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.

Ghosts, ghoulies etc….

I never thought that I would see a ghost but recently I’ve begun seeing them. Later I’ll explain it – but it’s a bit of a delicate subject so I’ll approach it delicately and indirectly.

I don’t know if you believe in ghosts – from the above you know that I do now in reality. But seriously people look at you escance if you talk about seeing a ghost. We usually have a short Bible reading around the table after the evening meal and it often leads into a bit of discussion. At that time we were reading slowly through the book of Ecclesiastes and if you know the book at all you probably remember the word ‘vanity’. It occurs five times in the second short verse and another 29 times in the book. So you wonder what it can be talking about. Maybe it’s talking about the shadowy shades of life after death. But no it is talking about the life we all live every day, this side of any shadowy existence. Thus as one of our sons who still lives at home, is a linguist we started looking at how it was translated in some other languages and then looked up the meaning of the Hebrew word ‘Hebel’, like many words in various languages, a word has to be seen in context and has many shades of meaning. The word seems to mean without substance, vapourish, ghostly and things like that. Interestly the Preacher in Ecclesiastes says that life on this planet is the shadowy, passing, ghostly one – the reality is with God!

Most people would say they don’t believe in that rubbish and would even scoff at the reality of life beyond the grave. And then I hear a cricketer say that they are playing this match dedicating it to their friend Phil who died recently. But when they are running up the pitch for their hundredth run they look heavenward and signal to their friend. To be honest I do believe in persons whom I cannot see, and the reality of what is to come. But this isn’t a sermon, it is to tell you about my real contact with ‘ghosts’.

I’m on a new long acting, slow-release medication which I swallow twice a day. After a successful sit in the loo, you can imagine my surprise on looking into the bowl and seeing the same tablet which I had swallowed earlier. When this happened several other times I wondered how much good the tablets could be doing me. No recovery of them was even contemplated. So I started crushing them and swallowing them crushed in jam. They tasted terrible and gave me a very troubled stomach. So a look in Dr Google explained that I was looking at a ‘ghost’ tablet. The medication had been extracted and the frame into which it had been embodied only remained as a ghost. From now on I’ll swallow it whole! If I’d been a physician instead of a surgeon I’d probably have known.

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

Arriving at Shashemane.

Looking East travelling from Addis to South

We travelled for the first time to Shashemane in April 1968. We had arrived in Ethiopia 16 days earlier and we were taken down the 250 Km ride by a couple of missionaries who were travelling further south to their station (another hospital 120Km on the road leading to Kenya). It was good to hear of their experiences in Ethiopia where they had been for many years. Our mission station was big and very busy. There follows an ‘Excerpt From: Barry L Hicks. “Have Scalpel – Will Travel.” Apple Books.’ 

We arrived in Shashemane at about three o’clock in the afternoon and were taken straight to the home of Dr Lindsay and Mrs. Marion McClenny, some of the loveliest people one could ever wish to meet. They were due to go on furlough in a few weeks and we just had that time to be inducted into the work. As we arrived and were introduced Lin, usually called ‘Mac’, told me that he had a patient he wanted me to see urgently – but we had time for a cup of tea first. (Tea provided by Americans! And hot tea at that.) By 3.30 we were in the hospital and we eventually got home for the evening meal at about 11.30.

In the mean time we had seen the patient he wanted me to see – a teenager with a right sided large bowel obstruction due to a huge caecal tumour – and two obstetrical emergencies both of whom needed surgical intervention; we had also seen a couple of other lesser emergencies. Mac dealt with the obstetrical cases – a high forceps and a Caesarean – and I did the right hemi- colectomy for the teenager.

I knew that I was going to have to deal with the obstetrical and gynae procedures as soon as he left and so was keen to learn all I could before he departed on furlough. The specimen of bowel removed from the girl, containing the large mass in the caecum, was sent to the only pathology laboratory available in Ethiopia at that time at the Black Lion Hospital in Addis Ababa. The report arrived exactly one year to the day after the operation. It was fortunate that the patient was not kept in the hospital until the report came back. Typical of patients in countryside Ethiopia, she never returned for any follow up anyhow, so I don’t know what happened to her in the long run.

Very early in my stay there I was asked to review the seven hundred inpatient lepers. I think that I was the first one with any specific leprosy surgical training who had ever been there and if not the first then certainly the first for a long while. In India I had learned a lot of reconstructive procedures and doing this review I had the twofold objective of finding those who could be helped by surgery and to discharge those who did not require inpatient therapy. Thinking about long term hospitalisation had changed rapidly in the few years prior to this period of time.

On the first count I found few who wanted surgery, basically because as farmers they valued strength in their hands above the restoration of the finer movements such as those used in writing – the majority couldn’t write in any case. Sadly also they were valued in their families because of the loss of sensation which allowed them to lift hot things, such as cooking pots, off the fire without pain. Many of them, although the infectious element of their disease had been cured, were left with marked deformity and shortening of their fingers.

The leprosy hospital was built largely by money given by the Leprosy Mission on land given by Princess Tenagnework. It was a 50 bed hospital with an operating suite.

Dominic Cartier

 

A snippet from my book…

Taken from the front veranda of our home – living in retirement!

I am, I guess, getting a bit lazy with the hot, muggy weather and the aging process. So what I am doing today, and may continue to do for a while, is posting a segment of Chapter 20 from my book ‘Have Scalpel Will Travel.

The chapter is entitled ‘A Different Culture’. I was working on a Mission Station as a Surgeon, which was a full time job. But soon I discovered that people had to be assessed and treated taking into account different things. One of these was their religion. For instance i) the dietary requirements can cause real problems treating a post operative case during Ramadan or ii) the strong religious commitment of some created unwillingness to be seen for examination particularly by a foreign infidel iii) There was a very high incidence of low large bowel obstruction due to volvulus and in treating this certain procedures, of necessity, needed the creation of a colostomy. This stopped them going into the mosque to pray. Sometimes they chose to die, although with experience we were able to reduce the incidence of needing a colostomy. This led to one of my areas of disagreement with the Surgical Department in Addis. I am delighted that my way has won the day all over Ethiopia by this time. As seen in the picture below patients, they often presented with infected burns on their abdomens – burnt to try and drive out the evil spirits causing the problem. Or often the patient had drunk the blood of an animal sacrificed to appease the spirits causing the problem. These last two situations were seen because of the animist background of the community.

My book is an ebook, presented through Smashwords. The author is Barry Hicks and you’ll have to decide if this article or the ebook is written under a pseudonym. It is easily found on internet by typing in Smashwords.com Have Scalpel Will Travel. Memoirs of an Older Surgeon. It’s cheap and I think an interesting read; you may or may not agree on that! There are no gruesome pictures, although I have many!

Continue reading “A snippet from my book…”