Dandelions age and the wind blows …

Salaam alekhem! Greetings from London on the eve of my next Heathrow exit. The long overdue blog update is here at last!

Training in Liverpool STM

Soon after the apparent success of the LSTM-LSS course in Hargeisa I found myself involved in a second course in March, this time in Liverpool. The students in the School of Tropical Medicine studying Reproductive Health and Public Health attend the Life Saving Skills course before they return to their home countries. Liverpool’s Women’s Hospital also houses one of Europe’s largest reproductive medicine departments and a period of maternity leave for one of the doctors provided me with the opportunity to return to IVF work in April. Collecting eggs and replacing embryos in a centre of excellence is a far cry from delivering babies and picking up the pieces in the developing world but I find I switch readily from one role and context to another and fortunately my colleagues in the Women’s Hospital are sufficiently flexible and understanding to allow me to pursue both passions. Now I find myself with the opportunity to return to Somaliland for two weeks to train doctors in Caesarean delivery as part of a 3-person team.

One thing that has filled much of the spare time in the 3 months since my first visit (and has delayed the blog sequel until now – sincere apologies to all) has been the examination of 3 years worth of data from two of the Somaliland maternity hospitals. The larger unit in the capital delivers about 240 per month and the smaller one, in the coastal town of Berbera 2 hours drive to the north-east, less than 30. The C-section training is for the staff of the smaller hospital but much of it will take place in the capital because of the greater opportunity for clinical teaching, and to a lesser extent because of the cooler climate. In fact 10-12% of mothers are delivered by Caesarean by surgeons who are not obstetricians. Two 4-day courses are planned, catering for about 20 people including supporting staff. One of the sad statistics is the death of 10-12% of babies delivered in these maternity units. Stillbirth is the usual reason given but this term does not explain the underlying cause and newborn deaths are rarely recorded. I still don’t have a handle on the number of maternal deaths but it is thought to be around 1 in 250. Safe Caesarean is just one of many interventions required to reduce these unacceptable death rates.

The humble dandelion, common but fresh and beautiful

So it’s farewell once again to family, friends and fellowship, and to the flora and fauna of Bala and Penllyn. In the absence of other tourist destinations we plan to visit again the cave paintings of Las Geel. I hope to avoid the unwelcome advances of the antelope-with-attitude in the grounds of Maansoor Hotel, Hargeisa. My intention is to bring home some more wild honey as the supply has run out but no more vacuum packed dried dates which didn’t prove popular.

I think one of my bigger concerns is the overnight transit in Nairobi, since it is a less safe place to be than Hargeisa. In Somaliland the people are very friendly, the money changers sit unguarded in the marketplace with mountains of paper shillings, and armed guards of the Special Police Unit are detailed to look after our safety.

Too soon the flower goes to seed and the wind blows it away

Hopefully I’ll be able to update you when we arrive and this time I’ll try not to leave too long between blog posts. This time I’m travelling with Julie from a London teaching hospital. God willing neither of us will lose one another between flights and I’ll be back in Bala and Liverpool before all the dandelion clocks have gone …