Before I tell you about the unusual clinics I have done this week let me update you on Yalew, briefly describe a home visit, and mention an exciting occurrence.
An Exciting Occurrence
Dorinda, a nurse/midwife from New Zealand, returned from a stay in the UK this week and brought me two packets of Sainsbury's "Taste The Difference" dry-cured free-range back bacon. You wouldn't believe the excitement twelve rashers of quality bacon could cause. Yesterday's breakfast was the best ever. Safe to say that pig did not die in vain. And Dorinda came as close as anyone I have met in a long time (to whom I am not married) to getting a spontaneous hug.
Thank you to those of you who have asked after Yalew and thank you for praying for him. He's much better, up and about, smiling and talking again. I have met him on a couple of occasions since the accident. He has greeted me warmly, with a big smile, a typical Ethiopian handshake (which involves a shoulder each - ask me to demonstrate when I see you) and a hug. According to him I am a "bat'am conjo sow" - nothing to do with pigs, it loosely translates to "you're a great guy". He continues to be supported by the Horizon project here at Bingham.
I almost blogged about Gezahegn last week as I had had to do a home visit, but felt it was all a bit too sensitive. However things changed this week and I feel I should briefly share his story. Gezahegn was a 38 year old SIM employee with terminal liver cancer, caused by hepatitis B, diagnosed a few months before I arrived here. Carolyn, a SIM missionary of some 40 years standing introduced me to him a short while ago, and last week asked me to see him at home as he was getting weaker and was very chesty. We had had awful trouble getting him some morphine for his pain but had succeeded via a hospice service. It took us nearly an hour to drive to his home in the back streets down a rough track where we were greeted by his young wife Abiyot and two small children. She made us coffee the traditional way so we knew we were going to be there some time. Gezahegn was on the floor in the sitting room on a mattress, weak with a raging chest infection. His brother was there from the Kafa area way out of Addis south west, and wanted to take Gezahegn back with him to his family home. There was more to this urge than simply the love of a close family. They felt that a "traditional healer" could try some "herbal" medicine as this was reputed to cure illnesses like Gezahegn's although it would cause a lot of vomiting and diarrhoea. Also, were Gezahegn to die in Addis the bureaucracy and cost of transporting a body would be so prohibitive he would have to be buried here. I advised against travelling as he was so weak, treated his chest infection and his pain, and after some lovely coffee Carolyn stood and prayed for him, Abiyot and the children. I left knowing I wouldn't see Gezahegn again. He did go back to the Kafa area, and this time Abiyot and the children went with him. They got as far as the end of the metalled roads where they stopped for a few days, and it was there Gezahegn died. His family came to get him, and carried his body for two hours on foot back to his family home and his final resting place. Abiyot and the children will come back to Addis Ababa soon. Carolyn will do her best to help her but there are no Social Workers, no benefits to claim, no NHS, no bereavement counsellors and no widow's pension. She can't afford the rent now. Please pray for Abiyot.
In 2006 I visited a project based near SIM HQ in a desperately poor neighbourhood that was addressing the needs of people with HIV/AIDS. It left a lasting impression on me and I was keen to get involved with it again if at all possible. This week offered an opportunity to join a team of doctors and nurses from the US who were here for two weeks to do some community clinics as part of this project. I joined them on Tuesday and Wednesday as they were short of a doctor. On Tuesday we were in the back streets around HQ in a small facility the project owns that had been turned into a temporary clinic. I consulted at a table with a translator in the same room as another doctor and a nurse practitioner both doing the same thing with their own translators. Patients queued outside and were "triaged" by two nurses first. We saw over 70 people that day. There was a room put aside for us to share with an old bed to use as an examination couch but it had no windows, no light (not strictly true - there was a light but it didn't work) and no door - it opened on to a small back yard thronging with people. A makeshift curtain appeared eventually and provided rudimentary privacy. On Wednesday we went out of Addis to a community centred on a cobblestone factory where people work all day hacking cobblestones out of big rocks for the princely sum of 6.7p a pop. If they work hard they can make about £8 a day. Here we consulted in an edifice used as a church made of wooden poles, corrugated metal and plastic sheeting. I'll tell you about three people I saw on Tuesday.
I was quite nervous sitting with my translator waiting for my first patient. When she was led towards me by a friend supporting her I thought she was probably dying. Thin, weak, wizened beyond her 60 or so years, barely able to walk, jaundiced, and with a swollen abdomen . 15 minutes later I knew she was dying. She was in terminal liver failure probably from cirrhosis caused by hepatitis B. Further investigation would be academic. I gave her some pain relief and the local pastor prayed with her. The project will try to give her some support, but she will die soon. The reason? In the course of her medical "care" many years ago she may well have been injected with a dirty needle. She's now paying the price.
A lady in her 40s wanted a further opinion about a tumour on her back. She had a warm smooth hemispherical swelling the size of half a melon over her right shoulder blade extending over her shoulder with another lump above her right collar bone. This had been present and worsening for 5 years. She had been to a local hospital (Addis's biggest government teaching hospital) on several occasions over a long time. They had offered surgery then withdrawn it; they had offered radiotherapy then withdrawn it. They needled it, and discharged her. She has no idea what it is and no plan to manage it exists. While it's not really painful, it seriously affects the movement of her right arm and shoulder. None of us could arrive at a conclusion partly because it was so odd and partly because we had no way to access any records of her previous investigations.. Hopefully she will follow our advice and go the Korean Christian hospital where imaging and testing will be done properly and she will be treated appropriately. Poor Ethiopians get woefully inadequate management sometimes. If I ever find out what this was I'll let you know.
Finally, a 40 year old came and complained about itching. She had a rash all over her lower legs and wet boggy toes. Her old, very poor quality footwear was worsening the toes and the skin was coming off. I looked her over, and concluded this was an infection needing an antibiotic, nursing care, dressings and better footwear. I asked the project manager if he could help her. He came and spoke to her and she burst into tears. I asked what was wrong. She told me her father was dead; her mother had recently died; she was childless and had no support and no-one to care for her. She couldn't afford new footwear. I sat with her as she wept, and felt overwhelmed by the poverty, loneliness and sorrow this sad lady lived with day in, day out. Perhaps I could cure her infection, but not her broken heart. The pastor prayed with her. As you read this, try to imagine her life. Maybe, like I did, you will feel like weeping with her.