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Saturday, December 3, 2011

A First Hand Look at the Ethiopian Medical System

A preface to this story: About 5 weeks ago, our assistant Ambaye slipped in our driveway and broke his pinky finger. We did what we could to splint it here and gave him some ibuprofen, then took him to the hospital in Debark. This was on a Saturday, and we found out (much to our chagrin) that the hospital is CLOSED on the weekends! What the heck? Luckily our friend Shif knew one of the doctors, and knew that he was watching the soccer game at a local restaurant, so we were able to get Ambaye some care once the soccer game had finished. They set and splinted his finger, but apparently did not tell him he had to leave the splint on. We came back a few days later from our trip to Bahir Dar and he had already taken the splint off. Of course, his finger wasn't healed and we ended up having to take him BACK to the hospital about 10 days ago. I accompanied him on that occasion, and got to see the Ethiopian medical system first hand. Very little sanitation or hygiene of any sort (there was a biohazard trash can with a piece of tape on it that said "Infectious" sitting open in the "emergency room" waiting area, for example), and not the best care. They didn't even bother to x-ray Ambaye's clearly broken finger, they just gave him ibuprofen and told him to go home. *sigh* So that was that.

Then a few days ago, we overheard one of our other assistants, Eshete, talking about how he had gotten a stick stuck under his thumbnail a week or so before, and now his finger was swollen and his arm was hurting. We immediately confronted him about his injury (which he should have told us about!) and found out that he had a high fever, pus coming out from under his thumbnail, and what sounded like the start of a serious systemic infection. We knew he needed some antibiotics STAT, but we didn't have any in our house to give him. After our experience with Ambaye at the hospital, we decided that maybe it would be more effective for one of us to try and get the antibiotics instead of Ambaye. At least we could tell the doctors what exactly we wanted, and it seemed like we would be more likely to get good care since we were white. I had a cut on my hand that was mostly healed, but looked passably infected with the application of some chapstick to the wound. So armed with a tube of chapstick and my most pitiful "help me" expression, Ali and I headed to the hospital. After various half Amharic-half English conversations, I managed to get a registration card (4 birr, and it said my name was Caitlin Paul John) and directions to a general waiting area. Ali and I sat there for about 15 minutes while all the other patients stared at us. We were the only white people anywhere in the building, so I guess we were worth looking at! Eventually, we got called into an exam room with a doctor who spoke a fair amount of English. I showed him my hand and explained that it was an injury from a stick that had gotten infected and that I needed some antibiotics. The funniest moment was when he asked how the injury had occurred. In reality, I cut my hand on a nail that we use to hang potholders on in our kitchen, but I sure as heck didn't want a tetanus shot in a sketchy hospital, so I said it was a stick. At the same time, Ali said "a nail"! Luckily the doctor didn't seem to hear her, or our bluff would definitely have been called. He proceeded to ask me if I had a fever or swelling or anything like that and I proceeded to answer with Eshete's symptoms. In the end, I guess I was convincing enough because he prescribed me two oral antibiotics and an antibiotic topical cream to put on my cut. 70 birr and several confused conversations later, we headed out of the hospital triumphantly! What an adventure.

We've been giving Eshete the antibiotics for the last few days, but they didn't seem to be helping. He came over this morning to tell us that his whole arm hurt, and his heart, and that there was a lot of pus. He was also running a pretty high fever, so Julie drove him to Debark instead of going to work. At the hospital, they prescribed him the same things they had given me, after much pushing from Julie. When she explained that those weren't working, they grudgingly also gave him a shot and some additional pills. Poor guy - he now has to take three pills four times a day! He's such a trooper. You can tell he is in serious pain, but he doesn't complain at all. We are keeping a close eye on him and hopefully he will start improving soon. What a scary situation though! And it makes me sad and scared for the people in this area that don't have knowledgeable white people to advocate for them at the hospital. I'm been super careful to not get injured because I definitely don't want to have to spend any more time in that hospital than necessary!

Outside of the medical drama, there has been some monkey drama as well. One of our oldest, most thoroughly studied units, the C group, started to fission into two units a couple of days ago. The unit had 8 adult females and two adult males - one, Webay, was the former leader male who became follower when he was taken over by the other male, Tequila, about 9 months ago. Apparently Webay decided he'd had enough and took back three of the adult females. So for the last couple of days, there has been lots of fighting, chasing, displaying and noisy mating. Very exciting! Both Tequila and Webay have sustained some pretty serious injuries - Tequila broke his wrist and Webay got his ear and head torn up. Two other males, another leader male Dikos and a young adult male Tangle (who I am following in my study) also joined in the fighting and got injured.

We thought things were pretty settled - Webay had successfully taken Coco, Carmen and Cee, and Tequila had the rest of the females. However, the situation got even more interesting today. Some bachelors showed up (the Condiments group - Ketchup, Relish, Sauerkraut and Onion), noticed the chaos, and decided to capitalize on the turmoil. Apparently, one of them was able to take over Tequila's part of the unit! I didn't actually see that happen, just heard the fighting and saw it from afar, but Ambaye said Tequila had disappeared by mid-morning and that now Ketchup was the leader of Tequila's females. It will be interesting to see if he can hold on to the unit. Apparently a few months ago, Ketchup successful took over a different unit (the Ks) but lost it with a couple of days to another male. I think the injuries the males had acquired before definitely caused problems.... Tequila was the one with the broken wrist, and he apparently couldn't defend his unit very well! It is definitely fascinating to watch. A little scary too, when a bunch of males are chasing each other and run right next to you at top speed! It's neat to see the whole takeover process, particularly when it is with a unit that we know so well! I am curious to see how the juveniles in the C group react and fare over the next few weeks. They are pretty much all past the age when infanticide is a concern, but who knows?

Speaking of infanticide, we had one in another unit earlier this week. The situation started out similarly to the C fission - the M group split into two, with the leader taking part of the unit and the follower taking the rest. However, one of the females with a newborn baby stupidly went with the male that had NOT fathered her child. He killed the baby, and the mother has been carrying the corpse around with her for the last few days. So sad! Very interesting though - I wonder what made her decide to go with that particular male instead of the other male (who was the father of her baby)? Fascinating, but very sad.

Another exciting thing happened today - I got interviewed for Ethiopian television! A small film crew wandered up to me while I was working, and asked if they could ask me some questions for a program they are making about the Simien Mountains. I said sure, and they filmed me and Ambaye! I don't know if it will actually make it onto the tv, but it was a pretty random and funny experience!

That's the news from up here! It's hard to believe that it's already December. I've been here for three months already! In less than two weeks, my family and Sam and Ruth will be arriving and we're going on vacation for a few weeks! I can't wait. It will be a nice change of pace from working, and a great opportunity to see some more of Ethiopia! Happy December to all of you - hope the holiday season is off to a good start back home!

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