Packing for five weeks away in a country where one cannot assume it will be possible to buy things that you might have forgotten is difficult. Add a few ideological arguments and you can make it almost impossible.
Let’s begin with clothes. Need to dress for comfort. Daytime temperatures are about 22-24oC, and nights about 7 oC, with it being colder when hiking at altitude. Culturally conservative country, visiting churches and monasteries, so mostly long pants. No sandals or “jiggers” get into your feet.
When we lecture the residents we are supposed to dress formally: Dress shoes, long-sleeved shirt and tie. That’s a bit of a pain, but I sort of get the point and in a way I respect it; we can be rather sloppy in our dress in North America. Sloppy clothes can lead to sloppy manners and sloppy thinking. I will be speaking at the annual national meeting of the Ethiopian Anesthesiologists, so I am reluctantly packing a jacket, tie and dark pants for that, as that is what I would wear to present at a similar meeting in Canada.
On the other hand, when we get laundry done, it is done by hand. Apparently they are very thorough, but also very rough. So maybe I need to pack second or third best items.
Should we be packing clothes with the idea that we would leave them behind, donating them to some worthy cause? It is tempting, and if I can find the right cause, I may do so. However, I have heard that its difficult to set up a clothing business in Africa, because you have to compete against free stuff donated by charities and dumped on the market.
Medical supplies are a more difficult issue. They have some basic drugs and equipment, enough for them to use when we are not there. Should we be teaching them to use what they have, or should we be bringing drugs we think they ought to have, or drugs that we are more comfortable using? For example, they do not have any anti-emetics. If you have an anesthetic, you have pain and you will vomit. Get over it, you are lucky to have had surgery and survived! Is that an acceptable cultural norm that we should let pass, or should we be bringing anti-emetics and showing them that something better is possible, at not very great cost?
Other groups have gone to African countries in the past and said: “Our advice is that you should do things this way and use these drugs”. When they come back a few months later and nothing has changed, they get annoyed and say: “Why are we coming if you don’t want and act on our advice?”
We seem to be taking almost exactly the opposite approach. We are there to provide what the Ethiopians ask for, it is their country and we are only there to provide what they tell us they want. If they want a lecture on Paediatric ICUs on April 28h we will provide one, even if no-one we are sending to Ethiopia that month has ever worked in a paediatric ICU.
So at the moment I am packing a bit of everything into two large bags and hoping the weight limit really is two 23 kg bags!