The last 2 weeks have gone quickly. I finished my picture leaflets and tried them out on the patients staying in the leprosy house. They all seemed quite amused by it but said they liked the pictures, and seemed to understand what most of them meant! (Addis was translating for me). At the end of the first session with them, they gave me a round of applause! I then said thank you in Amharic, and got another round of applause! Why don’t my London patients do this…?!
There have been a couple of newcomers to the house recently. One really young boy, maybe 16 who already has a collapsed nose and short fingers. He’s pretty chirpy though. Another man who was very upset as he has a totally swollen finger with a long finger bone sticking out the end. He has been in Addis for over a week now and is running out of money. However, he looked a bit perkier in the accommodation, probably because he is being housed and fed, so money worries should have lessened a little, and he now has a medical plan. A final older man has arrived from the country side with bad feet. He often sleeps in the teaching sessions and looks like he needs a bit of TLC – a lot of flies keep landing on him, though even when they land on his face he doesn’t seem to mind.
We have a new leprosy nurse with us now, to make a permanent team of 3. She was moved from a different bit of the hospital (they rotate people every now and again). She’s feisty to say the least! But can be good fun too. Now the nurses take it in turns to teach self care in the newly opened ‘tukul’ (little hut).
I have been broaching my thoughts on self care over the last 2 weeks. I read a rather depressing medical paper set in our hospital which showed that the leprosy patients (despite frequent teaching) don’t have a good understanding of their disease, and most of them do not perform self care (soaking feet, protecting hands and eyes etc.) well at all. One day I dropped the bombshell of the research results. The poor nurses were quite shocked, as they are the ones that provide the teaching. I stressed that I wasn’t criticising the teaching, but perhaps there are other things we could do as well?
Over the last two weeks we started making changes to the teaching of the patients in the leprosy house – encouraging the patients to tell us what they know (so holes in knowledge can be addressed), using the pictures to help and finally we persuaded one quite confident man to stand up and teach his fellow leprosy sufferers! Apparently he did a good job (as usual, I couldn’t understand!).
It was really nice to see the patients embracing it, but also my nursing colleagues. I can see it could be difficult having a foreigner come in and try to change things, even though it was the hospital that requested the change. But they rose to the challenge, and there was a lot more patient interaction. I also tried to encourage the staff to critically question the patients e.g. ‘your feet look quite dry – are you having difficulty soaking/oiling them?’ It transpired that whilst it was originally assumed all patients were soaking their feet every day, only 7/17 had a bucket in which to soak them. We are now going to push for buckets to be provided for everyone so they don’t have to buy them (as they are extremely poor).
We also made a video of a nurse/social worker leading a self care teaching session with us pretending to be patients. She will be retiring soon and we wanted to capture her style! It was quite fun. I soaked my feet in a tiny bucket (the only one I could easily find) and ‘vaselined’ my feet with Cowshed moisturiser (present from a former colleague – I forgot to go and find some vaseline!)
I have also finished my health care worker leaflet which explains about leprosy. I always find with leaflets and presentations that you can whack the whole thing out in a couple of hours, but the editing, corrections and formatting take about a week! Slightly annoying!
I also had another visit to ulcer clinic with a colleague that can translate between Amharic and English excellently. I discovered so much more about the patients! How I wish I could learn a language in a week, it would make life very easy! The man that runs ulcer clinic seems to be coming round to my ideas too, which is nice, though he still doesn’t understand me very well, and I don’t think it’s as simple as a language barrier! However, he humoured me and got a bunch of patients all soaking their feet in buckets outside. I say feet, really I should say foot – they only did one each… It’s a start though!
On my last day I ended up doing 4 presentations! One about my time at the hospital, which I then had to repeat as a key person had been tied up in clinic, then one about travel medicine to a private clinic that one of the doctors works at (I also got a free fish lunch there so that was nice!) and practiced the one I will do in London on a colleague. I was all talked out by the end!
Panic set into Addis on my last day though as they got the first coronavirus case in Ethiopia. The american school decided to close for 5 weeks (for reasons that remain a mystery) and I’ve never heard so many coronavirus phone calls in 10 minutes! I’m surprised the lines didn’t jam, and that was only in the dermatology department!
On my last afternoon I went to hang out with the dermatology girls, who had very sweetly made me lunch, and tea (as they had heard I’m still not keen on coffee- probably a good thing, theirs made my sternum twitch for 8 hours last time they gave me some!). We had a delicious salad with injera and wat (spicy lentil sauce). It was pretty good, though I had already had a fish lunch at the private clinic, so this was lunch number 2! And when you are the guest you are always expected to eat the most…
In my final week I also paid a visit to the fistula hospital. There is a book about which I read when I arrived here ‘The hospital by the river’ by Catherine Hamlin. Catherine and her husband Reg were Australian Christian obs and gynae surgeons who moved to Ethiopia on a short contract (but never left) providing maternity services in Addis Ababa in 1959. They realised how many women had fistulas (obstructed labour causing holes in bladder, uterus and rectum leading to incontinence for life) and set about trying to fix them. Fast forward 60 years: they built a hospital, survived the communist regime, set up several other hospitals around the country, started a midwifery school, fixed 60,000 fistulas, Catherine wrote a book, got her name on a bank and won millions of medical awards. She still lives on site aged 96 (Reg died quite a while ago), and apparently supervised surgery until she was 92! They are much loved by Ethiopia and are/were some of the most experienced fistula surgeons in the world (its very uncommon in the west). The hospital was amazing- light, airy, clean and full of flowers and trees. Apparently this was because Catherine likes gardening, but also wanted to make it seem like a ‘home from home’ for the rural patients who are used to lots of trees. Patients get a new dress, and donated patchwork blankets from all over the world. They are the happiest looking patients I have ever seen! You should definitely read the book.
I have had many a happy moment with my closest colleagues at work – I will really miss them when I go. They have taught me about Ethiopian culture, fed me and watered me. They are all entertaining, and great nurses. We had a discussion about men on one my last days – what traits in men are considered attractive to women. One colleague said that money is considered important, it is not popular (as a woman) to have a husband who earns less than you. When I asked my colleagues what they liked in a man (both are married), one replied she likes a tall man who behaves well, and the other said she likes a man with big lips who is good at using a hoe! It took some time to get that sentence across the language barrier…
Anna’s adventures 