catching up ...

Hello out there!

I just realized how little I have been writing these days.
Where have I stopped?
Did I tell about Addis?... No, I don’t t think so. I needed to go to the Mozambican Embassy. They did not answer emails nor did they pick up the phone and I needed info on how to get a new visa. It turned out that they have changed their number 2 years ago, but nobody ever bothered to adjust the online information.
I was lucky: The hospital car was going anyway, so there we went, the driver, Tenaw and is wife and son, who got a lift up to a place where they could catch a bus back to their town, and Nebret, who works in the finance department.
It was no easy trip for me. They were quite overprotective and it was an almost constant battle to move freely instead of staying with them, waiting in the car all the time. Of course that is not easy in a big, chaotic city, with a language you don’t speak and signs that you cannot read and Ethiopians want to make sure we ferenjis are safe. But I have managed before and like to be independent follow my own schedule.
Another hassle was looking for a hotel. For them, a hotel of 15 Euro per night is quite expensive, and already on the way it became clear to me that they preferred me to stay with them. Well, I thought it could be interesting to stay at places, where I usually would not come. And somehow it was. It took us several hours (that I had planned to spent with friends after checking into the hotel at which I had made reserves ) to find a place. Only the first night was really terrible, because the receptionist, a drunken mid-forties guy, kept knocking on my door every 30 minutes, because he wanted my passport - not only to register me, but he really wanted to keep it. I have to admit that I made quite a fuss about that. But it did not feel very nice to have to get up constantly (barely dressed) to discuss the matter again and again. And the place did not inspire enough trust to hand them over my papers!
Well, next day we changed hotel and I managed to have a meeting with the ambassador of the Mozambican Embassy, who took almost 2 hours to discuss with me the best way to get a proper visa. Unfortunately I am not sure whether I will be able to fulfill all the criteria. But we will see!
And I managed to meet Dr. Melesse and Moges, old friends from my last stay in Motta. So there were also bright sides to my stay. Addis, like most African cities, is not a beautiful place to walk around and there are few tourist attractions. But even though I am not a fan of big cities, it was interesting to some more impressions of it.
Here in Motta we had some quiet days which I still could not use for teaching, as several of the midwives had gone on training or on leave. So the head of midwives proposed to postpone trainings and teachings. And I very often get the impression that they are not very eager to learn or train. For example: I and Adrienne witnessed some, let’s say, not very smooth going, neonatal resuscitations. So we though it a good idea to repeat the training on that topic. But the only ones interested to practice where the students. The midwives mentioned that they knew how to resuscitate a newborn.
I try not to be too sad about that. And I know that some of the midwives here find me too pushy (I fear that it is more difficult for me to slow done my pace, than I had hoped). But I have to admit that I am sad, because it seems that so little of our efforts over the past 3 years have led to sustainable change. Lack of understanding of the people here? More time needed? Communication problems?
All these factors play a role in it, I guess. And there is no real stimulant for the employees, to improve their practice. Even though the government is trying to put into place a system of reviewing and monitoring the general quality of health care institutions and of staff members in particular. I cannot tell, whether it will work or not.
We also had an outreach – a visit to one of the remote health centers, which refer people to us. It was a very productive meeting. Hopefully it will help to improve the cooperation between the health centers and the hospital as well as the mutual understanding of each others difficulties under the local circumstances.
And lately we lost a mother, and had several severe neonatal asphyxias as well as 2 babies that died and one of a twin appeared to have Down syndrome, something that seems to be rare here, even though many women get children until reaching menopause) I know that is not all misery is always preventable, but it still makes me sad to see those little lives which never got a chance and those women who were just starting a family. And today a woman came for abortion (She already had 5 children and apparently no health worker ever had explained to her about contraception) Personally, I find it terrible to see that vivid baby on the ultrasound screen, knowing what is going to happen to him or her. And nobody around seems to care.
One success I had: We introduced the idea of umbilical vein injection (a way to get oxytocine into the placenta/uterus through the cord after delivery of the baby if the placenta is not born spontaneously). What used to be done very often, if a placenta would not be born soon after the baby, was to reach with the whole hand into the uterus and remove the placenta manually. This procedure is very painful and denigrating for the woman and it carries a high risk of infection. In Europe it is commonly done under general anesthesia!
If we inject a medication into the placenta, this is much less painful and intrusive. I did it for the first time a few days ago. It worked and we showed the technique to the midwives who are now interested in working with this technique. And even though it will not help in all cases, it will reduce the number of women who have to undergo those other procedures.
Furthermore we have one new midwife, fresh from university. His theoretical knowledge is very good, but he lacks practical skills and is reluctant to practice. We hope he will soon find his way and little by little will dare to do more hands on work.
And we will apparently get an eighth midwife soon to complete the staff. There was only one applicant and I was asked to write some questions for an intake exam. So I was asked to ask easy questions. I heard that he passed.
If there is little to do, we go for walks, play volleyball (I don’t really improve, but who cares, it is just for fun!), have coffee ceremonies… . There is always something to do.
And 3 days ago, we met Duko will having dinner in the Wubet hotel. He is Dutch and currently walking from Axum (northern Ethiopia) all the way down to the border with Kenya. So we had a really interesting evening and next day he came to visit us at the hospital before heading on. The doctors were all amazed by his project.
Well, let the pictures speak.
Big hugs for all of you! Hold on, even the European winter will have to make space for spring eventually!