The Horn of Africa

The chat/khat (Amharic/Somali) economy is estimated at USD$700,000 per day. It primarily grown near Harar, so most of this money is flowing back into Ethiopia. Usage estimates among women in Somaliland are 10-20%. Usage estimates among men are 80-90%.

 

Khat can cause discoloration of the teeth, but it is NOT the cause of the dark brown staining that I keep seeing here. That, apparently, is from too much iodine in the water. It's a problem in the eastern regions of Somaliland in particular and may disproportionately affect women. (I'm not sure I buy that last part.) It's considered... sexy.

 

Also sexy: being fat. In the States, there's such a stigma for women around age and weight that they'll sometimes lie even to their healthcare providers. Here, women hem and haw and don't want to tell you their age, or they'll tell you a more optimistic age. But with weight, we always get the real answer (or a, forgive the pun, inflated answer?). Being fat means you're prosperous. Sexy.

Not surprisingly, the top two medical problems in this country are hypertension and diabetes. Infectious diseases are third.

 

It seems rather popular here to dip your finger tips in henna. You do this once this week, then again two weeks later, then again two weeks after that. Once the henna wears off your fingers, which're black to the first knuckle, you're left with a three-tone fingernail. The farthest portion, which has had three immersions, is very dark, followed by a band that's light, in the middle, and then a very light band near the cuticle. As the nail grows out, a "natural color" band is added. It's nailpolish, a French manicure, done henna-style.

 

When I gently pushed a Somali woman about it, she said pushed back. "In America, they put on the plastic and little drawings on them!" She's right. It's equally strange in America, except that at least this way you can still wash dishes and type.

 

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I spent this morning and yesterday morning at the Hargeisa Group Hospital near "downtown." It's a government run hospital and is wildly different than this one.

 

It's... big. It's a compound, with buildings spread all around. In between some buildings are barbed wire fences. Goats meander around, chewing grass between the maternity ward and the surgical ward. There're flies everywhere. The paint is peeling off the walls. Tile floors are in disrepair, stained by who knows what. Ceiling panels are falling apart.

 

In the operating theatre, there're things I can't even identify. I imagine one of the machines must be an ECG and one must be oxygen, but they look like they're from a 50s sci-fi thriller. Little metal switches everywhere; these are pre-button. There're boards lying around that look like spanking paddles for an over-the-top fraternity, but I figure they're probably old school traction splints. If you put rope in one end... yes, maybe. They have an x-ray. Non-portable, tiny, easily decades old. The nearest CT machines are in Addis Ababa, Ethiopia, and Nairobi, Kenya.

 

I want to take pictures but I'm worried it'd seem demeaning. They're doing the best they can. The wards are large. 25-30 beds each. Each is staffed, it seems, by a few nurses -- usually two. Doctors are "on call," not on site. I'm not sure what to make of this arrangement. I suppose it's fine if you have really crack, top-notch nurses. Nurses are the ones who really -run- a hospital, even when doctors are there.

 

Unfortunately, during my tour on the first day, it appeared that a lot of the patients weren't getting the attention they needed. In the middle of the tour, with me in my white lab coat from this hospital, a mother pushed her baby at me. Prolonged labor, became a c-section, infant is now about 5 hours old. It's wailing in a weird staccato in line with obviously (visually) labored breaths. Forearms are cold. I ask if there was meconium, if anyone has listened to breath sounds, etc. Nada. Where's the post-natal care?

 

Anyway, they do a lot more surgeries at Group Hospital than we do here, so I'm going to be going back on Sunday and on Tuesday, early in the morning, to observe surgeries all day. I met their head anesthetist and Edna has put me in contact with the chief of surgery there. It should be a good learning experience.