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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… So Few Inches Apart

… and with these our hells and our heavens, so few inches apart…

                                                                                                             -Rich Mullins

I’ve always loved that line from Rich Mullins (my favorite Christian artist), probably because I’ve seen it play out time and time again both in my life as well as others.  This morning was a great example of that.  How within a matter of minutes I witnessed heaven and hell: a woman’s complete joy, another’s total anguish, and yet another’s excitement and anticipation.

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These are the newest additions at Soddo Christian Hospital!  Both boys and are a little over 5 pounds each! 

I had just started my Sunday morning run on a beautiful Ethiopian morning.  Clean cool air, the sun rising, birds singing, and relatively empty roads.  My phone rang with my midwife Biruk telling me that we had a mother with twins who had just arrived and she was completely dilated.  He thought that she was about 5 weeks early, and the first baby was head first but the second was sideways.  We try to deliver all of our twins in the operating room in case of an emergency and I told him to transfer her there and I would meet them.  I quickly ran back home, threw my scrubs on, and headed to the OR.

Twin deliveries have always been one of my favorite things about my job, but they tend to be a bit chaotic.  The anticipation of 2 babies just gets everybody a little more on edge.  We could see that the woman’s bag of water was about to break and I wanted to quickly ultrasound her before things started.  When I put the scanner on her abdomen I could not appreciate that the first baby was head first as Biruk had said and I questioned him about this.  Two seconds later her water broke, followed immediately by a healthy 5.5 # baby boy literally flying out of the birth canal – head first.  “Well – I guess that answers that question,” I told Biruk with a hint of sarcasm.

The second twin is usually the one that causes the most angst, worry, and trepidation.  A lot of bad things can happen.  We quickly ultrasounded the baby and saw that it was still sideways, but now the heartbeat was dangerously low.  I tried to find the feet or head with her water still intact but I could not – so I prayed as I broke her water and hoped that I could find something to pull down and quickly deliver.  The only thing I could find was a limb and I hoped that it was a leg and not an arm, because an arm would NOT be good.  Praise God it was a leg- and we found the other leg- and were able to help her deliver the baby breech and all was well – two beautiful healthy 5.5# baby boys.

The mother was crying with joy, and as I exited the operating room I was met by her husband and sister – all of whom were so happy to hear the good news.  I exited the OR area with a smile on my face as I celebrated with them as well.

But the next face that I saw was not smiling.  She was wailing loudly.  She was grabbing her head and shaking.  Her husband was holding her and trying to comfort her.  But he could not.  Nobody could.  Her child had just died.  As she was surrounded by more and more family the grief and anguish continued.  As I continued to walk I was struck by how just a few inches apart, just a few minutes apart – one woman was experiencing such joy and happiness while another was experiencing the worst pain and grief. Literally inches apart.  Literally minutes apart.

 

I went home and changed back into my running clothes, wanting to finish the run that I had started.  These thoughts were still kind of swirling in my head as I started out. About a mile into my run I saw some bright colors, something unusual for the middle of town on Sunday morning.  As I got closer I realized it was women in brightly colored dresses from a wedding party – and then I saw the couple posing for their wedding photos. The wedding will happen later today. Beautiful young people starting a new and happy chapter in their lives – again just a few inches and minutes apart from two other women experiencing their own heaven and hell.

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Their wedding will start later this morning!

The closeness of heaven and hell here is more evident to me than when I was back in the States.  But I know it’s there too.  It’s everywhere.  We just need to open our eyes to see it.  It just happens to be a little more obvious here.

 

Naked I came from my mother’s womb, and naked I will depart.

The Lord gave and the Lord has taken away; my the name of the Lord be praised.

                                                                                                                        Job 1:21

Sometimes it’s hard…

When life is good and we have no problems, we can almost let ourselves believe we have no need for God.  But in my experience, sometimes the richest blessings come through pain and hard things  – Anne Graham Lotz

So many things here are wonderful, amazing and good. The people who live here.  The sweet and amazing patients that we get to serve. The other missionaries we get to work alongside.  The food.  The weather. The ways we are able to make an impact in the health care of men, women, and children.  And the way we are able to share the Gospel and love of Jesus Christ.

But there are hard things.  There are things that hit you over the head, stop you in your tracks and make you wonder…

One of those hard things happened three times this month.  THREE times. We had 3 mothers die.  It’s called “maternal mortality” and it happens here in Ethiopia 22 times more frequently than it does in America.  As an OB/GYN in America I was usually pretty insulated from death.  It happens so infrequently.   In my 20 years practicing in America our hospital had 3 maternal deaths over that entire time.  That’s 3 deaths in almost 60,000 deliveries.  One maternal death is too many, but 3 in 60,000 over 20 years isn’t too bad.  Here in just a matter of a few months we had 3 – and that’s WAY WAY WAY too many.  The reasons for this are complex, but we’re doing all we can here to help improve that number and do all we can for these mothers.  The rate in Ethiopia has actually gone down almost 75% over the last 20 years but it’s still too high and we’ll continue to work on this issue.

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Maternal Mortality across the globe – Africa bears much of the burden

Another hard thing here is infant mortality.  A baby born in America has a 50% chance of surviving starting at 24 weeks and by 28 weeks that number is 98%.  Here in Ethiopia a baby has virtually no chance of surviving until 28 weeks.  And even at 32 weeks it is VERY challenging to take care of these babies and to help them survive.  We just don’t have the medications and tools necessary.  Here at Soddo we have an AMAZING doctor taking care of our premature babies but we continually struggle with premature babies dying.  Babies that would not die in America, but they do here. ALL.THE.TIME.  It’s gut wrenching for the mothers, the doctors, and the nurses who work so hard.

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This sweet little girl was born at 25 weeks and passed away the next day from prematurity.

2 weeks ago we had to deliver a very premature baby at 25 weeks because the mother had developed severe preecalmpsia and if we didn’t deliver her, she would have died.  So we delivered her baby knowing what would happen.  The next day I asked when the baby had passed away and I was told that the baby was still alive.  I was shocked and asked where she was, only to find that she had been put in a sterile room by herself lying on a cold steel table.  I was shocked, and asked why she wasn’t with the mother. Nobody really knew so we asked the mom if she wanted to hold her baby, again knowing that she would soon pass.  She said “yes” and we brought the baby into her. I was happy at least this baby would be with her mother as she passed, but then the family got involved.  I’m still learning about the culture here, but culturally (as we understand it) if they know that a baby is going to die they don’t want to be involved with the child. They think it’s too hard on the mother and family and they don’t want anything to do with the baby.  So they took the baby away back to the sterile room and back onto that cold steel table.  I was heart-broken over this and was NOT ok with it.  We’ve been taught to try and respect the cultural beliefs of those around us, but this was one of those situations where I just had to get involved. So I went back to our house, got Cheryl and one of our new friends, Toya, who is another American missionary, and we took turns holding her.  The sweet baby did pass away a few hours later, but she did so while in the loving arms of Toya.

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Infant Mortality across the globe – once again Africa suffers the most

These things are hard.  Very hard.  But it’s part of the journey here.  There are many many more good and joyful things than hard things.  Please pray for us and the rest of the staff here as we go along our journey here.  There are reasons for the hard things.  But sometimes understanding those reasons elude us.  And sometimes it is not for us to understand.  It is for us to walk through and trust in Him for all of our needs.

2nd Verse, WAY Different From The 1st

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Each face represents a million women

When I entered the country here in Ethiopia on August 18th I became #326 – actually it might be #327 – or #330 – but the most recent data says #326.  “What the heck is #326?!?” you say.  I’m the 326thOB/GYN to be currently practicing in Ethiopia. For a country of 110 million people. In comparison, Alabama has a fraction of our population, 4.8 million, and it has almost 500 OB/GYN’s – a State that’s 4% the size of Ethiopia.  And of our 327 OB/GYN’s here, as far as I know, I’m the 4thfrom outside the country.  So the needs here are great, and in many ways overwhelming, but it’s such a privilege to be here and to serve here!

I really loved the first 20 years of my career – 20 years in an amazing private practice in Birmingham with great doctors, nurses, staff and patients.  And after 20 years there was the occasional unusual case or situation – but things were definitely in a routine and I was familiar with 99% of the things that I dealt with on a daily basis.

During this “second half” of my career here in Ethiopia… not so much routine and familiar.  At.All.  And I love this part of being here.  I see things that I’ve only read about in medical school or residency-  and sometimes things that I’ve never even heard of.  I was blessed to have an amazing education at Indiana University and then at the Medical University of South Carolina.  They weren’t particularly preparing me for medicine in Africa – but they managed to teach and instill the things that I’ve needed to practice here in this amazing place. And for that I am SO grateful!

 

One of the main things we deal with here is something called “pelvic prolapse.”  To spare y’all too much detail – it’s when a woman’s pelvic organs decide that they’re tired of staying up where they’re supposed to be and they literally “fall down.”  In America this happens but people come in right away when it’s mild and there are many ways to address it.  Here these sweet women have been “living” with it for 3, 5, 10 or more years.  And it makes life extremely hard.  Hard to work, hard to do basic bodily functions, hard to have a normal relationship with their husband.  At one of our outlying clinics, in just 2 clinic days they identified 25 women who have this problem and are waiting for me to do surgery. We’re currently seeing and operating on 4 per week and by the time we’re done helping this group, I’m sure there will be many more waiting to be helped.  Probably a third of the surgeries that we do here are for that specific reason.

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Another big concern here medically is infertility.  In Ethiopia having children is VERY important.  Important to help with the family farm or business, and in helping the parents as they become older.  And polygamy is fairly common in this area and to the south.  So if a woman is not able to have children, there is a good chance that her husband will divorce her.  And a divorced woman has a tough time marrying again and has some social stigma that makes life difficult for her.  So many of our patient visits involve this area and we do what we can to help them achieve a pregnancy.

There are lots of unusual things I see and I’m constantly reading and researching about them.  There are a lot of infections that affect the population here and we’re regularly dealing with HIV, tuberculosis, hepatitis, syphilis, etc.  Then there are the just plain weird things that I see:

A charming 45 year old woman was referred from another hospital with what’s called a molar pregnancy.  It’s a weird deal where pregnancy tissue just goes crazy in growing out of control and it can eventually turn into cancer.  These cases are very rare in America – especially being 4 months along like she was.  We were able to successfully treat her with surgery and the chances of it turning into a cancer are very small.

Another young woman was very nauseated early in her pregnancy and was throwing-up a lot.  So much so that she… ruptured her esophagus.  I wasn’t even aware that this was possible in pregnancy.  Fortunately the rupture was small and she got better and is doing well.

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Most women in America get an ultrasound very early in their pregnancy.  Here… not so much.  Most women have never had one.  We had a patient who came in at 26 weeks for her first visit and they called me because they thought there was more than one baby… and there were… THREE.  She found out at 26 weeks that she’s having triplets. So far so good for her and please say a prayer that she and her babies do well during the rest of the pregnancy.

As  you can imagine, I have more stories than I can tell at one time and I’ll try and write occasionally about some of these. But my days here are constantly filled with amazing patients with interesting and challenging problems. Some of these we’re able to help with. Some we are not.  But we do all we can in the name of Christ and know that He is the great physician and able to do exceedingly and abundantly more than I ever could.  I’m glad someone has my back.

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As y’all already know we are serving here and missionaries and we’re so thankful to those who continue to support us.  If you’re interested in giving then please click on the link below:

 

http://fullnesscf.org/missions/nate-cheryl-ross

 

 

Gobble Bloggle

 

This shouldn’t come as a surprise to those of you who know us well, but we’ve never really been what you would call “traditionalists.”  Thanksgiving is no exception. Almost all of our 26 Thanksgivings together have been different. We’ve been in Indiana, South Carolina, Florida, Alabama, Georgia, and Tennessee, just to name a few places. We have eaten with friends, relatives, friends of relatives, relatives of friends, and even complete strangers. Probably the closest thing we have to a tradition is Nate being a turkey…err…uhhh….wearing a turkey costume.

The randomness of our Thanksgivings began when we first moved to the southern part of the U.S.  We were living in Charleston, South Carolina, with Nate working 80 hours a week in residency and us having met very few people.  We decided to drown our homesick sorrows in a Thanksgiving buffet, so we headed off to Ronnie’s Seafood on Shem Creek. We must have been the most pitiful pair in the joint, chomping on those legs of crab and turkey. Fortunately that was our last lonely Thanksgiving, as we made amazing lifelong friends in Charleston and often had friends and family visit us for the holiday.

This year, we’re in another new situation. Pretty far away from anything that even resembles a turkey, I might add – until Nate puts the costume on, of course. (Shh..don’t tell!) 

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And, although Thursday is a busy work day for Nate, we’ll be gathering on Saturday afternoon with the others who are serving here at Soddo Christian Hospital. This will include other forenjis: Swedes, Australians, and even Californians! We will have one important thing in common, though: a deep conviction that every good and perfect gift is from above (James 1:7).  No matter how weird the food tastes that day (and by that, I mean whatever I manage to cook!), how many times the electricity goes out, or how far away we are from so many we love, we want to have hearts that do this:

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This is our guest bedroom/office!!

This year has been such an adventure and really, we have only just begun. It hasn’t all been easy, but we are so thankful for each of you who take the time to pray for us, send us cards/packages, write us encouraging emails, like our Facebook pictures, support us financially, and look after our still unsold home in Birmingham.  We could not do this without each of you and the part that you play. We give MANY thanks to God for you!  

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Oh…and here’s our address just in case you’d like to send your fun Christmas cards to us. It just takes an international stamp from the post office…the hardest part is going to the post office!!! 

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For your efforts, we promise to proudly display your cards on our fridge! 

 

Here’s our website link!

 

 

 

Do you see what I see?

Last week we started Phase 2 of our Amharic language and culture training. With a new teacher (Yididya) and no other classmates, we began learning to read and write, as well as to tell stories using our increasing vocabulary. While I’m sure that sounds like loads of fun, it’s actually been pretty challenging.

One of the tools they use in the ‘Growing Participant Approach’ is called “Busy picture.” We look at the picture and use known vocabulary to describe the scene and then we learn new words. The picture above is the riveting tale of “The Banana Thief Monkey.”

On Wednesday, our picture was the scene below…

I wonder…when you look at this, what do you see?

I saw a campsite. Something people do for fun (although I’m not really sure why!). As we described the scene, we were both thinking in terms of setting up for a cozy campfire and some s’mores. People in the picture most certainly had chosen to engage in this activity.

And then Yididiya gently allowed us to see that we are still looking at the world through our American eyes. She began to explain to us that in Ethiopia, camping is primarily an activity of those who have been displaced from their homes.

With some additional research we learned that From January to June of this year, 1.4 million Ethiopians became internally displaced persons. That’s more than in war torn Syria or Yemen for the same time period. Ethnic conflicts in Ethiopia drove people from their homes and they have been forced to find shelter wherever they can. These numbers are in addition to Unicef’s estimates of 2.8 million previously displaced persons (due to ethnic violence or natural disasters) and nearly 1 million people who have sought refuge in Ethiopia from countries such as Sudan, Somalia, South Sudan, and Eritrea.

Many of these precious souls are living in tents. Others are on the streets or living with friends/relatives.

I’m not sure about you, but my mind has a nearly impossible time comprehending what this would be like. The trauma of having your home violently seized, family members killed or wounded, and everything you own taken is beyond my understanding. I can only ask God to give me a growing compassion for these individuals, and tools for loving them when we encounter one another.

I don’t think I’ll ever view camping in quite the same way again…