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16/2/2003 I arrived in my new workstation
in Kombolcha (See above) -the highlands of Ethiopia. It is very lovely -so far.
The house has a giant tortoise in the garden: 
I call him Great Uncle Harold. He seems to have a set routine which involves traversing the lawn at about 4pm - 5 (Farangi time)
Have spent some time in the local
market...
...checking out what is available, and for how much during this time of famine. Generally there's a lot of food available both quantity and variety - but it's not affordable for many people. I bought papaya and mangoes. Yummy.
18/2/03 My first day as a nutritionist!!!!!
Went to a distribution site at Degaan for supplementary food/ vitamins/ minerals
and mebendazol - to monitor current practice. Community Therapeutic Feeding
(CTC) will start there next week, hopefully, for the severely malnourished children.
Yesterday
was a bit difficult - following the existing drug protocols meant that all the
children were throwing up. Not a particularly auspicious start. Today we missed
out some of the high volume medications and concentrated on the Plumpy nut...
...-
that worked, as the little chap in the photo would no doubt testify. Yesterday
we had 8 admissions in one centre, and today another 8 - but in two centres.
Tomorrow we are having a review
day before going out to 2 new centres on Thursday. It also gives the outreach
teams a chance to visit all those already registered in their homes.
Things have been very busy here in
Kalu district. Today was the end of the third operational day of our community
therapeutic feeding programme and already we have 39 severely malnourished children
registered and being treated on the programme - that's on top of the 4000 women
and children already receiving food and medicines for moderate malnutrition.
Everything seems to be going according to plan -phew!
Other than that the rains have finally arrived - the first for over a year.
Whilst it would have been great for the crops, (if only people had expected
rain at this time of year...) it does make it difficult to get around as there
are only two tarmac roads in the area.
Sunday 02/03/03:
What do rural Ethiopians do on a Sunday
-wash the cow of course!
Just got back from a great day at the lake - we were surprised how large it
was. There's a promentary into the water with a monastery - which females aren't
allowed into so we climbed a tree, much to the surprise of the locals, and had
a look at the gardens anyway. Then we went into the village and had delicious
fresh fish for lunch. A very happy Carol.
We returned to the lake for a walk - inspecting the lakeside crops and marvelling
at the storks and other fishing birds that we could not name. For a while we
had an enormous entourage of children, but they soon found out how boring we
are and wondered off, leaving us to the tranquil lapping of the water and the
cries of the birds. The driver thought we were nuts - why would you want to
walk when you have a car?
05/03/03:
Well the numbers turning up for the
SFP are diminishing - probably because the FFW schemes are now beginning to
distribute much larger quantities of food than we give out. They are only short
term but it's still a bit worrying for the coverage of the programme and the
number of defaulters/ absentees. The other thing that we are finding is that
the proportion of severe malnutrition to moderate is not as high as the survey
figures had led us to believe. That doesn't necessarily mean that the survey
was crap - it may just mean that the really sick ones are being left at home
while mothers focus on the ones they think will survive, or...
Today we went to Adamie - half an hour on metalled road, an hour on poor dirt
roads. We finally admitted four children not on weight for height, or oedema
but for having MUAC less than 110mm (children >1 year old): a slightly dubious
admission criteria.
Picture today of the oedematous child
is very sad - Mum (notice the goitre) wouldn't let it go to hospital today ad
Dad's permission was required. The next time we can provide transport is Saturday,
but the child will probably be dead by then. 
On
a slightly cheery note - the other picture - of a mirasmic child is a 10 month
old twin weighing 2.4Kg (Mum brought the other , "healthy" twin in
yesterday - weighing in at a grand 3.1 Kg)
- the child took to the Plumpy very well - so we have high hopes of a full recovery.
08/03/03:
Well the journey to Dessie hospital
was entertaining. Next time I will remember to ask for a car with plastic seats
- what a mess! The mother of one of the patients was throwing up all over the
place. It was the first time she'd been in a car. At one point we stopped for
her to get out, and she started to scrabble about in the dirt by the side of
the road, returning to the car clutching a sod of earth which she then proceeded
to eat. Interesting.
The hospital itself was pretty hideous, but I have seen worse! The bureaucracy wasn't as crazy as it could have been - a few birrs makes it quite easy to get someone admitted. Don't think they will get particularly good treatment - especially over the weekend. The little chap that we thought would be our second gonner was actually a lot better and had regained his appetite, but had oedema still (not that the hospital noticed). If the hospital doesn't kill him then with iron and salt he might make it!
So having left the malnourished children to die in hideous circumstances, we tucked into a wholesome meal at a local restaurant before having juice at the new pastry shop!
14/3/03:
Here's the chappie we sent to hospital
last week who's now discharged looking a lot better. He spent most of the day
holding my hand and winking at me.
April 7th 2003:
Another new site opened today - in
Ressa. Only four children were admitted but it was really pleasant despite being
blisteringly hot. The MOH worker up there, Endelcatcho, is quite a card - I
have attached a photo of him topping up the IV for his baby guava tree.
He
made us lunch and we discussed what you do when you're posted to the middle
of nowhere for 5 years: you become "a medical botanist" and think.
May 2003
Ended up leaving late on Monday because somebody was very sure that the road to Dibie was open so we'd only have a short walk. On arrival at Fetacoma, which is at the bottom of the pass, the outreach worker told us that the road was down but he didn't know at what point.
Spent an hour haggling over camels
- as there wouldn't be any further up the pass, packed all the gear up into
sacks and climbed back into the car to check the road. We had to dig our way
out a couple of times and did get a considerable way before we met a huge landslide.
It was a three hour slog in the midday heat along nasty loose stones to get
to the clinic at Chira. The rest of the team - despite their slight builds and
puny aspect, glided gazelle-like hardly touching stone. Whereas the clumsy fararangi
stumbled torturously -gasping and cursing, legs like Elvis, face like a beetroot...
Chira itself is a delightful hamlet,
and the clinic itself is in a green cool spot. The health worker and one of
the Concern outreach workers both have perfect little tukels in the grounds
where we were able to have a party to celebrate the birth of the Prophet Mohammed.
I am sure he would have delighted in all the dancing and good cheer. Must admit
I was glad to hit the cement floor and sleep the dreamless sleep of the knackered.
The screening was pretty chaotic -
they are a lawless lot - the men sport huge afros with combs left in (on purpose
I think), carry axes nonchalantly over their shoulders and wear sarongs with
big belts. The woman all have heavily braided hair -lice slicked in place with
lashings of butter, they have masses of silver jewelry (most sought after are
the Mother Theresa medallions from the 60s), tatoos of various designs on forehead
and chin and teeth filed into endearing points. The SFP started at 7.30 and
didn't finish until about 5.30, and then the stragglers turned up at 6.00 (couldn't
really blame them as many of them had walked at least 6 hours - just for the
promise of 5kg of famix which has to be collected from Fetacoma) in the morning
so we didn't get going until about 8.30.
I chose the coffee and pain killer
route to Fetacoma. Whilst I still couldn't keep up with the rest of the team,
I could tolerate the pain in my knees and made it to down all the way to Fetacoma
in just over 4 hours, before the real heat set in .Spent the whole time just
looking down for the next footfall.Somebody kindly gave me a stick to help so
when I did eventually go down I managed to fall on it stab myself in the ribs
- luckily it broke before any really damage was done. Incidentally I never actually
saw any camels, but I did see some guys bearing sacks that might have contained
Plumpy Nut boxes running up the hillside!
Now I'm back in Kombolcha. First visit was to the fridge and then the fruit basket!