How Big is Australia Really?

I’m proud to be an Australian but love the country of Ethiopia where I worked for many years. Maybe wrongly, but I have often thought that many people think of Ethiopia as a small insignificant African country. And, possibly again wrongly, I have felt that some Australian professional people have felt themselves superior to those working in these ‘backward countries’. I guess this sort of thinking sprang into my mind again when I was watching an Indian movie last night. How can India produce films as good as Hollywood? Well the one I watched last night was better (different) than many I see from the USA. Maybe because they have 1.4 billion people from whom to choose good actors? But let’s not go too far down that road.

Ethiopia is a small African country. It is about sixty percent of the size of Queensland, or about 4 times as big as Victoria. It has a population four times that of Australia. If you want to compare its history with Australia’s, it is much older. Well, if we accept ‘Lucy’ as being one of the first human being, then it is older than our Original Australian’s history, and much much older than white Australia. Their ruling dynasty which ended with the murder of Haile Selassie in 1975 dated back to the time of King Solomon in Israel. Solomon died over 3,000 years ago. Then why is it backward? I would offend Ethiopians by asking that for they are very, and in many ways justifiably, proud of their country and people. Certainly they are progressing much more rapidly than the West did!

It has spectacular beauty; said to have massive gold and oil deposits; heights extend from 125 metres below sea level to 4,550 metres; there are enough rivers that all its electricity is hydro-produced.

But I really started to write about tertiary education. In 1968 when we arrived in Addis there was one University with 1,000 students. Now there are 30 Universities plus 61 other recognized private places with Higher Education standards.

According to my Mr Google – our University in North Queensland (JCU) has 17,500 students. Of the two Universities, where I mainly taught, Jimma University has 45,000, and Arba Mintch has 34,000. When we went to Ethiopia there were 300 doctors in Ethiopia and only 13 were Ethiopians. When I went to Arba Mintch in 2011 there were there 20 medical students per year, and when I left in 2016 there were 170+/year. In that same year, country wide, they graduated 3,000 young doctors. They are paid so little that many as soon as the government permits them they leave the country for richer paying fields – often to other African countries.

The last graduation I attended for doctor, architecture and Urban Planning graduates.

Maybe life was never meant to be fair, but a little more fairness would be nice.

Dominic Cartier

Everyone has a story – Habtamu

During our last term in Ethiopia we only had our youngest adopted son living with us. But that meant we had a house full of boys. Three ate with us three or four times a week and there were others from time to time. The memories of those three are precious to us and I might get to write about the other two sometime. I’ll call this one Habtamu, a name which means ‘the rich one’, although he was and is truly poor. As time passed we got to know the history of all of them.

Habtamu was scholastically the brightest of them all. In grade 8 where the pass mark was 37% in the government exam he got 80 something. He was the only one of the three who had a vision of a tertiary education. He was orphaned at age 5. His parents had bought a place in Arba Mintch, and having sold their village place were killed on the way to their new home in a bus crash. Their three children survived. The home which they had bought had 3 rooms. Their eldest child was a girl who was given the responsibility of bringing up her two younger brothers – Habtamu being the youngest. The sister is now married and has a child. Habtamu lives in a little room on the side of the house. He often asked our son to help him in the evenings or weekends when they, like the Israelites in Egypt years before, trod mud and grass together to patch the walls. We paid for all four boys to go to a private school (a cheap one – but they got a full days teaching, whereas in the public schools you only got half day teaching). When we left our son came back to Australia with us. Two of the boys started work but Habtamu wanted to continue his education. Without being lavish we have continued to support him, with the help of a couple of generous people.

He still lives in that same small room on the side of his married sister’s home. But he may well be seen as richer than most because we have bought him a computer and a few other things. Have these things been a blessing? It needs a yes-no answer.

Yes, it has allowed him to continue with his now tertiary education. His score was enough to get him a place in a University but not at the one in his area. He would have to have gone hundreds of kilometres away to do a course which he hadn’t chosen. He still tries to help care for his older brother who studies at a Government University far away. So he elected to go to night school for some extra points and is taking an accountancy course at a private institution. These are courses which have to be paid for.

The answer is ‘no’ because there have been many attempts to break into his room. (The home is not in a good place). A few months ago he was beaten up and ended in the local hospital. His injury was in the upper third of his face and particularly around his right eye with a lot of swelling and some lacerations. Continue reading “Everyone has a story – Habtamu” →

A view of Obstetrics

Having a family is exciting! Maybe not all beer & skittles but fantastic!

Modern obstetric care in the ‘so called’ first world countries is on the whole excellent. In quoting statistics one must remember the old adage ‘lies, damn lies and statistics’. The internet tells us that in the best countries the maternal mortality rate is 2/100,000 live births. In Ethiopia it is 421/100,000 live births, and I’m sure that it was worse 50 years ago. Around the world there is apparently an obstetric tragedy every 11 seconds. I cannot find figures for maternal deaths when the baby is born dead. That is the world I entered in 1968. This doesn’t include those who live with vesico-vaginal fistulae, of which there are 9,000 new cases annually in Ethiopia (quoted by the late Dr. Catherine Hamlin); nor those who survive ruptured uterus. I’m sure many of these died before they reached a hospital where they could be operated on.

I took out the figures in Soddo (my second long stay in Ethiopia) over a year period and we had a 95% survival rate of those who reached hospital alive. I had reopened the hospital in Soddo in 1993 after the country was freed from the communist era. I was the only surgeon there. I was on call 24/7. After a while we had an obstetrician there who did the day O&G work and was on call at night every second week for obstetric emergencies. But initially I did them all , and later out-of-hours cases every second week. I was also called in to deal with the situation if there was also a ruptured bladder, which occurs in about 10% of cases.

I shall only mention one case here, as I know medicine isn’t everyone’s ‘cup of tea’. My children say they were brought up on such things around the tea table.

In the countryside antenatal care was almost non existent. We ran such a clinic, but few attended and everyone was so busy we didn’t chase things up as hard as we ideally should have done. Most babies were delivered at home. People didn’t come to the hospital until things were obviously seriously wrong. If you lived, for instance, 50km from the hospital, for the majority, there were neither ambulances nor roads so they had to be carried on stretchers over mountainous tracks and crossing waterways. People were frightened to travel at night; and it took, I am told, above 20 people to carry the patient, sharing the work; so it is not surprising that people arrived late.

My first case of ruptured uterus came within a few days of my arriving on my first time in Ethiopia. I was the only doctor in the place. The story apparently was that the labour made no progress, so the native healer tried to do what we call an internal podalic version. In other words by putting his/her hand inside the uterus they intended to turn the baby to get the feet at the bottom so that they could have something to hold onto to attempt to pull the baby out. I don’t know how but whoever it was managed to tear up the front of the vagina and uterus as well as the back of the bladder from top to bottom, and they still could not deliver the baby. The patient obviously rapidly became much sicker and she was brought into the hospital. The baby was dead, but I repaired the long internal tears and she recovered.

abd in ruptured uterus — The double bubble is what is usually seen in a ruptured uterus

Unfortunately she developed a small fistula for which she was sent to the ‘Hospital by the River’ in Addis. She did well and was later delivered of a healthy child. I’m not sure where she fits into the statistics. Later when I was met with both a bladder as well as a uterine tear I used to bring down some mobilised omentum to separate the uterus and the bladder.