Diary from Ethiopia
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FRIDAY |
The following morning at sunrise I am
able to attend thoroughly to my little patient. I carry out a consultation
on the steps of our tukul. He is indeed 12 months old and he is the fourth
child in the family. By coincidence I happen to have an MSF MUAC (Mid-
upper arm circumference) bracelet in my bag. I put it on the frail and
skeletal upper arm of this baby. It reads “orange” – moderately
malnourished. Malnutrition is still, EVEN in 2007,
one of the five big causes responsible for the deaths of seven out of ten
children that die tragically before they reach their fifth birthday in
Africa. I tell you- in this
world of plenty – this world of cyberspace,
satellites, free intercontinental jumbo jet travel and digital
technology- this is a disgrace to
the whole of mankind! And wealthy European and North American
Governments should be ashamed of themselves for actively
recruiting Health Care professionals from developing countries to meet
their own selfish targets. Poor African countries (and Asian countries for
that matter) have been left devoid of Health care professionals. They need
their own teachers, doctors, nurses, sanitation experts far more than we
need them! And what is being done to reverse this economic brain drain?! My patient is at the classic age for
developing malnutrition- just as he is being weaned from the breast onto
solids. I ask Mum what she feeds him in addition to breast milk.
“Indura” – a starchy foodstuff that is the staple diet of most rural
Ethiopians. I’m sure this is the culprit responsible for his ten day
history of watery diarrhoea. Fortunately
Dr Howard has some medicines with her. And I have some camping food that
produces in total 478 kcalories. (Thanks Mum!) Not ”Plumpynut” it is true, but
will hopefully suffice given our predicament. I meticulously explain to
Mum that she must ONLY use the clean bottled water that we have given her
to make up the food. Next I take care to explain that she must
divide the food into five equal portions and only feed the child
one portion (containing 75-100 kcals)
per day. For hydration and ORS she must continue to breast feed.
Then I take Phil’s Swiss Army knife and cut each of the Ciprofloxacin
and Metronidazole tablets into quarters, and we measure out a five day
course into two plastic Kodak film containers. Hopefully these will cure
the diarrhoea ( For medic readers- Cipro is not contra-indicated in this
situation- the evidence for not using it in children is spurious and here
benefit outweighs risk, massively). I write a letter for Mum to take to
the nearest Health post, requesting that the local Health Extension Worker
vaccinate the child, dose him with Vitamin A and provide further
therapeutic feed. That is the best and only follow-up I can arrange. It is difficult to know whether this
is a life saved or not. But I can say with certainty the following: Yesterday this child was at high risk
of death. Today he has a high chance of life. And the intervention was not
rocket science. I give Mum a big, gigantic hug. She says to me in Amharic
“May God give you good health” and we go our separate ways. |
|
THURSDAY |
We spend a few days on holiday in the Highlands of Lalibella,
trekking. It is about 6 pm and the bright African sun is just going down. An Ethiopian farming lady rushes over to me. She looks young, maybe in her late teens. She has bare feet with coarse, leathery weathered skin. These feet have been exposed to the elements for many years. Strapped to her back is a baby. I would guess her baby is about 12 months old. She points and gesticulates at him and when I say "Hakim negna"- I am a doctor- her eyes light up with hope. He is sat in a leather pouch tightly fastened, with a hyperextended neck. Around Mum's neck hangs a large steel Coptic Ethiopian Orthodox cross. I take one glance at her baby and see that he looks very malnourished. His eyes are sunken. His hair is thin, brittle and has a hint of orange discolouration. His head is disproportionately large compared with the rest of his tiny body. His tiny arms are all skin and bone. My doctor's intuition/sixth sense/ call it what you like- tells me that this baby is at high risk of death without intervention. His feet and wrists look like he has been scratching. I'm sure he has scabies with some secondary staphylococcal infection. I beckon his Mother to follow us to our campsite and she does so willingly. For some reason I often seem to find myself functioning as some kind of magnet to sick people! Or maybe it is just that I have a trained eye for detecting pathology, coupled with a diligence that is, in itself, pathological. We arrive at our campsite. It consists of a small collection of tastefully constructed traditional Tukuls. We are greeted by another Coptic-Cross-Clad lady. She has a really severe convergent squint. On her forehead is a tattoo of an ill-defined, navy blue cross. Her face is kind and gentle. She produces a red plastic teapot and bowl and pours lukewarm water over my hands to wash them before dinner. Dinner is served in the dining tukul and we eat by candlelight. Then, begins the coffee-making ceremony. She places several dozen fresh green coffee beans on a cast iron plate. Then the said plate is heated on a small green kerosene burner. She patiently and evenly roasts the coffee beans until each is homogenous and dark-chocolate coloured. She blows a single puff of smoke onto my face. Then out comes a wooden mortar and pestle. The pestle is about two feet long and the mortar about six inches deep. She meticulously grinds the roasted beans into a fine sand and then pours the contents into a clay coffee pot. The end product is quite divine! |
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MONDAY
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We arrive in Addis Ababa on an overnight direct flight from
London. We are straight to work with our first meeting on Monday
afternoon. We meet the Directors of an Ethiopian charity called SUNARMA.
This is an agricultural and farming charity that has a UK office. Their
purpose is to promote tree and crop planting and assist rural farming
communities to be self-sufficient and provide themselves with adequate
food and wood for nutrition, construction and firemaking. The emphasis is
very much on SUSTAINED aid. They have identified that the communities
they serve have little or no access to healthcare and that is where our
role comes in. SHAPE (Shropshire Health in Africa-Ethiopia) has been
conceived as a result of my vision together with the dedicated help
of our steering group, Gordon, Jenny, Kim, Lorna, Phil and Digby. Our
website will be www.shapeafrica.org.uk Currently there is only the logo (designed by Jenny) on the home page. The Ethiopian Government has a very good plan for Primary Healthcare provision. We aim to work with them and assist in the implementation of this plan in any way that we can. The basic structure aims to have one Health Centre in each 'worreda' (Local Authority), a small number of health clinics and about 10-15 health posts. The structure is hierarchical with each Health Post staffed (hopefully) with a Health Extension Worker (HEW). The aim is that the HEW will provide basic healthcare eg vaccination, health and malaria education, and a few simple treatments. More advanced primary medical care is provided at Health Clinic/centre level. |
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SUNDAY |
We are driving back from a recreational outing at Lake
Langano on Sunday afternoon. As we drive through a dusty settlement,
vibrant with hustle and bustle, Liz notices six Marabou storks, stout and
upright on the top of a tree. They are so still they could easily be
mistaken for a Madame Tussaud's statue. Their bright orange scalps
contrast with their navy blue and white thorax. Their beaks are
dagger-like and Persil-ultra white. We stop our Toyota landcruiser
and all get out to photograph these majestic and proud creatures. After our wildlife photography session, I am slow to get back into the vehicle, and Piers (the Director of our partner charity-SUNARMA UK) plays a boyish prank and drives off without me. I am not flustered by the joke and use theopportunity to chat with a group of local children on the side of the road. They are fascinated with this friendly English "Ferenji". I notice one of the boys has several pale patches on his face. I lift up his T shirt and there are a couple more patches on his chest. I check the sensation of each patch, and it seems to be absent. Next I examine his Ulnar and Peroneal nerves. I roll the said nerves between my index finger and his bones. Each nerve is thick, firm and rope-like. I am confident that clinically he has Leprosy. Fortunately he is an early case and if he is diligent at taking the treatment he will be cured. There is no need for him to suffer a lifetime of stigma, disability and misery, as an undiagnosed patient would. When Piers turns up, I ask him to explain in Amharic (to the child) that he has an illness called Leprosy and that he can be cured if he goes to a Health Centre. We give him a 50 Birr note and explain that it is specifically for his illness and transport. He and his friends promise they will go and get treatment on Monday. "Ameseganulhu, Dinar-hun" are his parting words- thankyou and goodbye. |