Sunday again

hotel Azynzolo

lobby of the hotel

This morning I came to get breakfast and the kitchen was closed. I went to the reception to ask about it and the man said: sorry the lady is unwell. At that moment the boss came in, heard it and started real shouting: Bullshit. So he has phoned her and she is coming. This is the hotel I am staying at. It is near to the town centre, nice shady terrace and friendly people. Only this boss….. It is sometimes very strange to see how people communicate with each other.  A kind of staccato hard talking. Also to patients they talk like this. Someone enters: PAPER! Not please , not do you have a referral.  Have to get used to it. At the other hand very friendly, always laughing. Shaking hands a lot. What I also like very much is the music everywhere.  

bushmeat, dried wild rabbit

So on Tuesday I started with my second project, a small ultrasound office in Navrango, 25 km from here. They want to expand but it appeared they want me also to teach ultrasound. Albert is a real nice guy, he has studied business, but after some years working for a sugar company decided to start this. He trained himself and in some course to be an ultrasonographist, and he is rather good now. He has two trainees and a lady from another clinic, whom I have to train. We saw one lady who appeared to have a twin and she told us she has two twins already

guinea fowl eggs


Organisation is difficult. As there is no proper hotel in that village I still stay in Bolgatanga.

shea fruit

He borrowed the car from his brother and we drive every day up and down.It is a beautiful trip, nice landscape. on the road we buy guineafowl eggs and sheanut fruit and many other fresh vegetables In the evening I am invited in their house for dinner. His wife is nice, she is a police officer. And cooks very well!!!

The second they we went to Navrongo we suddenly stopped….. petrol finished.  We could see a petrol station  about 800 mt further down, we pushed the car, then the station had no petrol!!!! The big problem is this week the prices of the petrol .The government is going to higher the price of petrol next week , so all the tanks are closed ,waiting for the high price. There is a real crisis here. I saw on the news hundreds of cars, stuck in Accra. Anyway there were some boys who went in the village and bought two lt. of petrol for us. At that time for $1,5.  That evening he bought some more on the black market. Two days later we got stuck again, now on our way to Chiana, a small place where he goes every fortnight to make ultrasounds. This was really in the middle of nowhere , hot, middle of the day. We were lucky there was one tree. He went hitching on a motor cycle, bought 1 gallon in the next village- now $ 3 /lt .

black market

waiting for fuel

 It is a nice little town, a clinic with 2 midwifes, about daily one delivery. She gave us the bushmeat, a dried wild rabbit. Which i ate yesterday and it was delicious. We finished our program and came safely home. Someone told him that if he went at 04.00 in the morning to a certain tank there would be petrol. He waited 4 hours, then gave up. So yesterday we bought on the black market again $4/lt  Albert persisted to go to Paga, where the  sacred crocodiles are. I rather didn’t, afraid to get stuck again.  But we made it and had a nice day. His wife , daughter and a friend were with us. Paga is the border town to Burkina Fasso. A lake with lots of crocodiles is the attraction there. Of course they fed a chicken and we had to “sit” on itTwo more days and the trip comes to an end.

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sunday outing

procession, praying for rain

from Bolga in 4 hours in Ouagadougou

Already a week later. Much has happened, let me start with th sunday outing. One of the midwifes, Mary took me for a trip around the country, we had an amazingly old cab, hold together with ropes, but we made it all the way! the first town was Congo, where we were going to visit a cathedral on the top of a hill, that appeared to be closed. But we had the chance to see a large procession, with over 500 people along the road, clapping and dancing behind the cross. Mary –who is a moslima herself--- told me they were praying for rain. Anyway, an impressive site! Then we drove on to Bongo, to visit a small hospital. On the way we passed two health centres and a CHIP. Kind of very small HC, but they do deliveries there. This region is one of the poorest of Ghana, and you could see that in the fields. Women working hard sowing and digging, carrying water. It is a beautifull landscape, with a lot of very old trees. A great variety, I saw the kapok, neem, mahogany, teak, sheanut, and of course the BAOBAB. That is the tre I love most, and it is flowering now, which is only a short time, and I never saw it before. The sheanuts are covered by a green peal and in it a layer of very nice tasting fruit- like sweet avocado. And of the nuts they make the sheabutter. The land is very dry though, now wonder they’ re praying for rain.. The Bonga hospital was small but seemed neat and well organised.. One of the midwifes working here is a very famous midwife,  she won the price of the best midwife of the year and went to Washington to receive it. An amazing woman who managed to lower maternal death rate in this region by her own convincing methods. She went to all villages around her health centre to   why people kept delivering at home. After this inventarisation she changed the manner of working in the HC and people started coming. For instance they were allowed to take their own herbal bath. Maternal death does hardly occur anymore-she says. Now she is working on preventing teenage pregnancies. An inspiring lady! The price of 5000 dollar she used to buy bicycles for all the fieldworkers, to restaurate the health centre and invest in projects.

Than we had again a nice trip to the place Sirigu(only 5 km from the Burkina border) where another inspiring woman started a cooperation for women. 500 women are working for this organisation, painting, weaving baskets and making pottery. All in the old style. Also they paint their huts in the way it used to be den here. Beautiful to see, and of course I bought something there .

Next day was rhe last training day and we enden with a real ceremony and certificates. Most of them learned a lot and picked it up fast

Meanwhile I started my next project,  that will be for the next blog

Bijschrift toevoegen

shea nuts

with Agija Mary 

old baobab tree

last day teaching 

End of the training

message from Ghana

It is five days ago already that I arrived in Bolgatanga, northern Ghana. What I thought was to  be a small village seems a town with 80.000 inhabitants. I come here on behalf of a PUM project to teach midwifes on cervical cancer screening, a totally different job from the obstetrics I did before. First day I met John, the organiser. He found  me a reasonable hotel opposite the building where the workshop is given. I have trained 13 midwifes for three intensive days and today we started practicing. In the regional hospital-which looked amazingly clean to me, but the minister of health was visiting…..-we had a room and two beds. With some improvising we saw over 40 women How much one can learn in a few days.There is a great difference between these midwifes, some pick up very fast, others will have to prctice for a long time before I would trust the mto do the test. But they are all nice.  Laughing a lot. So these have been very intensive and tiring days.

The note where I stay, looks nice , but......

one of the midwifes on her motorcycle

Another midwife even with a child on the motorcycle!

practicing as grandma, Ghanaian grandchild?

village behind the hotel

 But I did get some time to see some of the town. I walked behind the hotel, you come in a simple village with beautiful baobab trees. Although a lot is cut down for cooking! Very nice = non begging children! With one of the midwifes I went to the local market, buzy and colourful as ever. Of course also the crafts market was visited, baskets, cotton, leather… too much

Temperature is very high here and it is humid. Even if you go out at night it is warm. Yesterdy I went with a PUM colleague to a restaurant  where they had a outside screening of the footballmatch england / urugay. A very pleasant evening!

In spite of the heat and the moderate hotel I am enjoying the stay here.

Tomorrow training again and sunday I am off!

impressies uit Sudan

Tomorrow is my last day here in Khartoum. It has been a nice time, the change from Ethiopia is amazing. So near and yet so different. We drove down with my sisters car, from Gondar to Gedaref, after a long quest for petrol. We bought in the black market in the end. So we started later than planned. It was a beautiful trip, a descent of more than 1000 meter, a good road. Customs did not take to long, then we are suddenly in an Islamic country. The town we stayed the first night was nice, a very cozy atmosphere walking around there.
Next day a few hours more to Khartoum seeing the Nile river once in a while. Beautifull trip it gets more and more busy when we near Khartoum I see the first camels!!
What a luxury to stay in the Netherlands residence, with a swimming pool, although the temperature of the water is lukewarm. That same night we visit the sufy dancing on the tomb of Hamid al Nil. they go in trance, kind of hypnotic. Real impressive!
Next day we make a walk on Tuti island, where blue and white Nile come together. Reminds me very much of the walks in Luxor.
We visit Omdurman market, make a boat trip on the Nile, drink coffee in the Embassy, have lunch in a trendy restaurant on the Nile: Al Housh, try to see Mahdi,s tomb twice, twice closed, go to the camel market and eat roasted camel meat, visit the Omdurman maternity clinic, where they do around 100 deliveries a day!! In short we had a nice time here and got a good impression of the country. Also because we met a lot of interesting people here. 

first time the sight of the blue nile

sufi dancing

camel market

khartoum

Tonight I will visit a special upperclass wedding, where no pictures are allowed. Tomorrow I fly back to Holland.

It will be difficult to accustom to Utrecht life again!

walk on Tuti island

 

the end

 Already a few days in Sudan, and I still have to write about my last weeks in Bahirdar. The last week was very busy again. Daily one or two caesareans, and many deliveries. In the month of march we had almost 150 deliveries, while it was usually around 100-110! Then I realized again what a good team we have there: never complaining when it is busy like that. Always caring for the patients . It was good the Ethiopian board did agree with us we need more staff, both midwifes and cleaners. How it works in Ethiopia: you post this ad on several places in town on big  billboards and people can apply  .We got about15 letters for the midwifes and we choose 7 to talk to. They had to be rather good in English, and at least 4 years of experience. Three were chosen, as we heard meanwhile one of our midwifes was going to work in the Mary Stoopes clinic, where they earn much more. But patients have to pay a lot for delivering there, so a totally different way of working.
On Friday Iris arrived, who was going to take over from me and will be there the month of April. We had the weekend for the handover, and rather busy also. My family arrived from Khartoum on Saturday( sister and husband) A wonderful sight to see them coming in their Sudanese car! Late my husband Jan arrived by plane from Holland. I was busy at that time and it was good my sister good pick him up at the airport! even during evening meal I had not much time to see them. Next day Sunday I hand over officially to Iris and prepared for my departure. That afternoon we had a wonderful farewell party, with coffee ceremony speeches and presents. Then I realized again what a nice people I have worked with and what a pity to leave them. One shares many sad and happy moments together in these two months. For them it is also difficult to see all these doctors go again. I am not sure about my future plans yet, but maybe I will return. If only to see the new building and to see these colleagues again. I do hope the plans will work out and the building will start soon!
Monday we left for Gondar from where we drove back to Sudan. This trip I will describe later.
Goodbye Ethiopia, it has been wonderful to work there again.

the last bicycle ride to the clinic

the last caesarean section

the last morning handover

the last rounds

final party, ritual bread cutting

goodbye.....

 

It has been a rather uneventful week. I was not looking forward to the duties 24/7, but strangely enough, I was called only once during nighttime the past week! Although there have been many deliveries46 in 1 week!, almost all spontaneous. Only two caesarians, and a few vacuum extractions. We induced one lady who had congenital malformation: an anencephalic child. ( child with no skull formed, only face) Always very sad. And one post term child died after delivery. Because we cannot do any investigations here, we sometimes just don’t know the reason. There is always a debate whether to transfer or not to the Fellleger hospital. There is a pediatrician and a “neonatology” department, but not real good care is taken. I visited in the beginning of my stay here and was really shocked by that ward.

The weekend is long, when the ward is not busy! I watched half of the Borgen-danish-series! Daphne was away with her family, and Margaret had left. Sunday afternoon the whole staff was invited by one of the laundry ladies, who delivered the week before. It was pouring with rain, so we went by ambulance (8 of us) It is always nice to see how people live and visit their homes. Tradition here is making a barley-porridge (gunfo) eaten with spiced melted butter. Seems to be good for women after birth. And they had really good talla-the local beer. And the woman in childbed with her baby are not joining, they are laying in a far corner, behind a curtain.

new stadium Bahir Dar 

first time in football stadium

 

cooking porridge in the compound

 

eating porridgegunfo porridge 

 

And it was good Tenaw, the surgical officer from Mota came to visit me. He arrived with the hospital car, and brought the Pelvitrainer for us to use here. It was good to talk to him about his and my work. He is really dedicated and very experienced now. It appeared he knew many of the staff here, from various training places. With him I visited the new stadium, which opened this week. Two weeks long there are games of all sorts, they call it Ethiopian Olympics. It is the biggest stadium of northern Africa they say. Entrance was free and for the first time in my life I watched a football match in  real!!There were female teams from Oromo region and Afar region playing. A nice relaxed atmosphere, I liked it!

Meanwhile I feel my English getting worse. I tend to speak as the Ethiopians do. They make all the same kind of mistakes: wait me, you come now, no matter, and these kind of abbreviations. I hear myself talking like this now too. It was good Margaret was here for a while to correct me!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

sunday

 

Two more weeks only!! How time has passed. Yesterday my colleague Margaret has left, back to Australia. It has been great to have her here, both as company and as colleague. These last two weeks here will be continuous duty again, 24/7. Daphne and her family left also today, so after a full social life the past time, a quiet weekend again. Although clinic is busy, two caesarians and 1 vacuum today. I could not enjoy the nice weather, being inside most of the time. Finally we had a sunny day again. It has been raining a lot the past week. The official rain season is july/august, and march is called the small rain month. Rather call it the big rains!! Even hail we had. Two times I took a bajaj(local TUCTUC) to the hospital. One time I asked the ambulance driver to pick me up. When he did not come I walked, got soaked. Seemed he thought there was too much rain to drive……
street life on the way to the clinic

We had several severe cases these weeks. Also a second maternal death, out of the blue after a normal delivery she went in shock, probably an amniotic fluid embolism. We transferred her to Felleger referral Hospital but it went so fast, she died on arrival. At that time a saw again what a terrible location that is. Patients all over the place. In the corridor, overcrowded rooms. We did call them that we were coming with a bad patient. Communication is bad, nobody knew we were coming and we had to place our stretcher on the floor….. intensive care??? Very sad experience. The other patient we worried about was a lady with a history of two neonatal deaths, the second a CS at 32weeks. Now again she ruptured membranes at 32 weeks and got temperature. We did a terrible CS, very adhesive tissue, had to do a classical incision (for the medical people) it took hours to get her “dry”. But she and the baby survived with blood transfusion and all the antibiotics we have. Then there was the unexpected twin. I had seen her for ultrasound and not detected the twin. But she had been in early pregnancy and also at that time no twin detected. No excuse of course. So the staff found it real funny and keeps reminding me of this case. Some cases I will always remember

the unexpected twins

 
Bajaj coming to get the patients

 

 

Morone with her daughter in her house and at her birthday!

Last week we were invited at Morones place. She is the lady who works here for us, washing and cooking. She is a very good cook, was taught by an American lady. She is good at making pizza’s and tortilla’s. But I am afraid I like injera better. She comes via the Grace centre, where she went after she got pregnant from a terrible man, she ran away. She has a nice daughter of 6 years now. In her neat little house we had a coffee ceremony. We then found out her birthday is on 14 March, so we organized a birthday party in our house. She had been to the hairdresser for the occasion and this gave her a totally different look, I almost did not recognize her. We had a nice party. Although a bit European I am afraid, with garlands and balloons.

 

For the rest I am getting to know the people around our house and on the way to the hospital. All very kind. But I can only say hello and goodbye. Some speak a little English. My Amharic has not improved very much yet. I should study more. But now I am going for a little walk along the lake!