schedule – Heated Stew

Over my time in Ethiopia I’ve worked in a number of Ethiopian government or University hospitals. I’ve had periods between two and five years over the time that I’ve been there, and for shorter periods in three others. Each morning in all of them it was seen as important to discuss the previous day’s admissions and operations.

A number of medical schools were suddenly started when the government decided they needed more doctors. There are over 20 at the moment, but remember the country’s population is now said to be 105 million. They didn’t have adequate qualified people to teach in any department or even adequate hospital facilities, at least in Arba Mintch.
Just as students began their clinical years of training in Arba Mintch, I transferred from Jimma University to Arba Mintch. I was paid by the University but, added to my University teaching responsibilities, I was expected to be the major surgeon at the hospital.

These, previously described, morning meetings were certainly held for the surgical department in Arba Mintch. I’m not sure about what happened in the other departments. Senior staff, post graduate trainees, interns and students were all meant to attend. In the established universities, where there had been trainees and students for a much longer period there were already buildings appropriate to the needs ; but this was not so in Arba Mintch. In Arba Mintch the University did not have an attached University hospital, so the students were sent to the Government Hospital, which was not given a grant to provide buildings for the students’ needs.

Initially we had 40 students per year, but by the time I left there were 170 per year. There were certain requirements laid down in the University laws which each student had to obey. For instance they had to attend 95% of all lectures and be signed in to have watched 20 operations. Apart from the first year of clinical attachment (4th year) we had students with us all the time as at that time there was no fifth year group. When the numbers were small we had the younger group half the academic year and the other half year we had the more senior class. Although they were with us full time for their attachment we didn’t have them all the time as they had to attend other departments as well. But at the end, because of the increase in numbers, in order to keep groups at a manageable size we had groups from both years all the time time.

Jimma mm — This is the group in the adequate room at Jimma.

For our morning meeting the expected attendance was – 3 surgeons; 2 or occasionally 3 post graduate students; 4 interns and up to about 65 students. The shed which we were given had no ceiling, old chairs, without enough for the people and no room for any more. The shed was about 10m by 7m. It is easy to imagine how crowded it was. So, as fortunately most were pretty slim, we could sit two per chair for some of them. I think some of them enjoyed that! We three surgeons had a general hospital to run, as well as the University department to run. In addition we were involved in the teaching programs for nurses, public health workers, anaesthetic students, and a course which tried to teach health assistants basic surgical procedures. Of course there were as well exams to be set and marked. We divided the numbers and apart from the morning meetings, which all had to attend, put a third under the wings of each surgeon. Not, of course, that I’m complaining or that I thought it ridiculous!!

daily chart — This is about an average number of cases to be presented, assessed, and taught about each morning meeting. Note the doctor’s writing!

The morning meetings lasted about an hour, then one surgeon had a clinical teaching ward round for his third of the students; followed by a ward round for the interns and nurses of the 60 or so patients in the surgical wards. One of the other surgeons was in the operating room. He had his third of the students with him. The third surgeon was in referral clinic with his third of the students.

Dominic Cartier

PS I have opened a second blog under my real name and it deals in a bit more depth and with a few more gory pictures with some of my unusual problems. It is called Medical Memoirs at hicksmedical.wordpress.com

African sunset After obtained my higher surgical degree I spent six months in India before going to Africa. Like a good boy I was up to date with vaccinations and all those necessary things before I left for India. I was ready for my life in Africa!
We flew along the Arabian coast line at the same speed as the day was starting – travelling East to West. All the way the sun shining on the cliffs was magnificent. Flying into Addis Ababa was green and so much like Australia with all the gum trees. Our two young boys were able to stretch out and sleep all the way from Karachi, which was bliss for us.

The landing was smooth; the passage through Immigration was not. Well, it was for my wife and the two boys. They were allowed through, were met by the mission heavies and taken to where we were to stay, whereas I was arrested. I was put into quarantine because my cholera injection was one day over the six months expiry time. All my arguments fell on deaf ears. My wife and the boys had had no problems in entering as they had joined me in India several months into my stay there and had their shots just before they left.In the quarantine station I met a Greek (I think) doctor who agreed with my very logical argument that the injection is not 100% effective and the six months is not exact to the day. He gave me a booster injection and sent me to where my wife and children were.
While not being usually very tearful, having been told that I would be sequestered for six weeks, she was crying buckets full. Tears rapidly turned to joy.
We had a few days to acclimatise before we were due to head south to the place I was to work. We had needed to buy five years clothes, kitchen stuff, linen etc. The two growing boys would need a lot of extra clothes. Things were very different in Africa 55 years ago and few things were available in the shops. Hospital expected requirements had to be ordered 6 months ahead of their needed date. We had planned to stay for 5 years. So, although we flew, 16 boxes had been sent ahead by ship.
We had to go to many offices over a couple of days to get it through customs but we were not charged duty. Foreign workers were very welcome at that time. There were 300 doctors for 30 million people and few of the 300 were trained surgeons.
Ten days after arriving in the country we were taken down to the hospital in which I was to work. There was a leprosarium with 700 inpatients plus an outpatient service. Many lepers had moved into the surrounding area as we were the only leprosarium in the southern region. There was also a 30 bed general hospital with an outpatient service with an average attendance of about 100/day. There was one doctor, 5 trained nurses and many national workers, including a number of trained dressers. Some other time I might say how we managed it all. I was to replace the one doctor who was leaving in 2 weeks on a years break.
We arrived at 3 in the afternoon. The doctor’s wife gave us afternoon tea. The doctor had some emergencies which he wanted me to see – as they needed surgery immediately!
We got home for supper at midnight having seen a number of patients and performed 3 operations. Two of which I recall – an urgent Caesarean Section and a bowel resection on a 16yo girl with a large mass obstructing the right side of her colon.
That was the start of a marathon run lasting several years.

double use of OR 2

Please don’t comment on the masks. I had operated on the patient seen in the background and was just preparing something on the second patient – a child – he too was asleep. Due to lack of staff to watch people adequately we sometimes ad even 3 patients in the OR. One being operated on and the others(s) being observed. From the greyness of the sideburns I can tell this was in my second trip. On the first trip – no grey, then white sideburns, then eventually all white! (I cut the kid out of the picture as he was not appropriately dressed).

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