Samboosas and Somali Tea

I haven't updated my blog in about a week....the internet has been a bit spotty here. I do not even know where to begin with telling about the last week. It has been wonderful, sad, frustrating, and everywhere in between. This is a compilation of various things....there is not really any order to it.

Last Thursday, Edna took Sherri, Lee Cassanelli, and I on a driving tour of some different areas in Hargeisa. We visited two different “shanty-towns” where many of the patients of the hospital live. There is a clear division in society here between the families that live in these “shanty-town” areas and those who do not. Families that have migrated into Hargeisa from surrounding Somalia regions often live in these rundown neighborhoods that have no electricity, running water, or good sources of employment. The other portion of the population lives in a more centralized area of Hargeisa with electricity and water. The living conditions and economic levels are definitely variable across the city.

This is what a house looks like in one of the poorer neighborhoods. They recycle milk containers and other recycled paper or tin products and roll them out into sheets which become the siding, and then on top they layer cloth.

There were little kids everywhere trying to occupy their time. These kids made a makeshift scooter.

Edna also took us to her farm. Apparently her family owns some random land outside of Hargeisa, and she is trying to get a farm started their so she can provide some additional food to the hospital. The drive out was wonderful as we got to see all sorts of Somaliland wildlife….baboons, camels, goats, dek deks (these tiny little antelopes), tortoises, and sheep. The environment is completely different traveling from downtown Hargeisa to about 30 minutes outside of Hargeisa. The land is actually green and the climate much cooler than where we are in central Hargeisa.

Here is the farm...mostly watermelon and then any type of bean they can grow.

The sad part of the week has been that I have seen three infants die, and also seen an intrauterine death (IUD). It is definitely not enjoyable to see newborns die. The first was the meconium aspiration baby I mentioned in my last blog. He did not make it. Then there was a bizarre 24 hours where there were three different sets of twins in the hospital. The first set of twins was a delivery of a 7 month pregnant woman at Group hospital (the government hospital across town). Both infants weighed 1.7kg (very little), and one died directly after birth. The second infant the family brought to Edna’s hospital where he was in the incubator for about 12 hours before dying. The second set of twins also began at Group hospital. The first baby was born vaginally at Group, but the second was a face presentation and they could not deliver her. The family brought the woman and the first of the newborn to the Edna’s hospital. The second baby was delivered by cesarean, but she had a lot of facial bruising and a cleft pallet. She ended up dying later in the day. The third set of twins was born at Edna’s hospital, and I got to see her deliver!! She had beautiful identical girls, both 2.5kg. The IUD was another sad case though….one that also started at Group hospital. The woman arrived at Edna’s around 9pm with all the supplies for a cesarean section. Apparently Group hospital had not surgeon, and so sent the family to Edna’s. There is no real communication between hospitals though, so everything is based on what the patient and/or the patient’s family says has occurred. They could not find the fetal heart rate, and it turns out she had been in labor for five days. The baby was delivered by cesarean and found to have the umbilical cord tightly wrapped around her neck.

These are sad stories, but they are not all sad. I have gotten to see a lot of healthy deliveries. Last night I helped out with the delivery of a woman having her ninth child, but she didn’t want to push. She kept grabbing my hand putting it at the top of her belly and saying “rei, rei, rei” (“push, push, push”). So I would remove my hand and tell her “rei, rei, rei.” I turned away for a minute and she grabbed hold of my skin and would not let go! Ouch…but I am definitely thinking she was in more pain delivering than I was with her pinching me.

Sherri and I got to go to an Ethiopian restaurant on Friday with Dr. Robert and Jennifer Thiel. It was wonderful to get out of the hospital complex for a little bit and have something different to eat. Overall, the food here is good but it is exactly the same everyday…so a little Ethiopian variety was much appreciated! I got my fill of injera and goat meat.

This is my little lizard friend living in my bathroom. I haven’t seen him for a few days, so maybe he left.

In the afternoon, there is a window where you can get snacks. I've heard it called the cafeteria and also the magic window.....

They have samboosas. The nurses here have introduced us to them. Most people have an afternoon snack and tea around 4pm after their afternoon naps. So if we are down in the hospital in the afternoon, we sit with the nurses and enjoy samboosas and tea.

Here I am enjoying some Somali tea....basically sugar and milk with a little tea.

World Cup craze is here in full force! The games are on at 2:30, 5:30, and 9:30pm, and someone at the hospital is always watching. Edna’s brother has watched almost every single one. After dinner, a group of us (doctors and volunteers) have been watching in Edna’s living room. The England v. USA match was a fun one since we had two Americans and two Brits at the hospital at the time. Most people here seem to be supporting England since they know most of their players.

As I mentioned before…you never quite know who will show up at Edna’s. She does not really tell us in advance who is coming, and so a Canadian couple has just arrived. They are recently married and decided to spend the summer in Somaliland. Harrison is a medical student and Lauren is a midwifery student. So far it has been really nice to have them around the hospital, and after Sherri leaves in a week it will be nice to have some other younger people still around.

Sherri and I are still teaching classes, which is a bit frustrating. The students are very sweet and appear motivated, but give them an assignment and it sort of goes downhill. We are now teaching two English classes a week for the Community Midwives group, helping out Thiel at her various English classes throughout the week, and continuing with two classes working on miniature research projects. It is frustrating when they say they want to be involved and learn English or research, but then they do not have the follow through to actually study or do assignments to help them improve. There are definitely some dedicated ones, but there are also some who seem to have no clue what is going on. Tonight we will be working with one of the research groups....we'll see how it goes.

There is also a British obstetrician/gynecologist visiting for a week, Peter Jackson. He was the first doctor to do a cesarean section at Edna's hospital back in 2002. He has since visited periodically to do various trainings and help write protocols for the hospital. He took an evening to give several of us a presentation on maternal health in the developing world. It was amazing!!! It has been wonderful to meet and talk to other people interested in global health, many of who have been working in the field for some time now.

Still haven't gotten to visit the market....hopefully on Saturday. Hope that wasn't too much randomness. That's all for now!