He now has more time to think abstractly and write blogs.
I grew up in Oceana in a relatively poor family with no radio, bathroom and an outside toilet. A toilet, that when the bucket was full, was emptied into a hole dug specifically for that purpose. As soon as we were old enough, old enough to dig, this became one of my chores. We all lived in a small country cottage, a bed for the parents, a smaller bed for the kids; a large enough yard to play cricket and kick a football – all you could ever need as a small boy growing up in the country. Continue reading “Introductory Regime”→
Why sad? I’ve so much to be glad about. My wife loves me; I love her. My dogs are lying at my feet. I’m enjoying a cup of coffee.
But I love trees and today we had eight cut down and their roots ground out. They took many years to grow. They weren’t sick. They were in the way. Electricity has become so expensive that we’ve had solar panels installed, and they stopped the sun shining onto the panels in the afternoons.
We have a heap of mulch which will make my gardening wife happy, but I’m sad
I guess that in the long run it is for the best; but I’m still sad!
Whenever my wife asked what I’d like for my first meal when we arrived back in Australia, my answer was invariably pork chops and ice cream. Not on the same plate, of course, but, in the early days, we didn’t get either in Ethiopia. As far as ice cream was concerned, after some years, there was one place, as you turned right at Mojo (about 80 km) to go to Shashemane, where an Italian guy sold gelati from a caravan. Years later there was a spot on the right side of the road as you drove out of Addis, where you could get several different kinds of ice cream; now there are places all over Addis and it is also available in most major towns.
Pork chops were off the list because neither Orthodox Christians nor Muslims eat pork. You couldn’t even get bacon. Because of the growing Chinese influence there are now a few places in Addis where you can buy pork, but it is still not a common meat and to many an absolute ‘no-no’,
You could buy beef which was hanging outside the butcher shops. The butchered halves hung there for all to see. The animals were killed early in the morning and it was good to get there early before there were too many flies. You could point to the piece of meat you wanted and they cut it off. You needed to cook it well, preferably in a pressure cooker. It seemed as if most animals were killed after a long life of pulling a plough!
Chickens (doro) were bought live. They were highly prized as meat. They were in the local custom killed in, to me, a rather gruesome way by sawing through the neck. We, as you probably know, kill them by placing their necks in a convenient place and with a swift swing of an axe chop off their heads, before hanging them up to drain out their blood. Again by local custom the bird is cut into eleven pieces and made into a very spicy meal. The favoured person is usually handed a piece called, when translated, the horse-rider, the meat on the breast bone.
If you wanted sheep meat you went to the market and bought a sheep. You could never buy lamb or mutton or hogget at a shop. You took the sheep home and killed it and prepared the meat there. African sheep don’t look like ours in Australia. They look like goats, but whereas goats ears and tails go up, those on sheep hang down. Goat meat also can be bought on the hoof, in the same way.
Being brought up in the south of Australia, in our childhood and youth, when not eating rabbit, we ate sheep, usually labelled lamb. On the farm they were aged by their teeth, in the shop by the butcher’s choice.
One weekend we decided we’d like some sheep meat. So the teenagers who were living with us A house full of teenagers. and I went to the local market on the Saturday afternoon and after a lot of haggling bought one. As a white person we financially suffered racism. Everything was a bit dearer for us. So I sent the boys out to suss out the best prices. I fooled myself if I thought this would work as I was well known in the town, as was the fact that the boys lived with us! I personally had no intention of killing it. Ato (Mr) Kassa, our gardener could do that on Monday, I knew that he’d be happy to do that for a share in the meat as a gift.
Here I ran into an unexpected hurdle. Sheep are not kept outside in countryside Ethiopia, they sleep in the house, I think for fear of thieves or hyenas. At any rate, in the evening we tied it up in the garden but it didn’t like that at all. It baa-baa-ed to the point of driving us near to insanity. We had to end up clearing a space in the inside laundry, and inviting him in. After that peace reigned until…..
Monday when he was dealt with by Kassa. He was a very tasty and the much enjoyed centre of a number of meals.
Interestingly, the intestine is a favoured piece of the kill and locals make it into nice spicy dish. Kassa and his family enjoyed it as part of his gift. On the whole I don’t like tripe.
In medical English we have the word digit which describes either a toe or a finger. In Amharic the word ‘taat’ which some scripts write as ‘xat’ because the letter x is an explosive ‘t’, our ‘x’ is written ‘cks’. The big toe is called the ‘owra xat’. ‘Owra’ is the added adjective to differentiate a rooster from a hen. It is an ‘owra doro’. So maybe we could call it the ‘rooster toe’.
Certainly the commonest thing with their big toes, in the West, for children, apart from getting their nails cut, are IGTN – or ingrown toenails. When I was in my early sixties I was not able to get a visa into Ethiopia and had a practice here in Australia. I did a few operations under local anaesthetics in my rooms. Things like small skin lesions, carpal tunnel blocks, vasectomies and IGTN.
Pre-teens and early teenagers don’t know what old really means. They think if you’re married and have a couple of kids then you’re ‘old’. One day I was operating on a young girl’s IGTN under local. She was a brave girl. We got talking and she mentioned this old man in some context for which, to me, ‘old’ didn’t seem correct. So I asked her what was the guys age – ’about 35’ she said. I said, ‘then what am I?’ The answer was that I wasn’t old. So I offered to do her other toe free if she wanted me to. She had the grace to laugh but one was enough for her, and besides, there wasn’t anything wrong with her other big toe.
Over the years one has seen a number of big toe issues. Bunions; fractures; cuts; dead bones in leprosy patients and rat bites; gout, arthritis, pyoderma gangrenosum ; cancer; dead toes particularly in diabetics or as a part of much more extensive gangrene in vascular disease. In Ethiopia we often saw people with six toes, usually on the outer side of the foot but not always. Some extra digits were very simple to remove, some more difficult. Why would you want to do anything? For me it was simple – because the patient wanted it. Usually it had something to do with foot wear.
Usually the big toe is longer than the others. Once I operated and shortened the second toe of a state AFL player because every time he played he developed a blister or shallow ulcer on the end of his second toe. It helped him a lot.
It reminds one of the saying – ‘I complained about having no shoes until I saw someone who had no feet. And I stand amazed at what some can do with their feet when they have no hands. They play the piano, tie up their siblings’ shoelaces, in fact, live a full life. And have you seen that guy with no hands nor feet but a world renowned speaker? Amazing!
Going back to my young girl’s statement, I wonder what old really means. Do I measure it in chronological or physiological terms; human years, historical years or eternal years? At over 80, I still feel like a young man even though living in a wrecked old frame.
I used to hear ‘All the world is mad but me and thee, and sometimes I have my doubts about thee.’ In the light of that consider the ‘me’ below and, if you want to, answer as the ‘thee’.
The world I live in has many levels. No doubt your life is as complex as mine, but I live –
inside my skin (which has different levels also!) – I’m old, unable to do what I used to do. Still mentally with it (my interpretation); a bit frustrated with the limitations of age, but fairly contented.
inside my family – as I’ve experienced contact with many families I think ours is pretty good; as family expands beyond a couple to children, their marriages, their children and their marriages down to great-grandchildren there is never going to be a trouble free family tree but ours is, on the whole as good as can be expected in an imperfect world. Whilst I love my kids dearly, I try to see them as of no more significance nor less significance than the smallest latest child born of any colour anywhere today. Truly they are more precious to me, and I’d gladly die for any of them, but of no more worth in the whole scheme of things.
inside my local community – sadly we are seeing too much unemployment, too much crime at all levels, but particularly in the youth aged group with house break-ins, and stolen vehicles high on the list. There is a feeling amongst a significant percentage of the community that offenders often get a slap on the wrist and are allowed to return to their previous activities. To quote a recent news article from the channel 9 News ‘Townsville’s growing youth crime problem has it listed as one of the worst criminal hotspots in the world, with the regional Queensland city named alongside Tijuana, Baghdad, Caracas and Tripoli’.
inside my state – there is high unemployment and the rural area has been affected in a significant extent by the action against transport of live animals and the anti-mining movement. This has had a statewide effect on unemployment and financial viability. At the moment the jobless rate in the state is 6.8%. Quoting the Queensland Times – ‘Outback Queensland’ included Mt Isa, Aurukun, Cape York and Longreach and the region had an average 28.4% youth jobless rate.
inside my country – we have had major fires, significant floods and of course the coronavirus restrictions with major social and economic effects. There are Black Lives Matter riots, seemingly brought to the boil by the killing of a black person (with a significant criminal record) by a white policeman in the USA. It seems to have acted as the straw on the camel’s back at this moment. The bit in parenthesis is not put as an excuse for the killing but as a fact to be considered, as it would be in any accused murder situation – something about ‘innocent until proven guilty’.
inside the world. USA, which claims to be a democracy, ever since the last President was elected, has been the scene of politically stirred up and cause-aided disturbances to bring it to the situation where it is no longer acting as a democratic country. It is complex but it seems to me as if the entrenched rich from all political streams don’t want the changes promised by successive Presidents, (promised in my view, to get elected) but not acted upon. The present President has fulfilled their ans some of his promises, and stirred up the entrenched who never wanted the promises fulfilled, but their person to get into power. Black lives matter is absolutely true; then, if that is true, may I ask, why are the majority of black people killed in the USA killed by black people, and why the issue of roughly 50% of abortions being performed on black people (only about 15% of the population) isn’t a major issue with the cause? Is there any reason why we don’t hear of the religious and inter-tribal murders of hundreds of blacks mainly by blacks? This is happening in big numbers in West Papua and Nigeria at the moment. There are the Middle East wars and many other concerning issues to be considered in addition.
inside the cosmos – well I think that there are efforts being made by a number of nations, at great cost and in the name of Science, to mess this up also. There may be some advantages which come from their searching.
I’ve read that ‘3 things remain – faith, hope and love’.
I guess my faith is that God, the Creator is still in control; my hope is that at every level we’ll act with integrity and learn from our mistakes; my aim, concerning love, is to be able to love friend and enemy and treat each person as I would seek to be treated.
I write a fair bit about my time in ethiopia. Obviously one didn’t always feel on top of things. Here is a comment I have written elsewhere, when I was on sight and waiting for my wife to join me I have shown a few pictures before. A few pictures from the past.
It was, however, all both mentally and physically exhausting. There was little change or even desire to change the problem areas of the hospital. Some of the younger doctors decided not to seek my help – at least immediately. So one morning they came and informed me that the previous night, being unable to deliver a breech they had just cut off the head and left it inside – would I now please remove it. It turned out to be relatively simple but was a very gory procedure.
Then, on another occasion, two days after delivering the first of twins the duty obstetrician said that the other twin was dead and he couldn’t get it out – would I please help? I was in the middle of an operation but I asked him to bring the lady around to the holding room and I would deal with the situation as soon as I finished the present case. I must confess I didn’t even examine the lady but just put her up in stirrups and applied a suction extractor to deliver the twin – only to find that it was alive, and, in fact, the second of triplets! Both of them survived even though it was a rush to prepare and get into action with baby resuscitation equipment. I had learnt to intubate the newborn ‘flat’ babies without a laryngoscope but by putting my finger onto the top of the larynx and passing the tube along my finger into the trachea.
I have just come across a letter I wrote to my wife when I was alone at Soddo. I copy several comments here directly quoting from my letter home.
1. On the weekend I made a note in a chart that someone (a little baby) hadn’t been seen for 48 hours and was very sick and that the GP should be called.There was no record that any medicine had been given at all, he was nearly dead.This led to the accusation that I was accusing the GP of incompetence and that he would never work with me again.The other GPs all supported him saying that I should not write in the chart but send him a message through the Medical Superintendent.
2. Then on Thursday morning I arrived to find a little child grossly dehydrated and on the point of death. In spite of all I tried to do he died about an hour later. I notified the Medical Super and the Head Nurse. They chose for the case to be discussed at the next morning’s meeting. When the case was brought up next morning the situation was not discussed as the doctors said that the meeting to was to discuss out of hours admissions and this child had come in during the day.
3. I was able to intubate a woman whose operation had been cancelled while I was away because they couldn’t pass the tube. I can understand why they found it hard. She is doing well now.
4.There were a number of other very interesting and some sad cases this week. The saddest was a little baby who had his penis, scrotum and contents bitten off by a dog.
5. I’ve been able to put a few new beds in the medical ward and hope this will strengthen my relationship with the physician
There are other points made in the letter but I think that shows the tone of the working conditions.
I am, at the strong encouragement of one of my sons, who says that there are some stories in my life worth recording, reviewing and extending a brief autobiography I wrote years ago. Going through a bit of it yesterday I came across this brief event of one day in my journey. This occured while I was briefly attached to a large teaching hospital in Addis Ababa.
I was on call one night on the eve of a large Muslim holiday. The next morning I left to go to the hospital surprised that I hadn’t had a single call over night. As usual we did a round of the whole surgical wards and early in the round I came across a poor lady lying in bed with most of her small bowel and a bit of her large bowel mixed in with a lot of dirt and gravel lying on the bed next to her. She had a large hole in her right side where all the tissues down to and including portion of the right iliac crest (part of her pelvis) had been torn off in a car accident.
Later I discovered the story. She had been hit by a car driven, by a nun, about four hundred kilometres south of Addis Ababa. The driver had taken her to the local hospital who stated, correctly, that they had no surgeon and the nearest hospital with a surgeon was one hundred and fifty kilometres up the road towards Addis. So the nun took her to that hospital, where she was told that they did have an appointed surgeon but he was away and they had no idea when he would return. They came to Addis, where the first three hospitals said that they had no empty beds. She was eventually admitted into St. Pauls – but nothing had been done for her. No IV fluids, no antibiotics, no dressings – in fact nothing at all except that she had been put in a bed.
I have learnt to be pretty patient but this stretched me to the limit. Why had nothing been done? The hospital was without water so the operating theatres were out of action and definitive treatment could not therefore be undertaken. I think it was planned to leave everything to the undertaker! So I organized for a drip and antibiotics and a clean moist dressing over the exposed entrails and planned to look into the water situation later. I had already noted a tap being used down the street by the general public.
Soon we came across another young man who had been stabbed in the back. He was as white as an Ethiopian can be. As he was of a higher social class he at least had a drip up but the blood bank was closed for the holiday. My wife had arrived in the country by this time and I arranged for her and a missionary nurse Jean Sokvitne to donate blood. With some difficulty we were able to collect it and cross match using Eldon cards.
I organized a group of workers and I worked with them. Between us, we carried water from the afore-mentioned tap and collected maybe a hundred litres in a large container outside the operating rooms. Grudgingly the staff agreed to operate. The young man when stabbed had had his renal artery and vein divided and fortunately the knife, avoiding the duodenum, opened into the peritoneum but not causing any bowel injury. He thus had a peritoneal cavity filled with blood but uncontaminated by intestinal content. We gave him two units of foreign blood and I showed the doctors how to filter the blood from inside his abdomen through gauze and we auto-transfused the patient. He survived and did very well.
Next we worked on the lady. It was difficult but we cleaned her intestines, cleaned the edges of her wound and after returning the bowel to its proper place closed the wound with considerable difficulty. She also recovered, although much more slowly than the young man. In addition to her physical disease she had underlying mental problems which added to her initial poor management and which made things difficult during her recovery.
The day after the holiday we had, as usual on working days, a morning meeting at which all admissions over the past couple of days were discussed. I was, surprisingly to me, severely chastised. Two motions were passed:
Never again would doctors be involved in carrying water to the hospital or in arranging for it to be carried as this was a government responsibility.
No auto transfusion would be used unless a modern cell saver were used (of course there were none in Ethiopia!) as the country was not a ‘banana republic’.
I spoke earlier about tangles with authorities. DEALINGS WITH THE LAW My biggest tangle saw me with a renewal request for my visa denied. I was working in a government hospital after ‘peace’ had been restored after the communist take over.
For some years there had been a great shortage of equipment, drugs and materials. The country was just coming out of years of war, and this was understandable. Fortunately I was able to keep working reasonably satisfactorily because of aid sent out from Australia. I had been working in 3 hospitals where I had a private practice, and public sessions – two were private and the other a public hospital. They very generously collected good second hand equipment, and from donations we were able to occasionally buy new but usually second hand items. We paid for it to come in ship containers. No duty was charged on its entry into Ethiopia, but then everything was a gift.
Suddenly, whilst a container was on the high seas, an import tax was announced amounting to some 35% of the new value of these gifted usually second hand items.
It was too late to not get it, it was already on the way.
After several days at the ‘goomrook’ (customs) I was handed a bill. To get the money I had to sell my second hand Toyota Land-cruiser. The government had paid nothing for all that we had shipped in for about four years. The bill was paid by me.
Then the fun began. The powers that were in place refused to release the container. So after three months of phone calls, pleading letters I sought an appointment with the official whom I knew had both the power to stop release or to grant permission. He wasn’t the head of health (she was a pleasant lady from a smaller tribe) but the highest in line from the ruling tribe.
After over two hours of my persisting to hear the ‘no, no, no’ which he kept uttering, and I think that he realising that there was another way to say ‘no’, said ‘ok, I will, come back tomorrow’. If I had agreed I knew that the chance of getting another appointment was minuscule. So I indicated my thanks for the ‘yes’, but as the paperwork was in front of him I wasn’t leaving until I left with the signed form. After about another 30 minutes of discussion, he said ‘ I will, but I don’t see what you see in those people!’ Naming the tribe amongst whom I was working. I should have shut up,, I guess, but couldn’t help saying ‘when you get to know them, Sir, they’re almost human.’ I got my paper and a little later the stuff. I’m convinced that he wanted the stuff for his own area.
I had won the battle, but I lost the war. Soon I had to seek a renewal of my work permit and visa. They were denied.
Some six years later, with another person in power, I got a visa again and spent another ten years working in the country.
Standards of nursing care, vary from place to place. I have sympathy for people in developing countries. Trained personnel are few; wages are low; materials are in short supply; sometimes patients personal habits are fairly low by the standards of those who have everything at their fingertips. Looking up Mr Google, the poverty line in Australia is said to be just under AUD67,000 annually. The wage of a newly graduated surgeon in Ethiopia is about AUD 500 per month. A house worker gets about AUD 50 per month.
I remember several events very clearly from my first few months in Ethiopia. I wanted to look down a patient’s throat, so I put my hand under his chin to lift it for me to inspect the inside of his mouth. He spat a glob of juicy purulent spit into my hand. Rather shocked I went out and washed my hand before coming back and trying again with the same result. It was the custom with no handkerchiefs, if you were sick a relative or friend took your sputum and wiped it somewhere, often on the wall. No wonder our walls looked like they did. But I learnt a cultural and very practical lesson.
When a second doctor joined me we made a combined effort to get the floors cleaned up. There was a layer, several, maybe five, mms thick of hard dirt ground into the floor. We got no response, until one day, walking through the ward, I accidentally put my foot in a ‘paw-paw’, their name for a bedpan. You will understand why now I never eat the fruit ‘pawpaw’. I enjoy Papaya, however.
But it made me mad. So I got the other doctor onside and, down on our knees with scrubbing brushes, we dealt with the floors of our 35 bed general hospital. I think it embarrassed the other staff as it was much cleaner after that. They talk about leading by example!
I remember a day when a new young worker was in the ward while I was doing my morning round. I was told that he had been employed as an assistant to the nurse. He seemed an affable chap. The next day he wasn’t there so I asked what had happened. There had been a patient with an IV Drip running and a tube into his stomach draining the contents as his intestines weren’t working. Without the drain he had kept vomiting. The new guy had been told that he was just to watch and learn for the first week or so. The nurse went for lunch and, on returning, was told that this patient had died. Apparently during the morning the new worker had seen someone put up another bag of IV fluid. Not content to wait , when this patient’s IV ran out, he took the gastric drainage bag and ran it into his IV line – with fatal results. What a tragedy.
I had two experiences at another hospital, which made me realise that I came from a different world. The first was when we had a Hong Kong anaesthetist for 2 weeks with me. We had got to know each other working in Australia and he came during his holidays to help me. He was an excellent anaesthesiologist. A man came in having been beaten and speared after committing a heinous act. We operated and I felt that we had everything under control, in fact, I expected a quick, complete recovery. Late in the evening I had a visit from my friend saying that he had just been to see the chap and everything was stable. The next morning he was dead. We couldn’t think of any reason why until I heard a worker say that he didn’t deserve to live, and I remembered hearing staff murmuring when he was admitted that he wasn’t worth the effort of operating on him. Judge nurse, I think had the final say.
Later I had a lady who with an obstructed labour had lost the baby, her uterus, her bladder, and needed a colostomy for bowel control. She survived after I did a colostomy and a very simple thing to drain her urine. When it appeared as if she would recover I created a new bladder out of intestine. On about the tenth day postoperative everything was going well and I took a two day trip to Addis. When I came back I went to see her and she wasn’t in the ward. They were honest enough to say that they thought that no woman in Ethiopia should live with that set up like that. So they had taken the opportunity of my absence to take everything out and send her home to die. Maybe they knew better than me, but it was hard to take.
I had an appointment to see my doctor yesterday morning. In conversation I mentioned that my wife and I, in spite of our age and my walking difficulties, intended to continue living where we do, some kilometres outside the city limit on a small 40 hectare (100 acre) property. We live upstairs with a grandson and two of our sons live downstairs in a granny flat. The doctor laughingly declared us ‘mad’ as there is so little to do ‘way out there’.
It made me think of what happened here yesterday. Was he correct in his statement? As I said earlier, we are five at the moment – my wife and I, 2 sons, one in his mid 50s and one in his early 20s and a grandson a few weeks older than his young uncle. So I’ll try and list what happened in this out-of-the-way, boring place.
My wife and I, in this cold spell, slept in a bit late. Excusable I think at our ages. Then she got up and worked in the garden for a while, while I did a bit of clearing around the inside. We both went together to my doctor’s appointment as she likes to check that I tell him everything. But she wasn’t let in because of social distancing, only the patient could enter the waiting room. So instead she went window shopping. The doctor had been one of my interns when I was director of surgery here so my visits are always interesting. He decided that I was still alive and I left with a few renewed scripts.
My wife was waiting at the door and led my off to buy something she had seen, for our kitchen. Having made the purchase, we were on our way home when she realised that she had left my prescriptions on the desk when she had paid for the new ‘thingamebob’. So we returned and while she went inside I had a call from our older son asking us to buy some masking tape for his painting job. So we had a trip to the hardware store. We got home just in time for lunch; then
I worked on the revision of a small book I wrote a few years ago for the medical students in Arba Mintch. It’s taking a while as now I’m planning a wider distribution, probably as an e-book.
my wife replied to email notes and wrote letters.
I had a return call from my tax man, which didn’t give me the answer I desired. C’est la vie.
I received a quote for a lift to help me up the stairs; I don’t like the idea but getting up and down them is getting harder. Not cheap but maybe necessary.
We got an email electricity bill. Our new solar system has cut two thirds off the last bill.
We had a lovely email from the mother of the adopted little baby about whom I wrote a post earlier. A baby is born
I had a discussion with the sales person about a water pump. I need to get water pumped from the dam to our house – about 500 metres, but fortunately over pretty flat ground, so there is not a great height to lift the water. It’ll need to be sorted out soon if we want to keep some green grass around the house.
Then my wife took our grandson for a driving lesson. He has never wanted to learn but if he is going to live here he’s going to have to become independent, we can’t spend the time taking him everywhere he needs to go.
My older son and our grandson spent most of the day painting. Then our son went to do some basic preparatory work to prepare for a fencing project starting with our neighbour on Saturday, on a boundary fence.
Our grandson spent hours after the evening meal writing music. He’s good at it and beginning to get some sales now.
Our younger son is an apprentice mechanic so he spent his day at work. When he came home he did some work renewing the thermostat in our farm Patrol vehicle.
After the evening meal, a short Bible reading and prayer. While the others scattered to their various activities I sat down to watch the next episode of Judge John Deed. I don’t think much of his sex life, but appreciate his stand for justice.
So Doc, I think there’s enough to do here! Maybe if we moved to town we’d be bored!