hophop

It's crazy to think I am just about at the half way point of my summer in Somaliland. In some sense, I feel very settled in and know the basic schedule for the hospital, classes, etc. On the other hand, each day seems to bring something different and slightly unexpected. I'm going to try and recap the highlights of this past week.

Sherri and I have been working on keeping some statistics for the hospital. The previous stats guy quit in March, and there seems to be no consistent recording of their patient diagnoses. However, Sherri and I quickly found that they do not have a very good system and so it has been a bit chaotic trying to keep them. They have the stats person read through all of the old charts to decipher what a given patient's diagnosis is and record this information. Unfortunately, they have discharge forms that clearly have a "Diagnosis:" blank....but nobody actually uses these. This has rather meant that Sherri and I try to decipher random doctors hand-writing and approximate the diagnosis into some broad, general categories.

Here is the lovely room of files:



Last Wednesday saw the arrival of two nurses from the United States. Dawn and Randi will be here until July 15th, and both are coming from the Chicago area and work at Children's Memorial Hospital in the PICU. It is always nice to have more people around to hang out with.

Sherri and I finally went to the market. It is a bit overwhelming with all of the booths of cloth. They have scarves hanging everywhere and then rows and rows of fabrics to be selected from to make dresses.


This man sits in the piles of cloth and then when you see one you like he will pull it out for you. Once you purchase the cloth you give it to a tailor to have the sides seamed together to form your dress. They are all one-size-fits-all dresses. You are supposed to stuff any excess cloth into your slip.


Last Thursday, there were about 15 people from the hospital (Edna, some staff and midwives, summer volunteers) invited to a patient's home for lunch. The patient was a Sudanese woman who delivered her first child, a boy, by cesarean section in the hospital about two weeks ago. There is a small Sudanese population living in Hargeisa, and it was interesting to have them all through the hospital during her few days here. In return for her care, her family invited all of us for a grand feast. I've never seen so much food at once!

This is a photo of most of the visitors at the lunch. Most of the Americans arrived at the house first, and none of us speak Arabic so we had to sit in awkward silence for sometime.



This is all the food sitting out! Everything is served community style, so you just take whatever you want. Goat liver, eggplant, peas, chicken, minced meat, Somali bread, orange soda, rice, noodles, hop hop, mango......


After lunch I was handed this cup....can you guess what it is??


At first, I thought it was just tea but the coloring is not right for Somali tea. Turns out it is "meat juice," or at least that is how Dr. Abdighani described it to me. It is a combination of the broth from cooking the various meats which is then simmered with vegetables. I was brave and took one sip....sort of salty and tasted like chicken broth.


Later, we did get real cups of tea and coffee. Real coffee is wonderful! At Edna's we only get Nescafe....

We also went out to eat at the Ambassador Hotel on Thursday evening as a farewell to Sherri and a welcome to Dawn and Randi. I had a chicken sandwich...not exactly like American chicken. Unfortunately, my camera battery was dead, so no photos. Sherri left first thing Friday morning.

Friday was very quiet at the hospital because all of the students had no classes from Thursday afternoon through today due to elections. The actual elections were held on Saturday. We thought it might turn out to be a busy day, but it was actually very quiet. The only bizarre part was a man came in covered in bees. They were locking the hospital doors behind him, and so at first everyone thought something really bad had happened outside. He was "stung by a bee" became he was "bitten by a bee" became he was "beaten." After about 20 minutes of this telephone-like game of interpreting what this patient had, it was determined he was indeed covered in hundreds of bee stings. Sounds awful but he did not have an anaphylactic reaction, and at least no one was beaten. The election results will not be announced until this coming Saturday. That is actually when there could be more problems if people are upset by the results. There is strong Kulmiye support within Hargeisa and they all seem pretty convinced he won....we will see.

Here is Ishmael proudly showing off that he voted! Voters had to register and arrive with their voter identification card at the polling locations, plus they also all dipped their pinkies as a double attempt to help prevent repeat voters.

Saturday through Monday were mostly spent down in the hospital observing and helping out around labor and delivery. Below is a photo of everyone sitting around the nurses stations waiting for something to happen.


On Monday, we all got extremely frustrated when there was another sad case in the hospital. A woman was progressing in labor all morning, but around 11am the vaginal exam showed a prolapsed cord. In North America, this would mean an emergency cesarean section. In Somaliland, this means lets be delayed for three hours while we find the husband so he can consent to a cesarean section. By the time the husband was located, arrived at the hospital, refused to sign for an hour, and was finally convinced, the baby was dead. Instances like these are infuriating! This death was not the result of a lack of recognition of the problem or a lack of resources or a lack of trained personnel....it was a complete delay in anything happening because consent comes first. We have asked the doctors before about these consent issues and they say occasionally a procedure is done without husband consent, but we have yet to see this happen.

Today, Lauren (midwife from Canada) and I went to Group hospital to see their labor and delivery department for the morning. It made us feel a lot less frustrated about the labor and delivery department at Edna's.

This is the delivery room with three beds. While Edna's basic set up is similar, Group hospital lacks a lot of supplies. When we arrived, there were actually two midwifery students from Edna's doing one of their clinicals. They had with them a bag of supplies...gloves, soap, gauze, scissors, IV equipment, etc. This seemed a bit bizarre, but we found out that unless they bring some supplies with them from Edna's then they will not be provided with gloves or soap at Group hospital for seeing patients.


Here is the infant resuscitation table. At Edna's there is no capability to intubate any patients, adult or baby. However, they do have resuscitation bags and oxygen...both of which appear to be absent from Group hospital.


The craziest part about Group's L&D department is that they have no charting system whatsoever. Patients get a vaginal exam and get asked a few basic questions when they come in, but none of the information is recorded. We asked the nurses how often they get their vitals and fetal heart rate....the response is basically whenever a patient complains of a problem or the nurses/midwives decide they will check in on a patient. Any of these things: vitals, vaginal exam reports, patient history, fetal heart rates, etc. are never recorded. Unlike Edna's hospital, they have many more patients. Today we saw around 12 women in the ward laboring. How the staff manage to maintain care and know which patients are which is anyone's guess. Lauren described it later as a bit of a "free for all."

Still seeing and learning lots. And eating lots of hophop (watermelon)!