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.

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.

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 12^th 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.

The Most Beautiful Place in The World?

We’re just back from some incredible trekking in the Tigray region.  We hiked with our new British friends whom we met at the kids’ school.  



 Tigray is in northern Ethiopia (close, but not too close to the Eritrea border).  It was the region most severely affected by the 1984-85 famine.




A bit of history about Eritrea/Ethiopia.   At various times in history Eritrea has been either on or off the map of Africa.  Eritreans share the same language (Tigryna) and culture as the Ethiopians of Tigray.

Eritrea had long been an independent nation.  It was then colonized by the Italians in the late 1800’s.  Then in 1948, for various political reasons, the UN’s General Assembly decided that Eritrea would become Ethiopia’s 14^th province.  Eritrea was then off the map of Africa.  

This forced arrangement didn’t work out terribly well.   In 1993, after many years of strife Eritrea became an independent nation (again). Eritrea is now back on the map of Africa.

From what we understand border tensions have eased over the last few years, but VSO still suggests that we don’t wander within 30km of the Eritrean border.

At any rate, we are lucky that we had the chance to trek in Tigray.   We flew into Axum and then drove 2 ½ hours on mildly hair-raising roads to start our hike.  We were rewarded with a four day trek , that took us into some of the worlds most spectacular scenery .  Of course, we came equipped with hiking boots and quick dry shirts, while local kids scampered around vertigo inducing cliffs, in broken plastic shoes.

The best part was that we didn’t have to carry our packs (this job was left to some very hardy donkeys).  As well, our meals were cooked by local women from nearby villages (which meant no cooking or clean up by us).   Our lodging was in “local accommodation”, which was a structure fashioned on local homes; no electricity or running water, but comfortable and clean (with perhaps the exception of the toilet facilities and a few fleas).  

 

We had a terrific guide who had grown up in a nearby village and knew the mountains like the back of her hand.  Every time we thought  “ are you crazy, there is no way we can climb up that ridiculously steep ridge”, she would know a way up.  

Who knew that Ethiopia was home to one of the most beautiful places in the world?

Too Much Altitude

Some of the X-country team

Today we ran our first road race in Addis Ababa.  We hitched a ride with Aysha and Sunil’s X-country team.  The race was sold out, but their coaches were kind enough to provide us with unused bibs.

Here’s a little play by play of my race.

The elite men

The race got going and it all seemed kind of cool.  We got to see the elite men start and Haile Gerbrselassie was there providing some inspiration.   Then the not so cool part; we had to run. 

The first 2km were not too bad, nice and flat.  Then things started to get a bit bad--hills and altitude to deal with. Running on the flats seems to be similar to running at home, running up hills seems to be is when the altitude starts to rear its ugly head.  Added to this was parched lips and a mouth that was as dry as a biscuit.  Luckily, the race was sponsored by Coca-Cola and glasses of coke were provided at about km 4 (no water, just coke!).   Finally things got very bad: the last km was all uphill and the battle in the head to not walk began, but a Coca-Cola as you crossed the finish line made you forget all your troubles.

The kids were terrific.  Aysha had done the same race (it’s part of a series) last month and took 4 minutes off her time this time around.   Sunil ran the race for the first time, the longest distance he has run!

For Mike and myself, more training is in order.  However, in spite of the near nausea, it was a great day.  Tons of runners, music, Amharic medals, and of course, Coca-Cola.  If only Addis could do something about the altitude, I would be set.

Capacity Building

Before I started working with VSO I hadn’t thought much about the idea of “capacity building”.   I’m still not sure I completely understand what capacity building is, though I did read a shockingly long Wiki entry about this very subject. 

At any rate, a lot of our job here falls into the category or idea of capacity building.

Working in Dawit's office

The Family Medicine Program in Ethiopia is still in its infancy (actually it’s still in the gestational period).  We are here to help build the program and get people on board with improving primary care.   Fortunately, from what we have read, good primary care does save lives, so we are starting on good footing.

Abbas and Brian

Our current team is Brian, Abbas, Dawit (our Ethiopian colleague) and the two of us. Initially, things seemed to be moving at a snails pace, but things have picked up and we have more and more to do.   There is often a little ping pong match going on in my head in that one minute the task seems unmanageable and I think what are we doing here then the next minute I think we are well on our way to doing something very good here.

The cafeteria at Y12 hospital

It is however nice to have a few concrete projects on the go.  We are all helping to prepare a day of CME for GP’s and possible recruits to the program.   We are also involved in a project to teach GP’s C-sections.  As you all know, women have very limited access to safe obstetrical care in Ethiopia, so we hope this will be a good capacity building project as well.   Luckily, a lot of this capacity building and planning can be done outside while sipping machiatos and eating cake.:)

On the home front, things are good. The kids continue to enjoy school and are making friends.  They are both running on the cross country team and have a 7.5 km road race this coming weekend.  I am no longer afraid to go into our kitchen, so we are cooking a bit more and eating out a bit less (this is good).  The weather has turned spectacular.  It’s sunny and warm everyday, which is a very welcome change from rainy and gloomy everyday.

Two Rivers Meet

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As many people know, the Nile River is generally thought to be the longest river in the world; about 6650 km long.

Lake Tana, source of the Blue Nile

It has two major tributaries the White Nile and Blue Nile.  These two rivers flow north, join up in Sudan and form the Nile River.  The Nile then carries on to Egypt and eventually empties into the Mediterranean Sea.

17th Century Bridge, on the way to the Falls

People may not know the Blue Nile is the source of most of the water in the Nile and its source is Lake Tana, in Ethiopia.   90% of the water and 96% of the sediment carried by the Nile originates in Ethiopia.

Blue Nile Falls

For various historical reasons Egypt has had control over the Nile water resources.  You can imagine the challenges surrounding sharing water in drought prone East Africa.  There is obviously some crankiness among the countries (Uganda, Tanzania, South Sudan, Burundi, Rwanda, DRC, Ethiopia and Kenya) through which the Nile flows as they have little control/access to the waters.  There has recently been progress on a Nile Basin Initiative to promote a peaceful solution regarding water sharing among theses countries. For more info. on this here is what the informative  Wikipedia has to say:  http://en.wikipedia.org/wiki/Nile_Basin_Initiative

All of us and Brian

During the Meskel holidays we  and our honourary family member, Brian took a little jaunt to the city of Bahir Dar to see the source of the Nile and the Blue Nile Falls.  A very lovely weekend.