Giving a lift in the countryside.

Do you ever watch ‘Morse’ on Television? Have you noticed that the main actor Morse (John Thaw) has a ‘dropped foot’ on the right? As a doctor you tend to spot diseases. And one day I saw this guy standing on the road side.

Taken on the road to Jimma in this picture you can see a lot.
  • The gum trees came from Australia.
  • You can deduce that we are driving on a high plain and in the distance, after a valley unseen for the cloud that fills it, is another mountain range. Going to Jimma from Addis you pass through several mountain range.
  • The ground looks fertile.
  • The old man isn’t standing up very straight. His knees are bent and his crutches don’t go up to fit nicely under his arms.
  • He’s obviously thumbing a ride. I can’t see a house anywhere near, and he is not at a designated bus stop. So I wonder how long he’s waited and to where does he want to go. It’s a long hard walk to any clinic in the area.

Either he’s got a bad medical practitioner who doesn’t know how to set up his crutches correctly or he’s got some nasty orthopaedic problem. His knees are bent; his back is bent over, but if they both were straightened out his crutches would be long way too short. I am most unlikely to know his language as this is a different tribal area. He looks a bit scruffy – see that patch on his knee? He probably has a different scent but most likely BO. I think we could make room for him but the kids would have to be squashed up. We’re in a bit of a hurry, and someone says ‘we’re running late already’. Look carefully – he is human. Wife says ‘well, are you going to give him a ride?’ Should I have?

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

Some aspects of University Years in Arba Minch

I spent the last years of my working life in the University at Arba Minch. The city has a population of more than 200,000. The University has more than 40,000 enrolled students. I went there as the medical students were about to enter their clinical years. They were not ready to receive students in the hospital but we had to do so!

In my time we had to take the Hippocratic Oath, which I’m sure would be impossible to take these days with abortion, euthanasia, sex change operations. At Arba Minch they had a commitment called ‘Passing the Light.’
There were a number of ex-patriots mainly Indian subcontinent or from the Philippines. There were only two Caucasians. I was the only one involved in training doctors. Thus for a while as they came to clinical years thy found my accent difficult.
Every morning we discussed the emergency admissions from the the previous day, deaths and the operations performed. Because of the way we divided the students for teaching there were 60-75 people packed into a small room. As you can see above there was no room between the front row of participants and the people leading. You can see the data projector hanging from the roof on a little platform attached by rope.
This is looking up at the ceiling. The mark on the wall is bird poop, and the tin roof without a ceiling made it very difficult during the rainy season.
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Robin and I shipped across a ship container of stuff to make the system workable even though not perfect. You are looking at a large part of my superannuation!
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There were other lectures to be given also. These were presented in the University grounds in much better facilities which had been prepared for the preclinical years.
If you let your eyes wander you can see the level of furnishings in the wards. There was one X-ray box for the whole hospital, so the light coming through the windows did the job. There was no radiologist to report on the X-rays.
But a University enrollment of 40,000 makes for a big graduation ceremony. Not all faculties graduated on the same day.
Terrorism either as anti-government protests or as a means of getting the attention of those in charge occurred, although thankfully not all that commonly.
But the purpose of training medical students is treat patients and we had an endless supply of them!

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