Aira Hospital

Medical work is never boring. Never is one day like the other.

Sunday we had a visitor from the German Embassy in Addis Abeba. The embassy has supported the hospital with vital monitoring equipment for the operating theater and it was a great pleasure to show the third secretary from the embassy around the hospital.

Unfortunately the wards were half empty with not many patients around. It is said that people are too busy with the coffee harvest to get sick and come to the hospital.

Only two days later the wards are full again. In particular the maternity where some patients are admitted on stretchers because all the beds are occupied.

This night we did 6 cesareans on women with complicated deliveries referred from different clinics.

One of the referral letters was very long and detailed. The closing words were “women should never die” (giving childbirth) written by a male nurse (the profession as nurse is male dominated by tradition).

Another fine example of how the Ethiopian male shows concern for the opposite sex - contradicting the common but untrue picture of the Ethiopian man as chronic woman abuser/oppressor.

6 times up in the night doing cesareans is really not for an old man like me. Today I am tired and the blog is short.

Rainy season and New Year approaching means less patients at OPD and in the wards

Even emergencies are less. This is due to the fact that when bringing critical sick to the hospital often a “helicopter” is needed. That is the local name for a bed carried on sticks by four men. Depending on the distance from the hospital 3 to 4 groups of four men will be needed to carry the “helicopter”. At important holidays that may be difficult to arrange. Not infrequent patients will then arrive later in even worse condition - if they survived the holidays that is.

One lady who claims to be 25 years old came in the night with prolonged and obstructed labor. She had a routine Cesarean with a live baby and that could have been the end of the story.

In the morning however we took time to listen to her as she disclosed the full story. The pregnancy was here 7’Th in a row – all previous 6 pregnancies had ended with stillbirth at home. She is living around Dessie in Wollo province. Take a look at the map!

A sister to her has been resettled in Wollega, and is living only one hour’s drive with car from Aira. The sister, apparently a dynamic person, persuaded her to come and have the baby here at the hospital. Although they came a bit late due to difficulties to find transportation in the night, the end was happy. She got a beautiful and healthy baby.

VIDEO ← click here for video

Had she attended the hospital’s antenatal clinic however she would immediately have been classified as a “risk mother” (and the baby as a “precious baby”) and told to stay at the hospital’s guest house for immediate access to the hospital’s service.

For all the abstract NGO sweet talk about “empowering women, preventive health care with focus on mothers and children and blah…… “again this hospital achieved a very concrete result for this woman who finally got that live baby she had been longing for. Why is that despised by NGOs which do not find our work worth to support?

Remember that a cesarean is a preventive measure! It prevents maternal and infant mortality and morbidity. In fact the hospital is doing a lot of preventive health care. Why is that so difficult to understand?

I will be back!

We are expecting the spare parts to arrive today from Addis Abeba. If God is willing we might be able to repair the sterilizer at least temporarily so that we can be back on the track with surgical activities as before.

This night we did a Cesarean on a woman who came in the last minute with obstructed labor. The uterus was on the verge of rupture with a tense Bandl’s ring (a sign of impending rupture). The nurse in charge thought she could hear faint fetal heart beats. We did not waste time to check with ultrasound since there was no electricity and it takes too long time to get the generator started.

The relief was great when a live baby was delivered – the nurse ululated of joy!

As the procedure was done in a hurry the assistant – Adei Tsehaye (Mamma Sunshine) – got injured by the needle. The fear is always contamination with HIV.

Some time ago we had a visiting gynecologist from Sweden who was particular worried by that risk. We started then to screen all surgical patients in the operating room before surgery. The test takes only a couple of minutes and you have the result instantaneously. After screening more than 1000 with only one patient testing positive we have stopped the screening.

Now we only test in case of incidents like the above. The patient tested negative as expected - another sight of relief that night.

Mother and child are doing fine this first day after surgery.

Rabia, the lady with Siamese twins from yesterday, is doing fine and could be discharged. However she and her husband want to have tubal ligation (sterilization) done, so she will stay until Monday and have it done before returning home. They are happy with the two healthy children they already have. Surprisingly many couples have a modern approach to family planning, and settle with only two or three children.

While visiting her during the round in the morning, I found the roommate sleeping on the floor. That lady had previously one stillbirth, and now she had a successful surgery for a ruptured uterus with another dead fetus. She is in fact discharged, but since she stayed in the hospital longer than usual, the bill went up to 800 birr (60€). At arrival the husband made a deposit of 500 birr, and the remaining 300 birr (20€) they could not pay. Many patients are trying to run away from the bill - even those who can afford to pay- so the staff is forced to be very strict and a bit tough. Trying to squeeze the couple for additional money, they let her sleep on the floor and will not give out her private clothing. In fact she is kept as hostage. Many times it works, and hidden money comes into light. This couple however is poor, and 500 birr is a lot of money for them. They also face further expenses since the only way to get a live baby is to have a cesarean. Therefore the 300 birr was covered by the poor fund. When the woman heard the news, she couldn’t believe it at first.

Now it is only to pray, hope and wish that they will return in time for a cesarean next time she is due to deliver.

Holliday again! Today we are celebrating the Moslem holiday Eid Al-Fitr, which marks the end of one month’s fasting, the Ramadan. The holiday is floating without a fixed day. The imams scrutinize the sky, and when the crescent of the moon is sighted at first, the end of Ramadan is pronounced. That is somewhat inconvenient for a busy hospital, not knowing when the holiday will be. Therefore we follow the official calendar of the Mekane Yesus Church, according to which the holiday is today. But actually it was yesterday. Confusing for the patients, when people were off and shops closed yesterday, but the hospital was in full activity. Today patients show up as the rest of the community is in full activity, but we are taking the day off.

At the morning round a child was waiting to be operated for an elbow fracture, but otherwise it was peaceful. The child had been looking after a sheep, and had it attached to the arm by a string. The sheep tried to escape, and he fell, breaking the arm. He was operated in the morning. The fracture was reduced and fixed with two pins. Since we cannot afford the original orthopedic equipment, I have to use ordinary stainless steel wires and cut them sharp at the end. The drill is off course manually operated

The type of fracture (supracondylar humerus fracture) which the boy sustained has a great risk of vascular complications, but he was lucky to avoid that. Not long ago we were forced to amputate the arm of another boy with a similar fracture which was treated wrongly by the “worgesa” - a local bonesetter.

The maternity is busy as always. In average we handle around 1 300 deliveries a year, and we perform around 400 cesareans a year – already during the first 6 months of this year 219 were done. At the moment we have 10 women as inpatients after cesarean.

It is a women’s’ world. All the patients have a mother, a mother-in-law, a sister and other female relatives attending during and after delivery. When both the grandmothers are present, there is often tension and quarreling between them about who should take care of the baby. They will give all kind of good and bad advises to the newly delivered mother, often harmless, but sometimes harmful. One innocent habit is to spread butter on top of the child’s head – smells awful but doesn’t harm.

The fathers are also around, but hey keep a low profile for once.

After a normal delivery the mother will be discharged after a day or earlier, after a cesarean on the third day or earlier. Now when the maternity is becoming full, we have to discharge early, and that is not popular among the newly delivered mothers. This is their only legal opportunity to have some rest for a couple of days – otherwise their days are always filled with hard work from the sun rises to late after it settles.