Gotland special higer clinic

December 19 - 22 2011

The week began with a new reminder of the difficult medical inequality for people in Ethiopia. A patient with a very severe infection of the upper left yaw. The infection had caused necrosis of the bone and it looked almost like cancer. A biopsy had rolled out the cancer diagnosis so a curable operation could have been made. An operation was decided next morning but when we came we were told that the family had gone home for money. They haven’t come back so one can wonder about the situation for the patient. This is the problem we face as long as we don't have our own operation facility with general anesthesia. We have to rely on the routines at this small private hospital. They allow reduction fees for many patients who are in special need but to know how to support is difficult and patients or rather the family says that they will get money and then it happens that they don't return.

We had tried to locate the family of the baby with mandibular fracture I operated last year. That was shown not to be easy. As there are no personal numbers or social security numbers it is very difficult to do follow ups here. There are patients cards but data like address are often missing and cards are often renewed on every visit. I made a “WANTED” paper with a picture of the mother and twins and date of surgery. A doctor at the dental department then tried to find if anyone on the hospital remember how they where and where they might be living. The hope for success was limited.

On Thursday morning Samuel got a call from the hospital and we were asked to come. They said that they had some information. When we got there we were surprised seeing the mother and children. I was very happy to find that the baby looked fine and the jaw was in correct position and you could not see a sign in the moth that the mandible had been divided. The scar was not seen in normal position of the head but of course seen from below. The mother had walked to the hospital with one twin on her back and the other was carried by her about 5-6 years old son. They had probably walked an hour and a half so we decided to drive them home. They are living at a small farm just outside the town. We walked the last part and was invited to see how they live. Now we know how to find them next year so we can follow up and perhaps see if the teeth are coming normal.

Tomorrow is Christmas Eve and here you can't feel that it is some special. It feels like midsummer time but we are now slowly getting aware that we soon are getting home. That’s nothing we want. We would like to stay longer. A sad thing is that the container is not coming to Bahir Dar while we are here. It is now in Addis Ababa and the paper works are ok so now it would be just the customs check of what is in the container. The container will probably arrive a few days after we left.

November 28 – December 18 2011 

Times run fast and we are getting naturalized to the path and rhythm of Ethiopian life. There is nu rush and nothing seems to be done immediately.

The clinical work has mostly been routine except from a very unusual case. A patient with mandibular luxation (the jaw displaced in open position) She had the the jaw in this position for more than a month. She thought that the devil had struck her. Normal reposition that I have carried out many times did not work. We decided to do it under general anesthesia but it wasn't possible to move the jaw from its position. Some fibrosis or/and ancylos must have developed so the joint was stuck in wrong place. We had to cancel the effort after Samuel and I and the anesthesiologist each had tried to manipulate the jaw.

We couldn't find any good guidance in the literature, in books we have and on the Internet. After a lot of thinking we thought of treating the patient making a surgical “fractures” of the joint heads. Over Skype we discussed with a friend and colleague professor in Kuwait and we came to the decision that the “fracture” operation was the only alternative to leaving the patient in this state for the rest of her life.

The operation was carried out the next day by intra oral approach. The instrument are not the ones we normally have at home but luckily we had fetch my dad's surgical hammer and chisels that still were in Samuels container. After closing the incisions a intermaxillary fixation was carried out with the teeth in normal relation. We will see the outcome next week when the fixation will be changed to elastics

A operation like this is a delicate thing as blood transfusion is difficult to get. At this little private hospital there is no blood bank. In the pre-room to the operating theater I found a form for ordering blood transfusion direct from a donor. This is the way they use when blood is needed.

On the way out from the operation we found that a new patient with the same condition that also had been for more than a month. It is almost unbelievable that two identical cases should appear. This time we tried with local anesthesia but no luck so we have to try with general anesthesia next week and hopefully we don't have to operate.

On Sunday 11 our daughter and family arrived and we have had five days together looking around in Bahir Dar and going out on a boat tour on the Tana Lake. There were also time for bird watching with help of our friends here in Bahir Dar. They have now left for their tour south of Addis Abeba including Bally Mountain and other national parks.

The container is probably in Addis Abeba now and hopefully the last document will be sent today Sunday 18. The shipping list document with values of the items that we sent first we had to change the layout and now the value should bi in dollar instead of birr. (The Ethiopian currency). One could be mad at this but there is nothing you can do against a rigid authority.

Below some pictures from this period.

Week 28/11 3/12 some pictures. i will try to comment them later when I can be at a better Internet connection

November 26-27 2011

This weekend on Saturday at 1 o’clock we were invited to Gulilat’s and Mastewal’s home to celebrate their son Nebiyu’s three years birthday. There were a lot of people, mostly adults and we were served a nice lunch. The house was all made up for celebration and the event was extensively documented by Gulilat behind the video camera. Little Nebiyu cut the bread and then the birthday cake and blowed the cake candles out. He seemed a little uncertain about the meaning of it all, but after a while I think he somehow understood that he was the middle point. We got a glimpse of  his little newborn brother in the arms of his beautiful mother, when she took her time to sit for a while.

 After the party we went for a walk down to Lake Tana shore together with Annelie, Titti’s Swedish colleague and Pramod an Indian guest professor at Bahir Dar University. We sat by the lake and had some beer and interesting talks about Ethiopia, India and Sweden and other things.

After leaving Pramod taking a Bajaj home, the girl that Annelie met earlier joined us on the way to Annelie’s hotel and we sat down by the pool to talk. This is a very nice girl that Annelie is thinking of supporting in the future. Although she is only 9 year she is quite good at English. After that we got a Bajaj home in the early evening dark.

On Sunday we had a nice and slow morning after a night with mouse hunt. A small one that wasn’t so much trouble but we have to do something about the gap below the outside door.

Melaku, who we met the first time we came to Bahir Dar (2007), phoned and we decided to go to town together for lunch and pick up Annelie on the way. We had lunch at a nice place in the beginning of the straight road to the University. We then went for a long walk past the new clinic building and then to the bridge over the Nile. There were no hippos this time but it was interesting to see how people drove their cars into the Nile to wash them. It is astounding to think that this water will end in the Mediterranean Sea. We then returned back towards the town and Lake Tana hotel. This hotel is built in the time of Haile Selassi and you can see how powerful it must have been. There is a very beautiful garden and we watched the sun set over the lake. We walked the nice path along the sea to town where we took a Bajaj home together with Melako, as he lives in a building next to ours.

Now we are prepared for the next week

November  monday 21 - friday 25

On Monday morning we got up at about seven and after a shower etc I walked to the next building in our condominium where there is a “home bakery” shop and got two new baked bread for three birr ($0.19 SEK 1.30) direct from the oven. The morning air and sun is lovely and makes you feel so good.  Home for tea and then Titti went to University to be there at 9. I have some time more to watch TV news. There are hundreds of free channels from a satellite with mostly Arabic but some broadcasting English spoken films, BBC News and Aljazeera News English. Aljazeera is surprisingly good taking up different opinions on difficult subjects. Samuel and Fantu came at about a quarter past ten and we went to the clinic.

Ethiopians are not used to come on booked appointments so on this morning the waiting room was empty which is very unusual after a weekend. But later in the morning patients dropped in.

 The water supply is a problem and now the water has been gone for several days. The clinic has to rely on fetched water in bottles from downstairs. Samuel is tired of this problem and there is no way to put pressure on those responsible. As Samuel says “welcome to Ethiopia”. Instead a reserve water system must be installed and we started to plan for one. We went out looking for a suitable barrel and we found one for about 150 liters.  At lunchtime (12.00) we went home to Samuel & Fantu’s for a nice lunch and rest till about a quarter past two and then back to the clinic until sunset at 18.

The workdays look about the same but of course the patient case varies a lot of ear problems, some fractures and infections.

During the week we continued on planning for what we now call the x-ray department and one important thing for that is a good Internet connection. There is an insurance firm in the building but to connect to theirs is not possible due to security issues but it means the possibilities are there. Next step is Ethiopian telecom.

Samuel is very eager to get the vacuum suction working. The equipment from Sweden works only on three phases and to find out if there are any in the building we had to ask the general manager to get permission to get into the place where all the electric meters are. This is a thing that is typical in Ethiopia. You can’t ask the people on the “floor” directly. Anyhow there are three phases available, but you have to change meter and wiring. An ordinary vacuum cleaner is an alternative but vacuum cleaners are not known in Bahir Dar. A friend is going to Addis Abeba  for the weekend and he is going to find out if there is one.

This inspection of the electrical system resulted in that the managers of the building wanted me to inspect the water system. (They thought I was an all round technician, not only surgeon!) The water system has very low pressure and is only meant to deliver water on ground level. Therefore every house has a pump to a tank placed high up, but the clinic building relies on pumps that make the pressure directly. A delegation of four men went to the installation and I could find out how it all works. There are two pumps, apparently one is working as backup. The problem is the electrical installation. I Sweden you would not dare to get near it.  Lose hanging wires with naked live ends. Contactors not properly screwed to the wall. I had no volt meter but one in the delegation had a screwdriver with an indicator lamp. Trying to find out if the current reached the engines I had to open a lid on the engines. It seamed to be ok but the engines did not work. Eventually I found that the grounding of the system wasn’t properly done and made the indicator giving false response. To make something happen, Samuel decided to call for an electrician to inspect it together with us. Samuel thinks it is a good thing that he this way may get in control of the water system although he has to pay for it. On Monday we will have a new go at it.

This is the report of the week. As you see I am having a good time and Titti is also getting on well at the university with her fellow colleagues, meetings and social contacts.

/hans

Waitingroom

We flew from Stockholm at 20.00 and arrived at Addis Abeba 10 hours later on Friday morning 2011-11-11. Our plane for Bahir Dar wasn't leaving until 15 in the afternoons so we had to spend the day at the airport. There is no possibility to store luggage. We started off by sitting at a café between the international and domestic buildings. Along with us was a colleague to Titti from Linnaeus University who is a part of the exchange project with Bahr Dar University. It was cloudy and the temperature in Addis was just about right for us. After some hours we checked in for the domestic flight. There is a restaurant where you can get what you want but best of all in a corner there are some easy chairs that people have taken apart and put the cushions on the floor were you can lye down and sleep. We thankfully took that opportunity as we were quite tired after the flight.

When we arrived in Bair Dar our friends Samuel and Fantu met at the airport and we went to the Papyrus Hotel where Annelie was going to stay. We had a nice dinner at Papyrus, as we were quite hungry, and our friends including teachers Gulilat and Mogus had coffee. Then to the flat that one of Titti’s colleagues had fixed for us. When we came there they welcomed us with the traditional coffee ceremony. It was a good flat in the outskirts of Bahir Dar but they were mending the toilette and other things were not in place so it felt a little troublesome as we just wanted to unpack and rest. You can say the Ethiopian way of life started a little too quick.

During the weekend we walked around the town and met some friends. A lot new buildings and more roads were built since we were here last year.

On Monday morning Titti went to the university and I went to the clinic. Samuel had several consultations and some of them I could take part in. We also had time for discussion and planning for the container that is on its way. The week went on in the same way and we had some operations. One major under general anesthesia at the Gambi Hospital. It was a large cyst in the left lower jaw. Apart from this I have done some technical service on the equipment.

During the week end we were invited to Samuel and Fantu for Saturday lunch and on Sunday we had lunch at a farmer and looked at his ecological agriculture, and a dinner at Titti’s colleague Biset.

Below som pictures that I will comment later when I have a better internet connection