pictures from the first weeks

The poor lady ,severe preclampsiaa

simegnew, midwife, in the ward

bicycle racers

few from desnet terrace

sunday morning, blog from 2 weeks ago......

 

Sunday morning, time for a new blog. In the weekend we don’t do the handover in the morning, I go on rounds about 10 o’clock. As there is no ANC, there are also no ultrasounds. So this gives us a weekend feeling. Today was a quiet start. Now I am sitting with my coffee on the veranda. It is cloudy, and it has been raining a lot passed night. Very good to settle the dust a bit. Because dusty it is in the streets here. Water is brown when showering.

This week has been quite busy again and some crazy things we had. There was a lady carried in by 6 man( farmers) who had delivered at home but the placenta did not come . She was brought to hospital but delivered her placenta on the road. They did cut the cord, but did not tie the cord on the baby side. God is merciful, the baby did not bleed. In these cases we are always afraid of tetanus, but luckily this mother had had antenatal care and got tetanus prophylaxis. On arrival we put her on the couch, to inspect on tears. She appeared to have a terrible diarrhea. Mean while a second woman in labour came in, with a premature twin. She arrived fully dilated, first one a breech. We tried to get the first ady out as fast s possible, but she was too feeble to move and it took ages. The twin was delivered- second cephalic. All in the same room…….. The firstborn had a good start, but became blue after a while, recovered on oxygen but unfortunately died the first night, may be a congenital heart disease ? For the first time in my life Ive seen a grown up with measles. She came-36wks pregnant- with a rash in her face, red eyes and coughing, feeling very bad. I had no clue, but the midwife told me this is measles. Because she was so ill we send her to the referral hospital. We don’t want measles on our ward and it is a medical problem, not obstetrical.  We also had to refer a baby with a cephalic hematoma, and very anaemic.

In spite of the busy week we went also on some outings, which is possible, because we are with two gynecologists now. We went to teach in a health centre in the outskirts of Bahir Dar and I then realized how big this city is. On my bike I only get around in the centre, near the clinic. This was a wide area with many new houses. In this health clinic we trained emergency obstetrics and also when to refer. Because still they keep high risk pregnant women too long in their centers .They are real eager to learn. % nurses, 2 health officers, but no midwife. They only do 12-15 deliveries a month…… After this we visited the family guidance association of Ethiopia. This exists already a long time, giving information on sexual behavior for the young people. Lately they started antenatal care and now also are going to do deliveries. The first has yet to come. It is a beautiful place, in a beautiful surrounding. They have a nice library where students can come to study, with several computers. There is a amazingly big garden, with a tennis court, volleyball and basketball field. The refurnished building for deliveries looked very nice. It is supported by IFFA and also the Dutch embassy!

Another day I made a visit to the Grace center, where women with children and no money are welcome. We had sent one of our patients and wanted to know how she is. It is a rather expanding organisation, because there is so much need. Started by two couples. Recently they rented some houses in the near region; this is where we could find our lady. We were a bit disappointed to see the shacks she is living in, but it looks clean, they bring her water and food is provided. She and the baby looked well.

That same day I went to visit Felleger hospital, the big referral-trainig hospital. It is amazingly busy there, they can not really cope. About 25 deliveries a day, people all over the place. Overcrowded rooms, in the corridor and also not so clean.  We were shown around by our colleague dr Bezezew, a very nice man, who is really trying to make the best of it with his 2 colleagues. Our deliveries are a relief to them. Neotalogy department also overcrowded and they have to improvise. No real incubators.

Friday night we had dinner in Kuriftu lodge, very posh and out of the place when you have seen al these poor people. But we had a nice dinner and even south African wine! Laterwe even set at the fireplace.

So life is good here, I am half way now!

continue life in Bahirdar

 

Sunday morning, time for a new blog. In the weekend we don’t do the handover in the morning, I go on rounds about 10 o’clock. As there is no ANC, there are also no ultrasounds. So this gives us a weekend feeling. Today was a quiet start. Now I am sitting with my coffee on the veranda. It is cloudy, and it has been raining a lot passed night. Very good to settle the dust a bit. Because dusty it is in the streets here. Water is brown when showering.

This week has been quite busy again and some crazy things we had. There was a lady carried in by 6 man( farmers) who had delivered at home but the placenta did not come . She was brought to hospital but delivered her placenta on the road. They did cut the cord, but did not tie the cord on the baby side. God is merciful, the baby did not bleed. In these cases we are always afraid of tetanus, but luckily this mother had had antenatal care and got tetanus prophylaxis. On arrival we put her on the couch, to inspect on tears. She appeared to have a terrible diarrhea. Mean while a second woman in labour came in, with a premature twin. She arrived fully dilated, first one a breech. We tried to get the first ady out as fast s possible, but she was too feeble to move and it took ages. The twin was delivered- second cephalic. All in the same room…….. The firstborn had a good start, but became blue after a while, recovered on oxygen but unfortunately died the first night, may be a congenital heart disease ? For the first time in my life Ive seen a grown up with measles. She came-36wks pregnant- with a rash in her face, red eyes and coughing, feeling very bad. I had no clue, but the midwife told me this is measles. Because she was so ill we send her to the referral hospital. We don’t want measles on our ward and it is a medical problem, not obstetrical.  We also had to refer a baby with a cephalic hematoma, and very anaemic.

In spite of the busy week we went also on some outings, which is possible, because we are with two gynecologists now. We went to teach in a health centre in the outskirts of Bahir Dar and I then realized how big this city is. On my bike I only get around in the centre, near the clinic. This was a wide area with many new houses. In this health clinic we trained emergency obstetrics and also when to refer. Because still they keep high risk pregnant women too long in their centers .They are real eager to learn. % nurses, 2 health officers, but no midwife. They only do 12-15 deliveries a month…… After this we visited the family guidance association of Ethiopia. This exists already a long time, giving information on sexual behavior for the young people. Lately they started antenatal care and now also are going to do deliveries. The first has yet to come. It is a beautiful place, in a beautiful surrounding. They have a nice library where students can come to study, with several computers. There is an amazingly big garden, with a tennis court, volleyball and basketball field. The refurnished building for deliveries looked very nice, but not used yet. It is supported by IFFP and also the Dutch embassy!

Another day I made a visit to the Grace center, where women with children and no money are welcome. We had sent one of our patients and wanted to know how she is. It is a rather expanding organisation, because there is so much need. Started by two couples. Recently they rented some houses in the near region; this is where we could find our lady. We were a bit disappointed to see the shacks she is living in, but it looks clean, they bring her water and food is provided. She and the baby looked well.

That same day I went to visit Felleger hospital, the big referral-trainig hospital. It is amazingly busy there, they can not really cope. About 25 deliveries a day, people all over the place. Overcrowded rooms, in the corridor and also not so clean.  We were shown around by our colleague dr Bezezew, a very nice man, who is really trying to make the best of it with his 2 colleagues. Our deliveries are a relief to them. Neotalogy department also overcrowded and they have to improvise. No real incubators.

Friday night we had dinner in Kuriftu lodge, very posh and out of the place when you have seen al these poor people. But we had a nice dinner and even south African wine! Laterwe even set at the fireplace.

So life is good here, I am half way now!

training in the health Centre

 

 

the rooms from Grace Centre where our patient stays

our neonatal care iscangeroo method and syringe feeding , baby 33 wks, 1.2 kg, 10 days old now      neonatal intensive care, baby on CPAP

new waiting area in the family guidance building

 

 

 

                                                                            lake view, with pelicans

 

Time for a new blog. Meanwhile a new  visitor has arrived, Dr Margaret Booth, from Australia. She actually just climbed the Kilimanjaro with 8 people as a fund raising project and they raised 60.000 austr. dollars for  our new building .The rest of the group went home, but she wanted to see the clinic, also about possibilities to work here in the future for a while. After a few days of getting used to the way of working here we now actually take turns in duties, which for me is a great relief. She stays 3 weeks! Although on the whole it is not to bad, some days-and nights!! –it can be too busy. Kind of luxury. This weekend we had a good time, were able to make a walk along the lake, had some nice dinner in Lakeshore restaurant, it felt like a real weekend.

the lady described below

Last week we could discharge the lady who came in almost dead, preeclamptic. Although at first she did not want the baby , in the end she grew fond of her. She has no whereabouts, place to stay. Here in Bahirdar is a place called Grace centre(head is called Mercy!) where homeless mothers can stay with their children . After some bureaucratic difficulties we managed to get her in there. At this time we heard her story. 8 Months ago she left her husband and went with two other girls to Bahirdar, with 30 birr in the pocket(=about one euro) here she has been doing odd jobs and found that she was pregnant, did nt want to go back, has not taken any antenatal care. So now she may stay four weeks here, but then has to go back to her family.

                                                                                   

                                                                                    impression of the ward, on a quiet day             Also last week there was a sight I shall not forget. It was very busy at that time, many people in labor in the ward. One of the mothers was a muslim women, totally covered in a nikab (only eyes visible.) these are usually women who have been with their husband to the emirates or saudi arabia,for work. When she was in labor and had to be examined she just pulled up her nikab, there she lay: uncovered lower body part, face covered. And she did not seem to mind at all. So that will be her Ethiopian upbringing, because here people feel no shame for their bodies. The other day we also saw naked men climbing a tree on the shore and jump in the water. I’d love to take pictures of these situations, but felt I could not do this.

I think about 30 % of the people here are muslim most are koptic Christians. The Imam starts at 4 in the morning and is calling every so many hours, but the church service starts at 5 or 6 and goes on for a long while. I don’t know what is better. Besides that we have a barking dog in one of the neighbor houses. It is good I have earplugs with me. Today the pre-eastern has started, that means; no met, no eggs or dairy products. Here it is better than in Mota, because a bigger pace and also tourists coming here. Last week there was a hijack of an Ethiopian plane, going to Rome. It seems the copilot who hijacked that plane comes from a rich family here in Bahirdar. Our ambulance driver , who always knows everything happening around town, pointed his house to us. Actually quite near our house!

So this is the latest news from bahirdar

The last two days have been amazingly quiet. Even now on the ward only four beds are occupied, 4 ladies in labor. And we have our “High risk room”, with two beds. Here is one lady staying already  a few weeks with hypertension, she is 32 weeks now and we hope to get her to 34 weeks. The other one is a very sick lady, admitted a few days ago with severe preeclampsia. Very high blood pressures, very much edema and hardly urine production. We tried to make her deliver normally, but unfortunately she was not able to push and the baby was born by Caesarian section. Luckily in good condition. She her self was in bad condition. During the CS about 3 lt of ascites (fluid in the abdomen) was removed. We had problems to stabilize her blood pressure. Today- day 3 after the operation- she finally feels a bit better and urine production is coming. As she had no force to feed the baby, one of our midwifes who is still breastfeeding her baby expressed some milk to give this baby. She just sits in that room, amidst of all people expressing her breast. It is amazing to see how people so easily help each other. Even the other lady in this room let her family bring some clothes and food, because she had seen this is a very poor lady. Actually she worked as a day laborer until the day of admission, never had any controls in pregnancy. There seems to be no husband, no relatives, we have to try to get help for her.

For the rest life here is getting her routine. Every morning we start in the clinic at 8.30 with the morning session, all admitted patients have to be presented. Teaching moment! Then we make rounds and at 10.30 I start doing Ultrasounds. Every patient from the ANC (ante natal clinic) has to have ay least one ultrasound, the rest on indication. There are very many first cases! We discussed it this week ,it is getting far to busy, many people come from the whole town . So now we made the decision to only see the people who are referred, who are poor and from this KEBELE. Bahirdar is divided in 15 or more Kebeles, and they all have an own health center. In these health centres there is also obstetrical care, usually one midwife. As we are in the place of a health center we have to see these people. For the rest we see to many well to do ladies, who might as well go to a private clinic….. They come by car, nicely dressed and have good jobs and ask for the sex of the baby. Of course we understand they too  like to come to our clinic, but it is getting to much. As for the ultrasounds, I am training two midwives to do this, because us gynecologists have better things to do than routine ultrasound…  In the afternoon there is no program, but usually busy with clinical cases. Today for the first time I have an afternoon without being called to the clinic-up till now!

The house is fine, there is running water and a functioning toilet. But to shower we usually use a bucket, because the showerstream is very poor, and not heated. We have Morone here, a nice young lady who cooks and cleans for us. She is an unmarried mother with a daughter of 5, has been trained by an American expat. She cooks western style, but I ask her to make injera once and awhile .Here are many more possibilities for shopping of course. Climate is colder than it should be this time of the year, I am happy I brought my down sleeping bag!

The internet is a problem apart. They tell me here it has never been as bad as it is now. There is a resort where we go for free Wifi, but also there it doesn’t work all the time. Ghion hotel, where I stayed two years ago with Jan, has also a problem. My CDMA (dongle) is still there , but works only half of the time. So I hope I will be able to send this blog today or tomorrow, this time with some pictures.

Then about my bike. One was stolen just after I arrived. and it is difficult without, so I decided to buy another one. There came a neighbor willing to help me. He was so upset that his country people stole my bike etc etc. So next day he told me he had done some investigation and found a good second hand bike for me for 3000 birr. Seemed a good price to me. New saddle and clutches. I forgot to ask a bill , and asked Solomon the driver to get one for me. To my astonishment he came with two bills: one was of 5 years ago , he bought the bike for 1350 birr, the other one for me 3000 birr. Was I cheated? I don't know. Anyway I am happy with my bike!

visitingMota, happy to see Tenaw

the house in Bahir Dar

Maternity clinic right side the ward and labor room, at the end the Operation room

feeding the little baby with breastmilk from the midwife

hours of ultrasound

Back in Ethiopia

Today I am already one week in BahirDar and two weeks from home. It has been very busy, traveling, few days Mota and the first week here. Also the internet connection is not optimal here. Today I have my bureau and good internet, so o excuses anymore.

After a long journey via Sudan I arrived in Addis , where I met DR Melesse, who is training orthopedics now. Tuesday morning early I flew to BD and next day by ambulance to Mota. It was very nice to meet everybody there, and the visit was very much appreciated . Saturday I returned to BD and on sunday I took over the duty from Dr Hans . On wednesday I got my own room, with table and bed. From the beginning it has been very busy. Hans had told me there were about 4-5 caesareans a week, I did the tenth one last night, not even one week finished!. And also some bad cases, the first maternal death in this clinic, due to sepsis. So that is what we call in Holland the “vuurdoop”  i.e. baptism in fire, kind of hard start. Hopefully this weekend will give me some rest.

The clinic is a small clinic, started last year. On the grounds of an existing healthcare centre a new building is going to be build. Now there are some improvised buildings. One big room with 10 beds, two beds in what was planned to be the ultrasound room.  Both delivering mothers, post delivery mothers and women admitted for complicated pregnancy are in this one room. Adherent the labour room with two beds. It is reasonably equipped and clean! Next to it a building has been refurbished to act as an OR.  There are about 100 deliveries a month, figures are rising. There is a staff of 8 midwives, one OR nurse, several cleaners. The anesthetists come from Felleger hospital, the big referral hospital in town.

Bahirdar is a nice place, agreeable, though much bigger than Mota. A real town actually, on the shore of the Tanalake. I have not had the chance yet to look around, but I know it from past journeys. Nice asphalted lanes along the lake. Palmtrees. There is more to do here , like many nice little restaurants. But I must say, I think I preferred Mota, the quiet and tranquility there. Our house, where I live together with Daphne, a dutch midwife, is a nice house. There is running water, (though the boiler is not working…)we have a oven, good electricity mostly, so more comfort then in Mota. What I miss is the view, this is a courtyard with a high wall. In the morning we can sit in the sun on the veranda.

Moving around in this city takes more time, bycicling is a good way of transport. To the clinic it is 5 minutes from our  house. There was a nice bycicle, bought by one of the former gynaecologists here, but that one has been stolen this week, in front of the hospital. To go from one place to the other you can  also use the badjaj- like the tuktuk in Thailand. For one birr (4 eurocent) you can travel quite a distance.

These are the first impressions of my 4^th stay in Ethiopia. I enjoy being here again! Later on I will write more and try to put some pictures in. Now I have to go to the clinic again.

All is packed, tomorrow I leave for Ethiopia again, for almost three months.