Beware…

hospital plan

This is a medical post. The above is an elaborate scheme for a designed new hospital to replace the one built initially as a mission hospital by the Norwegian Lutherans. The design had many basic faults. Hopefully they listened and incorporated some changes. It should be opening soon and I trust it will work well. You may note the expected completion date (in our calendar 2017) it was hardly started by then!

You may not want to read beyond the ‘more’ line as there are some very interesting but a bit gory photographs. You can see worse on TV.

I almost always lived and worked in the southern part of the country, between 250 and 500 km from the capital. I had taught briefly in the capital, but that was where the vast majority of the nationals sought to be, so I usually worked down country.

Interestingly I had a postgraduate surgical trainee come down from the capital, as a patient, where he was working in a major teaching hospital for surgery on himself. He brought his own anaesthetist with him. The anaesthetist went to church and prayed while I operated on his colon cancer and my guy gave the anaesthetic. Follow up on Mesfin of the ‘3 Teenagers’

Another man come from the capital of a neighbouring country. He had drunk lye and had a very narrowed scarred oesophagus. He had an oesophagectomy performed and his oesophagus replaced with a piece of colon. We didn’t have a physiotherapist, so essential in the postoperative care of such patients, and I gave a crash course to the servant (slave) he had brought with him. The patient and the servant did well and the patient wrote to me yearly for several years.

But the case I wish to write about today is a man whom I met on arrival as a new professor at a down country University Hospital. He was a poor man with a huge scrotum. When he stood up his scrotum nearly touched the ground. When weighed, after excision, it was 30 kg. There were 2 trained surgeons there but they weren’t prepared to operate on him, even though they were quite senior.

It looked gross.
He was hardly able to walk.
His penis was buried inside the mass, so that when he urinated it was a mess.
Although married sex was not possible.

The cause was tuberculosis of his groin lymph glands and if you look at the photo later, you will see that his left leg had begun to swell as well.

The condition is called lymphedema and occurs because the lymph cannot drain back through the diseased nodes which are blocked by the disease. In his case they were affected by TB. Lymph is part of the blood carried out by the arteries which is filtered through the tissues and returned through the lymph channels higher up back into the veins. It has no blood cells in it but is a second return system running parallel in function to the veins. The volume drained as lymph is much less than is returned through the veins. In other words the volume carried out by the arteries equals the volume returned by the veins and the lymph.

Of interest are the following….

The shaft of the penis is not involved in the swollen diseased state, although its skin is.
If the patient hasn’t been circumcised the skin on the inside of the foreskin is not affected in the disease and can be used to help cover the penile shaft when closing the defect after excision. This man had been circumcised.
The testicles also are not involved in the disease but the spermatic cord is often very elongated, as the weight of the scrotum pulls the testes down.

So the aim of the surgery is to dissect out the penis and testicles without damaging them; excise the abnormal tissue; cover the defect – creating a new scrotum and covering the penis with skin, often using skin grafts.

Photo 1 shows the patient lying on the operating table prepared for surgery. As he had to be prep’d from the umbilicus down to his feet on the front and back, it was done with him awake and standing up. You will perhaps note the left leg has begun to swell.

Photo 2 shows the penis dissected out before the mass is excised.

Photo 3 shows the dissection complete and awaiting repair.

Photo 4 shows the excised scrotum, which weighed 30 kg.

Several days after surgery I asked him if he had had an erection. With the broadest of smiles – the frustrated young husband said “yes”.

Looking through my photos preparing for this I noted that my first assistant was a postgrad student, who is now working with the Red Cross in South Sudan. He’s a very good young surgeon. After his grandfather died he appointed me as his new g’father replacement.

The photos are below the line. Continue reading “Beware…” →

Solomon – the third teenager

Solomon has been introduced previously as one of the teengers in the post A house full of teenagers. As a double orphan we decided to adopt him. Solomon is a common name there, as Menelik I, who the first king of Ethiopia’s long dynasty ending with Haile Selassie, is claimed to be the the son of the Jewish king Solomon, from an intimate moment with her, when he was visited by the Queen of Sheba.

We were planning to bring the 3 boys with us on a holiday to Australia, and that made us put his adoption plan into actIon. We needed to get a passport and a visa for him and there was no one who could legally sign for his application papers. So we made an approach to the Australian adoption agency. They denied us permission because of our age. We were older than 45. (That age has since been raised to 65.) So we went to the Ethiopian adoption agency who said that we could but it had to be by Australian rules. Which meant we couldn’t.

So I, in desperation, went to the Ethiopian Immigration Authorities and asked if they would give me special permission to sign the application paper for a passport. They said “No. Adopt him, and then you can.” I explained the above and was told to forget them officials and to go to a down country regional court and adopt him.

We did that. We were interviewed. They asked sensible questions, and about an hour later we had adoption papers signed and in our hands. It had cost me the equivalent of about $1.50. By local custom he was my son. Although my wife had been questioned in the meeting she wasn’t mentioned on the adoption papers. He was now ours (well mine at least). If he was ever naughty I was told that your son had …. etc.

When we flew down for this adoption, we were in a small plane. It was his first flight. Looking out the window he asked what the black dots scattered around were. We told him that they were Kraals (local mud huts). He said, “they look like cow shit”. A word he must have learned from his mates at school!

If he was to come to Australia we needed a visa for him. There was no Australian Embassy in Ethiopia but there was a High Commission in Nairobi. I was to bring him to Nairobi for an assessment, a medical check etc and if all was ok to get a visa for Australia. Ethiopians don’t need a visa to get into Kenya.

Before Ethiopia would allow him to leave the country to pick it up in Kenya we had to have a letter from a lawyer verifying that he was in fact an orphan and that we had adopted him legally.

I had previously operated on the Minister of Justice, a lawyer, under local anaesthetic for a large lump on his thumb. He didn’t trust the sterility of the government facilities. I hadn’t charged him. He was prepared to sign such a letter for me but had never written one like that before. If I wrote it he would sign and stamp it. So I did that and took the draft to his office for translation into Amharic, signing and stamping.

I had a call telling me that I could pick it up, but it would cost me US$100. In the 90’s that was a fair bit of money. At any rate my/his letter worked.

In Nairobi he passed his medical and we had an interview with a very nice lady. She was thorough. Eventually she said to me “are you telling me that he is 16?” I replied “No, I’m saying that I want him to be 16.” If over 16 he wouldn’t have been given a visa. She told me that she assessed him as older than that, and that if I had answered “yes” she would have made him have X-rays to accurately age him. (He already had wisdom teeth), but as I had been honest she would give us a visa.

Australia still doesn’t accept him as our son. He was allowed in, because there was then (now removed) a condition of entry if a child had been living with you for more than 4 years that he could get an australian visa. Solomon met that condition.

We all came for a holiday but soon after returning to Ethiopia I was expelled from the country and we returned with just him to live. Several years after he arrived in Australia he applied for citizenship and it was granted. Whilst not academic he has a strong work ethic. He is an Australian citizen. He and his wife both work in an aged care facility.

On first arriving in Sydney he was walking down the street with one of our sons. He saw an elderly lady walking a chihuahua and audibly exclaimed “Do they have pet rats in Australia?” Eventually our son by birth calmed the lady down by explaining that this was almost Solomon’s first day in Australia and they had no such dogs over there. I think she had planned to hit him over the head with her umbrella. Pet owners can be like that!

A sixth child legitimately ours. We found another later!

A protesting crowd — a quiet protest in the capital. The procession was about a kilometre long.

Dominic Cartier

Like a son

kids galore

In 1968, when we first went to Ethiopia, we had a lady W/ro (weysero – mrs) Balynish. She was separated from her husband and had four children – 2 girls and 2 boys. We didn’t see much of the girls but the boys were often at our place playing with our boys. Tadessa the younger of the two was almost always at our place. He was confident, cheeky and lovely. He and our oldest son used to ride around on our two horses as bosom pals. We kept in loose contact with him until sadly he died recently. We helped send one of his sons to University. We were friends.

A couple of memorable moments.

Ethiopian food is more spicy than most of ours. I guess maybe this is not so true now as many other nations (eg Indian) foods have become part of Western food. This particular day Tadee (as we called him) was carrying on about how there were no very spicy spices in our ‘ferengie’ foods. “Are you sure about that,” I asked him. “Certain” he replied. So I went to the pantry and gave him half a teaspoon of Tabasco sauce. With great superiority he opened his mouth wide, confidently swallowed all of it; dropped the spoon and ran outside screaming for water. Lesson learned.

He was attending a nearby small church school where they had full day lessons. One Wednesday he came to our place, at lunch time, and was talking to his mother in the kitchen. We could overhear the conversation. He was boasting about how he had bested his teacher that morning. Apparently he had obtained 1 out of 20 for a maths test. The teacher at the end of the lesson asked the students to call out their marks to have them recorded. When asked to give his mark, he replied 11. 1/20 sticks in a teachers mind, so he was called out the front for lying. In spite of knowing that the punishment was a caning, he confidently went to the front and told the teacher that the teacher couldn’t cane him, because his name was Tadessa Cartier! He got away with it.

Calling him into where we were eating he, smiling broadly, verified the story. “What do you think I would do to your very good friend, my son, if he lied like that?” I asked. As the sentence came out his smile quickly disappeared. “You’d give him a hiding?”. “Yes I would. Are you sure your name is ‘Cartier’?”. He clung to our really very tenuous relationship. So I told him that I would give him a hiding but at school in front of his class, as if I gave it in our home no one else would learn a lesson.

After lunch we went to school together. The teacher said the facts were true. So I took off my belt and applied 3 good whacks to the seat of learning. He fled screaming and neither his mother nor we saw him for 3 days. I went off to review the hundred leprosy patients we had on the compound with severe foot ulcers, as I did every Wednesday afternoon. He came back without grudges and carried on as if he was Tadessa Cartier.

I loved that kid and still love the memory of him.

Dominic Cartier

Easter this year.

There was a stage when the local church head office had to deal with 4,000 displaced people. Displaced because nearly 100 churches and many homes had been burnt down by a group of fanatics. The University abuted the church property and our home was one that had previously been built for foreigners working with them. We weren’t directly involved until a friend in Australia sent a sizeable gift which he wanted us to equitably hand out to the needy; with stipulations we did it through the church heavies.

Ministers of every Christian denomination must feel that Easter in their calendars has been dealt a similar blow this year. The people got together and rebuilt their churches and I was asked to be present at the re-opening of several of them. They were rejoicing – because having suffered for their faith they were now in better shape than before. In one instance they even built a school for the children of their persecutors!

Easter means something to everyone! Travel, holidays, sport, religion.

There are always school and maybe university breaks. There are major sporting events; many go camping; it is a major holiday period.

The breaks have extended this year into areas where no one wanted them to go; people stood down from their jobs; many businesses, leisure spots, sporting events being closed! No travel permitted! And it’s no holiday at all, with the 2 person and 1.5 metre rules in place. There are resultant extreme financial problems for many.

This is all very sad, and affects us all, some very severely. It is not to be belittled, but it’s not the fault of Easter. It’s THAT virus!

Let’s remember, however, that Easter was not originally meant to be primarily a ‘holiday’ but a ‘holy day’. A time free from work, an opportunity to worship. The heart of ‘Easter’ is a religious thing. I think many will miss the services of the Holy (Passion) week – Maundy Thursday, Good Friday, Easter Sunday. We’re told that many go to church just at Easter and Christmas. Well this year they’ll miss out on Easter.

When I was young I wondered why they said that Jesus rose on the third day. He died Friday and Sunday is only 2 days later. It all made sense after I went to Africa. If I made the mistake on, for example, a Tuesday of telling a patient to come back in 14 days (there was no word for a fortnight), they always came back on the Monday. If I said come back for a check in 4 days they always (to my counting) came back in 3. You had to get used to it! Today was counted as day 1. Thus Friday, He died day 1, Saturday, in the grave day 2, Sunday – He rose on the third day.

The government can, and probably correctly, has cancelled public gatherings. They cannot cancel history, so our house will meditate and rejoice!

And I remember those in other lands who all year, every year, face Governmental restrictions and persecution, and I am glad that I can at least celebrate without fear in my own home.

Damien Cartier