Monday 19 August 2013

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. 

Sunday 11 August 2013

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...

Saturday 10 August 2013

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!!!



Friday 9 August 2013

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!!






Monday 5 August 2013


I had my first day at work today and the doctors are all lovely and soooo welcoming! I hope things carry on like this!! (....well not the weather - it is very very rainy - but it does mean that the mountains with the green trees and vegetation is amazing!!)

I went for the "morning meeting" which is where admissions are presented and management plans discussed. Then we went on the rounds - the hospital is so different to what I am used to - we are lucky to live where we are and have the medical care that we do.

There are exams tomorrow so I will be helping with them!! I wonder how they will compare!

...Just had a complete power cut in the cafe while writing this!! Luckily laptop works on battery and I have my "dongle" for internet! however the flies like the bright screen!! - oh - the candles are coming out - it's lovely!!!

Sunday 4 August 2013



I have arrived in Gondar and it is beautiful - it is so green and lush (and therefore there is also a lot of the rain)!! I will take some good piccys and post later in the trip.

Currently waiting in a hotel until they work out where the best place for me to stay is...

I start work tomorrow and am really excited!!!






Here are a few snaps of the airport.

And here is my life for the next 6 months or so!!
In the box is one of the hardest pillows I've ever felt, 2 blankets, an electric stove, a stabiliser and surge protector for when the power goes funny and a few provisions I bought in Addis to keep me going until I gind proper food.
There is also a kerosene stove - must remember to get the correct fuel - neither propane or butane will do apparently!

Friday 2 August 2013

Ministry of Health


Today (1st August) we were invited to the Federal Ministry of Health Of Ethiopia and had a great talk from Dr Mengistu one of the maternal and paeds health guys there.

It was really really good to find out the background from his point of view. He had been an obs/gynae in Ethiopia but then had traveled and worked around the world  and was now involved with public health as well.
Here is a picture of me getting excited about the guidelines they have here!!

This is the food we are eating every day! It is really great and I love it! The arrow points to injera which is nice - loads of people said that it was not good but I am enjoying it so far!!

Injera is not only a kind of bread—it’s also an eating utensil. 
In Ethiopia and Eritrea, this spongy, sour flatbread is used to scoop up meat and vegetable stews. Injera also lines the tray on which the stews are served, soaking up their juices as the meal progresses. When this edible tablecloth is eaten, the meal is officially over.
Injera is made with teff, a tiny, round grain that flourishes in the highlands of Ethiopia. While teff is very nutritious, it contains practically no gluten. This makes teff ill-suited for making raised bread, however injera still takes advantage of the special properties of yeast. A short period of fermentation gives it an airy, bubbly texture, and also a slightly sour taste.