not functional - not available ... but charming

Hello everybody,
After more than two weeks, I think it is time to write again. There were so many beautiful moments that I wanted to tell about, but everytime new things happened, and other days it was just amazingly busy at the hospital, and I did not manage to write.
10 days ago, Dr. David and me finally managed to visit Mertule Maryam Health Centre to give some classes to the medical staff there. The trip takes about 90 minutes in private vehicle – imagine the distance by foot in the middle of the night… But if you go there during the day the journey is magic. This beautiful landscape with the traditional and the new next to each other. On the top of one hill there was one of the traditional huts – round and with a straw roof - and next to it a sort of a small transformator station for electricity. Or some traditional shades and next to it big, modern machinery for road construction… But most of the time I felt like I was travelling in time…shepherds with their sheep and cattle, traditional houses, some of which were beautifully painted, the hay-stags next to the houses, women cooking on small clay stoves next to their huts… like out of a book about the old times. I think that was the moment I fell in love with this country.
And when we reached Mertule Maryam it was lunch time at the health centre. So we first went to visit an old church. The monks tell you it was built 300 AD, but telling by the style and a book on Ethiopian history I think it was built around 1500 AD. Still, this means it is very old. It is more a ruin than a church, but the stone carvings are incredible (have a look at the pictures below). And the monks are willing to tell you a lot about it (history or rather myths :)). There was also a somewhat newer church with beautiful paintings inside. The churches here are mostly round and have two entrances, one for women and the other one for men. You take of your shoes and then enter the church. In the centre of every church, hidden behind curtains and a wooden door, there is a copy of the ark, the shrine of the Jews in the old testament. But only the priests are allowed to see it. Churches are surrounded by a sort of a courtyard with many trees and around the courtyard there is a stone wall with 2 gates, usually also one for the men and one for the women. Women that are menstruating are not allowed to enter event the courtyard, so you will usually find a few women sitting or standing outside the gate to be able to follow the sermon and witness ceremonies, which for the bigger part take place on the courtyard around the church and not inside the church.
So, we visited that fantastic church and then went to the health centre, where very eager staff tried to learn as much as possible. A really good experience.
What a pity that a few days later we had a laboring woman from Mertule Maryam who was in labour for already 4 days and had been seen at the health centre the day before she came to us. They might have at least tried a vacuum delivery, which we had been practicing with them. But one wonders, why she was not sent to us 24 hours earlier. This could have prevented a dead baby and a fistula. Now,the young woman will have a terribly long way of recovery to go.
So, after all the wonderful experiences, there is always a harsh way to remind me of the hard life of the people around here and makes me wonder why some things are so difficult to organize or to change. Things that seem so easy to us: like sending a mother to hospital if she has been pushing for hours after a labour of many more hours,
But a few day later we had another marvelous walk in the vicinity of Motta, along a small creek, between cabbage fields, football playing boys, passing huge trees and cactus plants. Making me feel happy and full of joy to be here. Or when walk through the hospital courtyards and perveice the sweet smell of the juniper trees in the sun. Those contrasts can be shocking some times.
Dr. David has left in the meantime, and Dr. Adrienne form Holland arrived. She had a very hard start at the hospital. On here first day we had to do a symfysiotomy (for the non-midwifes among you: baby is too big to come out, so you cut the pubic bone open to make the pelvis wider… the baby can come out, and after healing the pelvis will be wider, which might prevent the mother from having the same trouble again next time). But too late: the baby died and the mother already had a fistula. Than another mother - with eclamptic seizures for already 36 hours - came in (for non-midwifes: she was having a 36 hours epileptic fit). She was already in coma. We could not safe her. And in the evening we would have had to do 2 cesarean sections, but the anesthetist appeared to have left without telling us (not paid well enough), so we could not operate.
Luckily we then had 2 miracles happen: we were still waiting (for 2 hours) to get the hospital car ready to transfer the mothers to the nearest referral hospital in the middle of the night. The two babies would just descend enough into their mothers pelvis to get them out with vacuum and fundus expression. Both of those tecniques I do not like usually, but it prevented the two uteruses from rupturing (one woman had already had one cesarean, and the other one was expecting her 7th child and they had all signs of an imminent rupturing uterus). The babies were born alive and are amazingly well considering the condition they were in and the difficult deliveries. Just to compare: in Europe we are not allowed to pull on babies head with the vacuum for more than 3 contractions in order to prevent damage. Well, those two babies both needed at least 7 contractions with vacuum and pushing on mommy’s belly, to get them out. I hated to do it, but it worked and saved lives. One of the babies weighted 4050 gr. This is huge considering the mother is about 1,50m tall!
But in those moments, when sad things happen that could have been prevented easily by better organization and administration, hat I can get very angry about everything. These things cost so much energy and patience and sometimes the life of a mother and/or baby.
But usually better days come in between and this helps us to carry on. Like today, when it was calm at the ward, we had time to do some practical training with the new students, go to the market and enjoy some Injera at the Wubet. And after discussing the situation of last night, we stated with some irony: The 2 most important sentences Dr. Adrienne would have to learn here: “Not functional!” and “Not available”. The first could be applied to the vacuum pump, the X-ray machine or the wheelchairs among others. The second would apply to Vitamin K for the babies, local anesthesia for suturing, IV fluids other than normal saline, blood for donation etc…
Crying or getting angry does not improve anything. So now, every time something doesn't go as it should go we just all smile and say “Not functional” and someone adds “Not available”, and then we have a laugh and try to improvise!
And now I will make some dinner (Tortilla de patatas), just sit down, have a nice chat with some colleagues and enjoy the evening.
Big hug from a very happy and positive minded Anna to all of you.