Living in Another Culture

I can’t vouch for the absolute truth of all of this, but a lot of people escaped from the Crusade wars in what is the Israel area of today, via a slightly circuitous route through Ethiopia. The evidence offered to support this ‘theory’ is twofold. Firstly, St George, the patron saint of England, is held in very high esteem in the Ethiopian Orthodox Church. Interestingly he is supposed to have died eight times and risen from the dead seven times. I don’t know of any scientific proof of this. Secondly there are many Tudor roses carved into the walls of the stone churches in the north. Many of the fleeing Crusaders, it is suggested, helped out in carving out these magnificent structures.

I suspect that some of these fleeing Crusaders tried to teach the Ethiopians some basic English words and mathematical terms. But I guess they either weren’t very good teachers or time has dimmed the past scholastic abilities. They remember the word ‘chin’ but now use it for the ‘thigh’ as we call the upper part of the lower limb. They remember the word ‘feet’ but have transposed the word to the other end of the body, and use it for the face. I’m pretty sure that they taught them also the other parts of the face, they almost got ‘eye’ correct and say ‘eyne’. They all know what their mouth is for but forgot the word for nose. This is where their maths lessons came into play. (I suspect some of the English may have been cockneys) so they named the nose ‘arfincha’ because it is an ‘alf an inch’ above the mouth. Sounds reasonable, but I’m not absolutely sure of the truth of it.

I did have a man whose lover bit off a large part of his nose, I guess that is maybe why we usually make love after a meal, so that people aren’t hungry. It was a 3 stage procedure to repair his nose. I’ve put a couple of pictures below the line. I also have a picture of a lower lip bitten off by a hungry lady. But I’ll save that for another day.

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How Big is Australia Really?

I’m proud to be an Australian but love the country of Ethiopia where I worked for many years. Maybe wrongly, but I have often thought that many people think of Ethiopia as a small insignificant African country. And, possibly again wrongly, I have felt that some Australian professional people have felt themselves superior to those working in these ‘backward countries’. I guess this sort of thinking sprang into my mind again when I was watching an Indian movie last night. How can India produce films as good as Hollywood? Well the one I watched last night was better (different) than many I see from the USA. Maybe because they have 1.4 billion people from whom to choose good actors? But let’s not go too far down that road.

Ethiopia is a small African country. It is about sixty percent of the size of Queensland, or about 4 times as big as Victoria. It has a population four times that of Australia. If you want to compare its history with Australia’s, it is much older. Well, if we accept ‘Lucy’ as being one of the first human being, then it is older than our Original Australian’s history, and much much older than white Australia. Their ruling dynasty which ended with the murder of Haile Selassie in 1975 dated back to the time of King Solomon in Israel. Solomon died over 3,000 years ago. Then why is it backward? I would offend Ethiopians by asking that for they are very, and in many ways justifiably, proud of their country and people. Certainly they are progressing much more rapidly than the West did!

It has spectacular beauty; said to have massive gold and oil deposits; heights extend from 125 metres below sea level to 4,550 metres; there are enough rivers that all its electricity is hydro-produced.

But I really started to write about tertiary education. In 1968 when we arrived in Addis there was one University with 1,000 students. Now there are 30 Universities plus 61 other recognized private places with Higher Education standards.

According to my Mr Google – our University in North Queensland (JCU) has 17,500 students. Of the two Universities, where I mainly taught, Jimma University has 45,000, and Arba Mintch has 34,000. When we went to Ethiopia there were 300 doctors in Ethiopia and only 13 were Ethiopians. When I went to Arba Mintch in 2011 there were there 20 medical students per year, and when I left in 2016 there were 170+/year. In that same year, country wide, they graduated 3,000 young doctors. They are paid so little that many as soon as the government permits them they leave the country for richer paying fields – often to other African countries.

The last graduation I attended for doctor, architecture and Urban Planning graduates.

Maybe life was never meant to be fair, but a little more fairness would be nice.

Dominic Cartier

Walking Down Memory Lane

African sunset

I try not to just live on memories. But I sleep a lot; walk slowly with a stick; or if the family goes out together they take me in a wheelchair to speed things up. I still can think clearly (or so I think) and I don’t find it easy to hand over all the control to a son who does almost everything about the place. He’s gracious and I’m trying – maybe in two senses of the word!

But memory lane is mostly pleasant to walk down. I’ve been transferring slides and photographs onto my computer and it has been a bit tedious but full of memories. Here are a few of them.

OV dams from hill copy

I used to own much of the land seen in this photo, but most of it is now sold. Some of the money enables us to live, but much has been invested in lives in Ethiopia. Those lives are very pleasant to remember and the memories give great joy. Some were sick; some were destitute; some needed education, but all were real people, and needed loving. Not always emotional love, but rather helping love. Some are dead already, I guess, but the money and effort was not wasted.

OV house 1 copy — When I was in Australia for several years, about 35 years ago, I bought this old house for $3,000 and we had it transported. It still stands today looking much better and surrounded by trees.

My computer collection of pictures begins from over sixty five years ago. I didn’t get a camera until I was in my older teens, so although there are a few photos of even great grandparents, mostly the photos start from when I met an amazingly beautiful young teenager. I started to ‘chase’ her from the day I first met her! We will have been married for fifty eight years come December. I’ve got about two thousand more slides and many photos to go through. What a lot of memories still to come!

street huts copy — Sorry about the focus, but these are the street huts people were living in on the street opposite the main government hospital in Addis Ababa.

Eth OR 01 copy — And this was one of the operating rooms that first greeted me in 1994

a day's operating copy — This is a list of one day’s emergency surgical admissions. The writing is terrible, but listed below it reads disease-wise ….

appendicitis; intestinal obstruction; intestinal obstruction, volvulus; acute appendicitis; Peritonitis from perforated duodenal ulcer; appendiceal abscess; stab wound to the abdomen; rectal fistula; oesophageal cancer; penetrating abdominal knife wound. Most of these would have needed surgery the same day except the oesophageal cancer which would need work up and time.

Yakob copy — As a baby I found him, deserted, being swept around on the floor of the paediatric ward.

Now he has a tertiary education and this should mean a satisfying life.

Money is useful if you use it wisely. Memories are more precious!

Dominic Cartier

A personal review of things

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.

Dominic Cartier.

A nightmare of a day!

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’.

Dominic Cartier