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!!