Tom is Alive

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None of us men could even begin to imagine what it would be like. Maybe you ladies could. Try to imagine living in a family; being the first of four wives all living in the same compound; there are plenty of kids from babies to teenagers; you’ve delivered fourteen babies and they’re all dead.

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Usually the husband had the largest house and each wife with her children had a smaller one.

Now you’re pregnant again and your heart is so full of hope!

Your husband loves you, but you share that love with three other wives. The months go past, your belly fattens, the kicks start coming, your hope and your fears grow and jostle in your mind. Seven months gone, only two more to go. A few days pass and your waters break. Oh, no, surely not another so tiny that it won’t survive,

But your husband loves you, so, although babies are usually born at home, he gets a horse and cart and takes you to the nearby infidel’s hospital so that maybe you’ll get a live one at last. He does really love you.

They have funny customs, but they look after you and you deliver a scrap that when you see him you can’t believe that he can live, and he certainly wouldn’t have in your home. They take him away from you. Not to say they are nasty, they care for you, express your breasts (both of them) and feed him through a little tube down his nose. They make another uterus for him out of a card-board box lined with cotton wool. They put an electric light in the end to keep his new home warm. They run oxygen into the box at first but after a few weeks decide he doesn’t need it any more.

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About this size he was taken home.

One of the foreign women takes him to her house each night because she explains that she wants to make sure he gets his 2-hourly feeds at night. You can see she loves both of us and wants him to live. You learn her name is ‘Hirut’ but lots call her ‘Ruth’. Her own two boys love to come and watch him with you. They love him, you can see, like a brother.

Gradually they teach you to sponge him down, and to feed your own milk down the little tube. Eventually you’re allowed to hold him for a while. He holds your finger; he pees into your face as only little boys can; he takes your heart in his hands and your hope grows. But then goes back into his box.

Then your breasts dry up and they start to feed him in a powder from a tin which they mixed with boiled water and let him drink from a bottle with a breast slipped over the end. They teach you to test the warmth of the milk substitute by dropping a bit onto your wrist. They always clean up the bottle and the little ’breast’. They explain this is necessary and teach you how to do it properly. They explain it is very necessary to do all this.

He’s soon no longer living in his box. They teach you to do it all so well. He grows so beautiful. You see Hirut would love to keep him, she has spent so many nights and so much effort, but she just encourages you and gives him lots of little clothes that her own boys wore. All the hospital love and they call him Tom. He kicks, he laughs, he cries, He’s beautiful. It’s time to take him home. The nurses give you a little party and then your loving man takes you home. Everyone there is excited for you and they love him.

Five days later, he’s running a temperature; another two days later little Tom is dead.

No one at home boiled bottles and their water came from the creek in which people bathed and near which they did their ‘business’. He got diarrhoea, started vomiting and died.

Later you got the courage to go back to the hospital and told them the news – they cried with you, and hugged you and loved you. As you left you missed hearing them say to one another ‘It was all our fault. We should never have been so clean.’

But sadly, Tom is dead.

Vanity of vanities, it’s all a fadin’.

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I’m not very handsome, but then, they say, character is more important than  looks. I hope my character is better than my looks! I’m old, wrinkled and with big bags under my eyes. 

It reminds me of that old ditty: licence photo

As a beauty I pose as no star;

there are others more handsome by far;

But my face I don’t mind it,

for I am behind it;

’tis the ones in the front get the jar.

My driver’s licence photo (taken years ago) is particularly awful. They insist on taking it against a white background and with white hair I look as if I am a pin-head. And you can see my under-eye bags, which have grown larger over the years. They don’t encourage you to smile, and with my white beard, grown since, I have no idea what I would look like now. The attached picture was taken 11 years ago, so you can imagine what I look like these days, with my white beard added!

There’s a story behind my white hair. When I first went to Ethiopia, as a surgeon, they called me the ‘baby doctor’. Not because I was a paediatric surgeon but because I looked so young. I was in fact 28. But I prayed for a few white hairs to look a bit more distinguished, and, obviously, didn’t stop praying about that issue soon enough. I am not going to dye it.

But that is all a diversion. I was called handsome once.

I arrived very early at the airport in Addis one day, because the taxi driver whom I always used had to get some kids to school on time and he could only take me early. Reception was closed, so I sat reading. Maybe half an hour later two young ladies arrived to open the Emirates counter. By their dress one was obviously Orthodox, the other a Muslim lady. The Orthodox lady got her place setup first so I went there. I was in my late 70’s, so was surprised, for two reasons, when the young Muslim lady said ‘you’re a handsome man’. Surprised because she was a Muslim and I an infidel and because I thought that she must need glasses.

The girl not serving me said ‘he’s not handsome, he’s just old; he’s not good looking!’ I will love the memory of the other girl for ever as she responded ‘0ld or not, he’s handsome!’ I love her, and always will. Even though I still she think she needs glasses.

Dominic Cartier

Life isn’t meant to be that hard!

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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

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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.

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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

I’m feeling sad!

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Why sad? I’ve so much to be glad about. My wife loves me; I love her. My dogs are lying at my feet. I’m enjoying a cup of coffee.

But I love trees and today we had eight cut down and their roots ground out. They took many years to grow. They weren’t sick. They were in the way. Electricity has become so expensive that we’ve had solar panels installed, and they stopped the sun shining onto the panels in the afternoons.

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We have a heap of mulch which will make my gardening wife happy, but I’m sad

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The top branch of the last tree
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It looks bare!
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what is!

I guess that in the long run it is for the best; but I’m still sad!

Dominic Cartier

I’m a carnivore!

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Whenever my wife asked what I’d like for my first meal when we arrived back in Australia, my answer was invariably pork chops and ice cream. Not on the same plate, of course, but, in the early days,  we didn’t get either in Ethiopia. As far as ice cream was concerned, after some years, there was one place, as you turned right at Mojo (about 80 km) to go to Shashemane, where an Italian guy sold gelati from a caravan. Years later there was a spot on the right side of the road as you drove out of Addis, where you could get several different kinds of ice cream; now there are places all over Addis and it is also available in most major towns.

Pork chops were off the list because neither Orthodox Christians nor Muslims eat pork. You couldn’t even get bacon. Because of the growing Chinese influence there are now a few places in Addis where you can buy pork, but it is still not a common meat and to many an absolute ‘no-no’,

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You could buy beef which was hanging outside the butcher shops. The butchered halves hung there for all to see. The animals were killed early in the morning and it was good to get there early before there were too many flies. You could point to the piece of meat you wanted and they cut it off. You needed to cook it well, preferably in a pressure cooker. It seemed as if most animals were killed after a long life of pulling a plough!

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Chickens (doro) were bought live. They were highly prized as meat. They were in the local custom killed in, to me, a rather gruesome way by sawing through the neck. We, as you probably know, kill them by placing their necks in a convenient place and with a swift swing of an axe chop off their heads, before hanging them up to drain out their blood. Again by local custom the bird is cut into eleven pieces and made into a very spicy meal. The favoured person is usually handed a piece called, when translated, the horse-rider, the meat on the breast bone.

chickens to market

If you wanted sheep meat you went to the market and bought a sheep. You could never buy lamb or mutton or hogget at a shop. You took the sheep home and killed it and prepared the meat there. African sheep don’t look like ours in Australia. They look like goats, but whereas goats ears and tails go up, those on sheep hang down. Goat meat also can be bought on the hoof, in the same way.

Being brought up in the south of Australia, in our childhood and youth, when not eating rabbit, we ate sheep, usually labelled lamb. On the farm they were aged by their teeth, in the shop by the butcher’s choice.

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One weekend we decided we’d like some sheep meat. So the teenagers who were living with us  A house full of teenagers.  and I went to the local market on the Saturday afternoon and after a lot of haggling bought one. As a white person we financially suffered racism. Everything was a bit dearer for us. So I sent the boys out to suss out the best prices. I fooled myself if I thought this would work as I was well known in the town, as was the fact that the boys lived with us!  I personally had no intention of killing it. Ato (Mr) Kassa, our gardener could do that on Monday, I knew that he’d be happy to do that for a share in the meat as a gift.

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This is a roadside market in Addis. Ours was held once a week as a major event in a square a hectare or so in size and people came from all the neighbouring towns.

Here I ran into an unexpected hurdle. Sheep are not kept outside in countryside Ethiopia, they sleep in the house, I think for fear of thieves or hyenas. At any rate, in the evening we tied it up in the garden but it didn’t like that at all. It baa-baa-ed to the point of driving us near to insanity. We had to end up clearing a space in the inside laundry, and inviting him in. After that peace reigned until…..

Monday when he was dealt with by Kassa. He was a very tasty and the much enjoyed centre of a number of meals.

Interestingly, the intestine is a favoured piece of the kill and locals make it into nice spicy dish. Kassa and his family enjoyed it as part of his gift. On the whole I don’t like tripe.

Dominic Cartier

The world we live in.

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I used to hear ‘All the world is mad but me and thee, and sometimes I have my doubts about thee.’ In the light of that consider the ‘me’ below and, if you want to, answer as the ‘thee’.

The world I live in has many levels. No doubt your life is as complex as mine, but I live –

  • inside my skin (which has different levels also!) – I’m old, unable to do what I used to do. Still mentally with it (my interpretation); a bit frustrated with the limitations of age, but fairly contented.
  • inside my family – as I’ve experienced contact with many families I think ours is pretty good; as family expands beyond a couple to children, their marriages, their children and their marriages down to great-grandchildren there is never going to be a trouble free family tree but ours is, on the whole as good as can be expected in an imperfect world. Whilst I love my kids dearly, I try to see them as of no more significance nor less significance than the smallest latest child born of any colour anywhere today. Truly they are more precious to me, and I’d gladly die for any of them, but of no more worth in the whole scheme of things.
  • inside my local community – sadly we are seeing too much unemployment, too much crime at all levels, but particularly in the youth aged group with house break-ins, and stolen vehicles high on the list. There is a feeling amongst a significant percentage of the community that offenders often get a slap on the wrist and are allowed to return to their previous activities. To quote a recent news article from the channel 9 News ‘Townsville’s growing youth crime problem has it listed as one of the worst criminal hotspots in the world, with the regional Queensland city named alongside Tijuana, Baghdad, Caracas and Tripoli’.  
  • inside my state – there is high unemployment and the rural area has been affected in a significant extent by the action against transport of live animals and the anti-mining movement. This has had a statewide effect on unemployment and financial viability. At the moment the jobless rate in the state is 6.8%. Quoting the Queensland Times – ‘Outback Queensland’ included Mt Isa, Aurukun, Cape York and Longreach and the region had an average 28.4% youth jobless rate.
  • inside my country – we have had major fires, significant floods and of course the coronavirus restrictions with major social and economic effects. There are Black Lives Matter riots, seemingly brought to the boil by the killing of a black person (with a significant criminal record) by a white policeman in the USA. It seems to have acted as the straw on the camel’s back at this moment. The bit in parenthesis is not put as an excuse for the killing but as a fact to be considered, as it would be in any accused murder situation – something about ‘innocent until proven guilty’.
  • inside the world. USA, which claims to be a democracy, ever since the last President was elected, has been the scene of politically stirred up and cause-aided disturbances to bring it to the situation where it is no longer acting as a democratic country. It is complex but it seems to me as if the entrenched rich from all political streams don’t want the changes promised by successive Presidents, (promised in my view, to get elected) but not acted upon. The present President has fulfilled their ans some of his promises, and stirred up the entrenched who never wanted the promises fulfilled, but their person to get into power. Black lives matter is absolutely true; then, if that is true, may I ask, why are the majority of black people killed in the USA killed by black people, and why the issue of roughly 50% of abortions being performed on black people (only about 15% of the population) isn’t a major issue with the cause? Is there any reason why we don’t hear of the religious and inter-tribal murders of hundreds of blacks mainly by blacks? This is happening in big numbers in West Papua and Nigeria at the moment. There are the Middle East wars and many other concerning issues to be considered in addition.
  • inside the cosmos – well I think that there are efforts being made by a number of nations, at great cost and in the name of Science, to mess this up also. There may be some advantages which come from their searching.

I’ve read that ‘3 things remain – faith, hope and love’.

I guess my faith is that God, the Creator is still in control; my hope is that at every level we’ll act with integrity and learn from our mistakes; my aim, concerning  love, is to be able to love friend and enemy and treat each person as I would seek to be treated.

Dominic Cartier

 

A personal review of things

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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!

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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

Winning the battle; Losing the war!

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I spoke earlier about tangles with authorities. DEALINGS WITH THE LAW My biggest tangle saw me with a renewal request for my visa denied. I was working in a government hospital after ‘peace’ had been restored after the communist take over.

For some years there had been a great shortage of equipment, drugs and materials. The country was just coming out of years of war, and this was understandable. Fortunately  I was able to keep working reasonably satisfactorily because of aid sent out from Australia. I had been working in 3 hospitals where I had a private practice, and public sessions – two were private and the other a public hospital. They very generously collected good second hand equipment, and from donations we were able to occasionally buy new but usually second hand items. We paid for it to come in ship containers. No duty was charged on its entry into Ethiopia, but then everything was a gift.

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In this photo, as an example, we had provided the following: the operating table, the portable light, the oxygen concentrator, the suction machine,the drapes and gowns,as well as the diathermy machine, the leads of which you can see covered in plastic. WE had the drapes and gowns made locally.

Suddenly, whilst a container was on the high seas, an import tax was announced amounting to some 35% of the new value of these gifted usually second hand items.

It was too late to not get it, it was already on the way.

After several days at the ‘goomrook’ (customs) I was handed a bill. To get the money I had to sell my second hand Toyota Land-cruiser. The government had paid nothing for all that we had shipped in for about four years. The bill was paid by me.

Then the fun began. The powers that were in place refused to release the container. So after three months of phone calls, pleading letters I sought an appointment with the official whom I knew had both the power to stop release or to grant permission. He wasn’t the head of health (she was a pleasant lady from a smaller tribe) but the highest in line from the ruling tribe.

After over two hours of my persisting to hear the ‘no, no, no’ which he kept uttering, and I think that he realising that there was another way to say ‘no’,  said ‘ok, I will, come back tomorrow’. If I had agreed I knew that the chance of getting another appointment was minuscule. So I indicated my thanks for the ‘yes’, but as the paperwork was in front of him I wasn’t leaving until I left with the signed form. After about another 30 minutes of discussion, he said ‘ I will, but I don’t see what you see in those people!’ Naming the tribe amongst whom I was working. I should have shut up,, I guess, but couldn’t help saying ‘when you get to know them, Sir, they’re almost human.’ I got my paper and a little later the stuff. I’m convinced that he wanted the stuff for his own area.

I had won the battle, but I lost the war. Soon I had to seek a renewal of my work permit and visa. They were denied.

Some six years later, with another person in power, I got a visa again and spent another ten years working in the country.

Dominic Cartier