I donut believe it

Something interesting happened this morning. It’s Valentine’s Day and, as is our custom on holidays, we gave each other a card. However, living in Ethiopia it’s not exactly possible to run to the Hallmark store to find Valentine’s Day card, so we resorted to making our own.

What I’m about to tell you is nothing short of miraculous. Not only because there’s probably a one in 10 million chance this could happen, but because of the thousands of days that led up to this day.

Nate gave me the card he made for me and it looked like this:

I laughed when I opened it, because I knew the card I had made for him looked like this:

I know, right. It’s crazy. Out of all the topics in the world that we could pick for a Valentines card, we both chose the subject of donuts.

And the same wording!

I donut know what I would do without you.

The thing is, even a few years ago, I’m not sure either of us would have been able to say that. No marriage is perfect, and ours has been far from perfect in many seasons. Yes, we’ve had many wonderful times, but there have been a few Valentine’s Day‘s that our cards could’ve read “I donut know how I can live with you” or ”I donut even like you.”

You might be surprised to know that we were close to the breaking point more than one time. We will spare you the gory details, but trust us, there were some gory details.

Our friend Carianne gave us this sign for Christmas one year:

I hung that sign in my closet for years and looked at it every morning. I prayed for miracles. Many days, I questioned if it was possible. On more than one occasion, I wanted to throw that stupid sign in the trash.

But the reality is, that’s exactly what God has done in us: miracles. He’s restored things that were broken, he infused us with joy where there was hurt, he gave us peace where there was anxiety. He took two broken people through journeys of healing, and the end result…well, we are still a work in progress, but let’s just say, God is good!

For anyone reading who might be struggling, know this: God can give you strength. He IS the God of miracles!

I remember seeing another sign a number of years ago that looked like this:

So that’s what we’re doing now. We’ve been married 28 years and we’re living our happily ever after. Praise be to God.

It donut get much better than this!

One Of The Worst Things…

Over my 25 years of practicing medicine I’ve had to give many people bad news.  It’s relatively uncommon in my specialty of obstetrics and gynecology, but it has happened.  Too many times.  I’ve had to tell pregnant women that their baby has died in the womb.  I’ve told so many women that they’re having a miscarriage and that there’s nothing we can do to change it.  I’ve told people that they have different STD’s, including HIV.  I’ve had to tell people that they have cancer.  And I’ve had to tell people that they will die, and that there’s nothing that we can do to stop it.  Each time I share these pieces of bad news it breaks my heart.

 

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But the worst thing that I could ever tell anyone here in Ethiopia is different than the worst things in America.  The worst thing I can tell someone here, by far, is that they are infertile and that there is nothing I can do about it.  There is more profound grief expressed over infertility than any other news that I’ve given.  When I’ve looked people in the eye here and told them that they have inoperative cancer and that they have only months to live, there is a calm acceptance.  A peace and resolve that I rarely saw in America.  I’ve told mothers and families that their babies have died or that the mother has died.  There is sadness, but not the reaction that infertility garners here.  It’s completely devastating.  There are tears.  Quiet weeping.  Sometimes shouting.  There is no worse news.

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The three most common scenarios here are either that the woman has gone into premature menopause (much more common here than in America – and it can effect women as young as their late 20’s), her tubes have been destroyed by infection (usually STD’s or tuberculosis), or her husband is producing no sperm.  In America there are “work arounds” to all of these problems:  Premature menopause?  We’ll hook you up with some donor eggs and/or a surrogate.  Tubes blocked?  There’s invitro fertilization (IVF).  No sperm?  We’ll find you a donor from a sperm bank.  But all of those technologies are either not available, cost prohibitive, or culturally unacceptable.  An infertility diagnosis really carries no viable solutions.

We encourage adoption and there are literally thousands and thousands of children in need of a home.  But unfortunately the idea of adoption is not culturally popular and few people chose it.  Amazingly the Ethiopian Prime Minister Abiy Ahmed has actually adopted two precious children and that is helping to break-down the stigma but it’s an area that still struggles to gain acceptance.

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I’ve also learned that infertility is the leading cause of divorce in Ethiopia.  When I was sharing with an Ethiopian friend about an acquaintance in America who was divorced the first question I was asked was “because of infertility??”  This shocked me at first because, even in America where divorce is relatively common and accepted, infertility would not be a culturally appropriate reason to divorce.  At least not from what I’ve seen and experienced.

So fertility is a huge issue here.  About one quarter of my patient visits in the clinic are regarding infertility.  We do have some things to offer women and their spouses.  Medications and surgeries can sometimes help them overcome the barriers that they are facing.  We do the best we can with the resources that we have.  But many times it is just not enough.  Please pray for these couples and our team as we share the love of Christ and do what we can to help them in their time of need.

When you see men with machine guns… just smile and wave!

The mornings here in Soddo are simply amazing – one of my favorite things about living here.  Crisp, a cool 55-57 degrees Fahrenheit, and relatively quiet.  I’m a runner and for me a quality run has cool temps, rolling hills, and some non-dangerous terrain.  It’s easy to get that here which is one of the things I love about running in the Horn of Africa!

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Recently we’ve had some political issues in our area.  The people group in our town and surrounding area want to become independent and recognized by the Federal government.  Sometimes the road to change here in Ethiopia can be fraught with some conflict and even violence.  There was a planned and/or expected event yesterday and because of this there were many Federal army troops in our city.  In fact we were not allowed to leave our hospital compound from Thursday afternoon until this morning.

As I left the hospital compound I didn’t see the same groups of people that I usually do.  There weren’t as many people exercising or going to market or doing their thing.  But there were some visitors… lots of dudes in pick-up trucks with machine guns.  They were part of the force to keep peace and order in town.  During my run I actually saw this same group of guys in Toyota pick-ups six times.  Not that I was counting or nervous about it.

Before we left for Ethiopia we went through a month of pre-field training that was essentially “how to be a missionary and not screw it up too badly” – but I don’t recall the lecture entitled “how to handle lots of men with machine guns.” I quickly decided that my approach should be smile, wave, and be very very friendly.  So that’s what I did.  The big guy manning the .50 caliber machine gun on the truck, looking a little menacing in his dark sunglasses and head scarf, saw me and… smiled back.  It was quite reassuring.  Maybe he liked me?  Maybe I amused him?  Maybe if he’s smiling he won’t shoot at me if things get crazy some random day??  So I kept smiling… and he kept smiling back all six times I saw him.

As I came across other random people on my run I thought I should probably give them just as big of a smile and a wave as the machine gun dude.  There was a group of children that were going to school.  I’m not sure why they had school on Saturday but they did look super cute with their notebooks and pencils!

 

 

There was a boy who was playing with a little homemade soccer ball and after I waved he decided to kick it back-and-forth with me so I stopped and tried out my non-existent soccer skills.

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There were men getting ready to start their jobs as taxi drivers.  The roads were all closed yesterday so they seemed ready and anxious to get back to work today.

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I even said hello to some dogs, although most looked a bit frightened and skiddish about my presence.  Dogs here are not pets but are security for homes or just street dogs.  And they aren’t treated particularly kindly.

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The lesson I learned this morning is that life is generally better if you’re actually nice to everyone that you meet.  And not just the people who you’re afraid might hurt you or that you’re trying to influence.  I don’t know about you but I usually get pretty busy doing… whatever it is that I happen to be doing.  I’m focused.  Determined.  In my own world.  Not particularly present in the moment or cognizant of those around me.  I’m just trying to do “my thing.” But if I actually reach out, greet people, and make a concerted effort to be nice and kind, then the world around me tends to be a better place.

I definitely saw this played-out this morning, thanks to my new friends with machine guns.  My hope is that others can learn this lesson, sans the machine guns.

 

 

Are we there yet… are we there yet…

Confession –  I love to tease children.  Okay, maybe “tease” isn’t the correct word.  Maybe some better word choices would be exasperate, inflame, provoke, irritate, or perhaps annoy.  But I enjoy doing it.  I really don’t know why (maybe I’ll ask my therapist when I’m back in the States).  I would argue that I’m naturally good at it.  It’s just a gift that I seem to have.

Yesterday I started using that gift on what I thought was our way back to America.  We’ve been in Ethiopia for a little over a year now.  Honestly I’m extremely happy and content here and I’m not particularly “needing” to go, but it was time to head back to see our friends and family.  And maybe eat a lot Mexican food.

We were traveling 6 hours from Soddo to the capital of Addis Ababa in a van with a sweet family from Sweden, the Aronsson’s, who were traveling to Kenya for a meeting.  The parents, Joakim and Malena, are physicians here at the hospital and their children, Leo and Isak, are 9 and 4.  They call me “turkey man.”  This stems from last year’s Thanksgiving (a holiday not frequently celebrated by Swedes) where I dressed in a giant turkey costume.  They obviously had no idea why a grown man from America, or from any country for that matter, would dress in this way.  And ever since that time I’ve become “turkey man.” Cheryl is, by association, “turkey man’s wife.”

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Soon after leaving Soddo I started asking Isak over and over… “are we there yet?”  This actually managed to not only annoy Isak, but most of the people in the van.  So eventually I gave up on this and directed my attention to Leo.  Both Leo and I haven’t had a haircut in about 3 months and he’s at the point where he looks like a bearded collie (not that there’s anything wrong with looking like a bearded collie).  So I proceeded to pretend to have a giant pair of scissors and to cut his hair.  And that lasted throughout most of the rest of the morning.

Soon after leaving we received word that there might be possible protests in the country and to be aware.  Between times of torturing the children, I looked outside the van as we drove and saw nothing to be concerned about.  However, a little over halfway on our journey we received a phone call that we needed to stop traveling immediately.  That there was trouble up ahead in and around Addis and that we needed to get more information before continuing on.  We stopped in a small town called Bui at a quaint restaurant that had only 3 items to serve:  eggs, shiro (an Ethiopian dish), and spaghetti.  And lots and lots of coffee… 😁

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And we waited… and waited… and waited.  It’s hard to get accurate information in Ethiopia.  There’s no equivalent of CNN, Fox News, or NBC.  Real time information relies mostly on word of mouth.  And the word was that all roads leading into and out of Addis were shut down because of protests.  We didn’t know why.  We just knew that everything was shut down.  The final straw was an Ethiopian friend who called who had some contacts in the security arena and he thought that the roads may be blocked for a couple of days.  So with heavy hearts we got in the van to head back to Soddo, each of our minds racing about how we would/could eventually get to our final destinations.

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The roads of Ethiopia are… challenging.  People and animals everywhere.  And not the best road conditions.  About an hour outside of Soddo I heard Melena scream and as I quickly looked up I heard a “thud” and saw a donkey flying off of our van and onto the side of the road.  Not good – for both the donkey and us.  We stopped and our driver Galchu had to meet with the elders of the area to discuss the situation.  What happens in this event is a price is negotiated and occupants of the van pay for the animal (even though this was in no way Galchu’s fault) and we move on.  As this was being negotiated we were surrounded by dozens of local people who were intrigued about our van full of white people.  In case you’re wondering… the going rate for hitting a donkey along the road is $68.03. Approximately.

 

After 14 hours of “traveling” we returned to Soddo.  We’re still here, and HOPEFULLY will depart tomorrow in another attempt to return to America.  And the good news is that we’re traveling again with the Aronsson’s and I’ll have Leo and Isak to… engage.  After initially having some qualms about leaving a place that I’m happy and content in, I think I’m now ready to leave and for a break.
Are we there yet??…

Don’t Be An A**

“If you ‘assume,’ you make an ‘ass’ out of ‘u’ and ‘me’” – I still remember the first time I heard this quote.  It was relatively late in life – during my OB/GYN residency in Charleston, SC.  For some reason this was a big moment for me – I can tell you where I was (on the labor and delivery unit, about to enter the perinatal unit through a big set of double doors) and who said it (one of my attending professors who wasn’t particularly funny or clever – so I was struck by the quote even more given the source). I don’t remember the context – but I do remember the quote and I even briefly wondered if my attending had actually originated this extraordinary piece of wisdom, but I quickly dismissed that thought.  But I did not discard the quote as I thought this was an amazing droplet of wisdom that I needed to hold onto.

 

 

 

I will fully admit to being prone to quick assumptions.  During my 20 years in private practice in America, I was fairly good at this.  I would make multiple assumptions simply based on what was in the chart before I walked in.  This was based on where they lived, age, where they worked, marital status, number of children they had, church attended, and how they found their way to me. If they were a married woman with 2 children from a certain area and a certain church and referred from someone I liked, then I thought I knew her deal.  If she was single and a professor and didn’t attend church and wasn’t referred, well then I made a totally different set of assumptions.  In both cases I was usually wrong.  Actually – I was always wrong.

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As we hit the one year mark of being here in Ethiopia and look forward to returning and visiting the States in the Fall, I find myself thinking about what people will ask us and what we’ll talk about.  And what it will be like in general.  I’m afraid that people will make a lot of assumptions about me and us. And that many of them might be wrong.

 

People might assume that because I’m a missionary that I’m some sort of spiritual giant without struggles or questions.  That assumption would be wrong.  I’m just like everyone else attempting to put my faith into action each day but sometimes not understanding what that should look like.  And not doing it very well at all some days.   And I still have lots of questions about God, the whole trinity thing, why bad stuff happens, other faiths, etc.  But I try and do the best I can daily with what I know and what’s been revealed to me.  The rest is up to Him.

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One assumption might be that I’m just suffering miserably here without all the luxuries of America like ice cream, cable TV, reliable internet, and an easy way to wash and dry clothes.  But the reality is that I love it here.  I don’t think of myself as suffering in the slightest.  I literally thank God every day when I wake up that I’m here.  That prayer might be a little more difficult some mornings after a hard night, but it remains the same.  I really love being here and I honestly find it hard to imagine NOT being here. Although a little ice cream from time to time would be nice…

 

Because of the some of the crazy things that I see and have to do here some might assume that I’ve become some kind of “super OB/GYN” that can tackle anything that comes through our gates.  Wrong.  Some of the cases that I see I have literally no idea what to do with.  We had a six year-old girl brought here after being hit by a bus.  She had injuries to her genitals that I had never even heard of or knew were possible. I felt so overwhelmed as I began the surgery but one of my fellow missionaries wisely said to me “you know Nate, what better place could this girl be in?  We have a trauma surgeon, an OB/GYN, and an orthopedic surgeon always on call.  What other place in this country has that!?!”  And he was right.  And by the grace of God she did well and eventually went home alive and ok.  And it’s just a matter of time before the next impossible case comes in that overwhelms me and pushes me to rely on Him.

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I bet you assume Dr. Mark and I coordinated our shirt choice?!

You also might assume that if you see our Facebook posts, read our newsletter, or even read these blogs that you’ve pretty much heard the whole story.  You would be wrong.  While we try to be transparent and open in what happens here, there are just things and stories that can’t make it onto the world wide web.  This is the case for each of us – both you and me.  When I read or see a Facebook post I assume that this is approximately 0.72% of the story.  With THIS assumption, I’m pretty sure I’m closer to right.

 

And lastly I’ll admit that I’m probably assuming that people will assume that I can sum up “how is Africa” in about 2-3 minutes. I cannot.  I’ll probably come up with some 2-3 minute answer for those who are looking for that.  But I can’t give a quick cute snippet of over a year of my life living in Ethiopia.  Of all the stories, the people, the lessons, the challenges, and the way that God has worked over this period of time.

Maybe I shouldn’t assume that.  And maybe you shouldn’t either.  That way neither of us will be an a**… 😉

 

No White Saviors

I’m white.  (In case you hadn’t noticed.)  Very white. In fact, Ancestry.com has confirmed that I’m pretty much as white as you can get. Close to a 50-50 split between German and Scottish ancestry – with a little Norwegian (7%) thrown in – from what I’m assuming was a scandalous relationship between a Viking and some Scottish woman during a Viking raid about a thousand years ago.

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I’m reminded of my “whiteness” almost daily. When we run in town, children and others will shout out that we are “forenj” (which means foreigner) and “china” (which also means anyone who is light skinned and not from here).  In fact today on my run I decided to count the number of times that I was reminded of this:  54 times…54.

I read this weekend about a young woman from America who was living in one of our neighboring countries, Uganda.  She has no formal medical training and the allegations are that she started providing medical care to children there and in the process many children were injured or died.  I have no idea if these allegations have any truth to them, but if so I’m sure she did what she did with good intentions.  The problem is that there has been this long history of white Americans, and Europeans, who are well-intentioned but end up doing harm and not understanding or respecting the cultures in which they visit.  This recent story about the woman in Uganda and others are highlighted by an organization called ‘No White Saviors.’

My first reaction to this is “well – surely this does not apply to ME!  I would never have this attitude…”  Or would I? Or did I?  Or do I?

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When we first started doing short-term missions in Ghana more than 16 years ago we were well-intentioned.  But we really hadn’t thought things through well.  Things such as whether we were negatively impacting an already established health care system.  Or whether the medications we were prescribing were safely packaged and labeled.  Or whether there was any long-term follow-up for the patients after we left.  We later found out that each time we went over I had been practicing illegally.  I assumed with my “white – American – educated and trained in America” mindset that I could just enter the country, be welcomed with open arms, and then start treating patients.  I was wrong.

I’ve learned a lot over the years from reading what others have written.  Especially the books ‘When Helping Hurts,’ ‘Making the Blind Man Lame,’ ‘Cross-Cultural Servanthood,’ and ‘The Great Omission’. And I’ve learned much from mistakes I’ve made and from training prior to entering the mission field here in Ethiopia. But despite all of this wisdom and knowledge and experience… I still struggle.

 

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When I find that something is happening in the operating room or the hospital is different from what I was used to in America, I sometimes feel compelled to tell everyone what they should do.  When surgeries don’t start on time or it seems to take forever between one case and another I feel urged to “share” with everyone how we did it in America and then what they should do in order to “fix it”.

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Greg Suratt, our pastor in Charleston at Seacoast Church, once said “I won’t ‘should’ on you if you don’t ‘should’ on me.”  I love to “should” on people.  Sometimes I think I might have the spiritual gift of “shoulding.”  The problem is that my “should” is usually pretty stinky.  My “should” is based on what I think is good or right.  It often times doesn’t take into account the culture or the people that I’m living with.  It disrespects the people that I’ve chosen to partner with.  I’m a guest here and I have much to learn.  And I’m constantly reminded of this struggle.

Please pray for me and us as we continue to learn how best to serve here.  How to best partner with the amazing people and to affect the changes that God wants to happen.  And as for those times that I want to rise-up and start “shoulding” on people… I’ll blame the Viking in me.  All 7% of it.

Cancer Sucks (warning – graphic pics)

I’ve been thinking a lot about cancer recently.  One of my good friends and former nurses, Tammy, was just diagnosed with breast cancer.  I know that diagnosis is devastating to receive.  I know that it changes your life forever.  I also know that in Tammy’s case she should do just fine.  She found it and immediately had the right testing done, quickly saw a fantastic breast surgeon who performed the needed surgery, and will next have radiation therapy.  Her insurance paid for these critical services and her chance of survival is near 100 percent. And THAT is good news!

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The news in Africa, and what I’ve seen here, is not as good.  In America I mostly dealt with finding breast cancer and referring them to our amazing surgeons.  If I found other gynecologic cancers they were usually referred to one of our specialists to receive care.  I always knew that my patients were in the best of hands.  I knew that my hands were not trained to deal with these cancers, especially the advanced ones.

Here in Ethiopia I’ve been repeatedly challenged in dealing with cancer.  And many times it’s very advanced and there’s nothing I can do.  In other cases I’m forced to deal with these cancers to the best of my ability, and many of those cancers have been extremely rare types.  I couldn’t do this work without the expert advice of one of my friends in Birmingham: gyn oncologist Monjri Shah.  I’m literally texting her every couple of weeks with multiple questions and for advice.  She is making this possible here for me and I’m so thankful for her!

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One patient was a sweet 19 year-old young woman from a very rural tribe near the Kenyan border.  She had been bleeding and had noted a mass for over a year.  I took her to the OR to examine her and I found a tumor that I had never seen before.  It filled the entire birth canal and looked like clusters of grapes.  It was a cancer called sarcoma botryoides – I had read about it medical school and residency but had never ever seen a case of it. Her only chance of survival was to go to the capital for further surgery and chemotherapy.  Whether her family actually took her and arranged for her care I will probably never know.

 

 

A second patient was this precious 30 year-old woman who had very large benign tumors called fibroids.  These are very common here and can lead to infertility, pain, and heavy bleeding.  During her surgery I discovered another growth – again one that I had never seen before.  We biopsied it and it revealed another rare and aggressive cancer of the lining of the womb.  I called her family to have her brought her back in for further surgery which she desperately needs but she is declining surgery and praying for God to heal her…

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These were the benign tumors – the deeper tumor we found was cancerous

My most recent patient is an equally tragic case. She’s a wonderful 28 year-old woman who is 19 weeks pregnant.  She noticed that her belly was more swollen than it should be and came to see us here. We found a lot of fluid in her abdomen (called ascites), a mass in her pelvis, and a blood clot in her neck (I’ve NEVER seen anything like this before).  We took her to the operating room where we found that she had very advanced ovarian cancer.  Her prognosis is VERY poor and my current hope is that she will survive long enough to deliver a baby that is able to survive.  Even that may not happen.  The odds are against her.

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A rare ovarian cancer in a pregnant patient

These are absolutely heart-breaking cases.  It’s even harder because… in most cases I can’t even tell the patient what is going on.  “What?!?!” you are saying to yourself.  Culturally here, if there is bad news such as cancer, you tell the family members but not the patient.  It’s up to the family to share the news with the patient.  When I told my pregnant patient’s husband about his wife’s prognosis, he told me I could not tell her.  He did not want her to give up hope.  In America this would obviously never happen.  But here, this is the cultural way that this is handled and I must respect that.  I may not agree or understand, but it’s not my place to violate this cultural practice.

One other unusual thing here is that the families want to literally see the tumors that we remove.  Not a picture – the ACTUAL tumor.  So usually at the end of the case the OR tech will carry the tumor out to show the family as I explain what we found, did, and what to expect.

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We initially thought this nearly 20 pound tumor was benign – but it turned-out to be cancerous and after some additional surgery she is cancer free!

So between doing surgeries on cancers that I would never do in America, respecting a culture that I’m still learning about, and dealing with rather limited resources, I’ve had my hands full here. Simply trying to do the best I can with what I have and showing the love of Christ to all who enter our gates.

Please pray for these patients that I’ve mentioned as well as the others that I’ve not shared about yet.  And pray for Tammy too!  She would appreciate it!

 

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