Maybe Malnutrition plus ?….

Don’t you wish that you had a better memory. I have a terrible memory for names and it gets me into trouble. My wife accuses me sometimes of not being interested in people. But that’s not true. I understand why it frustrates her and when we meet up with people we’ve not seen for a while she has learnt to say to me ‘Dominic you remember ….?’ The stock answer is obviously ‘Of course I do! So lovely to meet you again.’ Unfortunately, if I’m not very careful I’ve forgotten almost immediately. Not that I’ve forgotten the person, only the name and I can go on chatting about past memories, but not using names! Well, in truth, it’s not quite as bad as that but you understand. On the other hand hand I have little trouble remembering the events of our previous getting to know each other.

Don’t you think she’s beautiful? I do. Don’t you think that she’s skinny? I do. Besides her malnutrition can you pick her diagnosis? We have a lady come in every second Friday afternoon to help a bit. She is a nurses aid. So I showed her the picture and asked her what was wrong with the girl. She said ‘you mean apart from her being malnourished?’ She is pretty skinny but I don’t think is actually malnourished but certainly a bit underweight. But look at her left shoulder. I’ll bet that there was more than 100 cc of pus in that abscess. From the way she is sitting leaning on her elbow I’d be surprised if it is a pyo-arthritis; more likely an abscess in her deltoid muscle. Still pretty painful but not as bad as if there is pus in the joint. And it looks as if the glands are affected in her axilla.

I know how it hurts to get ‘bitten’ by a rose thorn. And if dad or mum couldn’t get it out, a child in our land would be taken to the hospital emergency or the doctor’s surgery. They obviously were not the poorest of the poor, (look at that pretty pillow), but even so she didn’t turn up at the hospital until the abscess was this size.

Seriously thank God and the government and a slowly changing attitude to illness, things are a lot better than they were fifty years ago. But the need in Ethiopia and many countries is still huge. At least momentarily it makes you wonder if you or I can make any useful difference. Our grandkids and great grandkids have already so much more than we did or our kids did when we/they were young. So we have (except when they are very small) stopped giving presents. So for Christmas in all their names we give a larger gift to an organization who we believe we can trust to deliver aid on the ground. For birthdays we tend to give smaller gifts in the person’s name to a worthy cause – and there are so many of them around. Do any of you have good suggestions to pass on? If so please let us know.

Cain years ago try to fob God off when he was asked a question about his brother Abel (whom you might remember he had murdered) by saying ‘Am I my brother’s keeper?’ Well I’m not going to run around wringing my hands because I can’t solve every problem, but the question is thought provoking.

Two loveable imps. One having lost most of his right arm; the other with half a thumb gone and having lost his scalp to a hyena. You can see the dressing under his cap. Lovely kids!

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

Jimma – a city of Ethiopia

The road which we walked from our home to town or to the hospital. Before we got onto the asphalt there was about 400 metres of dirt or mud depending on the season

Our little local shop. Muhammad was a lovely guy and became a friend.

The administrative parts of the University were well built. The hospital was an old Mission Hospital and not up to date or adequate.

The tea room for the University staff was very pleasant. The one for hospital workers was very different!

The hospital doctors tea area, as seen from sitting at one of the chairs.

There was much building being undertaken, including a new hospital. It is now, about 12 years after its planned opening, being used. There were many large hurdles which had to be surmounted..

While we were in Jimma there was a period of Christian persecution. About 90 Orthodox or Protestant churches and many of the Christians’ homes were burnt down. We were living in a rented home on the town church compound and hundreds of people fled and were housed on the compound.

At Jimma we found and adopted our seventh child! He’s now much taller than Robin.

This was taken the day the first 4 doctors were granted their postgraduate surgical certification. From left to right : One of the graduating surgeons – he was very capable but very hot-tempered and the last I knew he had be ‘shifted sideways’ for threatening to kill the medical director; An Egyptian surgeon on staff; another of the graduates – after further training he is now a pediatric cardiac surgeon in Addis Ababa (he did further training in Israel and Melbourne); a graduate who with further training is now a plastic surgeon in Jimma; a girlfriend; a graduate who has worked in Africa but outside Ethiopia; me; a doctor in postgraduate training who has now his certificate and has started his own private hospital; a hanger-onerer!

Dominic Cartier

People make or break your day!

Often one hears of, or reads about, nasty experiences dealing with people across the counter. Well in the last two days I have twice experienced just the opposite. That is I’ve had contacts where people have made my day! I am in a run of seeing doctors and having tests which isn’t always the most pleasant of experiences and being made to feel comfortable is great.

First up I had to see a specialist whom I had known during his early post-graduate training in a department where I was a senior. I saw him late in the afternoon on the day when he had just arrived back from his Christmas break and I’m sure was exhausted and just wanted to get off duty. But for the first half an hour we talked about the past, he obviously had in some way or other followed my path when I had returned to Ethiopia. He even knew that I had had a period of teaching French! Then he dealt with me in a most kind and professional way, explained his thinking and ordered several more investigations which he wanted performed. And at the end treated me pro bono!

Then this morning I had to go to the X-ray department and sort out a tangle of appointments. At the end of of last week they had declined to carry out a CT scan because of things from my past history. They had ordered other blood tests, the results of which I was carrying with me. I also had the request for the test which they had declined to do earlier and two new requests one of which I wanted added into the previous CT request and the other which was totally different. There were obvious advantages in combining the two different CT scans.

Approaching the desk when called we (my son and I) were met by a beautiful very young looking (that’s almost everyone these days) receptionist. She expected to just open the book and give me an appointment but it wasn’t that easy. She had never, I think, been faced by an old man who knew what he wanted and would, if possible, like his own way. It was not easy for her because they had to contact someone to read the results of the previously ordered tests; she had never dealt with a patient wanting to have two requests ordered by two different doctors rolled into one; then the third test couldn’t be done in their radiology unit and the barium needed for it is difficult to find. I think because of Australia-Chinese relationship at the moment it is hard to get. Then the possible alternative to be used as a contrast in the examination had to be approved by the surgeon ordering the test, and he could not be contacted as he was operating. She sought help from a senior, another young looking very pleasant lady, and together they worked on the problem for about 45 minutes.

Through it all she was calm, professional, friendly and nice to work with. Thus I have had two very pleasant contacts in two days. Now I remain hopeful that the tests will be as comfortable and that the results are decisive and nice! I don’t know her and maybe we’ll never meet again, but she made my day! I was very happy to tell her so.

Dominic Cartier

If only….

The picture below is the one on the front of my autobiography. It was taken in the mid 90’s in Soddo, Ethiopia. I developed a fairly close relationship with the boy who is walking with me. He was deaf and dumb. There was a blind school nearby but he wasn’t blind. There wasn’t anywhere near to help him. In my early days there before we got a vehicle, I often walked past his home going between our home and the hospital. If only I hadn’t had an already heavy schedule…. but had the chance to meet the family and know more about him. I got to hear his story from the workers and did my best to be a friend to this little guy isolated in an overpopulated area inside his silent world. So we’d walk together sharing a chocolate bar, pointing out things that interested us, but sadly absolute silence. If only we’d known ‘signing’ …. Our home was about a kilometre beyond his and when I was walking home he’d walk with me but then after a while suddenly break off and run home to his area of safety.

Then we bought an old 4WD and as I drove past he would climb up on my knee and steer for maybe half a kilometre before tapping my arm to stop, hop out and run home. I think that either his playmates indicated that I was coming or he, being deaf and dumb, appreciated the vibrations from the car transmitted through his feet. At any rate it was rare for me not to see him coming to the side of the road, waiting for me as I drove past. When we left Soddo one of the saddest things was leaving him. He did not have an intelligence problem, and hopefully as things progress medically in the land, he will get help. If only I’d been able to find an appropriate school…

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I did meet him again several years later when I visited the Soddo area again. He ran up to me with a very broad smile but scratching himself all over. He was covered with scabies. The diagnosis was easy and the treatment relatively cheap, but not all that easy, as it involved bathing and washing clothes. Having worked there just a few years earlier I quickly worked out how much to get him seen, and medicine ordered, then added a little for inflation and gave it to one of the hospital staff to sort out. I was told that after I had left the pharmacy had been privatised and costs adjusted (in)appropriately. Thus the money which I was offering was now insufficient to even get him a card to be seen. I added more, but had to leave and am not sure who prospered from my money, the boy or the one sent on an errand. If only I’d been able to stay and look after him myself….

Life has so many ‘if only‘ situations. You’d go mad if you held onto them too tightly.