Mothers of Africa in Ethiopia
Cardiff University and NHS departments of Anaesthesia have set up a charity called ‘Mothers of Africa’ in response to the appalling maternal mortality figures in Sub Sahara Africa. Paul Clyburn and Jill Curtis describe their visit to Ethiopia.
Jill Curtis doing some hands on teaching in Ethiopia
Mothers of Africa is a charity that has been set up by Cardiff University and NHS departments of Anaesthesia , in response to the appalling maternal mortality figures in sub Sahara Africa. In an effort to create further educational links for Mothers of Africa, we contacted one such charity: The Ethiopia Gwent Link which is based in Neville Hall Hospital, Abergavenny. The Gwent Link sends teams to Ethiopia for 10 to 14 days, once or twice a year.
On a Friday evening in late October, Jill Curtis and I arrived in Heathrow to meet eight members of the Gwent Link and catch the Air Ethiopia flight to Addis Ababa. As well as the usual battered cases, there were large boxes containing all sorts of medical equipment. We met up with Nick, a BBC reporter who was accompanying us to make a documentary for BBC Wales.
Our journey started well and I was impressed by the good quality of the roads which with low levels of motorised traffic (but loads of donkey carts) allowed our driver to put his foot down. I quickly changed my view on the good progress we were making when, while travelling at over 100 kph along a straight road, we suffered a frightening tyre blow-out. Several hours later, we were glad to arrive at Hawassa.
The hospital in Hawassa is the teaching hospital for Southern Ethiopia. Despite this role, it is not a busy hospital and there are no tertiary services. Most of the wards have not yet been commissioned, a good thing as the road to the hospital is unfinished. It is also built on the shore of the picturesque but malaria infested lake. Although it is a nice new building with beautiful gardens, inside it is dirty and neglected. Much of the donated equipment is unused, either because of lack of knowledge and skills or the inability to repair things that breakdown. The sterile supply unit appeared well equipped with four rather impressive (donated) autoclaves until we found that only one had ever worked and when it broke down, surgery had to stop until it could be fixed.
The Gwent Link had organised two 5-day courses running in parallel: one for midwives and the other for health officers. The midwives usually work alone or in pairs in isolated health centres managing difficult deliveries in the local community and have little opportunity for ongoing education and training. Jill and I helped Kyle Jacques, an Accident and Emergency staff grade in Neville Hall, with the health officers course. As the health officers are also the more senior staff at a health centre and have to deal with trauma and surgical emergencies, we taught Advanced Trauma Life Support ( ATLS) type skills.
One evening in Hawassa, we accompanied Dr Yiffrou, Obstetrician and Dean of the Medical School, into the hospital to deal with an emergency. There, we encountered a very shocked young woman with a diagnosed ruptured uterus. She was having her fourth child and had been labouring at home for several days. When she became sick, her family, borrowing a neighbour’s donkey cart, carried her 10 km or so to the local health centre. Fortunately for her, she was managed by an experienced team including an anaesthetic nurse and a skilful obstetrician. Despite the absence of a recovery or level 2 or 3 care, she survived. But for every woman like her, four others fail to get to hospital and die at home or on the road.
As well as the three working in Hawassa, we met several others when we visited Yirga Alem, a busy hospital about 2 hours south of Hawassa and Dila hospital, an hour further south. We were able to observe the anaesthetic nurses at work and did some basic teaching as they were keen to learn. They administer spinal anaesthesia but are hampered by a poor supply of needles and local anaesthetic solutions.
Overall, we had an interesting and rewarding trip to Ethiopia. We learned a lot from collaborating with the Gwent Link and gained further insight into medical problems in sub Saharan Africa. Most importantly, we have established a useful contact with Dr Yiffrou who, as Dean of the medical school, is motivated and well placed to assist in educational projects in Southern Ethiopia. We intend returning with the Gwent Link to Hawassa next autumn and run our own course aimed at anaesthetic nurses from throughout the region. I only hope that on the next visit, we have a more sedate and careful minibus driver!