Tuesday 27 November 2012

Another List (repost of deleted post)



I was looking through some old posts and saw my “Surprise List”.  I
have compiled  another list.  It’s called the “The Surprising Things
That Make you Happy List".  Here it is:

Old cooking facilities


1.     Having the gas cylinder for our stove filled (this was a remarkable feat on Mike’s part). We can now cook on four burners.  This is a major improvement from cooking on a single plug in burner.

2.      Having a mostly reliable shower.

3.      Not having to wait 15 minutes to get onto a line taxi in the morning (this happens rarely, but when it does there is a lot of happiness).

4.     Ripe Guavas.
 
5.     Seeing school kids in their purple and yellow uniforms every morning in Mexico Square.

6.     Vim (it cleans everything).

7.     Not seeing a cockroach in a 48 hour period.

8.     The small stall, by our house, that sells beer, pop and toilet paper.

9.     Catching a glimpse of the hills surrounding Addis; this can make you momentarily forget that you are sitting in traffic, not getting too far.

10.  Knowing that in the next 10 months, I won’t experience one day with a temperature of minus 20 degrees C (this one is not so surprising)

                                                                           
5 star cooking facilities
Functioning stove

Monday 26 November 2012

WONCA





Vic Falls
Brian and I are just back from the WONCA Africa conference in Zimbabwe.  WONCA, strangely, is the acronym for the World Association of Family Doctors (or some variation of that).

The conference was held in the lovely town of Victoria Falls, Zimbabwe.  It was a bit of a challenge to arrange travel to Vic Falls, from Addis.  The only flights available were charters through Air Zimbabwe.  Air Zimbabwe has had its share of troubles over the last few years. 

lovely plane ride
This is what we read prior to flying: Air Zimbabwe was bankrupt, hadn’t paid any of their fuel bills for ages and was no longer allowed to fly in international airspace. This information did not fill us with confidence as we boarded the plane.  The flight of course turned out to be terrific—12 seater plane, in flight coca-cola, great pilot (though no co-pilot, but perhaps co-pilots are over rated) and we all arrived safe and sound.

The conference was very interesting for us.  There seems to be a lot of momentum for primary care in East and Southern Africa.  It was also reassuring for us to hear of the various challenges that other countries have faced.

Brian and I, (well, mostly Brian) were meant to present on the successful implementation of FM in Ethiopia.  We had to change the presentation to the barriers we have encountered in implementing FM in Ethiopia.  It was actually supposed to be our Ethiopian colleague, Dawit doing the presentation.  He was unfortunately not able to get a visa for Zimbabwe so was unable to attend. 

I find it perplexing, that as Canadians, we can just show up in Zimbabwe and obtain a tourist visa on arrival.  If you are a citizen of an African country, you need to apply for a visa weeks in advance and then may be denied a visa (discouraging).

A good week was had; we met many interesting people and got to know a few East African family medicine colleagues.

Friday 9 November 2012

It's Sometimes Hard to Wash your Hands


There are contradictions in life that we see everyday.  Sometimes it takes something very small to make you become acutely aware of this.  Here is my little missive for the day.  It’s about hand hygiene.

The link between hand washing and the spread of disease was established about 200 years ago, almost simultaneously in a Vienna and Boston Hospital.  

Everyone knows it is important to wash your hands.  The WHO has put out a 216 page document on this subject.

Here in Addis we, and most other ferenji’s, walk around with little bottles of hand sanitizer in our back packs.  We spend a good part of the day whipping out our Purell bottles and madly sanitizing our hands at a moments notice (not sure what local people think of this slightly annoying habit of ours). 

In hospitals at home, we are informed that there are about 400 different hand washing points before, during and after a patient encounter.  There are now people employed to spy on us to make sure we perform adequate hand hygiene.  This is of course all good.

We have recently been attending inpatient rounds at Yekatit 12 hospitals.  The wards have between 6-8 patients in a room.  Patients have active TB, HIV, meningitis; they certainly don’t need any health care worker associated infections added to this.  Of course hand hygiene could be and easy part of the solution.  But it’s not so easy.

Same sink this morning
We saw there was a sink in the male inpatient ward.  Thought for starters we might bring in a bar of soap and we and the other healthcare workers could start washing our hands at the sink.  We were willing to forgo our hand sanitizer for a few hours. Seemed simple enough, except the next day there was no sink and I don’t think they have a maintenance department to come up and replace the sink.
Sink on the ward yesterday

Yet again, it’s not fair.  Overcrowding, under staffing and lack of funds make it extremely difficult for these types of preventive measures to be put in place. 

We continue to admire the work that everyone does here.

Thursday 1 November 2012

A Gloomy Post


One reads a lot about the burden of various medical issues in Africa: TB, HIV/AIDS, malaria, obstetrical complications and the list goes on.

It’s easy to forget that deaths from motor vehicle accidents are also a major public health issue in many parts of Africa.   Ethiopia is ranked 12th in the world for fatalities due to road traffic accidents.

We’ve seen a fair number of remnants of car crashes and unfortunately even pedestrians being hit by vehicles during our few months here in Addis.  A bit of a depressing topic, but I thought it deserved a post.

The people most vulnerable to road traffic accidents in low to middle income countries (this is the new vocabulary to replace “developing world”) are those who would not be able to afford a vehicle of their own (cyclists, pedestrians, and passengers using public transport).   Yes, the world is not fair.

Low- and middle-income countries account for over 90 percent of the deaths from traffic accidents, despite having only 48 percent of the world's vehicles.

The reasons for such miserable statistics are of course multifactorial.

 A big problem in Ethiopia is lack of adequate emergency medical services.  Victims who may have manageable injuries arrive at hospital too late or more commonly not at all.  As well, the majority of victims are underprivileged and unable to afford health care.

Added to this is a lack of seatbelts, a very poor road network, poorer conditions of vehicles, disorganized traffic…..

In Ethiopia, there is a law that requires the driver in a vehicle to wear a seatbelt.  It is surprising what can pass as a seatbelt  (a very loose burlap strap, worn rakishly over the shoulder, can often do the trick).

 The WHO projects road traffic injuries will be the fifth-leading cause of death globally by 2030, along with diarrheal illnesses, TB, ischemic heart disease etc.  By 2040 deaths from road traffic accidents are predicted to surpass deaths from HIV/AIDS in Africa.

No pictures for this post; thought that would be a bit grim.

On a less gloomy note, I am not so afraid of being hit by a bus these days and no longer feel the need to hold someone’s hand when I cross the street.   A bit of progress on my part.