"Talking" Carl Goes to Somaliland

It was a very quiet day at the hospital, partly because it's a Friday and partly because there are just those days.  Since we had a 5 baby day earlier this week, it's not really surprising to have a no-baby day.  I took the opportunity to make good on my promise to make goat cheese.  Edna and I are plotting a program where we teach women to make cheese out of goat and camel milk.  Right now, the milk is just drunk straight, which is fine, but when there's a lot of it it just goes to waste because you can really only drink so much goat's milk a day.  But I thought I should probably experiment with it before we start trying to teach other people how to do it!

Step 1:  Go to market, get goat's milk.

Step 2: Heat.

Step 3: Curdle. Lots of lemon here, so we used lemon.

Step 4: Strain curds from whey.  If no cheesecloth available, use what you've got a lot of in a hospital--gauze!

Step 5: Let it drip.

Step 6:  Cheese

It's not perfect (a little more crumbly than I would have liked), but it tastes good and got lots of rave reviews at dinner.  I take this as an honest compliment because I find Somalilanders to be almost overwhelmingly honest.  They will tell it to you like it is.

One of the ways this is most evident is in nicknames.  Because a handful of names are very common (Muna, Hoomda, Abdi, Mohammad, Fadoomo, etc.), a person with a common name is generally called that name plus a descriptive name.  For example, in the current post-basic midwifery class, there is "Smart" Muna, "Dumb" Muna, "Good" Hoomda, "Bad" Hoomda, and "Fat" Safa, "Skinny" Safa.  I'll be honest with you--these are pretty fitting nicknames, and they are called these openly to their faces and respond to them.

However, the worse nickname I've heard is definitely that of Abdi, the hospital electrician's.  Abdi's father Abdi the Elder had an unknown but unfortunate incident involving the loss of one his testicles, and his son inherited his father's common name...and nickname.  Despite Edna's campaign to have him be called Abdi "Light", he is widely known as, essentially, Abdi "One Testicle".  In public, to his face, every day, which no one except Edna and a series of horrified volunteers finds inappropriate at all.  Poor man.

I also took advantage of the slow day to tour the operating theater that's being built behind the hospital.  Right now, the only operating room is for c-sections, and the hospital really can't do other types of surgery.  This building adds 3 operating theaters, which drastically expands the operating capacity of the hospital, and Edna hopes to be able to add a full-time surgeon to the staff.

For several years, Edna has been sponsoring what are called "Fistula Blitzes" where teams of trained surgeons come in from Ethiopia and do a huge number of fistula surgeries in a short period of time.  However, these still manage to only get a small number of the women in Somaliland who need this surgery.  Because they will have more than 4 times the operating room space as before, many more women who need the surgery will be able to have it.

Here's the area where the doctors will scrub (that's a sink along the wall).

And here's the middle-sized of the three operating rooms.

Here's one of the men diligently working on completing the hospital on Edna's schedule:

I did end up seeing a few patients this afternoon.  I spend almost all of my time on the maternity side of the hospital, but I try to see pediatric patients whenever they come in, and two were in this afternoon.  The first was a baby girl who was born here just two days ago, and discharged home late in the afternoon on her day of birth. In the US, babies generally aren't allowed to be discharged until they have voided their bladder, and information about voids is carefully recorded as a way of assessing kidney function and hydration status.  It's pretty simple, because these babies are generally wearing diapers, many times with light yellow strips on the outside that turn blue when the diaper is wet.  This information is diligently recorded in the chart, and abnormalities are noted and explored.  Simple.

In Somaliland, however, the babies of women with normal vaginal births are often discharged just a few hours after birth, as this one was.  Furthermore, no diapers:  babies are wrapped in layers of cloth and the bottom one is just changed occasionally, so it's not always easy to tell what's going on.  This baby, as her mother reported, hadn't voided yet, which is NOT okay for a two day old baby.  She looked otherwise healthy, so we took her over to outpatient to use the antenatal clinic's ultrasound machine to look at her kidneys.  One kidney was very small and the other one very swollen with water  (hydronephrosis), and the bladder was empty, meaning that urine is never making it past her kidneys.  There was nothing that this hospital could do for her, having reached the end of our diagnostic capacity and limited in treatment options regardless of diagnosis.  The doctor referred her to Somaliland's (pop. 4 million) ONLY pediatrician.  Realistically, however, this baby will probably need a level of treatment available only Ethiopia.  Hopefully her family will have the means to provide this for her should it be needed, but I honestly don't know if that's the case.

The mother and baby went on their way, just in time for the arrival of a 6-year-old girl with fresh burns across her feet, up her left leg, side and ear from oil that had splashed/spilled. Not surpising, given that this is how oil is generally cooked with:

Lots of burns show up here.  The little girl was being pretty brave, until they started dressing the burns.  I was trying to distract her with stethoscope and pen light, and she was having none of it, and then I remembered my secret pediatric weapon, Talking Carl for iTouch.

Talking Carl has yet to fail me, and today was no exception.  I touched his stomach and he started laughing, and she stopped whimpering and looked up at me with these giant eyes and I handed it to her and she went to town.  They finished up her dressings and admitted her for fluids and observation, but she'll be fine.

My personal health care philosophy is that you generally encounter people when they're having a really bad day (obviously, most maternity care is more or less an exception).  You, as a health care provider, are in a position to do something about their bad day, and anything you can do to make that day a little less bad--kind words, gentle care, Talking Carl--is pretty much worth it.  And don't worry--I always douse Carl in rubbing alcohol after his pediatric encounters!