A time for reflection (and a hug & a glass of red wine)................................

February 11^th

Tomorrow I will do the 10-hour journey again to Addis in order to be there on Saturday morning when Mark's flight arrives from London bringing us together for a short weekend (he returns first thing on Monday morning). This weekend was a distant beacon of light, to look forward to in the first week when I was so very homesick but as I settled in I have sped towards it very rapidly. It was chosen as it is not only Valentine's day on Sunday but also is the weekend where I am exactly half way through my "working time" in Ethiopia (our planned holiday at the end would make it less than half way but I see this as a separate chapter in my journey here).  Although I am sure I will continue to see new and challenging things and still have so much to learn about how to provide the best care with few resources, I thought that this would be a good time to reflect on my experiences over the last five weeks.

There are very many things that I have learned although these are rarely things that will be very useful to my clinical practice back home as the myriad of Health & Safety and infection control recommendation, not to mention risk management processes would take a dim view of many of the practices here.

Some of the things I have learned:

-       That the Ethiopian pelvis is tricky and so babies get stuck more commonly.

-       That the Epthiopian midwives despite relatively basic training manage amazingly well (although there are occasional short-falls in care that I feel are understandable though need work to try to avoid).

-       That you can manage obstetric problems effectively with a lot less resources than I would ever have believed possible (we only have a choice of five antibiotics here compared to dozens in the UK).

-       That fortunately I was well trained in gynaecology and so after 12-years I managed to drag the skills and knowledge out of storage and back into use.

-       That yet again I wish I had done neonates when I was training but that even a relatively old dog can learn new tricks when put through immersion/flooding therapy.

-       The importance of avoiding waste and considering a second life for many items that we usually throw away (more about this in a future blog).

-       That I never want to work anywhere with anything other than a state funded Healthcare system (a controversial statement I realise- but completely heart-felt).

-       How people appear happy in spite of adversity- often of the worst type I can imagine.

-       How easily a full term babies can get sick and die and how unlikely to survive even a slightly premature baby is (the first lottery we unknowingly enter with the winners fortunate enough to be born on a developed country)

-       On a personal level how easily you can adjust to having less comfort than you are used to without any detriment to real happiness (although this is not a hardship experience by any means).

-       That I can manage without a glass of wine at the end of a busy day (however reluctantly).

-       How well you can feel on a diet of vegetables, beans and pulses (but no epiphany here I'm afraid as I do miss meat and chocolate).

I am plan to continue my blog which more than anything I intended as a permanent memoire for me but I have been heartened by the messages from friends & family who are following it and finding it interesting. There is still so much to tell as I have written little about the wonderful people with their cheerful fortitude or of the complexities of the Oromifa & Amharic languages, or of Gimbi town itself and the surrounding countryside, of the pitfalls of an Ethiopian outpatient consultation (which I am still learning to avoid) or the terrible perinatal mortality rate and the response of local people to it- so I have plenty of things that I want to write down and that is before I write about any of the interesting cases I manage on a day to day basis.