A late night..

Just after the communists were driven out of Ethiopia, the organisation we were connected to preferred us not to travel at night. We were seconded to a government hospital in Soddo. There was still a fair bit of shifta (bandit) activity. We had planned to leave earlier than we did, but I was held up at work. Our planned trip was about 400 km. It was almost getting dark when we filled up the main tank with diesel in a town about 150 km from our departure spot. We were using the reserve tank and didn’t switch back onto the freshly filled main tank until we arrived at the next main town a further 100 km along the way.

Within about ten kilometres, having spluttered for a while, the engine stopped altogether, My wife and I, with the 3 Ethiopian teenagers who were living with us, were stranded just outside a prison farm in the dark. A place which we had heard was not well secured.

What should we do? There was a mission station back in the town we had just passed with people we had met. We could not contact them as in those days no such things as mobile phones existed. So my wife and the oldest teenager stayed with the car and the younger two and I set out to walk back for help. I guess we were a bit scared, it was dark and I had seen at the hospital what bandits could do. I can’t remember what we talked about until the youngest explosively let off a prolonged emission from his nether end. He was embarrassed but so what! It got us talking about what sounds were common to all mankind. We could in the languages we knew between us, apart from belches and fluffs,  only think of  ‘amen’ and ‘hallelujah’. 

By the time this enlightening conversation was over we arrived back at the last town, and were able to get help. Our acquaintance at the mission got some tools and 20 litres of diesel and a tow rope. I went to the local motel and found out how much it would cost to stay overnight.

With the mission guy’s help, having been towed back to the mission station, we discovered that the diesel we had bought previously was about 80% water. This was drained out, his diesel put into the tank, we were profuse in our thanks then went to the local fuel place and filled up. By now it was getting late, so I went back to the ‘motel’. But the manager had heard about us and, realising that my wife and I were white, doubled the price for all of us even though 3 were Ethiopians.

I decided we’d take our chances of bandits on the road rather than be robbed by this guy. So off we went for the last 150 km. No more robbers, and we arrived at about midnight. We hadn’t been able to contact them but the place we were to stay (friends) having been worried about us were glad to see us arrive.

Bominic Csrtier

What’s cooking?

Some of you older ones will remember the coupons which allowed your family to buy food during and after World War II. I was still pretty young (5) when the war ended so I don’t remember all the details but if you had a slice of bread it often had fat (lard) from the cooking plus some salt and pepper; you could have butter or jam but not both on your bread; special desert was a jam tart which you were allowed to help your mother cook.

(If you note a lot of spelling mistakes it is because my dog is insisting on putting her paws on my shoulder and licking my ear!)

Back to cooking. I remember when we got a coupon allowing us to get some rice – for instance. Basically we ate a very plain meat, potatoes and vegetable diet with very occasional desert. Somehow at Christmas they seemed to go overboard with lots of lonely old people from around the district and a plethora of delicious food.

Then as a medical student I went into National Service. We weren’t allowed to join the medical corps and I was a cook. So I can tell you that maggots float to the top when meat is boiled and scooped off and there is still good meat to serve the troops – while you (the cook) opened a tin of preserved fruit for yourself. It was good training as my wife doesn’t like cooking much.

So then I went to India where the food was so spicy I wondered why they didn’t just serve up the coals. I got used to it but I remember going to a wedding where the food was so spicy that hardly anyone ate much. I asked why for a wedding it was made so spicy and was told that it allowed them to invite lots of guests. I lost about 20 kilos in my 6 month stay in India.

On arriving in Ethiopia they use different spices. In India spices were hot in the mouth; in Ethiopia they were hot both ends – entering and leaving. Graciously the people who knew us toned it down for we foreigners. But it did give me a taste for more than what we had as kids.

Coming up to date, I want to give you a marinade sauce recipe. I sold some land to a neighbour who still owes me money (they are very faithful in their payments) but who kill their own pigs and cattle and sheep. They send us gifts sometimes. We are very thankful for it but it really isn’t quite as tender as you buy in the shop – but as a gift much cheaper!

So I’ll share with you my mixture to make it more tender and which still reminds me of some of my Indio-Ethiopian past. I know you’re supposed to measure everything exactly but I excuse myself by saying I do it to taste. So what you’re getting is approximate.

  • 2 tablespoons of olive oil
  • 2 teaspoons of lemon juice
  • 1/2 teaspoon of English mustard powder.
  • about 3/4 cup of tomato paste
  • 2 overflowing tablespoons of honey or brown sugar
  • 2-3 dessert spoons of Worcestershire sauce
  • 2-3 dessert spoons of ABC thich sweet soy sauce
  • 3 teaspoons of hot spicy SRIRACHA hot spicy chili sauce
  • salt and pepper to taste.

I mix it all up and if the meat is suitable (eg chops) marinate in the fridge for some hours. Then cook the meat in it. If I think the meat is going to be very tough I use a slow cooker and boil up my mixture separately and use it as a gravy/sauce.

None of us have died; one likes me to limit the tomato paste a bit, but they keep coming back for it!

You might like it spicier, then add some ground chilli – which I tend to do if we have Ethiopian visitors.

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

A picture walk of our life in Ethiopia

Just a bit of a pictorial taste of our daily life in Ethiopia

About once a month we ended the day for a posh evening out at the lake side hotel.
For visitors we usually went out on the nearby lake.
the view from our front door
It reads ‘for all, it is possible’ There is a big push for literacy.
The simple life, but not the usual there.
The common way of life in towns large and small.
The small Indian church we attended put on for the public a pre-Christmas night.
I think they meant ‘drug’.
A modern University admin building
The hospital cafeteria.
Clinical students had a ceremony as they became interns to make somewhat like the hippocratic oath we took years ago.
modern facilities with all mod cons in the hospital!
But my days were spent with real people!

Cutting away.

Some relationships don’t last. Cut them off. Certainly some bumps and lumps need to be cut off. Cancer is often cured by its removal. So much money is spent on face lifts and tummy tucks that it is almost unbelievable.

Could you ask for a more handsome face!

But, as I’ve mentioned in other posts, I’m going through slides and memories. I’ve been thinking, as I’ve looked at slides, about the reasons for which I have amputated kids’ limbs. I’ll tell you a few!

Personally I have not been involved in amputating a child’s limb in Australia. In Ethiopia I have done a lot – too many to count! I just want to mention the reasons. These are not listed in a time sequence, except the first.

  1. The first one, and that soon after I arrived as a young surgeon (28) in the country, was because a kid, playing in the paddock came across an old unexploded Italian bomb. He succeeded in making it explode amd lost an arm, an eye and had a piece of bomb lodged in his heart. Three operations on the same boy at the same time. He did well and left – one armed, one eyed but with a normal working heart.

2. Another because he was run over by a train. He lost 3 limbs, both legs above knee and one arm below his elbow. I was not the first to operate on him but had later to revise a poor job. As he told me the story later, I wished that I had been the first surgeon, because if he told me the truth (and I have no reason to doubt him) we could have preserved more limb length than was saved. I had to reoperate soon after I first met him because there were spikes of bone sticking into his skin making every movement there excruciating.

3. One because of an electrical burn. He lost both his right arm at the shoulder and his left leg below the knee. He had other extensive burns and suffered tetanus infection before his eventual survival.

4. The majority because of no doubt well intentioned but faulty local healer treatment. Of these over many years we had almost one a week. The splints applied were too tight and post splinting principles of normal follow up were not practiced. That is you must release the splinting if there is any sign that it is too tight.

5. Certainly I had to amputate in lepers because of uncontrolled infection, but the only child with infection as the primary cause of amputation was a girl with extensive gas gangrene.

Often in these children there was so much severe infection that they needed quick early surgery to remove the mess and then reconstruction later. One I remember had 3 cardiac arrests on the table. Others were brought so late that they died , sometimes within hours of arrival, because of septic shock.

6. Several for limb cancers. The pictures, if I showed them, are revolting as they came so late. The smell often was nauseating, but you just had to hold it in, and get on with the job at hand!

There are some nice photos of happy customers below the line – no blood, few bandages.

Continue reading “Cutting away.”