It’s only Monday and already I feel frustrated and like I’m banging my head against a brick wall. Here is just a sample of two stories from the day.
Last week a 30 week preterm baby was admitted after being born in a local health centre. In contrast to a 31 week baby who was admitted after birth a few weeks ago and stayed hypothermic with respiratory distress until she sadly died at the age of 3 days more resources were available for his care. He was placed under the radiant warmer (to make sure he was kept warm) and started on bubble CPAP (a type of breathing support which I had made following diagrams found on the internet from oxygen tubing and a plastic bottle filled with water connected to an oxygen concentrator). We also started aminophylline to stimulate his breathing. In the UK intravenous caffeine would normally be used (no you can’t get it unless you’re a preterm baby!) but that is not available here. The baby had been doing well and is breathing for himself without any support and tolerating milk feeds down a nasogastric tube. When we checked on Saturday he had started to get a bit jaundiced (not uncommon in preterm babies). Despite trying there were no lamps working to attempt phototherapy (a proper phototherapy machine is a dream in the future) so we did our best by trying to turn him towards the window to catch some sunlight. Unfortunately on Monday despite everything else going well the jaundice was significantly worse. The machine is broken to measure the actual level but the baby was glowing so severely jaundiced! If the jaundice level gets too high there is a risk of brain damage. I asked and referred the baby to the nearest tertiary hospital that could provide treatment to try and prevent this. The hospital is in Mekelle, a 6-8 hour drive away, and the mother had problems getting transport to get there.
Next to that little boy is another girl who was preterm also but about 33-34 weeks. She has an imperforate anus and a fistula so stool was coming out the vagina. Her abdomen had been getting bigger and bigger as there was no outlet. The surgeon at the hospital decided he couldn’t operate after seeing the baby at the weekend. If an operation isn’t done urgently the baby will die. It took me all day asking different people to find out which hospital I could refer the hospital to, the one in Mekelle or straight to one in the capital Addis. Finally after writing the referral at midday at 4pm I found I could refer the baby to Mekelle.
Despite asking I was told there was no hospital transport available for the babies due to no fuel. It was up to the family to make the journey themselves if they could to Mekelle and the hospital there. Discussions and counseling were still happening when I left the ward that evening. When you know that treatment is available and can’t break through all of the barriers to get the patients to the treatment it’s so hard and upsetting when you know a poor outcome could be prevented by early treatment.
Today I went in to the ward and found that both families had left together this morning at 5am to make the journey to Mekelle. I will be crossing my fingers and praying for them both.
The journey began with getting up at 4.45am to walk to the bus station so I was ready for when they opened the gates at dawn. The mad dash across the stony, dusty ground began as soon as the gate opened – everyone desperate to get a seat on the bus. I was directed onto a minibus instead of one of the larger buses that would go on to Mekelle as I wanted to get off at Adigrat. After bargaining on the price, I knew it should be 44 birr he started at 100 and we settled on 50 with me to tell the traffic police I paid 44, I sat and waited for other passengers to board. No one seemed to be joined me with everyone getting on one of the two buses next door so I abandoned my minibus and hopped onto one of the buses which left almost immediately despite not being full. It was an old green single decker bus and the inside was covered in chince curtains with lots of fringe. The aisle was very narrow with barely room for the conductor to squeeze past. The first stop was Adwa where we picked up the rest of the passengers after a long wait around in the bus station.
We travelled through spectacular scenery snaking up and down winding mountain roads. There were smallholdings all along the way with terraced hillsides and crops grown on even the smallest bits of land. Since the rains have only just finished the countryside is still green with the leaves on the trees, cacti and the tef (local grain) in the field. The closer we got to Adigrat the less green it became with the crops further along and some even being harvested and the field tilled as we go closer. Following arriving in Adigrat I took myself down to Eve hotel to wait for Helen and Ashley to finish their morning of work. The journey continued later that afternoon with us all sitting with our luggage in the back of a hospital car. The beautiful scenery continued with the main problem being trying to avoid all of the cattle and donkeys trying to commit suicide by walking in front of the truck. The driver was very good at emergency stops!
On the way back the driver kindly stopped at various points along the way for us to take pictures and pointing out orthodox churches sitting on the top of hills. After a great day spent in Adigrat with Helen and Ashley it was another early get up to catch the bus back to Axum Sunday morning. This time I ended up getting on a minibus, which left when all of the seats were filled. Travel sickness seemed to be more of an issue – it was dealt with by the conductor passing out plastic bags and one guy sticking his head out of the window! As on the way to Adigrat about half way along the road everyone started passing money forward. The bus then stopped and collected a bag full of small balls of soil wrapped in plastic. People then secreted them about their person or rubbed it onto their faces. The soil came from Debre Damo an orthodox monastery which was founded in the 6th centry and only allows male visitors. After a quick and unexpected change of minibus in Adwa I made it back to Axum by 9.30am.