One week down

There seems to be so much to tell each time I sit down to write, but I’ll try to spare you from a long-winded post. Tuesday saw the departure of Binke and Sinead back to the UK, which has made lunch and dinner conversation pretty quiet as they were quite the entertainment. The same day Professor Lee Cassanelli from the African Studies department at University of Pennsylvania arrived to visit the hospital for a few days. We never seem to know who might show up at Edna’s.

Also on Tuesday, Sherri and I went on 8am rounds with Dr. Robert (mentioned him before….he is a general practitioner trained in the states but has been working in Africa for quite a while) at Group hospital. Apparently, the numbers of patients at Edna’s and Group are down due to the campaigning….everyone keeps forgetting they are sick or something. We visited the female and male wards at Group, and most of the patients seem to be in much worse condition than the patients currently at Edna’s hospital. I saw the most emaciated woman I have ever seen in my life. She is only 15 years old, and they cannot figure out what is wrong with her. Another young girl has TB for the third time, and it appears she is drug resistant. In the male ward, there were several cases of patients with combined TB-HIV/AIDS. HIV/AIDS medications are available but often these cases are not well managed. Amongst the women especially, there seems to a strong sense of denial when it comes to HIV diagnosis.

It seems that everyone in Hargeisa has epigastric pain!!! At Edna’s and at Group, there are so many patients who seem to have a chief complaint of epigastric pain…it just seems slightly bizarre. There are higher levels of diabetes and hypertension than I had expected. We always hear about them in the West, but I assumed they would be much lower here….that’s not the case. Diabetes is poorly managed in most cases. Patients with chronic conditions do not seem to completely grasp the idea that they must consistently take their medications every day. Many people stop taking their medications once they are feeling better and only start again when they are feeling sick, which does not really work when you have diabetes and need to take medication every day. This is a problem in the States too, but it seems pretty prevalent amongst patients here.

Sherri and I have been attending and helping out at the various English classes. All the girls are taught their nursing classes in English, but after helping out at some of these classes I am not quite sure how they are learning anything about nursing. There is a wide range of skills, with some being very low. Today, the students had a crossword puzzle to complete. We just take it for granted that everyone knows what a crossword puzzle is but these girls had never seen one. Most of them wanted to put entire words in a single box, so it took quite some explaining to get a single letter in each box. As far as the nursing classes, we found out later that the star student, Rahma, actually explains everything from the classes to the girls in Somali in the evenings. Rahma is quickly becoming one of my favorite people to talk to. Her English is the most advanced of any of the students here and she is also at the top of her class in nursing/midwifery. Her ultimate goal is becoming a doctor in the U.S. and then returning to Somaliland. She is our go-to person if Sherri and I have a question about Somali culture, the hospital, or anything.

In the hospital, there have been quite a variety of interesting cases. Around 10:30am a woman came in saying she was in labor. The nurses took her into the exam room to find her fully dilated and about 5 minutes later out popped a baby boy! There is another woman pregnant with twins! She is 8 months pregnant but came in showing signs of preeclampsia. There has also been a sick baby. L He was born Tuesday while Sherri and I were gone to Group hospital. It was a preeclamptic woman induced and the baby had meconium aspiration. He now has pneumonia and has been in the incubator all day with the nurses carefully monitoring him. I haven’t seen that many sick babies before, so it has been sort sad to see him doing so poorly.

On a happier note, one of my favorite patients is going home today. The mother’s name is Sofia and after having a c-section a few days ago, she is going home with her son, Mohamed. She always waves to Sherri and I, and she now has her sister, who can speak English, talk to us whenever we stop by to visit. Today we took pictures of her with her new baby!

On the medical ward, there is also a new patient with a bullet in her brain from Mogadishu. Her daughter was killed, and she was shot in the head about two months ago (everyone here hates Mogadishu and the violence everyone hears about there). Her family has transported her to Hargeisa. She was pretty stable, but has since fallen down and is now having regular convulsions on her left side. She came with an x-ray from Mogadishu showing the bullet…it entered the back of the head and is about one inch below the skull surface. There are no capabilities for neurosurgery in Somaliland….or anywhere else in this region of Africa. I’m not sure what they will do with her.

Some other random things:

My least favorite thing about Somaliland: the flies! The mosquitoes are not bad at all, but there are flies everywhere. They congregate around the sick patients. It seems the sicker you are the more flies will be on you. They are pretty unpleasant.

Today, Edna and her family received a bride’s gift. Whenever someone gets married, the bride’s family prepares gifts to be given to various relatives in celebration of the wedding. Here are some photos of the traditional bride’s gift. The top has been cut off, but the outer portion is mashed dates and spices with decorative peanuts. Inside of the date bowl there is dried camel meat and camel fat. Not exactly what I would call appetizing, but apparently this is one of the most common bride gifts. I tasted the outer date portion upon some strong urging….gross! It wouldn’t be so bad except the dates taste like smoked meat because of the camel inside. Sherri’s description: combination of beef jerky and fruit cake.

Maybe that was a little long-winded….sorry.