Tuesday, December 17, 2013

Moeilijke keuzes...

Door Floris Braat.

De afgelopen week was het druk op de verloskamers. Elke dag meer dan zes bevallingen. Gelukkig is ook hier het merendeel ongecompliceerd, maar er zijn momenten dat het lastig is om de goede keuzes te maken. Zo nam ik afgelopen vrijdag in de namiddag twee vrouwen op. Een vrouw voelde al drie dagen geen leven, terwijl dat daarvoor meerdere keren per dag was. Op de echo was het kind klein, maximaal 32 weken oud en vrijwel geen vruchtwater. De hartslag van het kindje was goed. Ik besluit om de moeder een medicijn te geven om de longen van het kindje voor te bereiden op een vervroegde bevalling.

Een tweede opname was een vrouw met zwangerschapsvergiftiging, te hoge bloeddruk en eiwit in de urine. Het kindje was ongeveer 37 weken oud, had geen afwijkingen op de echo en een normale hartslag. We stabiliseren de moeder met het medicijn magnesiumsulfaat dat hier goed verkrijgbaar is en geven een ander middel om weeën te maken.

De volgende ochtend kom ik op de afdeling en hoor ik dat beide kindjes zijn overleden........ Een moeilijk moment. Hadden we het anders kunnen doen? We verliezen hier regelmatig kinderen omdat het moeilijk is om de conditie van de ongeboren kinderen in te schatten.

In Nederland maak je in beide gevallen een continue registratie van de hartslag een zogenoemde CTG registratie. Dat is hier niet beschikbaar. Een ander punt is dat dergelijke gevallen hier gewoon op de afdeling terecht komen. Er zijn twee verpleegkundigen die zeer bekwaam zijn, maar ze moeten wel de hele “ward” in de gaten houden. In Nederland worden dergelijke zieke mensen of kwetsbare zwangerschappen zeer nauwlettend ongeveer een op een in de gaten gehouden. Tevens is een arts continu aanwezig op een dergelijke afdeling. Het onderstreept nogmaals de grote verschillen tussen de setting in de ontwikkelde en de ontwikkelingslanden.

Dagen waarop zulke problematiek zich voordoet zijn lastig. Ik vraag me af of ik het had kunnen voorkomen. Had ik toch direct een keizersnede moeten doen? In beide gevallen denk ik van niet. In het geval van het eerste kindje waren de overlevingskansen in deze setting minimaal geweest. Het geboortegewicht was erg laag en er zijn hier beperkte opvangmogelijkheden voor prematuren. In het tweede geval is het risico voor de moeder groot als je direct een keizersnede doet, na enkele uren stabiliseren is dat wel mogelijk. Er was echter geen aanwijzing bekend dat het kindje in nood was.

Zulke problemen geven me soms een gevoel van machteloosheid. Toch zie ik ook de zaken die wel goed gaan. Ethiopië is volop in ontwikkeling. De belangrijkste medicatie is voorhanden en we maken in het ziekenhuis gebruik van de mogelijkheden die we hebben. De afgelopen maanden is er nog geen moeder tijdens of vlak na de bevalling overleden en dat is zeker een noemenswaardige prestatie van het hele team hier. Zeker dat laatste maakt me trots om hier te werken en bij te dragen aan het reduceren van de moeder- en kindersterfte.

Wednesday, December 11, 2013

Weekend in Addis / temporary job opening / Milestones Maternity Waiting Home

Sinterklaasje, kom maar naar Ethiopie met je knecht…
Sinterklaas arrived in Addis at the Dutch school with a VW bug with de “Pieten” following in a bajaj, the Ethiopian tuk tuk. Elin slept through most of the celebration, but Merlijn loved it, though in awe of this old man with a long beard, high red hat and cape. His favorite helper of Sinterklaas, was the cuddle Piet (knuffel Piet) who said that she was happy that Merlijn came. Merlijn was still talking about that one sentence the entire next day. See the pictures below.
Stubbornness led to long search
Finding a nice hotel in Addis is not easy, partly because the city’s infrastructure and traffic are currently a nightmare. To give you an idea: we had to put on our 4WD part of the way. We do admire the vision behind it to build a subway/railway system throughout Addis. As for the hotels, they are either out of our budget, overpriced or somewhat grimy. We had stayed at a nice hotel last time, but when we came back they charged us $5 extra. Somehow the conservation ended with both the manager and us being stubborn, and us wandering around town to find another place and ending up paying $5 more than what the previous hotel had asked. After some thorough searching we found a lovely place to stay, Jazly Bed & Breakfast, with comfy rooms, delicious food and the friendliest staff. Definitely a recommendation if you are staying in Addis. Still out of our budget, but Addis is not the place to be on a volunteer allowance: too many possibilities of living a luxury life.
Patient in Addis
People in Addis seem to spend a lot of time waiting: in a traffic jam, at the Commercial Bank of Ethiopia that doesn’t seem so commercial, in line for a minibus, or waiting to see a doctor while being preached at by Korean television. I did all the waiting, except for the minibus, I decided to walk. It’s interesting what waiting does to a person, from agitation to complete relaxation, from meeting interesting people to wandering off in your own mind. Waiting at the Korean Hospital was interesting: feeling a bit vulnerable myself I could only imagine how the people who looked a lot worse off than me were feeling. My conclusion: being sick is not a good idea in Ethiopia, you need good genes and/or money to survive over the life expectancy of 59 years (World Bank, 2011). Despite this line of thought, I was impressed by the organization of the patient flow and the helpfulness of most of the staff. *
Milestones: Maternity Waiting Home
Milestone 1: yesterday, we received an email from the Tilly and Albert Waaijer Foundation that our request for 50% of the construction costs was accepted by the board!!!
Milestone 2: the FlorentinaFoundation is organizing a one-week Support Trip at the end of March/beginning of April to help physically and financially to build the Maternity Waiting Home. If they come with a group of 15 people, we have secured the funds for the construction. If you are interested to join, please let me know, I will send you the letter.

Milestone 3: VSO The Netherlands will donate 5,000 euro for the monitoring and evaluation of the project if we organize it through a third party, to ensure continuity and objectivity.
In the next two months, we aim to raise funds for and prepare the baseline study and community work for the project, and start planning the construction. 
In sum, quite a lot of work to do… and no nanny! Roza was operated on and needs to recover for at least the next two weeks. Any one interested in doing some babysitting in Ethiopia?

*) For those of you that want to know: I was feeling rather good the past week, after deciding to do the cooking myself and baking bread every day. When I got to Addis, I became sick again. The conclusion of both the Korean Hospital and the Haven Ziekenhuis in Rotterdam is that my intestines are oversensitive at the moment, as a result of being sick so often and the antibiotics. The next three weeks should be “zero exposure” to see if my health improves.

Wednesday, December 4, 2013

Did you know that...?

·       We’ve been in Ethiopia for 4 months and 1 week.
·       We often forget that we are living at 2,100 meters, higher than most ski resorts in Europe.
·       Ethiopians often ask: “How do you find the air-conditioning?”. We think they mean the weather / air.
·       If our cock does not wake us at 5 or 6 am, the Mosque or the Orthodox Church will do by chanting across town.
·       We eat peanut butter and/or honey sandwiches every morning on white French-like buns.
·       I’ve started baking whole wheat bread in an oven that looks like an UFO.
·       We often have a horse grazing in front of our house at sunset, which gives me the Pippy Longstocking feeling.
·       Merlijn can now imitate how a horse pees.
·       We don’t have a washing machine, but our laundry is cleaner than in the Netherlands (thank you Yetm, sorry Robert Bouten, who has our old washing machine).
·       Every one is afraid of dogs in Butajira, even sweet little puppies (how weird we Westerners are to keep dogs as pets).
·       Ethiopia also has autumn and wintertime. First brown leaves fell from the trees and last night, we had to add an extra blanket to our bed to stay warm. Days however are still about 25-30 degrees, so we’re not complaining.
·       Coffee is a BIG thing in Ethiopia. A coffee ceremony follows strict rules and can last for hours.
·       The children in our street have (mostly) stopped running up to us when we step out the door. Merlijn even played soccer with them last week, they were really sweet to him but he still finds it a bit overwhelming.
·       When two of the little boys in our street ran up to our car, Merlijn said: “there’s Money and Money again”. (Children sometimes say “money, money” when they see us. When I am in a good mood, I think positively that they are practicing the only English they know).
·       Merlijn knows the word “dirty” in English, Dutch and Amharic; he prefers the English version.
·       Elin is a real “Habesha” (Ethiopian), see the picture.
·       The biggest bank note Ethiopia has is 100 birr (4 euro). Imagine the size of bag you need when you pay for a car in cash.
·       At the bank, the same old lady with reading glasses is endlessly counting money with a whole pile of money around her like Scrooge McDuck.
·       This whole Ethiopian experience is a big challenge, but also rewarding and a great learning experience.
About our work with VSO at Butajira Hospital, did you know that:
·       Every year, nearly 3 million babies die within the first month of life, most from preventable causes. More than a third of these babies die on their first day of life – making the birth day the riskiest day for newborns and mothers almost everywhere.
·       This is especially true in developing countries, where 99% of global maternal deaths occur.
·       90% of Ethiopian women deliver at home, with the help of a relative or traditional birth attendant.
·       It is proven that skilled birth attendance can prevent most maternal and neonatal deaths.
·       That’s why we want to set up a Maternity Waiting Home here in Southern Ethiopia, where pregnant women with high risk or those who live far away can await birth during the last weeks of their pregnancy.
·       We are currently fundraising for the project. With some more perseverance from our side and good will from NGO’s, we hope to soon have between 10,000 and 15,000 Euro available for the project, which is 35% - 50% of the required funds.

Monday, December 2, 2013

Take a short tour of our "redecorated" house in Butajira

Take a short tour of our lovely house, now so much nicer to live in thanks to gifts from our great friends and family. It still might look quite basic, but we feel at home. Luna is now part of the family, one of the chicken seems to be broody, I haven't been sick for over a week, and Merlijn has found a play friend in "Fikir" (which means Love), the cutest 3-year old. She is the daughter of one of the nurses at the hospital, who also has a 1-year old girl that Elin can play with. And coming week, we are going to Addis to see Sinterklaas! All in all, life has been good to us these past weeks :-). More news soon, so stay tuned ;-).