I can get frustrated!

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!

A day in the bush

I had an appointment to see my doctor yesterday morning. In conversation I mentioned that my wife and I, in spite of our age and my walking difficulties, intended to continue living where we do, some kilometres outside the city limit on a small 40 hectare (100 acre) property. We live upstairs with a grandson and two of our sons live downstairs in a granny flat. The doctor laughingly declared us ‘mad’ as there is so little to do ‘way out there’.

It made me think of what happened here yesterday. Was he correct in his statement? As I said earlier, we are five at the moment – my wife and I, 2 sons, one in his mid 50s and one in his early 20s and a grandson a few weeks older than his young uncle. So I’ll try and list what happened in this out-of-the-way, boring place.

My wife and I, in this cold spell, slept in a bit late. Excusable I think at our ages. Then she got up and worked in the garden for a while, while I did a bit of clearing around the inside. We both went together to my doctor’s appointment as she likes to check that I tell him everything. But she wasn’t let in because of social distancing, only the patient could enter the waiting room. So instead she went window shopping. The doctor had been one of my interns when I was director of surgery here so my visits are always interesting. He decided that I was still alive and I left with a few renewed scripts.

My wife was waiting at the door and led my off to buy something she had seen, for our kitchen. Having made the purchase, we were on our way home when she realised that she had left my prescriptions on the desk when she had paid for the new ‘thingamebob’. So we returned and while she went inside I had a call from our older son asking us to buy some masking tape for his painting job. So we had a trip to the hardware store. We got home just in time for lunch; then

I worked on the revision of a small book I wrote a few years ago for the medical students in Arba Mintch. It’s taking a while as now I’m planning a wider distribution, probably as an e-book.
my wife replied to email notes and wrote letters.
I had a return call from my tax man, which didn’t give me the answer I desired. C’est la vie.
I received a quote for a lift to help me up the stairs; I don’t like the idea but getting up and down them is getting harder. Not cheap but maybe necessary.
We got an email electricity bill. Our new solar system has cut two thirds off the last bill.
We had a lovely email from the mother of the adopted little baby about whom I wrote a post earlier. A baby is born
I had a discussion with the sales person about a water pump. I need to get water pumped from the dam to our house – about 500 metres, but fortunately over pretty flat ground, so there is not a great height to lift the water. It’ll need to be sorted out soon if we want to keep some green grass around the house.

Then my wife took our grandson for a driving lesson. He has never wanted to learn but if he is going to live here he’s going to have to become independent, we can’t spend the time taking him everywhere he needs to go.
My older son and our grandson spent most of the day painting. Then our son went to do some basic preparatory work to prepare for a fencing project starting with our neighbour on Saturday, on a boundary fence.
Our grandson spent hours after the evening meal writing music. He’s good at it and beginning to get some sales now.
Our younger son is an apprentice mechanic so he spent his day at work. When he came home he did some work renewing the thermostat in our farm Patrol vehicle.
After the evening meal, a short Bible reading and prayer. While the others scattered to their various activities I sat down to watch the next episode of Judge John Deed. I don’t think much of his sex life, but appreciate his stand for justice.

So Doc, I think there’s enough to do here! Maybe if we moved to town we’d be bored!

We like the morning and evening ‘paintings’

Dominic Cartier

DEALINGS WITH THE LAW

Relationships with the law aren’t always easy. To quote the old saying “the law is an ass”. Yes it is, but no it isn’t. I think you know what I mean. Sometimes sticking to the strict letter of the law seems crazy, but I won’t follow that line any further.

I have three episodes at least of disagreements with law authorities in Ethiopia. There is a fourth more complex one that I may tell you about sometime, but not today.

In the first, the ‘traffic’ as they call them stopped me up in Addis. There you drive on the right. Coming to a corner where there were four lanes travelling each way I wanted to turn left. I wanted to cross in front of four lanes. Those coming in the other direction had a stop light. In the past, two lanes had been allowed to turn left, but, unbeknown to me, the rules, the law, had changed – now, one only could turn. So, doing what I thought I knew was right, I turned from the now illegal lane and was whistled over by the ‘traffic’.

As a bit of background, if fined in Addis they take away your licence, give you a fine slip, you immediately go and pay the fine, then come back to the same person, show your receipt and get your licence back. By then the person with your licence may or may not still be there. Or you can pay a bribe, which I am not in the habit of doing.

The guy asked for my licence. Resisting the temptation to tell him that I drove without one (I did have one) I simply said ‘no’. I think it shocked him a bit. ‘Why not?’ I was asked, ‘don’t you have one?’. So I explained that I did but that I knew how fines were handled, that I had a 500 km trip ahead of me and I wanted to be on my way. And, without stopping for him to get a word in, I asked if he had ever done wrong and been forgiven? Again, without stopping, I said that I knew that I had accidentally done wrong, and ended by saying ‘please forgive me!’ He smiled, looked at my licence which I had slowly taken out, and he waved me on. Nice guy!

A patient was brought to our hospital from the prison with a broken thigh bone (femur). We were ordered to treat him. It turned out that, according to him, ‘they’ at the prison had broken his leg. We did not have facilities to put in an intramedullary* nail which would have allowed him to walk in a few weeks, so he was put up in traction. Those bones heal slowly and usually need about three months to heal properly. I think the guy preferred our bed to the prison. Less than a week later the prison guards were there to take him back to prison. After a long and fairly heated discussion they left, without the patient, but with my promise that if they returned with an official letter stating that they would take him to the police hospital in Addis, I would fix him in such a way that he could travel the 200+ km to get there. It didn’t take long for them to get the paper. I knew that, as they drove out from our hospital, if they turned right they were going to Addis, if they turned left they were not. They turned left.

I was only about 30 in the late sixties. Maybe I was young and foolish. Not long before an important person had been involved in an accident near the hospital. Having treated the injured, I had been requested to write a legal report as to what had happened. The report obviously didn’t please the wealthy guy who had caused the accident. So, a policeman arrived in my office and offered me a considerable bribe if I would rewrite the report according to his suggestions. Maybe foolishly, but with great satisfaction (he was not a big man) I picked him up by the scruff of his neck and the seat of his uniform and threw him out the door. I am thankful that I heard no more, as I suspect I was right to refuse but wrong to do what I did!

* intramedullary nails were first used in WWII to allow the Germans to rapidly mobilise prisoners of war who had broken femurs, for example, pilots who had parachuted out of their planes. This concept is used a lot these days.

Dominic Cartier

What do you think?

I have a friend, an African friend, who did his medical training in Russia. I don’t think that he is a liar. He told me that when he was there, not infrequently, as he walked on the streets, he would feel people checking his lower back to see if he had a vestigial monkey tail. I have not checked for myself, but I know that he has an excellent brain! You probably think that in the twenty first century this behaviour is unbelievable. And yet almost all educators of today are teaching that we have come from monkeys. So why not test the theory?

You probably know the story of the little girl who asked her mother where humans came from and got the ‘God story’. She later asked her father the same question and was given the ‘monkey story’. At the evening meal she accused someone of lying to her. Her mother replied that she had given her the story of her, the mother’s, own family, and that the father had given the story of his family. He was dumbfounded! The child seemed satisfied.

This coronavirus affair has I’m sure made us all question the way it has been handled. That is not to say that we’re complaining at what has been organised, but we would be dumb domesticated animals if it didn’t make us think, and ask questions like..

How many have died of other viral illnesses, during the same period? And maybe, how many have died unnecessarily of other non-treated diseases?
Why can you have an abortion but not meet your ageing parent in a home?
Why are the suicide, domestic violence rates, and incidence of mental illness climbing?
Are we living in a runaway world?
What will happen to my family if I die?
What’ll happen to me if I die?

The list could go on for a lot longer and maybe your questions differ from mine.

When I was a Surgical Registrar in the 1960s I saw the film ‘Lord of the flies’. It was not based on a true story, but graphically pictured how a group of higher class youngsters from England gravitated into selfishness, murder and cannibalism when marooned, for roughly a year, on a deserted island. Just recently I have read an apparently true report of six Tongan boys who to escape the rigours of a strict school, stole a boat and paddled towards New Zealand. They coped by cooperating. They were marooned for more than a year on a deserted island, until they were found by a fisherman. This without doubt is at its root a true story. The recent report about this event leads the author to suggest that whereas the theory of the imaged book highlights the weakness of human character, the truth of the true story is that people are really basically good. And our basic goodness should be highlighted.

Compare how Australians pull together during bushfires versus why do Australians light bushfires and steal from what is left? How do we balance the generosity of the government when they want cooperation, with their usual treatment of some segments of needy society? Why do some blossom in community service at times like we are going through, and others crash into terrible attitudes and situations as mentioned above? Is there truly good and evil in the world? Should our goals be self-centered, financial, comfort seeking or maybe “goodness and truth”? The eternal question – why am I here?