Time for another update. This time about the working conditions here.
The hospital where we are teaching was built 60 years ago, and looks like it has not seen a coat of paint since. To call it decrepit is to insult decrepitude. It has not been maintained at all. There are lights missing, toilets not working, elevators not working. If this was Baragwanath in the days when I worked there it would be unacceptable. But here they put up with it. One of the faculty told us,with some despair, how he has watched the deterioration over the last 20 years.
However, the government priority is not in tertiary care, and they are reluctant to put money into teaching hospitals. This is a bit short sighted, since Ethiopia is developing rapidly and they are going to need specialists and even internists, paediatricians and obstetricians in large numbers in the future. They will not be able to meet the demand unless they start training people now. As an example of how Ethiopia is developing they have opened up 13 new universities in the last 10 years or so. The governments priority seems to be on education, perhaps rightly so, but it is disconcerting to see how poor the medical facilities are here.
In many ways practicing medicine here is an intellectual exercise. First, patients present at the late stages of their disease, with advanced cancers, untreatable bony deformities due to tuberculosis, advanced cirrhosis, advanced cardiac failure, etc. Since there is little that can be done for these patients diagnosing the cause of the illness is irrelevant, but is only a mental exercise. And even then diagnostic facilities are limited. CT scans are done, but are of poor quality. Interpretation is sometimes iffy. Ditto for pathology.
Patients have to pay for these services, so the ability to manage patients is often constrained by what the patient can afford, which may be nothing. It's all very discouraging, and I am glad that I do not have to practice in these circumstances. I wonder what things would have been like if I had stayed in SA at
Baragwanath.
On a lighter side, I am slowly conquering those 8 flights of stairs that I ache to climb. Today I had to climb them 3 times. I am getting less and less breathless, but my leg muscles continue to protest that I am abusing them.
Food here is monotonous. Most restaurants serve a variation on the same things - spaghetti, macaroni, fried fish, fish prepared in other ways (similar from restaurant to restaurant). I have not been brave enough to try any meat dishes except chicken. Some of the dishes I have tried, e.g., soup, did have bits of meat in them. All I can say is that the concept of tender meat is foreign here. The chicken must have been long past its sell-by date. The meat was similarly tough. So, no meat for me. However, food is cheap, so I should not complain, given that I have to eat out most nights and most lunches.
There is a very good Italian restaurant about a block from the hospital, where we will go once or twice a week. They know us there by now. Very good salad bar and well-prepared other items that one usually finds on an Italian restaurant menu. We have agreed that we will eat in most nights, but perhaps eat out over the weekend.
I have so far given 5 presentations and have 6 to go over the next two weeks. We also interact with the GI trainees every day, either clinics, case presentations, journal club presentations, etc. We are getting to know them quite well.
Overall the week has so far been uneventful, except that the internet at the hotel has been out of commission for a few days. It's working now, but who knows for how long.
I think I have briefly mentioned the conditions in the city. This is a very poor country. The older buildings are all somewhat dilapidated, although there is a lot of construction an a number of newer buildings that are privately owned and maintained. The streets are in very poor repair. Really, the potholes in Toronto are nothing by comparison. The potholes here can break an axle. In addition they are building a light rapid transit system, and they have left the roads in a terrible state. You almost need a 4-wheel drive vehicle to negotiate city streets in places. Traffic at rush hour is terrible, slowed down substantially by the poor state of the roads, and also by the fact that there do not seem to be many rules of the road, or at least people do not adhere to the rules of the road. It's chaotic. For those of you who have never been to Africa I don't think you can really imagine how things are. Even for those of us born in South Africa, thing were much better regulated in SA than they are here.
However, no more carping! More next time after our birding weekend
The hospital where we are teaching was built 60 years ago, and looks like it has not seen a coat of paint since. To call it decrepit is to insult decrepitude. It has not been maintained at all. There are lights missing, toilets not working, elevators not working. If this was Baragwanath in the days when I worked there it would be unacceptable. But here they put up with it. One of the faculty told us,with some despair, how he has watched the deterioration over the last 20 years.
However, the government priority is not in tertiary care, and they are reluctant to put money into teaching hospitals. This is a bit short sighted, since Ethiopia is developing rapidly and they are going to need specialists and even internists, paediatricians and obstetricians in large numbers in the future. They will not be able to meet the demand unless they start training people now. As an example of how Ethiopia is developing they have opened up 13 new universities in the last 10 years or so. The governments priority seems to be on education, perhaps rightly so, but it is disconcerting to see how poor the medical facilities are here.
In many ways practicing medicine here is an intellectual exercise. First, patients present at the late stages of their disease, with advanced cancers, untreatable bony deformities due to tuberculosis, advanced cirrhosis, advanced cardiac failure, etc. Since there is little that can be done for these patients diagnosing the cause of the illness is irrelevant, but is only a mental exercise. And even then diagnostic facilities are limited. CT scans are done, but are of poor quality. Interpretation is sometimes iffy. Ditto for pathology.
Patients have to pay for these services, so the ability to manage patients is often constrained by what the patient can afford, which may be nothing. It's all very discouraging, and I am glad that I do not have to practice in these circumstances. I wonder what things would have been like if I had stayed in SA at
Baragwanath.
On a lighter side, I am slowly conquering those 8 flights of stairs that I ache to climb. Today I had to climb them 3 times. I am getting less and less breathless, but my leg muscles continue to protest that I am abusing them.
Food here is monotonous. Most restaurants serve a variation on the same things - spaghetti, macaroni, fried fish, fish prepared in other ways (similar from restaurant to restaurant). I have not been brave enough to try any meat dishes except chicken. Some of the dishes I have tried, e.g., soup, did have bits of meat in them. All I can say is that the concept of tender meat is foreign here. The chicken must have been long past its sell-by date. The meat was similarly tough. So, no meat for me. However, food is cheap, so I should not complain, given that I have to eat out most nights and most lunches.
There is a very good Italian restaurant about a block from the hospital, where we will go once or twice a week. They know us there by now. Very good salad bar and well-prepared other items that one usually finds on an Italian restaurant menu. We have agreed that we will eat in most nights, but perhaps eat out over the weekend.
I have so far given 5 presentations and have 6 to go over the next two weeks. We also interact with the GI trainees every day, either clinics, case presentations, journal club presentations, etc. We are getting to know them quite well.
Overall the week has so far been uneventful, except that the internet at the hotel has been out of commission for a few days. It's working now, but who knows for how long.
I think I have briefly mentioned the conditions in the city. This is a very poor country. The older buildings are all somewhat dilapidated, although there is a lot of construction an a number of newer buildings that are privately owned and maintained. The streets are in very poor repair. Really, the potholes in Toronto are nothing by comparison. The potholes here can break an axle. In addition they are building a light rapid transit system, and they have left the roads in a terrible state. You almost need a 4-wheel drive vehicle to negotiate city streets in places. Traffic at rush hour is terrible, slowed down substantially by the poor state of the roads, and also by the fact that there do not seem to be many rules of the road, or at least people do not adhere to the rules of the road. It's chaotic. For those of you who have never been to Africa I don't think you can really imagine how things are. Even for those of us born in South Africa, thing were much better regulated in SA than they are here.
However, no more carping! More next time after our birding weekend
Given the conditions in the hospital I wonder how many of the doctors stay. Is their training anywhere near the standard of training they might get in North America (apart from the clinical training)?
ReplyDeleteAre there private hospitals where those with means can get decent treatment? It sounds worse there than India or Egypt.
Too bad about the food- I don't feel like I am missing anything. Keep the blogs coming!