics and myself. I have been able to read a few good books guilt free, listen to the rain on my tin roof every night as I fall asleep, drink the best coffee in the world and discover the wonderful feeling of helping people in great need.

Today has been a rather good day! Firstly, to my great excitement, there was HOT water. Somehow, randomly, it reappeared and I had the most wonderful hot shower to start my morning. I obviously won't assume continuation of this apparent miracle - I'll just savour each time it occurs.

To counterbalance the hot water situation, the electricity went off just as I was boiling the kettle for my coffee. It was still off when I returned home for morning tea. I obviously looked forlorn because, all of a sudden, my housekeeper Meron rushed off and returned with some smoking hot embers. She proceeded to boil the kettle and make us some coffee. I have no idea where she got them from but it was very sweet!

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Then, to top it off, I came home for lunch to find this lovely selection of treats: strawberry jam, chips and fresh banana bread. Heaven!!

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The hospital for 2 days has been quiet, so yesterday I braved the complicated streets nearby; always double checking my bearings as I walked. As I moved further into the outskirts of town, I discovered where many of my patients must live. There is certainly a lot of poverty here. Many of the houses are tiny and basic and open straight onto the street.
It is school holidays here so kids are everywhere on the streets playing and laughing. They clearly love to see a white face and are either very shy or overconfident. They like to say 'hello', 'how are you', and 'welcome to Ethiopia'. They will often want to shake my hand or give me a high five. It's nice to see them looking healthy and happy.

One thing I don't like is being approached by men as I walk. They are always in their early 20s, well dressed and articulate. They want to strike up a conversation. Some are clearly tour operators or shop owners wanting to direct me to their business, but others just seem to want to chat and welcome me to their country. Maybe sadly, maybe sensibly, I am reluctant to engage these men. I'm paranoid of scammers and pickpockets and I don't want to take any risks. Occasionally a guy will seem genuine and I'll have a little conversation but then quickly move on.

Yesterday I found a cafe. It is like a little oasis: shaded and filled with tiny birds. I thought it must be good when I walked in and found several policemen and some UN Aid Workers sitting there. The waitress spoke no English but I now speak Amharic! Bunna = coffee! I had 2 rich, black, sweet cups of bunna and it cost me a grand total of 90c (including tip!) May Street Larder has a lot to answer for!

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This afternoon was still peaceful at work so we all sat around folding up swabs!

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Posted by gunny64 08:34 Archived in Ethiopia Comments (2)

Coffee

sunny 28 °C
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It has been a long 48 hours! The internet has been down, the electricity has been on and off, my shower is still cold and I have been busy at the hospital. However, there seems to be a small window of opportunity to get a blog post up......but it will be a brief one.

I have become obsessed with coffee! Ethiopia is thought to be the birthplace of coffee and it shows. Coffee is everywhere. Many houses along the streets have a small table with cups sitting outside their door waiting for coffee to be served. I cannot believe how different it tastes here in Ethiopia. Everyone knows I love my 'skinny flat white' and will go to great lengths to find a good barista. I've never enjoyed espresso and find black coffee generally very bitter. But here, it is smooth and rich with no bitterness at all. I started drinking it black like the locals as the milk is unpasteurized and I didn't want some nasty disease, but now I choose it that way. I also, like the locals, love it very sweet!

I've known that my housekeeper, Meron, buys fresh coffee beans every week and we end up with beautiful ground coffee powder. She goes to the market and buys a very particular type. I've been hoping to catch her in the process of dealing with the beans. Yesterday was my lucky day and she was very happy to show me the entire process.

These are the fresh beans. It's hard to believe that these hard, green beans provide so much pleasure to the world.

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She goes through them and discards the duds then washes them thoroughly. They are then placed on a baking tray and put into a very hot oven. Meron watches them closely, stirring them around occasionally until they were 'ready'. It was hard to get from her what 'ready' meant but they were pretty charred black and smoking.

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She then tosses and blows the beans in the tray to remove all the light husky material and discards any that don't look right.

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Next comes the hard work! She grinds the freshly roasted beans by hand in a metal container. The rich coffee aroma as she does this is amazing and I was salivating; desperate for a hit! I had a turn but quickly tired. I think I'll use an electric grinder at home!

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And voila! Freshly roasted and ground Ethiopian gold. Now for the taste test......

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And to top it off, an Ethiopian lunch: lentils, shiro wat (chick pea stew), pickled beetroot, spinach and salad and, of course, injera. The food is always served on a big tray lined by injera and everyone eats together from this dish. I just love the communal nature of their eating and now don't think twice about launching in using my fingers. It is such a beautiful sensory way to eat (haha who would have thought they'd hear me say that?!).

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Today has been a very stressful day. At one point I was pacing the floor of the ward. It happened to be lunchtime so one of the midwives told me 'not to worry' and to enjoy some food with them. Once again, out came the huge platter lined with injera. Several of the midwives had brought food - a potato dish and a meat dish - which was tipped onto the plate. And we all tucked in and shared the meal together.
There are 2 lessons from this:
1. Midwives around the world are beautiful people (actually my dear wife, Jenny, was the one who mentioned this and she is quite right!)
2. Food fixes everything!

Posted by gunny64 09:03 Archived in Ethiopia Comments (3)

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