Life isn’t meant to be that hard!

African sunset

 

soddo kids.jpg
Life is different in the countryside in Ethiopia. There are kids everywhere and they aren’t taught not to trust you. This may cause some problems but I think that they are less likely to be molested than in the West. Median age of Ethiopia is 19.
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Only one arm (due to a native healer mishandling a fracture), but what a smile.

You may not want to read more if you’re a bit squeamish! But it isn’t as bad as many kid’s TV programs – except that it is real. I really loved the kids I dealt with!

Continue reading “Life isn’t meant to be that hard!”

Pandemic Funerals

African sunset

Pandemic limitations have reduced the numbers at funerals, but have also made it possible to attend (or at least listen to) funerals without travel. In 1968 we arrived in Ethiopia. The man who had been station head at the time when I had to leave in 1973 for health reasons, had a funeral last Saturday in Canada. My wife and I attended the ceremony. Well, not quite, but we watched it on U-tube last night.

Seventy years earlier he had travelled by ship with two other young men for their first term of missionary service. So it was interesting to remember not only my contacts with the man who had died but also with the other two.

The dead man had married a beautiful lady and by the time we knew him had 4 children. He was a good leader, but what I remember most was that his youngest child, a daughter was about the same age as our oldest son. We had a platform type swing in the front of our place, and his daughter and our son used to, during school holidays (they both went to boarding school in Addis) stand at each end of plank, goggle eyed, swinging back and forth. Puppy love, I guess; nothing came of it.

Some years later I met him again in Addis. He had remained in Ethiopia in an Administrative role during the time of the communist rule. I visited during that time for the Australian division of the mission. I wanted to visit my old hospital but was forbidden. Everyone thought that it would cause a riot. But, I did need to do a bit of travel in Addis. I did not have an in-date Ethiopian licence. One of his sons, who had a licence, was out visiting him. So my friend offered his son as a driver. His licence had been obtained to drive automatic vehicles. All the vehicles available had stick gears. I’m glad that the traffic wasn’t as busy then as it is today. It was a scary ride, but we did arrive both ways without an accident.

I knew one of the other men quite well but the story is second hand. Much later he and his wife adopted a young Ethiopian girl. I can’t understand how but the Ethiopian officials allowed them out of the country without a Canadian visa for her. The other end wouldn’t let the child into Canada. The guy, nice but a bit pushy, unsuccessfully argued with them for quite a while, but eventually put the baby on the desk and began to leave. ‘OK, she’s your problem now’, he said.

baby

He was called back, some agreement was reached, and eventually everyone was happy.

The other guy with his wife who went with him on the same ship reminded me of a couple who were working on the Ethiopian-Kenyan border. There were poor roads, no phones, his wife as the only trained nurse in a nurses clinic on site; there was no other medical help available without travelling hours on terrible roads. They were so ‘out-on-a-limb’, distance wise and in political uncertainty, that the headquarters in Addis had  radio contact with them each morning and evening. And describing the roads as terrible, I mean terrible, unmade, ‘mud-slides’ and rivers with no bridges to be crossed.

clouds in mountains

Late one Saturday afternoon the husband complained of abdominal pain, his wife assessed him as having appendicitis. It was too late to fly a helicopter down but the decision was made to get everything set up for action in the morning. A helicopter was arranged, and everything was planned to be able to leave in the morning if he was still unwell. After the morning radio contact we would make a decision depending on what his wife thought. She was still worried, so another nurse, and I set out with sterile instruments, sterile disposable drapes, a spinal anaesthetic tray and a strong torch.

We had two alternative plans in place. If there was a fear that it was far progressed we would bring him back on the helicopter so that he could be watched in hospital in Addis, after surgery; or if it seemed the correct diagnosis but an early case we’d operate there and leave him in the care of his wife.

We travelled down at low altitude in a glass bottomed helicopter. It was soon after the civil war had ended and the people were frightened of low flying air machines. As we passed overhead, the men and their beasts out ploughing took off helter-skelter, often the men in one direction and the beasts in the other, still pulling their ploughs. I don’t know why the pilot flew low; it wasn’t funny for people on the ground; but it looked so from above! And when I say that we flew at a low altitude, what I should say was that we didn’t fly far above the ground. Ethiopia is mountainous so we had lots of ups and downs so as to not hit mountains. I guess we fluctuated between four and ten thousand feet, altitude wise.

table operation

At any rate I decided (correctly) that he had early appendicitis so I operated on him on the kitchen table, using a strong torch for light (held by the pilot) and under spinal anaesthesia. After surgery we watched him for a couple of hours, had lunch and returned to Addis. The next morning on the radio his wife was asked how he was getting on. She said that he was in the garden watering. She called out to him; he was happy and said ‘Thanks for making house calls.’

Pathology proved the diagnosis correct.

Dominic Cartier

A personal review of things

African sunset

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!

African sunset

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:
  1. 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.
  2. 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

I can get frustrated!

African sunset

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.

We had many more good, rather than bad, results!