No Fireworks Firework Night

Poor Guy. Every year...It’s a regular annual event at Bingham to tell our bemused non-British staff, especially the new arrivals, that every year for the last 400 years or so on 5th November the British burn effigies of a Catholic terrorist, set off fireworks and eat soup.

So, as a practical demonstration of this strangest of UK celebrations last night at a compound gathering we burned an effigy of a Catholic terrorist, ate a great deal of soup, but didn’t set off any fireworks. We couldn’t - because the police told us not to. It appears that when you live in a country under a “State of Emergency”, burning effigies is OK, but setting off fireworks definitely isn’t.

Oddly though, fireworks are not mentioned in the “Directive for the Execution of the State of Emergency” issued by the Ethiopian Government’s “Command Post” on 15th October. An awful lot of other stuff is though. Like writing anything that disagrees with the government, watching certain satellite TV channels, or reading their websites. You could be in a lot of trouble doing pretty much anything that upsets anyone else. If you suffer from insomnia, read the whole thing here.

The Ethiopian Prime MinisterApart from a pretty tight restriction on travelling out of Addis (and not being allowed sparklers) Chris and I have not really been affected by the first “State of Emergency” to be declared in this country for 25 years. The Prime Minister, Hailemariam Desalegn, is trying to prevent further anti-government and inter-ethnic protests such as the one Chris and I narrowly missed a month ago. In addition to the State of Emergency and as an apparently conciliatory measure he’s also done a major cabinet reshuffle this week, bringing in (amongst 14 other new faces) a new Minister of Health. I’d quite like to meet the new Minister of Health, because yet again my clinic finds itself in a spot of bureaucratic bother.

Our lovely clean clinicThe SIM HQ Clinic is officially a “Medium Clinic”. That means we have to provide a wide range of primary care services (which we do), and we should do all our own blood tests on site with our own lab technician (which we don’t). In a similar way to all 8000 GP practices in the UK we very successfully outsource our lab tests to a professional lab (ICL) where we get an excellent (in an Ethiopian sense) service, and timely results. We can get complex unusual tests done via Germany; like the hepatitis C virus genotyping test I did on someone last week. I doubt any other “Medium Clinic” can do that! But to be relicensed for another year (something my resident’s ID depends on), we are told we have to do our own tests on site, with our own lab technician. Putting aside the fact that we currently provide a far better service for blood tests than any other “Medium Clinic”; that we have no room available; that we can’t afford all those staff and machines; that we do no more than 4 tests a day; that we can never do the same quality tests as ICL does - putting all that aside, unless we start doing it we won’t be relicensed, so I can’t have a resident’s ID. And that’s after a very successful inspection by a couple of sensible people from the Ministry of Health who could clearly see we do a very good job. Despite being the only doctor they have ever met who has a tuning fork (it’s on their list of necessary clinic equipment) unless we tick this particular “on site lab test” box on the list of “standards” it doesn’t matter how much we exceed that standard or how excellent everything else is, we’re in trouble.

So, despite being one of the best clinics in the city and in a bureaucratic flurry of concern for process over quality, the SIM HQ Clinic is again under threat of being downgraded or even closed. Several of us will go for a meeting at the Ministry of Health on Monday 7th November to see if we can gently persuade. I’ll put a tie on. That’ll show them.


Good luck Phil - the lucky tie and your winning negotiating skills should hopefully get them to see sense!  Sometimes it's safer and more efficient to let another service do what they are best at.  Hope it all goes well.  

I haven't been anywhere with a guy for the bonfire as long as I remember. However our new (ish) neighbourhood are really keen on fireworks we discovered last night. And yet the kids slept through it!


Can you argue that you are providing the service - but through outsourcing? [

Although outsourcing has been around as long as work specialization has existed, in recent history, companies began employing the outsourcing model to carry out narrow functions, such as payroll, billing and data entry. Those processes could be done more efficiently, and therefore more cost-effectively, by other companies with specialized tools and facilities and specially trained personnel.In 2014, the global market size of outsourced services was 104.6 billion U.S. dollars, the highest point to date. Currently, outsourcing takes many forms. Organizations still hire service providers to handle distinct business processes, such as benefits management. But some organizations outsource whole operations. The most common forms are information technology outsourcing (ITO) and business process outsourcing (BPO).. Tell them you are using BPO - that should floor em.




Oh my goodness, that is so silly. Really hope they see how good the outsourcing is! But in a system which is no where near logical, all we can do is pray!

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