My VSO adventures

My final blog – what I will miss and what I’m looking forward to

Well it’s time for me to leave Ethiopia soon and make my way back to the UK. I’m going to take some time to pick up my life in the UK and get things organised as well as catching up with friends and family on my return. Overall I have enjoyed the last 10 ½ months. There have been a lot of challenges along the way with patience and resilience needed but I have also had so many amazing experiences, been welcomed by the people here and made friends with some lovely people.

Here are some of the things I will miss about Ethiopia in no particular order:
1. Looking up into the sky and seeing so many stars in the sky. With almost no light pollution the number of stars and planets that can be seen is staggering and awe inspiring.
2. Almost every child that we come across on the daily walk to work wants to say hello and also to shake our hands. Apparently it’s good luck to shake a ferengi’s hand. I think that bizarrely I will miss the attention and friendliness when I leave.
3. I’ve had over 10 months of daily sunshine here and even though it’s the rainy season now we still get some sun during the morning. It’s been lovely to have the sun daily and soak up it’s warmth.
4. The work/life balance here is definitely more in favour of life! The two hour lunch breaks where you are expected to leave the hospital and go home to eat your lunch were hard to get used to at first but now very much enjoyed.
5. Every time you see someone rather than just abruptly asking for what you need first you need to exchange greetings with each other. This involves handshaking and sometimes kissing each other’s cheeks. There are many ways to say hello and how are you. Every one of these, as well as the proper responses, are normally used before you continue on with the conversation.
6. Having never really been a coffee drinker before coming to Ethiopia I have become a convert! The coffee here served as part of the coffee ceremony is a bitter brew made palatable by a few teaspoons of sugar. Some local coffee will definitely be in my luggage coming back.
7. Ethiopian food is lovely with a great range of spices used. One of my favourite dishes is tegamino, a thick chickpea flour and spice paste, served with injera, a thick pancake made from tef (the local stable grain).
8. Being able to buy cheap, in season vegetables has been lovely. This has meant lots of meals from scratch without any of the processed cheats normally used. I’m sure I’ll be using some of those cheats when I get home but I hope to do more cooking with fresh ingredients.
9. Over the year I have made many great friends in people at work, people living in Axum (Ethiopian and ex-pats from the States) as well as my fellow volunteers. I will miss seeing these people every week and hope to keep in contact after I return to the UK.
10. One thing I have learnt to respect over the last months is the power of the purple stamp! In Ethiopia everyone has a purple stamp – the hospital, local businesses, VSO. If you want anything to happen first a form or letter has to be produced but unless you have the purple stamp the letter is worth nothing ☺

Here are some of the things (in no particular order) that I’m looking forward to when back in the UK:
1. Being able to speak the same language as patients and nurses so that I can be sure that what I am saying has been understood. This enables me to be sure that patients and parents understand what is happening and why I am doing things. It means that the nurses follow instructions that I give and understand why they are important as well as to come and tell me if the patients are deteriorating.
2. Surprisingly one of the things I’ve missed most is a variety of fresh fruit. I’m looking forward to apples, pears, grapes, melon, pineapple and strawberries.
3. A decent bottle of red wine – no further explanation needed.
4. A wide variety of lovely cheeses (especially soft cheese like brie and camembert). Outside of Addis and cheese brought back to the UK it’s not possible to find cheese in Ethiopia.
5. Seeing family and friends again after the time away and catching up on everyone’s news as well as just spending time with people.
6. Having daily access to hot and powerful showers. Although I’ve been lucky and have had hot water where I am living the water pressure is never great which can make it difficult at times.
7. The insects in Ethiopia seem to love me. Not having to worry about getting bitten all the time and having to keep applying insect repellent will be much appreciated.
8. Working in Ethiopia has made me appreciate the NHS even more. Healthcare, which is free at the point of care, where you can give the patients the treatment they need without needing to worry if they can afford it is unimaginable to people in Ethiopia. People use holy water or traditional remedies as they don’t trust the medical system here leading to delays in presentation and poorer outcomes for patients.
9. Less bureaucracy or at least bureaucracy that I understand and know!
10. I’m looking forward to seeing the changing seasons and all the differences they bring. One thing that made me feel homesick last year was all the pictures of autumn as the leaves changed colour.

And finally thank you to everyone who has helped and supported me over the last year. It has been wonderful to read all of the messages that people have left on the blog.


The Neonatal Unit in Photos

Neonatal Unit Critical Care Room

Neonatal Unit Critical Care Room

Kangaroo Mother Care room

Kangaroo Mother Care room

Nurse's station (with viewing windows through to the critical care and KMC room)

Nurse’s station (with viewing windows through to the critical care and KMC room)

The first patients admitted to the neonatal unit

The first patients admitted to the neonatal unit

The first Kangaroo Mother Care admission - with a normal temperature now they are having KMC!

The first Kangaroo Mother Care admission – with a normal temperature now they are having KMC!

Ward round on the neonatal unit with one of the paediatric masters and one of the new neonatal nurses.

Ward round on the neonatal unit with one of the paediatric masters and one of the new neonatal nurses.

The new bathroom block for mother's.

The new bathroom block for mother’s.

My leaving coffee ceremony on the ward with paediatric and gynaecology ward staff.

My leaving coffee ceremony on the ward with paediatric and gynaecology ward staff.

Official inauguration of the neonatal unit the day before I left Axum.

Official inauguration of the neonatal unit the day before I left Axum.

Guests and hospital staff at the inauguration ceremony (if you look closely I'm wearing Ethiopian traditional dress!)

Guests and hospital staff at the inauguration ceremony (if you look closely I’m wearing Ethiopian traditional dress!)

Fifteen Steps to Creating a Neonatal Unit

Finally it is complete only 4 days before I leave Axum! The process to creating the neonatal unit as been a long one with many challenges along the way. This is how I did it for those that are interested:

Step 1: Find out that a neonatal unit is what the main objective of your placement is. It took me a little bit of time to do this as it wasn’t specifically mentioned in my initial placement objectives and when ever I asked people at the hospital I was told to ‘tell us what you think’. After I had come up with an action plan for improvements following feedback from the hospital and VSO it was apparent there was one priority – creating a neonatal intensive care unit!

Step 2: Write a proposal for funding. Initially I didn’t know that funding was available. (I found out about four months into my placement that I could get a VSO small grant.) Once you find out you write the proposal using an example provided and data gathered about neonatal admissions and mortality by painstakingly going through the ward admissions book to get figures. Ask the medical director for help with the costing’s for items (you find out later not always entirely accurate!)

Step 3: Experience sharing visit. You are told that you can’t submit the proposal as an experience sharing visit to a neonatal unit already established by previous VSO volunteers has been arranged and you need to go on that first. (See blog: Travelling and exploring – Part 2)

Step 4: Submit the proposal and receive feedback. The feedback doesn’t seem to take into account that hospitals in Ethiopia are similar and also that neonatal units all need to be to the same standard and contain the same equipment. Lots of e-mails and conversations partly resolve this issue.

Step 5: Get told that you have been granted the funding. The money doesn’t actually appear in your bank account until a few weeks later. A week after you have used your own money to run the 1st staff training course (see blog What do you do with free weekends?). The money comes in installments and you have to prove how you spent each section of the money before you get the next instalment.

Step 6: Start refurbishment works. Following instructions for painting and putting lino flooring in the rooms designated for the neonatal unit spend frantic weekend cleaning the rooms before the painting is done (see blog With a lot of help from my friends). Feel like everything may happen quite quickly (you’re wrong!).

Step 7: Start construction works. Medical director decides that you can change the bathroom into a nurse’s station and that a new bathroom can be built (using funds from the VSO grant which requires much discussion to get approval). Since you are creating a nurse’s station can now have viewing windows into neonatal rooms. Lots of mess created by making windows undoing all of the work that was done in cleaning and initial refurbishment! Construction of bathroom outside and work needed in neonatal unit itself takes a long, long time. Progress is made and then stops and then continues in an ongoing cycle. Repeated discussions with the hospital CEO take place about progress with multiple warnings given to the contractors.

Step 8: Get equipment. This requires a couple of afternoons with the head paediatric nurse and the pharmacy stores manager poking around in the three different storerooms at the hospital. Lots of good and unexpected things found which will be useful. The remainder of the equipment requires a trip to Addis with the pharmacy stores manager to purchase. Although some things are not available in the country you manage to get most of the vital equipment. (See blog The ongoing building work.)

Step 9: Re-start refurbishment works. Once you finally have the neonatal unit building works completed (work is still ongoing on the bathroom block) start refurbishment work again. Spend a day and a half cleaning – including scrapping years of encrusted dirt off tiles in the old bathroom/new nurse’s station. Keep asking for other refurbishment works to be done. Explain can’t run neonatal unit until the works are completed.

Step 10: Organise staffing. Get the hospital to assign four nurses for the neonatal unit (1 for each shift looking after 10 babies). Try to ensure that you get good nurses who will be willing to learn and deliver good nursing care. Arrange for extra training in currently operating local (8 hours away) neonatal unit. Once they arrive on paediatric ward try to get head paediatric nurse to understand that they need to be scheduled on separate shifts – it doesn’t work if they are all on the same shift. They should not be covering the paediatric ward only the neonatal unit as the whole point is the babies need specialist nursing care with extra observation and monitoring.

Step 11: Give multiple warnings that you are leaving so project needs to be completed. First warning given with a month to go following which multiple warnings are given on a weekly basis. After returning from annual leave with only 10 days until you finish have a frank discussion with CEO expressing concerns that the unit won’t be finished before you go. Then spend three days following people around and repeatedly going back to harass people to get the odd jobs done so the unit is in a state where you can do final cleaning and move equipment into place.

Step 12: Buy floor for the neonatal unit. This actually takes the best part of the week even though it seems like a simple task. You go to the shop and see a good lino covering (thicker than the previous so less likely to tear hopefully). Then get told it will be brought later that day. Continue to go back to the administration/finance department to ask when it is coming. The following day get told that the price is above the market value (but also told it was the cheapest price and can’t get to the bottom of how the market value was reached). Get approval from the CEO for the extra cost. In the afternoon finally get collected and taken off across a muddy square to a different shop from the previous day. The lino is not the same and much thinner lino, which now is cheaper than the price you were told this morning. Go back to the hospital and speak to the CEO explaining the difference in quality and why the thicker flooring is better. Get the ok to buy the better material but told it will take another two days to go through the procurement progress again. Finally loose your temper. Get told they will speed the process if possible. Go on another trip with procurement people in tow to visit all three shops that sell the flooring you want. Get the costs for the correct type of flooring. (Out of interest the same price that you were told that morning). Back to the hospital as it’s the end of the day. Overnight awaiting the decision of the meeting to decide which of the quotes will be accepted. Ask in the morning when will get decision. Told would be two hours. Found by administrator to ask about the sample and if the floor brought could be different. Decided to go along to make sure the right floor brought. Taken back again to the same shop as yesterday and asked about buying the same poorer quality you were shown yesterday! Get pretty angry at this point. Convince them to go to the next cheapest quote shop. Find the flooring needed. Argument from hospital staff about the price with shopkeeper. Discover they’re arguing over 125 birr (£3.70). Offer to pay this to solve the issue but told no, just wait. Eventually the hospital gets the price they want and the floor is brought. In the afternoon fit the floor with the help of the nursing staff. Finally the worker who was meant to fit the floor turns up as you finish in time to glue the floor down. After three days the floor is complete!

Step 13: Final cleaning and organisation. Following the floor being laid co-opt nursing students, nursing staff and ward cleaner to do a final clean of walls and floor of unit (while the floor is still being glued down). Start to then move in equipment, which has been stored in various places around the ward. Make sure that equipment is cleaned before it is moved into nice clean neonatal unit first. Stick up posters of guidelines on the walls and try to remember what other equipment you may have that has been hidden so well you haven’t found it yet. 

Step 14: Find leak into the critical care room. When you go in part way through the organisation of equipment find that there is another leak this time in the roof of the room which will house critical babies. (There had previously been a leak in the roof of the nurse’s station which required fixing.) Since this was found on Saturday have to wait over the weekend and public holiday for Eid before you can inform the hospital management and get it fixed. Surprisingly it’s fixed within two hours of you telling people about it.

Step 15: Open the neonatal unit for business! It’s taken over 10 months to get to this stage and so pleased that it has happened before I leave Ethiopia. This morning we moved babies and mothers into the neonatal unit. Hopefully with good nursing care, from enthusiastic nurses, the outcomes for babies at Axum St Mary hospital will improve. The next blog will contain photos of the functioning neonatal unit. Thank you to everyone that I know who has helped to make this happen through supporting me over the last year as well as donations of money and equipment.

Why you need a four-wheel drive car in rainy season

Over the last week I spent time seeing all of the places in Ethiopia I wanted to visit before heading back to the UK. From Axum I travelled down to Bahir Dar (plane from Gondar and then minibus which limped into Bahir Dar with a broken fuel line causing frequent stoppages in the last section of the journey!) In Bahir Dar, on the edge of Lake Tana (the largest in Ethiopia), I got chance to relax and also see the Blue Nile Falls. They were more chocolate when I saw them and not has spectacular as in the past due to water being diverted for hydroelectricity but it was well worth the short walk. Of note I had the only officially trained female guide in Bahir Dar with me – really good to see women being given opportunities and training in this way.
Following this I headed back up to Gondar for an afternoon of sightseeing at Debre Birhan Selassie church, with wall paintings of the life of Jesus, and the Royal Enclosure which includes a number of castles built by Emperors during the 15th and 16th centuries. The church opposite the hotel didn’t make for a quiet neighbour but luckily I had my trusty earplugs.
The next day I headed up to the Simien Mountains, the roof of Africa and one of the most spectacular places I’ve been. We managed a short walk in amongst the clouds following the drive up. Almost immediately we came across a troop of Gelada baboon, which are only found in the Simiens. They live in massive family groups speaking to each other with about ten different calls creating a range of sounds. You can get so close to them – less than a meter away in some cases. The ground is covered in herbs as well as the grasses eaten by the Geladas. Walking along the scent of thyme is released into the air all around you.
It was lovely to stay at the Simien Lodge in the park (the highest lodge & bar in Africa at 3200m) with hot showers, hot water bottles, open fires and good red wine ☺ I spent a very enjoyable evening with two doctors in Ethiopia on holiday from the UK sharing a bottle of wine.
The following day we set off in the morning aiming to drive further into the park to a waterfall while there were no clouds obstructing the views. This was where the four-wheel drive became necessary! At the first section of deep mud in the road sadly the car got stuck. Luckily there was lots of help on hand from some of the local boys. After much trying the decision was made that the guide, scout and I would get out a walk hoping for the driver to get the car free and catch us up later.
After about an hour of walking with spectacular views of the mountains we saw the welcome sight of the car coming up the road. We drove on through some more deep mud before coming upon a long deep section of mud which wasn’t safe for the car to try. So it was time to get out and walk again. We did make it to the waterfall after a couple of hours. An amazing cascade down 500m of rock made even more impressive following all the recent rain.
After walking up, down and then up again we were met by the driver who had managed to get through, after several trucks and farmers had cleared a path. We managed the drive back down to Gondar without getting stuck again where it was an early night for me tired after my long walk at altitude. The next day it was time to head back to Axum where it is now time for the final push to complete the neonatal unit before I leave Ethiopia.

Two different weekends

With half an eye on coming home to the UK in a little over a month my attention last weekend was split between two events.
Here in Ethiopia all of the VSO Axum volunteers took a trip to Adigrat to visit Helen and Ashley, two of the VSO volunteers there. We got the opportunity to see the paediatric ward there, which is an old army barracks. There is a lot of space compared to Axum hospital and they’re also creating a neonatal unit. I am definitely jealous of the space that they have – all of our unit could fit into one of the rooms they have! The building work is completed for them (ours is still ongoing!) and they had done final cleaning that day. As in Axum there are still some outstanding issues that need to be sorted with the building before equipment can be moved in and the unit start to function. After looking around there was a coffee ceremony for Ashley as she is completing her placement and heading back to the UK. Lots of speeches were given, including a very complimentary one from the hospital CEO, and a beautiful cultural dress was given to her as a present. After the visit to the hospital we had a relaxed weekend with a farewell meal for Ashley combined with an early birthday meal for Helen on Saturday at the local cultural restaurant. We got the Sunday lunchtime minibus back to Axum with lots of twists and turns, unscheduled stops and passengers vomiting it was an enjoyable journey as always!

Leaving meal for Ashley & birthday meal for Helen at the cultural restaurant

Leaving meal for Ashley & birthday meal for Helen at the cultural restaurant

Back in the UK though I was missing out on all the fun of the Tour de France in Yorkshire. The Tour passed by the bottom of my parent’s street on the Sunday so there was a family party weekend at their house The ‘Hello Hello’ theme, yellow bikes and bunting created a party atmosphere. I got lots of updates and photos of all the action that included late night antics after a gig in Holmfirth I understand 🙂 I really missed being part of the fun there as well as seeing everyone after being here in Ethiopia for a year.
'Hello Hello' theme for the Tour de France weekend in Yorkshire

‘Hello Hello’ theme for the Tour de France weekend in Yorkshire

I’m looking forward to heading back to the UK to take part in all the celebrations and fun that happen with family and friends back home. At the same time I will miss all my friends in Ethiopia and the fun and celebrations we have had here.

The ongoing building work

It seems like it’s been a while since I last updated people on what’s been happening here in Ethiopia. It’s probably because nothing big or exciting has happened but I’ve certainly been busy.

With my flights home now booked it feels like there is a lot still to get done here. Work is progressing on the neonatal unit at the hospital. The building work is ongoing – changing a bathroom into a nurse’s station, putting in viewing windows between the nurse’s station and the two rooms the babies will be in, and also building another bathroom block. There seems to have been very slow progress and what I was told would take 2-3 weeks to complete now seems to have been about 5-6 weeks. It’s the same everywhere I guess – building work always takes longer than the contractor originally says! At least it has given me chance to get the guidelines for the neonatal unit all checked and completed so they will be ready for the opening.

While waiting for the building to be completed the four nursing staff who will run the neonatal unit have been selected by the hospital CEO and Matron. We are sending them to Ayder Referral Hospital in Mekelle for two weeks of training on the neonatal unit there. With two just completing their training the other two are going this weekend. Romil, my fellow volunteer here (a paediatric nurse), has plans for further training on their return to Axum and after the neonatal unit is open.

I also had another trip to Addis a couple of weeks ago for a health forum with all of the VSO health volunteers in Ethiopia. It was great to put faces to names and also find out that we all have faced similar frustrations no matter where we are in the country. Reassuring to know that it’s not just you having a problem! There were lots of positive suggests arising from the discussions which was good to see.

The opportunity of a trip to Addis was also used to buy some equipment for the neonatal unit. After the fantastic stores manager at Axum Hospital, who also took the trip to Addis, had collected quotes from three companies we met the following morning to decide on the cheapest. Following this we headed to the office of the winner where we sat waiting for a while for the manager to appear to allow us to view the equipment requested. After some discussions it was decided that we were better coming back in the afternoon. Since the trip to and from where I was staying involved two line (minibus) taxis across Addis it made for a long day sitting in traffic. In the afternoon though we were able to view some of the equipment and place an order, which will hopefully be delivered next week. (The break did also give me a chance for a cupcake at a western style cupcake café – a regular Addis treat when I’m there 😉 )

This weekend I’m doing what I think will be my final neonatal training course for hospital staff. Another 23 will be trained in newborn care and resuscitation meaning that 83 of around 100 hospital clinical staff in the hospital will now have been trained. Hopefully the neonatal unit building work will be completed soon and we can do final finishing touches and give it a through clean before opening it within the next month.

I’m also keen to fit in some final travelling before I head back to the UK. Still on the list to see are Gondar (one of the ancient capitals of Ethiopia), Bahir Dar (on the edge of Lake Tana), and the Simien mountains. Fingers crossed I can fit everything in in 5 weeks 🙂

Luxury in Ethiopia

Last week the volunteers in Axum went on our travels. With the leaver’s workshop (can’t believe it’s time to start thinking about this already!) in Addis it was a good excuse to explore a bit more of Ethiopia. Claire and I headed down to Hawassa, a town in the SNNPR region 5 hours bus ride south of Addis Ababa. It is so different from the Ethiopia I know here in Axum. Hawassa is on the edge of a lake and is full of lush greenery, birds, hippos, fishermen and not nearly as much dust as Axum.
We treated ourselves to a bit of luxury and stayed at the lakeside Lewi resort. The monkeys around the grounds provided lots of entertainment although you did have to guard your food. Claire was ‘mugged’ after breakfast by one monkey for her banana as we walked back to the room!
Relaxing by the pool provided much needed rest and relaxation.
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The local fish market was a beautiful scene. The fishermen and boys were checking the nets after coming in earlier in the morning and storks were everywhere looking for fish scraps. The boys throw these to them for the tourists but with their scary appearances I didn’t want them getting too close! We also had a wonderful meal and catch up with some other VSO volunteers who are working in Hawassa.
IMG_1876 IMG_1875
After a few days we headed back up to Addis for the workshop and meetings. Following this I decided to stay in Addis for a couple of extra nights and had the treat of staying at the Hilton hotel (thank you soooo much Mum and Dad). More relaxing by the pool happened as well as lots of lovely food. The margaritas were also amazing – the first cocktail since my arrival in Ethiopia.
I have very much enjoyed the luxury and break of the last week and I appreciated it all the more for it being so different from my everyday life here. It has shown me how far the gap between visiting a country and living in a country can sometimes be. Being aware of what is going on outside the hotel and tourist attractions is important and I hope I will continue to be more aware of what is happening in the local communities of places I travel to in the future.
I’m now back in Axum and it’s the final push to get the neonatal unit finished and equipped with the training needed done before I leave for the UK in a couple of months.