A Walk in the 'Hood

Today, after a morning in the maternity ward and then teaching the midwives about congenital abnormalities (developmental hip dysplasia, cleft palate, etc.), Joanne and I and one of Edna's trusty guard's went for a walk around the neighborhood.

One of the things I was most interested to see was the neighborhood khat (or qat or chat, depending on who's spelling) stands.


Khat is the leaves of the catha edulis plant and has similar chemical properties to amphetamines. Many, many people in Somaliland, both men and women, chew it, for the state of physical relaxation and mental activity it purportedly produces as well as the social aspects--in the afternoons, large groups of friends will get together, often at khat cafes, and chew and relax. It's viewed as harmless, and maybe even helpful, since some people think it makes them productive. Might be true, but it's a pricey habit. The plant must grow in highlands, so Somaliland imports all its khat from Ethiopia, at some estimates to the tune of US$500,000 per day. That's what Edna's hospital cost to build, for reference--as she said, "They chew one of my hospitals every day." Can you imagine what could be done in this country if it got past its khat habit?

Because the leaves are best consumed very recently picked, there's an extensive and effective distribution network to get it to Somaliland while still fresh. Word on the streets is that during the Somali civil war in the late 1980s, a daily ceasefire was called for the khat plan from Ethiopia to land. Side note: on the way to Edna's farm yesterday, she pointed out the major khat distributor in town's massive mansion on the outskirts of town. On the upside, he just did donate a new water tanker to the hospital...

Boys from around the neighborhood, clamoring to have their photo taken and thrilled to see it on the camera's view screen.


It's watermelon season! Vendors selling huge numbers of watermelons line the streets. We eat big chunks of watermelon with every meal, and every meal is also accompanied by fresh watermelon juice.


I have absolutely no idea what this bird statue, at the nearest circle to Edna's hospital, is, but our guard was quite excited to have his picture taken here.

The streets are lined with small stores like this, where people purchase basic household goods and non-fresh foodstuffs. They're simple and pretty cheap and sell very small amounts (tiny bags of salt rather than a box of salt, for example--though at quite a marked-up price) sometimes on credit in order for people in the community to be able to afford items.


An update on the woman I mentioned yesterday, who had suspected puerperal sepsis. This morning, her bloodwork came back that she had no markers of infection and she had no fever (and hadn't since she entered this hospital). Meanwhile, she bombed a neuro exam--very few reflexes intact, non-responsive, spastic muscle movements and repetitive movements of her mouth. Her family hadn't really been asked for a fully history and weren't terribly forthcoming with information even when directly questioned. Had she fallen? No. What was she like before the baby was born? Normal. Could she see well before? Yes, we only noticed she was blind when she kept missing her breasts when she tried to breastfeed. But then later it would appear in her chart that oh, yes, she fell in the hospital and hit her head when she delivered. And it only turned up this evening that she had cataract surgery a couple years ago.

So everyone was stumped, and while in the US she would have been sent for a CT scan and probably had a lumbar puncture, among other things, we had reached the end of our diagnostic abilities. The only thing to do was watch her carefully, give her broad-spectrum antibiotics, and keep thinking about it and asking questions. Then, today at lunch, she was more responsive to stimuli, but not oriented to person, place or time. But this evening, when an OB from Ethiopia came to consult on her, she was not only responsive but almost entirely oriented. Oriented enough to ask if she could have my watch, at least. She still has some muscle spasticity, but that was improving as well. So it looks like it was puerperal sepsis, almost certainly caused by the gauze that was left in her after the delivery, and that antibiotics was able to address. She'll be monitored closely for a few days, but it looks like, against anyone who saw her this morning's expectations, she might be just fine.

A better picture of the hospital, which without a doubt helped save a life today :)