Wow I had forgotten just how slow dail-up is.......................

7^th January 2010

I am now in Gimbi and due to the fact that unlike the rest of the world the Ethiopians never officially converted from the Julian to the Gregorian calendar it is Christmas day again. I have to tell you that unlike the UK it doesn't look much like Christmas as it is warm, sunny and very green outside.

The journey (yesterday) to Gimbi as promised was "long and hard" 440km taking 10hours. Two thirds of the road is fantastic (provided by the Chinese) but the middle third is truly terrible, although a fleet of brand new Chinese lorries and diggers is in evidence standing by to commence work on this section later this year. The driving here is some of the worst I have ever seen: the roads have little traffic but what is on the roads is either travelling very slowly or very fast. The belief that there will be nothing coming the other way results in some risky overtaking. Add to this the need to weave around paedestrians, dogs, goats, cows and donkeys in large numbers all with no apparent road sense and you begin to understand the tally of 7 over-turned vehicles on or near the road and 7 canine fatalities (assuming a hyena count in this category) that we saw on the journey here, thankfully non-witnessed.

Arrival was a big culture shock and I experienced my first pangs of severe homesickness and that "do I know what I'm doing" feeling was particularly strong. In fact a cup of tea brought it all into perspective: the accommodation is much better than I was expecting (rather like the hospital accommodation I stayed in as a junior), there is a hot shower, the cook had left me a more than edible supper and there is a mobile phone signal (so if O2 don't cut me off I can at least phone home when desperate). I put on some music (thanks to my ipod and portable speaker) and busied myself making it feel more like home (i.e. spreading my stuff everywhere). I also took solace from the good advice of a work colleague who has worked abroad and warned me that the 1^st few days would be dreadful but that it would soon get better (if you are reading this-thanks Asha).

I did my first round with the local obstetrician (Tekle) this morning and assisted him with a caesarean. Amazingly the threshold for LSCS seems very low- which many of you know goes against the grain for me so we will see how it goes. The differences with care in the UK are huge. Everything is done on the minimum resources, issues like patient confidentiality and privacy are considered luxuries beyond the most basic level, the neonate is secondary with little resuscitation possible, infection control is considered but limited by resources (beds are maximum 3-feet apart in the ward). This lists but a few however overall the sense of all staff trying their best (often working 1:1 on-call) given these constraints is obvious. I just need a bit of time to see if there are things that can be done that will make the staff's lives easier and/or help the women they care for.

As it is Christmas here are no clinics so I am now on-call for the labour ward with Tekle and hence have time for a blog update. Well that really is more than enough to expect any of you to read and I will try to keep it shorter in future but at the moment everything is very new and different. Keep warm in the snow-bound UK!