A baby is born

A baby girl is born. So what’s so amazing about that? We’ll call the girl Rahel which isn’t her real name. Her birth mother had just been left by her husband, and none of her family wanted her. She was an epileptic, and fell into a fire and was very seriously burned. She lost her left breast and had serious full thickness burns on her left side and down her left arm. She was pregnant and at term. She delivered Rahel the day after she was admitted to the hospital. The mother would have nothing to do with her, I think understandably in the circumstances. The mother was dreadfully ill and sadly weeks later died, after lots of treatment. There were no relatives around.

But the story is about Rahel. She was taken to the special care baby unit, where after a few days they rebelled and said she wasn’t a sick baby so she couldn’t stay there. So she was brought into her mother’s ward, my wife bought infant formula for her, but they rebelled for the same reasons. So we brought her to our house while we tried to work out a solution. We were in the middle of adopting our second Ethiopian son who was about 10 at the time. We all loved her but didn’t feel as if we could or would be allowed to adopt her. Our next door neighbours were Europeans, supervising the care of street kids whom they placed in willing local homes and financially supported the families to cover the cost of an extra child. Our neighbours knew English but their prime languages were different. Thus their household spoke four languages – their two home country languages (very different), English and Amharic, the common language of the local populous. They already had three boys of their own but after some consideration decided they would like to adopt her.

My wife, although she loved her very much felt that we should not even try to adopt her. I agreed. So when they decided to take her we were sad/glad to let them have her to see how the boys accepted her. They loved her dearly.

Then one after the other the three boys came down in series with chickenpox. So for the baby’s sake she came back to live with us until the risk of her getting the disease was over. Many times a day the non-infected boys would come to our door, accusing us of stealing her. They wanted her back.

During this time we went to a town a couple of hundred kilometres away to visit our first adopted Ethiopian, who was back in the country courting a young lady who is now his wife and the mother of their two children. We were sitting in a little restaurant with our two boys and little Rahel. At a nearby table were sitting two well dressed men. They were talking in the tribal language of our son who overheard and understood their conversation. Apparently there had recently been several cases of foreigners stealing babies to sell on the black market. They were policemen. They were deciding as to whether or not they should arrest us. Our son went over and spoke with them, explaining our situation. Then we joined them and it was all sorted out.

Chickenpox doesn’t last for ever and the family joyfully took Rahel back. The boys forgave us for stealing her! But then the birth mother’s relatives, who hadn’t come to the hospital, as soon as a legal adoption process began, came forward. They didn’t want her, but surely she was worth something. All I know is that after a bit of trouble they were able to adopt her.

The last time I saw her one of our Australian sons was with us. He knew one of the parent’s language. She sat on his knee and spoke with him in that language for about half an hour. She spoke with us fluently in English. She also knew her other parent’s language and apparently knows Amharic well. At six she was fluent in four languages. Truly the little girl is well and truly born! The parents have since had another child of their own. A little girl.

You might not like the pictures below the ‘more’ line. They are of the birth mother’s burns.

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A photographic interlude

vultures & storks — Vultures and Maribou storks on the road near an abattoirs.

These two lakes are at Arba Mintch. Arba Mintch means forty springs. There were many more springs than forty. It is the only place in Ethiopia where we were prepared to drink the water straight from the tap. The two lakes are separated by a narrow strip of land and there is a creek running between the two. Yet their surfaces are about a metre and a half different. Abiya is higher than Chomo

A moonlight meal — A pleasant meal, on a moonlit night looking over the lakes at Arba Mintch.

Dominic Cartier

Nazret v Adama

For many years the rulers of Ethiopia were from the Amhara tribe. Their religion is orthodox Christianity and they changed other tribal names of towns and areas to suit their desires, often to Biblical names. With the several changes of government over the last nearly 50 years many names have been reversed to their former names and Nazret (Nazareth) is again Adama. (The Oromos use a lot of doubling of letters to show how long a letter is to sound. They spell it Adaamaa). Is that of significance to this post? Well, yes it is. With the rise of tribalism, local people were put into positions which had previously been filled with Amharas, that is members of the then ruling tribe – not that they either were always a perfect fit for their posting. The replacements were not always well qualified. Thus the CEO of the Nazret hospital was now from the Oromo tribe. The young surgeon who wanted me to come was an Amhara. The Oromos are an Islamic tribe in the main. So when I was brought before him, the question was why he should allow this foreigner into his hospital at the request of an Amhara. There was not open hostility but below the surface suspicion.

My friend had told me that the boss had had several unsuccessful attempts to have a large umbilical hernia repaired. The hernia was visibly bulging through his shirt. So, somehow or other, it became the conversation piece. Eventually I persuaded him , if I could get a nylon mesh imported from Australia, to allow me to repair the hernia again. I promised him a 98% success rate. He agreed, and I was allowed ‘in’ to help my friend. His operation went well.

Note – in fact promising 98% sounds good but for each individual the outcome of a complication is either zero or a hundred percent. You get trouble or you don’t. He didn’t, so everything was okay for me after that. He was a happy, now cooperative, customer.

In fact it hadn’t been easy for me to make the decision to go there. Prior to meeting the CEO my wife and I had gone down, on a public holiday afternoon, to inspect what was involved. The wards were much like most Ethiopian hospitals; the surgeon was obviously trying his hardest without a lot of administrative cooperation. Not that they were against him but they had no real understanding of how to run a hospital.

But, as a surgeon, I was particularly interested in what the operating rooms were like. And seeing what we saw it was a hard choice to agree to work in them. There had been a procedure done the night before. The room had not been cleaned up; there was dirty linen on the floor and a considerable amount of blood about. A window was broken and there were flies feasting on the tasty morsels which they could smell and easily find. So in choosing to go I undertook to do and to get done quite a bit before my first operating list.

or rom copy — Their operating room was much worse than this!

The school at which I taught part-time Because of Bilingual Canada had a rule that the year 10 students had to have a civic experience in the community for a couple of days during the school year. That year I bought some materials, and the students with the day workers from the school all came down and the windows and screens repaired, a decent setup for pre-operation scrubs put in place, the OR complex was painted and an emu parade performed over the hospital grounds to clean up the very messy area. Thank you, school.

Adama has a population of about 500,000 and an elevation of just over 1,700 metres (nearly 6000 feet).

Dominic Cartier

Tensaiyeh*

maregu 7

This is the story of one whom I’m sorry is not our son. The Australian government, I think for financial reasons would not countenance an adoption. They did give us a 6 months medical visa but we had to pay all expenses and he had to leave at the end of those few months.

He was run over by a train. His father was dead; his mother was cruel to him. I’ve seen the burn marks that she inflicted on his one remaining arm. He was a street kid, and I’ve no doubt a thief, a beggar and a bit of a rascal. He lived on the streets of the place I used to go to operate on Fridays. I’ve explained about Friday operating there before. I didn’t do his initial surgery but saw him on a Saturday morning round when he was just about to be discharged to be a street beggar again.

He had been operated on by a surgeon for whom I didn’t have the greatest regard. A boy to remember/a surgeon to forget.

Later the young boy told me that when trying to hitch a ride to a bigger town for better pickings, his friends who were pulling him onto the train let him slip and he fell under the slowly moving train. He lost both legs and his right arm. He told me later that when taken to the hospital he still had both knees, and his thumb and two fingers on his right hand. If you have to amputate it is a good thing to remember that the longer the stump the easier to use an artificial limb. And a few fingers can be very useful!

When I saw him that day both legs were amputated very high, and his right arm was amputated just below his elbow. He was in considerable pain because in his left leg stump the bone had not been smoothed, it was not covered with muscle and the sharp spike of bone was half way through the skin.

I took him home with me that day. It was interesting because he knew no English and my Amharic isn’t perfect by a long way. I asked him three questions,

Did he wake at night with night mares? The answer was ‘no’.

Did he need to pee at night? Asked, obviously, because I’d have to carry him to the toilet. He said ‘no’, which was usually correct.

Was he worried about the future? His answer surprised me. ‘No, there’s a God in heaven, He’ll look after me.’

On the trip back it rained a bit. When it stopped other traffic splattered dirt onto the front window so that I used the windscreen wipers and sprayed, as you do, water to clean them. He asked where the water was coming from. I told him that there were two little boys under the bonnet who peed when I told them to do so. He looked at me a bit shocked so I explained the reality. But I think it helped him to know that I was a real man, like his father used to be to him. We got on famously.

I remember his first bath. He’d never seen one or been in one. He clung to me as I lowered him in, screaming at the top of his voice. Having got in, and discovering it was warm and very pleasant he didn’t want to get out. We never had that problem again.

Soon he had to go back into hospital and have the bone in his left stump sorted out; of course, not at the same hospital.

The next while was a bit mixed up; he stayed with friends while we came back to Australia for my cancer surgery; then my wife returned to Ethiopia to finish the academic year teaching her grade 4 kids. Tenesaiyeh lived with my wife while she was there. We got a medical visa for him to come to Australia for artificial limbs. I had three years of troublesome, even if not overly serious, complications after my cancer surgery. So I had plenty of time to act as his personal chauffeur and physiotherapist while he got his prostheses made and began to use them. Before I had to take him back to Ethiopia he was slowly walking up and down stairs. He scooted around on a little skate board and used to love sitting in front of the TV conducting with Andre Rieu.

The local school allowed him to attend (this was new for him); he loved it and they were so good to and for him. He went around at school on his skateboard. I’m not sure how legal it was!

Australia wouldn’t let us adopt him but arrangements were made for him to be adopted into the USA. For legal reasons he had to spend time in an orphanage in Ethiopia before he could go to America. When I took him back, I spent a few days seeing him daily until I left to return home. He came to the airport with me and it took 2 people to pry him off me, for me to be able to leave. It was similar to getting him into the bath first time – except he didn’t enjoy the orphanage.

His new parents, for reasons I cannot fathom, soon found his prostheses too much problem and disposed of them. So he’s a wheelchair bound guy these days but a champion wheelchair Olympian. He’s a University student and we still correspond as ‘my American son’ and ‘my Aussie dad’. He tells me he wishes he had been allowed to stay here. So do I!

josh m — Although the hand was opening pair of hooks – he could use it well. The limbs were made to look much more normal after correct fittings were sorted out.

Tensaiyeh was not his name. It is used as a boy’s name and means ‘my resurrection’.

Dominic Cartier

A boy to remember/a surgeon to forget.

As older professionals, whatever that profession is, we were all young and inexperienced once. So one must not be too judgemental of others’ mistakes. I used to tell my students that we all make mistakes, but, if possible, reduce your own by learning from the mistakes of others.

I mentioned in a previous post When to leave the training nest? that, for a time, I visited and operated with/for a friend every Friday. One week I discovered that a second, just graduated surgeon had been appointed there. Neither my friend nor I knew anything about him, but as there were 2 operating rooms he suggested that we had to appoint someone upon whom the new chap should be the surgeon. Maybe one of us should have watched him, but we were in the other operating room, both involved in a complex case.

To divert – you can get hernias in many places but the commonest are in the groin or at/near the umbilicus. A rough, workable definition of a hernia is a bulge of an organ (or part thereof) through what normally contains it. Basically three words are used in describing the way you repair a hernia.

Herniotomy – the simplest of the three, where you push back the contents and just cut off the sac, which is usually a bit of peritoneum. This is the common way of repairing a child’s groin hernia.
Herniorrhaphy – where you sometimes include a herniotomy but then try to repair back to normal anatomy.
Hernioplasty – wherein you sometimes do the above but try to strengthen things by rotating something or adding some foreign material, usually some sort of plastic mesh.

We chose for him to operate on an about 8 year old boy with a common type hernia on which you did the simplest of the three repairs above, in colloquial language, it should have been a cinch. He did his operation and the boy was sent back to the ward.

On the next morning, while seeing my patients from the previous day, I came across this boy, screaming in pain and in obvious great distress. He had an exquisitely tender mass extending from his umbilicus to just above his right knee.

He was not my patient and I was not the head of surgery. So I asked my friend to contact the surgeon who had operated and ask him to see his patient. The guy didn’t answer his phone. I needed to go, so I suggested that my friend try to ring again in about an hour but that if didn’t come that my friend would have to re-operate himself – he was very capable to do that. The guy answered the next time, but refused to come; my friend operated. The top of the bladder had been cut off and left open, so the mass was all urine.

I’ve never heard on any occasion of such a thing happening. Can I forgive him? As I said at the beginning we all make mistakes. I find it very hard to understand this mistake, but certainly I don’t forgive his refusal to come when called to review his patient.

The kid recovered, but instead of a day case, his recovery took quite a while.

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