Visit to a local health centre

There was a volunteer from Europe visiting and she wanted to see a Health Centre so I hopped into the van as well and went with her!

It was about a one hour drive away from Gondar Hospital into the countryside (Past Azezo and past the turning to the airport). The asphalt road ran out so then it was along very bumpy track.

Antenatal clinic

If there were any complications then the patients from here would be sent to Gondar Hospital - along said dirt road - either in the health centre ambulance or in the Red Cross one or Hospital one.

They said they had one or two deliveries everyday but there was no-one there when we visited. It was super clean!

 For the neonatal resuscitation

The health centre was staffed by 2 midwives and then there were 7 other nurses who did different clinics etc - the head midwife said he would love more training for the nurses as there were times that the midwives were not at work so the nurses cared for the pregnant ladies.

The autoclave

The smallest ambulance you ever may see!! They say it attaches onto the Bajaj (tuktuk) - would not fancy it though along the bumpy road - being in a 4x4 was bad enough! 

The Health Centre













The Delivery Suite at the Health Centre

The Delivery Suite

The conditions on Delivery Suite are hard - there are often women sleeping on mattresses on the floor and I feel awful when you have to literally step over them when doing the ward rounds.


It is quite unclean but it is so hard to keep clean with an uneven concrete type of floor as dirt just gets in the cracks. We have just swapped the wards around so actually this is now the post natal ward and the Delivery suite has a nice new floor and is much cleaner and brighter! Yeh! And sometime (supposedly June) there will be the new hospital!!

If a patient needs any drugs then the family member is given the prescription and goes to the hospital pharmacy to buy them - if they are not available in the hospital they have to go out to one of the private pharmacies to find them. This is the same if they need a Caesarean Section - the relative is given a full list including catheter, cannula, antibiotics, a number of sterile gloves, painkillers. Obviously if there is an emergency then they do have some spares but these would generally be replaced afterwards. If the patient cannot pay or does not have any attendants then again there are some spares and there are social workers who can sort out the finances. 

There is very little privacy and certainly no single rooms! The area where the women deliver has 3 couches (4 now we have moved) but there is no screen between them. The women deliver alone with no relatives with them. Spinals are given for Caesarean sections but not for much else...

RCOG go to The First FIGO Africa Regional Conference!

What an honour for Ethiopia to hold The First FIGO Africa Regional Conference! The organisation was excellent - there was no "African Time" here!! The sessions were extremely well coordinated. If I had one complaint it would be that there was too much going on - with 4-5 sessions running concurrently so it made it difficult to decide which sessions to go to.
The current president of FIGO Africa was present and very proud of his country (Ethiopia) and the whole conference.
The president of FIGO Prof Arulkumaran was heavily involved and very supportive of the conference.




The RCOG held some very well received sessions which really shows how committed they are to assisting Developing Countries to improve maternal mortality internationally.

Prof Walker

Prof Walker (Sen Vice Pres International -2013) ran two successful workshops about how the well established guidelines of the RCOG can be easily adapted to be used in Developing Countries. The created lively debate amongst the delegates attending the workshop but did culminate in a general agreement that when starting to create protocols and guidelines it is definitely easier to adapt established evidence based guidelines than to start from scratch.







The RCOG had a session chaired by Alison Wright on what the RCOG can offer Healthcare Institutions and Individuals outside the UK.
http://www.rcog.org.uk/international

Paul Fogarty (Sen Vice Pres Global Health) spoke about the Global Issues that the RCOG was involved in and the benefits of overseas members - the picture shows the number of countries the RCOG already plays a part in.

Paul Wood spoke about the importance of a robust training and education scheme and how the MRCOG exam can be a very important milestone not only in the UK trainees career but also how important it can be for non-UK graduates to gain this very well recognised and respected qualification. 

There was a great representation from members of the RCOG and UK based obstetricians including Lesley Regan, Hani Fawzi, Justin Konje, Alison Fiander, Isaac Manyonda, Austin Ugwamadu, Babatunde Gbolade and this is just a list of the ones that I knew/met!

The support from Lizzie Rafii-Tabar (Overseas), Lorraine Rossati (Director of Global Health RCOG) and Ann Tate (Director of Development RCOG) was superb throughout the whole conference.

And the session ended with Dr Sophia explaining why she is flying throughout Africa!! ...to raise awareness of the massive challenges African women have with access to healthcare and how much more likely they are to die in childbirth than their European Counterparts.

LIKE ON FACEBOOK for UPDATES - http://www.facebook.com/FlightForEveryMother 

SEE MORE AT

http://www.flightforeverymother.com

http://www.blogflightforeverymother.com

Would you fly in a tiny plane around Africa for the sake of Women's Health?!!??!?!

That is what Dr Sophia Webster, UK-based Obstetrician, is doing!!! All because African women face many more health challenges than their European counterparts and are much more likely to die as a result of having a baby.

Me and Sophia!! (I was in awe!!!)

I was soooo impressed to meet Sophia and hear her talk so passionately about the challenge that she has set herself to raise awareness of the massive barriers African women have during childbirth.

 She is:

•  visiting multiple medical and midwifery units
•  donating essential midwifery + medical equipment 
•  facilitating skills teaching among local staff focusing on the 3 most serious pregnancy  complications: massive bleeding, serious infection and very high blood pressure
•  listening to and recording the stories of the patients and their carers that they encounter
•  visiting schools
•  stimulating discussion within each country and beyond about the factors which influence the  health of women during pregnancy and childbirth
•  inviting donations to 7 key maternal health charities performing sustainable work in this field

See more here!!

 http://www.flightforeverymother.com/

http://www.blogflightforeverymother.com/

@foreverymother

https://www.facebook.com/FlightForEveryMother

RCOG go to VSO ETHIOPIA!!!!

I met with the RCOG Global Health Team and we had a very successful meeting with VSO Ethiopia. The RCOG are very keen to increase their involvement in Global Health which I feel will be a really positive move which will benefit not only the developing countries involved but also will provide excellent training opportunities for members of the College.

At the meeting we discussed the successes of the VSO/RCOG partnership and how maternal health in Ethiopia has improved thanks to the efforts of previous volunteers. These include Kate Darlow (read her story!!) who took over from Ruth Lawley in Bahir Dah and Mary McCauley who had a very successful time in Yirgalem Hospital and had numerous posters accepted at the FIGO conference for her work there!

Kate Darlow

We discussed how beneficial it will be when we can increase the number of volunteers in Ethiopia as this would allow projects set up by one volunteer to grow and develop. It would be great if both senior trainees and consultants were involved as both different groups have very valuable skills to offer. From a personal point of view I would highly recommend coming to work in Ethiopia! The doctors here have been very enthusiastic to have a UK trainee working with them and it is a fantastic and friendly country!! And believe me - if you have had a little idea in your head that you might want to do this kind of work at some point don't ignore it - just go for it!! Once you start applying there will be some obstacles but you just need to take your time and work round them and then you will find yourselves out here meeting so many amazing new friends and colleagues and learning so much!!

Present at the meeting from the UK were Alison Fiander, Justin Konje, Alison Wright, Lorraine Rossati, Ann Tate and Lizzie Rafii-Tabar.

G'Oats so simple

I won't be graphic - and don't worry there are no graphic pictures either!

Goat market

Bit of bargaining...

Off we go!!

How else do you get your goat home, if not in a bajaj?

Tibs....

Goat stew, Goat pie and actual Tibs....yummy!!!

Lalibela

Lalibela is a World Heritage Site and it is amazing! It is famous for churches that are carved out from the rock - "rock-hewn" to use the correct term. It is said that all the work was completed in 23 years and this was possible because while the regular workers were sleeping, angels came down from heaven to work on the churches through the night.

Essentially there was flat rock and then they chipped rock away to leave these amazing churches which are below the ground - just imagine being the first person to do the first bit of chipping away.

King Lalibela decided to build them to avoid the pilgrims having to make the dangerous journey to Jerusalem. Or he may have been inspired to build them after he went to heaven (while he was in a coma after his brother had poisoned him) and met God who told him to re-create Jerusalem in Ethiopia. Whatever the reason the churches are so interesting and here are some piccys.

Then there is these really odd looking restaurant which has amazing views, good food and plenty of beer - but no power on the night that we went....

Market time for New Years Eve

Arada - the market where I buy my veggies.

It was pretty busy on New Years Eve.

There are some little shops (concrete/mud/tin) but most of the veggies are sold by women crouching on the floor.

I haven't quite plucked up the courage yet to buy a live chicken - apparently the black ones are cheaper because they are the evil ones!

You can also buy live goats - good for Tibs (Fried lamb/goat dish)

To and from work

Normally in the morning I take a line taxi which is a blue and white minibus that you have to bustle to get on - rather similar to the tube I guess...

 I generally walk home in the evening and here are a couple of snaps!

 They love the babyfoot here!

Labour ward

The hospital is predominantly single story buildings which I think were built by the Italians when they were in Ethiopia in the middle of last century. There is a massive new hospital being built next door and it continues to grow slowly - but I hear that there are issues with funding coming from a few different places and I also hear that it has been in progress for a long time and is likely to take some time still to complete.

The conditions on labour ward are cramped and there is nothing that can be done about this presently. Obviously when the new hospital is built it will move there and presumably have more space but for the moment the conditions are as follows:
There is the antenatal room which consists of 6 beds and normally has two or three mattresses on the floor to accommodate further women. There are also 4 beds and additional mattresses in the corridor. It can be difficult to walk around and often you have to step over women lying on the floor. There is the labouring room which again has 6 beds. Fetal monitoring is generally done using the pinard fetal stethoscope but there is a ctg machine which is used for high risk patients - although there is no paper so you cannot read the ctg so it is just used as a measure of fetal heart beat. All examinations are done in this room so you can imagine there is very little privacy. Generally the women are alone during labour but sometimes there may be a female accompanying them. When the women are ready to give birth they walk through to the delivery room which has 2 delivery couches and the neonatal station - which is a table with a portable radiator on it to keep the babies warm. Theatre is at the end of the corridor where caesarean sections can be performed.

There is very little analgesia used here. MROP/ventouse/forceps/EUA are done with no analgesia/anaesthetic.

The doctors work extremely hard but essentially there just needs to be more of them!!

I’ve been through the Cave of Retzius with Dr Ambaye – amazing fistula surgeon

I spent another couple of amazing days with the fistula surgeon from Addis. Her name is Dr Ambaye (you will read about her in “Hospital by the River”). She now works in and around Addis travelling to the hospitals when they have enough cases for her to operate on. On Monday and Tuesday there were much more complicated cases.

**WARNING – MEDICAL INFO THAT SOME PEOPLE MIGHT NOT LIKE!!!!

Circumferential defects

This is where the uretha and the bladder have been completely broken down – so there is the bladder up above and then no connection whatsoever to the urethra below. I was thinking “How on earth is this ever going to work!?” She mobilised bottom part of the bladder which then allowed the bladder to meet the urethra. She joined the anterior part of the bladder to the urethra to close the gap and then closed the rest of the bladder posteriorly as the defect in the bladder was bigger than the proximal end of the urethra that it was required to join to.

Bladder to anterior abdominal wall

This patient had been operated on 4-5 times previously but without success. She had a circumferential defect (as above) but also she had urine leaking from her anterior abdominal wall. What Dr Ambaye did this time was to enter the cave of Retzius and continue all the way up until she reached the very top of the bladder and found the communication to the anterior abdominal wall and then calmly cut the entire length of the anterior wall of the bladder until she reached the fistula, she then cut the scar tissue out and repaired the bladder. A truly amazing operation. She later told me that she likes the challenge of a difficult case and finds the successes extremely gratifying.

I had dinner with Dr Ambaye that night and she spoke about how she feels when she can make such a difference to the lives of these women. She learnt fistula surgery from Catherine and Reg Hamlin but she said the main thing that she learnt was how much they cared for the patients and she also inherited this intense passion for caring for the fistula patients. 

Fistula Surgery

Today I had my first experience of fistula surgery in Ethiopia and I felt very emotional about it. It is impossible to imagine what women with fistula go through....

The problem that these women have usually results from obstructed labour: which is when the baby does not fit into the pelvis properly and so becomes stuck. In the UK we would perform a caesarean section and usually both mum and baby do very well. Due to the lack of resources here, that is not always possible, particularly in the more rural areas...What does happen is that the baby dies and after a couple of days the fetus becomes soft enough to pass through the pelvis. Unfortunately by that time there has been damage to the bladder and/or bowel meaning that urine and/or faeces leaks uncontrollably through the vagina. The resultant smell and uncleanliness can often lead her to be cast out by her husband/family. So she has to deal with the loss of a baby and the shunning of her family: the social isolation she suffers following this is devastating.

The operation aims to stop the leakage and restore the anatomy to as close to normal as possible. The surgery is free and transport to and from the hospital are also free. While the women are in hospital they are taught how to read and write and how to function successfully in the world. The hospital follow the women up when they are discharged and when women are cured it transforms their lives.

One of the many things that they are trying to do in Ethiopia is to reduce the amount of fistula happening and this is by training more doctors and associated health care professionals to recognise the signs in labour and to be able to perform the Caesarean section at the right time. It takes time to train people and get the infrastructure so things can improve but it is happening!!

A good book (non-medical) about the plight of the fistula patients is written by one of the doctors who founded the Addis Fistula Hospital - it is called "Hospital by the River" - it will make you weep...

Tourist Day!!!

Today I went on a tourist outing with the lovely Canadian that I met on the CNIS (http://www.cnis.ca/) course that was running in Gondar Hospital the previous week. We went to the castles in Gondar which are amazing!! And would have been more amazing if we (the British) hadn't bombed them during WW2 - but to be fair we were trying to liberate Ethiopia - but I apologised all the same!!

 

 We then went to the baths - which are empty all the time apart from during the festival of Timkat where they are filled and everyone piles in to celebrate the baptism of Jesus Christ in the River Jordan - happens on the 19th Jan - so I am looking forward to that!

Then we took a drive up to Hotel Goha which gives the best views of Gondar and the region around and it is breath-taking!! The surroundings are not what you think Ethiopia is!! I think that this is going to be a favorite place for me over the next 6 months! It takes you right away from the hustle and bustle of the town below.

As I had previously tried the red wine we thought it was right to try to local white wine! It tasted a bit like sherry - maybe we should have taken the advice given to us previously...mix it with Sprite!!!

First O&G night out!!

Last night I was invited out for dinner by the senior who I will be working with as a welcome to me and as a goodbye to a lovely visiting Canadian OBGYN who I had assisted on a teaching through CNIS (http://www.cnis.ca/). CNIS aims to teach life-saving skills in an ethical, sustainable and cost-effective manner. The instructors follow a standardized curriculum, in which they employ simulators, skills laboratories, and supervised teachings in the operating room. We had typical Ethiopian food followed by some good old Shoulder Dancing - I am rubbish at it but it is good fun!!

Attempting shoulder dancing

Failing at shoulder dancing!

OBGYN!!

At work I have been settling in and appreciating the differences between the hospital/care here and in the UK. I have been examining the medical students - they use the case study and viva set up and were asking about our OSCE set up in the UK.

I have found someone to wash my clothes and he irons and folds them and even pairs the socks - it's great!!