My 101st Heated Stew attempt.

Our small church has two congregations. At 9AM we have a service for mainly older white people, you might label us a ‘dying’ church. But we do have an outreach into India, South Africa and Ethiopia where people from an overseas church which was disrupted have scattered to other places. The outreach is by the internet. Then we have a much younger Indian congregation which meets at about 10.30 for a service and then an all age Sunday School. Once a month we have commenced a combined service with communion. Today was the first such combined service.

You might wonder what a dog staring at a Television set has to do with church services. I’ve written about my dogs before. Sadly they are both dead, euthanized, because they got into my sheep and started killing them. Here is Liesel staring very intently up at a very colourful, very active packed scene. What is she thinking? How is she reacting? I talk to animals, I may be even more stupid as I sometimes talk to myself. They recognize expressions, they respond to moods but I don’t know what they are thinking. I guess when I talk to myself I can tell myself what I’m thinking!

So what has that got to do with church this morning? The Indian adults, although from a different background have been in Australia for long enough to understand our ways of thinking. But I wondered what the kids thought. Their church services are in their own tongue, Malayalam, and this morning was the first time some children have been in an adult English speaking service. The kids’ English is good, but there are real differences in styles of worship.

In the morning tea afterwards I called one of the little kids to talk to me. He was a bit shy and his older brother came to guard him. He’s in grade 1. So I asked him if he could add up. ‘Yes’, he said. I asked him to add up 1+1, then 2+2, then 6+3 and he got them all correct. I saw him counting on his fingers. I knew that kids in grade one don’t deal in thousands so I asked him to add up 6 thousand and 3 thousand. He looked at me with his head on an angle to the side, thought for a moment and said nine thousand. So I asked him if he knew subtraction. The bigger brother said that his little brother hadn’t learnt that yet. So I told him, the older brother, to let his brother try to answer. So I asked 2-1, then 4-2, then 9-6 and he got them all correct. I then asked what if he took 4,000 from 10,000. And sharp as a tack he told me 6,000. For you and me very easy, but I thought for a grade one boy, that was excellent.

I wonder what people think and how much they understand when a church service is going on. The Indian children sat perfectly well behaved – not a noise out of place. But how much did they or any of us hear of the prayers, the songs, the preaching, the communion? I guess it will be told in the way we live our lives this week.

Please note the small skateboard under the table, in the dog picture above. It hasn’t been used for many years. The small boy seen below playing below with two of my grandchildren was run over by a train and lost both legs and an arm. We were allowed to bring him to Australia for medical help but not permitted to adopt him. He used the skateboard and the little ‘do-dad’ in front of him in the picture below to get around. He is now a University student in the USA. We still correspond but I’d love to see him face to face before I die!

He used to love sitting in front of the TV, conducting Andre Rieu as he watched a DVD.

The day I first met him he was about to be discharged to be a beggar on the streets of Ethiopia. I brought him home that evening and it was the beginning of a long friendship. He knew no English, but we had Amharic as a common language. I asked him if he had to get up to pee at night. He said ‘no’. I asked because I knew it would either mean a wet bed or me getting up to carry him to the loo. Then I asked him if he ever woke up screaming at night after the accident. I was surprised and delighted when he replied ‘There is a God in Heaven and I have left it in His hands.’ He was somewhere between 8-10. It was drizzling rain and, on a dirty road, I kept having to use the windscreen wiper and following behind other vehicles when the rain stopped I had to use the water spray jets to clean the window. I tested him when he asked where the water came from. He had never been in a car. I told him that there were two little boys under the hood and I would give them a little electric shock and they would pee for me. I kept a straight face. He looked worried for a moment and then burst out laughing. ‘Now, tell me the truth!’ I knew we would get on well, and we still do.

People can think! It’s what they do with what they’ve learned that counts!

Dominic Cartier.

Looking at a picture..

You can wander through your photos and think different things…..

  • Why did I take that?
  • I can’t remember what that was!
  • Weren’t we stupid to do that.
  • I wonder where they are now? etc
There are no other nasty pictures to follow and this is just a little six week old baby boy.

This photo takes me back over a lifetime of medical practice.

The past…As a first year intern in Adelaide, in the days when specialists were not as plentiful, I was sidelined into being a temporary anaesthetic registrar for six months to cover a shortage. It would be not even an option in this day of many more available people. But it gave me the opportunity to have a hands on experience which has served me well throughout my years of practice as a surgeon. Almost all of my time in Ethiopia I had to give/supervise all of my anaesthetics when I was the surgeon. So for chests and abdomens, orthopaedic and urological procedures the responsibility for the anaesthetic lay with me. Sometimes I even had to unscrub and deal with a problem before getting back to the operation. And tiny babies are a special problem; this boy was vomiting and needed to have his abdomen opened. I was, once the child (everyone knew that he was a boy, in spite of the troubles which politicians seem to have these days!) was properly anaesthetised going to leave the management at the head end to a cleaner. The length of the trachea in which the tube had to stay was only a couple of centimetres long – if it moved up he couldn’t be breathed for; if it went in too far, one of his lungs and maybe even one and a half of his lung capacity would be blocked off! I can remember my years of specialist surgical training; I can remember leaving my parents and siblings for a life in a land with, to me, a variety of unknown languages and a totally different culture.

The present….Here was the first born son a young family whom they had watched for a couple of weeks as he vomited everything they fed him and they were afraid that he would die. They were unsure if they could trust this young foreign white man, in their eyes an infidel. But they came and all their hopes were hanging on this moment.

The future…He survived and they were very, very happy. But here I have to let my mind float away into the ether. What sort of education did he get; is he married; did he become a good boy and make wise choices; is he a blessing or a curse to those around him. But that is the future of every patient you treat – some you get to follow and know, others are just passing in the night. Do you wonder why I like looking at the photos on my computer?

Dominic Cartier

Some aspects of University Years in Arba Minch

I spent the last years of my working life in the University at Arba Minch. The city has a population of more than 200,000. The University has more than 40,000 enrolled students. I went there as the medical students were about to enter their clinical years. They were not ready to receive students in the hospital but we had to do so!

In my time we had to take the Hippocratic Oath, which I’m sure would be impossible to take these days with abortion, euthanasia, sex change operations. At Arba Minch they had a commitment called ‘Passing the Light.’
There were a number of ex-patriots mainly Indian subcontinent or from the Philippines. There were only two Caucasians. I was the only one involved in training doctors. Thus for a while as they came to clinical years thy found my accent difficult.
Every morning we discussed the emergency admissions from the the previous day, deaths and the operations performed. Because of the way we divided the students for teaching there were 60-75 people packed into a small room. As you can see above there was no room between the front row of participants and the people leading. You can see the data projector hanging from the roof on a little platform attached by rope.
This is looking up at the ceiling. The mark on the wall is bird poop, and the tin roof without a ceiling made it very difficult during the rainy season.
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Robin and I shipped across a ship container of stuff to make the system workable even though not perfect. You are looking at a large part of my superannuation!
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There were other lectures to be given also. These were presented in the University grounds in much better facilities which had been prepared for the preclinical years.
If you let your eyes wander you can see the level of furnishings in the wards. There was one X-ray box for the whole hospital, so the light coming through the windows did the job. There was no radiologist to report on the X-rays.
But a University enrollment of 40,000 makes for a big graduation ceremony. Not all faculties graduated on the same day.
Terrorism either as anti-government protests or as a means of getting the attention of those in charge occurred, although thankfully not all that commonly.
But the purpose of training medical students is treat patients and we had an endless supply of them!

Dominic Cartier

Meanings of words

I have been told that there is a tribe in South America which has 40 words to differentiate shades of what we might, in a single word, describe simply as ‘green’. And in a country without sign posts they use these shade words to direct people on forest paths. For example travel on the path for …. (distance) until you see a tree of …. (shade of green) then turn left. in about …. (distance) you will see a bush of …. (shade of green) there turn right. etc – you get the idea. No doubt this has worked well for centuries and still does, but what a mess a traveller would be in if someone purposefully substituted the word for a different shade of green.

I wonder how many shades of green are in this area of Ethiopian countryside?

I looked up ‘shades of green’ on google search and the list is long and interesting. Usually just saying green is enough but sometimes we need to be more specific. And this applies to many other words. And we can get into or cause trouble by unintentionally or intentionally using a shade of meaning which the speaker or author didn’t intend. There are about a million words in the English language but I am told that the average word usage of the common person is only in the thousands – 10 to 20,000. I looked up the word ‘guilty’ in google search. This is part of what I read…

guilty/ˈɡɪlti/ Learn to pronounce adjective

  1. culpable of or responsible for a specified wrongdoing.”he was found guilty of manslaughter” Similar: culpable, to blame, blameworthy, blameable, at fault, in the wrong, responsible, answerable, accountable, liable, censurable, reproachable, condemnable, reprehensible, erring, errant, delinquent, offendings, felonious, iniquitous, criminal, convicted, peccant
  2. Opposite:innocent.
    • justly chargeable with a particular fault or error.”she was guilty of a serious error of judgement”
    • conscious of, affected by, or revealing a feeling of guilt.”he felt guilty about the way he had treated her “Similar: ashamed, guilt-ridden, conscience-stricken, remorseful, sorry, regretful, contrite, repentant, penitent, rueful, abashed, shamefaced, sheepish, hangdog, mortified, discomfited, distressed, uncomfortable, in sackcloth and ashes, compunctious. Opposite:unrepentant

Let us say that the little baby pictured above died. That is not true, he did very well after his emergency surgery. He recovered quickly and was sent home well, but with a lot of growing up to do. But picture this scenario: –

He came in with an obstructed gut. He was operated upon and the condition corrected. On being woken up from his anaesthetic he vomited, inhaled his vomitus, but after that treated well according to the book but over the next 24 hours dies. A distraught parent accuses me of killing the baby and says that they hope I feel well and truly ‘guilty’. Should I feel guilty? I had made the correct diagnosis and done the right operation. My name was still on the end of the bed as the responsible surgeon. I had seen him and ordered several things post operatively. I was not the anaesthetist. Measures should have been taken by the anaesthetist to reduce the risk of him vomiting to a minimum, which he did not take. But I was by then in a side room writing up the case record. The mistake having been made I raced back into the operating room and did all I could to correct the situation.

But that accusation is that I have killed him and should feel guilty. I don’t think that it is fair to say that I have killed him, even if in a court the lawyers would have tried hard to push that all the responsibility of the anaesthetist fell back on me as the team leader so….? Now coming to the guilty word I have to confess that maybe I should feel guilty. I’ve seen that anaesthetist make similar mistakes before and because it was after midnight and I was tired I chose to do what was legal but maybe not wise i.e. do the rest of my legal paperwork and hopefully get home to bed. I had previously spent time on several occasions explaining the right way and watched him through several operations. I had since then stayed in the room on several occasions making sure that he did the waking up procedure correctly. But he was still relatively inexperienced. Because of the hour should we have waited until the morning, accepting that he may have died overnight and would certainly have been medically worse by the next day. If everyone had rested he might have lived and grown up to be a healthy man.

Would that label me guilty? I understand why the parents did, and I have to struggle hard to say that I bear no guilt. But I reject that I should feel guilty of murdering him or even of having done the wrong thing. Surely there must be a synonym in there for my feelings at this moment. Blameable? – but surely it is not my responsibility to do someone else’s work correctly. Ashamed? – because in the world there is such inequity between what we have in my home country cf my adopted land. Remorseful? – that I didn’t stay in the operating room until the child was wide awake. But then I knew that the post-op care workers often slept on their duty time – so should I have watched him overnight? Am I to bear the whole weight of the medical inadequacies on my shoulders.

Often when I use a word I have to depend on my reader/hearer to discern the context into which I am using it. It is not easy for the user or the recipient of a word to be sure of the correct meaning and I guess we have to settle for being honest, generous and understanding in our assessments.

Auguste Rodin | The Thinker (Le Penseur) | French | The Metropolitan Museum  of Art

Dominic Cartier

Under the Thumb.

It may be almost illegal these days to say that about a husband-wife relationship! Particularly if you are the male speaking! There I go, being provocative again. But I’m not talking about a person but about a load of work.

Some years ago I self published a book – a sort of autobiography come medical journey of mine. It sold out and is 10 years out of date at any rate. Then a few years ago I wrote a book, probably better called a booklet, for my students as they began their clinical surgical courses. It was relevant to their situation with lack of facilities and language difficulties. Their ability to read thick tomes was limited, so I tried to put the very relevant stuff in a compressed form. As I meet a new era of Western students sold on investigations, before physical examinations, I’m convinced that it may be of use to them also.

I’m pretty dumb, computer wise, but my eldest son, who lives on our farm and runs it and who runs me is a wizard. He wants to reproduce them and also shortly after them another pictorial cum anecdotal short book of our lives. So at the moment the thumb of pressure to get it done on time is hard on me! Publication date for the first two is set for November 27. Between now and then we have a granddaughter’s wedding to attend about 1,500Km away, and a sheep shed to get built, so the pressure is on, the thumb is pressing down.

My first book was called ‘Have Scalpel – Will Travel’, and the new edition will have the same name but with ‘Revised and Updated’ added. The other will be ‘Medical Diagnosis – a Surgical Approach.’ I’m slowly labouring through the third one – as yet unnamed.

The introduction to the first book was and will remain as follows: –

They cut off the tip of his ear.
Yes he was a thief and this was the custom.
He was naked and caught stealing clothes left out by the river to dry.
He could see no-one but they saw him!
He was tightly bound with his hands behind his back and taken to court.
Eventually he was brought to the hospital.
One arm was already gangrenous. It had to be amputated.
The other – the nerve supply had been cut off by the pressure of the binding and the arm was paralysed, probably forever. 

How did he feed himself?
How? He had his food put on the cupboard by the bed – but there was no one to feed him.
He had to feed himself.
So he got up like a dog on his knees and elbows.
He ate like a dog.
My heart was touched and so each day I stayed back at lunch time and fed him myself.
What became of him? I don’t know.
But to God he is a person – to the others he was just a thief. 

One night I sat in the common room of Addis Ababa HQ of SIM – the mission with which I was associated. I had just come up from Soddo on business and had left behind this one who deeply disturbed me. People were singing that beautiful old hymn ‘Peace, perfect peace when all around….’ Yet I was not totally at peace. Sitting in that common room I was not totally at peace. Was I doing all that could and should be done in these circumstances? Certainly the future my young thief saw ahead had no pension, no physiotherapy, and no social support. 

Am I my brother’s keeper? 

The title of the second book.

Maybe more later. Watch this space!

?Dominic Cartier