In at the deep end

14^th January

Tekle the Ethiopian Obstetrician & Gynaecologist has left for a well earned holiday, hopefully he will be back in 8 or 9 days or so (the uncertainty is not because I am concerned he won't come back but because the reality of finding transport for the 10 hour journey from Addis back to Gimbi, is that a degree of flexibility in timing is required). So that leaves me in at the deep end doing a 1:1 on-call for anything they deem to be roughly within my sphere of competence.

Fortunately the gynaecology is coming flooding back which is just as well as the clinic today presented me with an array of gynaecology complaints. to manage including both a cervical and an ovarian cancer. I also saw my first woman with a urinary fistula, which is a problem virtually unheard of in the UK (I have seen it once before in my entire career) and is a result of labouring usually for days when the baby is stuck and can't get out (obstructed labour for medical readers). This woman delivered in September, she had delivered 4 children previously without a problem but with her fifth baby laboured for 3-days at home before presenting to the hospital. Her uterus had ruptured, the baby had died and she required a hysterectomy. Today was a routine follow-up and it was obvious (olfactory assessment) as soon as she arrived that she was leaking urine uncontrollably. She will require further very specialist surgery, the light at the end of the tunnel is that there is a specialist fistula hospital in Addis where she can receive treatment with a high chance of success for free.

More of an issue for my competence is the neonatology as in the absence of any other doctor this is my remit as well.  Neonatal resuscitation was something I was prepared for but the management of postnatal temperatures and feeding problems was not. I really wish I had brought a neonatology book although I have realised that my books are of limited use as most of the investigations and the treatments they describe are not available here. Fortunately I have managed to find a very basic reference book and look up antibiotic doses and feed volumes, we are not talking very high tech management since the limit of treatment is intramuscular antibiotics, feeding through an naso-gastric tube and nasal oxygen therapy. One of the other visitors is a neonatal nurse from America and she has been a great source of reassurance and advice.

There is so much that I could tell you about like the attitude of women to pain and to the loss of their babies (which sadly is a daily occurrence). There is also plenty to tell you about the nurse-midwives attitude to the same that, at times can be pretty shocking but I need to save something for future blogs as there are ten weeks ahead of me in Gimbi!

Sorry about the lack of pictures but unfortunately the dial-up is unable to cope with the file sizes so I will try to send some back mid-term when Mark comes out to visit.